RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES, KARNATAKA, BANGALORE - DOC 6

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					                                   SYNOPSIS



          RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

                       BANGALORE, KARNATAKA.



“FUNCTIONAL OUTCOME OF CONSERVATIVE MANAGEMENT IN

                   ROTATOR CUFF TENDINITIS ”



  Name of the candidate        :       Dr. JOHN EDMUND BENNY. T

  Guide                        :       Dr. K. RAGHUVEER ADIGA

  Course and Subject           :       M.S. (ORTHOPAEDICS)




                       Department of Orthopaedics ,

                    Father Muller Medical College,

                   Kankanady, Mangalore – 575002.

                                     2011
        RAJIV GANDHI UNIVERSITY OF HEALTH SCIENCES,

                       BANGALORE, KARNATAKA.

         PROFORMA FOR REGIST RATION OF SUBJECTS FOR
                                  DISSERTATION


1.   Name of the candidate and         Dr. JOHN EDMUND BENNY. T

     address (in block letters)        PG IN ORTHOPAEDICS

                                       FATHER MULLER MEDICAL COLLEGE,

                                       KANKANADY

                                       MANGALORE - 575002

2.   Name of the Institution           FATHER MULLER MEDICAL COLLEGE

                                       KANKANADY

                                       MANGALORE - 575002

3.   Course of st udy and Subject      MASTER OF SURGERY

                                       ORTHOPAEDICS

4.   Date of admission to course       09-04-2011

5.   TITLE OF THE TOPIC:

      “FUNCTIONAL OUTCOME OF CONSERVATIVE MANAGEMENT IN

                           ROTATOR CUFF TENDINITIS”




                                       1
6.   BRIEF RESUME OF THE INTENDED WORK:

     6.1 NEED FOR THE STUDY

          Inflamation and degenerative changes in rotator cuff and adjacent structures are

     predominant causes of shoulder pain. The most common symptoms being pain, restriction

     of movement and muscular weakness.

          The most common methods currently applied to alleviate pain include analgesics,

     physical therapy methods of rehabilitation and in a minority surgery.[5]

          Despite extensive research there is no definitive results on the level of improvement of

     symptoms and the duration taken for recovery of symptoms following conservative

     management. Furthermore previous studies of effectiveness of conservative therapeutic

     approaches have largely relied on clinical assessment alone and the published data does not

     provide any correlation between pre and post functional outcome of rotator cuff tendinitis.[4]

          The physiotherapy encompasses a broad range of interventions and forms the most

     important modality of management in rotator cuff tendinitis.[1]

          Despite different methods being used in the treatment of rotator cuff tendinitis there is

     no consensus about the effectiveness of various conservative measures of management and

     their correlation with radiological evidence.[2]

          This study is intended to observe the role of various modalities of conservative

     management and the functional outcome of the measures.




                                               2
6.2 REVIEW OF LITERATURE

     Kim Bennell et al did a controlled multicentric prospective randomized study on 112

participants who completed a 22 week trial on management and noted that at 11 weeks there

was no significant improvement in the shoulder pain or disability index. The active group

showed a significantly greater improvement in shoulder pain and disability index than the

placebo effect at the end of 22 weeks and all the secondary outcome measures favoured the

active group.[3]

     Carol A kennedy et al did a controlled multicentric, prospective randomized study on

361 consecutive patients who where given physical therapy noted that people with higher

pain intensity and disability scores at the start of the study improved better and that the

prognostic factors differ depending upon the format of outcome.[4]

     M.D. Charad et al reviewed 137 patients treated conservatively and found active

tendinitis in 35 individuals at a mean of 19 months of presentation, in addition 40 patients

had residual pain and 8 developed pain due to other causes. Early presentation and history

of overuse unrelated to occupation distinguished that 54 patients had resolved from active

tendinitis. The sizeable proportion of patients with chronic tendinitis were resistant to

conservative treatment suggests that rotator cuff tendinitis is not an early self limiting

condition and improvement in management is required.[2]

     J.P. Bonde et al studied the prognosis of shoulder tendonitis in 113 employees with

shoulder pain and clinical signs of shoulder tendonitis. The quantitative estimates of

duration, repetitiveness and forcefulness of current tasks were recorded. 50% of workers

recovered within 10 months, higher age being a factor for slowing the recovery.[5]




                                        3
             Harvard et al had done a randomised controlled study on 61 participants who were

     randomly assigned high graded exercise therapy and in low grade exercise therapy. They

     noted that the high grade group achieved significantly better outcome effects than the low

     grade group for pain, range of motion, isometric functional strength and function. However

     both groups increased function from pretest to post test.[l]

7.   7.1 Source of Data:

             All patients clinical signs and symptoms consistent with rotator cuff tendinitis to

     Department of Orthopaedics in Fr. Muller Medical College Hospital, Mangalore between

     April 2011 and September 2013.

     7.2 Method of Collection of Data:

     Study type:

             A prospective follow up study of functional outcome following conservative treatment

     in patients with rotator cuff tendinitis

     Sample and Sampling Technique

         A sample size of minimum 30 patients will be selected using purposive sampling

     technique, all of whom will undergo conservative management with physiotherapeutic

     modalities. The functional outcome following conservative management will be studied

     during follow up at 6 weeks, 12 weeks, and 6 months.

     Inclusion Criteria :

              Patients with shoulder pain diagnosed to have rotator cuff tendinitis

              Age - 18 years and above


                                                4
Exclusion Criteria:

        Previous shoulder surgery.

        Infection, bone disease, neoplasm, pathological fractures


        Shoulder anomalies

        Mental or psychiatric disorder

        Patients with inflammatory arthritis

        History of nerve blocks to the shoulder

        Patients with history of Intra-articular injections

        Patients with neurological impairment

        Unstable chronic or terminal illness (diabetes, malignancies)



Plan for Data - Analysis

       Collected data will be analysed by frequency, percentage, mean, standard deviation,

ANOVA for repeated measures and Chi- Square test.

7.3 Does the study require any investigations or interventions to be conducted on

patients or other humans or animals?

       Yes.

7.4 Has ethical clearance been obtained from your institution in case of 7.3

    Yes.




                                           5
8.   REFRENCES:

       1. The dose response effect of medical exercise therapy on impairment in patients with

          unilateral long standing sub acromial pain, Harvard Osteras and Tom Arlid

          Trostensen; Open orthop journal 2010; 4: 1-6.

       2. The long-term outcome of rotator cuff tendinitis- A Review study. M.D. Charad,

          L.M. Sattelle and B.L. Hazelman; Rheumatology. 1988; 27(5): 385-389.

       3. Efficacy of standardised manual therapy and home exercise programe for chronic

          rotator cuff disease: a randomised placebo controlled trial Kim Bennell, Elin Wee,

          Sally coburn, Sally Green, Anthony Harris Margret Staples, Andrew Forbes and

          Rachelle Buchbinder; BMJ. 2010; 340:c2756.

       4. Prognosis in soft tissue disorders of the shoulder: predicting both change in

          disability and level of disability after treatment. Carol A kennedy, Micheal Manno,

          Sheilah Hogg-Johnson, Ted Haines, Laurie Hurley, Deirde McKenzie and Dorcas E

          Beaton ; Physical Therapy July 2006; vol. 86 no. 7: 1013-1032.

       5. Prognosis of shoulder tendonitis in repetitive work: a follow up study in a cohort of

          Danish industrial and service workers; J P Bonde, S. mikkelsen, J H Andersen, N

          Fallentin J Baelum, S W Svendsen, J F Thomsen, P Frost, G Thomsen, E Overgaard,

          A Kaergaard ; Occup Environ Med 2003;60:e8 doi:10.1136/oem.60.9.e8




                                           6
9.    Signature of the candidate


10.   Remarks from guide                      Satisfactory



11.   Name and designation of
      (in block letters)                      DR. K. RAGHUVEER ADIGA
                                              PROFESSOR,
      11.1 Guide                              DEPARTMENT OF ORTHOPAEDICS,
                                              FATHER MULLER MEDICAL COLLEGE
                                              KANKANADY
                                              MANGALORE - 575008


      11.2 Signature



      11.3 Head of the Department             Dr. JACOB CHACKO
                                              PROFESSOR AND HEAD OF THE
                                              DEPARTMENT
                                              DEPARTMENT OF ORTHOPAEDICS,
                                              FATHER MULLER MEDICAL COLLEGE
                                              KANKANADY,
                                              MANGALORE - 575002
      11.4 Signature




12    12.1 Remarks of the chairman and Dean



      12.2 Signature




                                       7

				
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