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Functional Rehabilitation
Published in James Crossley, Functional Exercise and Rehabilitation, 2021
Movement of the shoulder is supported by the shoulder girdle, the pseudo-joint formed by the scapula gliding over the thorax, and the articulation between the clavicle and sternum medially (the sternoclavicular joint) and acromion process laterally (the acromioclavicular joint).
A to Z Entries
Published in Clare E. Milner, Functional Anatomy for Sport and Exercise, 2019
The thoracic region consists of the thoracic spine, ribs, and sternum. The joints of this region are the sternoclavicular joint, the intervertebral joints, and the anterior and posterior articulations of the ribs. The thoracic spine is less mobile than the cervical spine, despite having more (12) vertebrae than the cervical spine (7). The sternoclavicular joint is formed between the sternal end of the clavicle and the clavicular notch of the manubrium of the sternum.
Test Paper 4
Published in Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike, Get Through, 2017
Teck Yew Chin, Susan Cheng Shelmerdine, Akash Ganguly, Chinedum Anosike
The acronym SAPHO (synovitis, acne, palmoplantar pustulosis, hyperostosis and osteitis), which was coined in 1987, is applied to occurrences of a wide spectrum of aseptic neutrophilic dermatoses in association with aseptic osteoarticular lesions. The sternoclavicular joint (most frequently affected) is involved in 65%–90% of cases. Hyperostosis and osteosclerosis are characteristic findings at conventional radiography and CT. Other findings include joint erosion and ankylosis. In the presence of active lesions, MR imaging with T2-weighted or STIR sequence may depict bone marrow oedema, a feature that helps differentiate active lesions from chronic ones. The ‘bull’s head’ sign (i.e., increased radiotracer uptake in the sternal manubrium and both sternoclavicular joints at delayed scintigraphy) is highly specific for the diagnosis of SAPHO and may obviate biopsy.
Applying a clinical decision-making model to a patient with severe shoulder pain ultimately diagnosed as neuralgic amyotrophy
Published in Physiotherapy Theory and Practice, 2022
Shoulder symptoms may be the most frequently encountered extremity diagnosis in general physical therapy practice and such symptoms account for about 10% of all patients seen in physical therapy (Kooijman et al., 2013). This creates a high economic burden for society with a mean annual cost of 4139 per patient, most of which was attributed to the cost of sick leave in a Swedish study (Virta, Joranger, Brox, and Eriksson, 2012). The shoulder is a particularly complex joint to examine due to the interrelations of the glenohumeral joint (GHJt), the acromioclavicular joint (ACJt), the sternoclavicular joint, the scapulothoracic joint, and cervical spine. The etiology of shoulder joint pain is diverse and includes pain from any of the joints mentioned above, as well as pain from the surrounding soft tissues, ligaments, nerves, and referral from the cervical spine or visceral organs including the heart and lungs. Pathologies involving the GHJt and surrounding soft tissues can include osteoarthritis, bursitis, rotator cuff tendinitis or tear, subacromial impingement, hypermobility, and labral defects to name only a few. Faced with so many possibilities, the differential diagnosis of shoulder pain can be challenging, even to the most experienced physical therapists. More purposeful and deliberate clinical decision-making processes may be helpful to physical therapists when faced with an unusual clinical picture.
What are Learner and Instructor Preferences for Group Size and Composition for a Series of Synchronous Online Case Discussions for Upper Extremity Trauma Surgeons?
Published in Journal of European CME, 2021
Nele Roels, Monica Ghidinelli, Michael Cunningham, Murat Bilici
The AO Trauma Online Course – Upper Extremity (Small Group Discussions) was delivered free of charge as a series of 8 modules, with each one covering 1 anatomical region from the existing AO Trauma Upper Extremity course (clavicle, scapula, proximal humerus, etc.). Participants learned the current patient management of pain, dysfunction, deformity, and cosmesis related to the upper limb’s trauma, including fractures from the sternoclavicular joint to the fingertip. Each week consisted of a 10-minute overview presentation on that week’s topic followed by a set of 3 or 4 prepared cases to be discussed online for 75 minutes. Each case is designed to contain a patient presentation with x-rays, CT scans, a diagnosis section, treatment options, the outcome of the case, and a wrap-up to reinforce the take-home messages. From week 3 onwards, the overview presentations were pre-recorded and available before the module to allow the full 90 minutes for discussion. All materials and links were provided through the course home page in the learning management system (Totara Talent Experience Platform https://www.totaralearning.com/en/products/learning-management-system).
Zoledronic acid monotherapy improves osteoarticular involvement in SAPHO syndrome
Published in Scandinavian Journal of Rheumatology, 2020
C-R Wang, Y-S Tsai, J Whang-Peng
A 53-year-old female visited the outpatient rheumatology clinic of National Cheng Kung University Hospital with a 9 year history of pain over bilateral sternoclavicular joints and clavicles. In particular, she had an allergic history to NSAIDs. Physical examinations revealed swelling over her painful areas, unremarkable appendicular joints, and no dermatological findings. Laboratory profiles showed elevated erythrocyte sedimentation rate (ESR; 98 mm/h) and C-reactive protein levels (CRP; 30 mg/dL) with unremarkable haematological, liver, and renal functions. Autoantibody profiles (anti-nuclear antibody, rheumatoid factor), human leucocyte antigen-B27, and blood cultures gave negative results. Despite no abnormalities on an initial X-ray on 12 December 2008, a second image exhibited hypertrophic sternoclavicular joints and enlarged proximal clavicles on 17 October 2011, and follow-up radiography demonstrated increased swelling of sternoclavicular joints and clavicles, with changes in hyperostosis and osteosclerosis on 30 August 2017 (Figure 1A). Syndesmophytes were also identified at the cervical and lumbar spine. A whole-body bone scan displayed marked radiotracer uptake over the clavicles, sternoclavicular junctions, and sternum, a pathognomonic bullhead sign in SAPHO syndrome (Figure 1B) (5). Furthermore, severe osteoporosis was diagnosed by lower T scores over the lumbar spine (−3.6 sd) and femur neck (−2.6 sd) with bone fracture.