Shoulder

2. Soft Tissue Injury
 RANA SALMAN
 Malik Abdul Rehman

3. SOFT TISSUE
The structure which connect and support
the organs in the body
Muscle
Ligament
Tendon
Bursa
fascia
Soft tissue injury
Injury of these structure in known as STI

4. Muscle
A body tissue consisting of long cells that can
contract and produce motion is known muscle
Muscle injury usually called strain
Tendon
A fibrous connective tissue attach muscle to bone
Tendon injury called sprain

5. Degree of injury
First degree mild
Second degree moderate
Third degree severe
Sprain is more sever then strain

6. ligament
A fibrous connective tissue that attach bone to bone
Sprain
Total tear can be as painful as a broken bone

7. Fascia
A thin connective tissue that sround and hold every
organ, blood vessel ,bone nerve fibre and muscle in
proper place
Symptoms of facia injury mimic like muscle and tendon
BURSA
Fluid filled sac or sac like cavity ,especially one
countering friction in a joint

8. Management of upper
extremity

9. Management of shoulder region
Any pathology in these joint
Glenohumeral JOINT
ACROMIOCLAVICULAR
Sternoclavicular Joint
NONOPRATIVEMANAGEMENT
lead the condition of hypo mobility
Impairment Of Body Structure And
FUNCTION
 Inflammation
 Pain
 Edema
 Muscle spasm
 Joint effusion

10. PLAN OF CARE AND INTERVENTION
 Educate the patient
 Control pain and edema
 Maintain integrity of associated areas
 Passive range of motion
 Active assisted range of motion
 Increase joint play
OPRATIVE MANAGEMENT
• TSR
• TS Arthroplasty
• Glenohumeral arthroplasty
• Rotator cuff arthroplasty
MANAGEMENT
Early shoulder motion passively and assistive only for six weeks
Maintain humeral depression
Avoid superior translation
Stretching
strengthening

11. CONTRAINDICATION
Don’t allow active shoulder flexion
and abduction until the patient can lift
the arm without hiking the shoulder

12. MANAGEMENT FOR ELBOW DISORDER
Tennis elbow lead to hypomobility micro tear in ECRB
ACUTE
Joint effusion
Pain
Muscle guarding
Fracture
dislocation
SUBACuTE
cRONIC
Capsular pattern variation

13. STAGE FOR RECOVERY
STAGE 1
STAGE 2
STAGE 3
Rest ,ice, compression
PROM, ACTIVE ROM,STRETCHING, BRACING
RESISTED ROM AND STRENGTHINING

14. MANAGEMENT
 Educate the patient
 Maintain soft tissue and joint mobility
 Maintain integrity of associated areas
 Gentle ocellation of grade 1 and 2
OPRATIVE
• TER
• TEA

15. MANAGEMENT
Immobilized for 1,3 week at 45 to 90 degree
Maintain mobility shoulder wrist and hand
Regain motion of elbow and forearm
Manage edema
Maintain mobility of uninvolved joint
Increase range of motion
Improve muscle strength and endurance

17. WRIST AND HAND
When compression of median and
ulnar nerve
Pain radiate with different pattern
NON OPRATIVE MANAGEMENT
 Patient educate
 Pain management
 Activity modification
 Maintain joint tendon mobility and muscle integrity

18. OPRATIVE MANAGEMENT
 Metacarpophalangeal implant arthroplasty
 Proximal inter phalangeal
 Carpometacarpal arthroplasty of thumb
All these occur due severe fracture over use syndrome or
deformity
MANAGEMENT
Prevent adhesion
Restore control and mobility of wrist
Maintain mobility of uninvolved joint
PRECaution  SSI

19. MANAGEMENT OF LOWER
EXTRIMITIES

20. maNAGEMENT OF HIP REGION
Sciatic nerve
Obturator nerve
Femoral nerve
L1, L2, L3, S1, S2
NON OPRATIVE
Educate the patient
Decrease pain
Decrease stiffness
Joint mobilization
Stretching
 Increase ROM

21. SURGRICAL
 THR
 THA
MANAGEMENT
o Educate patient
o Positioning
o Improve strength in both extremities
o Gait training
PRECauTION
Foot is in neutral position

22. MANAGEMENT FOR KNEE REGION
 Peroneal nerve
 Saphenous nerve
With damaging sensory loss and muscle weakness
Innervation of medial side of knee and leg also effect
Management
Educate the patient
Limit its functional activity
Maintain associated muscle function
Joint mobilization
PRECauTION Prevent patellar adhesion

23. SURGERY
• TKR
 TKA
 Patellar instability
MANAGEMENT
Compression to wrap to control effusion
Pain modulation
Ankle pump
passive ROM
Active assistive ROM of knee
Superior or inferior patellar mobilization
Gait training

24. THE ANKLE AND FOOT REGION
Common fibular nerve
Posterior tibial nerve p
Plantar and calcaneal nerve
Nerve root is L4 L5 and S1
When these nerve entrap pain radiate with different pattern
 Movement restrict
 Muscle weakness
 Gait deviation
MANAGEMENT
• Educate patient
• Decrease pain
• Maintain joint
• Prevent muscle integrity
• Increase joint play
• PROM +AROM
• Improve gait and balance training

25. SURGERY
• TAA
• TAR
MANAGEMENT
o Immobilized
o Weight bearing
o Prevent DVT
o functional mobility
o Proper neutral position
o Prevent dystrophy of associated areas

26. THANK YOU

27. Do a good deed and throw it in the river.one
day it will back to you in the desert