Microsoft word - acromioclavicularjoint-sherryobrien-2000.doc

It Turned Out To Be The Acromioclavicular Joint
A Case Study for the Diploma in Injection Therapy 2000
By Sherry O’Brien MCSP
Shoulder pain is the third most common musculoskeletal complaint
presenting to the general practitioner and sequential y the physiotherapist
(Van der Hiejden, 1999). 18% of al sick leave benefit claims were made in
1994 in the Netherlands for neck, shoulder problems.
Approximately 5% of al consultations in general practice are reported to
concern shoulder disorder and each year about 1 per 100 adults in the UK
consult their GP with a new episode of shoulder pain (Van der Heijden).
Although there exists a comprehensive shoulder examination (Cyriax 1983)
much debate stil exists over the diagnosis of shoulder pain which is
highlighted in this case study. The manipulative therapy combined with
injection therapy lead to a successful outcome and confirmation of a
The literature search performed for this study used medline (1980 -2000) with
the keywords acromioclavicular joint, subacromial impingement, corticosteroid
injections and rotator cuff. Further literature was gained from course
The case study highlighted the importance of correct diagnosis coupled with
accurate placement of the intra-articular steroid injection(Jones et al
Onset and Duration
Past Medical History
Drug History
subscapularis bursa which lies between the tendon of subscapularis and the anterior capsule. The nerve supply of the acromioclavicular joint is C4 and the nerve supply of the glenohumeral joint, surrounding ligaments and muscles is C5-6 (Saunders,1993). Objective Examination
Cervical spine - Ful painfree
Thoracic spine - Restricted
Shoulder movement
R.T. P.B.
Differential Diagnosis
Lat. Rot.
Med. Rot. +ve++
neck were excluded as there was ful painfree active movements of Elb Flex.
Other Tests
Immediate reassessment
One week reassessment
One month reassessment
Repeat Injection
Immediate reassessment.
One week reassessment –
One month reassessment.
Cyriax JH, Cyriax PJ. (1983) Illustrated
Manual of Orthopaedic Medicine. Butterworths. Eustace JA, Brophy DP’m Gibney RP et
al (1997) Comparison of the accuracy of
steroid placement with clinical outcome in patients with shoulder symptoms. Annals of Rheumatic Diseases 56: 59-63. Harryman D et al. (1990) Translation of
Haslock I, Macfarlane D, Speed C.
injections: a survey of current practice. Hollingworth GR, Ellis RM, Hattersley
. (1983)
shoulder pain : results of a double blind Hulstyn MJ, Fadale PD. (1995)
Arthroscopic Anatomy of the Shoulder.
Orthopaedic Clinics of North America 26: Jones A, Regan M, Ledingham J.
(1995) Importance of placement of intra-articular steroid injections. BMJ 307: BIBLIOGRAPHY
Kendall FP, Mcreary EK, Provance PG.
ACPOM (1999) A clinical guideline for the
Edition. Williams and Wilkins, Baltimore. Lewis J. (1999) Assessment and
British National Formulary. Number 28,
Nordin M, Frankel VH. (1989) Basic
Bamji AM et al (1996) The painful
Ombregt L, Bisschop P, Ter Veer HJ,
Barry M, Jenner JR (1995) Pain in the
Van de Velde T. (1995) A System of
Cawley PJ, Morris IM. (1992) A study to
Pellecchia GL, Paolino J, Connell J.
(1996) Inter-tester reliability of Cyriax skin preparation prior to joint injection. Corrigan B, Maitland GD. (1988)
Saunders S, Cameron G. (1997)
Injection Techniques in Orthopaedic and
Sports Medicine. W.B. Saunders
Company Ltd.
Van der Hijden GJMG, Van der Windt
DAWM, Kleijnen J et al (1996) Steroid
injections for shoulder disorders : a
systematic review of randomised clinical
trials. BrJGenPract 46: 309-316.
Van der Hijden GJMG (1999) Shoulder
disorders : a state of the art reivew,
Ballieres Clinical Rheumatology. Vol 13
No. 2 287-309.
Winters JC, Jorritsma W, Groenier KH
al (1999) Treatment of shoulder
complaints in general practice : long-term
results of a randomised, single blind study
comparing physiotherapy, manipulation
and corticosteroid injection. BMJ 318:


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Microsoft powerpoint - p4-oracle-plsql-04

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