...Rotator Cuff Repair PATHOPHYSIOLOGY Wells K (2013) defined rotator cuff injury as a condition involving damage to the rotator cuff tendons because of continuous irritation and tear. There are two factors that can predispose a person to this type of injury. The first type is intrinsic factor which means coming from within, this includes poor blood supply to an organ, normal attrition or degeneration with ageing and calcification of tendons. The other factor is called extrinsic factor which means coming from the outside. Some of the factors considered extrinsic are injury from accidents, falls and too much stress on the shoulders as a result of different movements involving exertion (Bilal, 2013). The injury is frequently associated with athletes who move their arms above the head in a repetitive manner like pitching, swimming, tennis and weight lifting (Wells, 2013). Paul’s occupation which is carpentry work and the repeated pitching and lifting of the ball during the rugby game eventually contributed to the irritation of his tendons from excessive pressure on the acromion process or bony knob of the shoulder. This also resulted to the swelling of bursa which is the lubricating sac between the tendons and the bones from subsequent rubbing against the acromion. Consequently, the shoulder becomes painful and if left untreated can lead to a tear in the rotator cuff and eventual injury to the shoulders (NMA News Direct, 2011). Predisposing Factors: Carpentry (repetitive...
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...family members. You can hurt yourself many ways playing tennis, although many people still continue to participate in the sport. There are really no preparations to playing tennis that will cause the injury, but there are many injuries that can occur while actually playing. First you need to reserve a court, get tennis, a racket, and the proper clothing. Most importantly you need the correct sports shoe. Finally you are ready to go and play tennis, don’t forget to stay properly hydrated when doing any intense activates such as tennis. There are many hazards and injuries that your body can sustain while playing tennis. The first thing comes to my head is a groin strain, luckily that has never occurred to me while playing. Since you are running the whole time on your feet on a hard surface, it is a possibly to cause a plantar fasciitis. Lastly with the force that your shoulder endures while serving the tennis ball at high speeds, could possibly cause a rotar cuff injury. The possibility of having all these injuries is very likely, and there could be more if you are not careful. Although not all injuries can be prevented like we have discussed in the personal injury discussions, there are some steps you can take to lessen the chance of getting hurt. All of the example of injuries above can easily be prevented by the stretching before, warming up, stretching after, and not being too reckless. Stretching is so important for any sport. Stretching warms up your muscles, and prevents...
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...The rotator cuff uses four muscles to keep the shoulder in its socket and it connects the humerus to the shoulder blade. It is made up of four muscles, the subscapularis, teres minor, supraspinatus, and infraspinatus. A rotator cuff tear occurs when one of these tendons are torn so that the humerus is no longer intact (Armstrong). Depending on the severity of tears, there are different types. A partial tear causes damage but it is not fully torn, while a full-thickness tear causes enough damage to sever the tendon into two separate pieces (Armstrong). The main reasons for a rotator cuff tear are from an injury or damage over time. An acute tear happens because of an injury, like trying to lift more than you can handle. A degenerative tear...
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...practice Rotator-Cuff Failure Frederick A. Matsen III, M.D. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author’s clinical recommendations. A 63-year-old woman presents with a 2-year history of progressive weakness and discomfort in her right shoulder, especially when she puts dishes on the top shelf in her kitchen. She is otherwise healthy and has had no injuries. Her physician diagnosed “bursitis” and gave her four subacromial corticosteroid injections; the first two seemed to relieve her symptoms temporarily, but the last two were ineffective. Physical examination reveals some atrophy of the muscles of the right shoulder and weakness when her right arm is elevated. Magnetic resonance imaging (MRI) reveals a large defect in the rotator cuff. How should her case be managed? The Cl inic a l Probl e m From the Department of Orthopaedics and Sports Medicine, University of Washington, Seattle. N Engl J Med 2008;358:2138-47. Copyright © 2008 Massachusetts Medical Society. The rotator cuff is a synthesis of the capsule of the glenohumeral joint with the tendons of the subscapularis, supraspinatus, infraspinatus, and teres minor muscles (Fig. 1).1 The rotator-cuff mechanism precisely centers the humeral head by compressing it into the glenoid concavity. The individual muscles of the cuff help...
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...rehabilitation process (Anderson & Parr, 2013). Strengthening the other muscles that help support the shoulder can help prevent the injury from getting worse and relieve some of the pain. Injections or surgery are also an option for more severe cases. The different types of surgery would be arthroscopic tendon repair, tendon transfer, open tendon repair, bone spur removal, and should replacement. Not having surgery when you have a rotator cuff tear can limit the activities that you can do, the tear can get worse, and your strength in your shoulder will stay the same or decrease...
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...Tendinitis Causes The most common cause of tendinitis is overuse and repetitive motion from recreational, athletic, or occupational activities. Risk factors for tendonitis include repetitive movement, trauma, thermal injury to the tendon, use of certain antibiotics (such as levofloxacin and ciprofloxacin), and smoking. Tendinitis can also occur in people with diseases such as rheumatoid arthritis, obesity, and diabetes. These are some of the more common forms of tendinitis: •Medial epicondylitis (golfer's elbow, baseball elbow, suitcase elbow) is caused by inflammation of the tendons that attach to the medial epicondyle of the elbow. If you put your arms to your side with the palms facing forward, the medial epicondyle is the bony part of the elbow nearest to your body. Repetitive movements involving forceful wrist flexion and rotation can cause this elbow tendinitis. •Lateral epicondylitis (tennis elbow) is caused by inflammation of the tendons that attach to the lateral epicondyle of the elbow. If you put your arms to your side with the palms facing forward, the lateral epicondyle is the bony part of the elbow farthest away from your body. Repetitive movements involving extension and rotation of the wrist can cause this elbow tendinitis. •Rotator cuff tendinitis (swimmer's shoulder, tennis shoulder, pitcher's shoulder) is caused by sports that require movement of...
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...Sports Injury Assignment Moira Ijzerman Georgetown District High School Patellar Dislocation What is a Patellar Dislocation? The patella rests in a groove on the anterior aspect of the femur, called the patellofemoral groove (American Academy of Orthopedic Surgeons, 2011). Patellar dislocation occurs when the patella (kneecap) slides laterally out of the patella femoral groove where it normally rests (Ebraheim, 2011). Anatomy The patella bone protects the largest joint in the body, the knee (Temertzoglou & Challen, 2003). The knee is made through the union of 3 bones; the femur, tibia and the patella. (Physio Advisor, n.d.). The patella is situated at the anterior aspect of the knee and lies within the patellofemoral groove (Ebraheim, 2011) which, according to Physio Advisor (n.d.) is located on anterior of the femur. The patella is enveloped by the tendon of the quadriceps muscle, and then goes on to attach to the anterior surface of the tibia (Physio Advisor, n.d.). This relationship forms a joint designed to give the quadriceps muscle leverage when extending the knee (Sports Injury Clinic, n.d.). Each of the bones involved is lined with cartilage to allow cushioning between the bones. The patella also has connective tissue known as the patella retinaculum which attaches it on either side of the femur. This joint is known as the patellofemoral joint (Physio Advisor, n.d.). The patella normally lies in the patellofemoral grove and is only designed...
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...Muscles of the Shoulder/Upper Arm Movements of the Humerus (upper arm at the shoulder) • Movements of the humerus: – – – – – Flexion and Extension Abduction and Adduction External and Internal Rotation Horizontal flexion or Horizontal adduction Horizontal extension or Horizontal abduction Flexion and Extension Abduction and Adduction External and Internal Rotation Horizonal flexion or adduction Horizontal extension or abduction Muscles of the Shoulder/Upper Arm • Anterior: – Pectoralis major, Coracobrachialis, Subscapularis Pectoralis major • Origin: – Clavicle, sternum, and costal cartilage of ribs • Insertion: – Near the intertubercular groove of the humerus • Actions: – Flexion, horizontal flexion, internal rotation, adduction • Used in bench press, pushup, pull-ups, throwing, tennis serves Pectoralis Major Coracobrachialis • Origin: – Coracoid process of scapula • Insertion: – Humerus (medial) • Actions: – Flexion, adduction, horizontal flexion – Primarily an assisting muscle Coracobrachialis Subscapularis • Origin: – Subscapular fossa of scapula • Insertion: – Lesser tubercle of humerus • Actions: – Internal rotation, extension and adduction Subscapularis Muscles of the Shoulder/Upper Arm • Superior: – Deltoid, Supraspinatus Deltoid • Origin: – Clavicle, scapula • Insertion: – Deltoid tuberosity of humerus • Actions: – Abduction – Anterior deltoid: horizontal flexion...
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...Patient #1 Subject is doing really well, she’s in for just a check up on a chronic problem. She reports she’s doing really well, she needs her cholesterol checked. The rash on her groin has completely cleared up on Licon. Objective noted no acute stress, vitals noted, blood pressure looks pretty good, noted clear skin trauma dry, extremities in a remarkable movement which i think is congruent, labs are updating including a CMP and lipid panel and I got a fasting blood sugar which was 118; so subsequent A1C was drawn and that was found to be 6.1. Unfortunately she had gone ahead and left prior to getting the A1C. Assessment: hypertension, hyperlipidemia, new onset boarder line diabetes. Plan: need to contact her about this finding, and discuss the implication, we’ll adjust medicines as needed when her labs come back and follow up in 3 months. Patient #2 ...little more trouble doing this one, had trouble, patient doing quite well, overall... lungs mostly full with hollow expansion, no edema, but PFT is 1.65 liters which is 63% atrophy which is 83% of patient, which is slightly worse compared to last PFT which was 1.83 liters..... mildly worsening lung functions. Plan: at this point I would like to continue to watch her and see her back in 6 weeks, if lung functions remain low then start her on Prednisone pills. I would like to wait to see whether its just the season or not. Wait until follow-up. Patient #3 Right totally arthroplasty wound, multifactorial...
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...Have you ever wonder what it is like to be in the boots of a US Service Member during their deployment phase? Also have you ever wonder what it was like to fight in a combat zone and the trials and tribulation they face when the deployment goes on? Well I’m going to tell you the three phases of a deployment. First you start with the ceremony, the lonely flight and finally the trials and tribulations of the combat zone. As you well know I’m no longer in the military but I going to tell you these phases through my eyes when I was in the army during my combat tour in Afghanistan from June 2010 to June 2011. It all started when I first sergeant told us what time to be at the company so we can have our early formation before we head to the Green Ramp. If you don’t know what Green Ramp is, it’s the final holding area that separates the soldiers and the plane. The reason why they call it that because it’s a small ramp that leads to the plane and it has green lands on the sides of the ramp. The formation time was 0500 and the weather was so nice that I could hear all the early birds chirping away. The formation time came and the first sergeant held accountability for all the fellow enlisted and officers that were going with us to Afghanistan. When we all found out what time we were heading to Green Ramp, we all decided that this was going to be a very long day. One of my soldiers came up to me and asks will this be a steadfast deployment and I told him I sure hope so. When it was finally...
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...This case study is of a male patient that was observed while interning at Action Potential Physical Therapy clinic. The patient was being seen for pain in his right shoulder and diagnosed with poor rotator cuff muscle strength. He was referred so that the physical therapist can help reduce his symptoms and get him back to his quality of life. Back in 2004 he had a rotator cuff repair and initially began receiving physical therapy. The patient however did not finish his treatment and always felt slight discomfort. It was not until recently that he began feeling more troubling and sharp pain in his shoulder. His symptoms have been chronic but mild, he did not seek out professional help until 2/7/17. He experienced discomfort when he slept on...
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...Have you injured your shoulder in an accident? Are you suffering from age-related shoulder deterioration? If your shoulder has become damaged by age or injury, you're probably already looking for solutions. Often, the best way to fix the issue is via some type of surgery. When you're talking to your potential shoulder surgeon about this treatment, here are some questions you should consider asking: What sort of complications can happen with this type of surgery? All surgery, even minor surgery, has some risk of complications. An honest shoulder surgeon will give you a list of things that might happen. For example, he or she might tell you that, if the damage is more extensive than what shows on the scans, you might need several surgeries to...
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...Active | 10-06-2015 | NA | NA | Chronic fatigue syndrome [SNOMED-CT: 52702003] | Active | 10-06-2015 | NA | NA | DEPRESSIVE DISORDER NOT ELSEWHERE CLASSIFIED [SNOMED-CT: 274574004] | Active | 08-13-2009 | NA | NA | OSTEOARTHROSIS GENERALIZED INVOLVING UNSPECIFIED SITE [SNOMED-CT: 201819000] | Active | 08-22-2013 | NA | NA | RHEUMATOID ARTHRITIS [SNOMED-CT: 69896004] | Active | 07-15-2008 | NA | NA | LUMBAGO [SNOMED-CT: 279039007] | Active | 07-15-2008 | NA | NA | RHEUMATISM UNSPEC [SNOMED-CT: 274574004] | Active | 07-15-2008 | NA | NA | LONG-TERM (CURRENT) USE OF OTHER MEDICATIONS [SNOMED-CT: 274574004] | Active | 06-03-2009 | NA | NA | ENTHESOPATHY OF HIP REGION [SNOMED-CT: 30936004] | Active | 06-30-2011 | NA | NA | ROTATOR CUFF SYNDROME OF SHOULDER AND ALLIED DISORDERS...
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...one of the most musculoskeletal conditions treated in physical rehabilitation centers, affecting individuals of all ages and occupations. Most of the injuries of the glenohumeral joint (shoulder) are caused by physical activities performed at home, work and sports, where the tissues (ligaments, tendons and muscles) are the most affected. Cervical osteoarthritis predisposes the emergence of this type of injury. It is common to develop shoulder osteoarthritis if you have it in the cervical spine. This communication between neck and shoulder is due to neurological and anatomical relationship between both. A pain on the shoulder and arm can be caused by a cervical herniated disc (C5-C6-C7), causing compression of the spinal nerve. In cases in which the shoulder pain is prolonged for several weeks without relief, the cause of the injury may be rupture or tearing of ligaments and tendons around the joint. An MRI is needed to obtain an accurate clinical diagnosis. A cause of shoulder pain most common and less diagnosed is the Myo-Facial Syndrome, better known as “Trigger Points”, which are nodules (knots) in the muscle tissue. This syndrome is aggravated when we suffer from nervous tension (stress), chronic poor posture, trauma to the spine and gastrointestinal problems. The infraspinatus muscle (external rotator of the shoulder) is the most susceptible to get swollen, producing “Trigger Points”, which will refer to the shoulder, sometimes the pain may radiate to...
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...Hi Disha, Thank you for sharing your post. In response to your question #1: In your current practice, what is the typical diagnostic tool used to identify shoulder disorder or any soft and bony tissue pathology? Typically, in the current rehabilitation setting (skilled nursing facility), the physician usually order for shoulder X-ray for any shoulder disorder because it is the least expensive diagnostic modality. After failed conservative treatment (rehabilitation management, non- steroidal treatment and others) with increase shoulder pain, the patient's medical practitioner will prescribe for magnetic resonance imaging (MRI). MRI is the gold standard useful indicator in finding the intensiveness of the rotator cuff tear (partial or complete)...
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