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Assessment of the Shoulder
- Dr. Gavin Nimon
Assessment of the Shoulder Dr. Gavin Nimon Head of Upper Limb - - PowerPoint PPT Presentation
Assessment of the Shoulder Dr. Gavin Nimon Head of Upper Limb - - PowerPoint PPT Presentation
www.glenelgorthopaedics.com.au Assessment of the Shoulder Dr. Gavin Nimon Head of Upper Limb Surgery- QEH Senior Lecturer- University of Adelaide MBBS FRACS (Orth) FRCS (Ed) www.glenelgorthopaedics.com.au Profile Gavin Anthony Nimon
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www.glenelgorthopaedics.com.au My Approach to Assessing and treating Orthopaedic Issues
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History
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Spur Os acromiale
Secondary bony Abnormalities
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Assessing The Non-Traumatic Shoulder Pain
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Factors leading to Cuff Tendinopathy
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www.glenelgorthopaedics.com.au Normal Cuff
Degenerative cuff ( smoker )
Cuff Degeneration
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- Dr. Gavin Nimon
Facts about Rotator Cuff Disease
- Degeneration is Normal
- Increases with age, relates to genetics, smoking , ? Overhead work
- Most tears asymptomatic
- Repair Does not guarantee won’t retear
- Asymptomatic tears, can be made symptomatic with treatment
- Do not know natural history of tear
- Evidence that surgery for impingement has no benefit
( but study flawed and surgery often involves Tx of ac joint or cuff)
Thus as in OA of hip
- Treat symptoms ( unless traumatic tear in young)
- Increase treatment as conservative options fail
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- Dr. Gavin Nimon
Rotator Cuff Treatment
- Physiotherapy
- Internal/ external Theraband exercises
- Hydrotherapy
- Cortisone Injections
Controversial ( could lead to greater tear) maximum 2-3
- Surgery
Arthroscopic vs Open Cuff repair vs debridement In severe cuff disease, ( degenerate) with massive tear ( and atrophy) = Reverse Shoulder Replacement ( ?? Causation in this scenario, and timing)
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Shoulder Arthroscopic Decompression
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Acromioplasty- Decompression
Side on view demonstrating Subacromial Spur Spur excised, bone now flat Spur being excised
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Post-op Surgery X-rays
AC joint excised arthroscopically Opposite AC joint- Not Normal Spur excised, not flat undersurface of acromion
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Arthroscopic Cuff Repair
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Arthroscopic techniques allow repair of small tears that may have previously been not treated with open techniques
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Factors influencing the recovery after Surgery
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www.glenelgorthopaedics.com.au Arthroscopic cuff Repair
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Frozen Shoulder
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- Dr. Gavin Nimon
Frozen Shoulder- Causation
- 1. ???? (Idiopathic)
- 2. Post –Traumatic
- 3. Diabetic
- 4. Often first pain may be when reaching behind, but does not
mean that is cause
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Diagnosis
- Initial Pain (often mistaken for bursitis)
- Pain is severe – look miserable
- Stiffness (ER =0 degrees)
- Age group (20-50)
- More common in diabetics, radiotherapy, post breast cancer
Treatment:-
- Time (longer wait, better outcome in all options)
- Hydrotherapy
- Corticosteroid injection (+/- hydrodilation)
- MUA and injection (risk of fracture)
- Arthroscopic release (risk of nerve injury)
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Anatomic Cuff Deficiency
Arthritis and shoulder replacement
Reverse Total Shoulder Replacement Anatomic Total Shoulder Replacement
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Its very important to be aware of the implant being recommended and that its long term results are within recommended result
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Shoulder Fractures
Reverse Total Shoulder Replacement In older patient Shoulder Fixation
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Shoulder Dislocations
- Fall on arm ? Abducted and externally rotated
- Needs Reduction Kocher/ Hippocratic etc
- Sling but then regain ROM
- 1st dislocation (Hovelius study)
- Multiple dislocation ( 2 or more – surgery)
Hovelius Study- scandinavia (35 years or less) 1st time dislocator – 85% chance of redislocation
Injury Primary Surgical Repair Open Bankart Repair ? Arthroscopic Bankart Repair
Prospective RCT Non-op vs scope repair 75% recurrent instability vs 11%
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Shoulder Stabilisation
Non- Anatomic (latarjet)
Arthroscopic Labral Repair
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www.glenelgorthopaedics.com.au Labral SLAP Repairs
- Over diagnosed
- Often incidental finding
- Not usually cause of pain ( but can be in some cases)
- Treatment labral repair vs biceps tenotomy/ tenodesis
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Clavicle Fractures
- Very Common (Cyclists particularly)
- Often Treated Non-operatively
- Can accept 1-2 cm shortening and displacement
- Surgery- plating
- Risks of N/V injury
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- Dr. Gavin Nimon
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- Dr. Gavin Nimon
AC Joint injuries
Grade 1-6
– Really “sprain” or “out” – Grade >4 (?3) do better with surgery – Surgery best < 2 weeks – 3-6 months off sport
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Grades of ac joint Injury
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- Dr. Gavin Nimon
A-C Joint injury
Fall on tip of shoulder or force transmitted through arm (straight)
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- Dr. Gavin Nimon
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- Dr. Gavin Nimon