Shoulder to Shoulder Heal like a Champion Robert Peterson, MD - - PowerPoint PPT Presentation

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Shoulder to Shoulder Heal like a Champion Robert Peterson, MD - - PowerPoint PPT Presentation

May 14, 2023 661 likes •1.31k views

Shoulder to Shoulder Heal like a Champion Robert Peterson, MD Orthopedic Surgeon, Sports Medicine 707.624.7900 NorthBay.org Shoulder Injuries, Disease, Conditions Shoulder fractures Shoulder instability (dislocation)

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Shoulder

to

Shoulder

Heal like a Champion

Robert Peterson, MD Orthopedic Surgeon, Sports Medicine 707.624.7900 NorthBay.org

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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
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Shoulder Anatomy

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Shoulder Anatomy

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Humerus fracture

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Humerus fractures

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Humerus fracture

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Pediatric shoulder: growth plate injury

  • Trauma
  • Little League Shoulder
  • Conservative care
  • REST!
  • Surgery rare
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Clavicle fracture

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Clavicle fracture

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Clavicle fractures

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Scapula fractures

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Shoulder instability

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Shoulder instability

  • Acute vs. Chronic
  • Dislocation vs. Subluxation
  • Anterior
  • Posterior
  • Multidirectional
  • Voluntary
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Anterior shoulder dislocation

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Symptoms

  • Pain
  • Deformity
  • Swelling
  • Numbness
  • Weakness
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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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Surgery

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Posterior shoulder dislocation

  • 5% of all dislocations
  • High impact sports
  • Motor vehicle accident
  • Seizures
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Multidirectional Instability

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Biceps tendon

  • Pain in the front of the shoulder
  • Weakness
  • Cramping/Swelling
  • +/- Bruising
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Possible causes

  • #1 cause is a lifetime of

normal activity

  • Repetitive use, especially
  • verhead
  • Traumatic injury – fall,

heavy lift traction

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Long head of biceps tendon

  • Biceps Tendinitis
  • Rupture long head of Biceps
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Treatment

  • Rest, NSAIDS, activity

modification

  • Physical Therapy
  • Brace
  • Injection
  • Surgery (tenotomy vs.

tenodesis)

  • SLAP Repair
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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
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POSSIBLE CAUSES

  • Repetitive use
  • Falling on outstretched

arm

  • Traction injury
  • Catching something heavy
  • Motor vehicle accident
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SLAP TEARS

  • Multiple causes
  • Difficult diagnosis
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Treatment options

  • Rest, ice, NSAID’s
  • Physical Therapy –

emphasize motion and strength

  • Surgical Repair +/- biceps
  • Post-op rehabilitation
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Acromioclavicular (AC) joint sprain

(shoulder separation)

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AC Sprains

  • Usually caused by trauma

at the point of the shoulder

  • Local tenderness, swelling
  • Pain with motion, cross-

arm position

  • Pain with lifting
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AC Sprains

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AC Arthritis

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Subacromial Impingement Syndrome

  • Tendinitis
  • Bursitis
  • Impingement
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Symptoms

  • Cause is usually repetitive use
  • Pain in the front of shoulder
  • ften radiates to arm
  • Pain overhead and reaching
  • Often hurts at rest and with

sleep

  • Losing strength and motion
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Treatment

  • Rest, ice, NSAID’s,

therapy

  • Injection
  • Surgery for

decompression

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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
  • veruse and trauma but are most

commonly a result of degenerative changes

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Rotator cuff tear

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Symptoms

  • Pain around the shoulder
  • Worse with use
  • Pain at rest, worse at night
  • Loss of strength, then

motion

  • Crepitus
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Treatment

  • Rest and change in activities
  • Medication
  • Cold/Heat
  • Injection
  • Therapy/stretch/strengthen
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Surgery

  • Full thickness tears will

not heal

  • Tears may get worse

with time

  • Surgical success

depends on many factors

  • Open vs. arthroscopic
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Rehabilitation

  • Approx. 8-12 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

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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

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Frozen Shoulder

(adhesive capsulitis)

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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
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Shoulder arthritis

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Shoulder arthritis

  • Osteoarthritis
  • Rheumatoid arthritis
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Shoulder arthritis

  • Post-traumatic arthritis
  • Avascular necrosis
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Inflammatory arthropathies

  • Systemic lupus

erythematosus

  • Psoriatic arthritis
  • Ankylosing spondylitis
  • Gout
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Symptoms

  • Pain
  • Loss of motion
  • Aching, may change with

weather

  • Weakness
  • Crepitus (grinding, clicking)
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Treatment options

  • Non-operative

– Activity Modification – Stretching and strengthening – Heat and cold – Medications – Injections

  • Surgical

– Arthroscopy – Soft-tissue interposition – Joint Replacement – Fusion (arthrodesis}

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Shoulder replacement

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Safety first!

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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

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Thank you

Robert Peterson, MD, Orthopedic Surgeon, Sports Medicine NorthBay.org 707.624.7900