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SHOULDER AND ELBOW TEACHING

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Presentation on theme: "SHOULDER AND ELBOW TEACHING"— Presentation transcript:

1 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 CONSULTANT SHOULDER AND ELBOW SURGEON SUNRISE HOSPITAL, KOCHI FORMERLY CONSULTANT SHOULDER & UPPERLIMB SURGEON, DARLINGTON AND COUNTY DURHAM UNIVERSITY HOSPITAL, ENGLAND

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

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

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

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

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

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

8 INFERIOR CAPSULAR SHIFT
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 LIGAMENT HYPERLAXITY BENIGN FAMALIAL HYPERLAXITY MARFANS OSTEOGENESIS
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 BEATON SCORE HYPER EXTENSION LITTLE FINGER HYPER FLEXON OF THUMB
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 TRAUMATIC INSTABILITY
SNIMS KOCHI TRAUMATIC INSTABILITY DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

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

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

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

21 POST. DISLOCATION EPILEPSY ELECTRIC SHOCK DIRECT INJURY - BOXING
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 RECURRENT INSTABILITY
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 SLAP SUPERIOR BICEPS ACROMION LABRAL ANTERO POSTERIOR COROCOID SLAP
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 FROZEN SHOULDER SNIMS KOCHI
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

27 WHAT IS IT? All movements reduced PAIN AND STIFFNESS MIDDLE AGED WOMEN
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 1ST PHASE – FREEZING 3MONTHS 2ND PHASE – FROZEN 3-9MONTHS
SNIMS KOCHI 18 TO 24 MONTHS 1ST PHASE – FREEZING 3MONTHS 2ND PHASE – FROZEN MONTHS 3RD PHASE –THAWING MONTHS DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

29 1. Inflammatory synovitis 2. Proliferative synovitis
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 CAPSULE AND LIGAMENTS CONTRACTURE CORACO-HUMERAL LIGAMENT
SNIMS KOCHI CAPSULE AND LIGAMENTS CONTRACTURE CORACO-HUMERAL LIGAMENT DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

31 ASSOCIATION DIABETES DUPUYTREN’S TENNIS / GOLFERS ELBOW DEQUIREVAINS
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 DIABETES AND FROZEN SHOULDER
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 MANAGEMENT COUNCILLING ANALGESIC PHYSIOTHERAPY JOINT INJECTIONS
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 SUBACROMIAL IMPINGEMENT
SNIMS KOCHI SUBACROMIAL IMPINGEMENT DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON

36 WHAT IS IT? SUB ACROMIAL BURSA
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 SYMPTOMS AND SIGNS MIDDLE AGED PAIN ON OVERHEAD ACTIVITIES PAINFUL ARC
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 MANAGEMENT ANALGESICS PHYSIOTHERAPY SUBACROMIAL INJECTION
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 CALCIFIC TENDINITIS MIDDLE AGED ACUTE ONSET EXTREME PAIN
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 www.shoulder4u.com prathap@shoulder4u.com SNIMS KOCHI
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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