#439 Shoulder Pain: Impingement, Bursitis, Tendonitis, Cuff Tears, and Arthritis with Dr. Ted Parks
May 13, 2024
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Orthopedic surgeon Dr. Ted Parks discusses shoulder pain, from impingement syndrome to cuff tears. Topics include shoulder anatomy, MRI indications, AC joint pathology, and differentiating arthritis from frozen shoulder. The conversation covers practical tips for diagnosis, treatment options, and the significance of early recognition for effective management.
Impingement syndrome can progress from bursitis to cuff tears, warranting tailored treatment plans based on severity.
Physical therapy and cortisone injections are effective for impingement management before considering surgery.
Diagnosing AC joint arthritis involves specific tests, with treatment options ranging from oral meds to surgical intervention.
Deep dives
Exploring Impingement Syndrome on Shoulder Patients
Impingement syndrome in shoulder patients can vary across a continuum from bursitis to full tears, with bursitis being a common early presentation. Physical therapy can be a valuable initial treatment option, focusing on strengthening the rotator cuff muscles and correcting posture. Cortisone injections can provide temporary relief and help confirm the impingement diagnosis.
Surgical Solutions for Irreparable Rotator Cuff Tears
For irreparable rotator cuff tears, especially in chronic cases, reverse shoulder replacement surgery can be a viable solution. Subacromial decompression is often performed alongside rotator cuff repair to prevent impingement in the future. Understanding the continuum of impingement and rotator cuff pathology can guide the appropriate treatment approach.
Role of Imaging in Impingement Diagnosis
While MRIs can provide detailed anatomical information and aid in surgical planning, impingement syndrome can often be managed clinically without imaging. Cortisone injections, physical therapy, and surgical intervention can be guided by physical exam findings and response to conservative treatments. The need for imaging should be considered based on treatment progression and patient response.
Diagnosing Glenohumeral Joint Arthritis
Glenohumeral joint arthritis, characterized by worn cartilage coating on the shoulder joint, is typically seen in older individuals or those with high shoulder use, causing stiffness and pain. A key diagnostic indication is limited and painful range of motion, especially in activities like external rotation at 90 degrees. Factors such as age over 50 and high shoulder mileage from sports or work can raise suspicions of this condition.
Treatment and Diagnosis of AC Joint Arthritis
AC joint arthritis presents as shoulder pain specifically over the AC joint, often influenced by prior trauma. Methods for diagnosis include tenderness upon palpation and the crossed arm impingement test. Treatment options consist of oral anti-inflammatories, cortisone injections into the AC joint, and surgical intervention with a resection arthroplasty if non-invasive measures prove ineffective in alleviating symptoms. The importance of distinct diagnostic maneuvers and a tailored treatment approach for AC joint arthritis are pivotal in managing the condition effectively.
Repair and replace your old approach to shoulder pain! We cover shoulder anatomy, explain the continuum of impingement syndrome (from bursitis to tendonitis to rotator cuff tears to cuff tear arthropathy), how to take a good shoulder history, perform a high-yield physical exam, when to refer, and when to get an MRI. Plus, how to differentiate glenohumeral joint arthritis from frozen shoulder, and how to diagnose AC joint pathology. We’re joined by everyone’s favorite orthopedic surgeon, inventor, and renaissance man, Dr. Ted Parks.
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