This document discusses periarthritis of the shoulder, also known as frozen shoulder. It begins by defining the condition as an inflammatory disorder of the shoulder joint and surrounding soft tissues. It then describes the three stages of frozen shoulder according to Cyriax: stage 1 involves pain with movement, stage 2 includes increased stiffness, and stage 3 is the recovery stage with gradual return of movement. The document outlines causes such as injury, prolonged immobility, diabetes, and thyroid disorders. Signs, symptoms, diagnosis, and management are explained, including medications, cortisone injections, physical therapy, and possibly surgery if conservative treatment fails.
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.
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 the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
This is the presentation which was delivered to third year Bachelor of Physiotherapy students at Kathmandu University School of Medical Sciences (KUSMS), Dhulikhel, Nepal. Different schools of thoughts in manual therapy are the part of curriculum for the undergraduate students at KUSMS.
Brian Mulligan described novel concept of the simultaneous application of therapist applied accessory mobilizations and patient generated active movements
Supraspinatus tear - medial information martinshaji
A supraspinatus tear is a tear or rupture of the tendon of the supraspinatus muscle. The supraspinatus is part of the rotator cuff of the shoulder.
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In this i have covered the different sports injuries of upper extremities, their causes and their orthotic management.
Helpful for those, who are in the field of P & O.
What is Frozen Shoulder?
Frozen shoulder, medically referred to as adhesive capsulitis, is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.
Dr Susmit Naskar has specialisation in all sorts of spine-related problems including cervical, thoracic and lumbo-sacral spine. Spine surgery is the most demanding Orthopedic procedure which requires prolonged training and supreme discipline.We have listed some awareness tips for those patients who have spine related issues. Feel free to call us at “+91 6290 967 376” or mail us at info@advancespinesurgery.com.
Introduction to low back pain
Reasons for low back pain
Epidemiology of LBP
Causes of LBP
Risk factors of LBP
Diagnosis of LBP
Treatment for LBP
Occupational therapy interventions for LBP
Office Ladies Must not Ignore Lower Back PainFFragrant
Lower back pain can be related to some diseases, like PID, etc. Fuyan Pill, a traditional Chinese medicine, can help patients to eliminate symptoms and causes and achieve the goal of a cure.
Similar to Periarthritis shoulder & painful arc (20)
this ppt provides a comprehensive review & exam oriented details
compiled from journals & old edition textbooks. because ITB contracture has become a rare presentation. & new edition books doesnt speak about it much...
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
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
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These simplified slides by Dr. Sidra Arshad present an overview of the non-respiratory functions of the respiratory tract.
Learning objectives:
1. Enlist the non-respiratory functions of the respiratory tract
2. Briefly explain how these functions are carried out
3. Discuss the significance of dead space
4. Differentiate between minute ventilation and alveolar ventilation
5. Describe the cough and sneeze reflexes
Study Resources:
1. Chapter 39, Guyton and Hall Textbook of Medical Physiology, 14th edition
2. Chapter 34, Ganong’s Review of Medical Physiology, 26th edition
3. Chapter 17, Human Physiology by Lauralee Sherwood, 9th edition
4. Non-respiratory functions of the lungs https://academic.oup.com/bjaed/article/13/3/98/278874
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
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Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Title: Sense of Smell
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the primary categories of smells and the concept of odor blindness.
Explain the structure and location of the olfactory membrane and mucosa, including the types and roles of cells involved in olfaction.
Describe the pathway and mechanisms of olfactory signal transmission from the olfactory receptors to the brain.
Illustrate the biochemical cascade triggered by odorant binding to olfactory receptors, including the role of G-proteins and second messengers in generating an action potential.
Identify different types of olfactory disorders such as anosmia, hyposmia, hyperosmia, and dysosmia, including their potential causes.
Key Topics:
Olfactory Genes:
3% of the human genome accounts for olfactory genes.
400 genes for odorant receptors.
Olfactory Membrane:
Located in the superior part of the nasal cavity.
Medially: Folds downward along the superior septum.
Laterally: Folds over the superior turbinate and upper surface of the middle turbinate.
Total surface area: 5-10 square centimeters.
Olfactory Mucosa:
Olfactory Cells: Bipolar nerve cells derived from the CNS (100 million), with 4-25 olfactory cilia per cell.
Sustentacular Cells: Produce mucus and maintain ionic and molecular environment.
Basal Cells: Replace worn-out olfactory cells with an average lifespan of 1-2 months.
Bowman’s Gland: Secretes mucus.
Stimulation of Olfactory Cells:
Odorant dissolves in mucus and attaches to receptors on olfactory cilia.
Involves a cascade effect through G-proteins and second messengers, leading to depolarization and action potential generation in the olfactory nerve.
Quality of a Good Odorant:
Small (3-20 Carbon atoms), volatile, water-soluble, and lipid-soluble.
Facilitated by odorant-binding proteins in mucus.
Membrane Potential and Action Potential:
Resting membrane potential: -55mV.
Action potential frequency in the olfactory nerve increases with odorant strength.
Adaptation Towards the Sense of Smell:
Rapid adaptation within the first second, with further slow adaptation.
Psychological adaptation greater than receptor adaptation, involving feedback inhibition from the central nervous system.
Primary Sensations of Smell:
Camphoraceous, Musky, Floral, Pepperminty, Ethereal, Pungent, Putrid.
Odor Detection Threshold:
Examples: Hydrogen sulfide (0.0005 ppm), Methyl-mercaptan (0.002 ppm).
Some toxic substances are odorless at lethal concentrations.
Characteristics of Smell:
Odor blindness for single substances due to lack of appropriate receptor protein.
Behavioral and emotional influences of smell.
Transmission of Olfactory Signals:
From olfactory cells to glomeruli in the olfactory bulb, involving lateral inhibition.
Primitive, less old, and new olfactory systems with different path
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
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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
3. INTRODUCTION
The periarthritis of shoulder also called as
adhesive capsulitis or Frozen shoulder, is
a chronic, inflammatory disorder of the
shoulder and surrounding soft tissues.
This condition is frequently caused by injury,
leading to pain and lack of use.
As the joint becomes progressively tighter
and stiffer, simple movements, such as raising
the arm, become difficult.
4. DEFINITION
Peri arthritis Shoulder
is a condition in
which there is
inflammation of
tissues around the
joint capsule. The
Gleno- humeral joint
(that is the shoulder
joint) becomes
painful and stiff.
5. SIGNS
Inspection
1)Patient holds arm protectively at side
2)Deltoid and Supraspinatus atrophy
Palpation
1)Generalized pain at rotator cuff
and biceps tendon.
6. Limited range of motion
1)Loss of both active and passive Shoulder Range of
Motion
2)Loss of motion in all planes
8. According to CYRIAX, there are 3 stages of
symptoms
Stage 1:
Pain persists in shoulder
It does not spread beyond elbow.
Person can sleep on the affected
side. Pain remains only in
movement.
Stage 2:
This stage is not clear but any symptom exceeding
beyond stage 1, is considered to be stage 2.
9. Stage 3:
Pain extends till wrist.
Person can’t sleep on the affected side.
Vague chill pain on movement.
In early stages, the pain is worse in night.
Later pain is present
10. FROZEN SHOULDER IS CLASSICALLY
CHARACTERIZED BY THREE STAGES
Stage 1 – The painful/freezing stage. There is
usually a dull, aching pain onset of
predominantly nocturnal pain, usually without a
precipitating factor.
The pain is not related to activity, although the
end range of motion can increase the pain.
As the disease progresses, patients have pain
at rest which lasts 2-9 months, ROM is not
restricted.
11. Stage 2 – This is known as the
adhesive/frozen stage.
The shoulder typically becomes increasingly
stiff, daily activities such as grooming one’s
hair, reaching for a seatbelt, ove becomes
difficult.
Although the pain does not normally get worse,
the muscles may start to waste slightly as they
are not being used.
12. Stage3 - This is the recovery/thawing stage in
which you gradually regain movement of the
shoulder.
The pain also fades, although it may recur from
time to time as the stiffness eases.
Although it is possible that you may not regain full
movement of your shoulder, you will be able to do
many more tasks than previous stage.
This stage can last any period of time from five
months to 3-4 years.
13. CAUSES/ETIOPATHOGENESIS
Periarthritis Shoulder is usually a disease of unknown
cause.
In some cases there is a history of previous trauma or
injury to the joint before the onset of condition.
This condition occurs when a person is not using the
shoulder
joint, keeping it in a guarded way with less movement, due to
pain.
This reduces the flexibility of the joint. Which in-turn causes
reduction in the movements of shoulder like flexion (forward
movement), extension (backward movement), abduction
(sideways movement) and rotational movements.
14. Age and Sex
People 40 and older are more likely to
experience frozen shoulder
More common in women
(especially in postmenopausal
women) than men
15. Prolonged Immobility
In period of immobility your arm and shoulder
remains immobile (still) for long periods of time
while you recover which may cause your shoulder
capsule to tighten up from lack of its use. For
Example:
In rotator cuff injury, brachial plexus injury,
cervical spinal cord injury
Stroke
Fracture at or around shoulder.
Recovery from surgery (chest or breast surgery)
17. Frozen Shoulder Facts
2-5% of the population.
It is more common in women (60%)
It is at least five times more common in diabetics
It is slightly more common in patients with
Dupytren’s contracture and shares some of the
same pathology
About 15% of people get it on both sides
18. It may have a genetic component i.e./ it can
run in the family
It may well have an hyper responsive
auto- immune component
It seems to affect 40-70 year olds (in
Japan it is known as 50’s shoulder)
About 15% of people get it on both sides
19. This reduces the flexibility of the joint. Which
in- turn causes reduction in the movements of
shoulder like flexion (forward movement),
extension (backward movement), abduction
(sideways movement) and rotational
movements.
20. DIAGNOSIS
• X-rays—a test that uses radiation to take
pictures of structures inside the body, to rule
out other possible causes of the stiffness
• MRI scan—a test that uses magnetic
radiation waves to make pictures of the
tissues in the body, used to examine the soft
tissues around the shoulder
• Arthrograms—x-ray pictures taken after dye
is injected into the shoulder area. This test
is difficult to perform with this shoulder
condition.
21. MANAGMENT
• Medical Treatment
• Anti-inflammatory Medications
Anti-inflammatory medications have not been shown
to significantly alter the course of a frozen shoulder,
but these medications can be helpful in offering relief
from the painful symptoms.
• Cortisone Injections
Cortisone injections are also commonly used to
decrease the inflammation in the frozen shoulder joint.
It is unclear the extent of the benefit of a cortisone
injection, but it can help to decrease pain, and in turn
allow for more stretching and physical therapy. What is
known, is the cortisone is only effective when used in
conjunction with physical therapy for the management
of a frozen shoulder.
22. Surgery
Surgery is an option if there is no improvement after 4
to 6
months of intensive therapy. Surgeries include:
Closed manipulation:-
This involves forceful movement of the arm at the
shoulder joint to loosen the stiffness. This is performed
under anesthesia and followed by intensive physical
therapy.
23. Arthroscopic surgery
An arthroscope, which is a long,
thin, fiberoptic tube with a light on
the end, is inserted through a
small incision in the shoulder.
Using this tube and other small
instruments, the tightened tissues are
released and the shoulder is
manipulated. Physical therapy must be
done after this surgery
24. Prevention
To help prevent frozen shoulder:
Do regular strength training and range of
motion exercises. This will help maintain a
strong and flexible shoulder joint.
After any injury to the upper extremity
(hand, wrist, elbow, etc), always move the
shoulder through a full range of motion
several times a day.
26. Also Known As
Impingement Syndrome
Subacromial Impingement
Supraspinitus Syndrome
Swimmer’sShoulder
Thrower’sShoulder
27. • 1867fIrst jarjavay’
sDescribed
As Subacromial Bursitis
• 1931 Codman Noted That
Patients With Inability To
Abduct The Arm Had
Incomplete Or Complete
Ruptures Of The
Supraspinatus Tendon
28. • 1972 Neer Characterized It By Ridge Of
Proliferative Spurs And Excrescences On The
Undersurface Of The Anterior Process Of Acromion
Apparently Caused By Repeated Impingement Of
Rotatory Cuff And Humeral Head With Traction Of
The Coracoacromial Ligament.
• Later Neer Introduced Impingement Syndrome
The Supraspinitus Insertion Into Greater Tubirosity
That Passes Beneath The Coracoacromial Arch
During Forward Flexion Of Shoulder Is Susceptible
To Impingement.
29. • Neer Impingement
Sign
With The Patient
Seated, The Examiner
Raises The Affected
Arm In Forced
Forward Elevation
While Stabilizing The
Scapula, Causing The
Greater Tuberosity To
Impinge Against The
Acromion.
• Neer Impingement Test
• Subacromial Injection
Of 10 Ml Of 1%
Xylocaine. Pain
Caused By
Impingement
Usually Is
Significantly
Reduced Or
Eliminated, But Pain
Caused By Other
Conditions (With The
Exception Perhaps Of
Calcific Tendinitis) Is
Not Relieved
32. • Age-related Degenerative Changes, Including
Decreased Cellularity, Fascicular Thinning And
Disruption, Accumulation Of Granulation Tissue,
And Dystrophic Calcification, All Have Been Noted
And Are Likely Irreversible
• Some Have Suggested That The Rotator Cuff
Tendons May Fail In Tension As A Result Of
Throwing A Baseball Or Other Overhead Sports.
33. There Are Four Types
• Primary Impingement
• Secondary
Impingement
• Subcorochoid
Impingement
• Internal Impingement
34. • Primary
It Is Classic Version And Occurs Without Any Other
Contributing Pathology
Divided Into
Intrinsic
Extrinsic
35. • Secondary
It Occurs When There Is
Instability Of The Glenohumeral Joint Allowing
Translation Of Humeral Head Typically Anteriorly
Resulting In Contact Of Rotatory Cuff Against
Coracoacromial Arch Inrinsic Extrinsic
36. • Intrinsic
Structures Passing Beneath The Coracoacromial
Arch Become Enlarged Resulting In Abutment
Against The Arch
1. Thickining Of Rotator Cuff
2. Calcium Deposits
Within Rotator Cuff
3. Thickening Of
Subacromial Bursa
37. • Extrinsic
When The Space Available For The Rotator Cuff Is
Diminished Subacromial Spurring
1. Acromial Fracture
2. Osteophytes Off
Acromioclavicular Joint
3. Exostoses Of Greater
Tuberosity
39. INTERNALIMPINGEMENT
• Internal Contact Of The
Rotator Cuff Occurs With
The Posterosuperior
Aspect Of Glenoid
When The Arm Is
Abducted, Extended And
Externally RotatedAs In
The Cocked Position Of
The Throwing Motion
40. • Often Seen In Throwers Who Have Lost Internal
Rotation Of Shoulder
• This Loss Causes The Center Of Rotation Of
Humeral Head To Move Upward So That The
Contact Between Rotatory Cuff And Biceps Tendon
Attachments Increases