Rotator Cuff Pathologies

No tenderness observe clinically. It mostly occur to middle aged people, Commonly affected side is the edge of Supraspinatous and progress posteriorly to involve Infraspinatous and TeresMinor tendon and Subscapularis.

To prove that patient is suffering from RotatorCuff pathologies a physiotherapist should need to perform two tests

1. Hawkins Test
2. Neer's Test

1. Hawkins Test: Patient need to actively perform internal rotation of shoulder including 90 degree forward flexion of upperarm (humerus) and internal rotation of forearm.
2. Neer's Test: It is used to test impingement at shoulder joint.If patient is suffering from pain when shoulder is at 120 degree forward flexion or either started pain at 60 degree of humerus forward flexion.

Clinical Features:

1. Pain
2. Weakness
3. Limited Active Abduction.

Anti Inflammatory Drugs:

1. Celecoxib
2. Acetaminophen (Paracetamol)
3. Naproxen
4. Tolmetin

In Rheumatoid Arthritis patient WBCs view the synovium as nonself and initiate inflammatory attack.

WBC's Activation stimulate "T"-Lymphocytes which recruit and activate Monocytes and Macrophages, these monocytes and macrophages secrets proinflammatory cytokines which include Tumor Necrosis Factor (TNF alpha) and Interlukin (IL-1) into synovial cavity leading to joint destruction and others systemic abnormalities such as Rheumatic Arthritis. Two types of Lymphoctes "T" and "B" activated which produce Rheumatoid Factors and other antibodies to maintain inflammation which alert Defensive Reaction causing Progress Tissue Injury.

Drugs Of Rheumatoid Arthritis:

1. Hydroxychloroquine
2. Infliximab
3. Sufasalazine

Drugs For Gout:

1. Allopurinol

Note: Aspirin should be avoided in gout

Therapeutic Uses Of Prostaglandins:

1. Modulating Pain
2. Inflammation
3. Fever

Some physiological function also control:

1. Acid Secretion
2. Mucus Production in Gastrointestinal Tract
3. Uterine Contractions
4. Renal Blood flow

Adverse Effects Of NSAID'S Drugs:

It should be given lowest effective dose for shotest duration period

Generally avoided in third trimester due to premature closure of ductus arteriosus

Disease Modifying AntiRheumatic Drugs:

DMARDS are at increased risk for infections such as Tuberculosis, Fungal opportunistic infection and sepsis.

Note: TNF alpha inhibitors and NON TNF BIOLOGIC Agents shouldnot be use together due to risk of severe infections.

Reactivation Of Hepatitis B may occur with use of these agents

GOUT:

Gout is a metabolic disorder characterized by high level of uric acid in blood hyperurecemia

Hyperurecemia can lead to deposition of sodium urate crystals initiates inflammatory process involving infiltration of granulocytes that phagocytize urate crystals.