Musculoskeletal: Acute Lower Back Pain

Save this PDF as:
 WORD  PNG  TXT  JPG

Size: px
Start display at page:

Download "Musculoskeletal: Acute Lower Back Pain"

Transcription

1 Musculoskeletal: Acute Lower Back Pain Acute Lower Back Pain Back Pain only Sciatica / Radiculopathy Possible Cord or Cauda Equina Compression Possible Spinal Canal Stenosis Red Flags Initial conservative treatment is usually reasonable Urgent Imaging Imaging indicated No Red Flag Conservative treatment Not improved Cause found Bone scan + Spect CT Red Flag present Cause uncertain If pain not improving or progressive neurological deficit MRI is most appropriate CT guided nerve root block if nerve compression identified MRI If MRI not available CT MRI is most appropriate CT guided epidural steriod injection if caudaequina compression identified Musculoskeletal: Acute Lower Back Pain Treat If suspected stress fracture If suspected infection If suspected bony metastases Red Flags Age of onset < 20 years or > 55 years Recent history of violent trauma Constant progressive, non mechanical pain (no relief with bed rest) Thoracic pain Past medical history of malignant tumour Prolonged use of corticosteroids Bone Scan or CT MRI Bone Scan Drug/alcohol abuse, immunosuppression, HIV Systemically unwell Unexplained weight loss Widespread neurological symptoms (including cauda equina syndrome) Structural deformity Fever MRI +/- other imaging for metastatic disease

2 Musculoskeletal: Non Traumatic Hip or Knee Pain Non-Traumatic Hip or Knee Pain Clinical Assessment Musculoskeletal: Non Traumatic Hip or Knee Pain Mild Arthritis Conservative management If conservative management fails consider intra-articular steroid/local anaesthetic injection Cause for pain found Further investigation as indicated by severity of symptoms and fitness for potential surgery Initial conservative treatment is appropriate X-Ray of affected joint(s) Mod-Severe Arthritis Referral to orthopaedics, if patient fit for and requests surgery Cause for pain still uncertain MRI knee or MRI hip

3 Musculoskeletal: Post Traumatic Knee Pain Post Traumatic Knee Pain Fracture Treat (may need CT for Treatment Plan) Ottawa Rules - Clinical decision rules for X-Ray in acute knee injury Knee X-Rays are indicated when any of the following are present: Age 55 years or older Tenderness at head of the fibula Isolated tenderness of the patella Inability to flex knee to 90 degrees Inability to walk four weight-bearing steps immediately after the injury and in emergency department X-Rays indicated Fracture not seen on X-Ray Ongoing suspicion of fracture CT/MRI X-Rays not indicated Likely soft tissue injury MRI when available (or arthrography/ arthroscopy) Musculoskeletal: Post Traumatic Knee Pain Normal with high clinical suspicion Bone scan

4 Musculoskeletal: Shoulder Problems Shoulder Problem (Pain, Instability, Stiffness) Clinical Examination Musculoskeletal: Shoulder Problems Decreased external rotation Frozen shoulder Osteoarthritis X-Ray Include: True glenohumeral, AP axillary and lateral views Frozen shoulder confirmed Fracture detected Consider CT Osteoarthritis not visible and decreased external rotation Shoulder trauma including dislocation X-Ray Include: AC joint and axillary lateral views (Do not accept standard lateral) No fracture but painful movements Inject bursa (under ultrasound). If no improvement, MRI 1) Pain with elevation and/or internal rotation 2) Weak elevation and external rotation Impingement syndrome Rotator cuff tear X-Ray (+ impingement views) and Ultrasound bursa injection No improvement Consider MRI arthrogram Inject bursa & hydrodilatate glenohumeral joint/ physiotherapy Inject bursa (under ultrasound - guidance). If no improvement, MRI

5 Musculoskeletal: Ultrasound Medicare Rebate Guide Medicare has restricted rebates for shoulder and knee ultrasound. A Medicare rebate is claimable only when one or more of the following clinical indicators is applicable and noted on the referral. Shoulder Ultrasound Evaluation of injury to tendon, muscle or muscle tendon junction Rotator (biceps, subscapular, supraspinatus, infraspinatus) Biceps subluxation Capsulitis and bursitis Evaluation of mass including ganglion Occult fracture Acromioclavicular joint pathology Knee Ultrasound Abnormality of tendons or bursae about the knee Meniscal cyst, popliteal fossa cysts, mass or pseudomass Nerve entrapment, nerve or nerve sheath tumour Injury of collateral ligaments NB Non specific pain alone is not an accepted Medicare indication. Musculoskeletal: Ultrasound Medicare Rebate Guide

6

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause

.org. Shoulder Pain and Common Shoulder Problems. Anatomy. Cause Shoulder Pain and Common Shoulder Problems Page ( 1 ) What most people call the shoulder is really several joints that combine with tendons and muscles to allow a wide range of motion in the arm from scratching

More information

ORTHOPAEDIC SURGERY REFERRAL AND MANAGEMENT GUIDELINES. Barwon Health Guide to Triage Categories. Referral & Management Guidelines: Shoulder.

ORTHOPAEDIC SURGERY REFERRAL AND MANAGEMENT GUIDELINES. Barwon Health Guide to Triage Categories. Referral & Management Guidelines: Shoulder. ORTHOPAEDIC SURGERY REFERRAL AND MANAGEMENT GUIDELINES Barwon Health Guide to Triage Categories Referral & Management Guidelines: Shoulder Back Hips Knees Ankles & Feet Elbows Wrist & Hand General BARWON

More information

CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN

CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN CLINICAL PRACTICE GUIDELINES FOR MANAGEMENT OF LOW BACK PAIN Low back pain is very common, up to 90+% of people are affected by back pain at some time in their lives. Most often back pain is benign and

More information

KNEE INJURIES DR. ANDREW POTTER SPORT & EXERCISE MEDICINE PHYSICIAN

KNEE INJURIES DR. ANDREW POTTER SPORT & EXERCISE MEDICINE PHYSICIAN KNEE INJURIES DR. ANDREW POTTER SPORT & EXERCISE MEDICINE PHYSICIAN CLASSIFICATION MENISCUS ACUTE CRUCIATE LIGAMENT (ACL/PCL) MEDIAL COLLATERAL LIGAMENT PATELLAR INSTABILITY LOOSE BODY CHRONIC PATELLOFEMORAL

More information

Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario

Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Page 1 Closed Automobile Insurance Third Party Liability Bodily Injury Claim Study in Ontario Injury Descriptions Developed from Newfoundland claim study injury definitions No injury Death Psychological

More information

Low Back Pain Protocols

Low Back Pain Protocols Low Back Pain Protocols Introduction: Diagnostic Triage And 1. Patient Group Adults aged 18 years and over with routine low back problems. Patients who have had recent surgery should be referred directly

More information

Clinical guidance for MRI referral

Clinical guidance for MRI referral MRI for cervical radiculopathy Referral by a medical practitioner (excluding a specialist or consultant physician) for a scan of spine for a patient 16 years or older for suspected: cervical radiculopathy

More information

Chapter 6 Musculoskeletal System Diseases and Disorders

Chapter 6 Musculoskeletal System Diseases and Disorders Chapter 6 Musculoskeletal System Diseases and Disorders Anatomy and Physiology Bones and Joints Bones provide framework and support; classified by shape and composition Joints: where two or more bones

More information

Rotator Cuff Tears. Most tears occur in the supraspinatus but other parts of the tendon may be involved.

Rotator Cuff Tears. Most tears occur in the supraspinatus but other parts of the tendon may be involved. Rotator Cuff Tears Description Rotator cuff tear is a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form a

More information

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4

Refer to Specialist. The Diagnosis and Management of Shoulder Pain 1. SLAP lesions, types 1 through 4 The Diagnosis Management of Shoulder Pain 1 Significant Hisry -Age -Extremity Dominance -Hisry of trauma, dislocation, subluxation -Weakness, numbness, paresthesias -Sports participation -Past medical

More information

Rotator Cuff Injury and Pathology

Rotator Cuff Injury and Pathology Rotator Cuff Injury and Pathology The rotator cuff is made up of four muscles - supraspinatus, infraspinatus, subscapularis and teres minor. The tendons of these muscles blend together to form a cuff around

More information

Diagnostic Imaging Exams

Diagnostic Imaging Exams Guide for Chiropractors Diagnostic Imaging Exams CREATED FOR OUR CHIROPRACTIC PARTNERS This document has been prepared by the specialized, board-certified radiologists who interpret patient exams for Center

More information

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE:

Notice of Independent Review Decision DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Notice of Independent Review Decision DATE OF REVIEW: 12/10/10 IRO CASE #: NAME: DESCRIPTION OF THE SERVICE OR SERVICES IN DISPUTE: Determine the appropriateness of the previously denied request for right

More information

ROTATOR CUFF SYNDROME Arbejds- og Miljømedicinsk Årsmøde 2008 ROTATOR CUFF SYNDROME = SHOULDER PAIN Steen Bo Kalms, Shoulder- and Elbow Surgeon ROTATOR CUFF SYNDROME VERY COMMON DIAGNOSIS ON REFERRED PTT

More information

Frequently Asked Questions Common Orthopaedic Conditions

Frequently Asked Questions Common Orthopaedic Conditions Frequently Asked Questions Common Orthopaedic Conditions What is the difference between a sprain and a strain? A strain occurs when a muscle is stretched or torn. A sprain occurs when a ligament is stretched

More information

SOFT TISSUE KNEE INJURIES

SOFT TISSUE KNEE INJURIES SOFT TISSUE KNEE INJURIES Soft tissue injuries of the knee commonly occur in all sports or in any activity that requires sudden changes in activity or movement. The knee is a complex joint and any injury

More information

IMAGING EVALUATION FOR LOW BACK PAIN. Christine Athwal, M.D. Faculty Advisor: Timothy Cobb, M.D.

IMAGING EVALUATION FOR LOW BACK PAIN. Christine Athwal, M.D. Faculty Advisor: Timothy Cobb, M.D. IMAGING EVALUATION FOR LOW BACK PAIN Christine Athwal, M.D. Faculty Advisor: Timothy Cobb, M.D. TABLE OF CONTENTS Introduction Case presentation Differential diagnoses of low back pain Evaluation of low

More information

Temple Physical Therapy

Temple Physical Therapy Temple Physical Therapy A General Overview of Common Neck Injuries For current information on Temple Physical Therapy related news and for a healthy and safe return to work, sport and recreation Like Us

More information

The Sporting Knee. Research. Education. Dr Lingaraj Krishna Consultant Division of Hip and Knee Surgery National University Hospital

The Sporting Knee. Research. Education. Dr Lingaraj Krishna Consultant Division of Hip and Knee Surgery National University Hospital The Sporting Knee Dr Lingaraj Krishna Consultant Division of Hip and Knee Surgery National University Hospital Assistant Professor Department of Orthopaedic Surgery National University of Singapore Clinical

More information

A Patient s Guide to Shoulder Pain

A Patient s Guide to Shoulder Pain A Patient s Guide to Shoulder Pain Part 2 Evaluating the Patient James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation

More information

There are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions

There are four main regions of the back; the cervical (C), thoracic (T), lumbar (L), and sacral (S) regions Low Back Pain Overview Low back pain is one of the most common disorders in the United States. About 80 percent of people have at least one episode of low back pain during their lifetime. Factors that

More information

A Simplified Approach to Common Shoulder Problems

A Simplified Approach to Common Shoulder Problems A Simplified Approach to Common Shoulder Problems Objectives: Understand the basic categories of common shoulder problems. Understand the common patient symptoms. Understand the basic exam findings. Understand

More information

Imaging of the Spine. Dr Nicola Bees Consultant Radiologist

Imaging of the Spine. Dr Nicola Bees Consultant Radiologist Imaging of the Spine Dr Nicola Bees Consultant Radiologist Imaging of the Spine Types of Imaging available Value of Imaging in back pain With red flags Without red flags Imaging Guidelines Terminology

More information

Elbow Injuries and Disorders

Elbow Injuries and Disorders Elbow Injuries and Disorders Introduction Your elbow joint is made up of bone, cartilage, ligaments and fluid. Muscles and tendons help the elbow joint move. There are many injuries and disorders that

More information

:{ic0fp'16. Evaluation and Management of Knee and Shoulder Pain. Andrew Ferris, DO. ACOFP 53 rd Annual Convention & Scientific Seminars

:{ic0fp'16. Evaluation and Management of Knee and Shoulder Pain. Andrew Ferris, DO. ACOFP 53 rd Annual Convention & Scientific Seminars :{ic0fp'16 ACOFP 53 rd Annual Convention & Scientific Seminars Evaluation and Management of Knee and Shoulder Pain Andrew Ferris, DO Evaluation and management of Knee and Shoulder pain Andrew Ferris DO

More information

Appointment Types First outpatient. Clinic Types CATS Spine CATS Hip and Knee CATS General Orthopaedic Injection Clinic Podiatry/Foot and Ankle

Appointment Types First outpatient. Clinic Types CATS Spine CATS Hip and Knee CATS General Orthopaedic Injection Clinic Podiatry/Foot and Ankle Clinic Types CATS Spine CATS Hip and Knee CATS General Orthopaedic Injection Clinic Podiatry/Foot and Ankle Conditions Treated Ankle & foot pain & stiffness Back pain & stiffness Carpal Tunnel/ Nerve impingement/entrapment

More information

Low Back Injury in the Industrial Athlete: An Anatomic Approach

Low Back Injury in the Industrial Athlete: An Anatomic Approach Low Back Injury in the Industrial Athlete: An Anatomic Approach Earl J. Craig, M.D. Assistant Professor Indiana University School of Medicine Department of Physical Medicine and Rehabilitation Epidemiology

More information

Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders. Dr John Trantalis

Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders. Dr John Trantalis Clues to Diagnosing and Managing Common Shoulder & Elbow Disorders Dr John Trantalis Overview Key diagnostic criteria for common shoulder and elbow disorders Then give summary of condition. Demog, hs,

More information

Spinal Surgery 2. Teaching Aims. Common Spinal Pathologies. Disc Degeneration. Disc Degeneration. Causes of LBP 8/2/13. Common Spinal Conditions

Spinal Surgery 2. Teaching Aims. Common Spinal Pathologies. Disc Degeneration. Disc Degeneration. Causes of LBP 8/2/13. Common Spinal Conditions Teaching Aims Spinal Surgery 2 Mr Mushtaque A. Ishaque BSc(Hons) BChir(Cantab) DM FRCS FRCS(Ed) FRCS(Orth) Hunterian Professor at The Royal College of Surgeons of England Consultant Orthopaedic Spinal

More information

Elbow Examination. Haroon Majeed

Elbow Examination. Haroon Majeed Elbow Examination Haroon Majeed Key Points Inspection Palpation Movements Neurological Examination Special tests Joints above and below Before Starting Introduce yourself Explain to the patient what the

More information

Sample Treatment Protocol

Sample Treatment Protocol Sample Treatment Protocol 1 Adults with acute episode of LBP Definition: Acute episode Back pain lasting

More information

Shoulder Surgery. How the Normal Shoulder Works.

Shoulder Surgery. How the Normal Shoulder Works. Page 1 of 6 Shoulder Surgery Your shoulder is the most flexible joint in your body. It allows you to place and rotate your arm in many positions in front, above, to the side, and behind your body. This

More information

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community

EFSUMB EUROPEAN FEDERATION OF SOCIETIES FOR ULTRASOUND IN MEDICINE AND BIOLOGY Building a European Ultrasound Community MINIMUM TRAINING REQUIREMENTS FOR THE PRACTICE OF MEDICAL ULTRASOUND IN EUROPE Appendix 12: Musculoskeletal Musculoskeletal ultrasound comprises a wide range of different examinations increasingly performed

More information

Shoulder and Elbow Problems

Shoulder and Elbow Problems Shoulder and Elbow Problems Mr Amir Salama Consultant Orthopaedic Surgeon Heart of England Trust Parkway Hospital Shoulder Pain Traumatic/ Injury fracture Dislocation/ instability SLAP Cuff tear Non

More information

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH)

A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) A Patient s Guide to Diffuse Idiopathic Skeletal Hyperostosis (DISH) Introduction Diffuse Idiopathic Skeletal Hyperostosis (DISH) is a phenomenon that more commonly affects older males. It is associated

More information

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity

UPPER EXTREMITY INJURIES. Recognizing common injuries to the upper extremity UPPER EXTREMITY INJURIES Recognizing common injuries to the upper extremity ANATOMY BONES Clavicle Scapula Spine of the scapula Acromion process Glenoid fossa/cavity Humerus Epicondyles ANATOMY BONES Ulna

More information

Workers who do overhead activities such as painting, stocking shelves or construction Athletes such as swimmers, pitchers and tennis players

Workers who do overhead activities such as painting, stocking shelves or construction Athletes such as swimmers, pitchers and tennis players Rotator Cuff Tears Description Rotator cuff tears are a common cause of pain and disability in the adult population. The rotator cuff is made up of four muscles and their tendons. These combine to form

More information

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS Learning Objective Radiology Anatomy of the Spine and Upper Extremity Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images Timothy J. Mosher,

More information

Knee Arthroscopy Prior Authorization Request Form

Knee Arthroscopy Prior Authorization Request Form Prior Authorization Request Form Member Name: DOB: HPHC ID#: Requesting Provider #: Requesting Provider Phone #: Requesting Provider NPI #: Facility Name/Location: Requested Setting: Surgical day care

More information

Rotator Cuff Tears in Football

Rotator Cuff Tears in Football Disclosures Rotator Cuff Tears in Football Roger Ostrander, MD Consultant: Mitek Consultant: On-Q Research Support: Arthrex Research Support: Breg Research Support: Arthrosurface 2 Anatomy 4 major muscles:

More information

DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA

DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN. Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA DIFFERENTIAL DIAGNOSIS OF LOW BACK PAIN Arnold J. Weil, M.D., M.B.A. Non-Surgical Orthopaedics, P.C. Atlanta, GA MEDICAL ALGORITHM OF REALITY LOWER BACK PAIN Yes Patient will never get better until case

More information

Adhesive Capsulitis. Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center

Adhesive Capsulitis. Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center Adhesive Capsulitis Jennifer Holden, MD PGY-2 Department of Emergency Medicine University of Mississippi Medical Center Definition: A condition of varying severity characterized by the gradual development

More information

Shoulder Impingement/Rotator Cuff Tendinitis

Shoulder Impingement/Rotator Cuff Tendinitis Copyright 2011 American Academy of Orthopaedic Surgeons Shoulder Impingement/Rotator Cuff Tendinitis One of the most common physical complaints is shoulder pain. Your shoulder is made up of several joints

More information

.org. Herniated Disk in the Lower Back. Anatomy. Description

.org. Herniated Disk in the Lower Back. Anatomy. Description Herniated Disk in the Lower Back Page ( 1 ) Sometimes called a slipped or ruptured disk, a herniated disk most often occurs in your lower back. It is one of the most common causes of low back pain, as

More information

Alain Elbaz MD North Cypress Medical Center

Alain Elbaz MD North Cypress Medical Center Alain Elbaz MD North Cypress Medical Center Shoulder Arthroscopy The shoulder joint is prone to injury since it is very mobile. Frequent overhead movements and sudden trauma can damage the tissues inside

More information

In Office Treatment of Common Pediatric Shoulder Injuries. Jeffrey Bechler, MD

In Office Treatment of Common Pediatric Shoulder Injuries. Jeffrey Bechler, MD In Office Treatment of Common Pediatric Shoulder Injuries Jeffrey Bechler, MD Main Objective Make you Comfortable with Diagnosing and Treating Common Shoulder Injuries/Problems Objectives 1) Epidemiology

More information

BACK PAIN Red Flags & Referral for Surgery. B BALAIN Cons Spine Surgeon RJ&AH Orthopaedic Hospital, Oswestry

BACK PAIN Red Flags & Referral for Surgery. B BALAIN Cons Spine Surgeon RJ&AH Orthopaedic Hospital, Oswestry BACK PAIN Red Flags & Referral for Surgery B BALAIN Cons Spine Surgeon RJ&AH Orthopaedic Hospital, Oswestry Mini Quiz Diagnosis? Role for Surgery? Patient history no 1 Low back Pain for 6 months, getting

More information

BACK TO BASICS. Learning from our Incidents: RED FLAGS in the Emergency Department

BACK TO BASICS. Learning from our Incidents: RED FLAGS in the Emergency Department BACK TO BASICS Learning from our Incidents: RED FLAGS in the Emergency Department The case A 58 year old female presents to the ED with a 1 week history of progressively worsening back pain, radiating

More information

Copyright Bradley Whale 2011. No unauthorised reproductions.

Copyright Bradley Whale 2011. No unauthorised reproductions. Knee Anatomy While there are four bones that come together at the knee, only the femur (thigh bone) and the tibia (shin bone) form the joint itself. The head of the fibula (strut bone on the outside of

More information

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC

Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Rotator cuff tears Acute or chronic? Mary Obele ANZSOM September 2012 Acknowledgement: ACC Anatomy Epidemiology Asymptomatic rotator cuff tears: prevalence is 35% (5) 15% full thickness and 20% partial

More information

SHOULDER PAIN LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM.

SHOULDER PAIN LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM. LIFE OR SPORTS, WE GET YOU BACK IN THE GAME.SM SHOULDER PAIN Fort Sanders Regional The Trustees Tower 501 19th Street, Suite 600 Knoxville, TN 37916 Tel 865.524.5365 Fax 865.673.8007 The Tower at Parkwest

More information

SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS?

SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS? SPINAL STENOSIS Information for Patients WHAT IS SPINAL STENOSIS? The spinal canal is best imagined as a bony tube through which nerve fibres pass. The tube is interrupted between each pair of adjacent

More information

Information on the Chiropractic Care of Lower Back Pain

Information on the Chiropractic Care of Lower Back Pain Chiropractic Care of Lower Back Pain Lower back pain is probably the most common condition seen the the Chiropractic office. Each month it is estimated that up to one third of persons experience some type

More information

ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com

ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com Date notice sent to all parties: May 27, 2014 IRO CASE #: ReviewTex, Inc. 1818 Mountjoy Drive San Antonio, TX 78232 (phone) 210-598-9381 (fax) 210-598-9382 reviewtex@hotmail.com Notice of Independent Review

More information

.org. Cervical Spondylosis (Arthritis of the Neck) Anatomy. Cause

.org. Cervical Spondylosis (Arthritis of the Neck) Anatomy. Cause Cervical Spondylosis (Arthritis of the Neck) Page ( 1 ) Neck pain can be caused by many things but is most often related to getting older. Like the rest of the body, the disks and joints in the neck (cervical

More information

DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES

DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES DIVISION OF RHEUMATOLOGY DEPARTMENT OF MEDICINE UNIVERSITY OF WESTERN ONTARIO POSTGRADUATE EDUCTION ORTHOPAEDIC OFF-SERVICE GOALS & OBJECTIVES GOAL #1 develop the ability to order and understand interpretation

More information

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist

Ms. Ruth Delaney ROTATOR CUFF DISEASE Orthopaedic Surgeon, Shoulder Specialist WHAT DOES THE ROTATOR CUFF DO? WHAT DOES THE ROTATOR CUFF DO? WHO GETS ROTATOR CUFF TEARS? HOW DO I CLINICALLY DIAGNOSE A CUFF TEAR? WHO NEEDS AN MRI? DOES EVERY CUFF TEAR NEED TO BE FIXED? WHAT DOES ROTATOR

More information

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and

Rotator Cuff Pathophysiology. treatment program that will effectively treat it. The tricky part about the shoulder is that it is a ball and Rotator Cuff Pathophysiology Shoulder injuries occur to most people at least once in their life. This highly mobile and versatile joint is one of the most common reasons people visit their health care

More information

GP Assessment of the Shoulder. Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service

GP Assessment of the Shoulder. Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service GP Assessment of the Shoulder Keith Littlebury MSc Grad dip Phys Extended Scope Physiotherapist Camden CATS service Aims Refresh shoulder anatomy Classification of common shoulder conditions seen in primary

More information

Physiotherapy fees and utilization guidelines for auto insurance accident claimants

Physiotherapy fees and utilization guidelines for auto insurance accident claimants No. A-12/97 Property & Casualty ) Auto Physiotherapy fees and utilization guidelines for auto insurance accident claimants To the attention of all insurance companies licensed to transact automobile insurance

More information

Hitting a Nerve: The Triggers of Sciatica. Bruce Tranmer MD FRCS FACS

Hitting a Nerve: The Triggers of Sciatica. Bruce Tranmer MD FRCS FACS Hitting a Nerve: The Triggers of Sciatica Bruce Tranmer MD FRCS FACS Disclosures I have no financial disclosures Objectives - Sciatica Historical Perspective What is Sciatica What can cause Sciatica Clinical

More information

Meniscus Disease and Treatment A Guide for Patients

Meniscus Disease and Treatment A Guide for Patients Meniscus Disease and Treatment A Guide for Patients Anil K. Gupta, MD, MBA Sports Medicine and Shoulder Surgery Toledo Orthopaedic Surgeons 1 Background Meniscal tears are among the most common knee injuries.

More information

Cervical Spondylosis (Arthritis of the Neck)

Cervical Spondylosis (Arthritis of the Neck) Copyright 2009 American Academy of Orthopaedic Surgeons Cervical Spondylosis (Arthritis of the Neck) Neck pain is extremely common. It can be caused by many things, and is most often related to getting

More information

1 of 6 1/22/2015 10:06 AM

1 of 6 1/22/2015 10:06 AM 1 of 6 1/22/2015 10:06 AM 2 of 6 1/22/2015 10:06 AM This cross-section view of the shoulder socket shows a typical SLAP tear. Injuries to the superior labrum can be caused by acute trauma or by repetitive

More information

Clinical Guideline. Low Back Pain Orthopaedics. Princess Alexandra Hospital Emergency Department. 1 Purpose. 2 Background

Clinical Guideline. Low Back Pain Orthopaedics. Princess Alexandra Hospital Emergency Department. 1 Purpose. 2 Background Princess Alexandra Hospital Emergency Department Clinical Guideline Orthopaedics Review Officer: Katherine Isoardi Version no: 1 Approval date: 18/03/2015 Review date: 18/03/2017 Approving Officer Dr James

More information

THE DIAGNOSIS AND MANAGEMENT OF SOFT TISSUE SHOULDER INJURIES AND RELATED DISORDERS

THE DIAGNOSIS AND MANAGEMENT OF SOFT TISSUE SHOULDER INJURIES AND RELATED DISORDERS THE DIAGNOSIS AND MANAGEMENT OF SOFT TISSUE SHOULDER INJURIES AND RELATED DISORDERS Key Messages Initial diagnosis and management Refer people with red flags immediately for specialist evaluation. Refer

More information

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke

Shoulder Injuries. Why Bother? QAS Injury Prevalence. Screening Injury 29.2% 12 month cumulative injury prevalence. Dr Simon Locke Shoulder Injuries Dr Simon Locke Why Bother? Are shoulder and upper limb injuries common? Some anatomy What, where, what sports? How do they happen? Treatment, advances? QAS Injury Prevalence Screening

More information

what do you mean by Acute Carpal Tunnel Syndrome? 7/14/2012 Acute Variants of Typically Chronic Conditions

what do you mean by Acute Carpal Tunnel Syndrome? 7/14/2012 Acute Variants of Typically Chronic Conditions what do you mean by DMK Acute Causes of Chronic Conditions Acute Carpal Tunnel Syndrome? Acute Variants of Typically Chronic Conditions Acute Variants of Typically Chronic Conditions Kennedy-White Orthopaedic

More information

GROIN, HIP & BACK PAIN

GROIN, HIP & BACK PAIN Mr Simon Jennings GROIN, HIP & BACK PAIN Mr Simon Jennings BSc, MB BS, FRCS, Dip Sports Med FRCS (Trauma & Orthopaedics) Consultant Orthopaedic Surgeon Northwick Park Hospital & Harley Street The London

More information

Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine

Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine Ontario Insurance Commission Commission des assurances de l Ontario Physiotherapy Utilization Guidelines for Soft Tissue Disorders of the Spine Commissioner s Guideline No. 2/97 Physiotherapy Utilization

More information

Upper limb injuries. Traumatology RHS 231 Dr. Einas Al-Eisa

Upper limb injuries. Traumatology RHS 231 Dr. Einas Al-Eisa Upper limb injuries Traumatology RHS 231 Dr. Einas Al-Eisa Pain in the limbs: May be classified under 4 headings: 1. Joint pain 2. Soft tissue pain 3. Neurogenic pain 4. Orthopaedic causes (fractures,

More information

.org. Arthritis of the Hand. Description

.org. Arthritis of the Hand. Description Arthritis of the Hand Page ( 1 ) The hand and wrist have multiple small joints that work together to produce motion, including the fine motion needed to thread a needle or tie a shoelace. When the joints

More information

What is a Sports Physician?

What is a Sports Physician? What is a Sports Physician? Dr Mike Bundy MBBS MRCGP Dip Sports Med FFSEM Consultant in Sport and Exercise Medicine Medical Director at Pure Sports Medicine Ex-England Rugby senior team Doctor www.puresportsmed.com

More information

Shouldering the Burden

Shouldering the Burden Shouldering the Burden Wheelchair Athletes and Shoulder Injuries Dr. Julia Alleyne BHSc(PT) MD MScCH Dip Sport Med CMO, 2015 Parapan Games, Toronto Faculty/Presenter Disclosure Faculty: Dr. Julia Alleyne

More information

History Inspection Palpation Range of motion Other Tests

History Inspection Palpation Range of motion Other Tests Diagnosis and Management of Common Shoulder and Hip Complaints UCSF Essentials of Primary Care August 8, 2013 Carlin Senter, M.D. At the end of this hour you will know 1. The differential diagnosis for

More information

Pathophysiology of Acute and Chronic Low Back Pain

Pathophysiology of Acute and Chronic Low Back Pain Pathophysiology of Acute and Chronic Low Back Pain Mary Beth Partyka MSN APN Adult Nurse Practitioner Adult Pain Service Advocate Christ Medical Center Presentation Objectives Review the incidence of acute

More information

A Patient s Guide to Labral Tears of the Hip

A Patient s Guide to Labral Tears of the Hip A Patient s Guide to Labral Tears of the Hip 6565 Fannin Street Houston, TX 77030 Phone: 713-790-3333 DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete

More information

.org. Rotator Cuff Tears. Anatomy. Description

.org. Rotator Cuff Tears. Anatomy. Description Rotator Cuff Tears Page ( 1 ) A rotator cuff tear is a common cause of pain and disability among adults. In 2008, close to 2 million people in the United States went to their doctors because of a rotator

More information

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D.

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D. Hand and Upper Extremity Injuries in Outdoor Activities John A. Schneider, M.D. Biographical Sketch Dr. Schneider is an orthopedic surgeon that specializes in the treatment of hand and upper extremity

More information

Ultimate Frozen Shoulder Therapy Guide. - User Review --->>> Click Here CHECK NOW

Ultimate Frozen Shoulder Therapy Guide. - User Review --->>> Click Here CHECK NOW Sharp pain on top of shoulder ac joint, adhesive capsulitis in hip symptoms, frozen shoulder exercises to avoid, frozen shoulder acupuncture therapy. Ultimate Frozen Shoulder Therapy Guide. - User Review

More information

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S.

6/3/2011. High Prevalence and Incidence. Low back pain is 5 th most common reason for all physician office visits in the U.S. High Prevalence and Incidence Prevalence 85% of Americans will experience low back pain at some time in their life. Incidence 5% annual Timothy C. Shen, M.D. Physical Medicine and Rehabilitation Sub-specialty

More information

Shoulder Pain in General Practice.

Shoulder Pain in General Practice. Shoulder Pain in General Practice www.shouldersurgery.co.za A Short History of Medicine 2000 B.C. - "Here, eat this root. 1000 B.C. - "That root is heathen, say this prayer. 1850 A.D. - "That prayer is

More information

Arthroscopy of the Hip

Arthroscopy of the Hip Arthroscopy of the Hip Professor Ernest Schilders FRCS, FFSEM Consultant Orthopaedic Surgeon Specialist in Shoulder and Hip Arthroscopy, Groin and Sports Injuries Private consulting rooms The London Hip

More information

Arthritis of the Shoulder

Arthritis of the Shoulder Arthritis of the Shoulder In 2011, more than 50 million people in the United States reported that they had been diagnosed with some form of arthritis, according to the National Health Interview Survey.

More information

Advanced Practice Provider Academy

Advanced Practice Provider Academy (+)Dean T. Harrison, MPAS,PA C,DFAAPA Director of Mid Level Practitioners; Assistant Medical Director Clinical Evaluation Unit, Division of Emergency Medicine, Department of Surgery, Duke University Medical

More information

CUBOID FRACTURE. The cuboid bone lies on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones.

CUBOID FRACTURE. The cuboid bone lies on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones. CUBOID FRACTURE Introduction The cuboid bone lies on the lateral side of the foot, in front of the calcaneus, and behind the fourth and fifth metatarsal bones. Isolated fractures of the cuboid are uncommon,

More information

A printable version of these Orthopaedic Referral guidelines is available here. Shoulders and Upper Limb

A printable version of these Orthopaedic Referral guidelines is available here. Shoulders and Upper Limb A Medical Director Referral form can be downloaded from the following webpage: http://www.svhm.org.au/gp/outpatient_information.htm Fractures 1 Fractures of the Upper Limb 1 Hand Fractures 1 Fractures

More information

HIP AND SHOULDER PAIN GP ASSESSMENT TIPS AND INJECTION TECHNIQUES M. B., B. S. D I P R A C O G D I P M U S C M E D G C H P E

HIP AND SHOULDER PAIN GP ASSESSMENT TIPS AND INJECTION TECHNIQUES M. B., B. S. D I P R A C O G D I P M U S C M E D G C H P E HIP AND SHOULDER PAIN GP ASSESSMENT TIPS AND INJECTION TECHNIQUES DR D E N N I S O C O N N O R M. B., B. S. D I P R A C O G D I P M U S C M E D G C H P E DISCLAIMER LEARNING OBJECTIVES Review hip and shoulder

More information

THIS IS A REPORT TO THE COURT BASED UPON THE HISTORY OF THE INJURIES SUSTAINED BY THE CLAIMANT, THE TREATMENT, CONDITION AND PROGNOSIS.

THIS IS A REPORT TO THE COURT BASED UPON THE HISTORY OF THE INJURIES SUSTAINED BY THE CLAIMANT, THE TREATMENT, CONDITION AND PROGNOSIS. MEDICAL REPORT THIS IS A REPORT TO THE COURT BASED UPON THE HISTORY OF THE INJURIES SUSTAINED BY THE CLAIMANT, THE TREATMENT, CONDITION AND PROGNOSIS. NAME: ADDRESS: Shoulder Birmingham DOB: Age 62 ACCIDENT

More information

Uncovering the Cause of Your Shoulder Pain. Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217

Uncovering the Cause of Your Shoulder Pain. Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217 Uncovering the Cause of Your Shoulder Pain Joseph Lorenzetti PT, DPT, MTC Athleticare Kenmore 1495 Military Road Kenmore, NY 14217 What do Physical Therapists do? Skilled in the assessment of musculoskeletal

More information

Anatomy of the Shoulder

Anatomy of the Shoulder Anatomy of the Shoulder Dislocations of the sternoclavicular joint Pathomechanism: fall on the outstreched upper extremity Classificatios: a. anterior : Clinical signs: prominence at the joint b. posterior:

More information

ANATOMY: ACROMIAL SHAPE AND SLOPE:

ANATOMY: ACROMIAL SHAPE AND SLOPE: ROTATOR CUFF DISEASE AND IMPINGEMENT Irritation and injury of the rotator cuff are the most common shoulder problems encountered the sports medicine community. While these problems can occur after a specific

More information

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel#

Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX Tel# Orthopaedic and Spine Institute 21 Spurs Lane, Suite 245, San Antonio, TX 78240 www.saspine.com Tel# 210-487-7463 PATIENT GUIDE TO SHOULDER ARTHROSCOPY ACROMIOPLASTY WHAT IS ARTHROSCOPIC SURGERY? Athroscopic

More information

Shoulder Orthopedic Tests

Shoulder Orthopedic Tests Shoulder Orthopedic Tests Tendinitis (Supraspinatus) Supraspinatus tendinitis is a common inflammatory condition of the shoulder that causes anterior shoulder pain. Pain is present especially in abduction.

More information

Shoulder Arthropathies. Crystal Skovly, PA-C Orthopedic Institute Yankton, SD

Shoulder Arthropathies. Crystal Skovly, PA-C Orthopedic Institute Yankton, SD Shoulder Arthropathies Crystal Skovly, PA-C Orthopedic Institute Yankton, SD Covered Glenohumeral Arthritis Impingement Syndrome Rotator Cuff Tears Rupture of the Long Head Biceps Tendon Shoulder Instability

More information

Return to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition

Return to same game if sx s resolve within 15 minutes. Return to next game if sx s resolve within one week Return to Competition Assessment Skills of the Spine on the Field and in the Clinic Ron Burke, MD Cervical Spine Injuries Sprains and strains Stingers Transient quadriparesis Cervical Spine Injuries Result in critical loss

More information

Osteoarthritis (OA) of the Knee

Osteoarthritis (OA) of the Knee Integrated Musculoskeletal Service Osteoarthritis (OA) of the Knee Information and Exercise Leaflet for Patient s and Carers What is osteoarthritis? Arthritis means inflammation of the joints. Osteoarthritis

More information

SHOULDER PAIN. Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments

SHOULDER PAIN. Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments SHOULDER PAIN Anatomy Conditions: Muscular Spasm Pinched Nerve Rotator Cuff Tendonitis Procedures: Subacromial, Glenohumeral and Acromioclavicular Injections Nonprocedural Treatments Surgery: Rotator Cuff

More information

Shoulder vs Neck Pathology. Goal: Simplify Evaluation of the Painful Shoulder. Shoulder: Bony Anatomy Three major bones. Shoulder Disorders: Overview

Shoulder vs Neck Pathology. Goal: Simplify Evaluation of the Painful Shoulder. Shoulder: Bony Anatomy Three major bones. Shoulder Disorders: Overview 4 5:45 pm Orthopedic Update: Hand and Shoulder SPEAKERS Charles S. Day, MD, MBA Arun J. Ramappa, MD Presenter Disclosure Information The following relationships exist related to this presentation: Charles

More information