Shoulder Tendonitis
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Right Ring Finger Volar Mass in a 14-Year-Old
6/6/2017 Right Ring Finger Volar Mass in a 14YearOld Boy CASE REPORT FREE Right Ring Finger Volar Mass in a 14YearOld Boy Mary P. Fox, MD; Jack E. McKay, MD; Randall D. Craver, MD; Nicholas D. Pappas, MD Orthopedics Posted May 22, 2017 DOI: 10.3928/014774472017051801 Abstract A trigger digit is relatively uncommon in adolescents and often has a different etiology in that age group vs adults. In the pediatric population, trigger digits frequently arise from a variety of underlying anatomic situations, including thickening of the flexor digitorum superficialis or flexor digitorum profundus tendons, an abnormal relationship between the flexor digitorum superficialis and flexor digitorum profundus tendons, a proximal flexor digitorum superficialis decussation, or constriction of the pulleys. In addition, underlying conditions such as mucopolysaccharidosis, juvenile rheumatoid arthritis, EhlersDanlos syndrome, and central nervous system disorders such as delayed motor development have been associated with triggering. Less commonly, triggering secondary to intratendinous or peritendinous calcifications or granulations has been described, which is what occurred in the current case. This report describes a case of tenosynovitis with psammomatous calcification treated with excision of the mass from the flexor digitorum superficialis tendon and release of both the A1 and palmar aponeurosis pulleys in an adolescent patient. [Orthopedics. 201x; xx(x):xx–xx.] The etiology for a trigger digit in the adolescent population can be complex and extensive, including underlying anatomic causes or other pathological processes such as fracture, tumor, or traumatic soft tissue injuries.1–5 Current literature has not described a case of tenosynovitis secondary to a peritendinous soft tissue mass consisting of psammomatous calcification in the adolescent population. -
Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions. -
Calcific Tendinitis of the Shoulder
CME Further Education Certified Advanced Training Orthopäde 2011 [jvn]:[afp]-[alp] P. Diehl1, 2 L. Gerdesmeyer3, 4 H. Gollwitzer3 W. Sauer2 T. Tischer1 DOI 10.1007/s00132-011-1817-3 1 Orthopaedic Clinic and Polyclinic, Rostock University 2 East Munich Orthopaedic Centre, Grafing 3 Orthopaedics and Sports Orthopaedics Clinic, Klinikum rechts der Isar, Online publication date: [OnlineDate] Munich Technical University Springer-Verlag 2011 4 Oncological and Rheumatological Orthopaedics Section, Schleswig-Holstein University Clinic, Kiel Campus Editors: R. Gradinger, Munich R. Graf, Stolzalpe J. Grifka, Bad Abbach A. Meurer, Friedrichsheim Calcific tendinitis of the shoulder Abstract Calcific tendinitis of the shoulder is a process involving crystal calcium deposition in the rotator cuff tendons, which mainly affects patients between 30 and 50 years of age. The etiology is still a matter of dispute. The diagnosis is made by history and physical examination with specific attention to radiologic and sonographic evidence of calcific deposits. Patients usually describe specific radiation of the pain to the lateral proximal forearm, with tenderness even at rest and during the night. Nonoperative management including rest, nonsteroidal anti-inflammatory drugs, subacromial corticosteroid injections, and shock wave therapy is still the treatment of choice. Nonoperative treatment is successful in up to 90 % of patients. When nonsurgical measures fail, surgical removal of the calcific deposit may be indicated. Arthroscopic treatment provides excellent results in more than 90 % of patients. The recovery process is very time consuming and may take up to several months in some cases. Keywords Rotator cuff Tendons Tendinitis Calcific tendinitis Calcification, pathologic English Translation oft he original article in German „Die Kalkschulter – Tendinosis calcarea“ in: Der Orthopäde 8 2011 733 This article explains the causes and development of calcific tendinitis of the shoulder, with special focus on the diagnosis of the disorder and the existing therapy options. -
Pediatric Trigger Finger Due to Osteochondroma
HANXXX10.1177/1558944715627634HANDde Oliveira et al 627634research-article2016 Case Report HAND 1 –7 Pediatric Trigger Finger due to © American Association for Hand Surgery 2016 DOI: 10.1177/1558944715627634 Osteochondroma: A Report of Two Cases hand.sagepub.com Ricardo Kaempf de Oliveira1, Pedro J. Delgado2, and João Guilherme Brochado Geist3 Abstract Background: The trigger finger is characterized by the painful blocking of finger flexor tendons of the hand, while crossing the A1 pulley. It is a rare disease in children and, when present, is usually located in the thumb, and does not have any defined cause. Methods: We report 2 pediatric trigger finger cases affecting the long digits of the hand that were caused by an osteochondroma located at the proximal phalanx. Both children held the diagnosis of juvenile multiple osteochondromatosis. They had presented at the initial visit with a painful finger blocking. Surgical approach was decided with wide regional exposure, as compared with the trigger finger traditional surgical techniques, with the opening of the A1 pulley and the initial portion of the A2 pulley, along with bone tumor resection. Results: Patients evolved uneventfully, and recovered the affected finger motion. Conclusion: It is important to highlight that pediatric trigger finger is a distinct ailment from the adult trigger finger, and also in children is important to differentiate whenever the disease either affects the thumb or the long fingers. A secondary cause shall be sought whenever the long fingers are affected by a trigger finger. Keywords: trigger finger, pediatric, flexor tendon, bone tumor Introduction Case 1 The trigger finger, also known as stenosing tenosynovi- A 13-year-old girl who had juvenile multiple osteochondro- tis, is rare in the pediatric population and, when present, matosis (JMO) reported 18-month long complaints of left is usually located on the thumb and associated with a hand ring finger pain and snapping. -
Musculoskeletal Diagnostic Imaging
Musculoskeletal Diagnostic Imaging Vivek Kalia, MD MPH October 02, 2019 Course: Sports Medicine for the Primary Care Physician Department of Radiology University of Michigan @VivekKaliaMD [email protected] Objectives • To review anatomy of joints which commonly present for evaluation in the primary care setting • To review basic clinical features of particular musculoskeletal conditions affecting these joints • To review key imaging features of particular musculoskeletal conditions affecting these joints Outline • Joints – Shoulder – Hip • Rotator Cuff Tendinosis / • Osteoarthritis Tendinitis • (Greater) Trochanteric bursitis • Rotator Cuff Tears • Hip Abductor (Gluteal Tendon) • Adhesive Capsulitis (Frozen Tears Shoulder) • Hamstrings Tendinosis / Tears – Elbow – Knee • Lateral Epicondylitis • Osteoarthritis • Medical Epicondylitis • Popliteal / Baker’s cyst – Hand/Wrist • Meniscus Tear • Rheumatoid Arthritis • Ligament Tear • Osteoarthritis • Cartilage Wear Outline • Joints – Ankle/Foot • Osteoarthritis • Plantar Fasciitis • Spine – Degenerative Disc Disease – Wedge Compression Deformity / Fracture Shoulder Shoulder Rotator Cuff Tendinosis / Tendinitis • Rotator cuff comprised of 4 muscles/tendons: – Supraspinatus – Infraspinatus – Teres minor – Subscapularis • Theory of rotator cuff degeneration / tearing with time: – Degenerative partial-thickness tears allow superior migration of the humeral head in turn causes abrasion of the rotator cuff tendons against the undersurface of the acromion full-thickness tears may progress to -
Primary and Secondary Consequences of Rotator Cuff
Hafizur Rahman Department of Mechanical Science and Engineering, University of Illinois at Urbana-Champaign, Urbana, IL 61801 Primary and Secondary e-mail: [email protected] Consequences of Rotator Cuff Eric Currier Department of Mechanical Science and Engineering, Injury on Joint Stabilizing University of Illinois at Urbana-Champaign, Urbana, IL 61801 Tissues in the Shoulder e-mail: [email protected] Rotator cuff tears (RCTs) are one of the primary causes of shoulder pain and dysfunction Marshall Johnson in the upper extremity accounting over 4.5 million physician visits per year with 250,000 Department of Mechanical Engineering, rotator cuff repairs being performed annually in the U.S. While the tear is often consid- Georgia Institute of Technology, ered an injury to a specific tendon/tendons and consequently treated as such, there are Atlanta, GA 30332 secondary effects of RCTs that may have significant consequences for shoulder function. e-mail: [email protected] Specifically, RCTs have been shown to affect the joint cartilage, bone, the ligaments, as well as the remaining intact tendons of the shoulder joint. Injuries associated with the Rick Goding upper extremities account for the largest percent of workplace injuries. Unfortunately, Department of Orthopaedic, the variable success rate related to RCTs motivates the need for a better understanding Joint Preservation Institute of Iowa, of the biomechanical consequences associated with the shoulder injuries. Understanding West Des Moines, IA 50266 the timing of the injury and the secondary anatomic consequences that are likely to have e-mail: [email protected] occurred are also of great importance in treatment planning because the approach to the treatment algorithm is influenced by the functional and anatomic state of the rotator cuff Amy Wagoner Johnson and the shoulder complex in general. -
Impingement Syndrome and Tears of the Rotator Cuff
Impingement Syndrome and Tears of the Rotator Cuff Dr Keith Holt Impingement is a very common problem in which the tendons of the rotator cuff (predominantly supraspinatus) rub on the underside of the acromion (the bone at the point of the shoulder). This causes pain due to the repeated rubbing of those tendons and it is especially bad with certain positions of the arm. In particular it is difficult to put the arm behind the back and to use it in the elevated position. This makes it difficult to drive, change gears, hang clothes, comb one’s hair, and even to lie on the affected shoulder. The cause of this problem can be: How does the shoulder work? The shoulder, like the hip, is a ball and socket joint (like a tow 1) A muscle imbalance problem due to poor functioning bar). Unlike the hip however, the socket is very small and is of the rotator cuff tendons themselves; thus allowing the not big enough to hold the head of the humerus (the ball) arm to ride up and rub on the acromion, squashing the in place. This gives the joint a large range of motion but, as rotator cuff tendons in the process: or a consequence, it also means that it is potentially unstable. 2) A mechanical problem where the space for the tendon To function normally, muscles on both sides of the joint must is inadequate. One way this can occur is with an injury work together to hold the joint in place during movement. to the tendon itself which causes swelling of that tendon This means that when the deltoid muscle (see diagrams) lifts such that it becomes too large for the space at hand the arm out from the side of the body, the supraspinatus and [primary tendonitis (inflammation of the tendon) with other muscles of the rotator cuff must pull down on the top secondary impingement [rubbing of the tendon on the of the humerus. -
Physiopathology of Intratendinous Calcific Deposition Francesco Oliva1, Alessio Giai Via1 and Nicola Maffulli2*
Oliva et al. BMC Medicine 2012, 10:95 http://www.biomedcentral.com/1741-7015/10/95 REVIEW Open Access Physiopathology of intratendinous calcific deposition Francesco Oliva1, Alessio Giai Via1 and Nicola Maffulli2* involved tendon is the supraspinatus tendon, and in 10% Abstract of patients the condition is bilateral (Figure 1) [1]. The In calcific tendinopathy (CT), calcium deposits in the nomenclature of this condition is confusing, and, for substance of the tendon, with chronic activity-related example, in the shoulder terms such as calcific periar- pain, tenderness, localized edema and various degrees thritis, periarticular apatite deposition, and calcifying of decreased range of motion. CT is particularly tendinitis have been used [2]. We suggest to use the common in the rotator cuff, and supraspinatus, terms ‘calcific tendinopathy’,asitunderlinesthelackof Achilles and patellar tendons. The presence of calcific aclearpathogenesiswhentheprocessislocatedinthe deposits may worsen the clinical manifestations of body of tendon, and ‘insertional calcific tendinopathy’,if tendinopathy with an increase in rupture rate, slower the calcium deposit is located at the bone-tendon recovery times and a higher frequency of post- junction. operative complications. The aetiopathogenesis of CT Calcific insertional tendinopathy of the Achilles tendon is still controversial, but seems to be the result of an manifests in different patients populations, including active cell-mediated process and a localized attempt young athletes and older, sedentary and overweight indi- of the tendon to compensate the original decreased viduals [3]. Usually, radiographs evidence ossification at stiffness. Tendon healing includes many sequential the insertion of the Achilles tendon or a spur (fish-hook processes, and disturbances at different stages of osteophyte) on the superior portion of the calcaneus. -
Rotator Cuff Injuries
Scott Gudeman, MD 1260 Innovation Pkwy., Suite 100 Greenwood, IN 46143 317.884.5161 OrthoIndy.com ScottGudemanMD.com Rotator Cuff Injuries Front View Muscles of the Rotator Cuff Shoulder Anatomy Subscapularis Back The tendons of four muscles in the upper arm form View Supraspinatus the rotator cuff, blending together to help stabilize the shoulder. Tendons attach muscles to bone and are the mechanisms that enable muscles to move bones. It is because of the rotator cuff tendons, which connect the long bone of the arm (the humerus) to the scapula (the shoulder blade) that we can raise and rotate our arms. The rotator cuff also keeps the humerus tightly in Infraspinatus the socket (glenoid) when the arm is raised. The tough Supraspinatus fibers of the rotator cuff bend as the shoulder changes Teres position. Minor What are Rotator Cuff Injuries? For normal shoulder function, each muscle must be healthy, securely attached, coordinated and condi- tioned. When there are full or partial tears to the rotator cuff tendons, movement of the arm up or away from the body is impaired, making it difficult or impossible to rotate the arm in its ball-and-socket joint. Causes of Rotator Cuff Injuries Injuries to the rotator cuff tendons of the shoulder can happen to anyone over time. Rotator cuff tendons can be injured or torn by excessive force, such as pitching, lifting a very heavy object with the arm extended or trying to catch a heavy object as it falls. Occasionally, these accidents happen to young people, but typically a rotator cuff tear occurs to a person who is middle-aged or older who has experienced problems with the shoulder for some time before the injuring event. -
A Systematic Review of Shockwave Therapies in Soft Tissue Conditions: Focusing on the Evidence Cathy Speed
Downloaded from http://bjsm.bmj.com/ on February 8, 2018 - Published by group.bmj.com Review A systematic review of shockwave therapies in soft tissue conditions: focusing on the evidence Cathy Speed Cambridge Centre for Health ABSTRACT other tissues.2 Many of the physical effects are and Performance, Vision Park, Background ‘Shock wave’ therapies are now considered to be dependent on the energy delivered Histon, Cambridge, UK extensively used in the treatment of musculoskeletal to a focal area. The concentrated SW energy per 2 Correspondence to injuries. This systematic review summarises the evidence unit area, the energy flux density,(EFD, in mJ/mm ), Dr Cathy Speed, base for the use of these modalities. is a term used to reflect the flow of SW energy in a Rheumatology, Sport & Methods A thorough search of the literature was perpendicular direction to the direction of propaga- Exercise Medicine, Cambridge performed to identify studies of adequate quality to tion and is taken as one of the most important Centre for Health and ‘ ’ 3 Performance, Conqueror assess the evidence base for shockwave therapies on descriptive parameters of SW dosage . There House, Vision Park, pain in specific soft tissue injuries. Both focused remains no consensus as to the definition of ‘high Cambridge CB24 9ZR, UK; extracorporeal shockwave therapy (F-ESWT) and radial and ‘low’ energy ESWT, but as a guideline, low- [email protected] pulse therapy (RPT) were examined. energy ESWT is EFD≤0.12 mJ/mm2, and high fi 2 4 Accepted 25 June 2013 Results 23 appropriate studies were identi ed. There is energy is >0.12 mJ/mm . -
Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions
MEDICAL POLICY POLICY TITLE EXTRACORPOREAL SHOCK WAVE TREATMENT FOR PLANTAR FASCIITIS AND OTHER MUSCULOSKELETAL CONDITIONS POLICY NUMBER MP-2.034 Original Issue Date (Created): 7/1/2002 Most Recent Review Date (Revised): 3/23/2020 Effective Date: 6/1/2020 POLICY PRODUCT VARIATIONS DESCRIPTION/BACKGROUND RATIONALE DEFINITIONS BENEFIT VARIATIONS DISCLAIMER CODING INFORMATION REFERENCES POLICY HISTORY I. POLICY Extracorporeal shock wave therapy (ESWT) using either a high- or low-dose protocol or radial ESWT, is considered investigational as a treatment of musculoskeletal conditions, including but not limited to plantar fasciitis; tendinopathies including tendinitis of the shoulder, tendinitis of the elbow (lateral epicondylitis), Achilles tendinitis and patellar tendinitis; stress fractures; avascular necrosis of the femoral head; delayed union and non-union of fractures; and spasticity. There is insufficient evidence to support a conclusion concerning the health outcomes or benefits associated with this procedure. II. PRODUCT VARIATIONS TOP This policy is only applicable to certain programs and products administered by Capital BlueCross and subject to benefit variations as discussed in Section VI. Please see additional information below. FEP PPO: Refer to FEP Medical Policy Manual MP-2.01.40, Extracorporeal Shock Wave Treatment for Plantar Fasciitis and Other Musculoskeletal Conditions. The FEP Medical Policy Manual can be found at: https://www.fepblue.org/benefit-plans/medical-policies-and-utilization- management-guidelines/medical-policies. III. DESCRIPTION/BACKGROUND TOP CHRONIC MUSCULOSKELETAL CONDITIONS Chronic musculoskeletal conditions (e.g., tendinitis) can be associated with a substantial degree of scarring and calcium deposition. Calcium deposits may restrict motion and encroach on other structures, such as nerves and blood vessels, causing pain and decreased function. -
Rotator Cuff Tendinitis Shoulder Joint Replacement Mallet Finger Low
We would like to thank you for choosing Campbell Clinic to care for you or your family member during this time. We believe that one of the best ways to ensure quality care and minimize reoccurrences is through educating our patients on their injuries or diseases. Based on the information obtained from today's visit and the course of treatment your physician has discussed with you, the following educational materials are recommended for additional information: Shoulder, Arm, & Elbow Hand & Wrist Spine & Neck Fractures Tears & Injuries Fractures Diseases & Syndromes Fractures & Other Injuries Diseases & Syndromes Adult Forearm Biceps Tear Distal Radius Carpal Tunnel Syndrome Cervical Fracture Chordoma Children Forearm Rotator Cuff Tear Finger Compartment Syndrome Thoracic & Lumbar Spine Lumbar Spine Stenosis Clavicle Shoulder Joint Tear Hand Arthritis of Hand Osteoporosis & Spinal Fx Congenital Scoliosis Distal Humerus Burners & Stingers Scaphoid Fx of Wrist Dupuytren's Comtracture Spondylolysis Congenital Torticollis Shoulder Blade Elbow Dislocation Thumb Arthritis of Wrist Spondylolisthesis Kyphosis of the Spine Adult Elbow Erb's Palsy Sprains, Strains & Other Injuries Kienböck's Disease Lumbar Disk Herniation Scoliosis Children Elbow Shoulder Dislocation Sprained Thumb Ganglion Cyst of the Wrist Neck Sprain Scoliosis in Children Diseases & Syndromes Surgical Treatments Wrist Sprains Arthritis of Thumb Herniated Disk Pack Pain in Children Compartment Syndrome Total Shoulder Replacement Fingertip Injuries Boutonnière Deformity Treatment