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Shoulder pain Dr Shrenik Shah

Shoulder pain Dr Shrenik Shah. Overview. Anatomy Clinico-patho-radio correlation How to manage day to day shoulder problems? Promising modality - RSWT. Anatomy. 4 articulations Sterno-clavicular Acromio-clavicular Humero-scapular Thoraco-scapular. Rotator cuff. Rotator cuff.

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Shoulder pain Dr Shrenik Shah

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  1. Shoulder painDr Shrenik Shah

  2. Overview • Anatomy • Clinico-patho-radio correlation • How to manage day to day shoulder problems? • Promising modality - RSWT

  3. Anatomy • 4 articulations • Sterno-clavicular • Acromio-clavicular • Humero-scapular • Thoraco-scapular

  4. Rotator cuff

  5. Rotator cuff • Subscapularis • Supraspinatus • Infraspinatus • Teres minor

  6. Range of motion • Elevation-0-160* • External rotation- 0-60* • Internal rotation –thumb reaches upto spinous processes thoracic 6-8 • Adduction – crossbody • Abduction- 0-170* • Flexion- 0-170* • Extension- 0-30*

  7. Pain on greater tuberosity impinges on to acromion Pain on overhead motion Sleeping on affected side Night pains Impingement syndrome

  8. DIAGNOSIS • History • Clinical exam- tests • Hawkins • Neer • Jobe • Xray • Usg • MRI

  9. x-rays

  10. Usg and MRI

  11. Impingement etiologyrotator cuff tears

  12. Supraspinatus tendinopathy

  13. Rotator cuff tears

  14. Rotator cuff tears • Etiology • Degenerative • Increasing incidence with age • Symptoms sometimes start with a trivial trauma • Should be diagnosed within 3 weeks • Treated early

  15. Arthroscopy

  16. Partial rotator cuff tear

  17. Massive tear of rotator cuff

  18. Xray

  19. Glenohumeral arthritis

  20. Shoulder arthroplasty

  21. Frozen shoulderAdhesive capsulitis • A specific entity • Unknown etiology • Women > men • 40-60 years • Risk factors • DM,x5 more • Thyroid diseases • Cervical disc disease

  22. Stages of frozen shoulder 1. Freezing: pain ++ lose ROM 6 weeks to 9 months 2. Frozen: pain decreases but stiffness+ 4-6 months 3. Thawing: ROM slowly improves 6 months to 2 years

  23. Treatment • Drugs- analgesics and NSAIDs, etc • Steroid injections • Physical therapy • Manipulation under anesthesia • Arthroscopic release • ESWT/ RSWT

  24. Pre ESWT

  25. Post ESWT

  26. CONCLUSION • Shoulder needs both clinical evaluation and imaging to arrive at a diagnosis. • Plan of treatment: early intervention can prevent unavoidable sequelae • Rotator cuff tear arthroapathy • Small lesions triggering adhesive capsulitis • Noninvasive RSWT works in most patients • Reduces suffering to great extent • Decreases rehab time • Restores early motion

  27. THANK YOU WWW.ESWTINDIA.COM

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