Transcript Meniscus Injury/Knee Pain

Shoulder Pain/Impingement
Matthew E. Mitchell M.D.
Disclaimer
 Patients should discuss specific injuries with their primary
care doctor or surgeon. This site is meant to give general
information to patients about specific patient problems. It
is impossible to individualize this discussion to specific
patient issues.
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Shoulder Pain
 Many conditions cause shoulder pain
 Extra Articular pain “outside of the joint”
– AC (acromial clavicular) joint pain
– Impingement or “bursitis”
– Rotator Cuff Tear
 Intra articular pain “inside the joint”
– Arthritis
– Cartilage injury
– Loose bodies
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Extra-articular
 Impingement or bursitis
– Inflammation of bursa or “sac” in subacromial space
 Symptoms
– Crepitus which patients call “popping” “crunching” in
shoulder
– Pain with overhead activity
– Pain localized on apex of shoulder
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Anatomy
AC joint
Clavicle
Acromion
Bursa:
Location of
“Bursitis”
Rotator Cuff
Underneath Bursa
Humerus
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Treatment of Impingement
 Physical Therapy
– Regain range of motion
– Start strengthening
 Injections
– Caution in young people
– Toxic to cartilage
– Limit injections to 3 or less
 Surgery
– Arthroscopic decompression
– Shave piece of bone and remove inflamed bursa
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Results of Treatment
 Most patients get better with physical therapy and
modifications to activity in 6 months
 Surgery has good results when people have had a
favorable response to injections
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AC or Acromio-clavicular Pain
 Pain located in the joint that connects the acromion and
clavicle
 Symptoms
– Pain located in the mid clavicle or “collar bone” area
– Sometimes occurs in weight lifters
– Can also exist with impingment or “bursitis”
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Anatomy
AC joint:
location of
AC pain
Acromion
Bursa: Location
of “Bursitis”
Rotator Cuff
Underneath Bursa
Humerus
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Clavicle
AC Pain Treatment
 Physical Therapy
– Regain range of motion
– Start strengthening
 Injections
– Caution in young people
– Toxic to cartilage
– Limit injections to 3 or less
 Surgery
– Arthroscopic decompression
– Shave part of joint out
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Results of Treatment
 Physical therapy can be beneficial if “bursitis” or
impingement is also present
 Injections can give very good relief of pain
 Surgery has high predictive success if
injections temporarily relieve pain
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Rotator Cuff Tear
 Tear of the small muscles around the shoulder
 Symptoms
– Pain with overhead activity
– Weakness
– Pain on apex of shoulder
– More common in people over 40 years old
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Anatomy
Rotator Cuff
Muscle “Covers” the
Shoulder Like a Cuff
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Treatment
 Treatment depends on symptoms and age of patient
 Young patients with tears should probably have early repair even
if symptoms are not severe
 Middle age patients 40-60 years old should be trialed with nonoperative treatment but
 enlargement of tear and arthritis is a possibility
 Older patients with large tears can be treated with injections and
non-operative treatment
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Results of Treament
 Very large tears are difficult to treat
 In older patients pain is reliably relieved but
strength may not be improved with surgery
 In younger patients some improvement in strength may be
possible with surgery
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Intra-articular Pain
 Cartilage Injury
– Labrum (surrounds the articular cartilage)
– Arthritis (articular cartilage)
 Symptoms
– Dislocations
– Throwing pain
– Loss of strength
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Intra-articular Pain
Arthritis: articular
cartilage
Superior Labral
Tears: throwing
pain
Inferior Labral
Tears:
instability and
dislocation
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Treatment
 Physical Therapy
– Range of motion
– Strengthening
 Injections
– Used to help with diagnosis
 Surgery
 Arthroscopic repair of labral injury
 Tighten capsule if necessary
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Results
 Arthroscopic repair of labral injuries
– Good results with accurate diagnosis
 Arthroscopic treatment of dislocation
– It has results equal to open repair but these reports are
early
– There may be a role for early repair in young active
people
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Summary
 Shoulder pain has intra-articular and extra-articular causes
 Burisitis or impingement is most common extra-articular
cause
 The main initial treatment is physical therapy and activity
modification
 Surgery has good results in most cases
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