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SHOULDER AND ELBOW TEACHING

SEPTEMBER – OCTOBER 2012. SHOULDER AND ELBOW TEACHING. DR.KR. PRATHAP KUMAR MB, FRCS( Tr&Orth ), FRCS, D’ORTH, Dip ATLS FELLOWSHIP SHOULDER SURGERY(MANCHESTER) FELLOWSHIP HAND SURGERY(LIVERPOOL) ASSISTANT PROFESSOR, DEPT OF ORTHOPAEDICS, SNIMS, KOCHI

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SHOULDER AND ELBOW TEACHING

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  1. SEPTEMBER – OCTOBER 2012 SHOULDER AND ELBOW TEACHING DR.KR. PRATHAP KUMAR MB, FRCS(Tr&Orth), FRCS, D’ORTH, Dip ATLS FELLOWSHIP SHOULDER SURGERY(MANCHESTER) FELLOWSHIP HAND SURGERY(LIVERPOOL) ASSISTANT PROFESSOR, DEPT OF ORTHOPAEDICS, SNIMS, KOCHI CONSULTANT SHOULDER AND ELBOW SURGEON SUNRISE HOSPITAL, KOCHI FORMERLY CONSULTANT SHOULDER & UPPERLIMB SURGEON, DARLINGTON AND COUNTY DURHAM UNIVERSITY HOSPITAL, ENGLAND

  2. SNIMS KOCHI www.shoulder4u.com prathap@shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  3. SNIMS KOCHI WHAT IS ROTATOR CUFF? www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  4. SNIMS KOCHI ROTATOR CUFF MUSCLES • Group of Muscle which rotate the shoulder ? • (EXTERNAL & INTERNAL ROTATION) • Also abduct (elivate) the arm www.shoulder4u.com DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  5. SNIMS KOCHI ROTATOR CUFF FUNCTION • CENTRALISE THE SHOULDER JOINT : TO KEEP THE CENTRE OF ROTATION OF HUMERAL HEAD CONSTANT www.shoulder4u.com DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  6. SNIMS KOCHI ROTATOR CUFF MUSCLES • External Rotator Supraspinatous Infraspinatous Teres Minor • Internal Rotator Subscapularis www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  7. SNIMS KOCHI SUPRASPINATUS • Unipinnate • Supraspinous fossa • Anterior aspect of the G Tuberosity • Supraspinous Nerve • Abduction • Centralisation of Gleno humeral joint www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  8. SNIMS KOCHI INFRASPINAOUS • Infraspinous area of scapula • Multipinnate • Middle part of top of G tuberosity • Supraspinous Nerve (C5) • External rotation • Centralise Gleno-humeral joint www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  9. SNIMS KOCHI TERES MINOR • Lateral and inferior border ?????????? • Tip of posterior aspect of Greater tuberosity • Axillary Nerve (C5) • External Rotation in 90degree abduction • Centralise Gleno-humeral joint www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS(GEN), D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  10. SNIMS KOCHI SUBSCAPULARIS • Anterior ( Costal) part of body of scapula • Lesser tuberosity • Upper and Lower subscapularis nerves • Internal rotation of shoulder • Centralise Gleno-humeral joint www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  11. SNIMS KOCHI ROTATOR CUFF INJURIES • TRAUMATIC • DEGENERATIVE • AGE RELATED • ASSOCIATED WITH GHJ DISLOCATION www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  12. SNIMS KOCHI SYMPTOMS & SIGNS • PAIN SUDDEN ONSET / INSEDIOUS • OVERHEAD ACTIVITIES • ADL AFFECTED • TENDER OVER GR.TUBEROSITY • WASTING • PSUDOPARALYSIS • INTACT NEUROLOGICAL STATUS www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  13. SNIMS KOCHI INVESTIGATION • RADIOGRAPH • ULTRASOUND SCAN • MRI SCAN • WHICH IS BETTER? www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  14. SNIMS KOCHI MANAGEMENT NON-OPERATIVE • ANALGESICS • PHYSIOTHERAPY (DELTOID REHABILITATION) • CUFF REPAIR ARTHROSCOPIC x OPEN www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  15. SNIMS KOCHI COMPLICATIONS • 2 FROZEN SHOULDER • CUFF ARTHROPATHY • INSTABILITY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  16. SNIMS KOCHI OSTEOARTHRITIS GLENO-HUMERAL JOINT • SYMPTOMS & SIGNS • PAIN • PRIMARY:AGE RELATED • SECONDARY • INSEDIOUS ONSET • LIMITATION OF MOVEMENTS (EXT.ROTATION) - ADL • RADIOGRAPH www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  17. SNIMS KOCHI MANAGEMENT • NON-OPERATIVE • ANALGESICS • I/A INJECTIONS • MOBILISATION • PHYSIOTHERAPY • OPERATIVE • RESURFACING ARTHROPLASTY • HEMIARTHROPLASTY • TOTAL SHOULDER ARTHROPLASTY • REVERSE SHOULDER ARTHROPLASTY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  18. SNIMS KOCHI www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  19. SNIMS KOCHI SHOULDER ARTHROPLASTY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  20. SNIMS KOCHI COMPLICATIONS • 2 FROZEN SHOULDER • CUFF ARTHROPATHY • INSTABILITY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  21. SNIMS KOCHI ROTATOR CUFF ARTHROPATHY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  22. SNIMS KOCHI AC JOINT ARTHRITIS SIGNS AND SYMPTOMS MANAGEMENT ANALGESICS ACJ INJECTION PHYSIO ACJ RESECTION : ARTHROSCOPIC / OPEN www.shoulder4u.com • AGE RELATED • INJURY ACJ INSTABILITY • PAIN • TENDERNESS • RESTRICTION OF MOVEMENTS • +VE CROSS ADDUCTION TEST DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  23. SNIMS KOCHI RUPTURE OF LONG HEAD OF BICEPS (LHB) • RUPTURE FROM SUPRA GLENOID TUBERCLE • TRAUMATIC • DEGENERATIVE • POP EYE SIGN • PAIN / SOME LIMITATION • IGNORE / TENODESIS www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  24. SNIMS KOCHI SHOULDER ARTHROSCOPY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  25. SNIMS KOCHI SHOULDER ARTHROSCOPY www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  26. SNIMS KOCHI www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  27. SNIMS KOCHI www.shoulder4u.com www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  28. SNIMS KOCHI TRAUMA www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  29. SNIMS KOCHI AC JOINT INJURY MECHANISM TYPES OF INJURY www.shoulder4u.com • FALL ON TO SHOULDER • RTA • FOOSH TYPE 1 TYPE 11 TYPE 111 TYPE 1V TYPE V1 TYPE V DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  30. SNIMS KOCHI MANAGEMENT TYPE 1, 11 & 111 TYPE 1V, V & V1 SURGICAL STABILISATION ACJ RECONSTRUCTION ACJ RESECTION & RECONSTRUCTION www.shoulder4u.com • NON-OPERATIVE • BROAD ARM SLING DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  31. SNIMS KOCHI FRACTURE CLAVICLE ANATOMY OF CLAVICLE EPIDEMIOLOGY OF FRACTURE www.shoulder4u.com • ONLY LONG BONE IN HORRIZONTAL POSITION • INTRA-MEMBRANOUS OSSIFICATION • FOOSH DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  32. SNIMS KOCHI FRACTURE CLAVICLE CLASSIFICATION COMPLICATIONS BRACHIAL PLEXUS INJURY SUBCLAVIAN ARTERY / VEIN INJURY www.shoulder4u.com • MIDDLE 1/3RD 80% • DISTAL 1/3RD 10-15% • MEDIAL 1/3RD 5% DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  33. SNIMS KOCHI FRACTURE CLAVICLE MANAGEMENT NON-OPERATIVE OPERATIVE OPEN # NEUROVASCULAR INJURY SHORTENING OF CLAVICLE >2CM PROTRACTION OF SCAPULA www.shoulder4u.com • BROAD ARM SLING • ANALGESICS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  34. SNIMS KOCHI ORIF CLAVICLE www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  35. SNIMS KOCHI ORIF WITH LOCKING PLATE www.shoulder4u.com www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  36. SNIMS KOCHI FRACTURE NECK OF HUMERUS EPIDEMIOLOGY www.shoulder4u.com • OLD AGE • OSTEOPOROSIS • YOUNG PATIENTS • HIGH VELOCITY • FOOSH DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  37. SNIMS KOCHI CLASSIFICATION www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  38. SNIMS KOCHI MANAGEMENT NON-OPERATIVE OPERATIVE DISPLACED FRACTURES EARLY MOBILISATION ORIF WITH PLATE & SCREWS LOCKING PLATE www.shoulder4u.com • ANALGESICS • COLLAR & CUFF SLING • WEEKLY RADIOGRAPHS • EARLY MOVEMENTS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  39. SNIMS KOCHI ORIF # NECK OF HUMERUS www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  40. SNIMS KOCHI COMPLICATIONS • MALUNION • NON-UNION • STIFFNESS • CRPS • NERVE AT RISK • AXILLARY NERVE www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  41. SNIMS KOCHI www.shoulder4u.com prathap@shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  42. SNIMS KOCHI ? www.shoulder4u.com DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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