UPPER EXTREMITY PAIN AND MANAGEMENT
|
|
|
- Noreen Small
- 10 years ago
- Views:
Transcription
1 UPPER EXTREMITY PAIN AND MANAGEMENT 117th Missouri Osteopathic Annual Convention May 1,2015 Chateau on the Lake, Branson, Missouri Charles Orth DO,FAOAO Program Director Orthopedics Prime Health Blue Springs MO
2 I have no financial disclosures
3 Goals of This Presentation Review common shoulder pathology Rotator Cuff, Labrum, Arthritis Elbow Medial & Lateral Epicondylitis Carpal Tunnel Syndrome Hand Pathology & Treatment Understand exams, treatments, differentials When to test, When to refer
4 Attrition Cuff tears are due to? A. Extrinsic Impingement B. Intrinsic Impingement C. Shoulder Instability
5 SHOULDER PATHOLOGY Glenohumeral (GH) Subacromial (SA) Acromioclavicular (AC)
6 Rotator Cuff Chief complaint Traumatic injury or Atraumatic Prior treatments SYMPTOMS: Pain, Weakness, Instability, Motion Loss, Neurologic Changes
7 Rotator Cuff Remember an injury can cause a tear The only other reason for tears is? Attritional tear is due to EXTRINSIC impingement
8 Rotator Cuff Tears Is it torn or not Exam and MRI help diagnose Partial and full tears both can progress Begin with standard x-rays MRI CT Arthrogram US EMG
9 Physical exam Cervical exam: pain usually constant goes above shoulder Palpate Inspect : atrophy Range of Motion Strength, start below shoulder then go up Neuro: Tinels, etc Special tests Stability tests
10 Cervical Spine issues Nerve root or central cord issues can refer distally Any prior cervical issues? Need to R/O neck issues If neck symptoms, start with X-ray C3-4, 4-5 level
11 Cervical Spine Tests Motor Sensory Strength Reflex Lhermitte Sign
12 Inspection Visual inspection, scars, atrophy, scoliosis, winging Atrophy: which muscles Deltoid, Supraspinatus (SS),Infraspinatus (IS),Teres Minor (TM) Biceps: Rupture long head(popeye) Deltoid= Axillary Nerve SS/IS= Suprascapular Nerve TM=Axillary nerve
13 Motion Loss Active motion loss:?cuff, AC Impingement, Arthritis, Loose Body Passive motion loss: Adhesive Capsulitis, loose body Prior to any surgery goal is obtain ROM for better results Know motion before surgery for comparison after
14 Adhesive Capsulitis Frozen Shoulder Pain with loss of motion Fibroblastic proliferation Associated with : Diabetes, autoimmune disorders, prior surgery as lung and breast, prolonged immobilization Mostly External Rotation (ER) motion loss but global loss as well
15 Adhesive Capsulitis NSAIDS Physical Therapy Intra-Articular injection Heat Within one month considerable relief and better motion MUA Arthroscopic Release only after 3-6 month failed care
16 GH INJECTION coracoid
17 Adhesive Capsulitis
18 Impingement Tests Classical tests for external or bursal pain Primary Compressive Disease from coracoacromial arch Neer vs Hawkins tests Injection test: 10cc 1% lidocaine SA space Crepitance with motion in SA space Pain that recreates patients symptoms
19 Impingement Tests HAWKINS NEER
20 Subacromial Injection Post acromion
21 Treatment Impingement Rest NSAIDS Therapy for Strength Injection Arthroscopy
22 Internal Shoulder Impingement has loss of which motion? A. External B. Internal C. Flexion D. Extension
23 Internal Impingement GIRD: Glenohumeral Internal Rotation Deficit Typically Throwers Pain in extreme ER, throw position Limited IR seen Weakness has a Positive empty can sign Posterior tenderness at infraspinatus insertion area ASMI( American Sportsmed Institute): AOSSM.org STOP program: all sports
24 GIRD Image
25 Rehab of Overhead Athletes Dynamic Stabilization Drills Muscle balance Core Program Overall body mechanics Inflammation modalities, cold laser, iontophoresis Incorporate, motion, stretch, strength, throwing phases
26 Overhead Rehab Decrease irritating sport activity 2-8 weeks Continue with other phases of rehab, motion, stabilize, strengthen, resume activity Follow pitching rules counts and rest days Months of rest during season
27 Shrug Sign Pt will abduct shoulder as the rotator cuffs goal is to hold down the humeral head Shrug caused by torn cuff, weak, or absent cuff Deltoid normally then can elevate the shoulder Reliable for cuff pathology Clin Orthop Relat Res 2008;466:
28 Rotator Cuff Strength Testing It takes 20% deficit of strength to detect weakness Always compare opposite side Hand dominance
29 LIFT OFF TEST SUBSCAP EXAM Subscapularis Testing Belly Press Test Bone Joint Surg Am 1996:78:
30 SUPRASPINATUS TESTING
31 INFRASPINATUS TESTING STRONGEST EXTERNAL ROTATOR SEATED EXT. ROTATION ELBOW AT 90 DEGREE
32 Biceps Tendon Pain Generator Speeds Test Yeargason s Test
33 Radiologic testing for pathology With MRI evaluate muscle atrophy Atrophy determines age of tear Retraction of tear Impingement Labral injury Loose body Remember arthrogram or Ultrasound if cannot do MRI
34 Typical MRI of Cuff Tear
35 Partial Rotator Cuff Tears May occur over time Can progress More common on articular side, MRI PASTA= partial articular side tendon avulsion Delamination process Usually under 45 age Tear 50% or greater repair to bone Smaller 20%. Larger 51%, Full tear 29% Yamanaka etal. Clinical Ortho 1994
36 Partial Cuff Tear PASTA
37 Full Cuff Tears To repair or not Is Physical Therapy Relevant
38 Full Cuff Tears to repair or not Evidence Based Orthopedics 2012: Ch 89: Ch 88; Bursectomy equal to acromioplasty Home exercises preferred to PT US as effective as MRI for detecting full cuff tears Weakness, loss of function, acute injuries are reasons to repair
39 Shoulder Instability Means an abnormal excessive motion in one or more directions Instability is pathologic Multidirection (MDI) instability infers an inferior direction Bidirectional instability seen in throwers Laxity is different is not pathologic, Neuromuscular
40 Understanding Instability Frequency, acute, fixed Direction: ANT,POST,INF,MDI Cause: Traumatic Atraumatic Degree: Subluxation Dislocation Congenital Neuromuscular
41 Understanding Instability Congenital: usually multi-directional Ehlers-Danlos, Marfans Traumatic: 90% or more anterior dislocation
42 Anterior Shoulder Laxity Test Done in the plane of scapula Feel degree of motion Apprehension
43 Relocation Test
44 Sulcus test 0= no translation 1= 1cm or less 2= 2 cm or less 3> 2cm 3cm or > = MDI
45 Which is the best x-ray to detect a Bony Bankart Lesion? A. Y-View B. Westpoint C. Internal Rotation External Rotation
46 Instability X-Rays Standard x-rays Y view Axillary view Westpoint view: Bony Bankart Lesion
47 Dislocation X-ray AP VIEW Y VIEW
48 WestPoint X-Ray
49 MRI for Instability Labral tear Labral Tear
50 Plain xrays Look for simple OA
51 Osteoarthritis Shoulder Increases with age Global motion loss Pain Crepitance NSAIDS, Physical Therapy, Intra-articular Injection Surgery: Total Shoulder vs Reverse Shoulder
52 Shoulder Clinical Exams Neer Hawkins Obrien Lift off Belly Press Speed Yeargason Hornblower Impingement Cuff pathology SLAP/Labrum SubScap Subscap Bicep Bicep Infraspinatus/Teres Minor
53 Useful Websites/Apps pitching, and medical info page CORE Clinical Orthopedic Exam: app Procedures Consult: app CME: OAKSTONE PUBLISHING Orthopedic Sports Medicine/A comprehensive review
54 Which exercises are best for lateral epicondylitis? A. Concentric B. Isometric C. Eccentric
55 Lateral Epicondylitis Tennis Elbow Most Common elbow disorder diagnosed for pain 1-3% of adults each year Usually dominant arm 50% of all tennis players
56 Elbow Anatomy ECRB** Extensor Carpi Radialis Brevis Extensor Digitorum Communis (EDC) Microtears Histology shows angiofibroblastic tendinosis
57
58 History Onset s Lateral elbow pain Wrist extension and grip pain Difficult opening things, jars, lids, driving
59 Eccentric Tyler Twist Exercise
60 Physical Exam Pain over lateral epicondyle slightly anterior Pain with resisted wrist dorsiflexion: COZEN test Differential Dx: Cervical Radiculopathy, Radial Tunnel, Intra-articular pain, elbow instability X-rays usually normal, may show calcific tendonitis MRI will show changes 80% or > improve over 1 year
61 COZEN TEST
62 Tennis Elbow Evidence Evidence Based Orthopedics 2012: CH:92, MRI/US useful to aid clinical diagnosis Initial corticosteroids useful in short term NSAIDS may be no more effective than placebo for long term relief
63 Medial Epicondylitis Golfers Elbow Dominant arm 75% of time Much less common than lateral Seen in golfers, pitchers, carpenters, racquet players MC: FCR and PT Ulnar nerve symptoms Approx. 50% 40 s-50 s Grip affected, worse in pronation motions X-rays usually normal
64 Treatment Similar to Lateral Epicondylitis treatment Be careful of ulnar nerve with injections Iontophoresis Topical Pain Lotions Conservative care works 80% of time Surgery: 85% success
65 Carpal Tunnel Syndrome MC compressive neuropathy Risks: Female, Pregnancy, Hypothyroid, RA, Smoker,ETOH Assoc. conditions: DM,Hypothyroid,RA,Pregnancy,Amyloid Repetitive motion/vibration jobs
66 Symptoms Numbness median nerve fingers Nocturnal pain Hand Diagram
67 Carpal Tunnel Exam Atrophy thenar Durkins Compression Test: Most sensitive exam, 30sec Phalens test Tinels test Sensory exam 2ppt Semmes-Weinstein: more sensitive EMG
68 EMG Increase in Latencies Distal sensory > 3.2ms Motor >4.3ms Decrease conduction velocity <52 m/sec abnormal
69 Carpal Tunnel Treatment NSAIDS Nite Splints Exercise Activity modification Steroid injection, 80% transient improvement Failure to improve with injection poor prognosis Carpal Release Revision Carpal Tunnel Release: 75% have some relief
70 Carpal Tunnel Injection
71 References Nerve glide exercises Steroid Injections Splinting Evidence Based Orthopedics 2012: CH 119: 1012=1019
72 Which nervous system is involved in Minor Causalgia? A. Autonomic B. Sympathetic C. Parasympathetic
73 CAUSALGIA THE DREADED RSD WHEN PHYSICAL EXAM DOES NOT MATCH NORMAL EXAM Pain is way out of the normal Even light touch, painful Skin changes even hyperhidrosis Skin color changes
74 Causalgia the Dreaded RSD Start aggressive pain management Use all modalities Narcotic, NSAIDS, Neurontin type, Topical compounds add ketamine Physical Therapy May need Pain management for sympathetic blocks
75 Dequervains Syndrome Stenosing tenosynovitis 1 st Dorsal wrist compartment F>M, age Causes: Idiopathic, Pregnancy, Overuse, Traumatic
76 Dequervains Test Finkelstein Test: positive
77 Dequervains Treatment NSAIDS Thumb spica splint Steroid injection Surgical release
78 Dequervains Release
79 Trigger Finger Stenosing tenosynovitis of flexor tendon sheath A1 pulley is area of entrapment DM more common, RA, amyloidosis Ring finger most common Can have pain, locking, or locked finger Feel crepitance, or bump, or click at A1 pulley Thumb does not respond well to injections
80 Trigger Finger Treatment NSAIDS Nite splint Activity modification Injection: Steroid 1-3 injections common Injections in DM does not work as well Surgery if all fails
81 Trigger Finger
82 Paronychia Infection MC hand infection( 1/3 of all ) Adults usually Staph aureus DM usually mixed infection Chronic look for candida albicans Nail bitters, suckers, manicures, trauma
83 Paronychia Infection Treatment Warm soaks Antibiotics Possible nail removal I&D, separate incision if needed
84 Paronychia Infection Incision
85 Attrition Cuff tears are due to? A. Extrinsic Impingement B. Intrinsic Impingement C. Shoulder Instability
86 Internal Shoulder Impingement has loss of which motion? A. External B. Internal C. Flexion D. Extension
87 Which is the best x-ray to detect a Bony Bankart Lesion? A. Y-View B. Westpoint C. Internal Rotation D. External Rotation
88 Which exercises are best for lateral epicondylitis? A. Concentric B. Isometric C. Eccentric
89 Which nervous system is involved in Minor Causalgia? A. Autonomic B. Sympathetic C. Parasympathetic
90 THE END
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
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
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:
Arthroscopic Shoulder Procedures. David C. Neuschwander MD. Shoulder Instability. Allegheny Health Network Orthopedic Associates of Pittsburgh
Arthroscopic Shoulder Procedures David C. Neuschwander MD Allegheny Health Network Orthopedic Associates of Pittsburgh Shoulder Instability Anterior Instability Posterior Instability Glenohumeral Joint
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
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
Eric M. Kutz, D.O. Arlington Orthopedics Harrisburg, PA
Eric M. Kutz, D.O. Arlington Orthopedics Harrisburg, PA 2 offices 805 Sir Thomas Court Harrisburg 3 Walnut Street Lemoyne Mechanism of injury Repetitive overhead activities Falls to the ground Falls with
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
Musculoskeletal: Acute Lower Back Pain
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
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
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
.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
.org. Tennis Elbow (Lateral Epicondylitis) Anatomy. Cause
Tennis Elbow (Lateral Epicondylitis) Page ( 1 ) Tennis elbow, or lateral epicondylitis, is a painful condition of the elbow caused by overuse. Not surprisingly, playing tennis or other racquet sports can
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
Injuries to Upper Limb
Injuries to Upper Limb 1 The following is a list of common sporting conditions and injuries. The severity of each condition may lead to different treatment protocols and certainly varying levels of intervention.
28% have partial tear of the rotator cuff.
ROTATOR CUFF TENDON RUPTURE Anatomy: 1. Rotator cuff consists of: Subscapularis anteriorly, Supraspinatus superiorly and Infraspinatus and Teres minor posteriorly. 2 Biceps tendon is present in the rotator
Most active and intricate part of the upper extremity Especially vulnerable to injury Do not respond well to serious trauma. Magee, 2008. pg.
PTA 216 Most active and intricate part of the upper extremity Especially vulnerable to injury Do not respond well to serious trauma Magee, 2008. pg. 396 28 bones Numerous articulations 19 intrinsic muscles
Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation
Internal Impingement in the Overhead Athlete: A Correlation of Findings on MRI and Arthroscopic Evaluation Lee D Kaplan, MD J Towers, MD PJ McMahon, MD CH Harner,, MD RW Rodosky,, MD Thrower s shoulder
TOWN CENTER ORTHOPAEDIC ASSOCIATES P.C. Labral Tears
Labral Tears The shoulder is your body s most flexible joint. It is designed to let the arm move in almost any direction. But this flexibility has a price, making the joint prone to injury. The shoulder
Ergonomics Monitor Training Manual
Table of contents I. Introduction Ergonomics Monitor Training Manual II. Definition of Common Injuries Common Hand & Wrist Injuries Common Neck & Back Injuries Common Shoulder & Elbow Injuries III. Ergonomics
Differentiating Cervical Radiculopathy and Peripheral Neuropathy. Adam P. Smith, MD
Differentiating Cervical Radiculopathy and Peripheral Neuropathy Adam P. Smith, MD I have no financial, personal, or professional conflicts of interest to report Radiculopathy versus Neuropathy Radiculopathy
Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior
Abstract Objective: To review the mechanism, surgical procedures, and rehabilitation techniques used with an athlete suffering from chronic anterior glenohumeral instability and glenoid labral tear. Background:
NERVE COMPRESSION DISORDERS
Common Disorders of the Hand and Wrist Ryan Klinefelter, MD Associate Professor of Orthopaedics Department of Orthopaedics The Ohio State University Medical Center NERVE COMPRESSION DISORDERS 1 Carpal
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
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
SHOULDER INSTABILITY IN PATIENTS WITH EDS
EDNF 2012 CONFERENCE LIVING WITH EDS SHOULDER INSTABILITY IN PATIENTS WITH EDS Keith Kenter, MD Associate Professor Sports Medicine & Shoulder Reconstruction Director, Orthopaedic Residency Program Department
Rehabilitation Guidelines for Arthroscopic Capsular Shift
Rehabilitation Guidelines for Arthroscopic Capsular Shift The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular
Reducing Upper Extremity Injuries in the Workplace: Prevention, Ergonomics & Treatment Algorithms. Indiana Hand to Shoulder Center
Reducing Upper Extremity Injuries in the Workplace: Prevention, Ergonomics & Treatment Algorithms Nicholas E. Crosby, M.D. Nancy M. Cannon, OTR, CHT Indianapolis, Indiana Indiana Hand to Shoulder Center
Shoulder Examination
Shoulder Examination Summary Inspection Palpation Movement Special Tests Neurological examination Introduction Shoulder disorders are can be broadly classified into the following types: Pain Stiffness
9/7/14. I do not have a financial relationship with any orthopedic manufacturing organization
I do not have a financial relationship with any orthopedic manufacturing organization Timothy M. Geib, MD Oklahoma Sports & Orthopedic Institute September 27, 2014 Despite what you may have heard, I am
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
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
Lateral Epicondylitis Surgical Treatment and Rehabilitation
1 Lateral Epicondylitis Surgical Treatment and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: Lateral epicondylitis primarily involves the origin of the extensor carpi
THE WRIST. At a glance. 1. Introduction
THE WRIST At a glance The wrist is possibly the most important of all joints in everyday and professional life. It is under strain not only in many blue collar trades, but also in sports and is therefore
Shoulder Instability. Fig 1: Intact labrum and biceps tendon
Shoulder Instability What is it? The shoulder joint is a ball and socket joint, with the humeral head (upper arm bone) as the ball and the glenoid as the socket. The glenoid (socket) is a shallow bone
Shoulder MRI for Rotator Cuff Tears. Conor Kleweno,, Harvard Medical School Year III Gillian Lieberman, MD
Shoulder MRI for Rotator Cuff Tears Conor Kleweno,, Harvard Medical School Year III Goals of Presentation Shoulder anatomy Function of rotator cuff MRI approach to diagnose cuff tear Anatomy on MRI images
Upper Extremity Special Tests. Cervical Tests. TMJ Dysfunction
Upper Extremity Special Tests Cervical Tests Vertebral Artery Test: used to test for vertebral artery occlusion or insufficiency. The subject lies supine on the plinth with the examiner seated behind with
Shoulder Pain and Weakness
Shoulder Pain and Weakness John D. Kelly IV, MD THE PHYSICIAN AND SPORTSMEDICINE - VOL 32 - NO. 11 - NOVEMBER 2004 For CME accreditation information, instructions and learning objectives, click here. A
Elbow Tendinopathies
Elbow Tendinopathies Tennis Elbow Biceps Ruptures Triceps Ruptures James T. Mazzara, M.D. Shoulder and Elbow Surgery Sports Medicine Occupational Orthopedics Patient Education Disclaimer This presentation
Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair
Rehabilitation Guidelines for Anterior Shoulder Reconstruction with Arthroscopic Bankart Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on
Rehabilitation Guidelines for Shoulder Arthroscopy
Rehabilitation Guidelines for Shoulder Arthroscopy Front View Long head of bicep Acromion Figure 1 Shoulder anatomy Supraspinatus Image Copyright 2010 UW Health Sports Medicine Center. Short head of bicep
Examination of the Elbow. Elbow Examination. Structures to Examine. Active Range of Motion. Active Range of Motion 8/22/2012
Examination of the Elbow The elbow is a complex modified hinge joint The humero-ulnar joint is a hinge joint allowing flexion and extension The radio-ulnar joint allows for pronation and supination of
Treatment Guide Understanding Elbow Pain. Using this Guide. Choosing Your Care. Table of Contents:
Treatment Guide Understanding Elbow Pain Elbow pain is extremely common whether due to aging, overuse, trauma or a sports injury. When elbow pain interferes with carrying the groceries, participating in
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
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
Boxing/Kickboxing Shoulder Injuries and Prevention
Boxing/Kickboxing Shoulder Injuries and Prevention Dr. Paul Newhart, D.C. Kickboxing and boxing are an excellent workout regimen, as long as precautions are taken so as not to injure the shoulders, elbows
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,
The 10 Most Common Hand Pathologies In Adults. 1. Carpal Tunnel and Cubital Tunnel
The 10 Most Common Hand Pathologies In Adults Bobbi Jacobsen PA C 1. Carpal Tunnel and Cubital Tunnel CARPAL TUNNEL (median nerve) ( ) Pain and numbness Distal, proximal radiating Sensory disturbance Distribution
10/16/2012. Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines
Orthopaedic Management of Shoulder Pathology Marc J Breslow, MD Illinois Bone and Joint Institute Morton Grove, Des Plaines Opening Statements IBJI Began fall 2007 9000 Waukegan Rd, Morton Grove 900 Rand
The Diagnosis-Driven Physical Exam of the Shoulder
The Diagnosis-Driven Physical Exam of the Shoulder April 24, 2014 Carlin Senter MD, Natalie Voskanian MD, Veronica Jow MD Carlin Senter, MD Assistant Clinical Professor UCSF Sports Medicine 1 Natalie Voskanian,
Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair
Rehabilitation Guidelines for Posterior Shoulder Reconstruction with or without Labral Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a
.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
10/1/2007. Philosophy. Pune Shoulder Rehabilitation Programme (PSRP) 9 th Annual TRAC meeting, Budapest. Principles -I. Design. Study-I.
Dr. Ashish Babhulkar D.Orth., DNB(Orth.), MCh.Orth.(Liverpool,UK.),FRCS(Tr. & Orth.) Shoulder & Joint Replacement Surgeon Pune, India Pune Shoulder Rehabilitation Programme (PSRP) Philosophy Design an
CUMMULATIVE DISORDERS OF UPPER EXTIMITY DR HABIBOLLAHI
CUMMULATIVE DISORDERS OF UPPER EXTIMITY DR HABIBOLLAHI Definition Musculoskeletal disorder (MSD) is an injury or disorder of the muscles, nerves, tendons, joints, cartilage,ligament and spinal discs. It
Knee Injuries What are the ligaments of the knee?
As sporting participants or observers, we often hear a variety of terms used to describe sport-related injuries. Terms such as sprains, strains and tears are used to describe our aches and pains following
THE SHOULDER. Shoulder Pain. Fractures. Instability and Dislocations of the Shoulder
THE SHOULDER Shoulder Pain 1. Fractures 2. Sports injuries 3. Instability/Dislocations 4. Rotator Cuff Disease and Tears 5. Arthritis Fractures The shoulder is made up of three primary bones, the clavicle,
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
Evaluation of Disorders of the Hands and Wrists
Evaluation of Disorders of the Hands and Wrists Case 27 yo female with 6 month history of right forearm and hand pain Works as secretary, symptoms are interfering with her job duties Complains that she
A Patient s Guide to Guyon s Canal Syndrome
A Patient s Guide to DISCLAIMER: The information in this booklet is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or
Overhead Strength Training for the Shoulder: Guidelines for Injury Prevention and Performance Training Success
Overhead Strength Training for the Shoulder: Guidelines for Injury Prevention and Performance Training Success Robert Panariello MS, PT, ATC, CSCS Strength training is an important component in the overall
5/7/2009 SHOULDER) CONDITIONS OF THE SHOULDER NOW IT TIME TO TEST YOU ICD-9 SKILLS: PLEASE APPEND THE APPROPRIATE DIAGNOSIS CODE FOR EACH:
SHOULDER CONDITIONS OF THE SHOULDER AND THEIR TREATMENT Presented by Kevin Solinsky, CPC,CPC-I,CEDC, CEMC The is a major joint and plays a large part in daily life, particularly for athletes and those
Informed Patient Tutorial Copyright 2012 by the American Academy of Orthopaedic Surgeons
Informed Patient Tutorial Copyright 2012 by the American Academy of Orthopaedic Surgeons Informed Patient - Carpal Tunnel Release Surgery Introduction Welcome to the American Academy of Orthopaedic Surgeons'
Upper Extremity MMI and Impairment Rating
Upper Extremity MMI and Impairment Rating 1 How to Determine Maximum Medical Improvement 1. Understand the definition of MMI 2. Review the DWC Form-032, Request for Designated Doctor Examination 3. Review
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
Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy
Anterior Capsular Repair Rehabilitation Program Methodist Sports Medicine Center, Indianapolis, IN Department of Physical Therapy Anterior Capsule reconstruction is a surgical procedure utilized for anterior
INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D.
05/05/2007 INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D. Hand injuries, especially the fractures of metacarpals and phalanges, are the most common fractures in the skeletal system. Hand injuries
Medical Report Checklist: Upper Extremities Peripheral Nerve Disorders Impairments (PND)
http://www.pdratings.com/ Craig Andrew Lange [email protected] California Workers Compensation Certified AMA Guides Impairment & Disability Rating Specialists Voice: (415) 861-4040 / Fax: (415) 276-3741
CONSTRUCTION WORK and CUMULATIVE TRAUMA DISORDERS
Connecticut Department of Public Health Environmental and Occupational Health Assessment Program 410 Capitol Avenue MS # 11OSP, PO Box 340308 Hartford, CT 06134-0308 (860) 509-7740 http://www.ct.gov/dph
Full version is >>> HERE Ulnar Neuropathy Differential Diagnosis and Prognosis. Disclosures: None
Ulnar Neuropathy Differential Diagnosis and Prognosis Disclosures: None Goals of Lecture Describe anatomy: sites of entrapment Ulnar nerve Discuss differential diagnosis of ulnar nerve pathology Identify
POSTERIOR LABRAL (BANKART) REPAIRS
LOURDES MEDICAL ASSOCIATES Sean Mc Millan, DO Director of Orthopaedic Sports Medicine & Arthroscopy 2103 Burlington-Mount Holly Rd Burlington, NJ 08016 (609) 747-9200 (office) (609) 747-1408 (fax) http://orthodoc.aaos.org/drmcmillan
ROTATOR CUFF TEARS SMALL
LOURDES MEDICAL ASSOCIATES Sean Mc Millan, DO Director of Orthopaedic Sports Medicine & Arthroscopy 2103 Burlington-Mount Holly Rd Burlington, NJ 08016 (609) 747-9200 (office) (609) 747-1408 (fax) http://orthodoc.aaos.org/drmcmillan
BWC Diagnosis Determination Guidelines Quick Reference
BWC Diagnosis Determination Guidelines Quick Reference Overview BWC relies on Managed Care Organizations to gather pertinent medical documentation from all treating providers to suppt the allowance determination.
What Are Bursitis and Tendinitis?
Bursitis and tendinitis are both common conditions that cause swelling around muscles and bones. They occur most often in the shoulder, elbow, wrist, hip, knee, or ankle. A bursa is a small, fluid-filled
Dermatomes and Myotomes
Dermatomes and Myotomes C1 C2 C3 C4 C5 C6 C7 C8 T1 Upper Cervical Flexion Upper Cervical Extension Cervical Lateral Flexion Shoulder Girdle Elevation Shoulder Abduction Elbow Flexion Elbow Extension Thumb
Lean-Ergonomic methods to reduce workers compensation costs (Part 2 of 2) Cumulative trauma disorders can be classified as: What is CTD?
#425 Lean-ergonomic methods to reduce workers compensation costs, Part 2 of 2 Lean-Ergonomic methods to reduce workers compensation costs (Part 2 of 2) Govid Bharwani, Ph.D, Biomedical Engineering Thursday,
UHealth Sports Medicine
UHealth Sports Medicine Rehabilitation Guidelines for Arthroscopic Rotator Cuff Repair Type 2 Repairs with Bicep Tenodesis (+/- subacromial decompression) The rehabilitation guidelines are presented in
Rehabilitation Guidelines For SLAP Lesion Repair
Rehabilitation Guidelines For SLAP Lesion Repair The anatomic configuration of the shoulder joint (glenohumeral joint) is often compared to a golf ball on a tee. This is because the articular surface of
ACL plastik, erfarenheter av. tidig kirurgisk behandling. tidig kirurgisk behandling 6/12/2013
in sports Per Renström, MD, PhD Professor emeritus,,, Sweden Member ATP and ITF Sports Science and Medical Committees Physician Swedish Football Association Presentation at the IOC Advanced team physician
Rotator Cuff Repair and Rehabilitation
1 Rotator Cuff Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: The rotator cuff complex is comprised of four tendons from four muscles: supraspinatus, infraspinatus,
SHOULDER INSTABILITY. E. Edward Khalfayan, MD
SHOULDER INSTABILITY E. Edward Khalfayan, MD Instability of the shoulder can occur from a single injury or as the result of repetitive activity such as overhead sports. Dislocations of the shoulder are
Proximal border = palmar wrist crease Distal border = Kaplan + ring finger axis
FPL FCR Proximal border = palmar wrist crease Distal border = Kaplan + ring finger axis Thenar motor branch Kaplan s cardinal line: distal TCL thenar branch Superficial palmar arch superficial arch Originates
J F de Beer, K van Rooyen, D Bhatia. Rotator Cuff Tears
1 J F de Beer, K van Rooyen, D Bhatia Rotator Cuff Tears Anatomy The shoulder consists of a ball (humeral head) and a socket (glenoid). The muscles around the shoulder act to elevate the arm. The large
Full version is >>> HERE 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
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
Completing the Loop: Management of the Adolescent Sports Injury. Adam Thomas, PT, DPT, ATC
: Management of the Adolescent Sports Injury Adam Thomas, PT, DPT, ATC https://www.youtube.com/watch?v=vbufpo 8s3As On field assessment can be the most efficient when the health care provider has observed
Biceps Tenodesis Protocol
Department of Rehabilitation Services Physical Therapy The intent of this protocol is to provide the clinician with a guideline of the postoperative rehabilitation course of a patient that has undergone
Radiculopathy vs. Peripheral Neuropathy. What to do with arm pain? Defining Arm Pain. Arm Pain
Radiculopathy vs. Peripheral Neuropathy What to do with arm pain? Miriana G. Popadich RN, MSN Clinical Care Coordinator Brachial Plexus Program Department of Neurosurgery University of Michigan Timing
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.
Rehabilitation Guidelines for Elbow Ulnar Collateral Ligament (UCL) Reconstruction
Rehabilitation Guidelines for Elbow Ulnar Collateral Ligament (UCL) Reconstruction The elbow is a complex system of three joints formed from three bones; the humerus (the upper arm bone), the ulna (the
THORACIC OUTLET SYNDROME
THORACIC OUTLET SYNDROME The Problem The term thoracic outlet syndrome is used to describe a condition of compression of the nerves and/or blood vessels in the region around the neck and collarbone, called
Dr Doron Sher MB.BS. MBiomedE, FRACS(Orth)
Dr Doron Sher MB.BS. MBiomedE, FRACS(Orth) Knee, Shoulder, Elbow Surgery PATIENT NOTES ARTHROSCOPIC SHOULDER SURGERY I have suggested that you consider an Arthroscopic procedure to assess and treat your
Common Injuries of the Hand, Wrist, & Elbow. Terry M. Messer, MD October 25, 2007
Common Injuries of the Hand, Wrist, & Elbow Terry M. Messer, MD October 25, 2007 Introduction! Hand, Wrist, & Elbow Injuries are common! Increase in intensity/frequency of sports training! Sedentary lifestyle
THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T
THE SHOULDER JOINT T H E G L E N O H U M E R A L ( G H ) J O I N T CLARIFICATION OF TERMS Shoulder girdle = scapula and clavicle Shoulder joint (glenohumeral joint) = scapula and humerus Lippert, p115
COMMON ROWING INJURIES
COMMON ROWING INJURIES Prevention and Treatment Jo A. Hannafin, MD, PhD Professor of Orthopaedic Surgery Hospital for Special Surgery, Cornell University Medical College Team Physician, US Rowing FISA
Sports Medicine. Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients
Sports Medicine Assessing and Diagnosing Shoulder Injuries in Pediatric and Adolescent Patients Sports Medicine at Nationwide Children s Hospital Nationwide Children s Hospital Sports Medicine includes
A Patient s Guide to Carpal Tunnel Syndrome
A Patient s Guide to Carpal Tunnel Syndrome 651 Old Country Road Plainview, NY 11803 Phone: 5166818822 Fax: 5166813332 [email protected] DISCLAIMER: The information in this booklet is compiled from a
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,
Postoperative Protocol For Posterior Labral Repair/ Capsular Plication-- Dr. Trueblood
Postoperative Protocol For Posterior Labral Repair/ Capsular Plication-- Dr. Trueblood Indications: Posterior shoulder instability is a relatively uncommon finding in normal adult shoulders. The most common