Slide 1

Report
My “Achy Breaky” Shoulder
Shoulder Pain and
Treatment
Kennedy Club Fitness, Paso
Mark G. Kowall, M.D., M.B.A.
September 24, 2013
The Orthopedic Specialty Hospital
Knee and Shoulder Training
Shoulder Pain
Most common sources
 Impingement
Rotator Cuff Problems
 Instability
Labrum Tears
 Trauma
Less Common Sources
 Arthritis
 Frozen Shoulder
Anatomy
Impingement Syndrome
(“umbrella diagnosis”)
Bursitis
(25-40 y/o)
Tendinitis
(40-50 y/o)
Rotator Cuff Tear
(>50 y/o)
Impingement
“Bursitis/Tendinitis”
“Bursitis/Tendinitis”
Symptoms
Pain with overhead motion
Shoulder to elbow location
Night time awakening
Pain with lifting
Occasional neck pain radiation
Usually no numbness/tingling
“Bursitis/Tendinitis”
Treatment
Exam
XRays
NSAID’s
Physical Therapy or Home Therapy
Steroid Injection
MRI
Surgical Treatment
“Decompression”
Rotator Cuff Tear
Rotator Cuff Tear
Similar Symptoms as Bursitis
More pain
More weakness
Sometimes specific trauma but
More often “age related”
Edge of tendon
MRI
Rotator Cuff Repair
Instability
(Labrum Tears)
S.L.A.P. Lesion
Bankart Lesion
Repair of the Labrum through the Arthroscope
Trauma
Shoulder Separation
AC Joint
Fall off Bike onto shoulder
Usually no surgery
(Depends on severity)
Trauma
Shoulder Dislocation
“Ball and Socket” Joint
Often requires ER visit
Can lead to recurrent dislocations
Trauma
Fracture
Common in older population
(Usually no surgery)
Younger population
(more frequent surgery)
“Arthritis”
=
“Tread Wear”
Cartilage
Healthy
Joint
Osteoarthritic
Joint
“tread wear”
Arthritis
“Acromioclavicular Joint”
Normal
Arthritis
Common in younger patients
“Weight lifters”,
construction workers
Acromioclavicular Joint
Treatment
NSAID’s
Activity Modification
Steroid injection
Arthroscopic Surgery
(Removal of arthritic end of clavicle)
Arthritis
“Ball and Socket Joint”
Shoulder X-Ray
Arthritis
Normal
Advanced
Arthritis
Joint Space
Arthroscopy – Microfracture
small awl used to make holes in
bone
promote re-growth of cartilage
Shoulder Replacement
Frozen Shoulder
(Adhesive Capsulitis)
Frozen Shoulder
Treatment
Pain control (NSAID’s, steroid
medication and injection)
Physical Therapy
TIME, TIME, TIME
Sometimes manipulation of shoulder
under general anesthesia
Information Resource
www.ShoulderKneeSpecialists.com

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