In the name of God

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In the name of God
Shoulder periarthritis

• The merciful ,
• The compassionate

Salehi Iraj
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Rotator Cuff Tendinitis TearsBicipital
Tendinitis Tears
Shoulder periarthritis

• Tehran University for Medical Science
• Salehi A., I., M.D., Rheumatologist
• RRC - Amir Alam

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Introduction
Shoulder periarthritis

• Using in many movement
• High ROM
• Low Stability
• Shoulder Periarthritis
• Most common periarthritis
• Less than 1/2 of people involved
• Most common cause of sh. pain

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Shoulder Pain
Shoulder periarthritis

• Periarthritis 85
• Referred pain 15
• Articular pain 5

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Etiopathogenesis
Rotator Cuff Disorders

• Impingement
• Compression critical blood
• Ischemia
• Degeneration
• Less HH. Depression
• Compression

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Epidemiology
Rotator Cuff Tendinitis

• Middle age Old age
• F gt M
• Uncommon in age lt 25
• 70 of Shoulder pain
• More common in
• Workers
• Housekeeper
• Athlete

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Etiology
Rotator Cuff Tendinitis

• Exercise(1/3), Overuse(1/3)
• Pulling
• Pushing
• Lifting
• Reaching
• Overhead positioning
• Idiopathic 1/3
• Falling Accident in
  Degenerative RC

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Clinical Findings
Rotator Cuff Tendinitis

• Shoulder pain
• Focal subacromial tenderness
• Painful arc (SS)
• Pain in external rotation (IS)
• Midarc abduction strength test (SS)
• External rotation strength test (IS)
• Empty can sign

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Painful arc
Rotator Cuff Tendinitis

• Abduction 60 - 120
• Mild 90 - 120
• Moderate 70 - 120
• Severe 45 - 120
• Adduction
• Horizontal level

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Paraclinical F.
Rotator Cuff Tendinitis

• No necessity
• X-Ray
• Calcification lt 30
• Cuff arthropathy
• Pathology(research)
• Stage I lt25 y/o
• Stage II 25-40 y/o
• Stage III gt40 y/o

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Diagnosis
Rotator Cuff Tendinitis

• Only Hx. PH.Ex.
• History Sh. pain
• Physical examination
• Lateral tender point
• Painful arc
• No necessity for Paraclinic

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Treatment
Rotator Cuff Tendinitis

• Step I
• Oral NSAIDs /or Steroids
• Resting Avoiding from
• Pulling
• Pushing
• Lifting
• Reaching
• Overhead positioning For
  a few (2) weeks

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Treatment
Rotator Cuff Tendinitis

• Step II if no response to step I
• .Subacromial injection
• .Resting of PPLRO
• Absolute 3 days
• Relative 1 months
• .Exercise Abduction, Ext. rotation
• .If Muscle tonisity
• gt75 gtDaily activity
• lt50 gtsecond injection(6 weeks later)

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Outcome
Rotator Cuff Tendinitis

• Recurrency 30
• Frozen shoulder 10
• Rotator Cuff Tears 1-2
• Acromioclavicular OA 1-2
• Glenohumeral OA lt1

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Epidemiology
Rotator Cuff Tear

• Age
• Common gt50 y/o
• Less common 30 - 50 y/o
• Uncommon lt30 y/o
• Acute /or partial younger man
• Chronic /or complete older
• Prevalence
• MRI all ages 34 ages gt60 54
• Autopsy 25, Complete Chronic

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Etiopathogenesis
Rotator Cuff Tear

• NL RC only sudden, severe trauma
• Falling with out-stretched arm
• Rapid hyperabduction
• Lateral falling upon closed arm
• Degenerative RC commonly
• gtLess H.H. depressor function
• gtMore compression ischemia
• gtMore degeneration gt ..
• gtSpontaneous tear or same above

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Clinical Findings
Rotator Cuff Tear

• Complete Transversal
• Cannot abduction(SS) ext.rot.(IS)
• Drop off sign(SS)
• Pseudoparalysis Nl sense DTR
• Pop sound with movement
• Atrophy Early(_), Late()
• Partial Longitudinal
• Similar to RC tendinitis

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Paraclinical F.
Rotator Cuff Tear

• No Homogram Biochemistry
• Plain PA X-Ray
• Subacromial space(SAS) lt1cm
• GH. AC. OA Calcification 30
• Dynamic PA X-Ray SASlt 6mm
• Arthrography
• MRI MR arthrography
• Sonography

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Paraclinical F.
Rotator Cuff Tear

• Subacromial space
• SAS lt 6 - 9 mm
• Discontinuity of Mahoneys line
• Distal subacromial osteophyte

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Paraclinical F.
Rotator Cuff Tear

• Arthrography
• Old standard
• Currently no use
• Replaced by MRI
• MR arthrography

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Paraclinical F.
Rotator Cuff Tear

• MRI
• Complete Tear
• 24 hr after injection
• Sensitivity Specificity gt95
• MR arthrography
• Partial Tear
• 100 accuracy

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Diagnosis
Rotator Cuff Tear

• In old age
• .Hx. PH.Ex.
• .Plain Dynamic X-Ray
• In young Middle age
• .HX. PH.Ex.
• .Plain Dynamic X-Ray
• .MRI 4 .MR arthrography

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Treatment
Rotator Cuff Tear

• Medical(conservative)
• Similar to RC Tendinitis
• To delay injection for 6 weeks
• Surgical
• Repair
• Arthroplasty
• Arthrodesis

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Treatment
Rotator Cuff Tear

• In old age
• Conservative
• Surgical
• Intractable shoulder pain
• RC tear Bicipital tear
• In young Middle age
• Mild to moderate
• .Conservative for 6 weeks
• .Surgical (if no response to 1.)
• Moderate to severe Surgical

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Bicipital Disorders
Bicipital Disorders

• Bicipital Tendinitis
• Secondary to
• RC Tendinitis GH. instability
• Most common type
• Primary
• Bicipital Tear in
• Degenerative tendone
• NL tendone

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Epidemiology
Bicipital Disorders

• MgtgtF
• Adultgt Middlegt Old age
• Exercise
• Weight-lifting in men
• Gymnastic in women
• Daily activity

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Etiopathogenesis
Bicipital Disorders

• Superior glenoid labrum
• Intra-articular portion
• Extra-articular portion

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Clinical Findings
Bicipital Tendinitis

• Pain
• Shoulder-arm
• Anterior
• Tenderness
• Yergasons m.
• Speeds m.

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Clinical Findings
Bicipital Tear

• MgtgtF
• Adult..Middle age
• Exercise
• Weight-lifting in men
• Sudden onset pain
• Popeye sign
• Lower ant. arm ecchymosis

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Paraclinical F.
Bicipital Disorders

• No necessity in primary type
• Secondary type
• X-Ray
• Arthrography
• Sonography
• MRI
• MR arthrography

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Diagnosis
Bicipital Disorders

• Only Hx. PH. Ex.
• Yergasons m.gt Bi. Tendinitis
• Popeye sign gt Bi. Tear
• Imaging is necessary if
• Secondary type
• Surgery indicated

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Treatment
Bicipital Disorders

• Bi. Tendinitis
• Conservative
• Similar to RC Tendinitis
• Bi. Tear
• Young adult Surgical
• Old age Conservative

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Impingement Syndrome
Shoulder Periarthritis

• Including
• RC Tendinitis
• Subacromial Bursitis
• Bicipital Tendinitis
• Impingement mechanism
• Compression

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