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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)

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Presentation on theme: "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)"— Presentation transcript:

1 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

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

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

4 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

5 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

6 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

7 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

8 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

9 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

10 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

11 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

12 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

13 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?

14 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

15 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI COMPLICATIONS 2 FROZEN SHOULDER CUFF ARTHROPATHY INSTABILITY

16 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

17 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

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

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

20 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI COMPLICATIONS 2 FROZEN SHOULDER CUFF ARTHROPATHY INSTABILITY

21 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI ROTATOR CUFF ARTHROPATHY

22 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

23 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

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

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

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

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

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

29 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 V TYPE V1 TYPE 1V

30 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

31 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

32 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI FRACTURE CLAVICLE CLASSIFICATION MIDDLE 1/3 RD 80% DISTAL 1/3 RD 10-15% MEDIAL 1/3 RD 5% COMPLICATIONS BRACHIAL PLEXUS INJURY SUBCLAVIAN ARTERY / VEIN INJURY

33 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

34 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI ORIF CLAVICLE

35 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI ORIF WITH LOCKING PLATE

36 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

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

38 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

39 DR.PRATHAPKUMAR MB, FRCS(Tr&Orth), FRCS, D’Orth CONSULTANT SHOULDER AND ELBOW SURGEON SNIMS KOCHI ORIF # NECK OF HUMERUS

40 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

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

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


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