My My “Achy Breaky” “Achy Breaky” ShoulderShoulder

Shoulder Pain and TreatmentShoulder Pain and Treatment

Kennedy Club Fitness, Paso

Mark G. Kowall, M.D., M.B.A.

September 24, 2013September 24, 2013

Knee and Shoulder Training

The Orthopedic Specialty Hospital

Shoulder PainShoulder PainMost common sources

ImpingementRotator Cuff Problems

InstabilityLabrum Tears

Trauma

Less Common Sources ArthritisArthritis

Frozen ShoulderFrozen Shoulder

AnatomyAnatomy

Impingement SyndromeImpingement Syndrome(“umbrella diagnosis”)(“umbrella diagnosis”)

Bursitis Bursitis (25-40 y/o)(25-40 y/o)

Tendinitis Tendinitis (40-50 y/o)(40-50 y/o)

Rotator Cuff TearRotator Cuff Tear (>50 y/o)(>50 y/o)

ImpingementImpingement“Bursitis/Tendinitis”“Bursitis/Tendinitis”

Pain with overhead motionPain with overhead motionShoulder to elbow locationShoulder to elbow location

Night time awakeningNight time awakeningPain with liftingPain with lifting

Occasional neck pain radiationOccasional neck pain radiationUsually no numbness/tinglingUsually no numbness/tingling

““Bursitis/Tendinitis”Bursitis/Tendinitis”SymptomsSymptoms

ExamExam XRaysXRays

NSAID’sNSAID’sPhysical Therapy or Home TherapyPhysical Therapy or Home Therapy

Steroid InjectionSteroid Injection

MRIMRI

““Bursitis/Tendinitis”Bursitis/Tendinitis”TreatmentTreatment

Surgical TreatmentSurgical Treatment““Decompression”Decompression”

Rotator Cuff TearRotator Cuff Tear

Rotator Cuff TearRotator Cuff Tear

Similar Symptoms as BursitisSimilar Symptoms as BursitisMore painMore pain

More weaknessMore weaknessSometimes specific trauma Sometimes specific trauma butbut

More often “age related”More often “age related”

MRIMRIEdge of tendon

Rotator Cuff RepairRotator Cuff Repair

InstabilityInstability(Labrum Tears)(Labrum Tears)

S.L.A.P. Lesion

Bankart Lesion

Repair of the Labrum through the Arthroscope

TraumaTraumaShoulder SeparationShoulder Separation

AC JointAC Joint

Fall off Bike onto shoulderFall off Bike onto shoulder

Usually no surgeryUsually no surgery

(Depends on severity)(Depends on severity)

TraumaTraumaShoulder DislocationShoulder Dislocation

““Ball and Socket” JointBall and Socket” Joint

Often requires ER visit Often requires ER visit

Can lead to recurrent dislocationsCan lead to recurrent dislocations

TraumaTraumaFractureFracture

Common in older population Common in older population

(Usually no surgery)(Usually no surgery)

Younger population Younger population

(more frequent surgery)(more frequent surgery)

Healthy Joint

Osteoarthritic Joint

“tread wear”

Cartilage

““Arthritis”Arthritis”==

“Tread Wear”“Tread Wear”

ArthritisArthritis“Acromioclavicular Joint”“Acromioclavicular Joint”

Normal

Arthritis

Common in younger patients “Weight lifters”, construction workers

Acromioclavicular JointAcromioclavicular JointTreatmentTreatment

NSAID’sNSAID’s

Activity ModificationActivity Modification

Steroid injectionSteroid injection

Arthroscopic SurgeryArthroscopic Surgery

(Removal of arthritic end of clavicle)(Removal of arthritic end of clavicle)

ArthritisArthritis“Ball and Socket Joint”“Ball and Socket Joint”

Shoulder X-RayShoulder X-RayArthritisArthritis

Normal AdvancedArthritis

Joint Space

Arthroscopy – Arthroscopy – MicrofractureMicrofracture

small awl used to make holes in small awl used to make holes in bonebone

promote re-growth of cartilagepromote re-growth of cartilage

Shoulder ReplacementShoulder Replacement

Frozen ShoulderFrozen Shoulder(Adhesive Capsulitis)(Adhesive Capsulitis)

Frozen Shoulder Frozen Shoulder TreatmentTreatment

Pain control (NSAID’s, steroid medication and injection)

Physical Therapy

TIME, TIME, TIME

Sometimes manipulation of shoulder under general anesthesia

Information ResourceInformation Resource

www.ShoulderKneeSpecialists.comwww.ShoulderKneeSpecialists.com