Overuse Injuries in Musculoskeletal System;

SHOULDER INJURIES

MR(DR) MOHD ROS B. MOHD ALI HOSPITAL KEMAMAN

Rotator Cuff Impingement, Bicipital Tendinitis, SLAP Lesions

SHOULDER JOINT

Shoulder Glenohumeral Joint

Has the greatest ROM of any joint Able to rotate in every direction Easy to dislocate

Glenohumeral Joint and the Arm

sports involving the arm in an overhead position

racket sports, volleyball, water polo, swimming, etc.

Impingement Syndrome
Rotator cuff tendinitis Supraspinatus syndrome Subacromial compressive syndrome Pitcher^s shoulder Volleyball shoulder

Impingement Syndrome

includes a series of damages resulting from the clash of the rotator cuff muscles, subacromial bursa, and sometimes the long head of the biceps brachii muscle. It occurs when the arm is lifted high above the head in an overhead position

Impingement Syndrome

often occurs a consequence of shoulder overuse, ie, as repetitive motion disorder

Imaging Findings

Calcification of the supraspinatus tendon. Abnormal acromion process

Etiology-Pathogenesis

Cause by repeated microtrauma of curve acromion on the rotator cuff. In position of the arm at 90 degrees of ABD and maximal ER the supraspinatous tendon comes into contact with the posterosuperior glenoid rim (3.3)

Clinical Presentation

Insidous onset. Young athletes participating in sports requiring overhead arm movement. H/O injury to the shoulder.

pain on activity, tenderness in the shoulder area, crepitation, decreased ROM of shoulder joint,

Physical Exams

Pain to palpation of the rotator cuff Impingement sign. painful arch of motion. Pain and weakness to supraspinatous

Painful arch of motion

Supraspinatous Test

Arm held in a position of 90 ABD and horizontal ABD 30 with full IR

Impingement Test

injection of 10 cc of 1.0% xylocaine below the anterior edge of the acromion the patient is able to perform the Impingement Syndrome sign without any pain.

Impingement Syndrome
Treatment

Classification of Impingement Syndrome (Neer)

Stage 1: Edema and hemorrhage.

Typical age <25. Clinical course:Reversible. Treatment:Conservative.

Stage 3: Bone spurs and tendon rupture.

Stage 2: Fibrosis and tendinitis

Typical age:- 25-40. Clinical course:Recurrent pain with activity. Rx:

Typical age:- >40. Clinical course:Progressive instability. Rx: Anterior acromioplasty. Rotator cuff repair.

Consider bursectomy. C/A ligament division.

Stage 3 Impingement Syndrome

Tears or rupture of the rotator cuff, tears in the tendon of long head of biceps brachii muscle and changes in the bone. Small: largest diameter <1cm. Average: 1-3 cm. Large: 3-5 cm. Massive: > 5 cm. Rx.- Surgery.

Treatment

Stage 1:- Non-operative.

Acute painful stage: rest, physical therapy,electrotherapy, cryotherapy, extracorporeal shock wave therapy. NSAIDs, Steroid injections. Friction massage and strecthing exercises.

Stage 3:- Surgery;

Decompression/ anterior acromioplasty. Rotator cuff repair.

Physical Therapy;

Strecthing exercises

Bicipital Tendinitis

Bicipital Tendinitis

Overuse of the long head of the Biceps brachii muscle May occur as an isolated entity (Primary tendinitis), or more frequently a/w impingement syndrome and frontal instability of the shoulder (Secondary tendinitis)

Primary Tendinitis

Rare; reported in volleyball, swimmers, water polo, tennis, baseball players, and golfers.

Damage is localized within the intertubercular groove characterized by tenosynovitis. Causes- age related. Young individuals: anomalies of the groove and repeated traumas Older population: degenerative tendon changes

External factors:direct trauma, overuse of the arm in an overhead position.

Bicipital Tendinitis;

Signs and Symptoms

Severe pain in the area of the inter-tubercular groove. Pain increases gradually, usually without any trauma, and disappears when resting. Tender on palpating the biceps tendon in its groove.

Bicipital Tendinitis- Treatment

Non-operative:

avoiding the offending movements. NSAIDs. Moderate strecthing exercises.

Surgical treatment: @ >6 months fail non-surgical Rx.

Tenodesis of the long head of the biceps.

SLAP Lesions

SLAP Lesions

originates behind the biceps muscle tendon anchor and extends anteriorly to half of the glenoid.

SLAP Lesions-

Clinical picture and Diagnostics

Patients c/o pain and mechanical symptoms such as catching, locking, popping, or grinding.

No specific test to prove SLAP lesion. Most reliable tool is arthroscopy.

SLAP Lesions

Treatment is based on correct identification and proper classification of the lesion.

Surgery- resection of torn ligament to anatomical reconstruction of the biceps-labrum complex.

TQVM