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Information about PAINFUL SHOULDER

Published on February 15, 2014

Author: drmkreddy78


Common causes of PAINFUL SHOULDER: Common causes of PAINFUL SHOULDER Dr.A.Mohan krishna M.S.Ortho,Mch Orth (U.K), Consutant Orthopaedic Surgeon Apollo Hospitals. PowerPoint Presentation: Acute shoulder pain Fractures & Disclocations Calcific tendinitis Acute Rotator cuff tears Chronic shoulder pain Impingment Syndromes: Subacromial bursitis Rotator cuff tendonitis AC arthritis Hooked Acromion Osteoarthritis Shoulder Rheumatoid arthrits Partial rotator cuff tears PAINFUL SHOULDER-- CAUSES IMPINGEMENT SYNDROMES: IMPINGEMENT SYNDROMES Subacromial bursitis Rotator cuff tendonitis AC arthritis Hooked Acromion PowerPoint Presentation: IMPINGEMENT SYNDROMES Impingement is due to squeeging of rotator cuff and sub acromial bursa between the coracoacromial arch, anterior 1/3 of the acromion & AC joint above and head of Humerus below. Painful arc syndrome PowerPoint Presentation: SUBACROMIAL BURSITIS PowerPoint Presentation: ROTATOR CUFF TENDINITIS PowerPoint Presentation: ACROMIOCLAVICULAR ARTHRITIS PowerPoint Presentation: HOOKED ACROMION PowerPoint Presentation: 1.Pain: Exacerbated by overhead or above the shoulder activities Night pain, often disturbing sleep, lying on affected shoulder. acute :following an injury, particularly in older patients, 2.Loss of motion: 3.Weakness and inability to raise the arm IMPINGEMENT :clinical features PowerPoint Presentation: IMPINGEMENT :clinical features Painful arc Neers impingment test Hawkins impingment test PowerPoint Presentation: Xrays : Sometimes normal Xrays : shape of acromion AC joint arthritis MRI MSK Ultrasound: Cuff tears,Bursitis Arthrogram IMPINGEMENT : IMAGING PowerPoint Presentation: X RAYS AC JOINT ARTHRITIS HOOKED ACROMION PowerPoint Presentation: MRI: BURISTIS,ROTATOR CUFF PATHOLOGY PowerPoint Presentation: Avoidance of offending activity Physiotherapy NSAIDS Corticosteroid injection Surgery : Subacromial decompression IMPINGEMENT : TREATMENT PowerPoint Presentation: IMPINGEMENT :PHYSIO PowerPoint Presentation: IMPINGEMENT : SUBACROMIAL INJECTION - Out patient procedure. - Reduces inflammation. - Pain relief PowerPoint Presentation: IMPINGEMENT :SUBACROMIAL DECOMPRESSION Excision of inflamed bursa. Acromioplasty Excision of AC joint : Acromioclavicular arthritis Open /Arthroscopic decompression PowerPoint Presentation: Primary No underlying cause, Insidious onset, Global loss of movement FROZEN SHOULDER PowerPoint Presentation: FROZEN SHOULDER:Secondary Local Causes Impingement Syndrome Bursitis Synovitis Trauma Osteoarthritis Secondary General Diabetes Mellitus Thyroid disease Gout/ Pseudogout Drugs – Phenobarbitone Distant Myocardial infarction Head injury Pulmonary TB Carcinoma of Lung Cervical spine diseases Sub diaphragmatic pathology PowerPoint Presentation: FROZEN SHOULDER:Pathology Connective Tissue Disease Inflammatory Thick and contracted capsule with fibrosis Recurrent haemarthrosis / Infection Suprascapular Nerve Entrapment Reflex Sympathetic Dystrophy PowerPoint Presentation: Stage 1: Freezing Painful 3 – 4 months - Insidious onset of pain and loss of movement Stage 2: Frozen Stiff 6 – 12 months - Resolution of pain, continued stiffness Stage 3: Thawing Improves 6 months + - ROM improves FROZEN SHOULDER: STAGES PowerPoint Presentation: Plain X-ray : normal by definition Arthrography : decreased joint volume MRI : thick capsule Arthroscopy : Tight contracted joint space No adhesions Synovitis Tight axillary recess Loss of Subscapularis bursa Normal articular surface Synovial Bx - Inflammatory Synovitis ! FROZEN SHOULDER: INVESTIGATIONS PowerPoint Presentation: FROZEN SHOULDER: TREATMENT Stage 1: Acute Phase / Freezing Analgesia, maintain ROM as possible. Aggressive mobilisation /manipulation Contraindicated ?Intra- articular steroid injection? Stage 2: Frozen Physiotherapy, for mobilisation and stretching MUA Stage 3: Thawing MUA or arthroscopic release followed by physiotherapy. Shoulder function usually improves about 70% within 3-8 weeks PowerPoint Presentation: Frozen shoulder pathophysiology remains a puzzle Clinical course to resolution may take 1 to 3 years May be incomplete MUA/Arthroscopic release has a role and speeds up resolution FROZEN SHOULDER: TREATMENT PowerPoint Presentation: Thank you

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