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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 - PowerPoint PPT Presentation
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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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
• External Rotator Supraspinatous Infraspinatous Teres Minor
• Internal Rotator Subscapularis
ROTATOR CUFF MUSCLES
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
SUPRASPINATUS
• Unipinnate • Supraspinous fossa• Anterior aspect of the G
Tuberosity• Supraspinous Nerve• Abduction • Centralisation of Gleno humeral
joint
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
ROTATOR CUFF INJURIES
• TRAUMATIC• DEGENERATIVE• AGE RELATED• ASSOCIATED WITH
GHJ DISLOCATION
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
SYMPTOMS & SIGNS
• PAIN SUDDEN ONSET / INSEDIOUS
• OVERHEAD ACTIVITIES• ADL AFFECTED
• TENDER OVER GR.TUBEROSITY
• WASTING• PSUDOPARALYSIS• INTACT NEUROLOGICAL
STATUS
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
INVESTIGATION
• RADIOGRAPH• ULTRASOUND SCAN• MRI SCAN
• WHICH IS BETTER?
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
MANAGEMENT
NON-OPERATIVE
• ANALGESICS• PHYSIOTHERAPY (DELTOID REHABILITATION)
• CUFF REPAIR ARTHROSCOPIC x OPEN
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
COMPLICATIONS
• 2 FROZEN SHOULDER• CUFF ARTHROPATHY• INSTABILITY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
OSTEOARTHRITIS GLENO-HUMERAL JOINT
• SYMPTOMS & SIGNS• PAIN• PRIMARY:AGE RELATED• SECONDARY• INSEDIOUS ONSET• LIMITATION OF
MOVEMENTS (EXT.ROTATION) - ADL
• RADIOGRAPH
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
MANAGEMENT
• NON-OPERATIVE• ANALGESICS• I/A INJECTIONS• MOBILISATION• PHYSIOTHERAPY
• OPERATIVE• RESURFACING
ARTHROPLASTY• HEMIARTHROPLASTY• TOTAL SHOULDER
ARTHROPLASTY• REVERSE SHOULDER
ARTHROPLASTY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
SHOULDER ARTHROPLASTY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
COMPLICATIONS
• 2 FROZEN SHOULDER• CUFF ARTHROPATHY• INSTABILITY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
ROTATOR CUFF ARTHROPATHY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
AC JOINT ARTHRITIS
SIGNS AND SYMPTOMS• AGE RELATED• INJURY ACJ INSTABILITY• PAIN • TENDERNESS• RESTRICTION OF
MOVEMENTS• +VE CROSS ADDUCTION
TEST
MANAGEMENT• ANALGESICS• ACJ INJECTION• PHYSIO• ACJ RESECTION :
ARTHROSCOPIC / OPEN
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
RUPTURE OF LONG HEAD OF BICEPS (LHB)
• RUPTURE FROM SUPRA GLENOID TUBERCLE
• TRAUMATIC• DEGENERATIVE
• POP EYE SIGN• PAIN / SOME
LIMITATION• IGNORE / TENODESIS
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
SHOULDER ARTHROSCOPY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
SHOULDER ARTHROSCOPY
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
TRAUMA
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
MANAGEMENT
TYPE 1, 11 & 111
• NON-OPERATIVE• BROAD ARM SLING
TYPE 1V, V & V1
• SURGICAL• STABILISATION • ACJ RECONSTRUCTION• ACJ RESECTION &
RECONSTRUCTION
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
FRACTURE CLAVICLE
ANATOMY OF CLAVICLE• ONLY LONG BONE IN
HORRIZONTAL POSITION• INTRA-MEMBRANOUS
OSSIFICATION• FOOSH
EPIDEMIOLOGY OF FRACTURE
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
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
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI FRACTURE CLAVICLE MANAGEMENT
NON-OPERATIVE• BROAD ARM SLING• ANALGESICS
OPERATIVE• OPEN #• NEUROVASCULAR INJURY• SHORTENING OF CLAVICLE
>2CM• PROTRACTION OF SCAPULA
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
ORIF CLAVICLE
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
ORIF WITH LOCKING PLATE
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
FRACTURE NECK OF HUMERUS
EPIDEMIOLOGY• OLD AGE• OSTEOPOROSIS• YOUNG PATIENTS • HIGH VELOCITY• FOOSH
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
CLASSIFICATION
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
MANAGEMENT
NON-OPERATIVE• ANALGESICS• COLLAR & CUFF SLING• WEEKLY RADIOGRAPHS• EARLY MOVEMENTS
OPERATIVE• DISPLACED FRACTURES• EARLY MOBILISATION• ORIF WITH PLATE & SCREWS• LOCKING PLATE
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
ORIF # NECK OF HUMERUS
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
COMPLICATIONS
• MALUNION• NON-UNION• STIFFNESS• CRPS
• NERVE AT RISK• AXILLARY NERVE
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
www.shoulder4u.com
DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON
SNIMS KOCHI
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