1 / 34

SHOULDER

SHOULDER. SHOULDER OSTEOLOGY. SHOULDER OSTEOLOGY. ANATOMY:MUSCLES. ANATOMY:CAPSULAR ELEMENTS. IMPINGEMENT:ANATOMY. CA LIGAMENT. ACROMIAL SHAPES. ACROMIAL ANATOMY. ACROMIAL SHAPE. TYPE 1 (FLAT)17% TYPE 2 (CURVED) 43% TYPE 3 (ANTERIOR HOOK) 40% MORRISON & BIGLIANI (1987)

willson
Download Presentation

SHOULDER

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. SHOULDER

  2. SHOULDER OSTEOLOGY

  3. SHOULDER OSTEOLOGY

  4. ANATOMY:MUSCLES

  5. ANATOMY:CAPSULAR ELEMENTS

  6. IMPINGEMENT:ANATOMY CA LIGAMENT

  7. ACROMIAL SHAPES

  8. ACROMIAL ANATOMY

  9. ACROMIAL SHAPE • TYPE 1 (FLAT)17% • TYPE 2 (CURVED) 43% • TYPE 3 (ANTERIOR HOOK) 40% • MORRISON & BIGLIANI (1987) 80% PTS WITH RC TEAR HAD TYPE 3 ACROMION

  10. IMPINGEMENT SYNDROME:STAGES • STAGE 1 : REVERSIBLE EDEMA • STAGE 2: FIBROSIS • STAGE 3: ROTATOR CUFF TEAR

  11. DULL ACHE ACTIVITY RELATED PALPABLE TENDERNESS PAIN BETWEEN 30-60 DEGREE ABDUCTION POSITIVE IMPINGEMENT SIGNS PAIN IN BICIPITAL GROOVE IMPINGEMENT SYNDROME :STAGE 1

  12. IMPINGEMENT SYNDROME:STAGE 1 TREATMENT • NSAID • REST FROM PROVOCATIVE MANUVERS • PHYSICAL THERAPY

  13. ACHING DISCOMFORT PAIN AT REST/NIGHT SUBACROMIAL CREPITUS CATCHING SENSATION DECREASED ROM IMPINGEMENT SYNDROME:STAGE II DIAGNOSIS

  14. REST ICE NSAID SUBACROMIAL INJECTION P.T 1.R.O.M 2. PAIN CONTROL 3. STRENGTH ACROMIOPLASTY 86% SUCCESS IF NO RC TEAR OPEN VS ARTHROSCOPIC IMPINGEMENT SYNDROME:STAGE II TREATMENT

  15. OPEN ACROMIOPLASTY

  16. SUBACROMIAL DECOMPRESSION

  17. ROTATOR CUFF TEARS • PREVALENCE • ETIOLOGY • PHYSICAL EXAM • TREATMENT OPTIONS • REHABILITATION

  18. FULL THICKNESS JEROSCH ,1991-30.3% NEER ,1983- 5% UHLHOFF ,1986-20% WILSON, 1943-26.5% AGE : KEY FACTOR PARTIAL THICKNESS JEROSCH, 1991-28.7% YAMANKA, 1983-13% FUKUDA, 1980-13% DEPALMA, 1973-37% ROTATOR CUFF TEARS:INCIDENCE

  19. EXTRINSIC FACTORS ACROMIAL SHAPE OUTLET STENOSIS AC JOINT DJD OS ACROMIALE INTRINSIC FACTORS SUPRASPINATUS NERVE PALSY GLENOHUMERAL INSTABILITY HYPOVASCULARITY AGING R.C TEARS: ETIOLOGY

  20. PAIN WEAKNESS(ABD/ER) CREPITUS DROP TEST BURSAL EFFUSION LONG HEAD BICEPS RUTURE DECREASED ROM R.C TEARS: DIAGNOSIS

  21. R.C TEAR :DIAGNOSIS DROP TEST EXTERNAL ROTATION INTERNAL ROTATION

  22. R.C TEAR : IMAGING • PLAIN RADIOGRAPHS • ULTRASONOGRAPHY • ARTHROGRAM • MRI: GOLD STANDARD

  23. R.C TEARS: IMAGING INTACT NORMAL CUFF TORN ROTATOR CUFF

  24. R.C TEARS: XRAYS SOUCIL SIGN SHOULDER ARTHROGRAM

  25. ROTATOR CUFF TEAR:TREATMENT • NON-OPERATIVE • ROTATOR CUFF REPAIR ACROMIOPLASTY DISTAL CLAVICLE RESECTION REPAIR OF CUFF

  26. ROTATOR CUFF REPAIR • ACROMIOPLASTY OPEN VS. ARTHROSCOPIC • MOBILIZATION OF TENDON 1. BLUNT DISSECTION 2. RELEASE FASCIAL ATTACHMENTS 3. INCISE CAPSULE AT GLENOID LABRUM

  27. ARTHROSCOPIC SUBACROMIAL DECOMPRESSION SUBACROMIAL SPUR FINISHED ACROMIOPLASTY

  28. ROTATOR CUFF REPAIR • REPAIR 1. CREATE TROUGH 2. DRILL HOLES 3. NON-ABSORBABLE SUTURES 4. SOLID DELTOID REPAIR

  29. ROTATOR CUFF REPAIR

  30. ARTHROSCOPIC ROTATOR CUFF REPAIR

  31. ROTATOR CUFF REPAIR:REHABILITATION • WEEK 0-6 PASSIVE R.O.M • WEEK 6-12 ACTIVE R.O.M • WEEK 12+ STRENGTHENING

  32. ROTATOR CUFF REPAIR:RESULTS • NEER 1988-233 PATIENTS, 4.6 YEAR F.U. 77% EXCELLENT/GOOD 14% SATISFACTORY 9% UNSATISFACTORY • HAWKINS 1985 86% EXCELLENT/GOOD

  33. ROTATOR CUFF REPAIR:RESULTS • HARRYMAN, 1990- 112 PATIENTS 4.7 YEAR F.U. 80% GOOD PAIN RELIEF 80% REPIRS INTACT(S.S) 50% REPAIRS INTACT(IS,SUBSCAP) • PAIN RELIEF INDEPENDENT OF CUFF INTEGRITY • DECOMPRESSION IS THE KEY!!

  34. ROTATOR CUFF REPAIR:REASONS FOR FAILURE • POST-OP SCARRING • DELTOID DETACHMENT • INADEQUATE DECOMPRESSION • RECURRENT TEAR

More Related