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Disorders of the shoulder joint
- 1. Disorders of the shoulder joint Gunjita Negi MBBS 1st year AIIMS Rishikesh
- 2. Topics to be covered Dislocations Frozen shoulder Painful arc Ankylosis Arthrodesis
- 3. Dislocations Occurs when the bone moves out of the joint ( glenohumeral joint ) Most commonly dislocated joint Types Anterior (>95%) Posterior
- 4. Signs Patient in pain Absence of normal contour of shoulder Bryant’s sign – Anterior axillary folds look elongated Callaway’s sign – Axillary girth get increased Duga’s Test – Inability to touch the opposite shoulder Displaced head is palpable below clavicle or coracoid process Deformity – Shoulder extended, abducted, external rotation Hamilton Ruler Test
- 5. Management of Anterior shoulder dislocation Immediate Reduction ( Anterior dislocation) Stimson’s maneuver Hippocrates method Kocher’s technique Milch’s technique Immobilization Surgery
- 6. Posterior Dislocation Usually associated with seizures or electric shocks Often missed on radiography External rotation hindered Axillary Radiography best to diagnose it Inferior Sublaxation Often confused with shoulder joint dislocation Axillary radiography view is normal in these cases Is caused by deltoid muscle atony
- 7. Adhesive Capsulitis (Frozen Shoulder) Painful, progressive loss of shoulder movement Shoulder is stiff No radiological changes in the joint Effects both active & passive movements Occurs due to Inflammation Fibrosis Scarring Contraction of the capsule
- 8. Clinical presentation Generally in age group 40-60 ( mainly females ) Different phases are:- Pain and Freezing Stiffness or Frozen Resolution •Pain is worse at night •Increases with any movement •Lasts several months •Range of motion is limited as pain is diminishing •May last up to 1 year •May begin to resolve over time •May last up to 3 years
- 9. Conditions Associated Diabetes Thyroid problems Auto immune disease Stroke Rheumatoid arthritis Treatment Anti-inflammatory medication Physical therapy Injections Manipulation under anesthesia Surgery
- 10. Painful Arc Syndrome Tendons of the rotator cuff muscles become Irritated and inflamed as they pass through the subacromial space Supraspinatous Results in pain, weakness and Loss of movement Major site of compression is slightly anterior to the angle of acromion Abduction and elevation is painful at the range of 45-160 degree. Outside this range abduction is painless
- 11. Clinical Picture Pain at rest Pain radiate lateral and upper & upper lateral aspect of the arm Movement restricted Muscle weakness of the shoulder Muscle wasting of shoulder Loss of functional activity Limited range of motion
- 12. Treatment Non operative Treatment Nonsteroidal Anti-inflamatory Drugs (NSAIDs) Physiotherapy Subacromial injections Surgery Subacromial Depression
- 13. Ankylosis Stiffness of joint due to abnormal Adhesion or rigidity May be due to a disease or injury May be partial or complete Maybe due to inflammation of tendonious or muscular structures outside the joint or of the joint itself Painful condition . Will restrict movement of the affected joint
- 14. Causes End of bones of the shoulder joint grows in size abnormally An infection or traumatic injury or conditions such as arthritis can trigger the fusion Men are affected more than women Commonly observed between the ages 17-40 For mild and moderate – treatment is conservative Non steroidal anti inflammatory drugs Occasionally , steroid injections Surgery Treatment
- 15. Arthrodesis of shoulder joint Artificial ankylosis Artificial induction of Joint Ossification between two bones by surgery Indicated for irreversible and non reconstructible massive rotator cuff tears and deltoid muscle denervation as well as for detachment of deltoid from its origin
- 16. Indications Infection Paralytic disorders in children Post traumatic brachial plexus palsy Massive unreconstructible rotator cuff tears Paralysis or combined insufficiency of rotator cuff and deltoid Salvage of failed shoulder arthroplasty Arthritic diseases unsuitable for arthroplasty Recurrent dislocations Stabilization after resection of neoplastic lesions
- 17. Arthrodesis Ideally it’s carried out in an intra-articular procedure. All articular cartilage is removed from both surfaces of the joint. Both ends shaped to fit the required position Held there by internal fixation, an external fixator device or external splintage Where possible compression is applied to the bone ends to promote fusion Occasionally extra-articular arthrodesis is caried out.