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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 A SHOULDER JOINT? DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  4. SNIMS KOCHI SHOULDER JOINT COMPLEX DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  5. SNIMS KOCHI COMMON SHOULLDER PROBLEMS GLENO-HUMERAL JOINT OTHER SHOULDER PROBLEMS STERNO-CLAVICULAR JOINT ARTHRITIS / INSTABILITY ACJ DISLOCATION / ARTHRITIS SCAPULO-THORACIC DYSFUNCTION • INSTABILITY • IMPINGEMENT • FROZEN SHOULDER • ROTATOR CUFF DISEASE • OSTEO-ARTHRITIS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  6. SNIMS KOCHI AGE RELATED GLENO-HUMERAL JOINT PATHOLOGY • INSTABILITY 15-30Yrs • IMPINGEMENT 30-60Yrs • FROZEN SHOULDER 30-60Yrs • ROTATOR CUFF DISEASE 50 +Yrs • OSTEO-ARTHRITIS 60 +Yrs DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  7. SNIMS KOCHI INSTABILITY AMBRI TUBS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  8. SNIMS KOCHI INSTABILITY AMBRI ATRAUMATIC MULTIDIRECTIONAL BILATERAL REHABILITATION INFERIOR CAPSULAR SHIFT TUBS TRAUMATIC UNILATERAL BANKARTS SURGERY DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS(GEN), D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  9. SNIMS KOCHI LIGAMENT HYPERLAXITY • BENIGN FAMALIAL • HYPERLAXITY • MARFANS • OSTEOGENESIS • IMPERFECTA • 4. EHLERS DANLOS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  10. SNIMS KOCHI BEATON SCORE • HYPER EXTENSION LITTLE FINGER • HYPER FLEXON OF THUMB • HYPER EXTENSION OF ELBOW • HYPER EXTENSION KNEE • HYPER FLEXON OF SPINE • TOTAL 9 POINTS • 5/9 SCORE DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  11. SNIMS KOCHI TRAUMATIC INSTABILITY DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  12. SNIMS KOCHI TYPES OF DISLOCATION SHOULDER • ANTERIOR • INFERIOR • SUBCORACOID • POSTERIOR DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  13. SNIMS KOCHI ANTERIOR DISLOCATION • FLEXON –ABDUCTION • 15-25 YRS • BANKARTS LESION • HILLSACHS LESION DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  14. SNIMS KOCHI RADIOGRAPH DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  15. SNIMS KOCHI STABILISORS OF GLENO-HUMERAL JOINT • STATIC • DYNAMIC DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  16. SNIMS KOCHI LIGAMENTS • SGHL • MGHL • AIGHL • PIGHL • CAL • CHL DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

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

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

  20. SNIMS KOCHI KOCHERS HIPPOCRATES DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  21. SNIMS KOCHI POST. DISLOCATION • EPILEPSY • ELECTRIC SHOCK • DIRECT INJURY - BOXING DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  22. SNIMS KOCHI RECURRENT INSTABILITY BANKARTS HILLSACHS INSTABILITY GLENOID BONE LOSS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

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

  25. SNIMS KOCHI SLAP SUPERIOR LABRAL ANTERO POSTERIOR LESION BICEPS ACROMION COROCOID SLAP LABRUM DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

  27. SNIMS KOCHI WHAT IS IT? • All movements reduced • PAIN AND STIFFNESS • MIDDLE AGED WOMEN • External rotation less than 10 degrees • Functionally disabled • Periarthritis / Adhesive Capsulitis / Capsulitis DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  28. SNIMS KOCHI • 18 TO 24 MONTHS • 1ST PHASE – FREEZING 3MONTHS • 2ND PHASE – FROZEN 3-9MONTHS • 3RD PHASE –THAWING 9-24 MONTHS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  29. SNIMS KOCHI 1. Inflammatory synovitis 2. Proliferative synovitis 3. Maturation of the capsule, with reduced vascularity. 4. Burnt out synovium with a dense scar appearance. DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  30. SNIMS KOCHI CAPSULE AND LIGAMENTS CONTRACTURE CORACO-HUMERAL LIGAMENT DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  31. SNIMS KOCHI ASSOCIATION • DIABETES • DUPUYTREN’S • TENNIS / GOLFERS ELBOW • DEQUIREVAINS • PLANTAR FACITIS • FIBROFACITIS • CARDIAC • HYPERLIPIDAEMIA • THYROID PROBLEMS • EPILEPSY DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  32. SNIMS KOCHI DIABETES AND FROZEN SHOULDER • MORE SEVERE • 10-20% ASSOCIATION • 2-4 TIMES INCREASED RISK • TYPE I DM 36% LIFE TIME RISK • 10% BILATERAL DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  33. SNIMS KOCHI MANAGEMENT • COUNCILLING • ANALGESIC • PHYSIOTHERAPY • JOINT INJECTIONS • JOINT DISTENSION • MUA • CAPSULAR RELEASE OPEN / ARTHROSCOPIC DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

  35. SNIMS KOCHI SUBACROMIAL IMPINGEMENT DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  36. SNIMS KOCHI WHAT IS IT? • SUB ACROMIAL BURSA • TIP OF GR TUBEROSITY AGAINST ANTERO-LATERAL EDGE OF ACROMION • SUPRASPINATOUS IN BETWEEN DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

  38. SNIMS KOCHI SYMPTOMS AND SIGNS • MIDDLE AGED • PAIN ON OVERHEAD ACTIVITIES • PAINFUL ARC • IMPINGEMENT SIGN • IMPINGEMENT TEST • RADIGRAPH DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  39. SNIMS KOCHI MANAGEMENT • ANALGESICS • PHYSIOTHERAPY • SUBACROMIAL INJECTION • ARTHROSCOPIC SUBACROMIAL IMPINGEMENT DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  40. SNIMS KOCHI DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

  41. SNIMS KOCHI CALCIFIC TENDINITIS • MIDDLE AGED • ACUTE ONSET • EXTREME PAIN • A/C INFLAMMATION OF SS TENDON • DD: SEPTIC ARTHRITIS • ASPIRATION / STEROID INJECTION • ARTHROSCOPIC SAD +/- REMOVAL OF CALCIUM DR.KR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

  43. SNIMS KOCHI QUESTIONS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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