Manual of Musculoskeletal Medicine by Grant Cooper

By Grant Cooper

This high-yield, trouble-free guide is a realistic highway map for all physicians who diagnose and deal with sufferers with musculoskeletal indicators, together with physiatrists, orthopedists, internists, family members practitioners, rheumatologists, and neurologists. equipped through anatomic zone, the publication presents a step by step method of the analysis and competitive nonsurgical administration of universal musculoskeletal signs. each one bankruptcy opens with prognosis and remedy algorithms for universal leader proceedings. various high-yield issues provide a transparent photo of every criticism and a logical, stepwise method of administration. The authors additionally point out whilst a symptom is an emergency or calls for surgical evaluation.

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After the area has undergone sterile preparation, a mixture of lidocaine and triamcinolone acetonide is injected into the subacromial space. SUBACROMIAL STEROID INJECTION A posterolateral approach is favored by the authors. After informed consent is obtained, identify the acromion. 5 inch needle, 40 mg of triamcinolone acetate, and 3 mL of 1% lidocaine. qxd 1/21/08 2:42 PM Page 31 Chapter 2: Shoulder Pain 31 acromion. Sterilize this area using three iodine swabs and an alcohol pad. Using sterile technique, aim the needle parallel to the ground in the direction of the coracoid process (identified anteriorly by palpation).

For patients with advanced shoulder osteoarthritis that interferes with quality of life and who are resistant to conservative care, surgery may be an option. When needed, the most common and generally preferred form of surgery for shoulder osteoarthritis is total joint replacement. In younger patients interested in continuing to lift heavy loads and stay very active, a hemiarthroplasty may be more appropriate. In patients with damaged muscles or tendons that are incapable of supporting a replacement, a shoulder arthrodesis may be appropriate.

If the radial pulse diminishes when the head is turned to the affected side, TOS is suspected. However, this test is nonspecific, and many false positives may occur. Another test is to elevate the patient’s arm in the abducted and flexed position over the head. If the radial pulse diminishes, or symptoms are reproduced, some physicians believe this outcome suggests TOS. Diagnostic Studies Generally, radiographs are all that are needed initially. These films may reveal a cervical rib. MRI may also be useful, although not necessary to begin with, to evaluate for the specific site of impingement.

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