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1、1,Shoulder Pain,Wang Ying Department of Rehabilitation Medicine Renji Hospital, Jiaotong University,2,Shoulder pain is an extremely common complaint, and there are many common causes of this problem. It is important to make an accurate diagnosis of the cause of your symptoms so that appropriate trea
2、tment can be directed at the cause.,3,anatomies,The main joint in the shoulder is formed by the arm bone and the shoulder blade. The joint socket is shallow, allowing a wide range of motion in the arm. The rotator cuff is made up of 4 muscles that surround the arm bone. This cuff keeps the shoulder
3、steady as the arm moves.,4,The rotator cuff comprise,Supraspinatus Infraspinatus teres minor subscapularis,5,A common cause of shoulder pain is soreness of the tendon of the rotator cuff. Another common cause is soreness of the subacromial bursa (a sac of fluid under the highest part of the shoulder
4、). might have soreness after activities such as painting, lifting or playing a sport, which require someone to lift his arms. may not remember any specific injury.,6,Shoulder joint,7,8,9,subacromial bursa,supraspinatus,10,Abduction pain,11,some common causes,Bursitis / Rotator Cuff Tendonitis Rotato
5、r Cuff Tear shoulder bursitis/impingement syndrome Frozen Shoulder(periarthritis or adhesive capsulitis) Calcific Tendonitis,12,Shoulder Instability Shoulder Dislocation Biceps Tendon Rupture Arthritis others,13,Rotator Cuff Tears,Description Rotator cuff tear is a common cause of pain and disabilit
6、y in the adult population. Rotator cuff tear is most common in people who are over the age of 40. It may occur in younger patients following acute trauma or repetitive overhead work or sports activity. A cuff tear may also happen with another injury to the shoulder, such as a fracture or dislocation
7、,14,The rotator cuff helps to lift and rotate the arm and to stabilize the ball of the shoulder within the joint. Most tears occur in the supraspinatus but other parts of the tendon may be involved,15,16,Rotator Cuff Tears,17,Symptoms,Symptoms of a rotator cuff tear may develop acutely or have a mor
8、e gradual onset. commonly, the onset is gradual and may be caused by repetitive overhead activity or by wear and degeneration of the tendon. You may feel pain in the front of your shoulder that radiates down the side of your arm.,18,At first the pain may be mild and only present with overhead activi
9、ties such as reaching or lifting. It may be relieved by medication such as aspirin or ibuprofen. Over time the pain may become noticeable at rest or with no activity at all. There may be pain when you lie on the affected side and at night.,19,Other symptoms may include stiffness and loss of motion.
10、may have difficulty using arm to reach overhead to comb hair or difficulty placing behind your back to fasten a button. When the tear occurs with an injury, there may be sudden acute pain, a snapping sensation and an immediate weakness of the arm.,20,Common examples,Workers who do overhead activitie
11、s such as painting, stocking shelves or construction Athletes such as swimmers, pitchers and tennis players,21,Diagnosis,Diagnosis of a rotator cuff tear is based on symptoms, examination, X-rays, and imaging studies such as MRI (magnetic resonance imaging). examine shoulder to see if it is tender i
12、n any area or if there is a deformity. measure the range of motion of shoulder in several different directions and test the strength of arm. The doctor will also check for instability and problems with the (acromioclavicular) joint.,22,rule out,also examine neck to make sure that ones pain is not co
13、ming from a “pinched nerve“ in cervical spine to rule out other conditions such as osteoarthritis or rheumatoid arthritis.,23,Some of the signs of a rotator cuff tear,Atrophy or thinning of the muscles about the shoulder Pain when someone lift his arm Pain when someone lower his arm from a fully rai
14、sed position Weakness when someone lift or rotate his arm crackling sensation when someone move his shoulder in certain positions,24,Plain X-rays of a shoulder with a rotator cuff tear are usually normal or show a small spur. ultrasound or MRI. An MRI can sometimes distinguish between a full thickne
15、ss (complete) tear of the tendon and a partial tear. It can show the doctor if the tear is within the tendon itself, or if the tendon is detached from bone. In some circumstances, an Arthrogram, in which local anaesthetic and dye is injected into the joint, may also be helpful.,25,26,Treatment Optio
16、ns,pain relief improve the function of shoulder. It may take several weeks or months to restore the strength and mobility to ones shoulder.,27,Rest and limited overhead activity Use of a sling Anti-inflammatory medication Steroid injection Strengthening exercise and physical therapy,28,Rehabilitation,After surgery, the arm is immobilized to allow the tear to heal. The length of immobilization depends upon the severity of the tear. You will be given an exercise program to help regai
