PERIARTRITIS Inflammation of the tissues around (surrounding) a joint دکتر علی اصغر مغاری متخصص طب فیزیکی و توانبخشی

Adhesive Capsulitis Biceps Tendinitis Rotator Cuff Tendinitis Epicondylitis Olecranon Bursitis de Quervain Tenosynovitis Trochanteric Bursitis Knee Bursitis Jumper`s Knee Patellofemoral Syndrome Achilles Tendinitis

Acute management General aim is to decrease pain and inflammation while increasing the range of motion in all planes. Rest (relative rest) Ice Compression Elevation Immobilization and early mobilization Activity modification – Protected mobilization

Therapeutic drugs Analgesics Topical analgesics NSAIDs Topical anti-inflammatory agents Corticosteroids (short trial) Local anesthetic injections

Rehabilitation

Physical modalities Cryotherapy Superficial heat Contrast therapy Deep heat – Ultrasound – Diathermy Phonophoresis Iontophoresis

Electrotherapy TENS (Transcutaneous electrical nerve stimulation) Neuromuscular stimulators Laser Magnetic therapy Shock wave therapy

Exercise therapy ROM – Passive & active Restoration of range of motion (adhesive capsulitis) – Pendulum exercises, overhead stretches, and crossed adduction Stretching Strenghtening

Strengthening exercise The patient should start with static exercises and advance to progressive resistive exercises. – Thera band, light weights, and manual (self) resistance exercises can be used. Stretching exercise Proprioception exercise This is important to retrain the neurologic control of the strengthened muscles, Close kinetic chain Open kinetic chain

Correction of abnormal biomechanics – Biomechanical evaluation of any leg length discrepancies or underlying gait abnormalities should be performed. – Correction of these may be facilitated through orthotics or lifts.

Orthosis Forearm band (counterforce brace) wrist immobilization splints Thumb spica splint Shoe inserts (heel lift, lat wedge, arch support)

Task or Sport Specific The last phase of rehabilitation is to return to task- or sport-specific activities. This is an advanced form of training for the muscles to relearn prior activities. This is important and should be supervised so the task is performed correctly and to eliminate the possibility of reinjury or injury in another part of the kinetic chain from improper technique.

Procedures Injection of corticosteroid Aspiration Acupuncture Taping Autologous blood injections Platelet-rich plasma

thanks for your attention