1. SHOULDER

2. SHOULDER OSTEOLOGY

3. SHOULDER OSTEOLOGY

4. ANATOMY:MUSCLES

5. ANATOMY:CAPSULAR ELEMENTS

6. IMPINGEMENT:ANATOMY
CA LIGAMENT

7. ACROMIAL SHAPES

8. ACROMIAL ANATOMY

9. ACROMIAL SHAPE TYPE 1 (FLAT)17% TYPE 2 (CURVED) 43%
TYPE 3 (ANTERIOR HOOK) 40%
MORRISON & BIGLIANI (1987)
80% PTS WITH RC TEAR HAD TYPE 3 ACROMION

10. IMPINGEMENT SYNDROME:STAGES
STAGE 1 : REVERSIBLE EDEMA
STAGE 2: FIBROSIS
STAGE 3: ROTATOR CUFF TEAR

11. IMPINGEMENT SYNDROME :STAGE 1
DULL ACHE
ACTIVITY RELATED
PALPABLE TENDERNESS
PAIN BETWEEN DEGREE ABDUCTION
POSITIVE IMPINGEMENT SIGNS
PAIN IN BICIPITAL GROOVE

12. IMPINGEMENT SYNDROME:STAGE 1 TREATMENT
NSAID
REST FROM PROVOCATIVE MANUVERS
PHYSICAL THERAPY

13. IMPINGEMENT SYNDROME:STAGE II DIAGNOSIS
ACHING DISCOMFORT
PAIN AT REST/NIGHT
SUBACROMIAL CREPITUS
CATCHING SENSATION
DECREASED ROM

14. IMPINGEMENT SYNDROME: STAGE II TREATMENT
REST
ICE NSAID
SUBACROMIAL INJECTION
P.T
1.R.O.M
2. PAIN CONTROL
3. STRENGTH
ACROMIOPLASTY
86% SUCCESS IF NO RC TEAR
OPEN VS ARTHROSCOPIC

15. OPEN ACROMIOPLASTY

16. SUBACROMIAL DECOMPRESSION

17. ROTATOR CUFF TEARS PREVALENCE ETIOLOGY PHYSICAL EXAM TREATMENT OPTIONS
REHABILITATION

18. ROTATOR CUFF TEARS:INCIDENCE
FULL THICKNESS
JEROSCH , %
NEER , %
UHLHOFF , %
WILSON, %
AGE : KEY FACTOR
PARTIAL THICKNESS
JEROSCH, %
YAMANKA, %
FUKUDA, %
DEPALMA, %

19. R.C TEARS: ETIOLOGY EXTRINSIC FACTORS ACROMIAL SHAPE OUTLET STENOSIS
AC JOINT DJD
OS ACROMIALE
INTRINSIC FACTORS
SUPRASPINATUS NERVE PALSY
GLENOHUMERAL INSTABILITY
HYPOVASCULARITY
AGING

20. R.C TEARS: DIAGNOSIS PAIN WEAKNESS(ABD/ER) CREPITUS DROP TEST
BURSAL EFFUSION
LONG HEAD BICEPS RUTURE
DECREASED ROM

21. R.C TEAR :DIAGNOSIS
DROP TEST
EXTERNAL ROTATION
INTERNAL ROTATION

22. R.C TEAR : IMAGING PLAIN RADIOGRAPHS ULTRASONOGRAPHY ARTHROGRAM
MRI: GOLD STANDARD

23. R.C TEARS: IMAGING
INTACT NORMAL CUFF
TORN ROTATOR CUFF

24. R.C TEARS: XRAYS
SOUCIL SIGN
SHOULDER ARTHROGRAM

25. ROTATOR CUFF TEAR: TREATMENT
NON-OPERATIVE
ROTATOR CUFF REPAIR
ACROMIOPLASTY
DISTAL CLAVICLE RESECTION
REPAIR OF CUFF

26. ROTATOR CUFF REPAIR ACROMIOPLASTY OPEN VS. ARTHROSCOPIC
MOBILIZATION OF TENDON
1. BLUNT DISSECTION
2. RELEASE FASCIAL ATTACHMENTS
3. INCISE CAPSULE AT GLENOID LABRUM

27. ARTHROSCOPIC SUBACROMIAL DECOMPRESSION
SUBACROMIAL SPUR
FINISHED ACROMIOPLASTY

28. ROTATOR CUFF REPAIR REPAIR 1. CREATE TROUGH 2. DRILL HOLES
3. NON-ABSORBABLE SUTURES
4. SOLID DELTOID REPAIR

29. ROTATOR CUFF REPAIR

30. ARTHROSCOPIC ROTATOR CUFF REPAIR

31. ROTATOR CUFF REPAIR: REHABILITATION
WEEK 0-6
PASSIVE R.O.M
WEEK 6-12
ACTIVE R.O.M
WEEK 12+
STRENGTHENING

32. ROTATOR CUFF REPAIR: RESULTS
NEER PATIENTS, 4.6 YEAR F.U.
77% EXCELLENT/GOOD
14% SATISFACTORY
9% UNSATISFACTORY
HAWKINS 1985
86% EXCELLENT/GOOD

33. ROTATOR CUFF REPAIR: RESULTS
HARRYMAN, PATIENTS
4.7 YEAR F.U.
80% GOOD PAIN RELIEF
80% REPIRS INTACT(S.S)
50% REPAIRS INTACT(IS,SUBSCAP)
PAIN RELIEF INDEPENDENT OF CUFF INTEGRITY
DECOMPRESSION IS THE KEY!!

34. ROTATOR CUFF REPAIR: REASONS FOR FAILURE
POST-OP SCARRING
DELTOID DETACHMENT
INADEQUATE DECOMPRESSION
RECURRENT TEAR