ROTATOR CUFF SYNDROME Arbejds- og Miljømedicinsk Årsmøde 2008 ROTATOR CUFF SYNDROME = SHOULDER PAIN Steen Bo Kalms, Shoulder- and Elbow Surgeon ROTATOR CUFF SYNDROME VERY COMMON DIAGNOSIS ON REFERRED PTT S ILL DEFINED DISEASE PROPER EXAM AND RELEVANT INVESTIGATIONS BEFORE REFFERAL RELEVANT TREATMENT BEFORE REFFERAL SHOULDER PAIN DIFFERENTIALDIAGNOSIS IMPINGEMENT ROTATOR CUFF LESIONS AC-JOINT PATHOLOGY BURSITIS TENDINITIS FRACTURES (DELAYED DIAGNOSED) CAPSULITIS (GENUINE FROZEN SHOULDER) N. SUPRASCAPULARIS LESION BICEPS TENDON PATHOLOGY INSTABILITY PROBLEMS LABRAL PATHOLOGY TUMOR INFECTION 1

IMPINGEMENT INTERNAL (INSTABILITY PROBLEM) EXTERNAL (CORACOACROMIAL COLLISION) PROGRESSIVE DEGENERATION OF COLLIDING STRUCTURES ACUTE EXACERBATIONS ROTATOR CUFF PROBLEMS ACUTE TRAUMATIC LESIONS PARTIAL TOTAL ONE OR MORE TENDONS DEGENERATIVE (IMPINGEMENT RELATED) ACROMIOCLAVICULAR JOINT PATHOLOGIES BURSITIS/TENDINITIS ARTROSIS ARTHRITIS POSTTRAUMA DEGENERATIVE (IMPINGEMENT) CALCIFYING TENDINITIS (IMPING) TRAUMATIC 2

BICEPS TENDON PATHOLOGIES SUBLUXATION/LUXATION DEGENERATIVE (IMPINGEMENT) TRAUMATIC PARTIAL LESION RUPTURE INSTABILITY PROBLEMS TRAUMATIC ANTERIOR POSTERIOR NON TRAUMATIC VOLUNTARY MULTIDIRECTIONAL DIAGNOSING BEFORE SURGERY PATIENT HISTORY CLINICAL EXAMINATION ULTRASOUND X-RAY MRI ARTHROSCOPY PATIENT HISTORY DURATION? TRAUMA? PAIN HISTORY JOB HISTORY SPORTS? RELEVANT PARACLIN EXAM DONE? RELEVANT TREATMENT? 3

CLINICAL EXAMINATION RANGE OF MOVEMENT ACTIVE PASSIVE STABILITY STRENGHT TESTS AND SIGNS PARACLINICAL EXAMS X-RAY ULTRASOUND MRI MRI artrografi ARTHROSCOPY CHOICE OF TREATMENT DEPENDS ON AGE HISTORY PRIOR TREATMENT PHYSIOTHERAPY MEDICATION STEROIDS? PHYSICAL AND PSYCHIC STATE 4

CHOICE OF TREAMENT OFTEN IS MEDICATION PHYSIOTHERAPY PATIENT EDUCATION JOB COUNCELLING SURGERY CHOICE OF TREATMENT SURGERY IF 1. SYMPTOMS MORE THAN 6 MONTHS 2. NO EFFECT OF OTHER TREATMENT 3. UNCERTAIN DIAGNOSIS TYPE OF SURGERY DEPENDS ON PROPER DIAGNOSIS SURGERY DIAGNOSTIC ARTHROSCOPY ARTHROSCOPIC SUBACROMIAL DECOMPRESSION TREATMENT OF CUFF LESION SUTURE DEBRIDEMENT AC-JOINT SURGERY INSTABILITY SURGERY IMPINGEMENT CONTACT/COLLISION BETWEEN ROTATOR CUFF- SUBACROMIAL BURSA AND CORACOACROMIAL ARC 5

IMPINGEMENT A CONTINUING DEGENERATIVE PROCESS LEADING TO CUFF PROBLEMS, BICEPS PROBLEMS a.s.o. IMPINGEMENT SYMPTOMS PAIN REST/MOTION PAIN ELEVATION PROJECTED PAIN REGIO DELTOIDEA ELBOW, WRIST, FINGERS DECREASED ROM LOSS OFF STRENGHT ACROMIONS MORFOLOGI IMPINGEMENT IMPINGEMENT TREATMENT ACROMIOPLASTY = SUBACROMIAL DECOMPRESSION ARTROSCOPIC OR OPEN REHABILITATION 6

RESULTS OF SURGERY VERY DEPENDENT ON TYPE OF SURGERY NOT ALL TYPES OFF SURGERY COMPARABLE DEPENDING ON DIAGNOSIS EX. CUFF LESION NOT = AC JOINT PATHOLOGY RESULTS OF ROTATOR CUFF SYNDROME SURGERY RESULTS FOR IMPINGEMENT SURGERY RESULTS FOR CUFF SURGERY RESULTS FOR AC JOINT SURGERY RESULTS FOR BICEPS TENDON SURGERY A.S.O COMPARE ONLY SIMILAR DISEASES! RESULTS OF SURGERY DEPENDING ON CORRECT PREOP DIAGNOSIS CORRECT PATIENT INFORMATION EXPECTATIONS CORRECT AFTERTREATMENT CORRECT SURGERY 80 % GOOD AND EXCELLENT RESULTS >6 MTHS AFTER SURGERY IN PURE IMPINGEMENT CASES 7

LONG TERM RESULTS CHIN PY, J SHOULDER AN ELBOW SURG 2007 16(6)697-700700 NORLIN R, J SHOULDER AND ELBOW SURG 2008, JAN 17;12S-16S 16S How come they don t get rotator cuff syndrome? THANK YOU FOR YOUR ATTENTION! 8