Shoulder scenarios

1
Shoulder scenarios

• Mr Lee Van Rensburg
• January 2014

2
42 YO

• 6 week history
• Pain upper arm
• Rest 1-2/10
• Occasion (stresses it) 4/10
• Started after weekend gardening
• Desk top job
• Unable to play squash/ tennis
• Pain on putting on jacket
• Sleeping OK
• Rx
• Nothing (doesnt like tablets)

3
Sub acromial Impingement

• Supraspinatus tendonitis
• Subacromial bursitis
• Treatment
• EDUCATION
• Zone impingement
• Week end warrior
• Paint and decorate like professional
• Relative rest / time
• NSAID
• Physiotherapy
• Injection?
• Surgery ???

4
48YO Male

• 1 YR shoulder problems on and off
• Pain when plays sport exerts himself, radiating
  down arm
• Ache 4-5/10
• No Pain killers
• Not affecting sleep, affects quality of life
• Rx
• Physio in past made no better

5
Subacromial impingement 2

• Treatment
• Physiotherapy - ? had some
• Education
• Not 5 or 10 minutes
• Injection???
• Surgery
• Open
• Arthroscopic

6
Conditions Treated

• Rotator Cuff Disease subacromail
• decompression

7
52YO

• Pain in shoulder
• 2 yrs intermittent
• Limiting sleep
• Cant sleep on that side
• Works in warehouse struggling above shoulder
  height, no days off
• Played rugby in past
• Rx
• Physiotherapy
• Elastic bands no better
• GP cortisone injection
• Side sore no better

8
ACJ

• Treatment
• Physiotherapy ?????
• Education (Normal)
• NSAID
• Injection
• Surgery
• Open
• Arthroscopic

9
50 YO

• 6 month hx
• Pain and stiffness
• Pain slightly better following injection
• Swat fly grab cup severe stabbing pain
• Struggling above shoulder height
• Rx
• Injection (temporary)
• Physio made it worse

10
Frozen shoulder

• Treatment
• Phase
• Inflammatory
• Physiotherapy - relative rest, maintain ROM
• Injection
• Hydrodilatation
• Surgery No
• Frozen
• Physiotherapy
• Injection ?
• Hydrodilatation
• Surgery
• Thawing phase
• Physiotherapy
• Injection ????
• Hydrodilatation
• Surgery ?

11
65 YO male

• Stiffness and pain 2 yrs
• DIY enthusiast
• Occ affects sleep
• Rx
• Uses paracetamol
• Had injection
• Physio no difference
• Therabands made it worse

12
Arthritis

• Dx
• Beware Dx frozen shoulder without XR
• Treatment
• Physiotherapy
• Maintain state of cuff
• Injection ???
• Education
• Surgery
• Arthroscopic
• Open

13
48 YO

• Manager, desk top work
• No sport / hobbies
• Pain upper arm
• Increasing 6 weeks
• Sleep severe (9/10)
• Sudden movement 12/10
• Physio
• Made worse

14
Calcific tendonitis

• Ix
• X ray
• MRI
• U/S
• Treatment
• Physiotherapy
• Analgesia
• Injection
• Needle barbotage
• Surgery
• Arthroscopic barbotage and washout

15
62 YO

• Painter decorator
• Pain
• Arm, limiting activity above shoulder height
• Rest 4/10, Night 6/10
• Sleep
• Weak above shoulder height
• Rx
• Physio no better
• Injection temporary 2 weeks
• Ultrasound tear in tendon

16
Rotator cuff 2 cm degenerate

• Treatment
• Physiotherapy
• Education
• Injection??
• Surgery
• Open
• Arthroscopic

17
Cuff tear
18
22 yo

• Pain arm 8 weeks
• Rest 4/10
• Stresses it 8/10
• Worse at Gym, Personal trainer
• Rx
• Deep massage
• Rest

19
Micro-instabilityMuscle patterning

• Ix
• X ray Os acromiale
• MRI
• Treatment
• Physiotherapy
• Balance cuff
• Injection ??
• Surgery
• Open
• Arthroscopic

20
45 YO farmer

• Fall from tractor grabbed hand rail 2 weeks ago
• Sudden severe pain, could not move arm
• Rx
• Physio
• Pain better but still weak

21
Acute rotator cuff tear

• Ix ?
• X ray
• MRI/ U/S ??
• Treatment
• Physiotherapy
• Maintain ROM
• Rehab remainder of cuff
• Injection ??????
• Surgery
• Open
• Arthroscopic

22
Rotator cuff repair