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

SEPTEMBER – OCTOBER 2012

FORMERLY CONSULTANT SHOULDER & UPPERLIMB SURGEON, DARLINGTON AND COUNTY DURHAM UNIVERSITY HOSPITAL, ENGLAND

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

SNIMS KOCHI

www.shoulder4u.com

prathap@shoulder4u.com

WHAT IS ROTATOR CUFF?

SNIMS KOCHI

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

SNIMS KOCHI

ROTATOR CUFF MUSCLES

• Group of Muscle which rotate the shoulder ?(EXTERNAL & INTERNAL ROTATION)

• Also abduct (elivate) the arm

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

SNIMS KOCHI

ROTATOR CUFF FUNCTION• CENTRALISE THE SHOULDER JOINT : TO KEEP THE

CENTRE OF ROTATION OF HUMERAL HEAD CONSTANT

SNIMS KOCHI

• External Rotator Supraspinatous Infraspinatous Teres Minor

• Internal Rotator Subscapularis

ROTATOR CUFF MUSCLES

SNIMS KOCHI

SUPRASPINATUS

• Unipinnate • Supraspinous fossa• Anterior aspect of the G

Tuberosity• Supraspinous Nerve• Abduction • Centralisation of Gleno humeral

SNIMS KOCHI

INFRASPINAOUS

• Infraspinous area of scapula• Multipinnate• Middle part of top of G tuberosity• Supraspinous Nerve (C5)• External rotation • Centralise Gleno-humeral joint

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

SNIMS KOCHI

TERES MINOR

• Lateral and inferior border ??????????• Tip of posterior aspect of Greater

tuberosity• Axillary Nerve (C5)• External Rotation in 90degree abduction• Centralise Gleno-humeral joint

SNIMS KOCHI

SUBSCAPULARIS• Anterior ( Costal) part

of body of scapula• Lesser tuberosity• Upper and Lower

subscapularis nerves• Internal rotation of

shoulder• Centralise Gleno-

humeral joint

SNIMS KOCHI

ROTATOR CUFF INJURIES

• TRAUMATIC• DEGENERATIVE• AGE RELATED• ASSOCIATED WITH

GHJ DISLOCATION

SNIMS KOCHI

SYMPTOMS & SIGNS

• PAIN SUDDEN ONSET / INSEDIOUS

• OVERHEAD ACTIVITIES• ADL AFFECTED

• TENDER OVER GR.TUBEROSITY

• WASTING• PSUDOPARALYSIS• INTACT NEUROLOGICAL

STATUS

SNIMS KOCHI

INVESTIGATION

• RADIOGRAPH• ULTRASOUND SCAN• MRI SCAN

• WHICH IS BETTER?

SNIMS KOCHI

MANAGEMENT

NON-OPERATIVE

• ANALGESICS• PHYSIOTHERAPY (DELTOID REHABILITATION)

• CUFF REPAIR ARTHROSCOPIC x OPEN

SNIMS KOCHI

COMPLICATIONS

• 2 FROZEN SHOULDER• CUFF ARTHROPATHY• INSTABILITY

SNIMS KOCHI

OSTEOARTHRITIS GLENO-HUMERAL JOINT

• SYMPTOMS & SIGNS• PAIN• PRIMARY:AGE RELATED• SECONDARY• INSEDIOUS ONSET• LIMITATION OF

MOVEMENTS (EXT.ROTATION) - ADL

• RADIOGRAPH

SNIMS KOCHI

MANAGEMENT

• NON-OPERATIVE• ANALGESICS• I/A INJECTIONS• MOBILISATION• PHYSIOTHERAPY

• OPERATIVE• RESURFACING

ARTHROPLASTY• HEMIARTHROPLASTY• TOTAL SHOULDER

ARTHROPLASTY• REVERSE SHOULDER

ARTHROPLASTY

SNIMS KOCHI

SHOULDER ARTHROPLASTY

SNIMS KOCHI

COMPLICATIONS

• 2 FROZEN SHOULDER• CUFF ARTHROPATHY• INSTABILITY

SNIMS KOCHI

ROTATOR CUFF ARTHROPATHY

SNIMS KOCHI

AC JOINT ARTHRITIS

SIGNS AND SYMPTOMS• AGE RELATED• INJURY ACJ INSTABILITY• PAIN • TENDERNESS• RESTRICTION OF

MOVEMENTS• +VE CROSS ADDUCTION

MANAGEMENT• ANALGESICS• ACJ INJECTION• PHYSIO• ACJ RESECTION :

ARTHROSCOPIC / OPEN

SNIMS KOCHI

RUPTURE OF LONG HEAD OF BICEPS (LHB)

• RUPTURE FROM SUPRA GLENOID TUBERCLE

• TRAUMATIC• DEGENERATIVE

• POP EYE SIGN• PAIN / SOME

LIMITATION• IGNORE / TENODESIS

SNIMS KOCHI

SHOULDER ARTHROSCOPY

SNIMS KOCHI

SHOULDER ARTHROSCOPY

SNIMS KOCHI

TRAUMA

SNIMS KOCHI

AC JOINT INJURY

MECHANISM

• FALL ON TO SHOULDER• RTA• FOOSH

TYPES OF INJURY

TYPE 1

TYPE 111

TYPE 11

TYPE VTYPE V1

TYPE 1V

SNIMS KOCHI

MANAGEMENT

TYPE 1, 11 & 111

• NON-OPERATIVE• BROAD ARM SLING

TYPE 1V, V & V1

• SURGICAL• STABILISATION • ACJ RECONSTRUCTION• ACJ RESECTION &

RECONSTRUCTION

SNIMS KOCHI

FRACTURE CLAVICLE

ANATOMY OF CLAVICLE• ONLY LONG BONE IN

HORRIZONTAL POSITION• INTRA-MEMBRANOUS

OSSIFICATION• FOOSH

EPIDEMIOLOGY OF FRACTURE

SNIMS KOCHI

FRACTURE CLAVICLE

CLASSIFICATION• MIDDLE 1/3RD 80%

• DISTAL 1/3RD 10-15%

• MEDIAL 1/3RD 5%

COMPLICATIONS• BRACHIAL PLEXUS INJURY• SUBCLAVIAN ARTERY / VEIN

INJURY

SNIMS KOCHI FRACTURE CLAVICLE MANAGEMENT

NON-OPERATIVE• BROAD ARM SLING• ANALGESICS

OPERATIVE• OPEN #• NEUROVASCULAR INJURY• SHORTENING OF CLAVICLE

>2CM• PROTRACTION OF SCAPULA

SNIMS KOCHI

ORIF CLAVICLE

SNIMS KOCHI

ORIF WITH LOCKING PLATE

SNIMS KOCHI

FRACTURE NECK OF HUMERUS

EPIDEMIOLOGY• OLD AGE• OSTEOPOROSIS• YOUNG PATIENTS • HIGH VELOCITY• FOOSH

SNIMS KOCHI

CLASSIFICATION

SNIMS KOCHI

MANAGEMENT

NON-OPERATIVE• ANALGESICS• COLLAR & CUFF SLING• WEEKLY RADIOGRAPHS• EARLY MOVEMENTS

OPERATIVE• DISPLACED FRACTURES• EARLY MOBILISATION• ORIF WITH PLATE & SCREWS• LOCKING PLATE

SNIMS KOCHI

ORIF # NECK OF HUMERUS

SNIMS KOCHI

COMPLICATIONS

• MALUNION• NON-UNION• STIFFNESS• CRPS

• NERVE AT RISK• AXILLARY NERVE

SNIMS KOCHI

www.shoulder4u.com

prathap@shoulder4u.com

SNIMS KOCHI

SHOULDER AND ELBOW TEACHING

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