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Non-Operative Problems
Frozen ShoulderImpingementBiceps RuptureDegenerative LabrumShoulder Dislocation
Frozen ShoulderAka “Adhesive Capsulitis”Affects 2% of general populationCauses
Usually small, incidental trauma
Frozen Shoulder3 Phases
Inflammatory (Painful) phaseConstant painWorse with motion2-9 months
Freezing (Adhesive) phaseStiffness, loss of motionLoss of external rotation3-9 months
Thawing (Regressive) phasePain lessensRegain range of motion12-24 months
Frozen ShoulderTreatments
Physical therapy Relieve pain and inflammation
Then restore range of motion
Steroid injectionsTylenol, motrin
Occasionally narcotics
Patience
Impingement / Rotator Cuff Tendonitis
Very commonRotator cuff is pinched between humeral head and acromion
Impingement / Rotator Cuff Tendonitis
SymptomsPain with overhead activity
TreatmentMotrin, anti-inflamatoriesPhysical therapy
Relieve pain and inflammationStrengthen rotator cuff
Correct muscular imbalances
Steroid injectionAcromioplasty (shaving the bone)
Biceps Rupture (Long Head)
Occurs in older ageBiceps attaches to a fibrocartilage rim (labrum) in the shoulder socket (glenoid)
Biceps Rupture (Long Head)Degenerative wear over timeSymptoms
Cramping painCosmetic deformity
More noticeable in men
Treatmentre-attach tendon to bone Or - just leave it alone
Labral TearYoung
Repetitive stress injuryRehab or surgery
OlderDegenerative attritional wearUsually not the source of painUnpredictable outcomes with surgery
Shoulder DislocationBall of shoulder dislocated in front of socketNo prolonged immobilizationPhysical therapySurgery for younger athletes if recur
EpidemiologyFull thickness tears
411 asymptomatic volunteers13% age 50-5920% age 60-6931% age 70-7951% > age 80
Tempelhof et al JSES 1999
•• Overall cuff tearOverall cuff tearprevalanceprevalance 34% 34% •• 96 96 Asymptomatic Asymptomatic
ptspts•• partial or full tear partial or full tear
54% in age > 6054% in age > 60
Sher Sher JS et al JBJS Am 1995JS et al JBJS Am 1995
Natural history51% of asymptomatic cuff tears become symptomatic at average 2.7 years
Tear progressionPatients with symptomatic full thickness tear on one shoulder have 35% chance of full thickness tear on other shoulder!
But symptomatic side on average 30% larger
Yamaguchi et al JSES 2001
Predictors of nonsurgicaloutcome
Good prognostic factorsPretreatment symptoms < 3 months
82% excellent/good result
Bad prognostic factorsPretreatment symptoms >12 months
42% excellent/good result
Full thickness tear equal or more than 1 cm2
Functional impairment & weakness
Bartolozzi A et al CORR 1994
Steroid injections…. Don’t work?
Review of 9 randomized clinical trialsNo reproducible evidence showing improvements in
Range of motionPainFunction
Koester et al JAAOS 2007
Full Thickness tear
Surgery advocated forAcuteSignificant weaknessFunctional impairmentFailed conservative Rx
Treatment of small rotator cuff tears is usually successful with arthroscopicsurgery
80-94% success in small to medium cuff tears
Small Tears
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