Example: confidence

Painful Shoulder After Surgery for Rotator Cuff …

Vol 5, No 2, March/April 199797 Rotator cuff disease is a commoncause of Shoulder disability, partic-ularly in patients beyond the fourthdecade of life. Anterior acromio-plasty, combined with Rotator cuffrepair when indicated, generallyprovides predictable pain reliefand improved ,when pain continues in spite ofsurgery for Rotator cuff disease,patient management becomes morecomplicated and less is important to recognize thatpersistent Rotator cuff disease isonly one of the many potentialcauses for such pain (Table 1).Possible extrinsic causes includecervical radiculopathy; supra-scapular, long-thoracic, or spinal-accessory neuropathy; and adjacentor metastatic neoplastic causative intrinsicshoulder disorders may be intra-articular, such as osteoarthritis,adhesive capsulitis, recurrent ante-rior subluxation, and labral orbicipital tendon abnormalities, orextra-articular, such as subacromialimpingement, persistent or recur-rent Rotator cuff def

Intrinsic Shoulder Disorders Causes of persistent pain that are intrinsic to the shoulder include both intra-articular conditions (e.g., glenohumeral osteoarthritis,

Tags:

  Shoulder, Rotator, Surgery, After, Painful, Painful shoulder after surgery for rotator

Information

Domain:

Source:

Link to this page:

Please notify us if you found a problem with this document:

Other abuse

Transcription of Painful Shoulder After Surgery for Rotator Cuff …

1 Vol 5, No 2, March/April 199797 Rotator cuff disease is a commoncause of Shoulder disability, partic-ularly in patients beyond the fourthdecade of life. Anterior acromio-plasty, combined with Rotator cuffrepair when indicated, generallyprovides predictable pain reliefand improved ,when pain continues in spite ofsurgery for Rotator cuff disease,patient management becomes morecomplicated and less is important to recognize thatpersistent Rotator cuff disease isonly one of the many potentialcauses for such pain (Table 1).Possible extrinsic causes includecervical radiculopathy; supra-scapular, long-thoracic, or spinal-accessory neuropathy; and adjacentor metastatic neoplastic causative intrinsicshoulder disorders may be intra-articular, such as osteoarthritis,adhesive capsulitis, recurrent ante-rior subluxation, and labral orbicipital tendon abnormalities, orextra-articular, such as subacromialimpingement, persistent or recur-rent Rotator cuff defect, acromio-clavicular joint arthropathy, anddeltoid insufficiency.

2 Successfulmanagement begins with an accu-rate identification of the underly-ing pathologic process responsiblefor the most cases, an initial diagnosticimpression can be formulated onthe basis of the history, physicalexamination, and routine radiogra-phy. Additional studies that maybe useful include arthrography,ultrasonography, magnetic reso-nance (MR) imaging, electromyog-raphy, and scintigraphy. Selectiveinjections into the subacromialspace and the acromioclavicularjoint can help localize the pain orquantitate how much pain is attrib-utable to each area when both areinvolved. Diagnostic arthroscopymay be useful, especially whenextrinsic disorders have beenexcluded, the previously per-formed acromioplasty has beenjudged adequate by radiographiccriteria, and the Rotator cuff ShoulderDisordersIt is important to recognize thatpersistent pain After Rotator cuffsurgery may be the result of patho-logic processes extrinsic to theDr.

3 Williams is Assistant Professor, Universityof Pennsylvania School of Medicine, andAttending Surgeon, Shoulder and ElbowService, Hospital of the University ofPennsylvania, requests: Dr. Williams, Department ofOrthopaedic Surgery , University of Pennsyl-vania, Shoulder and Elbow Service, PennMusculoskeletal Institute, 1 Cupp Pavilion,Presbyterian Medical Center, 39th and MarketStreets, Philadelphia, PA 1997 by the American Academy ofOrthopaedic Shoulder pain After Surgery for Rotator cuff disease may be caused byconditions that are either extrinsic or intrinsic to the Shoulder . Extrinsic causesof persistent Shoulder pain include cervical radiculopathy, suprascapular neu-ropathy, abnormalities of scapular rotation (due to long-thoracic or spinal-accessory neuropathy), and adjacent or metastatic neoplasms.

4 Causes of persis-tent pain that are intrinsic to the Shoulder include both intra-articular condi-tions ( , glenohumeral osteoarthritis, adhesive capsulitis, recurrent anteriorsubluxation, and labral and bicipital tendon abnormalities) and extra-articularconditions ( , persistent subacromial impingement, persistent or recurrentrotator cuff defects, acromioclavicular arthropathy, and deltoid muscle deficien-cy). Successful management requires an accurate diagnosis, maximal rehabili-tation, judicious use of surgical intervention, and a well-motivated patient. Theresults of revision Surgery in patients with persistent subacromial impinge-ment, with or without an intact cuff, are inferior to reported results After prima-ry acromioplasty or Rotator cuff Am Acad Orthop Surg 1997;5:97-108 Painful Shoulder After Surgery for Rotator Cuff DiseaseGerald R.

5 Williams, Jr, MDshoulder. In addition, an extrinsiccause of persistent pain ( , cervi-cal radiculopathy) may coexistwith an intrinsic cause ( , recur-rent Rotator cuff defect), in whichcase diagnostic injection into thesubacromial space may help distin-guish between the intrinsic andextrinsic components of the an extrinsic cause for thepersistent pain has been identified,treatment should be the extrinsic causes of persis-tent Shoulder pain, cervical radicu-lopathy involving the fifth or sixthcervical root is perhaps the mostcommon. The symptoms of neckpain accompanied by radiation intothe upper extremity, numbness, orparesthesias suggest this radiography may revealcervical spondylosis or neuralforaminal encroachment.

6 If indi-cated, MR imaging of the cervicalspine and electromyography mayconfirm the and spinal-acces-sory neuropathies result in scapularwinging and poor scapular rotationduring overhead impingement symptomsmay develop as scapular rotationlags behind glenohumeral eleva-tion. Although true scapular wing-ing is an uncommon cause of per-sistent pain After Rotator cuff sur-gery, many patients will exhibitvarying degrees of scapulothoracicdysfunction. Scapulothoracic andscapulohumeral rhythm should beobserved in all patients with persis-tent symptoms After acromioplastyor cuff repair. In patients with se-vere scapular dysfunction associat-ed with winging, electromyographymay confirm the neurologic neuropathy mayalso result in impingement-likesymptoms because of the posteriorcuff weakness that results fromchronic nerve compression.

7 Patientspresent with severe atrophy of eitherthe supraspinatus and infraspinatusor the infraspinatus alone. This isassociated with weakness of externalrotation with the arm at the is helpful in con-firming the diagnosis and localizingthe site of compression to the infra-spinatus alone or to both thesupraspinatus and the resonance imaging mayreveal a ganglion cyst compressingthe suprascapular nerve (Fig. 1).Neoplastic processes are a veryrare but devastating cause of per-sistent Shoulder pain After rotatorcuff Surgery . The apical lung fieldsshould always be inspected onshoulder radiographs, because api-cal lung tumors ( , Pancoasttumors) cause referred shoulderpain through extension to thebrachial plexus or cervical roots.

8 Ifa lung mass is suspected, appropri-ate chest radiographs and medicalconsultation are indicated. Persis-tent pain may also be caused bydirect involvement of the shoulderby a neoplastic process. Magneticresonance imaging may be used tofurther characterize masses orunusual prominences discoveredon physical examination (Fig. 2). Painful Shoulder After Rotator Cuff SurgeryJournal of the American Academy of Orthopaedic Surgeons98 Table 1 Causes of Persistent ShoulderPain After Rotator Cuff SurgeryExtrinsic Shoulder pathologyBrachial plexopathyCervical radiculopathyLong-thoracic neuropathyNeoplasmReflex sympathetic dystrophySpinal-accessory neuropathySuprascapular neuropathyThoracic outlet syndromeIntrinsic Shoulder pathologyIntra-articularAdhesive capsulitisArticular cartilage defectBicipital tendinitisInstabilityLabral tearsOsteoarthritisExtra-articularAcromi oclavicular arthropathyDeltoid insufficiencyRotator cuff defectSubacromial impingementFig.

9 1 Left,Severe atrophyof the supraspinatus andinfraspinatus muscles in apatient with continued painafter arthroscopic acromio-plasty. Right,MR imagedepicts a ganglion cystcompressing the supra-scapular ShoulderDisordersCauses of persistent pain that areintrinsic to the Shoulder includeboth intra-articular conditions( , glenohumeral osteoarthritis,adhesive capsulitis, recurrent ante-rior subluxation, and labral andbicipital tendon abnormalities) andextra-articular conditions ( ,persistent subacromial impinge-ment, persistent or recurrent rota-tor cuff defects, acromioclaviculararthropathy, and deltoid muscledeficiency).Intra-articular Causes ofPersistent PainUnrecognized glenohumeral disor-ders may be responsible for persis-tent postsurgical Shoulder causation should besuspected when postoperativeradiographs reveal adequate de-compression of the supraspinatusoutlet, and the acromioclavicularjoint is CartilageAbnormalitiesGlenohumeral osteoarticulardisease may be a cause of persis-tent pain in at least two circum-stances: (1) unrecognized orunderappreciated preoperativeosteoarthritis and (2) cuff teararthropathy, or Milwaukee shoul-der syndrome.

10 Primary gleno-humeral osteoarthritis is character-ized by subchondral sclerosis andcyst formation, glenohumeral joint-space narrowing and osteophyteformation, asymmetric posteriorglenoid wear, and an intact orrepairable Rotator man-agement of primary osteoarthritisdoes not differ substantiallywhether or not there has been priorimpingement or Rotator cuff tear arthropathy is charac-terized by destruction of the gleno-humeral articular surfaces, accom-panied by chronic, massive rotatorcuff insufficiency and proximalhumeral migration, that persists orrecurs in spite of one or more pre-vious attempts at cuff pain may be improvedby humeral ,5 Functional improvement is lesspredictable than pain relief, espe-cially if the coracoacromial liga-ment was sacrificed during previ-ous cuff articular cartilagedefects of the humerus and glenoidmay cause persistent Shoulder painin the absence of generalized artic-ular degeneration.


Related search queries