Scribd
Upload
45 views37 pages

Comprehensive Guide to Shoulder Pathologies

The document discusses the shoulder and common shoulder pathologies. It covers 3 components of the shoulder - the glenohumeral joint, acromioclavicular joint, and scapula. The most common joint pathology is adhesive capsulitis, rotator cuff tendonitis, and impingement. The rotator cuff stabilizes the humerus and consists of 4 muscles that can develop tendonitis or ruptures. Other conditions covered include biceps tendon pathology, fractured neck of femur, shoulder dislocations, and frozen shoulder. The diagnosis, clinical features, prognosis, and treatment approaches for these conditions are summarized.

Uploaded by

Gugus Eka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd
45 views37 pages

Comprehensive Guide to Shoulder Pathologies

The document discusses the shoulder and common shoulder pathologies. It covers 3 components of the shoulder - the glenohumeral joint, acromioclavicular joint, and scapula. The most common joint pathology is adhesive capsulitis, rotator cuff tendonitis, and impingement. The rotator cuff stabilizes the humerus and consists of 4 muscles that can develop tendonitis or ruptures. Other conditions covered include biceps tendon pathology, fractured neck of femur, shoulder dislocations, and frozen shoulder. The diagnosis, clinical features, prognosis, and treatment approaches for these conditions are summarized.

Uploaded by

Gugus Eka
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PPTX, PDF, TXT or read online on Scribd

THE SHOULDER

Lecture by: M.K. Sastry


Program Director,
Post Graduate Studies and PhD Program
Introduction

 Components of the shoulder

 Most common joint pathology

 Rotator cuff

 Biceps Tendon
Introduction

 Fractured neck of Femur

 Dislocation

 Adhesive Capsulitis
3 components
 The glenohumeral
joint
 The acromiclavicular
joint
 The scapular
Diagnosis
 History

 Range of Movement

 Palpation

 Pain
Diagnosis
 Diagnostic tests (there are 65 that can
be performed!)
Most common joint pathology
Gh joint Ac joint Scapular
Adhesive Tendonitis Instability
capsulitis Impingement
OA (rare)
Dislocation
Shoulder or cervical nerve
root?
 Is there loss of shoulder ROM?

 YES = SHOULDER

 Are the reflexes reduced?

YES = CERVICAL
Rotator Cuff
 Stabilise the head of
the humerus while the
other major muscles
around the shoulder
are actively moving
the arm. Eg. When
deltoid is abducting.
They also initiate most
movements
3 main types of rotator cuff
lesions
 Tendonitis

 Partial rupture
 Complete rupture
Tendonitis
Supraspinatus Infraspinatus and Teres Subscapularis
Initiates abduction Minor Medically rotate
(Most commonly injured) Laterally rotate humerus humerus

• Painful arc at 90° • Painful arc at 90 • Painful medial


abduction abduction rotation
• Toothache type, • Resisted gh lateral
constant pain from rotation
acromion to deltoid • Thickened tendon
insertion posterior to ghjt
• Reverse scapular
pattern
Treatment of tendonitis
Early stages Later stages
• Frictions • Antiinflamatories
• Ultrasound • Stretching exercises
• Strengthening exercises
in pain free range
• Scapular control
• Shoulder taping to
offload tendon
Rotator cuff rupture
Partial rupture Complete rupture
• Cause usually traumatic • Cause fall onto point of
• As tendonitis but pain is shoulder with arm
sharper adducted/spontaneous
• Resisted abduction very due to degeneration
painful • Acute pain
• Passive elevation not • Inabiltiy to initiate
affected abduction
• Full passive rom if helped
through first 20-30º
Rotator Cuff strengthening
• Sidelying Lateral Rotation
Rotator Cuff strengthening
• Prone Horizontal Abduction
Rotator cuff strengthening
• Lateral rotator strengthening with
resistance band
Biceps Tendon
Tendonitis Rupture
• Pain in Buldge in
bicipital lower third
groove of upper
• Pain on arm.
resisted
forearm
supination
and elbow
flextion
Fractured neck of femur
 Pain on early movement.

 Upper arm swelling.


 Need to be investigated early
especially following a fall in the elderly.
Fractured neck of femur
 Should be kept moving as much as
possible.
Ghjt disclocation
 Carries a very specific history of
trauma.
 Anterior dislocation (abduction,
extension and lateral rotation).
Ghjt disclocation
 Usually involves tear of labrum.

 Physio aims to strengthen rotator cuff.


 After 3rd dislocation surgery is usually
necessary.
Adhesive Capsulitis / Frozen
shoulder
 inflammation of the shoulder capsule and
synovial membrane leading to adhesion
formation. This causes a thickening in the
capsule and constriction of the
glenohumeral joint due to the scar tissue
forming in the capsule.
Diagnosis
 Age 40+

 Cause ? Unknown

Possible: trauma, wrench, dislocation.


CVA, heart conditions, diabetes, viral.
Can also be secondary to cx
spondylosis or to tendonitis.
Clinical features
 Increasing dull ache over a few months
duration.
 Sharp pain when reaching the end of
pain free movement.
Clinical features
 Loss of movement in a capsular pattern

– lateral rotation – abduction - flexion

Most reduced >>>>>>>>>Least reduced


 Elevation and protraction of shoulder
girdle.
Clinical Features
 Pain over A/C joint and deltoid muscle
– can spread to neck and/or elbow
 All G/H movement often painful, not
specific planes
 Pain worse at night
Clinical Features
 Muscle spasm in pectoralis major and
latissimus dorsi
 Wasted deltoid 

 Associated posture
Clinical Features
 Dowagers hump

 Poke chin
Prognosis
 18 months to 3 years

 3 phases

1. Freezing –painful phase (worse at


night and when lying on it)

2. Frozen – stiff phase


Prognosis
 18 months to 3 years

 3 phases

3. Thawing- stiffness gradually eases


Physiotherapy
 Reduce pain with electrotherapy, TENS
and acupuncture until patient is able
to sleep and function day to day.
Physiotherapy
 Taping to rest the joint.

 Static strengthening exercises for the


shoulder.
 Introduce stretching in sub acute
phase .
Exercises to increase rom
Other treatment
 Anti-inflammatories

 Muscle relaxants

 Hydrocortisone injection

 Nerve block
Other treatment
 Surgery – Manipulation / Arthroscopic
capsular release .
Thank You

You might also like