Shoulder pain Dr Shrenik Shah Overview Anatomy Clinicopathoradio

  • Slides: 28
Download presentation
Shoulder pain Dr Shrenik Shah

Shoulder pain Dr Shrenik Shah

Overview • Anatomy • Clinico-patho-radio correlation • How to manage day to day shoulder

Overview • Anatomy • Clinico-patho-radio correlation • How to manage day to day shoulder problems? • Promising modality RSWT

Anatomy • 1. 2. 3. 4. 4 articulations Sterno-clavicular Acromio-clavicular Humero-scapular Thoraco-scapular

Anatomy • 1. 2. 3. 4. 4 articulations Sterno-clavicular Acromio-clavicular Humero-scapular Thoraco-scapular

Rotator cuff

Rotator cuff

Rotator cuff • • Subscapularis Supraspinatus Infraspinatus Teres minor

Rotator cuff • • Subscapularis Supraspinatus Infraspinatus Teres minor

Range of motion • Elevation-0 -160* • External rotation- 0 -60* • Internal rotation

Range of motion • Elevation-0 -160* • External rotation- 0 -60* • Internal rotation –thumb reaches upto spinous processes thoracic 6 -8 • Adduction – crossbody • Abduction- 0 -170* • Flexion- 0 -170* • Extension- 0 -30*

Impingement syndrome • Pain on greater tuberosity impinges on to acromion • Pain on

Impingement syndrome • Pain on greater tuberosity impinges on to acromion • Pain on overhead motion • Sleeping on affected side • Night pains

DIAGNOSIS • History • Clinical exam- tests – Hawkins – Neer – Jobe •

DIAGNOSIS • History • Clinical exam- tests – Hawkins – Neer – Jobe • Xray • Usg • MRI

x-rays

x-rays

Usg and MRI

Usg and MRI

Impingement etiology rotator cuff tears overuse Outlet stenosis instability degeneration extrinsic intrinsic

Impingement etiology rotator cuff tears overuse Outlet stenosis instability degeneration extrinsic intrinsic

Supraspinatus tendinopathy

Supraspinatus tendinopathy

Rotator cuff tears

Rotator cuff tears

Rotator cuff tears • Etiology – Degenerative – Increasing incidence with age – Symptoms

Rotator cuff tears • Etiology – Degenerative – Increasing incidence with age – Symptoms sometimes start with a trivial trauma – Should be diagnosed within 3 weeks – Treated early

Arthroscopy

Arthroscopy

Partial rotator cuff tear

Partial rotator cuff tear

Massive tear of rotator cuff

Massive tear of rotator cuff

Xray

Xray

Glenohumeral arthritis

Glenohumeral arthritis

Shoulder arthroplasty

Shoulder arthroplasty

Frozen shoulder Adhesive capsulitis • • • A specific entity Unknown etiology Women >

Frozen shoulder Adhesive capsulitis • • • A specific entity Unknown etiology Women > men 40 -60 years Risk factors – DM, x 5 more – Thyroid diseases – Cervical disc disease

Stages of frozen shoulder 1. Freezing: pain ++ lose ROM 6 weeks to 9

Stages of frozen shoulder 1. Freezing: pain ++ lose ROM 6 weeks to 9 months 2. Frozen: pain decreases but stiffness+ 4 -6 months 3. Thawing: ROM slowly improves 6 months to 2 years

Treatment • • • Drugs- analgesics and NSAIDs, etc Steroid injections Physical therapy Manipulation

Treatment • • • Drugs- analgesics and NSAIDs, etc Steroid injections Physical therapy Manipulation under anesthesia Arthroscopic release ESWT/ RSWT

Pre ESWT

Pre ESWT

Post ESWT

Post ESWT

CONCLUSION • Shoulder needs both clinical evaluation and imaging to arrive at a diagnosis.

CONCLUSION • Shoulder needs both clinical evaluation and imaging to arrive at a diagnosis. • Plan of treatment: early intervention can prevent unavoidable sequelae – Rotator cuff tear arthroapathy – Small lesions triggering adhesive capsulitis • Noninvasive RSWT works in most patients – Reduces suffering to great extent – Decreases rehab time – Restores early motion

WWW. ESWTINDIA. COM

WWW. ESWTINDIA. COM

SHOULDER SHOULDER OSTEOLOGY SHOULDER OSTEOLOGY ANATOMY MUSCLES ANATOMYSHOULDER SHOULDER OSTEOLOGY SHOULDER OSTEOLOGY ANATOMY MUSCLES ANATOMY
CLINICAL CASE HIP PAIN DR SHRENIK SHAH SHREYCLINICAL CASE HIP PAIN DR SHRENIK SHAH SHREY
Diagnostic dilemma Dr Shrenik Shah Shrey hospital CaseDiagnostic dilemma Dr Shrenik Shah Shrey hospital Case
ATHLETIC SHOES DR SHRENIK SHAH SHREY HOSPITAL NAVRANGPURAATHLETIC SHOES DR SHRENIK SHAH SHREY HOSPITAL NAVRANGPURA
PEIPHERAL NERVE INJURIES DR SHRENIK M SHAH SHREYPEIPHERAL NERVE INJURIES DR SHRENIK M SHAH SHREY
Shoulder Shoulder Shoulder Dislocations Most common type flattenedShoulder Shoulder Shoulder Dislocations Most common type flattened
Shoulder Analysis Chapter 5 Shoulder Muscle Exercises ShoulderShoulder Analysis Chapter 5 Shoulder Muscle Exercises Shoulder
Shoulder Joint Shoulder Glenohumeral Joint The shoulder jointShoulder Joint Shoulder Glenohumeral Joint The shoulder joint
The Shoulder Label the Shoulder The shoulder isThe Shoulder Label the Shoulder The shoulder is
Anterior Chest Pain a musculoskeletal perspective Dr ShrenikAnterior Chest Pain a musculoskeletal perspective Dr Shrenik
PAIN How to manage pain About pain PainPAIN How to manage pain About pain Pain
Pain Science PAIN DRAWING PAIN DRAWING PAIN DRAWINGPain Science PAIN DRAWING PAIN DRAWING PAIN DRAWING
THE SHOULDER COMPLEX Anatomy Bones Anatomy Ligaments AnatomyTHE SHOULDER COMPLEX Anatomy Bones Anatomy Ligaments Anatomy
Shoulder pain q The shoulder is the mostShoulder pain q The shoulder is the most
Shoulder Pain and the Shoulder Exam CHA AmbulatoryShoulder Pain and the Shoulder Exam CHA Ambulatory
THE SHOULDER ANATOMY BONES Shoulder Girdle 1 ScapulawithTHE SHOULDER ANATOMY BONES Shoulder Girdle 1 Scapulawith
Shoulder Anatomy Shoulder It is a ball andShoulder Anatomy Shoulder It is a ball and
Shoulder Anatomy Shoulder p It is a ballShoulder Anatomy Shoulder p It is a ball
THE SHOULDER JOINT AHMAD YASIN ALZUBI Shoulder anatomyTHE SHOULDER JOINT AHMAD YASIN ALZUBI Shoulder anatomy
Shoulder Upper Arm Injuries Skeletal Anatomy Shoulder UpperShoulder Upper Arm Injuries Skeletal Anatomy Shoulder Upper
THE SHOULDER ANATOMY BONES Shoulder Girdle 1 ScapulawithTHE SHOULDER ANATOMY BONES Shoulder Girdle 1 Scapulawith
Shoulder Trauma Normal anatomy Standard AP shoulder seriesShoulder Trauma Normal anatomy Standard AP shoulder series
Shoulder Anatomy How the shoulder works 01 TheShoulder Anatomy How the shoulder works 01 The
Shoulder Anatomy How the shoulder works 01 TheShoulder Anatomy How the shoulder works 01 The