Shoulder Injuries
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Introduction
Adhesive Capsulitis
Secquence of recovery
external rotation, abduction, internal rotation
- causes
- presentation and exam
- treatments
Presentation and Exam
usually a clinical diagnosis, but X rays can be useful to rule out secondary causes
Three stages
freezing (painful)
3-6 months
pain with active and passivr
frozen (adhesive)
4-6 months
thawing (recovery)
1-3 months
decreased pain
marked restriction
Treatments
Early gentle ROM exercises
modalities (heat)
NSAIDs
low dose TCAs (nortriptyline)
corticosteroid injection ?
manipulation under anesthesia or post-interscalene block - breaks up adhesions in frozen stage
Shoulder Dislocation
Anterior shoulder dislocation most commonly damages the axillary nerve.
- causes
- presentation and exam
- treatment
Causes
Associated with:
Bankart
Hill-Sach's lesion
posterior (EEE: electrocution, epilepsy, ethanol)
Presentation and Exam
Treatment
Shoulder Impingement Syndrome
- causes
- presentation and exam
- treatments
Causes
outlet impingement
subacromial spurs
Type II and III acromions
osteoarthritic spurs of acromioclavicular joint
thickened or calcified coracoacromial ligament
nonoutlet ligament
loss of rotator cuff...
Stage I
Stage II
Stage III
Presentation and Exam
Symptoms include:
- pain shooting down the arm can suggest radiculopathy
- weakness
- loss of function
Supraspinatus: abduction
empty can test
Hawkin's test - most sensitive for impingement
Neer's test
Treatments
prior injections into the shoulder: reaction, scarring, rupture
3 injections per joint per lifetime
Resources and References
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