Shoulder disorders

Disorders of the Shoulder

Dr. Wahby Ghalib
FJMC CABO MRCS

Rotator cuff syndrome

Impingement syndrome

Rupture of rotator cuff

Acute calcific tendinitis

Biceps tendinitis & rupture

Frozen shoulder


Impingement syndrome

Coracacromial arch : coracoid, acromion & ca ligament

Subacromial bursa separates ssp tendon from the arch

Pathology starts in ssp tendon & extends to the other tendons

Pathogenesis

Repeated compression & rubbing of ssp under the arch

Causes

Repeated abduction + flexion + IR

Swelling of the cuff or bursa as in gout & RA

C/F
Young  subacute tendinitis  more painful subsides completely


Elderly  chronic tendinitis  less painful, liable for complications

Tender shoulder in extension

Impingement sign





Cx
RC rupture

Bicipital tendinitis

OA

Rx
Rest

Analgesia

PT

Steroid injection

Surgery : acromioplasty

Rupture of rotator cuff

Causes

Traumatic : shoulder dislocation

Impingement syndrome

Types
Partial : more painful

Complete : drop - arm sign

wasted ssp & isp


Rx
Repair in the young

Acute calcific tendinitis

Aetiology : unknown

Pathology : deposition of HA crystals in ssp tendon

CF : acute shoulder pain subsides over few days

Biceps tendinitis & rupture

Tendinitis
Aetiology : impingement s.

CF : Speed test

Yergason test

Rx : = impingement

Rupture
The long head ruptures

Associates RC rupture

CF : Popeye`s sign

Rx : repair in young active pt.

Frozen shoulder

Pathology
Fibrosis in rotator interval, anterior capsule & CH ligament

Aetiology

Unknown

Associating conditions

DM

Dupuytren contracture

Hyperthyroidism

IHD

Hemiplegia

C/F
More in females

About 50 yr

Painful phase 6 m

Stiffness phase 6 – 12 m

Thawing phase 6-12 m





Rx
Analgesia

PH

Steroid injection

MUA

Surgery : release of contracted strctures

THANK YOU