1. Shoulder Pain: problems and solutions Ms. Ruth A. Delaney Consultant Orthopaedic Surgeon, Shoulder Specialist

2. Background

3. The Shoulder

4. Bones of the Shoulder Image from www.shoulderdoc.co.uk

5. Muscles, Tendons, Ligaments

6. Shoulder Pain: Where to start? Shoulder history & exam (GP/physio/shoulder specialist) Diagnosis o Xrays are often very helpful o MRI is not always the first thing to do! In some cases, you may never need an MRI or you may need a different type of scan (arthrogram, CT etc.) Plan o Further imaging to complete diagnosis o Anti-inflammatory medication o Physiotherapy o Injections o Surgery

7. Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures

8. Rotator Cuff Disease

9. Group of 4 muscles around the shoulder joint Function in shoulder joint stability and contribute to certain movements The tendons often degenerate over time Partial tears Tendinitis Impingement Full thickness tears MRI may be appropriate if rotator cuff weakness is found on clinical exam

10. Impingement

11. Full thickness tear

12. Treatment Options Physiotherapy Injections with local anaesthetic and corticosteroid (anti- inflammatory effect) Surgery o Arthroscopic subacromial decompression – keyhole surgery to clean out the inflammation, shave any bone spur, and remove any possible sources of pain o Rotator Cuff Repair – some tears are repairable, usually done as keyhole/arthroscopic surgery, rehabilitation takes approx. 6 months o Reverse Shoulder Replacement – in certain situations when a tear is very large and not repairable and the shoulder function is poor

13. Rotator Cuff Repair

14. Reverse Shoulder Replacement

15. Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures

16. Shoulder Arthritis

17. Treatment Options Injections o Steroid + local anaesthetic (reduces inflammation) o Viscosupplementation (attempts to replenish joint fluid) ?Arthroscopy o In some situations, keyhole surgery to “clean out” the inflamed tissue, shave loose flaps of cartilage, and smooth bone spurs may be considered o Results are usually temporary Shoulder Replacement o The most definitive way to treat shoulder arthritis o Longevity of the replacement will be negatively affected by heavy use of the shoulder or high impact activities

18. Shoulder Replacement

19. Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures

20. AC (AcromioClavicular) Joint

21. AC Arthritis Treatment Options Often seen on Xrays and MRIs without causing symptoms If symptomatic: o Anti-inflammatories o Steroid + local anaesthetic injections o Keyhole surgery to shave down the arthritic bone ends

22. Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures

23. Frozen Shoulder

24. Most cases will resolve without surgery The inflammatory process “burns itself out” Freezing, frozen, thawing stages Pain and discomfort can be severe, therefore attempts are made to shorten the process Steroids o Tablets in some cases o Injections Some patients go on to need surgical release of the capsule and manipulation of the shoulder under anaesthesia Gentle physiotherapy Pool exercises

25. Frozen Shoulder

26. Shoulder Problems in Over 50s Rotator cuff disease (tendinitis, tears) Shoulder Arthritis AC Joint Arthritis Frozen shoulder Fractures

27. Shoulder Fractures

28. Not all shoulder fractures need to be fixed Important to have a specialist opinion early, in order to decide if any surgery is needed Shoulder Fractures

29. Summary There are many potential causes of shoulder pain and dysfunction There are many ways to treat these problems History & Exam – Diagnosis – Treatment Plan MRI is not always required Non-surgical options exist for some problems Shoulder surgeries vary in terms of post-op rehab

30. Coming soon… www.shouldersurgeon.ie

31. Thank You Ms. Ruth Delaney Suite 14, Sports Surgery Clinic 01-5262335 ruthdelaney@sportssurgeryclinic.com