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Mr Lee Van Rensburg

January 2014

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6 week history Pain upper arm

Rest 1-2/10 Occasion (stresses it) 4/10

Started after weekend gardening Desk top job Unable to play squash/ tennis Pain on putting on jacket Sleeping OK Rx

Nothing (doesn’t like tablets)

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Supraspinatus tendonitis Subacromial bursitis

Treatment EDUCATION

Zone impingement Week end warrior

Paint and decorate like professional

Relative rest / time NSAID Physiotherapy Injection? Surgery ???

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1 YR shoulder problems on and off Pain when plays sport exerts himself, radiating

down arm Ache 4-5/10 No Pain killers Not affecting sleep, affects quality of life Rx

Physio in past made no better

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Treatment Physiotherapy - ? had some

Education Not 5 or 10 minutes

Injection??? Surgery

Open Arthroscopic

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GT-S Cambridge

Shoulder

Rotator Cuff Disease – subacromail

decompression

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Pain in shoulder 2 yrs intermittent Limiting sleep

Cant sleep on that side Works in warehouse struggling above shoulder

height, no days off Played rugby in past

Rx Physiotherapy

Elastic bands – no better GP cortisone injection

Side – sore no better

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Treatment Physiotherapy ?????

Education (Normal) NSAID Injection Surgery

Open Arthroscopic

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6 month hx Pain and stiffness

Pain slightly better following injection Swat fly grab cup severe stabbing pain

Struggling above shoulder height Rx

Injection (temporary) Physio – made it worse

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Treatment Phase

Inflammatory Physiotherapy - relative rest, maintain ROM Injection Hydrodilatation Surgery – No

Frozen Physiotherapy Injection ? Hydrodilatation Surgery

Thawing phase Physiotherapy Injection ???? Hydrodilatation Surgery ?

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Stiffness and pain 2 yrs DIY enthusiast Occ affects sleep Rx

Uses paracetamol Had injection Physio no difference

Therabands – made it worse

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Dx Beware Dx frozen shoulder without XR

Treatment Physiotherapy

Maintain state of cuff Injection ??? Education Surgery

Arthroscopic Open

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Manager, desk top work No sport / hobbies Pain upper arm

Increasing 6 weeks Sleep – severe (9/10) Sudden movement 12/10

Physio Made worse

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Ix X ray MRI U/S

Treatment Physiotherapy Analgesia Injection

Needle barbotage Surgery

Arthroscopic barbotage and washout

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Painter decorator Pain

Arm, limiting activity above shoulder height Rest 4/10, Night 6/10 Sleep

Weak above shoulder height Rx

Physio no better Injection temporary 2 weeks Ultrasound tear in tendon

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Treatment Physiotherapy

Education Injection??

Surgery Open Arthroscopic

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Pain arm 8 weeks Rest 4/10 Stresses it 8/10

Worse at Gym, Personal trainer Rx

Deep massage Rest

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Ix X ray Os acromiale MRI

Treatment Physiotherapy

Balance cuff Injection ?? Surgery

Open Arthroscopic

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Fall from tractor grabbed hand rail 2 weeks ago Sudden severe pain, could not move arm Rx

Physio Pain better but still weak

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Ix ? X ray MRI/ U/S ??

Treatment Physiotherapy

Maintain ROM Rehab remainder of cuff

Injection ?????? Surgery

Open Arthroscopic

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