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Orthopedics 5th year, 1st lecture (Dr. Ariwan)

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The lecture has been given on Dec. 1st, 2010 by Dr. Ariwan.

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Orthopedics 5th year, 1st lecture (Dr. Ariwan)

  1. 1. Orthopedic Problems of The Shoulder Joint <ul><li>Symptoms: </li></ul><ul><li>Pain (top, front, back). </li></ul><ul><li>Stiffness (progressive, diffuse). </li></ul><ul><li>Swelling , </li></ul><ul><li>Deformity (wasting, winging), </li></ul><ul><li>Instability (frank, clicking). </li></ul>
  2. 2. Supraspinatus Tendinits (Impingement Syndrome) Painful condition of the shoulder due to impingement of rotator cuff (Supraspinatus tendon) under the coracoacromial arch .
  3. 3. Pathology <ul><li>Repeated shoulder abduction, flexion& internal rotation rubbing of the tendon under the arch edema& swelling chronic scarring& calcification tendon tearing. </li></ul>
  4. 4. Clinical features <ul><li>Subacute Tendinits (Painful Arc Syndrome): </li></ul><ul><li><40 years. </li></ul><ul><li>Anterior shoulder pain after vigorous activity (swimming, overhead action). </li></ul><ul><li>Tenderness along anterior edge of acromion. </li></ul><ul><li>Active abduction pain between 60°-120° ( PAINFUL ARC). </li></ul><ul><li>Passive abduction, flexion &internal rotation elicit pain. </li></ul><ul><li>Self limiting at weeks. </li></ul>
  5. 5. Chronic Tendinits <ul><li>40-50 years. </li></ul><ul><li>Recurrent subacute attacks. </li></ul><ul><li>Pain especially at night, cannot lie on the side. </li></ul><ul><li>Stiffness limited activities. </li></ul><ul><li>Crepitus on moving the shoulder (fibroses, tear). </li></ul>
  6. 6. Imaging <ul><li>Plain X-ray: Early Normal. </li></ul><ul><li>Late Scleroses of greater tuberosity, OA acromio clavicular joint, calcification of supraspinatus. </li></ul><ul><li>US: Rotator cuff tears. </li></ul><ul><li>MRI: Tendinits, tears, anatomy of subacromial arch. </li></ul>
  7. 7. Treatment <ul><li>Conservative(self limiting): </li></ul><ul><li>Rest, avoid impingement position, physiotherapy(US, exercise), NSAID (short course). </li></ul><ul><li>If no response after 3weeks local injection of long acting steroid, protection for 6 months. </li></ul><ul><li>Operative: </li></ul><ul><li>Failures of proper conservative RX after 3 months decompress the cuff ACROMIOPLASTY (coracoacromial ligament, anterior acromion,…..). </li></ul>
  8. 8. Adhesive Capsulits (Frozen Shoulder) <ul><li>Progressive pain and stiffness t the shoulder which resolve spontaneously after 18 months without any radiological abnormality. </li></ul><ul><li>Pathology: Fibroblast proliferation in the anterior capsule and coracohumeral ligament. </li></ul>
  9. 9. <ul><li>Associations </li></ul><ul><li>DM. </li></ul><ul><li>Hyperlipidemia. </li></ul><ul><li>Hyperthyroidism. </li></ul><ul><li>Cardiac problems </li></ul><ul><li>Hemiplegia. </li></ul><ul><li>Major head &neck operations. </li></ul>
  10. 10. Clinical features <ul><li>40-60 years. </li></ul><ul><li>Trivial shoulder trauma aches in the arm & shoulder severe pain {PAIN}. </li></ul><ul><li>After few months progressive stiffness {STIFFNESS}. </li></ul><ul><li>Gradual functional recovery {RECOVERY}. </li></ul><ul><li>Slight waisting, mild tenderness, limitation of active and passive movements in all directions. </li></ul>
  11. 11. Treatments <ul><li>Conservative : Relief pain, prevent stiffness while waiting recovery. </li></ul><ul><li>NSAID. </li></ul><ul><li>Pendulum exercise. </li></ul><ul><li>After acute painful stage manipulation under general anesthesia+ local steroid injection physiotherapy. </li></ul><ul><li>Operative: Prolonged disabling stiffness after conservative therapy. </li></ul><ul><li>{Release of coracohumeral ligament+ Coracoacromial ligament}. </li></ul>

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