Injuries/disorders of the Elbow and Shoulder

Frederic C. Balduini, M.D.
Disclosures		The author has no relationships with commercial interests related to the content of the presentation.

Sports medicine specialist, Frederic C. Balduini M.D., notes the symbolic importance of the shoulder as in "carrying the weight of the world on one's shoulders" and then discusses the critical dependence we place on the shoulder. Using both diagrams and photographs, he explains the complex anatomy and biomechanics of the shoulder, emphasizing that its very flexibility can lead to overuse and trauma.

The intricacy is evidenced by the shoulder's composition of three bones and more than 14 dynamic and static muscles, each of which is illustrated. The four main ligaments and their actions are also reviewed.

Neurologic examination is a critical part of the clinical examination. The author describes several diagnostic tests that help define the various etiologic causes of shoulder injury – acute trauma, chronic overuse, and degeneration.

One result of overuse produced by, say, baseball pitching is biceps tendonitis. The lecture offers treatment guidance for this condition, including illustrations of how this works ... with the addition of four separate superior labrum anterior and posterior (SLAP) views showing tearing, fraying, and detachment of the superior labrum.

Biceps rupture, impingement syndrome leading to bursitis, rhomboid syndrome, arthritis and osteoarthritis are described lucidly along with their symptoms. Proposed treatments are made even clearer with excellent graphics. Six distinct types of shoulder separation are reviewed. When to use – and when to stop – steroid treatment is discussed.

Dr. Balduini concludes that the advent of MRI imaging has improved recognition and diagnosis of shoulder lesions, and as a result has led to more aggressive and effective management.