1. SHOULDER PAIN

2. Anatomy 1. Superficial layer Deltoid muscle Pectoralis major and minor muscles Trapezius muscle 2. Subdeltoid bursa

3. Anatomy 3. Rotator cuff Supraspinatus Infraspinatus Teres minor Subscapularis

4. Anatomy 4. Ligamentous capsule and Joint space

5. Shoulder Pain 1. Periarticular Structures 2. Glenohumeral joint 3. Distal Sites

6. Diagnostic Approach Most Common Causes of Shoulder Pain in Adults Rotator cuff tendinitis Rotator cuff tears Subdeltoid/subacromial bursitis Adhesive capsulitis/frozen shoulder

7. History 1. Perceived location ? 2. History of recent trauma ? 3. What precipitates the pain ? 4. History of occupational and sport activities ?

8. Physical Examination 1. Active ROM 2. Passive ROM 3. Resisted Movements 4. Palpation

9. Physical Examination Internal rotationExternal rotation

10. Physical Examination Impingement Test

11. Physical Examination External Rotator Cuff Strength Internal Rotator Cuff Strength

12. Interpretation of Physical Examination  active ROM +  passive ROM  arthritis, capsulitis, bursitis  lateral rotation  arthritis/capsulitis  abduction  bursitis  active ROM + normal passive ROM  rotator cuff lesions

13. Additional Diagnostic Tests Shoulder X-ray – trauma, suspected arthritis, chronic unexplained pain CT/MRI shoulder – evaluations of soft tissue lesions Ultrasonography of shoulder – rotator cuff tears Arthrography - rotator cuff tears, soft tissue lesions

14. Anterior Shoulder Dislocation

15. Posterior Shoulder Dislocation

16. Management strategies 1. Physical Therapy/Physical Activity Acute - brief period (2-3 days) of rest with the arm in sling ROM movements immediately to maintain mobility Avoid aggressive exercise or prolonged immobilization

17. Management strategies 1. Physical Therapy/Physical Activity 2. Medication NSAIDs/Acetaminophen 2-week course

18. Management strategies 1. Physical Therapy/Physical Activity 2. Medication 3. Injection therapy Contraindications: overlying soft tissue infections, septic joint, clotting disorder Avoid heavy arm use for several weeks after injection Serious complications are rare (< 1%)