Shoulder injury and back pain types

1. SHOULDER INJURY AND
LOWER BACK PAIN
By:
Abhishek Sirsikar
VIT UNIVERSITY, VELLORE, INDIA

2. Shoulder injury
• (Shoulder Injuries) The shoulder is a joint that
sacrifices stability for mobility. Because of this
trade off it is also a joint that is very
susceptible to injury. ...

3. Causes of Shoulder injury
• Rotator Cuff (RC) Injury
• Clavicle Fractures
• Biceps Tendonopathy
• Acromioclavicular (AC) Sprains
• Sternoclavicular (SC) Sprains
• Anterior Dislocation
• Posterior Dislocation
• Vascular & Neurological Injuries

4. Rotator Cuff (RC) Injury
• 3 degrees
• Most involve supraspinatus
• Tears usually at insertion on humerus
Mechanism
• Dynamic rotation of arm at high velocity
(overhead throwing)
• Usually involves individuals with a history of
impingement or instability

5. Signs & symptoms
• Pain w/ muscle contraction
• POT over greater tuberosity
• Loss of strength
• Complete tear produces pain, loss of function,
swelling and POT
Treatment
• RICE
• Decrease level of activity
• Exercises to strengthen rotator cuff

6. Clavicle Fractures
Mechanism
• Fall on tip of shoulder
• Direct blow to clavicle
Signs & symptoms
• Pain
• Deformity
• Hold arm close to side
• Hunch shoulders

7. Treatment
•Ice
•Immobilization
•ER visit

8. Biceps Tendonopathies
• Mechanism of Injury
– Repetitive overhead throwing
and lifting
• Clinical Features
– Pain anterior shoulder
– Possible signs and symptoms
of impingement
– Tenderness over bicipital
grove
– Speed’s test
– Yergason’s sign

9. Diagnosis
History & Physical
X-rays to rule out other
causes of pain
MR if suspect biceps tear
Treatment
Rehabilitate
Counterforce bracing
Surgery for tears

10. AC Sprains
• Mechanism of
Injury
– Fall with arm
adducted
• Risk Factors
– Contact sports
– Male athlete
– Bicycling and
horse riding
(falls)
Conoid
Trapezoid
Acromio-
clavicular

11. AC Sprains
• Clinical Features
– Pain with overhead or
cross body motion
– Self-splinting
– Tenderness of AC Joint
– Graded I-VI

12. AC Sprains
• Diagnosis
– History & physical
– X-ray – bilateral AP and
axillary (no weights)
• Treatment
– I & II – conservative
– III – controversy
• Surgery for backpackers
and parachutists
– IV-VI – surgery

13. SC Sprains
• Mechanism of Injury
– Direct blow anteriorly to
shoulder or clavicle
– Indirectly by fall on
lateral shoulder
• Risk Factors
– Contact sports such as
football or rugby

14. SC Sprains
• Clinical Features
– Pain over SC joint
– May present for other
injuries
– Grades:
• I – SC ligament injury
• II – Tear of SC ligament
and costoclavicular
ligament
• III – Dislocation of SC
joint; tear of SC ligament
and costoclavicular
ligament

15. SC Sprains
• Diagnosis
– X-ray – Chest AP/Lat
– CT scan if posterior dislocation
suspected
• Treatment
– I & II – Rest, ice, sling
– III (Anterior)
• Attempt reduction (unstable)
• Immobilize
– III (Posterior)
• Reduce as soon as possible
• Treat life threatening injuries

16. Anterior Dislocations

17. Posterior Dislocations

18. Vascular & Neurological
Injuries

19. Lower Back Pain
• 2nd most common cause for office visit
• 60-80% of population will have lower back
pain at some time in their lives
• Each year, 15-20% will have back pain
• Most common cause of disability for persons <
45 years
• 1% of US population is disabled
• Costs to society: $20-50 billion/year

20. Anatomy

21. Causes of Low Back Pain
• Lumbar “strain” or “sprain” – 70%
• Degenerative changes – 10%
• Herniated disk – 4%
• Osteoporosis compression fractures – 4%
• Spinal stenosis – 3%
Spondylolisthesis – 2%Spondylolysis,
diskogenic low back pain or other instability –
2%
Traumatic fracture - <1%
Congenital disease - <1%
Cancer – 0.7%
Inflammatory arthritis – 0.3%

22. Red Flags
• History of cancer
• Unexplained
weight loss
• Intravenous drug
use
• Prolonged use of
corticosteroids
• Older age
• Major Trauma
• Osteoporosis
• Fever
• Back pain at rest or
at night
• Bowel or bladder
dysfunction

23. Medications
• Anti-inflammatory medications (NSAID’s):
– Beneficial; no differences; watch side-effects
• Tylenol:
• Narcotic Pain Relievers:
– No more effective than NSAID’s
– Many side effects
• Muscle Relaxants (ie. Flexeril®):
– Can decrease pain and improve mobility
– 70% with drowsiness/dizziness

24. Chiropractic/Osteopathic
• Davenport, Iowa in 1895 by David Palmer;
‘done by hand’ (Greek)
• Spinal manipulation
• Conflicting evidence on the effects of spinal
manipulation
– ~75-90% improvement anyway within 4 weeks
• Greater patient satisfaction

25. Exercise & Bed Rest
• Advice to stay active:
– ‘There is no evidence that advice to stay active
is harmful for either acute low back pain or
sciatica.’
– Hurt does not equal harm
• One or two days of bed rest if necessary
• Light activity, avoiding heavy lifting,
bending or twisting (ie. walking)
• No data on any particular exercises

26. Massage & Physical Therapy
• Might be beneficial
• More quality research is needed
• Different types of massage
Acupuncture
• Very little quality research and data
• Seems to indicate that acupuncture is not
effective for the treatment of back pain

27. Intradiscal Electrothermal Therapy

28. Than
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