1. Shoulder 101 Lutul D. Farrow, MD University Medical Center
Human Motion Institute
Assistant Professor, Clinical Orthopaedic Surgery
University of Arizona College of Medicine
Department of Orthopaedic Surgery

2. Disclosure
I have nothing to disclose

3. Objectives After this presentation, the participant should be able to:
Diagnose common shoulder injuries
Understand nonoperative management of these injuries
List basic surgical treatment options for these various shoulder injuries

4. Introduction MSK injuries are common 40% of complaints to PCP
Affects ADL’s
Lost work/wages

5. The Shoulder Basics Shoulder problems are simple Three diagnoses
Impingement
Arthritis
Instability

6. The Shoulder It gets simpler! Less than 25 Over 40 years old
Think instability
Over 40 years old
Impingement
Arthritis

7. IMPINGEMENT

8. The Shoulder Impingement Multiple pathologies Blanket term
Tendinopathy
Bursitis
Rotator cuff tears
Biceps tendinopathy

9. The Shoulder
Pain generators
AC joint
Bursa
Rotator cuff
Biceps tendon

10. The Shoulder Impingement History Pain – variable location
PAIN WITH OVERHEAD ACTIVITIES
+/- Trauma
Subjective weakness
Easily fatigued
NIGHT PAIN

11. The Shoulder Exam Palpation Impingement tests Strength tests
Cervical spine

12. The Shoulder
Palpation
Big 3
AC joint
Bursa
Bicipital groove

13. The Shoulder Assess range of motion Painful arc Active Passive
Quick and dirty
Painful arc

14. The Shoulder Strength Testing Jobe’s Drop-arm Test Resisted ER
“Empty can”
Drop-arm Test
Resisted ER
Shoulder 201

15. The Shoulder
Plain X-ray AP
Outlet
Axillary

16. The Shoulder To MRI or not to MRI Gotta earn it!!!! Profound weakness
Shoulder dislocation older person
Failed conservative management
Gotta earn it!!!!

17. The Shoulder Nonoperative treatment Activity modification NSAID’s
Physical therapy
Scapular stabilization
Strengthening
Modalities
Injections

18. The Shoulder Operative treatment Arthroscopy Rotator cuff
Decompression
Biceps
Distal Clavicle
Arthroscopy

19. Instability

20. The Shoulder Instability
45% of dislocations involve glenohumeral joint
85% anterior
Incidence - 1.7% (anterior dislocation)
Male (78%) >> Female (22%)
Much Higher incidence in persons < 30 y.o.

21. The Shoulder Mechanism of Injury Pathoanatomy
Abducted, externally rotated arm
Humeral head driven anterior
Common in contact sports and overhead athletes
Hi-end athletes
Pathoanatomy
Torn capsule/ligaments
Torn Labrum
Variable bony injury
BEWARE RTC INJURY!!!!

22. The Shoulder History Traumatic Episode Direction? Red Herrings
Electrocution
Seizures

23. The Shoulder Physical Examination Apprehension test Rotator cuff
Axillary nerve
Ligamentous Laxity

24. The Shoulder
Imaging

25. The Shoulder Treatment 1st timers Athletes and repeat offenders Rehab
Consider surgery

26. The Shoulder Bottoni et al AJSM 2002
Nonoperative: 75% recurrence
Arthroscopic stabilization: 11% recurrence
Kirkley, Miniaci et al Arthroscopy 1999
Nonoperative: 47%
Arthroscopic stabilization: 15.9% (p < .03)
Porcellini et al Arthroscopy 2002
Acute arthroscopic stabilization:
92% stable at 2 year follow-up

27. The Shoulder Sachs et al JBJS 2007 Copers and Non-Copers
57% shoulders remained stable
20% requested surgical stabilization
Conclusion
Need for surgery in the acute period cannot be predicted
Copers and Non-Copers
60:40 Rule
80% won’t need surgery!

28. The Shoulder
Surgical Repair

29. Arthritis

30. The Shoulder Arthritis Shoulder less commonly affected
Typically > 50 yo
Typically “post-traumatic”
Genetic predisposition

31. The Shoulder Symptoms Activity pain ↓ ROM Stiffness Grinding/catching
Can mimic impingement

32. The Shoulder Exam Imaging Decreased ROM Crepitance Strength
Active = Passive
Crepitance
Strength
Imaging
Plain films
MRI: little utility

33. The Shoulder Conservative management Tylenol ASA NSAIDs Therapy
Injections?

34. The Shoulder Arthroscopic debridement Resurfacing Hemiarthroplasty
Total arthroplasty
Reverse arthroplasty

35. Conclusion Shoulder problems are very common
Age-based approach can be helpful
Most will be “impingement” related
Be careful about red herrings
Systematic approach will lead to high success rates with return of premorbid function

36. Thank You