Periarthritis shoulder & painful arc

hope this ppt helps in understanding the basics of periarthritis of shoulder.

1. PERIARTHRIT I S SHOULDER Dr Venkatesh V Assistant Professor Dept Of Orthopaedics Ssmc

2. PERI ARTHRITIS SHOULDER

3. INT R ODU C TION The periarthritis of shoulder also called as adhesive capsulitis or Frozen shoulder, is a chronic, inflammatory disorder of the shoulder and surrounding soft tissues. This condition is frequently caused by injury, leading to pain and lack of use. As the joint becomes progressively tighter and stiffer , simple movements, such as raising the arm, become difficult.

4. DEFINITION Peri arthritis Shoulder is a condition in which there is inflammation of tissues around the joint capsule. The Gleno- humeral joint (that is the shoulder joint) becomes painful and stiff.

5. SIGNS Inspection Patient holds arm protectively at side Deltoid and Supraspinatus atrophy Palpation Generalized pain at rotator cuff and biceps tendon.

6. Limited range of motion Loss of both active and passive Shoulder Range of Motion Loss of motion in all planes

7. S YM P T OMS Painful shoulder Stiffness in shoulder Difficulty to reach overhead at all times and all the movements of shoulder are severely limited .

8. According to CYRIAX , there are 3 stages of symptoms Stage 1: Pain persists in shoulder It does not spread beyond elbow. Person can sleep on the affected side. Pain remains only in movement. Stage 2: This stage is not clear but any symptom exceeding beyond stage 1, is considered to be stage 2.

9. Stage 3: Pain extends till wrist. Person can’t sleep on the affected side. Vague chill pain on movement. In early stages, the pain is worse in night. Later pain is present

10. FROZEN SHOULDER IS CLASSICALLY CHARACTERIZED BY THREE STAGES Stage 1 – The painful/freezing stage. There is usually a dull, aching pain onset of predominantly nocturnal pain, usually without a precipitating factor. The pain is not related to activity, although the end range of motion can increase the pain. As the disease progresses, patients have pain at rest which lasts 2-9 months, ROM is not restricted.

11. Stage 2 – This is known as the adhesive/frozen stage . The shoulder typically becomes increasingly stiff, daily activities such as grooming one’s hair, reaching for a seatbelt, ove becomes difficult. Although the pain does not normally get worse, the muscles may start to waste slightly as they are not being used.

12. Stage3 - This is the recovery/thawing stage in which you gradually regain movement of the shoulder. The pain also fades, although it may recur from time to time as the stiffness eases. Although it is possible that you may not regain full movement of your shoulder, you will be able to do many more tasks than previous stage. This stage can last any period of time from five months to 3-4 years.

13. CAUSES /ETIOPATHOGENESIS Periarthritis Shoulder is usually a disease of unknown cause. In some cases there is a history of previous trauma or injury to the joint before the onset of condition. This condition occurs when a person is not using the shoulder joint, keeping it in a guarded way with less movement, due to pain. This reduces the flexibility of the joint. Which in-turn causes reduction in the movements of shoulder like flexion (forward movement), extension (backward movement), abduction (sideways movement) and rotational movements.

14. Age and Sex People 40 and older are more likely to experience frozen shoulder More common in women (especially in postmenopausal women) than men

15. Prolonged Immobility In period of immobility your arm and shoulder remains immobile (still) for long periods of time while you recover which may cause your shoulder capsule to tighten up from lack of its use. For Example: In rotator cuff injury, brachial plexus injury, cervical spinal cord injury Stroke Fracture at or around shoulder. Recovery from surgery (chest or breast surgery)

16. Endocrine abnormalities such as: Diabetes Hyperthyroidism Systemic diseases Heart disease Parkinson’s disease

17. Frozen Shoulder Facts 2-5% of the population. It is more common in women (60%) It is at least five times more common in diabetics It is slightly more common in patients with Dupytren’s contracture and shares some of the same pathology About 15% of people get it on both sides

18. It may have a genetic component i.e./ it can run in the family It may well have an hyper responsive auto- immune component It seems to affect 40-70 year olds (in Japan it is known as 50’s shoulder) About 15% of people get it on both sides

19. This reduces the flexibility of the joint. Which in- turn causes reduction in the movements of shoulder like flexion (forward movement), extension (backward movement), abduction (sideways movement) and rotational movements.

20. DI A GNOSIS X-rays —a test that uses radiation to take pictures of structures inside the body, to rule out other possible causes of the stiffness MRI scan —a test that uses magnetic radiation waves to make pictures of the tissues in the body, used to examine the soft tissues around the shoulder Arthrograms—x-ray pictures taken after dye is injected into the shoulder area. This test is difficult to perform with this shoulder condition.

21. MAN A GMENT Medical Treatment Anti-inflammatory Medications Anti-inflammatory medications have not been shown to significantly alter the course of a frozen shoulder, but these medications can be helpful in offering relief from the painful symptoms. Cortisone Injections Cortisone injections are also commonly used to decrease the inflammation in the frozen shoulder joint. It is unclear the extent of the benefit of a cortisone injection, but it can help to decrease pain, and in turn allow for more stretching and physical therapy. What is known, is the cortisone is only effective when used in conjunction with physical therapy for the management of a frozen shoulder.

22. Su r g e r y Surgery is an option if there is no improvement after 4 to 6 months of intensive therapy. Surgeries include: Closed manipulation :- This involves forceful movement of the arm at the shoulder joint to loosen the stiffness. This is performed under anesthesia and followed by intensive physical therapy.

23. Arthroscopic surgery An arthroscope , which is a long, thin, fiberoptic tube with a light on the end, is inserted through a small incision in the shoulder. Using this tube and other small instruments, the tightened tissues are released and the shoulder is manipulated. Physical therapy must be done after this surgery

24. Prevention To help prevent frozen shoulder: Do regular strength training and range of motion exercises . This will help maintain a strong and flexible shoulder joint. After any injury to the upper extremity (hand, wrist, elbow, etc), always move the shoulder through a full range of motion several times a day.

25. PAINFUL ARC SYNDROME DR VENKATESH V ASSISTANT PROFESSOR DEPT OF ORTHOPAEDICS SSMC

26. Also Known As Impingement Syndrome Subacromial Impingement Supraspinitus Syndrome Swimmer’s Shoulder Thrower’s Shoulder

27. 1867 f I r s t j arjavay’s Described As Subacromial Bursitis 1931 Codman Noted That Patients With Inability To Abduct The Arm Had Incomplete Or Complete Ruptures Of The Supraspinatus Tendon

28. 1972 Neer Characterized It By Ridge Of Proliferative Spurs And Excrescences On The Undersurface Of The Anterior Process Of Acromion Apparently Caused By Repeated Impingement Of Rotatory Cuff And Humeral Head With Traction Of The Coracoacromial Ligament. Later Neer Introduced Impingement Syndrome The Supraspinitus Insertion Into Greater Tubirosity That Passes Beneath The Coracoacromial Arch During Forward Flexion Of Shoulder Is Susceptible To Impingement.

29. Neer Impingement Sign With The Patient Seated, The Examiner Raises The Affected Arm In Forced Forward Elevation While Stabilizing The Scapula, Causing The Greater Tuberosity To Impinge Against The Acromion. Neer Impingement Test Subacromial Injection Of 10 Ml Of 1% Xylocaine . Pain Caused By Impingement Usually Is Significantly Reduced Or Eliminated, But Pain Caused By Other Conditions (With The Exception Perhaps Of Calcific Tendinitis) Is Not Relieved

30. Acromial morphology has been implicated as contributing to impingement.

31. Age-related Degenerative Changes, Including Decreased Cellularity, Fascicular Thinning And Disruption, Accumulation Of Granulation Tissue, And Dystrophic Calcification, All Have Been Noted And Are Likely Irreversible Some Have Suggested That The Rotator Cuff Tendons May Fail In Tension As A Result Of Throwing A Baseball Or Other Overhead Sports.

32. There Are Four Types Primary Impingement Secondary Impingement Subcorochoid Impingement Internal Impingement

33. Primary It Is Classic Version And Occurs Without Any Other Contributing Pathology Divided Into Intrinsic Extrinsic

34. Secondary It Occurs When There Is Instability Of The Glenohumeral Joint Allowing Translation Of Humeral Head Typically Anteriorly Resulting In Contact Of Rotatory Cuff Against Coracoacromial Arch Inrinsic Ex t r i nsic

35. Intrinsic Structures Passing Beneath The Coracoacromial Arch Become Enlarged Resulting In Abutment Against The Arch Thickining Of Rotator Cuff Calcium Deposits Within Rotator Cuff Thickening Of Subacromial Bursa

36. Extrinsic When The Space Available For The Rotator Cuff Is Diminished Subacromial Spurring Acromial Fracture Osteophytes Off Acromioclavicular Joint Exostoses Of Greater Tuberosity

37. SUBCORACOID IMPINGEMENT Pain Caused By Contact Between The Rotator Cuff And The Coracoid Process Mainly Due To Prominent Coracoid Which May Be Idiopathic (Most Common) Iatrogenic

38. INTERNAL IMPINGEMENT Internal Contact Of The Rotator Cuff Occurs With The Posterosuperior Aspect Of Glenoid When The Arm Is Abducted, Extended And Externally Rotated As In The Cocked Position Of The Throwing Motion

39. Often Seen In Throwers Who Have Lost Internal Rotation Of Shoulder This Loss Causes The Center Of Rotation Of Humeral Head To Move Upward So That The Contact Between Rotatory Cuff And Biceps Tendon Attachments Increases

40. ARTHROSCOPIC FINDINGS Partial Rotatory Cuff Tear Posterior And Superior Labral Tears Anterior Shoulder Laxity

41. DIFFERENTIAL DIAGNOSIS Acromioclavicular Arthritis Glenohumeral Arthritis Shoulder Instability In Throwing Athletes Adhesive Capsulitis Fibromyalgia Cervical Spondylosis Suprascapular Nerve Injury

42. TREATMENT Non Operative Regimen Antiinflammatory Medication ½ Subacromial Cortisone Injection Physiotherapy On Strengthning The Rotatory Cuff & Full Range Of Movements

43. Operative Arthroscopic Or Anterior Acromioplasty

44. THANK YOU !!