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EPIDEMIOLOGi
Usia di atas 40 tahun Wanita > Pria
FAKTOR PREDISPOSISI
Diabetes melitus Stress fisik Stress psikis
ANATOMI
ANATOMI
SYMPTOMS
Nyeri yang timbul setelah berkurangnya ROM sendi bahu Nyeri yang terlokalisasi pada rongga rotatorik bahu Radiasi nyeri di bawah deltoid dan lengan anterior Nyeri saat berbaring bertumpu pada bahu yang sakit
SIGNS
Penderita memfiksasi lengan pada sisi tubuh Atrofi deltoid dan supraspinatus Nyeri pada daerah rotatorik bahu dan tendo biseps ROM terbatas Distrofi simpatetik relfleks : edema tangan, dingin, perubahan warna kulit.
DIAGNOSIS
Gejala klinis Gambaran radiologi (X-Ray)
MANAGEMENT
Preventif Pengobatan nyeri Fisioterapi Psikoterapi
Shoulder Injection
I. Frequency of injections A. Older patients: May repeat 2-3 times per year B. Younger patients: Consider surgery if no improvement 1. Repeat injection risks Rotator Cuff Rupture II. Precautions A. Risk of Rotator Cuff Rupture 1. Use with caution especially in young patients
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Scapulothoracic Injection
I. Indications A. Scapulothoracic articulation inflammation 1. Bursitis at inferior medial scapular border 2. Injured with pushing, pulling, and throwing 3. May be associated with popping or catching sensation Preparation A. Needle: 25-27 gauge 1.5 inch B. Intraarticular Corticosteroid 1. Methylprednisolone: 1 ml of 40 mg/ml or 2. Betamethasone (Celestone Soluspan): 1 ml C. Lidocaine 1%: 1-2 ml Approach A. Images 1. B. Patient position 1. Lying prone 2. Place hand of affected side on buttock C. Landmarks 1. Inferior and medial border of scapula D. Injected with sterile technique 1. Needle directed laterally in plane of scapula
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Injectable Corticosteroid
Short-Acting Injectable Corticosteroids
A. Cortisone 1. Relative Potency: 0.8 (25 mg) 2. Dosing a. Tendon Sheath and bursas: 20-50 mg b. Small Joints: 10-25 mg c. Large Joints: 50-125 mg Hydrocortisone 1. Relative Potency: 1.0 (20 mg) 2. Supplied: 25 mg/ml, 50 mg/ml 3. Dosing a. Tendon Sheath and bursas: 8-40 mg b. Small Joints: 8-20 mg c. Large Joints: 40-100 mg
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Typical doses of corticosteroid used for injection Structure Dose (mg)* injection (mL) Large joint Knee Shoulder Elbow
Volume of
40-60 30 20-30
20-30 20
0.5-1 0.5-1
20 5-20
0.5-1.5 0.25-1
*Doses shown are for triamcinolone hexacetonide for joint injection and methylprednisolone acetate for soft-tissue injection.