This document discusses the anatomy and clinical assessment of the rotator cuff. It describes the four muscles that make up the rotator cuff, their innervation and attachments. Common rotator cuff injuries like impingement syndrome and ruptures are explained. The physical exam involves assessing range of motion and performing special tests like Neer's, Hawkins-Kennedy, and lift-off to identify injuries.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This is a short presentation on common causes of shoulder pain, its clinical features,diagnostic methods and treatment modalities. This presentation would be helpful for general paractioners, orthopedic juniour registrars.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
This is a short presentation on common causes of shoulder pain, its clinical features,diagnostic methods and treatment modalities. This presentation would be helpful for general paractioners, orthopedic juniour registrars.
Complete descripition of the shoulder impingement syndrome and its management (both clinical and physical therapy intervention ) is explained in this slideshare,
The prostate is an exocrine gland of the male mammalian reproductive system
It is a walnut-sized gland that forms part of the male reproductive system and is located in front of the rectum and just below the urinary bladder
Function is to store and secrete a clear, slightly alkaline fluid that constitutes 10-30% of the volume of the seminal fluid that along with the spermatozoa, constitutes semen
A healthy human prostate measures (4cm-vertical, by 3cm-horizontal, 2cm ant-post ).
It surrounds the urethra just below the urinary bladder. It has anterior, median, posterior and two lateral lobes
It’s work is regulated by androgens which are responsible for male sex characteristics
Generalised disease of the prostate due to hormonal derangement which leads to non malignant enlargement of the gland (increase in the number of epithelial cells and stromal tissue)to cause compression of the urethra leading to symptoms (LUTS
Acute scrotum is a general term referring to an emergency condition affecting the contents or the wall of the scrotum.
There are a number of conditions that present acutely, predominantly with pain and/or swelling
A careful and detailed history and examination, and in some cases, investigations allow differentiation between these diagnoses. A prompt diagnosis is essential as the patient may require urgent surgical intervention
Testicular torsion refers to twisting of the spermatic cord, causing ischaemia of the testicle.
Testicular torsion results from inadequate fixation of the testis to the tunica vaginalis producing ischemia from reduced arterial inflow and venous outflow obstruction.
The prevalence of testicular torsion in adult patients hospitalized with acute scrotal pain is approximately 25 to 50 percent
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
These lecture slides, by Dr Sidra Arshad, offer a quick overview of physiological basis of a normal electrocardiogram.
Learning objectives:
1. Define an electrocardiogram (ECG) and electrocardiography
2. Describe how dipoles generated by the heart produce the waveforms of the ECG
3. Describe the components of a normal electrocardiogram of a typical bipolar leads (limb II)
4. Differentiate between intervals and segments
5. Enlist some common indications for obtaining an ECG
Study Resources:
1. Chapter 11, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 9, Human Physiology - From Cells to Systems, Lauralee Sherwood, 9th edition
3. Chapter 29, Ganong’s Review of Medical Physiology, 26th edition
4. Electrocardiogram, StatPearls - https://www.ncbi.nlm.nih.gov/books/NBK549803/
5. ECG in Medical Practice by ABM Abdullah, 4th edition
6. ECG Basics, http://www.nataliescasebook.com/tag/e-c-g-basics
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New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
4. subscapularis muscle is innervated by the
subscapular nerve and originates on the
scapula. It inserts on the lesser tubercle of
the humerus.
The supraspinatus and infraspinatus are both
innervated by the suprascapular nerve,
originate in the scapula, and insert on the
greater tubercle.
5. The teres minor is innervated by the axillary nerve,
originates on the scapula, and inserts on the
greater tubercle.
subacromial space lies underneath the acromion,
the coracoid process, the acromioclavicular joint,
and the coracoacromial ligament. A bursa in the
subacromial space provides lubrication for the
rotator cuff.
6. The rotator cuff is the dynamic stabilizer of the
glenohumeral joint. The static stabilizers are the
capsule and the labrum complex, including the
glenohumeral ligaments.
Without an intact rotator cuff, particularly during the
first 60° of humeral elevation, the unopposed deltoid
would cause cephalad migration of the humeral head,
with resulting subacromial impingement.
7. Extrinsic factors include
a traumatic tear in tendons from a fall or
accident.
Overuse injuries from repetitive lifting,
pushing, pulling, or throwing are also
extrinsic in nature.
8. INTRINSIC FACTORS
POOR BLOOD SUPPLY
DEGENERATION WITH AGING
CALCIFICATION OF TENDON
9. Rotator cuff dysfunction is typically a continuum of
pathology ranging from tendinitis and bursitis, to
partial tearing, to a complete tearing in one or
more of the tendons.
These tears most commonly occur at the
tenoperiosteal (tendon-to-bone) junction. Because
this area has a relatively poor blood supply, injury
to the tendon at this location is very unlikely to
heal.
10. Additionally, the constant resting tension in
the muscle-tendon unit, or muscle tone,
pulls any detached fibers away from the
bone, preventing their reattachment.
Finally, joint fluid from within the shoulder
may seep into the tear gap and prevent the
normal healing processes from occurring
12. is a clinical SYNDROME which occurs when
the tendons of the rotator cuff muscles
mainly supraspinatus undergo repititive
compression or rubbing under the coraco
acromial arch.
This can result in pain, weakness and loss of
movement at the shoulder syndrome
13. bony structures such as subacromial spurs
(bony projections from the acromion),
osteoarthritic spurs on the acromioclavicular
joint, and variations in the shape of the
acromion.
Thickenend or calcified coracoacromial
ligament .
14. Loss of function of the rotator cuff
muscles, due to injury or loss of strength,
may cause the humerus to move
superiorly, resulting in impingement.
Inflammation and subsequent thickening of
the subacromial bursa may also cause
impingement.[1]
15. The range of motion at the shoulder may be
limited by pain. A painful arc of movement
may be present during forward elevation of
the arm from 60° to 120°.
Passive movement at the shoulder will
appear painful when a downwards force is
applied at the acromion but the pain will
Cease once the downwards force is
removed.[1]
16. History and physical exam.
Xrays of the shoulder can be used to
detect some joint pathology and variations in
the bones, including acromioclavicular
arthritis, variations in the acromion, and
calcifcation.
Ultrasonography, arthrography and MRI can
be used to detect rotator cuff muscle
pathology
17. Conservative treatment includes
Rest
NSAIDS
PHYSIOTHERAPY
Therapeutic injections of corticosteroid and
local anaesthetic may be used for persistent
impingement syndrome.
18. Surgery may be done arthroscopically or as
open surgery.
The impinging structures may be removed in
surgery, and the subacromial space may be
widened by resection of the distal clavicle
and excision of osteophytes on the under-
surface of the acromioclavicular joint.[2]
damaged rotator cuff muscles can be
surgically repaired.
19. Most patients with a pathological condition
of the rotator cuff have insidious onset of
progressive pain and weakness, with
concomitant loss of active motion.
TWO TYPES
Full thickness tear
Partial thickness tear
20. Follow a long period of c/c tendinitis
Spontaneously after a sprain or jerking injury
of shoulder
CLINICAL FEATURES
Sudden pain and pt not able to abduct the
arm
Active abduction is impossible even when
pain subsides or has been abolished by
21. Injection of local anaesthetic.
But once the arm is passively abducted pt
can hold it up with deltoid(abduction
paradox) and when the pt lowers it sideways
it suddenly drops(drop arm sign)
22. Partial-thickness tears usually are located on the
articular surface of the supraspinatus near its
insertion.
Pt can abduct actively once the pain has been
abolished by local anaesthetic.
24. arthroscopic-assisted or arthroscopic
repair is appropriate for partial-thickness
and small to medium full-thickness rotator
cuff tears.
After standard repair, shoulder immobilized
for 6 weeks followed by assisted exercises in
flexion and external rotation to avoid
adhesions, disuse atrophy, and disruption of
the repairs.
25. Debridement and limited decompression.
to obtain and maintain the maximal range of
passive glenohumeral flexion and rotation
26. contracted, thickened joint capsule that
seemed to be drawn tightly around the
humeral head with a relative absence of
synovial fluid and chronic inflammatory
changes within the subsynovial layer of the
capsule.
27. Common in pts with
DM
CERVICAL SPINE DISEASES
HYPERTHYROIDISM
TRAUMA
INTRATHORACIC DISORDERS
29. Diagnostic tests in patients with a frozen shoulder
(including plain film roentgenograms) usually are
normal.
Treatment. self-limiting condition, lasting 12 to 18
months without long-term sequelae
Initial treatment is nonoperative,
NSAIDS
Transcutaneous electrical nerve stimulation (TENS)
and ultrasound
PHYSIOTHERAPY –PENDULUM EXERCISES
30. Cause-hypo vascularity
Phase 1—Precalcification stage.:
fibrocartilagenous metaplasia
Phase II—Calcific stage. During this stage
calcium is deposited into matrix vesicles,
which are excreted by the cells and coalesce
into larger calcium deposits. This stage can
be exceedingly painful, and many patients
seek treatment at this time
31. Phase III—Postcalcific phase. Pain subsides
markedly during this phase.
Nonoperative treatment usually includes
physical therapy, exercises, antiinflammatory
medications, and steroid injections.
32. indications for operative treatment: (1)
symptom progression, (2) constant pain that
interferes with activities of daily living, and
(3)conservative therapy-failure
Aspiration and Needling of Calcified Deposits
Excision of Calcium Deposits
34. HISTORY
INSPECTION
The shoulder, cervical region, and entire
upper extremity must be assessed-BONE &
SOFT TISSUE.
The dominant side may be lower than the
nondominant one. Observation of the soft
tissues is directed first at the contours of the
deltoid.
35. FROM ANTERIOR TO POSTERIOR-SOFT & BONY
STRUCTURES PALPATED.
EXAMINER STANDS BEHIND THE PATIENT.
THE STRUCTURES ASSESED ARE THE
STERNOCLAVICULAR JOINTS, SCM,
COSTOCHONDRAL JOINTS, FIRST RIB &
ACROMIOCLAVICULAR JOINTS.
36. SUPERIOR MIGRATION OF MEDIAL END OF
CLAVICLE IS NOTED IN STERNOCLAVICULAR
JOINT DISLOCATION.
STEP DEFORMITIES WITH SUPERIOR
MIGRATION OF LATERAL END OF CLAVICLE
SEEN IN ACROMIOCLAVICULAR JOINT
DISLOCATION OR SUBLUXATION.
38. The scapulohumeral rhythm is observed. If a painful
arc (ie, pain or inability to abduct because of pain)
is observed at 45-120°, a subacromial
impingement syndrome is suggested.
If the pain is greater after 120°, when full
elevation is reached, an acromioclavicular joint
disorder is suggested.
39. If a reverse scapulohumeral rhythm (ie, an
abduction initiated by the scapulothoracic
joint rather than by the glenohumeral joint)
is observed, a frozen shoulder is suggested.
41. With the examiner standing behind the
patient, the shoulder is passively flexed.
When the result is positive, this test
produces pain caused by contact of the
bursal side of the rotator cuff on the anterior
third of the undersurface of the acromion
and the coracoacromial ligament.
A positive test result suggests an
anterosuperior impingement syndrome
42. With the examiner standing behind the patient, the
shoulder is flexed passively to 90°, followed by
repeated internal rotation.
When the result is positive, this test produces pain
caused by contact of the bursal side of the rotator cuff
on the coracoacromial ligament and by contact between
the articular surface of the tendon and the
anterosuperior glenoid rim. Contact between the
subscapularis tendon and the coracoid process is also
observed.
A positive test result suggests an anterosuperior or an
anterointernal impingement test.
43. With the examiner standing behind the
patient, the hand on the ipsilateral side of
the examined shoulder is placed on the
contralateral shoulder. The elevation of the
elbow is resisted by the examiner.
When the result is positive, this test
produces pain caused by contact of the
bursal side of the cuff tendon with the
coracoacromial ligament and possibly the
undersurface of the acromioclavicular joint.
44. To identify the supraspinatus tendon
Full-can test: The shoulder is placed at 90°
of flexion and 45° of external humeral
rotation (thumb pointing upward, as if
someone is holding a full can right-side-up).
Shoulder elevation is resisted. The test result
is considered positive if it produces pain.
45. In the Patte test, the shoulder is placed at
90° of abduction, in neutral rotation, and in
the plane of the scapula. The examiner holds
the elbow of the patient, and the external
rotation is resisted. The test result is
considered positive if it produces pain.
To identify the teres minor tendon, use the
same tests used for the infraspinatus tendon
46. In the Gerber lift-off test, the shoulder is
placed passively in internal rotation and
slight extension by placing the hand 5-10 cm
from the back with the palm facing outward
and the elbow flexed at 90°. The test result
is positive when the patient cannot hold this
position, with the back of the hand hitting
the patient's back