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Differential diagnosis

Differential diagnosis. Mazyad Alotaibi. Differential diagnosis. What are the clinical features What structures could refer to the area -underlying structures -structures above -structures below Differential diagnosis and clinical reasoning. Inert Tissue.

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Differential diagnosis

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  1. Differential diagnosis Mazyad Alotaibi

  2. Differential diagnosis • What are the clinical features • What structures could refer to the area -underlying structures -structures above -structures below • Differential diagnosis and clinical reasoning

  3. Inert Tissue • Bone, cartilage, ligament, bursa, fascia, neural tissue • Test by passive stretching or by squeezing

  4. Contractile Tissue • Muscle, musculo-tendinous junction, body of tendon, teno-osseus junction, bone at insertion of tendon • Test by isometric contraction or by passive stretching

  5. Capsular Pattern • When a joint is irritated by trauma, disease or degeneration, the inflamed capsule contracts, producing a loss of range in a set proportion. • This is known as a capsular pattern. • Each joint has its own capsular pattern.

  6. Differential diagnosis • Eg. 1 Pain on resisted LR & passive MR Contractile tissue at fault LR – infraspinatus & teres minor Localise further by palpation • Eg. 2 Active -  ROM LR, Flex, MR Contractile or inert Passive -  ROM LR, Flex, MR Inert structure, capsular pattern  capsulitis

  7. Eg. 3 • Active = Full ROM, painful arc on abd Contractile (deltoid, supra. Sp) or Inert (capsule, bursa) • Passive = Full ROM, painful arc on abs Contractile – not working contractile unit & not putting it on stretch Inert – non-capsular pattern – not capsulitis - bursa; squeezing bursa in sub-acromial space Clinical diagnosis = sub-acromial bursitis

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