In the name of god

1. In the name of god

2. Calcificatintedinitis By: zohredolatkhah

3. Introduction • The part of the body where the humerus attaches to the scapula. • The shoulder must be mobileenough for the wide range actions of the arms and hands, but also stable enough to allow actions such as lifting, pushing and pulling. • It is made up of three bones. • Clavicle, • Scapula • Humerus.

5. Joints of the shoulder: 1. Glenohumeral joint(main one, ball and socket joint, articulation between the glenoidfossa of the scapula (shoulder blade) and the head of the humerus 2. Acromioclavicular joint(articulation between the acromion process of the scapula and the lateral end of the clavicle ) 3. Sternoclavicular joint (articulation between sternal end of the clavicle, and the manubriumsterni

6. There are two kinds of cartilage in the joint: 1. Articular cartilage: covers humerus head and glenoid surface. It’s a white cartilage which allows the bones to glide and move on each other. When this type of cartilage starts to wear out (a process called arthritis), the joint becomes painful and stiff. 2. Labrum: its a ring of rigid fibrous cartilage surrounding the glenoid cavity, it stabilizes the ball and socket joint!

9. Rotator Cuff muscles • The group of four muscles and their tendons that act to stabilize the shoulder . *the strength of the joint depend on the tone of these group of muscle which across in front,above ,behind the jont 1- Supraspinatous – abducts the arm 2- Infraspinatous – external rotation 3- Teres Minor – external rotation 4- Subscapularis – internal rotation

10. Anatomy

12. These muscles arise from the scapula and connect to the head of the humerus, forming • a cuff at the shoulder joint. • They hold the head of the humerus in the small and shallow glenoidfossaof the scapula. • Nerve supply:axillary and suprascapular nerve

13. Calcific Tendinitis • A disorder characterized by deposits of crytalline calcium phosphate in any tendon of the rotator cuff muscles causing inflammation and pain. • It is of unknown etiology. • Most people over the age of 40 Pain is aggravated by elevation of the arm above shoulder level or by lying on the shoulder. • sever Pain may awaken the patient from sleep. • its one of the most painful conditions in the shoulder .

14. When this condition is symptomatic, it may present in the following 2 ways: • Chronic, relatively mild pain with intermittent flares, similar to shoulder impingement syndrome, is believed to indicate that the condition is in the formative phase. • Mechanical symptomsmay arise from a large calcific deposit → build up of pressure in the tendon→intensepain→limitation of movement

15. There are three types of shoulder tendinitis. 1. rotator cuff 2. calcific tendinitis 3.biceps tendinitis The rotator cuff consists of four muscles around the shoulder joint that help control the shoulders position and keep it stable. With rotator cuff tendinitis the pain is located about three inches below the top of the shoulder and is felt when reaching over head or behind the back. Rotator cuff tendinitis will usually resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the areas surrounding the tendon, as well as exercising using light weights

16. Calcific tendinitis is caused by calcium deposits in the rotator cuff region. Symptoms include excruciating pain and sever restriction of shoulder motion. X-rays reveal calcium deposits within the rotator cuff or overlying the head of the humerus. Treatment includes injection of cortisone and a local anesthetic into the area surrounding the tendon. Multiple needle punctures into the calcium deposit may break up the deposit.

17. Biceps tendinitis is inflammation of the biceps tendons that attach to the shoulder. Biceps tendons that attach to the shoulder. Biceps tendinitis usually affects individuals whose occupation involves repetitive biceps flexion against resistance or whose activities include forceful throwing of a ball. Biceps tendinitis will resolve with rest, anti-inflammatory medications or an injection of cortisone and a local anesthetic into the area surrounding the tendon, as well as a sling to immobilize the shoulder. Surgery is occasionally required to stabilize a displaced tendon

18. Causes and risk factors of Tendinitis • The most common causes of tendinitis are injury, overuse, infection of the tendon sheath or disease (tendinitis is evident in rheumatoid arthritis, gout and psoriatic arthritis). More often than not, the cause of tendinitis is unknown

19. Prevention of Tendinitis • Proper conditioning • Gradual introduction of activity • Warm-up and stretching prior to exercise • Wearing appropriate shoes for the activity

20. Diagnosis of Tendinitis • In order to properly and accurately diagnose tendinitis a careful study of medical history and physical examination is required by the health care provider. X-rays are of great help for excluding any bone abnormalities or conditions like arthritis. As tendons are not generally visible to the naked eyes on x-rays. MRI’s and ultrasound are often found to be useful in the detection of tendinitis. Blood tests may be taken in order to confirm presence of any other underlying conditions. But such tests are generally not necessary in the process of diagnosing tendinitis.

21. Diagnoses by : • Xray • Ultrasound (more accurate) calcific deposits are visible as lumps or cloudy areas. Mostly found on the greater tuberosity

23. Treatment • NSAID injection • Injections, needling, and lavage Breaking up the calcific deposits by repeatedly puncturing them with a needle, aspirating the calcific material, with the help of saline. • Surgery(rarely required) • Physiotherapy to regain muscle strength

24. Thanks for your attention