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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