Common Shoulder Problems Ted Parks, MD

Which structure is least likely affected by subacromial impingement?

1. 2. 3. 4.

Subacromial bursa Supraspinatous muscle and tendon Tendon of the long head of the biceps Deltiod muscle and tendon

The most common shoulder (glenohumeral) joint dislocation is:

1. 2. 3. 4.

Anterior Posterior Inferior Superior

The “reverse total shoulder” procedure gets its name from the fact that: 1. 2. 3. 4.

A posterior (instead of anterior) incision is used The humeral component is implanted upside down The ball is on the scapula and the socket on the humerus The posterior muscles are moved to the anterior side and visa/versa

Anatomy

Anatomy: Layer One

Scapula

Anatomy: Layer One

Anatomy: Layer Three

Anatomy: Layer Three

Rotator Cuff (Anterior View)

Rotator Cuff (Posterior View)

Anatomy: Layer Four

Anatomy: Layer Five

#1: The Glenoid is Small and Shallow

#2: The deltoid force vector is essentially vertical when the Arm is at the side

#3: The deltoid inserts on the lateral humerus

Common Shoulder Problems Impingement • Bursitis • Rotator cuff & Biceps tendonitis • Rotator cuff & Biceps tears • Cuff tear arthtopathy Glenohumeral

AC joint

• Instability

• Instability

• Arthritis

• Arthritis

Subacromial Space Impingement

Anantomy: Layer Two

Anatomy: Layer Two

Rupture of Biceps tendon at shoulder from impingement

Anatomy: Layer Two

Shoulder Impingement

Subacromial Impingement History   



pain with overhead activities night pain pain that radiates to the upper third of the humerus pain reaching behind the back

Subacromial Impingement Physical Exam   

Impingement signs Tender over the greater tuberosity Pain and/or weakness with rotator cuff strength testing

Subacromial Impingement Physical Exam   

Impingement signs Tender over the greater tuberosity Pain and/or weakness with rotator cuff strength testing Resisted Internal Rotation = Subscapularis Resisted External Rotation = Infraspinatus “Jobe’s Test” for Supraspinatus

Subacromial Impingement Studies:  X-rays

AP Y view

Y-View X-Ray

Y View X-Ray

“Y” View X-ray

Subacromial Impingement Studies:  MRI

Subacromial Impingement Treatment: 

Stage 1: NSAIDS Physical Therapy

Subacromial Impingement Treatment: 

Stage 2: Subacromial Cortisone Injection

Subacromial Injection Technique 1cc Steroid 4cc Lidocaine   

Patient sitting Arm at side Lateral approach (posterior works, too)

Four scenarios after injection: 







They get better and stay better (winner!) They get better for a long time (>4mo), then it comes back (re-inject?) They get better for a short time (