1. My “Achy Breaky” Shoulder Shoulder Pain and Treatment
Kennedy Club Fitness, Paso
Mark G. Kowall, M.D., M.B.A.
September 24, 2013

2. The Orthopedic Specialty Hospital
Knee and Shoulder Training

3. Shoulder Pain Impingement Rotator Cuff Problems Instability
Most common sources
Impingement
Rotator Cuff Problems
Instability
Labrum Tears
Trauma
Less Common Sources
Arthritis
Frozen Shoulder

4. Anatomy

5. Impingement Syndrome (“umbrella diagnosis”)
Bursitis
(25-40 y/o)
Tendinitis
(40-50 y/o)
Rotator Cuff Tear
(>50 y/o)

6. Impingement “Bursitis/Tendinitis”

7. “Bursitis/Tendinitis” Symptoms
Pain with overhead motion
Shoulder to elbow location
Night time awakening
Pain with lifting
Occasional neck pain radiation
Usually no numbness/tingling

8. “Bursitis/Tendinitis” Treatment
Exam
XRays
NSAID’s
Physical Therapy or Home Therapy
Steroid Injection
MRI

10. Surgical Treatment “Decompression”

11. Rotator Cuff Tear

12. Rotator Cuff Tear Similar Symptoms as Bursitis More pain More weakness
Sometimes specific trauma but
More often “age related”

13. MRI
Edge of tendon

14. Rotator Cuff Repair

15. Instability (Labrum Tears)
S.L.A.P. Lesion
Bankart Lesion

16. Repair of the Labrum through the Arthroscope

17. Trauma Shoulder Separation
AC Joint
Fall off Bike onto shoulder
Usually no surgery
(Depends on severity)

18. Trauma Shoulder Dislocation
“Ball and Socket” Joint
Often requires ER visit
Can lead to recurrent dislocations

19. Trauma Fracture Common in older population (Usually no surgery)
Younger population
(more frequent surgery)

20. “Arthritis” = “Tread Wear”
Cartilage
Osteoarthritis is a particular type of arthritis which affects the cartilage in the joints, causing it to breakdown and eventually be lost all together.
Healthy Joint
Osteoarthritic Joint
“tread wear”

21. Arthritis “Acromioclavicular Joint”
Normal
Arthritis
Common in younger patients
“Weight lifters”, construction workers

22. Acromioclavicular Joint Treatment
NSAID’s
Activity Modification
Steroid injection
Arthroscopic Surgery
(Removal of arthritic end of clavicle)

23. Arthritis “Ball and Socket Joint”

24. Shoulder X-Ray Arthritis
Advanced
Arthritis
Normal
Joint Space

25. Arthroscopy – Microfracture
small awl used to make holes in bone
promote re-growth of cartilage

26. Shoulder Replacement

27. Frozen Shoulder (Adhesive Capsulitis)

28. Frozen Shoulder Treatment
Pain control (NSAID’s, steroid medication and injection)
Physical Therapy
TIME, TIME, TIME
Sometimes manipulation of shoulder under general anesthesia

29. Information Resource