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3 Most Common Diagnoses at Concentra - Treatment and Management
- 1. 3 MOST COMMON DIAGNOSES TREATMENT AND MANAGEMENT MEREDITH ORNDORFF, SPT UNIVERSITY OF COLORADO
- 2. OUTLINE Knee Injuries • Ligament Sprains • Meniscus Tears Shoulder Injuries • Impingement Syndrome • Rotator Cuff Tears Back Injuries • Treatment Based Classification
- 4. LIGAMENT STRAINS ▪ Grades 1-3 ▪ Grade 1 Strain: Mild Tear ▪ Grade 2 Strain: Moderate Tear ▪ Grade 3 Strain: Full Rupture ▪ Diagnosis ▪ ACL ▪ Anterior Drawer Test ▪ Lachman’s Test ▪ PCL ▪ Posterior Drawer Test ▪ Posterior Sag Sign ▪ MCL ▪ Valgus Test (0 + 30 degrees) ▪ LCL ▪ Varus Test (0+30 degrees) • Intervention • Brace/Immobilize initially to provide stability and allow proper healing • Bracing in extension allows healing and maintains extension ROM • Maintain ROM (flexion + extension) • Closed chain > Open chain • Minimizes translatory stress on ligaments • More functional • Promotes co-contraction • Strengthen hip musculature • Sidelying Hip Abduction • Squat – Single Limb • Deadlift – Single Limb
- 5. MENISCUS INJURIES ▪ 4 Hallmark Clinical Findings ▪ Joint Line Tenderness – good sensitivity ▪ Mild to Moderate Effusion – Delayed! ▪ Positive Entrapment Test – good specificity ▪ McMurray’s ▪ Apley’s ▪ Thessaly’s ▪ Quad shutdown and atrophy first 2 weeks ▪ Conservative Therapy ▪ RICE, Pain control ▪ AROM, AAROM ▪ Weight-shifts ▪ Hip Strengthening • Surgical Options • Menisectomy • Partial or Full debridement of tear • PWB 1-4 Days • Flexibility and ROM Focus • AROM/PROM Stretches • Patellar Mobilization • Return to Function: 4-6 weeks • Meniscus Repair • Repair of tear within vascular zone • Early Stages • NWB 1-3 weeks • ROM limited to 0-90 degrees • PWB 3-6 weeks • Middle Stages • Strengthening 6-8 weeks • OKC > CKC to limit WB stress • Late Stages • 10-12 weeks: Return to activity • Return to Function: 4-6 months
- 6. SHOULDER IMPINGEMENT ▪ 3 Types of Impingement ▪ Primary Impingement ▪ Mechanical, Space limiting condition in suprahumeral region ▪ Secondary Impingement ▪ Abnormal biomechanics ▪ Faulty Movement Patterns or hypermobility ▪ Internal Impingement ▪ Occurs inside the GH joint ▪ Posterior RC gets “pinched” when arm is in 90 degrees abduction/ER secondary to anterior laxity ▪ Common in overhead athletes ▪ Differential Diagnosis ▪ Hawkins Kennedy Test ▪ Painful Arc ▪ Infraspinatus MMT ▪ Neer’s Impingement Sign ▪ Empty Can // Full Can ▪ Treatment Strategies ▪ Manual Therapy ▪ GH Joint ▪ Thoracic Spine Manipulation ▪ Rotator Cuff Strengthening ▪ Scapular Stabilizer Training ▪ Proprioceptive // Neuromuscular Training
- 7. ROTATOR CUFF TEAR ▪ Types of Tears ▪ Interstitial (fraying) ▪ Partial Thickness ▪ Full Thickness ▪ Differential Diagnosis ▪ Drop Arm Test ▪ External Rotation Lag Sign ▪ Internal Rotation Lag Sign ▪ Belly Press Test ▪ Painful Arc ▪ Infraspinatus MMT ▪ Options ▪ Conservative Treatment ▪ Similar to impingement protocol ▪ Decompression without repair ▪ Repair of tear ▪ Treatment Priorities Following Surgery ▪ Primary Goal: PROTECT REPAIR! ▪ Sling for 4-6-8 weeks depending on tear ▪ PROM – Grade 1-2 Mobs for pain relief ▪ AAROM 4-6 weeks ▪ AROM 6-8 weeks ▪ Full ROM achieved within 12 weeks
- 8. LOW BACK PAIN TREATMENT BASED CLASSIFICATION ▪ Classify patient ▪ Level 1: Determine if patient is appropriate for PT ▪ Look for red/yellow flags ▪ Refer if needed ▪ Level 2: Determine stage/level of acuity ▪ Stage 1: ▪ Oswestry > 30 ▪ Unable to sit >30 mins ▪ Unable to stand >15 mins ▪ Unable to walk > ¼ mile ▪ If not in stage 1, treat by impairments Stage 3 Stage 2 Stage 1
- 10. • Neurological Signs • Leg Symptoms • Peripheralization with movement testing • Positive crossed SLR • Positive Prone Instability Test • Aberrant Motions • Hypermobility • Younger Age • Greater SLR ROM • Centralization during exam • Postural Preference • Sitting • Standing/Walking • Symptoms < 16 days • No symptoms below knee • Hypo-mobility • Hip IR > 35 degrees • Low Fear Avoidance Manipulation and Exercise Specific Exercise TractionStabilization
- 11. KEY POINTS TO REMEMBER WHEN TREATING LBP ▪ Primary pain generator can be identified in less than 15% of LBP cases ▪ Pain education is an imperative part of physical therapy treatment despite diagnosis ▪ Studies have shown that type of manipulation may not matter ▪ Following manipulation with exercise maintains mobility gains ▪ Central nervous system response promotes healing ▪ Identifying psychosocial factors that can affect LBP plays a large role in decreasing pain ▪ Addressing faulty movement patterns will prevent future LBP injury
- 12. TAKEAWAY MESSAGE ▪ Worker’s comp is a UNIQUE setting where clinicians have the opportunity to use physical therapy in an ideal manner – EARLY AND OFTEN! ▪ We must use this opportunity to treat patients for their pain and educate them on how to avoid future injuries due to the high physical demand of their livelihoods ▪ Two Key Pieces of Information You Can Provide EACH Patient 1. Pain Science Education ▪ How pain is interpreted by the brain 2. Body Mechanic Training ▪ How to prevent future injury
- 13. ANY QUESTIONS? THANK YOU TO JOSH AND NANCY FOR THEIR SUPPORT AND GUIDANCE IN MY LAST CLINICAL ROTATION