frozen shoulder and steroids - anzsom
TRANSCRIPT
![Page 1: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/1.jpg)
![Page 2: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/2.jpg)
ENIGMA
SOMETHING THAT IS DIFFICULT TO
UNDERSTAND OR EXPLAIN
![Page 3: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/3.jpg)
MY GOLF SWING
![Page 4: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/4.jpg)
FROZEN SHOULDER
NO EVIDENT CAUSE OR PROVOCATION
A Normal Shoulder
Persistently Painful
Global Stiffness
![Page 5: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/5.jpg)
FROZEN SHOULDER
Persistent Shoulder and referred arm pain
Protracted Course : Freezing : painful stiffening
1 – 9 months
Frozen : pain less, ROM frozen
6 months
Thawing : Slow resolution
2 years
![Page 6: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/6.jpg)
SHOULDER ARM REGIONAL PAIN
![Page 7: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/7.jpg)
IDIO PATHIC
DOCTOR - IDIOT
PATIENT - PATHETIC
![Page 8: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/8.jpg)
FROZEN SHOULDER
SHOULDER SPRAIN
ROTATOR CUFF STRAIN
![Page 9: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/9.jpg)
CASE 1
MRS. SM – AGE 59 – CLEANER
FALL AT WORK
NECK – SHOULDER – ARM PAIN
MRI – C5-6 DISC
Surgery Recommended
![Page 10: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/10.jpg)
CLINICAL EXAMINATION
LAY THE PATIENT SUPINE
FIX THE SHOULDER BLADE ON THE COUCH
PROTRACT THE RANGE OF MOVEMENT
![Page 11: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/11.jpg)
FROZEN SHOULDER - ALL MOVEMENT RESTRICTED
IMPINGEMENT - EXTERNAL AND INTERNAL ROTATION ARE
PRESERVED
![Page 12: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/12.jpg)
CASE 2
MR. RP - AGE 48 - FREEZING WORKER
CONTUSION SPRAIN RIGHT SHOULDER
LIMITATION OF MOVEMENT - SEVERE RESTRICTION
CALCIFIC TENDONOSIS + FROZEN SHOULDER
![Page 13: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/13.jpg)
CASE 3
MR. PW - AGE 46 - DAIRY FARMER
ROLLED 4WD BIKE - CONTUSION SPRAIN LEFT SHOULDER
DIABETIC
FROZEN SHOULDER
![Page 14: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/14.jpg)
CASE 4
MRS. DH - AGE 46 - AIRPORT SECURITY OFFICER
FALL - ROTATOR CUFF TEAR LEFT SHOULDER
SIMPLE ROTATOR CUFF REPAIR
CRPS LEFT FOREARM AND HAND - 4 WEEKS
FROZEN SHOULDER - 6 WEEKS
![Page 15: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/15.jpg)
FROZEN SHOULDER MAY BE ACCIDENT INJURY
RELATED
![Page 16: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/16.jpg)
CJ WOLF 2004
PAIN PATTERNS - NOCICEPTIVE
INFLAMMATORY
NEUROPATHIC
FUNCTIONAL
CENTRAL NEURAL SENSITISATION
CENTRAL NEURAL TRANSFORMATION
![Page 17: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/17.jpg)
SYNOVITIS
![Page 18: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/18.jpg)
? ! PATHO-PHYSIOLOGY ! ?
TRANSFORMING GROWTH FACTOR
PLATELET DERIVED GROWTH HORMONE
AUTO IMMUNITY
GENETIC PREDISPOSITION
![Page 19: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/19.jpg)
ARTHROSCOPY
![Page 20: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/20.jpg)
MRI
![Page 21: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/21.jpg)
CHRONIC PAIN DISORDER
PERSISTENT PAIN
BEHAVIOURAL DYSFUNCTION
![Page 22: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/22.jpg)
FROZEN SHOULDERS
DO NOT ALL EVENTUALLY RESOLVE
![Page 23: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/23.jpg)
TREATMENT
NOT SURGICAL
PHYSIOTHERAPY
CORTICOSTEROID
![Page 24: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/24.jpg)
![Page 25: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/25.jpg)
CORTICO STEROID
![Page 26: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/26.jpg)
INTRA-ARTICULAR KENACORT 80MG
SYSTEMIC – PREDNISONE
20MG - 10 DAYS
10MG – 10 DAYS
70% RESPONSE – 4 WEEKS
![Page 27: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/27.jpg)
ADRENAL EXTRACT
World War 2 German Aircrew
British Spies
![Page 28: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/28.jpg)
AND SO A MYTH WAS BORN
![Page 29: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/29.jpg)
TO HELP YOU SEE IN THE DARK
British - Carrots
STEROIDS
Americans
Amphetamines
![Page 30: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/30.jpg)
MECHANISM OF ACTION
Stabilises the Lysosomal Membrane of Immune system cells
Thereby Controlling the Release of Cytokines and P Substances
Thus diminishing the Inflammatory Reaction
![Page 31: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/31.jpg)
Orthopaedic
Surgeons aren’t
just Bone Heads
![Page 32: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/32.jpg)
CONCLUSION
FROZEN SHOULDER - Idiopathic
- Accident Injury Caused
CLINICAL EXAM - Patient Supine
- Protract True R.O.M
TREATMENT - Cortico Steroid
![Page 33: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/33.jpg)
THANKYOU - PETER WELSH
![Page 34: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/34.jpg)
![Page 35: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/35.jpg)
TGF
![Page 36: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/36.jpg)
LIMITATIONS : RESTRICTIONS
No don’t do’s
Can’t do’s
But pushing it doesn’t Help
![Page 37: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/37.jpg)
CORTICO STEROID INJECTION
How does it work
?
![Page 38: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/38.jpg)
Age 40-60
Family history
More common in
diabetics
Rarely recurs on
the same side
20% on opposite
DEVELOPS IN A NORMAL SHOULDER
![Page 39: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/39.jpg)
REGIONAL PAIN DIAGRAM
![Page 40: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/40.jpg)
WHY : HOW
Auto immune Reaction
Myofibroblastic Proliferation
Transforming Growth Factor
![Page 41: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/41.jpg)
M.U.A.
Manipulation Under Anaesthetic
A gentle stretch over 2-3 minutes
![Page 42: FROZEN SHOULDER and STEROIDS - ANZSOM](https://reader031.vdocuments.site/reader031/viewer/2022012301/61e1e1233030c61ccf429f7a/html5/thumbnails/42.jpg)
Glucocorticoids
Regulates glycogen
and lipid function
Boosts energy levels
Androgens
Anabolic , energy
boosting
ADRENAL CORTICOSTEROIDS