1 / 26

Shoulder complaints

Shoulder complaints. based on the NHG- guideline Shoulder complaints 2008 Wim Willems HOVUmc www.gpsupport.nl. Shoulder complaints. Complaints / medical history Physical examination Treatment / Injection therapy. A case history. Man, 35 years Construction worker

charlee
Télécharger la présentation

Shoulder complaints

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Shoulder complaints based on the NHG- guideline Shoulder complaints 2008 Wim Willems HOVUmc www.gpsupport.nl

  2. Shoulder complaints Complaints / medical history Physical examination Treatment / Injection therapy

  3. A case history Man, 35 years Construction worker Pain in the shoulder and upper arm (right) 3-4 months

  4. A case history Questions? Physical examination? Additional examination? (Blood tests / X-ray / Ultrasound / .. ) Treatment?

  5. Purpose What kind of shoulder pain has this patient? • Limitation of passive movement (abduction or exorotation) • No limitation of passive movement, however: painful abduction • No limitation of passive movement and no painful abduction

  6. Medical interview

  7. Medical interview Type of complaints • Where is the pain localized? • Radiation? • Painful movement(s) of the arm? • Pain during abduction? • Neck pain? • Feeling of instability ? • Known cause (work / sports / trauma)?

  8. Medical interview Severity of complaints • How long do the complaints exist? • Severity of the complaints • Limitations? Hindrance? • Complaints during the night? • Absence of work?

  9. Medical interview Factors that influence course • How long do the complaints exist? • Work relevant factors? • Psychosocial factors? • Effect of rest / movement / medication? • Complaints in the past?

  10. Physical examination

  11. Physical examination • Neck (esp. extension / rotation) • Active abduction shoulder (limited / painful / painful arc?) • Passive abduction (limited / painful?) • Passive exorotation (limited / painful?)

  12. Passive exorotation

  13. Passive abduction

  14. X-ray ? / ECHO ?

  15. X-ray ? / ECHO ? Not helpful in this stage

  16. Beware of:

  17. Beware of: • Pain ++, pins & needles, radiation (cervical radicular syndrome) • Pain in several joints, history of rheumatic arthritis, signs of synovitis (rheumatic arthritis) • Pain in both shoulders, pain / stiffness in pelvic girdle / malaise / elevated ESR (polymyalgia rheumatica) • Severe / persistent pain, fever, malaise, weight loss, chest pain, shortness of breath (cardiac / pulmonary / abdominal / septic arthritis) • Complaints not corresponding with age of patient

  18. Evaluation 1- With limitation of passive movement • Painful arc / abduction most prominently limited movement/ pain at the end of the abduction (subacromial syndrome) • Painful and restricted exorotation / exorotation most prominently limited (capsular syndrome / frozen shoulder)

  19. Evaluation 2- Without limitation of passive movement • Painful arc / abduction (subacromial syndrome)

  20. Evaluation 3- Without limitation of passive movement and without painful abduction • Cervical spine, • glenohumeral instability • a.c. / s.c.

  21. Treatment 1 Paracetamol / NSAID 2 weeks or longer when successful and necessary when ineffective: 2 Injection corticosteroid 10-40 mg triamcinolone acetonide (1 ml) (can be combined with lidocaine 20 mg/ml, 2 ml) and / or 3 Activating physiotherapy

  22. Anatomy • Humerus • Acromion • Acromio-clavicular joint • Clavicula • Proc. Coracoideus • Glenohumeral joint

  23. Subacromial injection • Needle 5 cm • 2 cm below the middle of the lateral edge of the acromion • Advance needle to well under the acromion

  24. Precautions • Asepsis / iodine • Single use ampoules • Respect all resistance while inserting needle and injecting

  25. Side effects • More pain temporarily • Flushing • Menstruation • (higher glucose levels)

  26. Thank you www.gpsupport.nl

More Related