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Management of the mangled hand

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Title: Management of the mangled hand Author: saremi Last modified by: Dr Saremi Created Date: 1/29/2010 6:14:17 PM Document presentation format: On-screen Show (4:3) – PowerPoint PPT presentation

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Title: Management of the mangled hand


1
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  • A hundred times every day ,I remained myself
    that my inner and outer life are based on the
    labors of other men living and dead,and that I
    must exert myself in order to give in the same
    measure as I have received.
  • ALBERT EINSTEIN

3
Painful shoulder
  • Dr.H.Saremi
  • Orthopaedic surgeon, Hand and Shoulder fellowship
  • Hamedan university of medical sciences
  • Besat Hospital

4
Shoulder
  • 4jonts
  • The least stable joint

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History
  • Age
  • Sex
  • Pain(character,onset,location,aggravating
    factors,
  • Factors that alleviate pain)

12
AGE
  • Instability more common in youthful years
  • Slap lesion,biceps tendinitis ----younger than
    30y
  • Calcific tendinitis---------middle age of women
  • Cuff tear arthropathy-----mid70s

13
SEX
  • 3 conditions have a significantly higher
    prevalence in female
  • 1.multy directional shoulder instability
  • 2.adhesive capsulitis
  • 3.cuff arthropathy

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  • History(pain,restrictedROM,instability)
  • PH.EX(CD)

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Impingement syndrom
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Impingement syndrom
  • Painful arc sign
  • Positive howkins sign and jobe test
  • Non operative treatment
  • Operative treatment(arthroscopic)

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Rotator cuff tear
  • Progressive pain and weakness
  • Restriction of ROM
  • May be an aging process(30-50 cadavr)
  • Partial or fullthickness
  • Non operative treatment
  • Poerative treatment(arthroscopic)
  • Rotator cuff arthropathy

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Frozen shoulder(adhessive capsulitis)
  • Restricted active and passive motion
  • Idiopathic(DM,IHD,cervical discopathyimmmobilizati
    onhyperthyroidism,stroke,Mi
  • Secondary(trauma,shoulder surgery)
  • Pain and restrictedROM(Int .R,Flex,ext.Rot)
  • Pain,Stiffness,Thawing
  • Non operative treatment
  • Operative treatment(arthroscopic release)

27
Calcific tendinitis
  • Site of diminished blood suply(1.5-2 cm to
    insertion of supraspinatus)
  • gt30y/o
  • WgtM
  • Precalcification stage
  • Calcification stage
  • Phase of formation
  • Resting phase
  • Resorptive phase
  • Post calcification phase

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Calcific tendinitis
  • Non operative treatment
  • Operative treatment(arthroscopic)

29
Biceps tendinitis
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Biceps tendinitis
  • gt30-40 years
  • Pain during flx and supination of elbow
  • Non operative treatment
  • Operative treatment
  • RUPTURE

31
Trauma to shoulder
  • Fx of the clavicle
  • Most common fx in children
  • mechanism
  • N.V damage
  • Open
  • Skin irritation
  • 1/3 distal
  • gt2cm over riding
  • Fliale shoulder

32
  • Complications
  • N.V damage
  • Non union
  • malunion

33
AC dislocation
  • Mechanism
  • Classification
  • treatment

34
Ac dislocation
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Sc dislocation
  • Anterior
  • posterior

36
Scapular fx
  • Glenoid
  • Body

37
Glenohumeral dislocation
  • More than 90 anterior
  • Abd,ext.Rot
  • PH.ex
  • Complication
  • Treatment
  • Post opp

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Posterior dislocation
  • Not obvious in Ap view
  • Abd,Int.rot
  • Following seizure and electroctutation

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Posterior dislocation
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Fx arround the shoulder
  • Greater and lesser tuberosity
  • Surgical and anatomical neck
  • shaft

47
AP-LAT scapular view
48
Axillary view
49
Neer classification
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