INTRAARTICULAR FINDINGS IN THE CHRONICALLY PAINFUL SHOULDER - A STUDYOF 32 POSTTRAUMATIC CASES

32 consecutive patients suffering from chronic shoulder pain for more than 6 months after a single, nondislocating shoulder trauma were exam ined clinically and by special radiographs, dynamic sonography, MRI an d arthroscopy. Typical complaints were pain during loading, especially during over the head activities. Symptoms of a ''dead arm'' and insta bility were also present. Patients with previous dislocations, traumas or radiographic signs of degenerative shoulder lesions were excluded. The patients had a decreased active range of motion and positive sign s of apprehension and impingement, but only 4 had clinical signs of sh oulder instability. Diagnostic evaluation identified labral tears, par tial and total rotator cuff lesions with sub-acromial impingement and tendinitis of the biceps tendon. Surgery was performed in 24 patients, using capsulolabral and rotator cuff reconstruction, arthroscopic lab ral resection and open subacromial decompression.In conclusion, patien ts with chronic posttraumatic shoulder pain have intraarticular injuri es, especially tears of the glenoid labrum. History, clinical findings , radiography and sonography are seldom diagnostic. MRI is valuable, p articularly for indentification of labral pathology, but arthroscopy a ppears necessary for a preoperative assessment.