Describing some of the most important disorders of the shoulder area: frozen shoulder, biceps tenosynovitis, biceps tendon tear, rotator cuff tear, impingement syndrome, Rotator Cuff Calcified Tendonitis
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
28,000 ankle sprains occur daily in the US (Kaminski 2013)
Ankle is the 2nd most commonly injured body site. (Ferran 2006)
Ankle sprains are the most common type of ankle injury. (Ferran 2006)
A sprained ankle can happen to athletes and non-athletes,
children and adults.
Inversion injury most common mechanism (Ferran 2006)
Only risk factor is previous ankle sprain (Ferran 2006)
Sex , generalized joint laxity or anatomical foot types are
not risk factors. (Beynnon et al. 2002 )
This presentation is made to act as a guide and a short reminder to clinicians and medical students on Volkmann's Ischaemic Contracture, which is a medical condition that can lead to activities limitation and public participation restriction. This presentation explore aspects of the condition such as what it is, causes, how it can be diagnosed, how it can be managed and others.
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.
Musculoskeletal Disorders or MSDs are injuries and disorders that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.)
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.
Musculoskeletal Disorders or MSDs are injuries and disorders that affect the human body’s movement or musculoskeletal system (i.e. muscles, tendons, ligaments, nerves, discs, blood vessels, etc.)
Musculoskeletal disorders
includes the following disorders:
Bone infections: Osteomyelitis, and Septic arthritis; Disorders of foot:
Hallux valgus (bunions), Morton’s neuroma (plantar neuroma), and
Hammer toe; Muscular disorders:
Muscular dystrophy, and Rhabdomyolysis
Each month, join us as we highlight and discuss hot topics ranging from the future of higher education to wearable technology, best productivity hacks and secrets to hiring top talent. Upload your SlideShares, and share your expertise with the world!
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examination,impingement syndrome,rotator cuff injury,shoulder,shoulder instability
All about orthopaedic shoulder examination. comprehensive ppt with all tests arranged symptom wise
Thoracic outlet syndrome is a condition that involves compression of the nerves or blood vessels that pass through the base of the neck. This can lead to disabling pain in the neck and shoulder, as well as pain, numbness, tingling and weakness in the hands and fingers.Thoracic outlet syndrome (TOS) is a term used to describe a group of disorders that occur when there is compression, injury, or irritation of the nerves and/or blood vessels (arteries and veins) in the lower neck and upper chest area. Thoracic outlet syndrome is named for the space (the thoracic outlet) between your lower neck and upper chest where this grouping of nerves and blood vessels is found.
Who is affected by thoracic outlet syndrome?
Thoracic outlet syndrome affects people of all ages and gender. The condition is common among athletes who participate in sports that require repetitive motions of the arm and shoulder, such as baseball, swimming, volleyball, and other sports.
Neurogenic TOS is the most common form of the disorder (95 percent of people with TOS have this form of the disorder) and generally affects middle-aged women.
Recent studies have shown that, in general, TOS is more common in women than men, particularly among those with poor muscular development, poor posture or both.
What are the symptoms?
Download a Free Guide on Thoracic Outlet Syndrome
The signs and symptoms of TOS include neck, shoulder, and arm pain, numbness or impaired circulation to the affected areas.
The pain of TOS is sometimes confused with the pain of angina (chest pain due to an inadequate supply of oxygen to the heart muscle), but the two conditions can be distinguished because the pain of thoracic outlet syndrome does not occur or increase when walking, while the pain of angina usually does. Additionally, the pain of TOS typically increases when raising the affected arm, which does not occur with angina.
Signs and symptoms of TOS help determine the type of disorder a patient has. Thoracic outlet syndrome disorders differ, depending on the part(s) of the body they affect. Thoracic outlet syndrome most commonly affects the nerves, but the condition can also affect the veins and arteries (least common type). In all types of TOS, the thoracic outlet space is narrowed, and there is scar formation around the structures.
Types of thoracic outlet syndrome disorders and related symptoms
Neurogenic thoracic outlet syndrome: This condition is related to abnormalities of bony and soft tissue in the lower neck region (which may include the cervical rib area) that compress and irritate the nerves of the brachial plexus, the complex of nerves that supply motor (movement) and sensory (feeling) function to the arm and hand. Symptoms include weakness or numbness of the hand; decreased size of hand muscles, which usually occurs on one side of the body; and/or pain, tingling, prickling, numbness and weakness of the neck, chest, and arms.
Venous thoracic outlet syndrome
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
NVBDCP.pptx Nation vector borne disease control programSapna Thakur
NVBDCP was launched in 2003-2004 . Vector-Borne Disease: Disease that results from an infection transmitted to humans and other animals by blood-feeding arthropods, such as mosquitoes, ticks, and fleas. Examples of vector-borne diseases include Dengue fever, West Nile Virus, Lyme disease, and malaria.
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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.
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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
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5. Muscles of the Shoulder Area
A. The Rotator Cuff
Supraspinatus
Infraspinatus
Subscapularis
Teres minor
B. Big muscles
Deltoid
Pectoralis major
Trapezius
Latissimus dorsi
Teres major
Biceps
6. Physical exam
• Inspection: atrophy, bulging, deformity
• Palpation
• Range of motion: (active, passive / both sides)
- Forward elevation (abduction+flexion)(!)
- Adduction, int. rotation, flexion
- Abduction, ext. rotation, extension
• Tests and signs
7. Physical exam: Tests & signs
• Impingement sign positive in rotator cuff
inflammation/ tearing
• Impingement test injection of local anesthetic to
subacromial space. Positive if pain goes away.
• Apprehension sign 90 degrees abduction & ext.
rotation + mild pressure from behind. Positive in anterior shoulder
instability.
• Drop Arm sign 90 degrees abduction & mild int. rotation.
Positive if the patient can’t hold his/her arm without help.
9. Diagnostic procedures: Radiography
• An AP view x-ray is enough in most cases.
• Lateral / Axillary view in specific cases, e.g.
posterior shoulder dislocation
• MRI / Arthrography for soft tissue injuries e.g.
rotator cuff tendon tearing
11. Biceps Tenosynovitis
• Usually affects biceps long head tendon
• Pain and inflammation after extensive exercise (e.g. tennis)
• Localized pain in bicipital groove
• Supination of the forearm increases the pain.
• Patients usually 30-40 y.o.
• Tx:
- rest, heating the painful area, NSAID,
- local hydrocortisone
12. Biceps Tendon Tear
• Etiology: sudden contraction e.g. heavy load
• Clinical presentation:
- 50-60 y.o. / upper or lower portion (usually upper)
- sudden & extreme pain which decreases over a short period
of time is a characteristic sign
- flexion and ext. rotation weakening of the forearm
- arm deformity (oval shape turns to round & its site changes)
- tenderness in tearing site
- ecchymosis in tearing site
- ROM of the shoulder is NORMAL
13. Biceps Tendon Tear
• Treatment:
A) older patients surgery NOT necessary
B) younger patients surgery
14. Degenerative Arthritis of Shoulder
• Etiology: hx. of past trauma to shoulder & tearing of
the rotator cuff muscles
• Clinical presentation: usually > 50 y.o. / shoulder
restriction of movement / pain with rotational
movements
• Dx: radiography ed articular space, sclerosis,
osteophyte
• Tx:
-medical: NSAID, physiotherapy, Intra-articular steroid
-surgical: joint replacement
16. Frozen Shoulder
• Etiology:
1) Primary ( idiopathic )
2) Secondary : trauma to / surgery on shoulder
- Underlying causes such as diseases of the heart,
brain & neck, breast cancer and diabetes
articular capsule fibrosis due to stimulation of
neurologic reflexes
- Psychological
** decreased articular space in both forms
17. Frozen Shoulder
• Clinical presentation:
- Mostly female / 5th & 6th decades
- Three clinical phases:
1. Persistent pain (esp. at night) + total limitation of movement
2. ed pain (or no change) + ed limitation of movement
3. Movements gradually return to normal form
- int. rotation is the first affected motion in frozen shoulder
- Limitation of passive movements (esp. rotation) to all sides is the key to dx
- Arthrography confirms the dx obvious decreased articular volume
18. Frozen Shoulder
• Treatment:
- Depends on the stage of the disease
- Patient education in all phases
- Corticosteroid / long acting local anesthetic inj.
- Manipulation of shoulder under anesthesia (stage
2,3) increases range of motion
- Arthroscopy (releases fibrotic capsule)
- Surgery (rarely)
19. Frozen Shoulder
• Psychotherapy is suggested due to the
psychological underlying causes of the disease
• Long-term prognosis is good.
• 80% of ROM returns in most cases
20. Rotator Cuff Tear
• Muscles and their functions:
1. Supraspinatus: humerus stabilizer + arm abduction
2. infraspinatus: ext. rotation
3. Teres minor
4. Subscapularis: int. rotation
22. Rotator Cuff Tear
• Etiology
1. Rotator cuff tendons chronically get stuck
between acromion process & greater
tuberosity
2. trauma
23. Rotator Cuff Tear
• Clinical presentation:
- Shoulder pain (the most imp.):
1. anterior with radiation to the arm
2. Mild at first and only when elevating the arm
3. Progression: pain at rest, frozen shoulder
- Decreased ROM (esp. start of shoulder abd.)
- In complete rotator cuff tear & supraspinatus tendon tear, the patient can’t start
shoulder abduction, however, if the shoulder is passively abducted (30 degrees) then
he/she can continue the abduction by using deltoid muscle.
24. Rotator Cuff Tear
• Physical exam:
1. Jobe test (empty can)
2. Ext. rotation stress test
3. Lift-off test
26. Rotator Cuff Tear
• Treatment:
1. Non-surgical: (50% useful)
- decreasing over-head activities of the shoulder
- NSAID
- corticosteroid inj.
- physiotherapy
2. Surgical
IMPORTANT: Complete rest leads to frozen shoulder so it is not
indicated in tx. of rotator cuff tear.
27. Rotator Cuff Tear
• Indications for surgical treatment:
1. No response to non-surgical tx.
2. Massive tearing
3. Acute tear (caused by trauma) esp. in young patients
4. Active patients esp. tear in dominant shoulder
5. Tear + muscular weakness
28. Impingement Syndrome
• Etiology:
- daily over head over activity & sports such as
tennis and swimming (Swimmer’s Shoulder)
- rotator cuff tendons esp. supraspinatus
tendon get stuck between humerus and
acromion process.
- acromion deformity
29. Impingement Syndrome
• Clinical presentation:
- Usually >40 y.o / starts gradually but trauma
or exercise can trigger an acute onset
- Low to moderate pain while active
- Empty can sign (pain and limited motion with
forward elevation & internal rotation) (imp.)
- Painful arc syndrome (pain with 45 to 120
degrees abd.)
30. Impingement Syndrome
- Sometimes: trauma -> broad tendon tear ->
inability to move shoulder -> drop arm test +
- Hawkins-Kennedy sign +
- Neer (Impingement) Sign +
31. Impingement Syndrome
• Diagnosis:
- No sign in AP radiograph
- Spur on the anterior border of
acromion/acromial deformity in true lateral x-
ray view of scapula
- Arthrography & MRI to rule out rotator cuff
tendon tear
32. Impingement Syndrome
• Treatment:
- heavy activities
- Physiotherapy
- NSAID
- Long acting corticosteroid (methyl prednisolone
inj.) in sub-acromial bursa (repeated injections
increases the risk of tendon degeneration & tear)
- Surgery (open or arthroscopy) if no response
after 3-6 months of treatment (esp. in case of
acromion deformity
33. Rotator Cuff Calcified Tendonitis
• Definition
• Epidemiology :
- 20 to 25 y.o / caucasian / male / western
countries
• Three phases
1. Calcium formation in tendon -> pain
2. Stability -> mild, chronic pain
3. Absorption -> scar & granulation tissue replaces
calcium , inflammation, throbbing pain
34. Rotator Cuff Calcified Tendonitis
• Radiographic finding: accumulation of calcium
under acromion process
• Treatment:
- Stage 1,2 : NSAID + physiotherapy
- Stage 3 : steroid + Saline inj. To subacromial space
/ ice pack / morphine for severe pain
- Arthroscopic surgery in case of no response
• Prognosis: calcium will be absorbed finally and
the pain goes away
35. Thank you for your
attention
Farbod Zahedi Tajrishi, Nov. 2015