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Sports M edicine C linic

Sports M edicine C linic

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Sports M edicine C linic

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Presentation Transcript

  1. Sports Medicine Clinic

  2. Presentation • Dull intermittent pain localize in the posterior and lateral shoulder • Symptoms are exacerbated by active and resistant abduction and external rotation of shoulder

  3. Name some of the causes of shoulder pain?

  4. Shoulder pain • Thoracic outlet syndrome • Rotator cuff tear • Impingement • Cervical spine pathology

  5. Draw the brachial plexus

  6. DDX? • Point tenderness at insertion of teres minor

  7. Exam - DDX • Atrophy of teres minor and deltoid

  8. DDX? • Paraesthesia occurs in cutaneous sensory distribution of axillary nerve , overlying the deltoid muscle in the lateral shoulder

  9. Check your brachial plexus drawings

  10. ddx?

  11. What is QSS?

  12. Quadralateral Space Syndrome

  13. What forms the Quadralateral Space?

  14. Quadralateral Space • Teres minor • Long head of triceps • Teres major • Humeral shaft

  15. Clinical Symptoms • Compression of the axillary nerve and posterior circumflex humeral artery • Especially in abduction and ER (ABER) from fibrous bands • Symptoms from nerve or vascular compression

  16. Quadralateral Space Syndrome • Rare • Frequently misdiagnosed • Images – confirm the diagnosed

  17. Causes of QSS • Fibrous band – tightens in abduction and external rotation • Paralabral cysts – associated with inferior labral tears • Tumors, hematoma

  18. EMG ?

  19. EMG • Non=specific • Inconsistent results

  20. MR arthrogram • Labral tear

  21. MRI • Atrophy of teres minor • Cysts • Tumor • hematoma

  22. Angiography • Flow occlusion of the posterior humerus artery with the arm abducted • ? Seen in normal • Valid study

  23. Shoulder pain

  24. Treatment • Little weakness -physical therapy - (4 to 6 weeks) • Significant weakness – surgical (Lysis of fibrous bands within the QSS (3 to 6 months)

  25. Summary