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31.08.2014

Left shoulder joint pain, reduce fat - Review

Author: admin
As a reminder, cartilage is the tissue that covers the bone surfaces within your knee joint– it absorbs shock and protects the ends of the bones from each other. Patients with extreme pain, major trauma, who are very ill or near death will always get treated first as Emergency Room resources are prioritized to care for these more critical cases. I am amazed by the number of swollen knees and sore shoulders that come through the emergency department and are referred to fracture clinic with a history of several weeks of symptoms.
There is much controversy as to how to treat knee pain nonoperatively, and if cortisone injections are dangerous in the knee. The knee, being one of the largest joints in the body, is susceptible to the development of conditions that cause pain and swellng, like osteoarthritis, trauma and rheumatoid arthritis.
Initially, we treat early osteoarthritis of the knee with physical therapy, weight reduction, anti inflammatory medications like Advil and Aleve, and eventually move to prescription anti inflammatory medications, pain killers, braces, knee injections and sometimes surgery. Cortisone has been one of the most common injections used in the knee for decades and benefits patients by relieving both pain and inflammation for weeks to months. Total joint replacements are performed for severe degenerative disease of the hip, knee, ankle, shoulder and even wrist, fingers and spinal segments. Each year, over 62,000 hip and knee joint replacement surgeries are performed across Canada. Hip and knee joint replacement requires removal of the degenerative joint surfaces and resurfacing with a prosthetic implant or implants. Hip replacements require arthroplasty of the ball and socket joint which connects the thigh (femur) bone to the pelvic cup (acetabulum).
The field of joint replacement is huge with billions of dollars worldwide directed at research and development of more durable, longer-lasting and better functioning prosthesis.
The Canadian Joint Replacement Registry (CJRR) was launched in 2000 to create a database of patients and implants used for arthroplasty procedures in order to offer insights into successes, failures, trends and complications that surgeons and patients experience. By adding revision surgery information to the database, we should eventually be able to develop survivorship information for specific implant types, the addition of antibiotic to cement, to surgical approach, and many others factors that are involved in procedure, implant selection and post operative care. And for more information about total joint replacements, please visit one of the largest manufacturers of prosthetic joint products, Zimmer.
The Knee is a rather simple joint when compared to other joints, like the elbow for example, but it is not a simple hinge joint as you might expect. The joint surfaces, on the ends of the femur and tibia bones which make up the weight bearing parts of the knee are coated with hyaline cartilage like on the end of a chicken bone.
A typical weekend warrior injury is a twist that results in pain, swelling, stiffness and decreased weight bearing tolerance.
According to Turner, amateur boxing is a sport that rewards technical proficiency and the use of athleticism rather than the power of administering pain. Some of my patients become so stiff that the shoulder seems to be stuck in position, preventing them from reaching, combing their hair, putting on clothes or even brushing their teeth with the affected arm. Investigations include an ultrasound, Xray or MRI of the shoulder to view the structures and determine the exact nature of the symptoms. Nonoperative treatments for shoulder injuries range from home stretching and rest, to cortisone injections and physical therapy modalities. This diagram should be filed in Google image search for , containing strong results for the topics of and .
Tissue grafts will not interfere with future treatment options, such as surgery or knee replacement, should they become necessary.
They are donor collections of small pieces of juvenile joint cartilage that are implanted into the affected areas of cartilage loss by a surgeon. There is evidence to suggest that frequent doses of cortisone may degrade joint cartilage and change the properties of meniscal cartilage by altering the cartilage cells.
Calcium supplements, though effective at correcting low calcium states, may cause other side effects in the body including kidney or bile stones, bone pain, nausea and vomiting, and pancreatitis among other conditions.


Pain management and the prevention of blood clots in the legs are two of the most important post operative issues that the medical team will address. Alternate bearing surfaces such as ceramics, and highly cross linked plastics with antioxidants to prevent degradation are currently the hottest topics in joint replacement research. If the bone on either side of the joint don’t break, then the ligaments, menisci and even some of the tendons from the large leg and thigh muscles which pass by the knee can tear. If this does not clear up with rest, ice, gentle ,movement and elevation of the leg after 2 or 3 days, then you should see your doctor for a physical examination.
Sometimes a CT scan, or an MR-arthrogram where dye is injected into the shoulder to better see the joint structures, are used. An injectin of an anesthetic into the AC joint, the glenohumeral joint, or in the space beneath the acromion can help identify which area is causing symptoms to better determine the diagnosis and the best treatment. Cayen who specializes in sport medicine and joint replacement surgery, as well as our administrative assistants.
There are also numerous scientific studies demonstrating direct toxic effects of cortisone on joint structures including ligaments. Some point along the line, the decision would be made whether to proceed with joint resurfacing or replacement based on the patient factors such as age and medical status, as well as disease factors such as severity and functional abilities.
Fractures of the vertebrae are rarely treated surgically unless severe and can be treated usually by a very short course of rest and then gentle physical therapy with pain management using mild medications. The acetabulum, or socket part of the joint, is resurfaced with a metal shell typically and a plastic, ceramic or metal liner that articulates with the ball portion of the implant. However, at somepoint, if the injury is significant, or if small traumas add up overtime, the shoulder begins to scream out for attention and block us from doing certain motions–typically reaching overhead, or carrying things away from the body. The use of pain patches, epidural anesthesia or spinal anesthesia has improved post operative pain management for total joint patients.
Even sleeping on the shoulder, or performing prolonged static activities such as holding a book to read, driving, or washing mirrors and windows can be intolerable.
Examination of the shoulder should include inspection, palpation, evaluation of range of motion and provocative testing. In addition, a thorough sensorimotor examination of the upper extremity should be performed, and the neck and elbow should be evaluated.
The unique anatomy and range of motion of the glenohumeral joint can present a diagnostic challenge, but a proper clinical evaluation usually discloses the cause of the pain.AnatomyThe shoulder is composed of the humerus, glenoid, scapula, acromion, clavicle and surrounding soft tissue structures. The shoulder region includes the glenohumeral joint, the acromioclavicular joint, the sternoclavicular joint and the scapulothoracic articulation (Figure 1a).
The glenohumeral joint capsule consists of a fibrous capsule, ligaments and the glenoid labrum.
Because of its lack of bony stability, the glenohumeral joint is the most commonly dislocated major joint in the body. The patient should be asked about shoulder pain, instability, stiffness, locking, catching and swelling.
Stiffness or loss of motion may be the major symptom in patients with adhesive capsulitis (frozen shoulder), dislocation or glenohumeral joint arthritis.
Pain with throwing (such as pitching a baseball) suggests anterior glenohumeral instability. Patients who complain of generalized joint laxity often have multidirectional glenohumeral instability.Distinguishing between an acute and a chronic problem is diagnostically helpful (Table 1). For example, a history of acute trauma to the shoulder with the arm abducted and externally rotated strongly suggests shoulder subluxation or dislocation and possible glenoid labral injury. Neck pain and pain that radiates below the elbow are often subtle signs of a cervical spine disorder that is mistaken for a shoulder problem.The patient should be asked about paresthesias and muscle weakness. The patient should be asked about previous corticosteroid injections, particularly in the setting of osteopenia or rotator cuff tendon atrophy.Physical ExaminationA complete physical examination includes inspection and palpation, assessment of range of motion and strength, and provocative shoulder testing for possible impingement syndrome and glenohumeral instability.


The neck and the elbow should also be examined to exclude the possibility that the shoulder pain is referred from a pathologic condition in either of these regions.INSPECTIONThe physical examination includes observing the way the patient moves and carries the shoulder. Swelling, asymmetry, muscle atrophy, scars, ecchymosis and any venous distention should be noted.
Deformity, such as squaring of the shoulder that occurs with anterior dislocation, can immediately suggest a diagnosis. Atrophy of the supraspinatus or infraspinatus should prompt a further work-up for such conditions as rotator cuff tear, suprascapular nerve entrapment or neuropathy.PALPATIONPalpation should include examination of the acromioclavicular and sternoclavicular joints, the cervical spine and the biceps tendon. The anterior glenohumeral joint, coracoid process, acromion and scapula should also be palpated for any tenderness and deformity.RANGE-OF-MOTION TESTINGBecause the complex series of articulations of the shoulder allows a wide range of motion, the affected extremity should be compared with the unaffected side to determine the patient's normal range.
For example, a patient with loss of active motion alone is more likely to have weakness of the affected muscles than joint disease.Shoulder abduction involves the glenohumeral joint and the scapulothoracic articulation. Beyond 120 degrees, full abduction is possible only when the humerus is externally rotated (palm up).The Apley scratch test is another useful maneuver to assess shoulder range of motion (Figure 2). Conversely, internal rotation and adduction of the shoulder are tested by having the patient reach behind the back and touch the inferior aspect of the opposite scapula.
The patient attempts to touch the opposite scapula to test range of motion of the shoulder. A patient with subacromial bursitis with a tear of the rotator cuff often has objective rotator cuff weakness caused by pain when the arm is positioned in the arc of impingement.
Conversely, the patient will have normal strength if the arm is not tested in abduction.1The supraspinatus can be tested by having the patient abduct the shoulders to 90 degrees in forward flexion with the thumbs pointing downward.
This test is performed by passively abducting the patient's shoulder, then observing as the patient slowly lowers the arm to the waist. The patient may be able to lower the arm slowly to 90 degrees (because this is a function mostly of the deltoid muscle) but will be unable to continue the maneuver as far as the waist.CROSS-ARM TESTPatients with acromioclavicular joint dysfunction often have shoulder pain that is mistaken for impingement syndrome. The patient elevates the affected arm to 90 degrees, then actively adducts it.Instability TestingThe tests described in this section are useful in evaluating for glenohumeral joint stability. Because the shoulder is normally the most unstable joint in the body, it can demonstrate significant glenohumeral translation (motion). Again, the uninvolved extremity should be examined for comparison with the affected side.7,8APPREHENSION TESTThe anterior apprehension test is performed with the patient supine or seated and the shoulder in a neutral position at 90 degrees of abduction. A decrease in pain or apprehension suggests anterior glenohumeral instability.YERGASON TESTPatients with rotator cuff tendonitis frequently have concomitant inflammation of the biceps tendon. The examiner resists forward flexion of the arm while palpating the patient's biceps tendon over the anterior aspect of the shoulder.SULCUS SIGNWith the patient's arm in a neutral position, the examiner pulls downward on the elbow or wrist while observing the shoulder area for a sulcus or depression lateral or inferior to the acromion. Referred or radicular pain from disc disease should be considered in patients who have shoulder pain that does not respond to conservative treatment.
The patient should be questioned about neck pain and previous neck injury, and the examiner should note whether pain worsens with turning of the neck, which suggests disc disease. Pain that originates from the neck or radiates past the elbow is often associated with a neck disorder.Plain film is a useful screening tool for degenerative cervical disc disease.
Further work-up and imaging studies depend on the differential diagnosis and the treatment plan.SPURLING'S TESTIn a patient with neck pain or pain that radiates below the elbow, a useful maneuver to further evaluate the cervical spine is Spurling's test. The patient's cervical spine is placed in extension and the head rotated toward the affected shoulder. The neck is extended and rotated toward the affected shoulder while an axial load is placed on the spine.



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