Upper Extremities

Acromioclavicular (AC) joint sprain presents with pain and swelling over the AC joint and pain with lifting the arm. Pain with cross-body adduction test strongly predicts this condition. Non-operative treatment includes rest, ice applications, and NSAIDs. Physical therapy focuses on range of motion and strengthening exercises, with the use of a sling for support. Symptoms typically improve within 2-6 weeks with conservative treatment. Surgery is considered for severe cases with significant displacement or persistent pain. Surgical indications include severe AC joint dislocation and persistent pain despite conservative treatment. Procedures such as AC joint reconstruction are performed. Recovery involves initial immobilization for 2-4 weeks and a gradual return to activities over 3-6 months. Success rates range from 80-90%, with complications including stiffness (5-10%) and recurrent instability (5-10%).

Shoulder arthritis is characterized by pain and stiffness in the joint, often leading to reduced motion. Deep, aching pain, crepitus, and gradual loss of function are strongly predictive of this diagnosis. Non-operative treatments include NSAIDs, heat applications, and activity modification. Physical therapy aims to maintain range of motion and strength, with corticosteroid injections for pain relief. While conservative treatment can be effective for mild to moderate arthritis, surgery is considered if pain and disability persist. Surgical indications include severe pain unresponsive to conservative treatment and significant functional limitation. Shoulder arthroplasty (total or partial replacement) is common. Recovery involves a hospital stay of 1-2 days and full recovery within 6-12 months. Success rates are high, ranging from 85-95%, with complications including infection (<1-2%) and prosthetic loosening (5-10% over 10-15 years).

Deltoid strain causes pain and tenderness in the shoulder, particularly over the deltoid muscle. Pain with resisted shoulder abduction strongly predicts this condition. Non-operative treatment includes rest, NSAIDs, and ice applications. Physical therapy focuses on stretching and strengthening the deltoid muscle. Symptoms typically improve within 2-4 weeks with conservative treatment. Surgery is rarely needed. Surgical indications include severe, persistent symptoms despite conservative treatment. Recovery involves 1-2 weeks initially, with a full return to activities within 4-6 weeks. Success rates are generally high with conservative treatment, with complications such as chronic pain (<5%) and re-injury (5-10%).

Shoulder dislocations usually refer to specifically the glenohumeral joint cause severe pain and deformity in the shoulder, often following trauma. A positive apprehension test strongly predicts this condition. Non-operative treatment includes reduction of the dislocation, immobilization in a sling, and NSAIDs. Physical therapy focuses on strengthening the shoulder muscles and preventing recurrence. Symptoms typically improve within 2-4 weeks with conservative treatment. Surgery is considered for recurrent dislocations or significant instability. Surgical indications include recurrent dislocations and persistent instability despite conservative treatment.

Biceps tendonitis presents with pain in the front of the shoulder and tenderness over the biceps tendon, often exacerbated by resisted supination of the forearm. Non-operative treatment includes NSAIDs and ice applications. Physical therapy focuses on stretching, strengthening, and activity modification. Symptoms typically improve within 6-8 weeks, but surgery may be considered if persistent after 3-6 months. Surgical indications include persistent pain and significant functional impairment. Arthroscopic or open tenodesis or tenotomy are common procedures. Recovery involves 4-6 weeks initially, with a full return to activities within 3-4 months. Success rates are high, ranging from 85-95%, with complications such as stiffness (5-10%) and recurrent pain (<5%).

Frozen shoulder is characterized by gradual onset of shoulder stiffness and pain, severely limiting mobility. Pain and stiffness in all directions of movement strongly predict this condition. Non-operative treatment includes NSAIDs, ice or heat applications, and physical therapy focusing on stretching and gentle mobilization. Corticosteroid injections may also be used. Symptoms usually improve within 6-12 months with conservative treatment. Surgery is considered if severe stiffness and pain persist after this period. Surgical indications include severe, persistent symptoms after 6-12 months of conservative treatment. Procedures such as manipulation under anesthesia or arthroscopic capsular release are performed. Recovery involves 2-4 weeks initially, with full return to activities within 3-6 months. Success rates range from 70-90%, with complications including re-stiffening (5-10%) and infection (<1%).

Shoulder labral tears cause pain and instability in the shoulder, often with a clicking or locking sensation. A positive O'Brien's test strongly predicts this condition. Non-operative treatment includes rest, NSAIDs, and physical therapy focusing on strengthening the shoulder muscles. Symptoms typically improve within 6-12 weeks with conservative treatment. Surgery is considered for persistent pain or instability despite conservative treatment. Surgical indications include significant labral tears with persistent symptoms. Arthroscopic labral repair is the common procedure. Recovery involves initial immobilization for 3-4 weeks and a gradual return to activities over 3-6 months. Success rates range from 85-95%, with complications including stiffness (5-10%) and recurrent instability (5-10%).

Shoulder impingement syndrome involves the compression of the rotator cuff tendons during shoulder movements, leading to pain and reduced motion. Symptoms include pain when lifting the arm, especially overhead, and night pain. A painful arc of motion and a positive Hawkins-Kennedy test are indicative of this condition. Treatment typically involves rest, NSAIDs, and ice. Physical therapy focuses on strengthening the rotator cuff and scapular muscles and improving flexibility. Symptoms often improve within 3-6 months with therapy; however, surgery may be necessary if conservative treatments fail after this period. Surgical indications include persistent pain and significant functional impairment despite 6 months of non-operative treatment. Arthroscopic subacromial decompression is a common procedure. The initial recovery period is 2-4 weeks, with a full return to activities within 3-6 months. The success rate is approximately 85-90%, with complications such as stiffness (5-10%) and infection (<1%).

Shoulder instability presents with a feeling of the shoulder slipping out of place, pain, and weakness. Positive apprehension and relocation tests strongly predict instability. Non-operative treatment focuses on activity modification, NSAIDs, and physical therapy to strengthen the rotator cuff and scapular stabilizers. Bracing may also be used. Symptoms often improve within 3-6 months, but surgery is considered for recurrent dislocations or persistent instability. Surgical indications include recurrent dislocations and persistent instability despite conservative treatment. Procedures such as arthroscopic or open stabilization are common. Recovery involves initial immobilization for 2-4 weeks and a gradual return to activities over 4-6 months. Success rates range from 85-95%, with complications including stiffness (5-10%) and recurrent instability (5-10%).

Proximal humerus fractures cause pain, swelling, and bruising in the shoulder, often following trauma. X-ray confirmation strongly predicts this diagnosis. Non-operative treatment includes immobilization in a sling, NSAIDs, and ice applications. Physical therapy focuses on gentle range of motion exercises initially, progressing to strengthening. Symptoms typically improve within 6-12 weeks with conservative treatment. Surgery is considered for significantly displaced fractures or fractures involving the joint surface. Surgical indications include displaced fractures and fractures with significant joint involvement. Procedures such as open reduction and internal fixation or shoulder replacement are performed. Recovery involves initial immobilization for 4-6 weeks and a gradual return to activities over 3-6 months. Success rates range from 80-90%, with complications including stiffness (10-20%) and hardware-related issues (5-10%).

Rotator cuff injuries are common and can include tears, tendonitis, and impingement. These injuries often result from repetitive overhead activities or acute trauma. Symptoms include pain when lifting or lowering the arm, shoulder weakness, and a crackling sensation with certain movements. Particularly, night pain, pain with overhead activities, and weakness on external rotation strongly predict rotator cuff tears. Non-operative treatment focuses on rest, NSAIDs, and ice applications. Physical therapy emphasizing strengthening and flexibility exercises is crucial, with corticosteroid injections for persistent pain. Improvement is typically expected within 6-12 weeks with consistent therapy, but surgery may be considered if significant pain or weakness persists. Surgical indications include persistent pain unresponsive to non-operative treatment for 6-12 months and large tears with significant functional impairment. Arthroscopic repair is common, with open repair for larger tears. The recovery timeline includes initial immobilization for 4-6 weeks and a gradual return to activities over 4-6 months. Success rates range from 80-95%, with common complications including stiffness and re-tear of the rotator cuff, occurring in 10-30% of cases.

Shoulder strain causes pain and tenderness in the shoulder, often with swelling and limited range of motion. Pain with resisted shoulder movements strongly predicts this diagnosis. Non-operative treatment includes rest, NSAIDs, and ice applications. Physical therapy focuses on stretching and strengthening, with a gradual return to activities. Symptoms typically improve within 2-4 weeks with conservative treatment, and surgery is rarely needed. Surgical indications include severe, persistent symptoms despite conservative treatment. Recovery involves 1-2 weeks initially, with a full return to activities within 4-6 weeks. Success rates are generally high with conservative treatment, with complications such as chronic pain (<5%) and re-injury (5-10%).