Your SlideShare is downloading. ×
ortho 06 common ortho dis 2 edited 12 mar 10
Upcoming SlideShare
Loading in...5
×

Thanks for flagging this SlideShare!

Oops! An error has occurred.

×

Saving this for later?

Get the SlideShare app to save on your phone or tablet. Read anywhere, anytime - even offline.

Text the download link to your phone

Standard text messaging rates apply

ortho 06 common ortho dis 2 edited 12 mar 10

1,508
views

Published on


0 Comments
2 Likes
Statistics
Notes
  • Be the first to comment

No Downloads
Views
Total Views
1,508
On Slideshare
0
From Embeds
0
Number of Embeds
0
Actions
Shares
0
Downloads
0
Comments
0
Likes
2
Embeds 0
No embeds

Report content
Flagged as inappropriate Flag as inappropriate
Flag as inappropriate

Select your reason for flagging this presentation as inappropriate.

Cancel
No notes for slide
  • Statistically significant improvement in “worst pain” and pain c first steps in AM.
  • Davis et al reported the <50% of patients with chronic heel pain were totally satisfied with the results of surgical intervention. Other’s have reported higher satisfaction rates, but with functional limitations.
  • Transcript

    • 1. Common Orthopaedic Disorders ภาควิชาศัลยศาสตร์ออร์โธปิดิคส์และกายภาพบำบัด คณะแพทยศาสตร์ศิริราชพยาบาล Handout can be download at www.ortho.chuckpaiwong.com/presentation
    • 2. Outlines
      • Septic arthritis
      • Osteomyelitis
      • Ankle sprain
      • Achilles tendon tear
      • Plantar fasciitis
      • Trigger finger
      • De quarvain
      • Carpal Tunnel Syndrome (CTS)
    • 3. Septic arthritis
      • Acute suppurative (septic) arthritis
      • Tuberculous arthritis
    • 4. Septic Arthritis
      • Causal Organism
        • Staph. Aureus
        • H. Influenzae in infant
        • Gonococcus in adults
      • Predis p osing condition
        • Rheumatoid arthritis
        • Chronic debilitating condition
        • IVDU, immunosup p ressive d rugs therapy
        • AIDS
    • 5. Septic arthritis
      • Pain around the joint
      • Malaise, fever and constitutional symptom
      • Limit ROM due to pain
      • Flexion contracture
      • Refuse to walk (kids)
    • 6. Septic Arthritis: Investigation
      • WBC, ESR raising
      • Hemoculture may be positive
      • X-ray: widening of joint space
      • Ultrasound : joint effusion
      • Arthrocentesis & Joint fluid analysis
      • simple, quick, reliable
    • 7. Joint Fluid Analysis
      • Characteristics & color
        • purulent, may be clear
      • WBC count & differentiation
      • Gram stain & culture & sensitivity
    • 8. Septic arthritis of the hip
      • Treatment
        • Symptomatic treatment
          • Rest
          • Analgesia
          • Hydration/ Nutrition
        • Drainage
          • Aspiration
          • Open drainage
          • Arthroscopy
        • Antibiotic 6-8 weeks
          • IV
          • Oral
    • 9. Osteomyelitis
    • 10. Acute Hematogenous Osteomyelitis
      • Incidence
        • Mostly in children
        • Adults with immunocompromised
      • Causative organism
        • Staph. Aureus in all ages
        • H. Influenzae common in < 4 Y r .
    • 11. Clinical Findings
      • Limb pain
      • Fever, malaise, failure to thrive
      • Metaphyseal tenderness
      • Painful, restricted joint motion
      • Local redness, swelling, warmth,edema
    • 12. Diagnostic Images
      • Plain X-ray
      • Ultrasound
      • Bone scan
      • MRI
    • 13. Investigations
      • CBC : Hb , WBC
      • C-reactive protein
      • ESR : usually remains
      • Hemoculture : 50% positive
      • Bone aspiration
    • 14. Treatment of acute Osteomyelitis
      • G eneral supportive treatment
        • analgesia, IV fluid
      • S plintage of the affected part
      • E ffective antibiotics therapy
        • Older children & properly fit adults
          • IV cloxacillin 1-2 wks + oral form 3-6 wks
        • Children under 4 yo.
          • cloxacillin + ampicillin
          • cephalolsporins (cefuroxime or cefotaxime)
          • co-amoxiclav.
        • Immunocompromised host
          • cloxacillin + gentamicin
          • cephalosporins ( ceftriaxone)
      • S urgical drainage
    • 15. Chronic Osteomyelitis
      • Etiology
        • Sequel to acute hematogenous osteomyelitis
        • following open fracture
        • following operation
      • Causative organisms
        • Staph.aureus, E.coli, S.Pyogens,
        • Pro t eus, and Pseudomonas
        • Staph. Epidermidis
        • : common with implants
    • 16. Pathology
      • Sequestrum
      • Involucrum
      • Clo a c ae
      • Sinus
    • 17. Clinical Features
      • R ecurrence of pain, pyrexia, redness and tenderness
      • D ischarging sinus
      • P athological fracture
      • N on-union
    • 18. COM : X-Ray Finding
    • 19. COM : Investigation
      • WBC ESR
        • non diagnostic
        • helpful for monitoring the progress of infection
      • Culture & sensitivity of causative organism
        • should be test repeatedly
        • often change and become resisted
    • 20. COM : Treatment
      • Antibiotics
        • depends on bact. Study
        • capable to penetrates sclerotic bone
        • non-toxic for long term use
      • Surgery
        • significant symptoms + clear evidence of sequestrum
    • 21. Ankle sprain
      • Lateral ankle sprain
      • Medial ankle sprain
      • Syndesmotic sprain (High ankle sprain)
    • 22. Ankle sprain
      • Correct diagnosis should be made
    • 23.
      • Anterior talofibular ligament (ATFL)
      • Calcaneofibular ligament (CFL)
    • 24. Ankle sprain
      • Grading
        • Grade 1: no swelling, tenderness, microtear of ligament
        • Grade 2: Mild to Mod swelling, tenderness, Patial tear of ligament
        • Grade 3: Severe swelling, marked tenderness, complete tear of ligament
    • 25. General treatment
      • RICE protocol
        • Rest joint
        • Ice – applied for 20 minutes every couple hours
        • Compression – elastic wrap
        • Elevate limb above heart
    • 26. Treatment – lateral ankle sprains
      • Grade 1 sprains
        • Ambulate
        • Bandage
        • Complete ligament healing in 2-3 weeks
    • 27. Treatment – lateral ankle sprains
      • Grade 2 sprains
        • Brace, Support
        • Complete healing within 6-8 weeks
    • 28. Treatment – lateral ankle sprains
      • Grade 3 sprains
        • Casting to control pain and swelling (controversial)
        • Complete healing 8 – 12 weeks
    • 29. Ankle Sprain
      • 3 phase rehabilitation
        • Inflammation: Medication, Short period immobilization
        • Early motion: ROM exercise, Gentle manipulation, modality?)
        • Strengthening exercise
    • 30. Early motion: ROM exercise, Gentle manipulation, modality?)
      • Ankle motion
      • Subtalar motion
      1-3 week
    • 31. Ankle strengthening exercise
      • Muscle power
      • Balance
      • Coordination
    • 32. Muscle power
      • Peroneal
      • Tibialis posterior
      • Tibialis anterior
      • Toe flexor/extensor
      • Intrinsic muscle
    • 33. Balance and Coordination
      • Core exercise
        • Abdomen, Lateral body
        • Back (upper, lower)
        • Groin
        • Chest
      • Body balance
        • Single leg stance
        • Straight line walking
        • Balance board
        • Side walk
    • 34. Ankle sprain surgery
      • Failed conservative treatment (at least 3 months)
        • Pain
        • Instability
      • Ankle arthroscopic debridement
      • Ankle ligament reconstruction (Mod Brostorm repair)
    • 35. Achilles tendon tear
    • 36. Physical Exam
      • Tender in Achilles
      • Loss of profile, Gap
      • Thompson test +
      • Excessive DF
      • Weak PF
    • 37. Achilles tear
      • Casting VS Repair
      • Functional demand
      • Surgery
        • Faster recovery
        • Better strength
        • Lower re rupture rate
        • Risk of surgery
    • 38. Achilles repair
    • 39. Plantar fasciitis
      • Most common plantar heel pain in adult
      • Plantar fascia inflammation/ tear
      • Pain
        • Morning pain or after a period of rest.
        • Improve with activity
        • No rest and no night pain
    • 40. Risk Factors
      • Middle age
      • Obesity, DM, Inflammatory joint disease
      • Athletes
      • Repetitive stress
      • Changes in activity
      • Abnormal foot biomechanics
        • Pes cavus
        • Pes planus-TA tightness
      • Bad shoes
    • 41. Diagnosis
      • Location of pain
        • Origin of plantar fascia from medial tubercle of the calcaneus
        • May be aggravated by passive dorsiflexion of the toes
        • Pain may radiate distally along plantar fascia
      www.your-feet.com
    • 42. DDx
      • Refer pain from spine
      • Nerve entrapment
        • Tarsal tunnel syndrome
      • Stress Fx, Calcaneal epiphysitis (Sever disease)
      • Tumor
      • Infection
      • Inflammatory disorder
      • Fat pad Disorder
      • Plantar fibromatosis
      • Achilles disorders, FHL tendinitis
      Not all heel pain is Plantar Fasciitis
    • 43. Treatment
      • Rest
      • NSAIDs
      • Stretching
      • Physical therapy
      • Shoe inserts
      • Orthotics
      • Night Splints
      • Casting
      • Corticosteroid injections
      • ESWT (Orthotripsy)
      • Surgery
      • Standard care is conservative but 10% still fail to respond
    • 44. Achilles stretching
    • 45. PF Stretching
      • More specific stretching of the plantar fascia employing the windlass mechanism may alleviate the early morning pain better.
      • DiGiovanni, JBJS 85, 1270-7, 2003.
    • 46. Corticosteroid Injections
      • Usually limited to 1-2 injections per heel
      • Temporary relief
      • May predispose to
        • fascial rupture
        • heel pad atrophy
      Do not recommended !!!
    • 47. Surgery
      • Reserved for cases resistant to conservative treatment
      • Subtotal plantar fascial release
      • Preserve at least 50% of lateral fibers
      • May lead to decrease in arch stability
        • Pfeffer GB, ICL, Vol 50, 2001
      cms.depuy.com
    • 48. Trigger finger
      • Stenosing tenosynovitis of A1 pulley
      • Snapping finger
      • Digital tendovaginitis stenosus
      • Chronic stenosing tendovaginitis
    • 49. Trigger finger
      • Pain
      • Tenderness
        • A1 pulley
        • MCP level
      • Swelling
      • Locking
    • 50. de Quervain
      • Tenosynovitis of 1 st extensor compartment
      • Abductor pollicis longus
      • Extensor pollicis brevis
    • 51. de Quervain
      • Pain
      • Tenderness
      • Swelling
      • Finklestein test +
    • 52. Carpal tunnel syndrome (CTS)
      • Median n. compression at wrist level
      • Symptom
        • Pain
        • Numbness
        • Weakness, Thenar muscle atrophy
      • Transverse carpal ligament (flexor retinaculum) : Thickening
    • 53. Carpal tunnel syndrome (CTS)
      • Tinel sign
      • Phalen’s test
      • Check C-spine and proximal nerve
    • 54. Trigger finger, de Quervain, CTS
      • Treatment
        • Rest/ Modify activity
        • Medication
        • Physiotherapy
        • Cortisone injection
        • Decompression (Surgery)
    • 55. Tennis elbow and Golfer elbow
      • Lateral (tennis) and Medial (golfer) epicondylitis of humerus
      • Treatment
        • RICE
        • Activity modification
        • Immobilization
        • Medication
        • Exercise
        • Cortisone injection
        • Surgery
    • 56. Summary
      • Many orthopaedic problems can be treated conservatively
      • Aware of critical/ uncommon condition
        • Infection
        • Malignancy
        • NV damage
      • Selectively refer case based on appropriate knowledge
    • 57. Thank you Any question? www.ortho.chuckpaiwong.com