Distal biceps tendon rupture - by Hussain Algawahmed
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Description of the relevant anatomy of distal biceps tendon followed by surgical options of fixation such as endo-button technique, interference screw and trans-osseous fixation with biomechanical comparison studies
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This document summarizes current management of anterior cruciate ligament (ACL) injuries, including anatomy, treatment options, surgical techniques, graft types, and rehabilitation. Key points include: ACL tears are common sports injuries; reconstruction is preferred over conservative treatment to prevent further damage; anatomic single- or double-bundle reconstruction aims to restore the native footprint; fixation and graft choices depend on patient factors; and rehabilitation focuses on regaining strength and function over 6-12 months before returning to sport. Surgical techniques and understanding continue to evolve based on research into knee biomechanics, healing, and failure rates.
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The Stone Clinic is a sports medicine clinic in San Francisco, California, offering orthopaedic surgery and medical care, physical therapy and rehabilitation, and radiology imaging services. The Stone Clinic was founded by Kevin R. Stone, M.D., an orthopaedic surgeon, combining himself with a team of nurses, physical therapists, imaging specialists, and patient coordinators, in 1988 to focus on caring for injured athletes and people experiencing arthritis pain.
The Stone Clinic is founded on the goal of rehabilitating all patients to an operating level higher than before they were injured. The Stone Clinic specializes in sports medicine and injury treatment of knee, shoulder, and ankle joints. Stone has lectured and is recognized internationally as an authority on cartilage and meniscal growth, replacement, and repair. Stone and the Stone Clinic are known for the development of the paste grafting surgical technique in 1991, combined with meniscus replacement, which are biologic joint replacement procedures for the regeneration of the knee joint. Surgical procedures were subjected to rigorous outcomes analysis with the results reported in peer reviewed journals. The surgical techniques have been taught to surgeons in the US and worldwide, through lectures and videos.
Nursing students, medical students, residents, fellows, and other physicians from various institutions around the world, rotate through The Stone Clinic and mentor with Stone. The Stone Clinic hosts the annual Meniscus Transplantation Study Group Meeting as well as the annual Professional Women Athlete's Career Conference.
Restorative Invection Therapy.ppt
Restorative injection therapies like prolotherapy and platelet rich plasma injections have been used for decades to treat chronic musculoskeletal pain. Prolotherapy originated from injections used to treat hernias in the 1st century AD and was developed in the 1950s to stimulate ligament repair. Studies since have shown it reduces pain and improves function in conditions like low back pain, knee pain, and groin injuries in athletes. Newer therapies involving platelet rich plasma and stem cells show promise based on studies demonstrating reduced pain and cartilage regeneration. While these therapies can cost hundreds for a typical treatment series, they provide an alternative to more invasive and costly surgeries that often only temporarily treat symptoms of chronic conditions.
Stemcell Research Paper on avascular necrosis-AVN-by Dr.Pradeep Mahajan
This case report describes the treatment of a 35-year-old male patient with avascular necrosis of the left femoral head using a cell-based therapy. The patient had a 10-year history of left hip pain and was diagnosed with stage II avascular necrosis. He underwent a treatment involving harvesting bone marrow concentrate, stromal vascular fraction from adipose tissue, and platelet-rich plasma, which were injected into the affected area. Follow-up over one year showed improved hip range of motion and pain, and radiological evidence of reduced necrosis and improved joint space. The report concludes the cell-based treatment halted progression of avascular necrosis in this patient.
Femoroacetabular impingement
This document discusses femoroacetabular impingement (FAI), a condition where the femoral head and acetabulum abnormally contact each other, from the perspective of a sports physiotherapist. It describes the two main types of FAI - cam impingement caused by a nonspherical femoral head, and pincer impingement caused by excessive acetabular coverage. Most cases involve a mix of both. Conservative physiotherapy management focuses on reducing inflammation, strengthening muscles, and gentle stretching. Surgical intervention like arthroscopy may be considered if conservative treatment fails to allow athletes to return to play.
Astro bone mets
This document summarizes guidelines for palliative radiotherapy for bone metastases. It finds that single fraction or short fractionated regimens of 8 Gy, 20 Gy in 4 fractions, 24 Gy in 6 fractions or 30 Gy in 10 fractions provide effective pain relief with minimal side effects. Bisphosphonates or surgery do not obviate the need for radiotherapy but may be used in combination. Stereotactic body radiotherapy and radiopharmaceuticals may benefit select patients but require further study.
Malignant spinal cord compression
It is an oncologic emergency. This slides contains a brief discussion on mechanism of spinal cord compression , common malignancies presenting with spinal cord compression , approach to a patient with cord compression like features and management this catastrophic situation.
Prolotherapy
Prolotherapy involves injecting an otherwise non-pharmacological and non-active irritant solution into the body, generally in the region of tendons or ligaments for the purpose of strengthening weakened connective tissue and alleviating musculoskeletal pain.
Neck Pain Treatment
Neck pain is an aching, burning, stabbing, shooting, or cramping pain. PCI is well known Neck Pain Treatment Clinic in Mumbai. Visit http://goo.gl/pqRBvJ & Get Relief from Neck Pain
Subtalar Dislocations
This document discusses subtalar dislocations, including:
- There are four main types - medial, lateral, posterior, and anterior. Medial dislocations are most common.
- Mechanisms of injury vary but often involve high-energy trauma like motor vehicle accidents or falls. Associated injuries are common.
- Treatment involves closed or open reduction depending on the situation, followed by immobilization for 4-6 weeks.
- Prognosis depends on factors like time to reduction and associated injuries. Most patients regain good function but arthritis and stiffness are common long-term.
Posterior lumbar fusion vs Lumbar interbody fusion Evidence based.pptx
Lumbar degenerative disc diseases (LDDD): irreversible process in lumbar disk architecture.
Sparse literature to choose proper technique to address these pathology with or without fusion surgery.
A clear benefit of lumbar fusion surgery: lowered pain and disability scores.
Lumbar surgery rates have increased steadily over time, and hence related complications.
Evidence of the superiority of one technique over the other is sparse.
Surgery offers greater improvement compared with non-operative treatment in LDDD.
Surgery in disc herniation resulted in faster recovery, However no added benefit of fusion surgery.
There was no obvious disadvantage of posterolateral fusion without internal fixation in patient with spondylosis.
Among patients with lumbar spinal stenosis without spondylolisthesis, decompression plus fusion surgery may not result in better clinical outcomes.
In patient with spondylolisthesis with or without stenosis, fusion is more effective than laminectomy in achieving a satisfactory outcome. Decompression only had the least satisfactory outcome.
Patients who underwent interbody fusion may have significantly higher fusion rates compared to posterior lumbar fusion only.
TLIF has advantages over PLIF in the complication rate, blood loss, and operation duration. The clinical outcome is similar, with a slightly lower postoperative ODI score for TLIF.
In the end, The choice of technique is still greatly based on the surgeons’ preference and experience.
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Distal biceps tendon rupture - by Hussain Algawahmed
- 1. Hussain Algawahmed, MBBS, FRCSC
- 2. Demographics Anatomy Etiology Clinical evaluation Radiography Treatment options Studies
- 3. incidence : 1.2 per 100,000 pts dominant extremity in 86% average age 47 years Smokers Males anabolic steroid use
- 5. Origin Insertion (10/17) Lacertus Fibrosus 3 layers
- 8. Theories: 1. Bony prominence 1. Irregularity of the radial tuberosity or bursitis
- 9. Theories: 3. Mechanical impingement 4. The presence of a watershed (low arterial flow) area of the tendon
- 10. Etiology
- 13. U/S MRI Other potential causes of pain in the antecubital fossa include cubital bursitis bicipital tendonitis partial biceps tendon rupture entrapment of the lateral antebrachial cutaneous nerve.
- 14. Descriptive Distal Biceps tendon rupture Acute Partial Complete Chronic Intact Aponeurosis Torn Aponeurosis
- 15. Partial: nonoperative management may be attempted with a focus on stretching and strengthening. Complete: Surgical: anatomical repair to restore supination as well as flexion
- 16. One Incision: High incidence of radial nerve inj. Less chance of HTO Two incision (Boyd and Anderson): Less Radial nerve inj. But more HTO and synostosis.
- 18. tendon-grasping sutures Bunnell or Krackow
- 19. identify and protect the lateral antebrachial cutaneous nerve
- 20. White arrows: standard approach Black arrows: modified muscle splitting Arm in Pronation
- 21. avoid violating the periosteum of the ulna
- 22. Potential mechanism of synostosis formation: The dotted outline of the instrument represents potential contact with bones and thereby creates a path along which synostosis may develop.
- 26. Options: Suture anchors in the radial tuberosity Endobutton (Smith and Nephew, Andover, Massachusetts, Arthrex) Interference screws
- 28. Suture anchor: creating a trough for tendon insertion vs. only lightly abrading the anterior cortex before inserting the suture anchor
- 30. Interference screw Mazzocca and colleagues
- 31. Endobutton By Bain and colleagues create a trough in the radial tuberosity small hole drilled in the posterior cortex of the radius
- 35. Spang JT,Weinhold PS, Karas SG. A biomechanical comparison of EndoButton versus suture anchor repair of distal biceps tendon injuries • 11 matched pairs (22 arms) • 10 mm displacement clinical failure point. •EndoButton: 16% higher load to clinical failure •not statistically significant. •Both provide comparable fixation strength
- 36. Greenberg JA, Fernandez JJ, WangT, et al. Endo- Button-assisted repair of distal biceps tendon ruptures J Shoulder Elbow Surg 2003;12(5):484–90. Clinical: 14 pts functional f/up 20 months: 97% recovery of flexion strength 82% recovery of supination strength 15 fresh frozen Cadavers
- 37. Mazzocca AD, Burton KJ, Romeo AA, et al. Biomechanical evaluation of 4 techniques of distal biceps brachii tendon repair Am J Sports Med 2007; 35(2):252–8.
- 38. Hypothesis: No difference under cyclic loading and ultimate failure between 4 methods Study design: Controlled Lab study Methods: 63 frozen specimens randomly assigned to 4 groups. Cyclic loading performed from 0 – 90 at 0.5 Hz for 3600 cycles with 50 N load. Displacement measured with a transducer. Specimens then pulled to failure at 120 mm/min.
- 41. > 4weeks delay pain and stiffness esp. supination Options: I. Reattachment to Brachialis: non anatomical II. Anatomical re-attachment. III. Interposition graft: FCR Achilis tendon Semitendenosis (+/- endobutton)