Shoulder. Shoulder. Robert Peterson, MD Orthopedic Surgeon, Sports Medicine NorthBay.org. Heal like a Champion

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1 Shoulder to Shoulder Heal like a Champion Robert Peterson, MD Orthopedic Surgeon, Sports Medicine NorthBay.org

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5 Shoulder Injuries, Disease, Conditions Shoulder fractures Pediatric shoulder injuries Sports Injuries Subacromial Bursitis Impingement Syndromes Rotator cuff tendinitis Rotator cuff tear Shoulder instability (dislocation) SLAP tears Biceps injuries Acromioclavicular (AC) injuries Frozen shoulder Arthritis Nerve injuries, stingers, burners

6 Shoulder Anatomy

7 Shoulder Anatomy

8 Humerus fracture

9 Humerus fractures

10 Humerus fracture

11 Pediatric shoulder: growth plate injury Trauma Little League Shoulder Conservative care REST! Surgery rare

12 Clavicle fracture

13 Clavicle fracture

14 Clavicle fractures

15 Scapula fractures

16 Shoulder instability

17 Shoulder instability Acute vs. Chronic Dislocation vs. Subluxation Anterior Posterior Multidirectional Voluntary

18 Anterior shoulder dislocation

19 Symptoms Pain Deformity Swelling Numbness Weakness

20 Treatment Put it back! (closed reduction) Sling for comfort Early motion Ice, rest, medication Rehabilitation Redislocation risk: 80% if age under 20, 35% if over 30

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22 Surgery

23 Posterior shoulder dislocation 5% of all dislocations High impact sports Motor vehicle accident Seizures

24 Multidirectional Instability

25 Biceps tendon Pain in the front of the shoulder Weakness Cramping/Swelling +/- Bruising

26 Possible causes #1 cause is a lifetime of normal activity Repetitive use, especially overhead Traumatic injury fall, heavy lift traction

27 Long head of biceps tendon Biceps Tendinitis Rupture long head of Biceps

28 Treatment Rest, NSAIDS, activity modification Physical Therapy Brace Injection Surgery (tenotomy vs. tenodesis) SLAP Repair

29 SLAP Tear (SUPERIOR LABRUM ANTERIOR TO POSTERIOR) Shoulder pain often deep Clicking, catching, grinding Feelings of Instability Loss of motion Loss of Strength (dead arm) Change in athletic motion

30 POSSIBLE CAUSES Repetitive use Falling on outstretched arm Traction injury Catching something heavy Motor vehicle accident

31 SLAP TEARS Multiple causes Difficult diagnosis

32 Treatment options Rest, ice, NSAID s Physical Therapy emphasize motion and strength Surgical Repair +/- biceps Post-op rehabilitation

33 Acromioclavicular (AC) joint sprain (shoulder separation)

34 AC Sprains Usually caused by trauma at the point of the shoulder Local tenderness, swelling Pain with motion, crossarm position Pain with lifting

35 AC Sprains

36 AC Arthritis

37 Subacromial Impingement Syndrome Tendinitis Bursitis Impingement

38 Symptoms Cause is usually repetitive use Pain in the front of shoulder often radiates to arm Pain overhead and reaching Often hurts at rest and with sleep Losing strength and motion

39 Treatment Rest, ice, NSAID s, therapy Injection Surgery for decompression

40 Rotator cuff Four muscles that connect humerus to scapula and stabilizes the shoulder joint Often refers primarily to the tendons attachment to bone Injuries arise most commonly from overuse and trauma but are most commonly a result of degenerative changes

41 Rotator cuff tear

42 Symptoms Pain around the shoulder Worse with use Pain at rest, worse at night Loss of strength, then motion Crepitus

43 Treatment Rest and change in activities Medication Cold/Heat Injection Therapy/stretch/strengthen

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45 Surgery Full thickness tears will not heal Tears may get worse with time Surgical success depends on many factors Open vs. arthroscopic

46 Rehabilitation Approx weeks to heal Recovery requires 6-18 months Early motion with limits Physical therapy is delayed Home exercises Goals of surgery: 1)pain relief, 2) functional recovery, 3) strength

47 Rotator cuff tear arthropathy Severe rotator cuff deficiency Repair is not feasible Tendon transfers Reverse total shoulder arthroplasty Allows deltoid muscle to elevate the arm

48 Frozen Shoulder (adhesive capsulitis)

49 Frozen shoulder Shoulder pain and progressive stiffness Freezing worsening pain and motion Frozen pain better, use limited Thawing less pain, slow improvement Untreated, time frame 6 mos. years Treatment is focused on therapy, includes meds, ice Manipulation under anesthesia Surgery is less common

50 Shoulder arthritis

51 Shoulder arthritis Osteoarthritis Rheumatoid arthritis

52 Shoulder arthritis Post-traumatic arthritis Avascular necrosis

53 Inflammatory arthropathies Systemic lupus erythematosus Psoriatic arthritis Ankylosing spondylitis Gout

54 Symptoms Pain Loss of motion Aching, may change with weather Weakness Crepitus (grinding, clicking)

55 Treatment options Non-operative Activity Modification Stretching and strengthening Heat and cold Medications Injections Surgical Arthroscopy Soft-tissue interposition Joint Replacement Fusion (arthrodesis}

56 Shoulder replacement

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60 Safety first!

61 Resources NorthBay.org Your local resource! orthoinfo.org Excellent source of info and exercise programs from the American Academy of Orthopaedic Surgeons sportsmed.org Home of the American Orthopaedic Society for Sports Medicine. Excellent information about the prevention and treatment of sports injuries amssm.org American Medical Society of Sports Medicine

62 Thank you Robert Peterson, MD, Orthopedic Surgeon, Sports Medicine NorthBay.org

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