Download presentation
1
Shoulder Examination & Common Pathology
Mr David Rose FRCS Consultant Shoulder & Elbow Surgeon
2
My Background Medical School: Royal Free (University of London - 2000)
South West Thames Ortho Rotation (St Georges) Fellowships: Johns Hopkins, USA 2008/09 (Research – Shoulder/Upper Limb) Perth Orthopaedic & Sports Medicine Centre, Perth, Australia 2012/13 (Sports Medicine Surgery) Addenbrooke’s, Cambridge 2013/14 (Shoulder & Elbow Surgery)
3
Current Position Consultant Orthopaedic Surgeon Maidstone & Tunbridge Wells NHS Trust Started February 2014 Main Interests: Arthroscopic and Reconstructive Surgery of the Shoulder & Elbow
4
Examination Look Feel Move Special Tests COMPARE SIDES
5
Referred Pain Neck Examination Cervical Spine Thoracic Spine
Cardiac Disease
6
Look Muscles - wasting, winging Deformity - malunion, scars, ACjt
7
Look Scapular Wasting
8
Look Winging
9
Feel Shoulder Bony Anatomy
10
Range of Motion Compare sides (great variation) Passive v Active
Loss of Motion - Mechanical - Muscular - Pain Inhibition - Neurological
11
Forward Flexion
12
ABduction
13
External Rotation
14
Internal Rotation
15
Special Tests Rotator Cuff Disease Instability
16
Rotator Cuff Disease Muscle Strength Impingement ACjt Pathology
Biceps Pathology
17
Supraspinatus Jobe’s
18
Subscapularis Gerber’s
19
Subscapularis Napolean
20
Impingement Neer’s
21
Impingement Hawkin’s
22
AC Joint Scarf
23
Biceps Speed’s
24
Biceps Yergason’s
25
Instability Generalised Joint Laxity Anterior Instability
Posterior Instability (no apprehension) Labral Pathology
26
Generalised Joint Laxity
27
Instability Sulcus Sign
28
Instability Apprehension
29
Instability Relocation Test
30
Posterior Instability
Jerk Test
31
Labrum O’Brien’s
32
Shoulder Pathology Instability Rotator Cuff Disease Frozen Shoulder
OA / RhA
33
Common Shoulder Pathology
Young - Instability Middle-Age - Rotator-Cuff & Frozen Shoulder Elderly - Rotator-Cuff & OA
34
Shoulder Pathology Instability Rotator Cuff Disease Frozen Shoulder
OA / RhA
35
Instability Traumatic v Atraumatic Bankart Tear Labral Tear
Capsular Laxity
36
Generalised Joint Laxity
Muscle Patterning Problems Teenage Female Uni- or Bi-lateral Physiotherapy (specialist)
37
First Time Dislocator Management Reduction
Sling immobilisation until comfortable Physiotherapy Recurrence ↓ with ↑ age ? Rotator cuff tear > 50yrs
38
Recurrent Anterior Dislocation
Management Activity modification Surgical Stabilisation – (open / arthroscopic / bony) Recovery wks - immobilisation wks - day to day activities mths - contact sports Outcome 90 – 95 % stable at 2 years
39
Shoulder Pathology Instability Rotator Cuff Disease Frozen Shoulder
OA / RhA
40
Rotator Cuff Disease Spectrum tendonitis ↓ full thickness tear
partial tear full thickness tear cuff arthropathy Tendinosis Tear
41
Rotator Cuff Disease Incidence of Rotator Cuff Defects
Arthrogram Study (asympt) 60+yrs 50% 80+yrs 80% MRI Study (asymptomatic) 19-39yrs 2% PT RCT 40-60yrs 28% RCT
42
Rotator Cuff Disease Treat the Symptoms
Non-Operative (+ activity modification) Operative
43
Management - non-operative
“Orthotherapy” - 3 Phases Control the Pain - NSAID - Cortisone Injection Regain ROM - Physio / exercises Muscle Strengthening - Physio / exercises - Activity modification
44
Steroid injection I prefer posterior approach
70-80% accuracy when performed “blind” 40mg depomedrone; 5-10mls marcaine 0.25%
45
Management - operative
Indications for Surgery Failure or relapse following adequate non-operative treatment (6mths +)
46
Management - operative
Expectations from Surgery Pain relief Variable functional recovery NOT a new shoulder – ‘degenerate tissue’
47
Management - operative
Address the Pathology Arthroscopic Subacromial Decompression AC joint Excision Rotator Cuff Repair Arthroplasty Muscle Transfer
48
Subacromial Decompression
49
Rotator Cuff Repair Double-Row Repair
Double-row arthroscopic rotator cuff repair: Re-establishing the footprint of the rotator cuff. Lo IKY et al. Arthroscopy 2003
50
Rotator Cuff Disease Management – (failed non-operative / ACUTE event)
arthroscopic decompression +/- rotator cuff repair Recovery ASD immediate mobilisation - 3 – 6 months optimal recovery Cuff Repair – 3 weeks sling Outcome 85% full recovery, 10% significantly better, 5% no worse!
51
Shoulder Pathology Instability Rotator Cuff Disease Frozen Shoulder
OA / RhA
52
Frozen Shoulder - 2% general population Common Condition Idiopathic
- women Idiopathic - Diabetes - Shoulder injury / pre-existing pathology
53
Frozen Shoulder Time Line pain stiffness Pain/Freezing Frozen Thawing
54
Frozen Shoulder Duration months – 3 years Recovery
complete – marked residual symptoms
55
Frozen Shoulder Management – Pain / Freezing pain stiffness
Pain/Freezing Frozen Thawing
56
Frozen Shoulder Management – Freezing / Painful
Conservative /Supportive - Supervised Neglect - Analgesia - Steroid Injection - Physiotherapy - Nerve Blocks - Capsular Hydrodilatation
57
Frozen Shoulder Management – Frozen / Thawing pain stiffness
Pain/Freezing Frozen Thawing
58
Frozen Shoulder Management – Frozen / Thawing Active /Supportive
- Encouragement - Physiotherapy - Exercise Programme
59
Frozen Shoulder Varying Subgroups?
Chambler Afw et al. The role of surgery in frozen shoulder. JBJS 2003;85-B:
60
Frozen Shoulder Management – Frozen / Thawing
Prolonged immobilisation (6 + months) → articular cartilage ligaments muscles
61
Frozen Shoulder Management – Frozen / Thawing Surgical
- MUA - Arthroscopic Capsular Release - Subacromial Decompression
62
Frozen Shoulder Management – protracted recovery < 9+ mths
arthroscopic capsular release + ASD Recovery - 2 days - inpatient physio - 2 + wks - intensive exercises / physio - 3 + mths - optimal recovery Outcome 90 % pain free / functional recovery
63
Problems around the shoulder
Summary - instability younger patient 1st time dislocation - rehabilitation recurrent dislocation - surgery
64
Problems around the shoulder
Summary - rotator cuff middle-age + patient asymptomatic pathology common treatment aimed at symptoms - NSAID, analgesia, physio acute vs chronic surgical intervention after failure of non-operative management
65
Problems around the shoulder
Summary – frozen shoulder 40 – 60 years 3 phases treatment - pain = supportive - frozen = supportive / physio - thawing = physio - frozen/thaw = surgery (non-improvers) Surgery for failure of non-operative treatment
Similar presentations
© 2025 SlidePlayer.com. Inc.
All rights reserved.