Joint injury 1.Affection shoulder 2.Affection knee 3.Affection elbow 4. Affection hip

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Text of Joint injury 1.Affection shoulder 2.Affection knee 3.Affection elbow 4. Affection hip

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  • joint injury 1.Affection shoulder 2.Affection knee 3.Affection elbow 4. Affection hip
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  • Affections of shoulder I.Anatomy 1. joint of shoulder 1> acromio-clavicular joint : disc 1) acromio-clavicular lig: disc 2) coraco-clavicular lig: coronoid & trapezoid lig. 2> sterno-clavicular joint 3> scapulo-thoracic joint 4> gleno_humeral joint: compare with head glenoid cavity is small and thin cause wide ROM but unstable.
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  • 2. Ligaments from coronoid process 1> coracohumeral lig. 2> coracoacromial lig. 3> coracoclavicular lig. 3. Movement of the shoulder joint 1> flexion: 1) ant. Fiber of deltoid 2) coracobrachialis 2> extension: 1) latssimus dorsi 2) teres major 3> abduction: 1) deltoid 2) supraspinatus
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  • 4> horizontal abduction: 1) post. Fiber of deltoid 5> horizontal adduction: 1) pectoralis major 6> external rotation: 1) infraspinatus 2) teres minor 7> internal rotation: 1) subscapularis
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  • II. Biomechanics glenohumeral motion scapulothorcic motion eg) abduction 180= gelnohumeral motion 90 - 110 + scaulothoracic motion 70-90 *clavicle motion: 40-60
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  • III. Thoracic outlet syndrome 1> cervical rib syndrome 2> scalenus anticus syndrome 3> costoclavicular syndrome 4> hyperabduction syndrome anatomy uppermiddlelower 1>scalenus anticus 2>scalenus medicus 3>1 st rib 1>1 st rib 2> clavicle 1> coracoid process 2> pectoralis minor 3>coracoid membrane
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  • 1. Cervical rib syndrome -characteristics: from 7 th cervical spine -anatomy: 1>bone or fibrous band 2>brachial plexus &subclavian a. -> over cervical rib going through the cervical rib & scalenus space. 3>c8 & T1 compression -Symptom: 1> pain or radiating pain to medial side of shoulder, forearm 2> paresthesia in ulnar N. area 3> radial A. pulse weakness
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  • Adsons test: is the loss of the radial pulse in the arm by rotating the head to the ipsilateral side following deep inspiration Diagnosis 1> simple X-ray 2> arteriograph: valuable Tx: 1> conservative: Posture correction and shoulder girdle strengthening exercises for the muscles, working posture, changes in sleeping habits. 2> operative: 1)cervical rib rimoval 2)scalenus anticus resection 3) Ist rib resection
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  • 2.Scalenus anticus syndrome -anatomy: abnormal hypertrophied scalenus -characteristic: 1)Prevalent in middle age 2)later than cervical rib syndrome 3) Prevalent in women (female) Sx & sign: similar with cervical rib syndrome Diagnosis: 1>angiography 2>MRI: scalenus anticus hypertrophy Tx: 1>conservative : 2>operative
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  • 3.Costoclavicular syndrome -anatomy; clavicle &1st rib space narrowing or deformity d/t 1)cerviothoracic scoliosis 2)clavicle fracture 3)nonunion or excessive callus of 1st rib 4)occupational problem 5)atrophy of m. of shoulder girdle -Wright test(=costoclavicular maneuver) :
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  • 4.Hyperabduction syndrome -anatomy: over abduction upper arm->teres minor tension->neurovascular structure tractioned by over hanging coracoid process d/t 1) repetitive trauma of neurovascular structure -Hyperabduction test *also positive at normal population Tx: 1) conservative: posture correction 2) operative: release or resectomy
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  • Subacromial space: Subacromial bursa: Subteltoid bursa: IV. Subacromial Syndrome
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  • 1.Supraspinatus tendinitis rotator cuff : 1,2,3,4, d/t rotator cuff ->degenerative change Mechanism: 1. upper arm abduction 2.supraspinatus glipped at humerus greater tubucle &acromion 3. With aging protection of the bursa weak, and continued trauma mechanical stimuli and inadequate recovery 4.supraspinatus early phage wear,local ischemia, inflammation stage, calcification
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  • Acute inflammation stage(=chemical furuncle) -acute calcareous tendinitis; calcifications - 25-45 yrs - rotation, abduction ->limitation sagital plane motion -> not limited Chronic tendinitis(=painful arc syndrome) -50-60yrs -shoulder jt, 60-90abduction-> contact with acromion lesion site-> pain D/Dx: degenerative artiritis of acromioclavicular joint (90 )
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  • 2.Bursitis Subacromial bursitis -supraspinatus lesion->scar tissue->bursal hypertrophy -Snapping shoulder : coracoacromial lig. -Dawbarns sign; pain at greater tubercl of humerus, when over abduction,bursa placed at under acromion, pain release. subcoracoid bursitis subscapular bursitis
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  • 3.Impingement Syndrome -Subacromial space : humeral head ->acromion -Rotator cuff 1)supraspinatus 2)infraspinatus 3)teres minor 4)subscapularis -shoulder pain was main reason d/t degenerative change of rotator cuff
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  • Stage of impingement syndrome Stage IStage IIStage III Pathology : Typical age: Clinical course: Treatment: Edema & Hemorrhage 40 Yr Progressive disability Ant. Acromioplasty &rotator curr repair
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  • Mechanism : 1.Upper limb abduction 2.Supraspinatus clipping between humerus great tubercle & acromion 3.With increasing age the protection of the bursa was weak, ongoing trauma due to mechanical stimulation and inadequate recovery 4.Supraspinatus early wear, local ischemia, inflammation, calcification *Dawbarns sign: pain at humerus great tubercle painless when complete abduction-> bursa placed at sub acromion.
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  • Sx & sign Night pain (Characteristic) Pain at: 90 abduction; sudden arm flexion Impingement sign: 90flexion &internal rotation upper arm Always combined Secondary biceps longhead rupture with supraspinatus rupture Dx: 1.shoulder series X ray: 1) sclerosis around acromion 2) sclerosis &cystic change around greater tubercle 2.athrogram 3. MRI
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  • Tx. 1.Conservativ Tx. 2.Operative Tx. : after conservative Tx 3Ms, still have symptom. 1) ant. acromioplasty
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  • 4.Rupture of supraspinatus tendon -Trauma history -Degenary change : essential prerequisite rupture -Partial tear : self healing possible Complete tear (x) - 45-65 yrs
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  • Sx & sign: - supraspinatus single rupture: abduction possible -rotator cuff widely rupture: abduction impossible *shrugging: abduction impossible, attempt to abduction *abduction paradox: *drop arm sign: Tx. -90% non surgery healing -Partial rupture: conservative Tx -Complete rupture: conservative Tx at once->operative Tx -Old rupture: not need surgery
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  • 5.Tenosynovitis of Biceps 40yrs Female digging or throwing ball Sx & sign -direct pain in groove of biceps long head tendon -Speed test: elbow jt. Extension & forearm supination, flexion shoulder jt. Under Constant resistance ->pain -Yergasons test : elbow jt. Flexion, supination forearm under Constant resistance ->pain Tx.: - conservative Tx. - operativer Tx.
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  • Adhesive Capsulitis, Frozen Shoulder 1. intrinsic factor 1)calcareous supraspinatus tendinitis 2)partial tear of rotator cuff 3)biceps tendinitis 4)prolonged immobilization 2. extrinsic factor 1)myocardial infarction 2)HIVD in cervical spine 3)CVA 4)reflex sympathetic dystrophy -45-60yrs.
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  • Sx & sign 1)pain: aggrevated by abduction, E/R, extension 2)stiffness 3)tenderness: Inferior shoulder Tx. - several months Physical Therapy - important to convince the patients it may fully recovered - conservative Tx. 1)thermal therapy 2)exercise : pendulum exercise -> finger tip wall climbing exercise (A/A movement) 3) NSAID, steroid 4) Manipulation
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  • Humeral Lateral Epicondylitis (tennis elbow) Charac: 1) humeral lat. Epicondyle origin common extensor tendon fiber contusion 2) tennis, golf hitting the ball moment, elbow have the varus force; When the extensor muscle tensioning in semipronation and racket is designed for faster than expected rush to elbow flexion and forearm extensor muscle at the moment is to hyperextension occurred Sx: 1) Turn the knob / twist a towel 2) Kettle holding the handle 3) Forearm caracole top of the hard lifting heavy objects Tx: 1.conservative Method 1)NSAID 2)Procaine +25mg Hydrocortisone : local inj 1-2 time 2. operative method
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  • Trigger Fignger & Thumb Charac: 1) thumb or finger, flexion or extension limitation at an angle +snapping sound 2) d/t trauma of rheumatoid synovitis Patho: 1) localized stenosis of flexor tendon sheath, located near the MP jt 2)2 nd : nodular thickening of the tendon ->disturbing smooth sliding in tendon sheath Tx: 1) cast splint & hydrocortisone 2)MP jt area skin transverse dissection ->A 1 pulley(1 st annular pulley) longitudinal incision -> stenosis site open & removal
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  • Avascular necrosis of the hip 1.Symptomatic a.Traumatic (Neck fracture,dislocation) b.Embolism (decompression sickness, Siconkle cell anemia, Gauchers disease) c.postirradiation 2.Idiopathic fat embolism, vascular lesion, coagulation defect 3.Male : female = 3:1 4.Sclerosis and lucency, Subchondral fracture (Cresent sign) 5.Core decompress, living bone graft, rotational osteotomy, arthroplasty
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