Common Orthopedic Conditions

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1 Common Orthopedic Conditions Clayton E Turner, MD Casper Orthopaedic Associates Casper, Wyoming Frontiers in Wyoming Medicine 2014

2 Common Orthopedic Conditions 1. Ankle Sprain 2. Plantar Fasciitis 3. Tennis Elbow 4. ACL Tear 6. Meniscus Tear 7. Rotator Cuff Tear 8. Carpal Tunnel Syndrome 9. Distal Radius Fracture 2

3 Ankle Sprain Ligament injury Ankle pain, tenderness, swelling Twisting force 3 One or more of these ligaments can be torn or stretched. Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

4 4 Ankle Sprain

5 Ankle Sprain 5 R.I.C.E. Rehabilitation Anti-inflammatory Brace Recurring problem Adequate healing time Rehabilitation surgery Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

6 Plantar Fasciitis Microtears of plantar fascia Painful heel Unrelated to heel spur on xray 6

7 Plantar Fasciitis Tape heel, arch Customized orthotics Stretching Massage Exercises 7

8 Plantar Fasciitis - Treatment Warm up well before sports or activities Ice heel, minutes after sports or stretching (freeze Styrofoam cups) Anti-inflammatories Night splint Massage 8

9 Plantar Fasciitis Prepare before running Wear good, supportive shoes Arch support Keep feet strong Avoid activities that cause heel pain If pain persists 9 Corticosteroid injection Surgical referral

10 Tennis Elbow Lateral epicondyle 10

11 Tennis Elbow Pain just distal to bony ridge Extensor muscle origin Avoid with: warm up Avoid with: stretch before play 11 Correct, well maintained equipment Condition beforehand Evaluate cause

12 ACL Injury Direct blow to knee Non-contact injury, with foot planted and an attempted change in direction pivot or cut Landing on straight leg Making abrupt stops 12

13 ACL Tear Normal anatomy Hyperextension Anterior cruciate ligament Patella Femur Anterior cruciate ligament tears Femur slips Tibia Fibula 13 Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

14 ACL Tear Treatment aggressive rehab and potential surgical reconstruction Incidence of ACL much higher among female athletes Combination of causal factors 14

15 ACL Tear- Prevention Land safely from jumps Practice cutting maneuvers Use little steps to stop Strengthening exercises 15

16 Meniscus Tear Helps knee joint carry weight, glide, and turn Twisting injury Football and other contact sports Subset of Degenerative Tears occurring in MA 16

17 Meniscus Tear Pain Giving way Locking Clicking Swelling 17

18 Meniscus Tear Normal meniscus Torn meniscus 18

19 19 Rotator Cuff Tear

20 Rotator Cuff Tear Shoulder pain Worse at night Weakness Catching Limited motion 20

21 Rotator Cuff Tear Treatment Rest Cold & heat Sling Physical Therapy NSAIDS Injection Surgery 21

22 Rotator Cuff Tear Prevention Avoid repetitive activities with the arm at shoulder level or higher 22

23 Carpal Tunnel Syndrome 23 Median nerve Transverse carpal ligament Flexor tendons Compressive neuropathy of the median nerve Common in: Pregnancy Diabetes Thyroid dysfunction

24 Carpal Tunnel Syndrome Numbness Clumsiness Tingling Pain 24

25 Carpal Tunnel Syndrome Splint or brace at night (neutral position) Ergonomic/work evaluation Cortisone injections Anti-inflammatories Surgery to release ligament if unresponsive 25

26 Distal Radius Fracture 26 Wrist fracture Fall onto outstretched hand (FOOSH) Snowboarders, skaters, elderly Nondisplaced - cast Displaced reduction possible surgery,? Intra- or extraarticular

27 Normal Wrist Normal wrist: 15 radial deviation 11 volar or palmar tilt Radial deviation Volar Tilt 27

28 28 Distal Radius Fracture

29 Wrist Fracture Cast Care Keep it dry Don t pull out the padding Don t stick objects inside Keep dirt, sand & powder out Don t break off or trim edges 29

30 Overuse Injuries Change Intensity Duration Frequency Common issue in the aging population 30

31 Overuse Injuries & Boomeritis Training errors Improper technique Less-than-optimal environment 31

32 Acute vs. Overuse Injuries Acute - sudden trauma such as sprains, strains, bruises, and fractures Overuse - series of repeated small injuries 32

33 Boomeritis Exercise - key, but... Bike accidents prevail Mortality > children < 50% wear helmets 33

34 Boomeritis tendinitis sprains bursitis strains 34

35 Treatment R.I.C.E. Modify or stop sports activities 90% of these issues can be addressed with conservative/nonsurgical measures Physical therapy & medication Surgery may be warranted in rare situations 35

36 Preventing Sports Injuries Know and abide by rules Wear appropriate protective gear Know how to use equipment Never play through pain 36

37 Preventing Sports Injuries Warm up & stretching are two separate steps! Dynamic stretch Combine the 2 into One activity 37

38 Overuse Injuries 38 10% Rule Don t Increase Activity by More Than 10% Per Week

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