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Degree of Instability

The degree of instability (dislocation, subluxation, and microinstability) is also important in determining appropriate treatment options. Dislocation refers to complete dissociation of the articular surfaces of the humeral head and the glenoid cavity.

Subluxation describes increased humeral head translation within the glenoid cavity, where the humeral head translates to the edge of the glenoid […]

Nonoperative Treatment

A trial of nonoperative care is implemented before surgical intervention is considered. The majority of patients with impingement syndrome can be managed conservatively. The treatment program consists of formal physical therapy, activity modification, anti-inflammatory, and the judicious use of steroid injections into the subacromial space.

By emphasizing the importance of following the rehabilitation protocol and […]

Intrinsic Factors

Intrinsic factors, such as degenerative changes within the rotator cuff tendons, are likely to cause problems because of subsequent weakness causing superior migration of the humerus, thus producing a secondary mechanical impingement.

Classification

– Grade 1: pretear condition with subacromial bursitis and/or tendinitis. – Grade 2: impingement with partial rotator cuff tears.

Symptoms and diagnosis

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Shoulder Instability

It is important to make a distinction between laxity and instability. Shoulder laxity is a translation of the humeral head on the glenoid (socket) in the absence of clinical symptoms or pathologic changes. This means that normal shoulders may be lax without being unstable. When the laxity results in clinical symptoms and is associated with […]

Slap Tear

SYMPTOMS

There is sharp impingement-type shoulder pain and weakness when trying to perform specific overhead activities, such as throwing a ball or serving in tennis.

AETIOLOGY

The SLAP ligament (Superior Labrum Anterior to Posterior) is the superior part of the glenoid labrum. Besides stabilising and centring the humeral head to the glenoid, it […]

Rotator Cuff Rupture

SYMPTOMS

There is usually exercise-related pain and weakness of the shoulder on abduction and in overhead activities. The player may relate that ‘something snapped’ in the shoulder. In many partial ruptures, the initial symptom is secondary impingement or muscle atrophy and weakness.

AETIOLOGY

The onset can be dramatic, with complete loss of abduction […]

Acromioclavicular Joint Arthritis

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Basics Description The AC joint can become a source of pain in the shoulder, often because of degenerative osteoarthritis, posttraumatic arthritis, or distal clavicle osteolysis. Diagnosing problems of the AC joint: Best diagnosed with pain on palpation, reproduction of pain with cross-body adduction, and diagnostic injections Plain radiographs, especially the Zanca view, or […]