Frozen shoulder

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(No Transcript)
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????? ????????Frozen shoulder
?????? ??????

• ??????? ???????
• diagnos and treatment

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????? ?????? ?????? ??????
???? ?????
???? ??? ??????? ?? ???? ?????? ?????? ???? ??
???????
??? ????? _ ???? ?????? ???? ?? ???????
Pmj learning
4
???? ?? ??????

• ??? ????? ???? ???? ?? ??????? ??????????? ???
  1968.
• ??????? ?? ?????? ?????? ?? ???? ?????????
  ?(???????? ????????)? ??? ??????? ???????? ??????
  ??????? ?? ????? (??????? ????????).
• ?????? ?? ?????? ?????? ????????? ??????????? ???
  35 ??? .
• ??? ?????? ?? ????? ??????? ???????? ????? ?????
  ?????? ????? ???????? (????? ????)? ?????? ?????
  ?? ?????? ?????? ? ?????? ??? ????????? (????).

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?? ??????? ?????????

• What is
• FROZEN SHOULDER?

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????? ????????

• ?? ??? ????
• ??????? ??????? ?????? ??? 2 4 ?? ????????
• ???? ?? ??????? ??? ?? 40 ???
• ??? ??? ?? ??????? ???????? ?? ????? (???
  ???????)
• ???? ??????? ???????? ??? ???????
• ?? ???? ????? (???? ?????)
• ???????? ???? ?????(???? ?? 20 ?? ??????)

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????????

• ???? ???? ????? ?????? ????? ?????????? ????? ???
  ?????? ?????? ???????? ?????????
• ????? ??? ??? ??? ????? ????? ????? ??????? ??
  ?????.
•  

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??????? Causes

• ?????? ?? ???? ??? , ??? ???? ??? ???????? .
• ???? ??????? , ???? ????? ???????? ???????? ???
  ???? ?????? ( rotator cuff).
• ??? ??? ???? ???? ????? ???? .
• ?????? ??? ????? ??????? ???? ??? ??????? ??????
  ???? ??? ??? ?????? ??? ?????? ????? ?????? ?????
  ( ??? ?? ????? ??????).

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• ???? ??? ???? ?????? (??? ??? 20 ?? ??????) .
• ??? ?????? ??????? ?? ????? ???????? ???????
  ?????? ??? ?? ?????? ??????? ? ?????? ?????
  ??????? .
• ???? ??? ??? ??? ???? ?????? (??? ???? ??????
  ??????? ??????) .
• ???????? ?? ???? ??? ????? ???????? ?? ???????
  ??????? .

10
??????? ?????? ?????

• ??? ???? ??????? ????? ??? ???? ??? ???? ???
  5-10 ?????? ?? ????? ???????? ? ????? ???????
  ???????? ??20-30 ??????.
• ??????? ????? ???? ?????? ????? ?????? ???????
  ??????
• ???? ?????? ?????? ??????? ?????? ??? ??? ?????
  ??????
• ?? ?????? ????? ????? ?????? ??????? ?? ?????
  ????????? ? ?????? ????? ??? ?? ????.
• ????? ?????? ?????? ?????? ??????? ???????
  ???????? ??? ??? ??? ???? ?????? ????? ??? ??????
  ?????.

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????? ???????? ???? ????? ???? ???? ?????

• ????? (Freezing) - ??? ???? ????? ???? ??????
  ????? ??? ??????? ?? ??????
• ????? (Frozen) - ??? ???? ????? ??? ???????
  ?? ????? ????? ?? ???? ?????
• ????? (Thawing) - ????? ???? ???? ????? ??????
  ?? ????? ???????? ??????

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???????diagnosis the
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????? ???????History

• ???? ??????? ??????? ??? ??? ?????? ??????? ??
  ????? ??????? (??? ?????? ??? ???????) .
• ?????? ????? ????? ??? ?????? ???????? ???????
  ?????? ?????? ??????? ????? ???????? (?? ????
  ?????? ?????? ???????) ? ?????? ??? ??? .
• ?????? ?????? ??? ?????? ??? ???????? ??? ??????
  ????????.
• ?? ????? ??????? ?????? ???????? ???? ???
  "??????".

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????? the Examination

• ??? ????? ??? ?????? ???? ???? ?? ????? ?????
  ???? ????? ?????????
• ???? ????? ???? ????? ????? ?????? (?? ???????50
  ???????) ?? ??? ???? ?????
• ??????? ????? ?????? ?? ??????? ????? ?? ??????

15
?? ??? ??? ??? ???? ? ????? ?????? ?? ?????? ???
???????
16
?? ?????? ??? ??? ???? ???? ??? ??? ???????
??????? ??????? ??? ????????? ?????? ???? ???
?????
17

• ??? ?? ??????? ??? ??? (? ??? ????? ????? ??????
  ????? ??????? ??? ????? ???)
• ???? ????? ?????? ???? ????? ?????? - ?? ???????
  ?? ?????? ??????? ????? ?????? ?????? ????? -
  ????? ?? ???? ???? ??? ?? ??? ??????? ?????? ???
  ????.

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• ??? ???? ??????????? ???????? ??? ?? ???? ??????
  ??????? ???? ???? ??? ?????? ?? ????????
  ?????????(??? ???? ??????? ????? ?????? ?? ?????
  ???????)
• ?? ???? ??? ?????????????? ??? ???????(subacromial
  )
• ??? ?? ?????? ????? ??? ????? (supraspinatus)
  ??? ???????? ???????.
• ??? ???? ??? ?????? ??????? ????? ?????? ???????
  ??? 90 ????
• ????? ???????? ??????? ??? ??????? ???????
  ???????? ???????? ??????? ? ??????? ???? ?????
  ??? ?????? ???? ??? ???? ???? ??????.

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??????? ???? ?????? ????? ????? ?? 90 ???? ?????
?? ?????? ?????? ?30 ???? ???????? ?????? ??
???? ?? ???? ?????? ????? ???????? ?????? ???
?????? ???? ???? ??? ??? ????? ?????? ????
?????? ????????
???? ??? ??? ??? ?????? ??? ???? ?? ????? ?????
?????? ???? ??????
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(No Transcript)
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?????? ??? ??? ??? ?????? ??? ???? ?? ?????? ???
????? ?????? ???? ??????

• ??????? ??? ?????? ????? ????? ?? ???(?? ??????)
  ?? ?????? ?? ????.
• ??? ?????? ????? ??????????? ?????? ???? ??????
  ?? ???? ????? ?????? ??? ??????

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??? ???????? ????????? ?????? ??? ????? ????
??????? ???? ????? ?? ???????? ????????.
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• ???????? ???? ???? ???? ?????.
• ??? ???? ?????? ???? ????? ??? ????? - ???? ?????
  ????? ???? ????? ?? ??????.
• ??? ?????? ??????? ?????? ???????? ????????
  (?????? "???????" ??? ?????? ?????? ???????
  ??????? ??????? ? ?????? ?????? ???????).

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???? ?????? ???????

• ?????? ??? ?????? ????? ????? ?? 90 ???? ???
  ????????? ????????? ???? ???????? ??? 90 ????.
• ???? ????? ????? ?????? ????? ??????? ????? ?????
  .

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(No Transcript)
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• ?????? ??????? ??????? ????? ??? ????? ?????
  ????? ?????? ??????? ??????? (???????? ???? ????
  ???? ???? ?? ??????)
• ??? ????? ???? ???? ????? ?????? ????????.

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??????? ????????diagnosis The Differential

• ??? ??????? ???????? ???? ????? ????
• ????? ?????? ????
• ?????? (??? ??????? , ?????)
• ?????? (?????? ?????? ?????? , ????? ?????
  ? ??? ?????)

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??????? ?????Shoulder structures
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??? (???? ???? ????) ???? (?????? ?
???? ? ???) O ?????? ??????? O
?????? ??????? ??????? O
??? ????? (????? ?????) ????
?????? O ?????? ??????? O
???? ??? ?????? ??????? ??????
(?????? ?)
30
?????????? ?????? ?????? ?? ??? ??? ????? ???
??????
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???????Learning bite

• ??????? ??? ?????? ??????? ??? ?? ?????? ?????
• ??? ???? ?????? ??? ??????? ??????????? ???????
  ????
• ?????? ????? ????? ????????? ??? ????? ? ??????
  ????? ???? ??????? ????? .
• ?????? ??????? ??? ??? ??????
• ??? ?????? ???? ?????? ?? ????? ??????? ????????
  ??? ?????????? ????????.
• ??? ?????????? ????????? ??????? ??? ??????
  ?????? ???????
• ??????? ??????? ?? ?????? rosuvastatin (40 ???
  ?????? ) ?????? ???? ??????? ?? ?????? ?????? ??
  ?????.

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???? ?????What happens?

• ????? ????????? ?????? ????????? ???? ????
  ??????
• . ?????
• ?????
• ???????
• ??? ?????? ?????? ????? ?????????? ???? ??????
  ???? ????? ???? ????.
• ??????? ?????? ????? ???? ???? ???? ?????
  ???????? ??????.

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• ??? ??? ?????? ?????? ??? ???? "???????" (???
  ????? ????? ?????? ???????????) ? ?????? ?? ??
  ????? ??????? ??? ?????? ???? ???? ???????
  ????????? ?? ???? ??????? ?????? ????? ???
  ???????? ???? ?????.
• ??????? ?????? ??????? ??? ??? ??????? ?????? ??
  ??? ?????? (???? ???? 50 ) ??? ??? ??????? ????
  ???????

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?? ??????? ??? ?????????What is known about
treatment?

• ?? ??????? ????? ???????? ??? ????? ??????? (12
  ??? ??? ????) ??????
• ?? ??????? ??? ?????? ????? ?????? ??????? ??????
  ?? ????? ?????? ??????? ????? ?? ??????? ? ?????
  ??? ???????.
• ??????? ???????? ??? ???? ?????? ???? ????
  ?????????(??? ???????? ????????? ?????????
  ?????????????
• ??? ??????? ????????? ???? ???????? ???????).

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• ????? ??????? ????? ????? ?????? ?????? (???
  ??????? ?????? ??????? ??? ????) ????? ?????? ?
  ??? ???? ??????? ??? ??????.
• ??? ?? ??? ???? ???? ?????? ????? ?? ??????
• ???????? ?? ????? ??????.
• ??? ?? ?????? ??? ????? ????? ???? ?????? ???????
  ???? ?? corticosteroids (??? ????? ??????? 30
  ????
• prednisolone ??????) ????? ?????? ?????? ???
  ?????? ??????? ?? ????? ?????? . ??? ?? 12
  ?????? ?????? ????? ???? ???? .