Friday, June 18, 2021
The clinical and anatomic pathology in frozen shoulder is derived from an acute inflammatory synovitis followed by an intracapsular soft tissue fibrosis, resulting in contracture of the capsule. Some have made an analogy of frozen shoulder to Dupuytren contraction in the palmar fascia of the hand. Dupuytren contracture has been associated with myofibroblasts present within the fibrous tissues, and these same cells can be found in the shoulder capsule with frozen shoulder. Frozen shoulder is commonly seen in association with thyroid disorders as well as diabetes. Patients with these associated systemic diseases often have a more severe and refractory clinical course. When associated with thyroid and diabetic changes, the treatment of frozen shoulder is often more difficult. The recovery phase is longer and protracted, and the recurrence rate and the number of treatment failures are higher with both surgical and nonsurgical treatment.
EXERCISES FOR RANGE OF MOTION AND STRENGTHENING OF SHOULDER
The rehabilitation exercises shown in this section are applicable to both nonoperative and postoperative treatment for all of the shoulder conditions discussed in this book. The specific exercises used, their progression, and their coordination with other treatment modalities are specific to the diagnosis, the severity of the pathologic process, and many other patient and surgical factors. A detailed discussion for each of these conditions is beyond the scope of this book.
SCROTAL SKIN DISEASES I: CHEMICAL AND INFECTIOUS
Many skin diseases of infectious, allergic, or metabolic origin can involve the scrotum. Among many yeasts, molds, and fungi, only a few are infectious and are termed dermatophytes (“skin fungi”). Skin fungi live only on the dead layer of keratin protein on the skin surface. They rarely invade deeper and cannot live on mucous membranes. Infections by the fungus tinea cruris (ring-worm) are very common in the groin and scrotum. It involves desquamation of the scrotal skin and contiguous surfaces of the inner thighs and itches (“jock itch”). Tinea begins with fused, superﬁcial, reddish-brown, well-deﬁned scaly patches, which extend and coalesce into large, symmetrical, inﬂamed areas. The margins of the lesions are characteristically distinct. The initial lesion may become macerated and infected and is painful and itches. Sweating, tight clothing or obesity favor development and recurrence of this fungal infection, derived mainly from the genera Trichophyton and Microsporum. These same organisms cause tinea pedis or “athlete’s foot.”
Homologues of External Genitalia Anatomy
Glans area, Epithelial tag, Urogenital fold, Urogenital groove, Lateral part of tubercle, Anal tubercle, Anal pit, Undifferentiated, Genital tubercle, Male Female, Glans, Epithelial tag, Coronal sulcus, Site of future origin of prepuce, Urethral fold, Urogenital groove,