Microsoft word - acromioclavicularjoint-sherryobrien-2000.doc
It Turned Out To Be The Acromioclavicular Joint A Case Study for the Diploma in Injection Therapy 2000 By Sherry O’Brien MCSP INTRODUCTION Shoulder pain is the third most common musculoskeletal complaint presenting to the general practitioner and sequential y the physiotherapist (Van der Hiejden, 1999). 18% of al sick leave benefit claims were made in 1994 in the Netherlands for neck, shoulder problems. Approximately 5% of al consultations in general practice are reported to concern shoulder disorder and each year about 1 per 100 adults in the UK consult their GP with a new episode of shoulder pain (Van der Heijden). Although there exists a comprehensive shoulder examination (Cyriax 1983) much debate stil exists over the diagnosis of shoulder pain which is highlighted in this case study. The manipulative therapy combined with injection therapy lead to a successful outcome and confirmation of a diagnosis. The literature search performed for this study used medline (1980 -2000) with the keywords acromioclavicular joint, subacromial impingement, corticosteroid injections and rotator cuff. Further literature was gained from course manuals. The case study highlighted the importance of correct diagnosis coupled with accurate placement of the intra-articular steroid injection(Jones et al 1995). ANATOMY AND BIOMECHANICS Onset and Duration Past Medical History Drug History
subscapularis bursa which lies between the tendon of subscapularis and the anterior capsule. The nerve supply of the acromioclavicular joint is C4 and the nerve supply of the glenohumeral joint, surrounding ligaments and muscles is C5-6 (Saunders,1993).
Objective Examination Inspection Treatment Cervical spine - Ful painfree Thoracic spine - Restricted Shoulder movement R.T. P.B. Differential Diagnosis Lat. Rot. Med. Rot. +ve++
neck were excluded as there was ful painfree active movements of
Elb Flex. Other Tests Injection Immediate reassessment One week reassessment One month reassessment Repeat Injection Immediate reassessment. One week reassessment – One month reassessment. Discussion Cyriax JH, Cyriax PJ. (1983) Illustrated
Manual of Orthopaedic Medicine. Butterworths.
Eustace JA, Brophy DP’m Gibney RP et al (1997) Comparison of the accuracy of
steroid placement with clinical outcome in
patients with shoulder symptoms. Annals of Rheumatic Diseases 56: 59-63.
Harryman D et al. (1990) Translation of Haslock I, Macfarlane D, Speed C.
injections: a survey of current practice.
Hollingworth GR, Ellis RM, Hattersley TS. (1983)
shoulder pain : results of a double blind
Hulstyn MJ, Fadale PD. (1995) Arthroscopic Anatomy of the Shoulder.
Orthopaedic Clinics of North America 26:
Jones A, Regan M, Ledingham J.
(1995) Importance of placement of intra-articular steroid injections. BMJ 307:
BIBLIOGRAPHY Kendall FP, Mcreary EK, Provance PG. ACPOM (1999) A clinical guideline for the
Edition. Williams and Wilkins, Baltimore.
Lewis J. (1999) Assessment and British National Formulary. Number 28, Nordin M, Frankel VH. (1989) Basic Bamji AM et al (1996) The painful Ombregt L, Bisschop P, Ter Veer HJ, Barry M, Jenner JR (1995) Pain in the Vande Velde T. (1995) A System of Cawley PJ, Morris IM. (1992) A study to Pellecchia GL, Paolino J, Connell J.
(1996) Inter-tester reliability of Cyriax
skin preparation prior to joint injection.
Corrigan B, Maitland GD. (1988) Saunders S, Cameron G. (1997)
Injection Techniques in Orthopaedic and Sports Medicine. W.B. Saunders Company Ltd. Van der Hijden GJMG, Van der Windt DAWM, Kleijnen J et al (1996) Steroid injections for shoulder disorders : a systematic review of randomised clinical trials. BrJGenPract 46: 309-316. Van der Hijden GJMG (1999) Shoulder disorders : a state of the art reivew, Ballieres Clinical Rheumatology. Vol 13 No. 2 287-309. Winters JC, Jorritsma W, Groenier KH etal (1999) Treatment of shoulder complaints in general practice : long-term results of a randomised, single blind study comparing physiotherapy, manipulation and corticosteroid injection. BMJ 318: 1395-1396.
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Early Perioperative Death Associated With ReexpansionPulmonary Edema During Liver Transplantation Wagner C. Marujo, Flavio Takaoka, Rita M. A. Moura, Fernando L. Pandullo, Andre R. Morrone, Marcelo M. Linhares, Alexandre Teruya, and Isaac Altikes Hydrothorax is a frequent finding in patients with end- REPE during a LT that rapidly led to the patient’s stage liver disease. During the he