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

• 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

Shoulder Anatomy

Shoulder Anatomy

Humerus fracture

Humerus fractures

Humerus fracture

Pediatric shoulder: growth plate injury

Trauma

Little League Shoulder

Conservative care

REST!

Surgery rare

Clavicle fracture

Clavicle fracture

Clavicle fractures

Scapula fractures

Shoulder instability

Shoulder instability

• Acute vs. Chronic

• Dislocation vs. Subluxation

• Anterior

• Posterior

• Multidirectional

• Voluntary

Anterior shoulder dislocation

Symptoms

• Pain

• Deformity

• Swelling

• Numbness

• Weakness

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

Surgery

Posterior shoulder dislocation

• 5% of all dislocations

• High impact sports

• Motor vehicle accident

• Seizures

Multidirectional Instability

Biceps tendon

• Pain in the front of the shoulder

• Weakness

• Cramping/Swelling

• +/- Bruising

Possible causes

• #1 cause is a lifetime of normal activity

• Repetitive use, especially overhead

• Traumatic injury – fall, heavy lift traction

Long head of biceps tendon

• Biceps Tendinitis

• Rupture long head of Biceps

Treatment

• Rest, NSAIDS, activity

modification

• Physical Therapy

• Brace

• Injection

• Surgery (tenotomy vs.

tenodesis)

• SLAP Repair

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

POSSIBLE CAUSES

• Repetitive use

• Falling on outstretched

arm

• Traction injury

• Catching something heavy

• Motor vehicle accident

SLAP TEARS

• Multiple causes • Difficult diagnosis

Treatment options

• Rest, ice, NSAID’s

• Physical Therapy – emphasize motion and strength

• Surgical Repair +/- biceps

• Post-op rehabilitation

Acromioclavicular (AC) joint sprain (shoulder separation)

AC Sprains

• Usually caused by trauma at the point of the shoulder

• Local tenderness, swelling

• Pain with motion, cross-arm position

• Pain with lifting

AC Sprains

AC Arthritis

Subacromial Impingement Syndrome

• Tendinitis

• Bursitis

• Impingement

Symptoms

• Cause is usually repetitive use

• Pain in the front of shoulder often radiates to arm

• Pain overhead and reaching

• Often hurts at rest and with sleep

• Losing strength and motion

Treatment

• Rest, ice, NSAID’s, therapy

• Injection

• Surgery for decompression

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

overuse and trauma but are most

commonly a result of degenerative

changes

Rotator cuff tear

Symptoms

• Pain around the shoulder

• Worse with use

• Pain at rest, worse at night

• Loss of strength, then motion

• Crepitus

Treatment

• Rest and change in activities

• Medication

• Cold/Heat

• Injection

• Therapy/stretch/strengthen

Surgery

• Full thickness tears will

not heal

• Tears may get worse

with time

• Surgical success

depends on many

factors

• Open vs. arthroscopic

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

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

Frozen Shoulder (adhesive capsulitis)

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

Shoulder arthritis

Shoulder arthritis

• Osteoarthritis • Rheumatoid arthritis

Shoulder arthritis

• Post-traumatic arthritis • Avascular necrosis

Inflammatory arthropathies

• Systemic lupus

erythematosus

• Psoriatic arthritis

• Ankylosing spondylitis

• Gout

Symptoms

• Pain

• Loss of motion

• Aching, may change with

weather

• Weakness

• Crepitus (grinding, clicking)

Treatment options

• Non-operative

– Activity Modification

– Stretching and

strengthening

– Heat and cold

– Medications

– Injections

• Surgical

– Arthroscopy

– Soft-tissue interposition

– Joint Replacement

– Fusion (arthrodesis}

Shoulder replacement

Safety first!

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

Thank you

Robert Peterson, MD, Orthopedic Surgeon, Sports Medicine

NorthBay.org 707.624.7900