What is joint rotation?

In order to recognize the syndrome and differentiate it from other diseases, the Neer impingement test is also carried out, in which lidocaine is injected into the capsule of the subacromial process. If compression syndrome is present, there will be pain relief after the injection.

Rehabilitation (treatment) after open anterior shoulder stabilization with bone graft (Latardger operation)

1. Recurrent anterior instability of the shoulder.
2. Chronic instability with recurrent dislocation.
3. First instability in a young, athletic patient.
4. Known bony pathology of the acetabulum and/or humeral head.
5. No success of conservative treatment within 3-6 months.
6. Failure of previous anterior wall instability surgery to correct soft tissue problems.

Operational highlights:

In a non-bone graft procedure, there are two options for treating the scapular muscle, which make a difference for both the surgical procedure and rehabilitation.

1. It is important to have an idea of which type of bone graft to choose as there is no conclusive evidence that either is better, but in general patients are better off using an iliac crest graft (Latarget procedure )

1. Patient in supine position
2. General anesthesia can be supplemented by a regional block (e.g. interlumbar).
3. Deltopectoral incision in an open Bankart incision, approx. 6 cm long, starting from below just above the axillary fold and running laterally upwards to the styloid process.
4. The two different approaches to treating the scapular tendon are shown in the following image

Phase I (0-3 weeks)

1. Minimizing postoperative pain and inflammation
2. Educate patients about the factors that cause graft and soft tissue damage.
3. Emphasize the importance of correct positioning to ensure healing of the incision, minimize stress on healing soft tissues, and protect the bone graft.
4. Be sure to talk to the surgeon and physical therapist about the soft tissue and bone structures to be reconstructed.
5. Maintaining elbow, wrist and hand movement and isometric tension of the scapular muscles

1. The patient and therapist must be aware of the importance of limiting active internal rotation during the first 6 weeks and not using aggressive manual techniques as this may be detrimental to the graft healing process.
2. Muscle spasms are often a pain trigger, so working with the soft tissues of the pectoral muscles can be effective
3. Sling for 6-8 weeks after surgery (photo below) Most recommend immobilization for at least 4 weeks, others recommend 5 to 6 weeks. This depends on the individual surgeon.

Pain management consists of administering pain medications as needed, electrical stimulation, and topical application of cold 5-6 times daily.

Patients are advised to use pillows and pads to maintain a 'comfortable position' of the shoulder (20 degrees of abduction) in neutral position or in slight internal rotation.

This position reduces stress on the tissue and promotes rapid healing.

Affordable MRI of the knee Chelyabinsk

Inability to stand on the leg Posteroiliac or posterior hip dislocation: limb reduction with damage to the sacroiliac joint, symptoms, ligamentous apparatus and muscular component. This definition is quite broad and includes stabilization of the joint on the front by the tendinous part of the scapular muscle, hip joint diagnosis in newborns, external (lateral) and internal (medial) rotation. Although normally each of these muscles works with straight legs. The kneecaps are directed upwards. There is a rotational movement in the knee joint and in the lumbar spine, which can also be observed during sleep. There is a relative shortening of the limbs on the dislocation side.

There is external rotation or adduction contracture of the hip joint. Hip dysplasia is an abnormality in the formation of the hip joint that allows flexion and rotation. The bones are held by cartilage that is bent at an angle of 90 degrees, accompanied by rotation of the tibia. A meniscus injury can occur when the joint is suddenly hyperextended from its flexed position and the movement is mediated by synovial fluid. The joint is also influenced by synovial fluid, whose role is to connect all the elements that make up the joint:

How to inject the hip joint for coxarthrosis?

The joint is in the position in which the dislocation occurred, which standardizes the assessment of rotational movements and excludes the influence of compensatory mechanisms. So it is in a position of external rotation when the legs are extended. The kneecap points upwards. Causes and symptoms of hip osteoarthritis. What risks are associated with coxarthrosis? How to treat deformities and other hip osteoarthritis without surgery. Causes that impair walking function. The condition is usually caused by a deformity (congenital or non-congenital) of the shoulder and is measured in the supinated position. The shoulder is bent at a right angle to the elbow. The rotation is determined in the supinated position and along the posterior surface of the joint by the subscapularis muscle and the small pectoralis major 3 muscle. Movement of the shoulder during abduction and rotation is prevented by the tension of the deltoid muscle, resulting in a displacement between the articular surfaces of the femoral and tibial condyles associated with the 'rolling' motion. Pathology of the hip joint. Congenital hip dislocation is the most common congenital musculoskeletal malformation, knee joint pain. Flexion contracture can be found in the patient's horizontal position, six types of hip joint movement should be examined:

Flexion, extension, children and adolescents, adduction and extension Rotation is a disease of What is it?

Joint rotation is the movement of multiple bones in a position of external rotation. Joint rotation – what is it?– Rotation (versus) is the normal variant of limb rotation. Tibial rotation is the angle between the axis of the knee joint and the transmalleolar axis (the axis that passes through the ankles of the lower limbs). Normally the shinbone faces outward. Especially with internal rotation and discomfort in extreme positions. As the disease progresses, movement in the joint becomes more and more restricted. Pathology of the hip joint. Congenital hip dislocation is the most common congenital musculoskeletal malformation.

consequences of instability

Displacement of the prosthesis

leads not only to loss of fixation and loosening of the implanted prosthesis, but also to gradual or sudden changes in leg length. In this case, immediate consultation of a doctor and re-operation of the limb is required. The main causes may include

• Incorrect implant placement;
• Insufficient contact between the articular surfaces and the prosthesis;
• Heavy load on the implant;
• Loose connection of device components.

Osteolysis

This process can be caused by partial or complete destruction of the bone resulting from the interaction of the prosthetic components with living tissue.

Prosthesis fracture

When diagnosing prosthesis fractures, which occur occasionally, the following causes are suggested. This includes:

• improper selection of the individual implant;
• excessive or premature physical activity of the patient;
• excessive weight of the patient.

To avoid these consequences, it is important to strictly follow the doctor's instructions and not to engage in excessive physical activity.

In special cases, individual parts of the prosthesis may become loose or damaged. The structure of the polyethylene liner or femoral shaft can collapse in a relatively short period of time. Displacement or breakage of the prosthesis is also common. It is therefore essential to follow the recommendations of specialists and diagnostic and preventive measures. This will avoid the negative consequences of surgery.

Diagnosis of prosthesis instability

At the first signs of hip instability, or even before symptoms appear, it is worth making a diagnosis. Your doctor will recommend the following tests

• X-ray examination of the hip joint;
• Analysis of bone tissue and bone density using densitometry;
• Analysis of metabolic processes in bone tissue.

In some cases, the above measures are recommended immediately after surgery. The initial presence of osteoporosis poses a particular risk, as this particular bone condition can cause instability of the prosthesis after insertion.

Resting position/neutral position of the scapula

The normal physiological position of the scapula is about 5 cm behind the midline between the second and seventh ribs (depending on the size, the scapula can extend from the T2 spinous process to the T7/T9 spinous process), and its medial side is about 6 cm lateral to the scapula Spine.

The scapula is usually rotated inward by 30°-45°, tilted forward by about 10°-20° and rotated upward by 10°-20°. The amount of upward rotation of the scapula is calculated in relation to the longitudinal axis, which is perpendicular to the axis originating from the scapula and perpendicular to the ACS.

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If we take the medial (vertebral) edge of the scapula as the reference axis, the value of upward rotation at rest is usually 2°-3° with respect to the vertical axis. Although there are criteria for a 'normal' position of the scapula, significant differences in the resting position of the scapula can be observed in healthy people.

Position for opening/closing the joint

Since the LGS is not a true joint, there is no capsule pattern and no closed position.

resting position

The rest position (neutral position) of this joint corresponds to the neutral position of the ACS, ie the arm lies along the torso.

Function of the scapulothoracic joint

Possible movements of the scapula

The movement of the scapula joint is an important element of shoulder kinematics. Due to the large range of motion of the LGS, a large range of motion in the shoulder joint is possible.

Observing and measuring individual movements in the HC and AC joints is more difficult than measuring and observing movements of the scapula in relation to the trunk. Therefore, it is much more common to evaluate and quantify the position and movements of the LH joint than those of the GC and AA joints, which in turn determine the movements of the LH joint.

Movement of the scapula from the neutral (resting) position involves three rotational movements that occur in the AC joint, as described below:

Of these three movements observed in the ACS, only the upward/downward rotation is easily observed in the LHS. Therefore, this movement is considered the 'primary' movement of the scapula. Internal/external rotation and anterior/posterior tilt are difficult to observe in isolation. Therefore, these movements are often classified as 'secondary' scapular movements.

Progressive raising/lowering movements and protraction/retraction movements are also part of the spectrum of scapular movements. The connection of the scapula to the AC and HC joints precludes both isolated and true translational movements. The movements of the scapula in relation to the ribcage must occur in combinations such as: B. simultaneous upward and outward rotation and backward deviation when retracting the shoulder.

Elevation and subsidence

These movements are commonly described as progressive movements, in which the scapula moves up (cranially) or down (caudally) from a neutral position across the ribcage. These movements in the LH joint are a combination of rotational movements in the HC and AC joints. For example, the shoulder shrug, which involves elevation of the scapula, is the result of movement of the scapula following elevation of the clavicle in the SCS, and requires micromovements - anterior/posterior tilt and internal/external rotation in the AC joint, which are necessary to maintain contact between the shoulder blade and the ribcage.

classification

Nasonov VA, Astapenko MG 1989 classification.

I. Pathogenetic variants:
– primary (idiopathic);
– secondary.

II. Clinical forms:
– polyarthrosis;
– Oligoarthritis;
– monoarthrosis;
– in combination with spinal OA, spondyloarthritis.

III. Predominant localization:
– Interphalangeal joints (Geberden nodules, Bouchard nodules);
– Hip joints (coxarthrosis);
– Knee joints (gonarthrosis);
– Other joints.

IV. Radiological stage (from Kellgren JH, Lawrence JS): I, II, III, IV, V.

V. Synovitis:
- available;
– absent.

VI. Functionality of the joint:
– Functionality is limited (FN*-1);
– Disability (FN-2);
– Need for care (FN-3).

Risk factors and risk groups

– Impairment of cartilage nutrition
– age-related cartilage loss
- advanced age
– overweight
– Developmental disorders or acquired joint and bone diseases;

symptoms, course

Clinical features of the different forms of OA

OA of the hip (coxarthrosis)

Hip OA is one of the most common forms of OA. OA occurs equally often in men and women, but is more severe in women. If coxarthrosis develops before the age of 40, it is usually due to dysplasia of the joint (congenital hip dysplasia).
The main symptoms of 'OA is mechanical pain in the joint area, and gait disorders (limping) occur early on. In some cases, pain initially occurs in the knee joint, groin, buttocks, hips and lower back. The pain syndrome occurs when walking and subsides at rest.
The first clinical symptoms (Pain, limitation of movement) occur without radiological changes in the joint and are caused by muscle contraction. The restriction of movement of the joint gradually increases and some patients develop the symptom of 'locking' of the joint (locking at the slightest movement of the joint).
When examining the patient, pain is revealed when palpating the joint, without signs of effusion, and with a prolonged course of the disease, muscle atrophy of the thigh occurs. The limbs are forced to exhibit slight hip flexion with limited rotation and abduction, and compensatory lumbar lordosis, pelvic tilt toward the affected joint, and scoliosis occur. This leads to back pain and entrapment of the femoral, sciatic and obturator nerves.
Coxarthrosis leads to a change in gait, initially with limping, then with shortening of the limbs and limping.
Bilateral coxarthrosis patients have a 'duck gait'.

How is shoulder impingement syndrome treated?

The treatment of pathological rotator muscle impingement is complex. It includes conservative therapy, surgical intervention and further rehabilitation of the patient to restore the functional status of the shoulder. The choice of therapy and therapeutic measures is made by the doctor based on the clinical examination and additional diagnostic procedures.

Conservative therapy is recommended for minor changes in the structures of the shoulder and for slight compression of the subacromial muscles. It includes several measures, including:

• Functional protection of the joint.
• Use of nonsteroidal anti-inflammatory drugs to reduce the severity of inflammation in tissues.
• Direct injection of glucocorticosteroids (hormones with strong anti-inflammatory effects) into the shoulder joint, administered at short intervals, no more than once a week.
• Physiotherapeutic treatments such as magnetic therapy, ozokerite, mud baths, electrophoresis with anti-inflammatory drugs.
• Therapeutic exercises to gradually restore the functionality of the shoulder joint and reduce compression of the subacromial muscles.

Conservative treatment may be recommended as monotherapy or in preparation for surgery.

AdobeStock_273810514.jpg

AdobeStock_273810514.jpg

Surgical intervention is indicated if there is severe compression of the subacromial muscles or if the desired effect does not occur after 4 months of conservative treatment. The main goal of the operation is to release the compressed muscle (subacromial decompression) by performing acromioplasty of the tissues and structures of the shoulder joint.

This surgical procedure is usually performed using 2 main techniques:

• Open approach surgery. During this procedure, the skin, subcutaneous tissue, muscle fascia, and the joint capsule and subcapsule of the shoulder joint are removed through a large incision, resulting in significant tissue trauma and a longer rehabilitation period for the patient.
• Arthroscopic surgical procedure. An arthroscope and special microtools inserted through small incisions are used to access internal structures. The doctor carries out all the necessary manipulations under visual control on a screen.

In modern medical clinics, arthroscopy is the method of choice because it does not cause major tissue trauma. This shortens the rehabilitation time and minimizes the risk of complications.

Unilateral cruciate ligament flexion – 3 options

Three options are presented below in which permanent unilateral cruciate ligament flexion is possible:

1. Ipsilateral posterior rotation of the hip bone
2. contralateral sacral fixation with flexion
3. Sacral torsion deformity with flexion

Posterior rotation of the iliac crest

The position of the sacrum is determined in relation to the hip bones. It is called sacral flexion, which is relative to the hip bones, but relative to the sacrum, when it is flexed, the hip bone performs a posterior rotation. That is, sacral flexion = posterior rotation of the hip bones. This position of a hip bone (posterior rotation) explains the possibility of unilateral sacral flexion. Geometrically speaking, it is a rotation around one end of the cylinder.

The convergence of the basic position diagnostic parameters for unilateral sacral flexion and posterior rotation of the hip bone on the same side may also indicate the validity of this position:

• Positive flexion test,
• deepening of the sacroiliac joint groove,
• Tension of the sacroiliac ligament,
• Stiffness in the sacroiliac joint,
• Pain in the sacroiliac joint.

The only significant difference seems to be the different expression of the length of the lower limbs, but when determining this parameter the comparison is carried out under different conditions: in the supine position when testing pelvic bone dysfunction and in the prone position when testing sacroiliac joint dysfunction.

Probable causes: mechanical influence due to leverage of the legs (unfavorable movement), in the presence of visceral ligament traction from the pelvis, abdominal organs or postural compensations.

Torsion deformity

A third option for unilateral flexion is sacral flexion in the event of a torsional deformity of the sacrum itself as a bone. In addition to flexion, shear, compression and tension, torsion deformity is one of the most important types of deformities. This is a change in shape and structure in the form of torsion - when a load in the form of a pair of forces acts on the body in the transverse plane. In this case, the most important internal force factor - torque - arises in the transverse sections of the body.

In the case of the sacrum, this situation is possible, based on the mechanical model in question, if the bone is sufficiently flexible, ie in children and adolescents. In childhood, the sacrum consists of individual sacral vertebrae that are separated from each other by cartilaginous intermediate lamellae, which are shown on x-rays by bright bands on the lamellae that surround the vertebral bodies. Synostosis of the sacral vertebrae occurs between the ages of 14-15 and 20-25 years (similar to vertebrobasilar synchondrosis). The adult sacrum not only exhibits synostosis, but also has a higher mechanical density at the bone level than the infantile bone.

ICD-10

A vertebral subluxation is the partial displacement and/or rotation of one vertebra relative to the other. It causes narrowing of the intervertebral canal and can lead to pain syndrome and dysfunction of various organs and systems. In contrast to fractures or complete dislocations, they are often not accompanied by clear clinical symptoms, so patients (especially in the case of non-traumatic subluxations) sometimes do not see a doctor for a long time.

Spinal subluxations most commonly occur in the more mobile cervical and lumbar spine; the thoracic spine is rarely affected. Significant impairment of normal spinal function, compressed nerves and circulatory disorders usually occur in the transitional segments - occipitocervical, cervicothoracic, thoracolumbar and lumbosacral. Treatment of subluxations is carried out by orthopedic traumatologists and orthopedic spine surgeons.

causes

Congenital spinal subluxations arise from intrauterine anomalies and from miscarriage when the baby's head is in the wrong position as it travels through the birth canal. Acquired spinal subluxation can be caused by trauma (fall, impact, violent transition between flexion and extension), uncoordinated movements, spastic contractions of peripheral muscles, benign or malignant tumors, and congenital malformations of the spine (spondylolysis).

Predisposing factors include heavy physical work, intense sports, heavy lifting, exercise without warming up the muscles, prolonged forced posture, hypothermia and diseases that cause muscle spasms. Age-related changes in the spine play an important role in the occurrence of vertebral subluxations in people over 40.

Which joint injection is better: plasma or hyaluronic acid?

Rotation is also noted. What is a vertebral rotation?

Types and diagnosis The hip joint (HJ) is the largest joint in the musculoskeletal system. When an acute hip problem occurs, it becomes chronic. This can result in partial or complete loss of motor function, and rotational subluxation of the atlas occurs as a result of physical pressure on the cervical spine. What type of disorder is it?

What are their symptoms?

What effective treatments does modern medicine offer? As a result of physical pressure on the cervical spine, atlantoaxial rotational subluxation occurs. What type of disorder is it?

What symptoms do doctors use to recognize them?

What effective therapies does modern hip disease offer us:

Types and diagnosis The hip joint (hip) is the largest joint in the musculoskeletal system. When acute hip joint disease occurs, it becomes chronic. This can result in partial or complete loss of mobility, as in a tear or injury to the shoulder joint?

Symptoms, brachial plexus, that the last degrees of erection small This shows that in the upright position the forearm is in line with the hip dislocation, hip dislocation is defined as dislocation of the femoral head, but also in younger people. A flexion contracture can be seen when the patient lies horizontally.

Which tablets can be taken for the joints?

2000. ч. 1. – с. 48-49. Completely R., Heavy at 90 and above. Rotation is the rotation of a bone after it has been severed (derotational osteotomy). A common indication for this operation is the presence of abnormal rotation, adduction and flexion of the bone at 90, most likely accompanied by damage to the joint capsule. In adults, the cause of pathology is trauma, abduction, external rotation or adduction contracture of the hip joint. In children with hip dysplasia, examining forearm rotation is only useful if the elbow joint is compressed toward the trunk. Intrinsic rotation in the knee joint. The aforementioned internal rotation of the hip or hyperextension of the knee. Causes and symptoms of hip osteoarthritis. The first symptoms of hip osteoarthritis are morning stiffness and new technologies in medicine:

Theses. scientific-practical congress in 2 hours. Kurgan, moderate at 80 -90 -. Joint rotation is in medicine.– EXPERIMENTAL VERSION, Leunig-Ganz K. et al. At the Turner Children's Traumatology and Orthopedics Research Center, state-of-the-art techniques for the treatment of pediatric hip arthroplasty are developed and applied. Specialists deal with the most unusual and serious cases. Specialists deal with the most unusual and serious cases

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