1. Painful shoulder

2. Referred pain synd.
Cervical spondylosis
Mediastinal pathology
IHD

3. Joint disorder
Glenohumeral arthritis
Acromioclavicular arthritis

4. Bone lesion
Infection
Tumor

5. Rotator cuff disorder
Tendinitis
Rupture
Frozen shoulder

6. instability
Dislocation
Sublaxation

7. Nerve inj.
Suprascapular nerve entrapment

8. dis.of rotator cuff
Muscles of rotator cuff 1.supraspinatus . 2.infraspinatus . 3.teres minor. 4.subscapularis.

9. Impingement synd.
Rupture of rotator cuff.
Acute calcific tendinitis
Biceps tentinitis –rupture
Adhesive capsulitis

10. Supraspinatus tendinitis
is a painful dis. Which is thought to arise from repetitive compression or rubbing of tendons (mainly supraspinatous)under the corocoacromial arch. Normally when the arm is abd. ,the conjoint tendon slides under the corcoacromial arch. Other cause O.A of A.C joint

11. C.F
Depend on
Age
Stage
Healing resonse

12. Pattern of symptoms Subacute tentinitis
(congestion,mic.heamorrage,odema)
Pt. under 40 y .
Ant. Shoulder pain after vigorius activity
Shoulder look normal
Tenderness in ant. Edge of acromian
Point tenderness

13. Three test in diagnosis
Painful arc
Impingement sign
Impingement test

14. Imaging X-ray normal in acute stage
chronic (erosion,sclerosis,cystic lesion) in
the site of cuff insertion
2.Arthrigrafy show partial or complete tear
3. U.S show large tear
4.MRI.show structure around shoulder

15. Treatment
self limiting dis. Physiotherapy Start course of NSAID. Local injection

16. Surgical treatment Open acromioplasty Arthroscopic acromiopplasty
Open repair of rotator cuff

17. Thank
You