Transcript SHOULDER 2003

SHOULDER
SHOULDER OSTEOLOGY
SHOULDER OSTEOLOGY
ANATOMY:MUSCLES
ANATOMY:CAPSULAR
ELEMENTS
IMPINGEMENT:ANATOMY
CA LIGAMENT
ACROMIAL SHAPES
ACROMIAL ANATOMY
ACROMIAL SHAPE
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TYPE 1 (FLAT)17%
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TYPE 2 (CURVED) 43%
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TYPE 3 (ANTERIOR
HOOK) 40%
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MORRISON & BIGLIANI
(1987)
80% PTS WITH RC TEAR
HAD TYPE 3 ACROMION
IMPINGEMENT
SYNDROME:STAGES
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STAGE 1 :
REVERSIBLE EDEMA
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STAGE 2: FIBROSIS
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STAGE 3: ROTATOR
CUFF TEAR
IMPINGEMENT SYNDROME
:STAGE 1
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DULL ACHE
ACTIVITY RELATED
PALPABLE
TENDERNESS
PAIN BETWEEN 30-60
DEGREE
ABDUCTION
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POSITIVE
IMPINGEMENT
SIGNS
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PAIN IN BICIPITAL
GROOVE
IMPINGEMENT
SYNDROME:STAGE 1
TREATMENT
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NSAID
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REST FROM PROVOCATIVE MANUVERS
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PHYSICAL THERAPY
IMPINGEMENT
SYNDROME:STAGE II
DIAGNOSIS
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ACHING
DISCOMFORT
PAIN AT
REST/NIGHT
SUBACROMIAL
CREPITUS
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CATCHING
SENSATION
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DECREASED ROM
IMPINGEMENT SYNDROME:
STAGE II TREATMENT
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REST
ICE NSAID
SUBACROMIAL
INJECTION
P.T
1.R.O.M
2. PAIN CONTROL
3. STRENGTH
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ACROMIOPLASTY
86% SUCCESS IF NO
RC TEAR
OPEN VS
ARTHROSCOPIC
OPEN ACROMIOPLASTY
SUBACROMIAL
DECOMPRESSION
ROTATOR CUFF TEARS
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PREVALENCE
ETIOLOGY
PHYSICAL EXAM
TREATMENT
OPTIONS
REHABILITATION
ROTATOR CUFF
TEARS:INCIDENCE
FULL THICKNESS
JEROSCH ,1991-30.3%
NEER ,1983- 5%
UHLHOFF ,1986-20%
WILSON, 1943-26.5%
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AGE : KEY FACTOR
PARTIAL THICKNESS
JEROSCH, 1991-28.7%
YAMANKA, 1983-13%
FUKUDA, 1980-13%
DEPALMA, 1973-37%
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R.C TEARS: ETIOLOGY
EXTRINSIC FACTORS
ACROMIAL SHAPE
OUTLET STENOSIS
AC JOINT DJD
OS ACROMIALE
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INTRINSIC FACTORS
SUPRASPINATUS
NERVE PALSY
GLENOHUMERAL
INSTABILITY
HYPOVASCULARITY
AGING
R.C TEARS: DIAGNOSIS
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PAIN
WEAKNESS(ABD/ER)
CREPITUS
DROP TEST
BURSAL EFFUSION
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LONG HEAD BICEPS
RUTURE
DECREASED ROM
R.C TEAR :DIAGNOSIS
DROP TEST
EXTERNAL ROTATION
INTERNAL ROTATION
R.C TEAR : IMAGING
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PLAIN RADIOGRAPHS
ULTRASONOGRAPHY
ARTHROGRAM
MRI: GOLD STANDARD
R.C TEARS: IMAGING
INTACT NORMAL CUFF
TORN ROTATOR CUFF
R.C TEARS: XRAYS
SOUCIL SIGN
SHOULDER ARTHROGRAM
ROTATOR CUFF TEAR:
TREATMENT
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NON-OPERATIVE
ROTATOR CUFF REPAIR
ACROMIOPLASTY
DISTAL CLAVICLE RESECTION
REPAIR OF CUFF
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ROTATOR CUFF REPAIR
ACROMIOPLASTY
OPEN VS. ARTHROSCOPIC
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MOBILIZATION OF TENDON
1. BLUNT DISSECTION
2. RELEASE FASCIAL ATTACHMENTS
3. INCISE CAPSULE AT GLENOID
LABRUM
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ARTHROSCOPIC SUBACROMIAL
DECOMPRESSION
SUBACROMIAL SPUR
FINISHED ACROMIOPLASTY
ROTATOR CUFF REPAIR
REPAIR
1. CREATE TROUGH
2. DRILL HOLES
3. NON-ABSORBABLE SUTURES
4. SOLID DELTOID REPAIR
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ROTATOR CUFF REPAIR
ARTHROSCOPIC ROTATOR
CUFF REPAIR
ROTATOR CUFF REPAIR:
REHABILITATION
WEEK 0-6
PASSIVE R.O.M
 WEEK 6-12
ACTIVE R.O.M
 WEEK 12+
STRENGTHENING
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ROTATOR CUFF REPAIR:
RESULTS
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NEER 1988-233 PATIENTS, 4.6 YEAR F.U.
77% EXCELLENT/GOOD
14% SATISFACTORY
9% UNSATISFACTORY
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HAWKINS 1985
86% EXCELLENT/GOOD
ROTATOR CUFF REPAIR:
RESULTS
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HARRYMAN, 1990- 112 PATIENTS
4.7 YEAR F.U.
80% GOOD PAIN RELIEF
80% REPIRS INTACT(S.S)
50% REPAIRS INTACT(IS,SUBSCAP)
PAIN RELIEF INDEPENDENT OF CUFF
INTEGRITY
DECOMPRESSION IS THE KEY!!
ROTATOR CUFF REPAIR:
REASONS FOR FAILURE
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POST-OP SCARRING
DELTOID DETACHMENT
INADEQUATE DECOMPRESSION
RECURRENT TEAR