Overuse Injuries Flashcards
Preventing overuse injuries?
- stretch prior to activity, shouldn’t hurt
- warm up prior to activity, break a sweat
- make sure you’re good enough in shape to participate
- ease back into activity
- don’t play through the pain
Diff shoulder injuries?
- overuse: fatigued tendons and muscles
- subacute: fatigued tendons and muscles that now slowly begin to tear/wear out: pain is increasing
- acute: fell, threw too hard, swung too hard, now your shoulder hurts
Diff overuse shoulder injuries? Presentation?
- tendonitis: irritation/inflammation of a tendon - pain down side of shoulder w/ overhead and behind back activity, nighttime pain
- tendonopathy: sick tendon, similar pain complaints, pain may have been evident for a longer period of time
Tx of overuse shoulder injuries?
- make sure that is all it is: xrays and MRI
- NSAIDs
- ice
- PT
- corticosteroid injection
What is a subacute shoulder injury? Dx, tx?
- progression of an overuse injury
- had occasional pain b/f, now it hurts worse and more frequently
- xrays for bones
- MRI for soft tissues
- if unremarkable:
NSAIDs
ice
PT
+/- corticosteroid injection
Dx and tx for acute shoulder injury?
- XR and MRI
- tx depends on findings
Workup for shoulder injuries? MRI indications?
- in general w/u for overuse, subacute, acute shoulder pain is all the same
- XRs are a must
- MRI indications: drop arm sign, external rotation lag sign, dislocation
Concerning shoulder injuries - + findings?
- pain doesn’t improve w/ conservative management
- findings on xrays: fx, arthritis
- findigns on MRI: found something wrong- rotator cuff tear, labral tear, biceps tendon tear
Tx of severe shoulder injury?
- shoulder arthroscopy
- clean up shoulder and repair torn tendons
Recovery time for shoulder surgery?
worst case scenario is a cuff repair:
- 6 wks: healing phase- typically start therapy at 3 wks, full time sling 3 wks/part time 3 wks
- 6 wks: rehab and strengthening
- typically at 3-4 months: start resuming previous activities slowly
3 sep compartments of the knee?
- patellofemoral
- medial
- lateral
2 main types of cartilage in the knee?
- articular cartilage: thin lining of resilient CT that serves as padding and an ultra low friction surface
- meniscal cartilage: serve to deepen the contact of the femur on the tibia, provide stability, and distribute force
- jt reaction force in the knee is about 3x body wt when walking, this is absorbed by menisci and articular cartilage
Problems w/ the knee?
- tendonitis
- meniscal tears
- ligament injuries
- cartilage injuries
- arthritis
What is tendonitis?
- irritation/inflammation of tendon
- typically responds well to rest, ice, anti-inflammatories, and focused PT
What is a meniscal tear? MOI?
- disruption of continuity of meniscus of the knee
- MOI: twisting, turning, deep knee bends, pivoting
Sxs of a meniscal tear?
- focal pain, typically intermittent
- swelling
- nighttime pain
- pain w/ activity
- catching/locking
Tx options for meniscal tear?
- PT, injections
- arthroscopic surgery: remove/fix the tear, 80-90% better by 6-8 wks
Tx of ligament tears?
- ACL: fix in active, physical individual, no real age restriction, CI if significant arthritis
- PCL: fix when sx, CI if sig arthritis
- MCL: brace for 6 wks, wt bearing as tolerated
- LCL: brace, fix if part of complex of lateral injuries
What is cartilage injury of the knee? Dx? Tx?
- damage to articular cartilage
- typically unclear of severity until time of arthroplasty
- variety of txs dependent on severity:
smooth down
microfracture - cartilage transplant: tx for smaller, focal cartilage defects, an attempt to prevent the progression to osteoarthritis (not useful in degenerative arthritis)
Tx of meniscus tear w/ mild/mod arthritis?
- rather common
- meniscus tear is the mechanical problem
- tx based on 6 wks of observation
- if sxs are improving, monitor
- if not or worsening, then consider viscosupplementation
What is viscosupplementation?
- soln of hyaluronan
- lubricant and shock absorber in jts
- OA reduces body’s ability to produce hyaluronan
- w/o it pt experiences pain of OA as jt wears out
- longevity: varies from pt to pt, depending on number of factors: age, wt, stage of disease
- max benefits: can be seen up to 12 wks from last injection
- in general: beneficial effects last from 6 months to a year
- no CI to a repeat injection series
Tx of medial and lateral epicondylitis?
- NICER: anti-inflammatories ice compression elevation rest
- for recalcitrant cases:
consider steroid injection, platelet rich plasma injection - most of the time these go away but some reqr surgery
What is platelet rich plasma?
- high concentration of fxnly viable platelets and their assoc growth factors
- extracted from small amt of pt’s blood: 9-18 cc
- spun through a simple centrifugation process to for a dense suturable fibrin matrix scaffold
- delivered arthroscopically/open and placed directly into tear site to stimulate a reparative healing response for soft tissue and bone repair
Applications for PDGF?
- direct liquid form injections of concentrated platelets for various tendonitis problems
- clot form applications w/ extended growth factor release for cuff repairs
