- The patient is a 38-year-old Thai man who was in a motorcycle accident while intoxicated. He hit a footpath and was thrown from the motorcycle, landing on his right shoulder on the road without a helmet.
- On examination, he had pain and limited movement in his right shoulder. Imaging showed a grade V injury of the right acromioclavicular joint with disruption of the acromioclavicular and coracoclavicular ligaments.
- He underwent open reduction and internal fixation surgery with tightrope fixation of the right acromioclavicular joint.
Biomwchanics of wrist and hand
- Kinematics and Kinetics of joints including flexion and extension mechanism
-Pathomechanics
- Prehension
-Functional position of wrist
Abstract Background and introduction: Our work aimed to compare and evaluate CT arthrography
(CTA) and MR arthrography (MRA) techniques in diagnosing glenohumeral joint instabilities,
also help the clinician to choose the ideal diagnostic modalities CTA & MRA either separately or
combined to reach the early and accurate diagnosis of glenohumeral joint instability.
Patient and methods: The study included 96 patients: 72 males, 24 females. Their age ranged from
14 to 51 years (mean =33), complaining of shoulder dislocation whether traumatic or nontraumatic
with glenohumeral instability.
For every patient, intra-articular contrast injection was done followed by CT and MRI arthrography
(CTA & MRA).
Results: Preliminary results showed the role of CTA & MRA in diagnosing the causes of instability.
Correlation between CTA and MRA may have a role in more accurate diagnosis of glenohumeral
instability.
Conclusion: The combination of CT arthrography and MR arthrography is a promisable one in
defining the type of instability
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Model Attribute Check Company Auto PropertyCeline George
In Odoo, the multi-company feature allows you to manage multiple companies within a single Odoo database instance. Each company can have its own configurations while still sharing common resources such as products, customers, and suppliers.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
Instructions for Submissions thorugh G- Classroom.pptxJheel Barad
This presentation provides a briefing on how to upload submissions and documents in Google Classroom. It was prepared as part of an orientation for new Sainik School in-service teacher trainees. As a training officer, my goal is to ensure that you are comfortable and proficient with this essential tool for managing assignments and fostering student engagement.
6. × A: airway patent, C-spine not tender
× B: Clear & equals breath sound, CCT neg
× C: BP 120/80, PR80, cap refill < 2 sec, no external
bleeding
× D: E4V5M6 pupils 3 mm RTLBE
× E: AW at Face & Rt. Shoulder, Contusion at Rt.
Parietal area 5x5 cm.
6
7. × Vital sign: BP 120/80 mmHg, HR80bpm, T 36.7 C, RR 20/min, O2sat
98%
× GA: A thai man, good conciousness, well co-operative
× HEENT: not pale conjunctiva, anicteric sclera, no
lymphadenopathy
× Heart: bradycardia, regular rate 78 bpm, no heaving, no thrill, apex
at 5th ICSMCL, normal S1 S2, no murmur
× Lung: equal chest movement, tympanic on percussion, Clear and
equal breath sound both lungs, no adventitious sounds
7
8. × Abdomen: normoactive bowel sounds, soft, not tender, no
hepatosplenomegaly, shifting dullness negative
× Extremities: no pitting edema, Rt. Shoulder limit abduction,
adduction and external rotation, clavicle palpable subcutaneously
× Neuro: E4V5M6, pupils 3 mm. RTLBE, no facial palsy, motor power
gr. 5 all, pinprick sensory intact, BBK absent, Siffness of neck
negative
8
9. × E-FAST : negative
× CXR : not seen fx.
× Flim pelvis : not seen fx.
× CT brain : not seen ICH, not seen skull fx.,
scalp swelling at Rt. Parietal region
9
23. injury to the
acromioclavicular (AC)
joint with disruption of the
AC ligaments with or
without coracoclavicular
(CC) ligament disruption
23
24. Anatomy!
× diarthrodial joint ; articulation of the scapula (medial
acromion) and the lateral clavicle
× oblique orientation of joint surface
× primarily gliding motion
× Coraco clavicular ligament average range 1.1-1.3 cm
24
27. mechanism of injury
(A) a direct force onto the
point of the shoulder
(B) indirect forces to the AC
joint can also cause injury.
For example ,a fall on to the
elbow can drive the humerus
proximally, disrupting the AC
joint.
28. × Pain usually over AC joint
× can also be referred to the
trapezius
Physical exam
× lateral clavicle or AC joint tenderness
× abnormal contour of the shoulder
compared to contralateral side
28
stability assessment
• horizontal (anterior-posterior) stability evaluates AC ligaments
> cross-body adduction
> horizontal instability (ISAKOS type 3B) may indicate
need for more aggressive treatment
• vertical (superior-inferior) stability evaluates CC ligaments
36. Type II: The AC ligaments are
completely torn with partial
rupture of the CC ligaments. There
may be a slight raise in the clavicle
on X-ray compared to the opposite
side, however the CC distance is < 25
% of contralateral
38. Type III: Both the AC and CC
ligaments are completely
ruptured. X-ray will show an
elevated distal clavicle with a
widening of the CC space by
approximately 25-100%
40. Type IV: Both the AC and CC ligaments
are completely ruptured. X-ray will
show the clavicle displaced
posteriorly into the trapezius
muscle. Lateral radiograph
demonstrates the clavicle
overriding the acromion, which is
suggestive of a posterior
dislocation
confirming a type IV injury is with the axial and/or scapular view on X-ray
42. Type V: Both the AC and CC ligaments
are completely ruptured. X-ray will
show a large superior displacement
of the distal clavicle accompanied by
an increase of the CC distance by
approximately 100-300% compared
to the contralateral side.
44. Type VI: Both the AC and CC ligaments
are completely ruptured. X-ray will
show the clavicle displaced into the
subacromial or subcoracoid
position.(inferior dislocation of
lateral clavicle)
47. × brief sling immobilization, rest, ice, physical
therapy
× indications
× type I and II
× Acute type III in most individuals
× good results when clavicle displaced < 2cm
47
48. × On arm sling 7-10 days
× Control pain (NSAID , analgesic)
48
49. × On arm sling 10-14 days
× Control pain (NSAID , analgesic)
× Pendulum exercise
49
50. Rehab
× Passive and active ROM
× Once symmetrical and
painless ROM >
isometric shoulder
strengthening
50
51. × Avoid return to sport
and heavy lifting
8-10 weeks
× Regain functional
motion 6 weeks
× Return to normal
activity 12 weeks
51
52. × CC interval restoration (ORIF vs.
Ligament Reconstruction)
× indications
× acute type IV, V or VI injuries
× acute type III injuries in laborers, elite athletes,
patients with cosmetic concerns
× chronic type III injuries that failed non-op
treatment
52
54. AC arthritis
× more common with surgical management than with
nonoperative treatment
Hardware failure
CC screw breakage/pullout
!
Residual pain at AC joint
× 30-50%
54
Coracoid fracture
× can occur with coracoid tunnel drilling
