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Shoulder pain Dr Shrenik Shah

Learn about shoulder anatomy, common problems, diagnostic methods, and treatment options including RSWT. Early intervention can prevent complications like adhesive capsulitis and rotator cuff tears. Visit www.eswtindia.com for more information.

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Shoulder pain Dr Shrenik Shah

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  1. Shoulder painDr Shrenik Shah

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

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

  4. Rotator cuff

  5. Rotator cuff • Subscapularis • Supraspinatus • Infraspinatus • Teres minor

  6. 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*

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

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

  9. x-rays

  10. Usg and MRI

  11. Impingement etiologyrotator cuff tears

  12. Supraspinatus tendinopathy

  13. Rotator cuff tears

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

  15. Arthroscopy

  16. Partial rotator cuff tear

  17. Massive tear of rotator cuff

  18. Xray

  19. Glenohumeral arthritis

  20. Shoulder arthroplasty

  21. Frozen shoulderAdhesive capsulitis • A specific entity • Unknown etiology • Women > men • 40-60 years • Risk factors • DM,x5 more • Thyroid diseases • Cervical disc disease

  22. 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

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

  24. Pre ESWT

  25. Post ESWT

  26. 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

  27. THANK YOU WWW.ESWTINDIA.COM

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