Patellar tendinitis, also known as jumper's knee, is an overuse injury caused by repetitive stress on the patellar tendon from activities like jumping, running, and bending the knees. It causes pain below or around the kneecap. Treatment focuses on rest, ice, stretching, strengthening exercises, and anti-inflammatory medications. If conservative treatments are unsuccessful, corticosteroid injections or surgery may be considered to repair tendon damage. Complete recovery can take several months and requires adherence to a physical therapy program to restore mobility and strength.
Patellar tendinopathy, also known as jumper's knee, is a chronic overuse injury caused by repetitive stress on the knee extensor mechanism from activities like jumping, running, and kicking. It results from microtears in the patellar tendon from forces that are 3 times greater than normal during movements like acceleration, deceleration, takeoff, and landing. Symptoms include dull aching knee pain after exercise that worsens with sitting or stairs. Treatment focuses on eccentric strengthening exercises and bracing to promote healing of the tendon.
Golfer elbow, also known as medial epicondylitis, is an overuse injury caused by repetitive motions that place stress on the tendons where the forearm muscles attach to the inner bump of the elbow. The condition causes pain on the inner elbow and difficulty with wrist movement. It commonly affects people over 30 years old who participate in sports like golf or tennis that involve swinging motions, or those with occupations requiring strong gripping. Conservative treatment includes rest, anti-inflammatory medications, physiotherapy, and bracing to decrease stress on the tendons.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It is most common in postmenopausal women and older adults. Key signs include loss of height, back pain from compressed fractures, and fractures of the spine, hips and wrists. Treatment focuses on lifestyle changes like exercise and diet to build bone density, as well as medications when needed to prevent further bone loss and reduce fracture risk. Physiotherapy emphasizes posture, balance training, strength exercises and avoiding flexion to help manage symptoms.
This document provides an overview of leprosy (Hansen's disease), including:
- It is caused by Mycobacterium leprae bacteria and primarily affects the nerves and skin.
- Symptoms include discolored skin lesions and loss of sensation which can lead to injuries.
- It is classified based on severity and can be diagnosed via skin biopsy or smear.
- Treatment involves long-term multi-drug antibiotic regimens.
- Surgical procedures and orthotic devices can help address deformities caused by nerve damage.
The Modified Ashworth Scale is a clinical measure of muscle spasticity in patients with neurological conditions. It is a 6-point scale ranging from 0-4 where lower scores represent normal muscle tone and higher scores represent increased spasticity or resistance to passive movement. The document provides detailed instructions on administering the Modified Ashworth Scale for assessing spasticity in the ankle plantar flexors, knee flexors, elbow flexors, and wrist flexors by standardizing limb positioning, stabilization, and movement during testing.
The document provides information about the history, benefits, safety precautions, and exercises using a Swiss ball (also known as exercise ball or gym ball). It describes how the Swiss ball was developed in Italy in 1963 and began being used for physiotherapy. It lists several benefits of using a Swiss ball for exercise including improved coordination, posture, muscle tone, strength, and reduced injury risk. It outlines safety precautions and provides guidelines for proper Swiss ball size, warm-up routines, and 12 different core-focused exercises that can be performed with a Swiss ball.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
Patellar tendinopathy, also known as jumper's knee, is a chronic overuse injury caused by repetitive stress on the knee extensor mechanism from activities like jumping, running, and kicking. It results from microtears in the patellar tendon from forces that are 3 times greater than normal during movements like acceleration, deceleration, takeoff, and landing. Symptoms include dull aching knee pain after exercise that worsens with sitting or stairs. Treatment focuses on eccentric strengthening exercises and bracing to promote healing of the tendon.
Golfer elbow, also known as medial epicondylitis, is an overuse injury caused by repetitive motions that place stress on the tendons where the forearm muscles attach to the inner bump of the elbow. The condition causes pain on the inner elbow and difficulty with wrist movement. It commonly affects people over 30 years old who participate in sports like golf or tennis that involve swinging motions, or those with occupations requiring strong gripping. Conservative treatment includes rest, anti-inflammatory medications, physiotherapy, and bracing to decrease stress on the tendons.
Osteoporosis is a disease characterized by low bone density and deterioration of bone tissue, leading to fragile bones and increased risk of fractures. It is most common in postmenopausal women and older adults. Key signs include loss of height, back pain from compressed fractures, and fractures of the spine, hips and wrists. Treatment focuses on lifestyle changes like exercise and diet to build bone density, as well as medications when needed to prevent further bone loss and reduce fracture risk. Physiotherapy emphasizes posture, balance training, strength exercises and avoiding flexion to help manage symptoms.
This document provides an overview of leprosy (Hansen's disease), including:
- It is caused by Mycobacterium leprae bacteria and primarily affects the nerves and skin.
- Symptoms include discolored skin lesions and loss of sensation which can lead to injuries.
- It is classified based on severity and can be diagnosed via skin biopsy or smear.
- Treatment involves long-term multi-drug antibiotic regimens.
- Surgical procedures and orthotic devices can help address deformities caused by nerve damage.
The Modified Ashworth Scale is a clinical measure of muscle spasticity in patients with neurological conditions. It is a 6-point scale ranging from 0-4 where lower scores represent normal muscle tone and higher scores represent increased spasticity or resistance to passive movement. The document provides detailed instructions on administering the Modified Ashworth Scale for assessing spasticity in the ankle plantar flexors, knee flexors, elbow flexors, and wrist flexors by standardizing limb positioning, stabilization, and movement during testing.
The document provides information about the history, benefits, safety precautions, and exercises using a Swiss ball (also known as exercise ball or gym ball). It describes how the Swiss ball was developed in Italy in 1963 and began being used for physiotherapy. It lists several benefits of using a Swiss ball for exercise including improved coordination, posture, muscle tone, strength, and reduced injury risk. It outlines safety precautions and provides guidelines for proper Swiss ball size, warm-up routines, and 12 different core-focused exercises that can be performed with a Swiss ball.
Supraspinatus tendinitis is an inflammation of the supraspinatus tendon, which is one of the most commonly affected structures in the rotator cuff. It often results from repeated overhead arm motions or other activities that cause impingement beneath the coracoacromial arch. Symptoms include pain in the shoulder region that is worsened by motions like lifting the arm overhead. Treatment involves rest, exercises to strengthen the rotator cuff muscles, modalities like ultrasound to reduce inflammation, and manual therapy such as transverse friction massage to the tendon.
The below training fitness standards are different from the Applicant Physical Abilities Test (APAT) fitness standards.
This hand-out has been designed to educate the reader on the United States Secret Service Physical Fitness standards and the proper protocols necessary to accomplish those standards. Recruits who will be attending training at the James J. Rowley Training Center (JJRTC) are expected to arrive in good physical condition, ready to begin a functional fitness program.
The fitness evaluation measures strength, endurance, and aerobic capacity in four core elements. The core elements are Push-ups, Sit-ups, Chin-ups, and the 1.5 mile run. The fitness evaluation will be administered at the beginning, during, and end of training. Secret Service weapon carrying employees are additionally required to participate in the USSS Physical Fitness Evaluation quarterly.
The following point system will be applied to the fitness category level achieved by the student in accordance with their age and gender. The point system will be applied to the four (4) core elements of the U.S. Secret Service Individual Fitness Profile Evaluation.
Physiotherapy Rehab After Total Hip ReplacementMozammal Rabby
This document outlines the phases of rehabilitation following a total hip replacement surgery. It discusses examination of the patient, education provided, and four phases of rehabilitation: immobilization, maximum protection, moderate protection, and minimum protection. Each phase focuses on specific goals like regaining range of motion, strengthening muscles, improving gait, and resuming normal activities. Precautions are provided to prevent dislocation and protect the new hip joint at each stage of recovery.
Bone tumours can be benign or malignant. Benign tumours include osteoid osteoma, osteoma, and haemangioma which typically have well-defined borders and do not metastasize. Malignant tumours such as multiple myeloma, Ewing sarcoma and osteosarcoma are poorly defined, invasive and can metastasize. Treatment depends on the type and severity of the tumour and may include surgery, chemotherapy, radiation therapy or palliative care. Physiotherapy can aid in pain relief, improving function and mobility, and maintaining quality of life for patients with bone tumours.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
The posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. The PCL prevents the femur from sliding off the anterior edge of the tibia and prevents hyperextension of the knee. Injuries to the PCL typically occur from direct blows to the flexed knee, falling on the knee, or hyperextension injuries. Treatment involves rest, bracing, and physical therapy, with surgery required for complete tears.
Shin splints are caused by fatigue and trauma to the muscles and tendons in the lower leg and ankle area from the excessive force exerted during activities like running and dancing. Athletes, runners, dancers, and aggressive walkers are most at risk. To avoid shin splints, one should use good quality shoes, gradually increase exercise intensity, rest when needed, and watch for proper form and terrain. Treatments include resting, icing, anti-inflammatory drugs, arch supports, exercises and compression sleeves.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
This document provides information on various types of hand orthosis including their objectives, indications, and principles. It describes static and dynamic orthosis used to immobilize, support, correct deformities, and facilitate motion of the wrist, fingers, and thumb. Examples include cock-up splints, gauntlet immobilization splints, and dynamic wrist extension splints. Biomechanical principles like three point pressure and stress distribution are discussed. Contraindications and importance of physical therapy evaluation and training are also summarized.
Physiotherapy for Rickets and OsteomalaciaSreeraj S R
Rickets and osteomalacia are metabolic bone diseases caused by a deficiency of vitamin D or calcium. Rickets occurs in children and is characterized by the failure of mineralization of the osteoid matrix in bones. The most common cause is vitamin D deficiency. Osteomalacia occurs in adults and results from impaired mineralization of bone. Symptoms include bone pain and muscle weakness. Physical therapy can help treat related impairments through exercises and manual techniques while ensuring medical management addresses the underlying deficiency.
Lumbarization and sacralization are spinal anomalies where the typical number of vertebrae in the lumbar or sacral spine is altered. Lumbarization occurs when the first sacral segment is not fully fused, appearing as a sixth lumbar vertebra. Sacralization is when the fifth lumbar vertebra is fused to the sacrum, appearing as one fewer lumbar vertebra. These conditions can cause lower back pain and biomechanical strain. Treatment may include medications, injections, physiotherapy including stretching, strengthening, and stabilization exercises, and in some cases surgery.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Functional re-education aims to retrain patients' movements and activities that they already know but cannot properly perform due to illness or injury. The goal is to increase independence through a tailored program of progressive exercises. Exercises may include rolling, sitting, kneeling, standing, and walking activities. Principles include thorough assessment, task-specific treatment, and avoiding discouragement to build confidence and independence over time.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
This document discusses shoulder impingement syndrome, including its anatomy, causes, symptoms, diagnosis, stages, and treatment approaches. It provides details on the rotator cuff muscles, signs and symptoms of impingement, external and internal factors that can lead to impingement, stages of the syndrome, common tests used for diagnosis, goals of treatment, and manual therapy, therapeutic exercise, and preventative measures used in treatment.
This document outlines physiotherapy management for patients with AIDS. The goals of treatment are to relieve pain, increase strength and endurance, and improve cardiovascular, pulmonary, and immune function. Interventions may include exercises, manual therapy, balance training, PNF, and desensitization techniques. Precautions like protective barriers and hand washing are important. A 12-week program combines aerobic exercise, resistance training, and manual therapy sessions 2-3 times per week.
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
The document discusses congenital club foot (CCF), also known as congenital talipes equinovarus (CTEV). CCF is a deformity occurring in the ankle, subtaloid, and mid-tarsal joints. There are several theories for its causes, and its severity depends on the degree of displacement, while resistance to treatment depends on soft tissue rigidity. The deformity can be categorized into four components: cavus, adductus, varus, and equinus (CAVE). Treatment aims to fully correct the deformity early on through non-operative methods like serial casting or the Ponseti method, which involves weekly manipulation and casting. Education of parents on care and follow-up is
The elbow complex is designed to provide mobility and stability for the hand. It consists of three joints - the humeroulnar joint between the humerus and ulna, the humeroradial joint between the humerus and radius, and the superior and inferior radioulnar joints. These joints allow for flexion-extension, pronation, and supination movements. The elbow is stabilized by ligaments and muscles like the biceps brachi, triceps, and pronators. Common problems affecting the elbow include tennis elbow, golfer's elbow, nursemaid's elbow, and cubital tunnel syndrome.
Upper Limb Orthotics - Dr Sanjay Wadhwamrinal joshi
This document summarizes a presentation on upper limb orthotics. It begins by defining orthotics as externally applied devices that modify the neuro-musculoskeletal system. It then discusses objectives of orthotics like support and correction. Various upper limb conditions that may require orthotics are listed, along with types of orthotics. Design features, examples of specific orthotics, and evidence-based research on orthotics effectiveness are also summarized. The presentation aims to provide an overview of upper limb orthotics for rehabilitation purposes.
Turf toe is an injury to the big toe caused by sudden forced extension of the toe upwards beyond its normal range of motion. This can occur during sports on hard artificial surfaces when an athlete's foot is forcibly stopped by their shoe gripping the ground. It damages the ligaments and joint capsule of the big toe, causing pain, swelling, and reduced motion. Treatment focuses on RICE and may include immobilization, physical therapy, or surgery for severe cases. Prevention involves wearing shoes with better support and limiting time on hard artificial surfaces.
A 13-year-old footballer has pain in both knees, with a hard, bony protuberance felt at the tibial tuberosity. This is likely Osgood-Schlatter disease, a common inflammation of the patellar ligament attachment on the tibial tuberosity in children aged 10-15. It is caused by repetitive quadriceps contraction through the patellar tendon. Diagnosis is typically clinical without imaging. Treatment focuses on conservative measures like rest, ice, compression, and elevation, along with analgesics to relieve pain and inflammation.
Physiotherapy Rehab After Total Hip ReplacementMozammal Rabby
This document outlines the phases of rehabilitation following a total hip replacement surgery. It discusses examination of the patient, education provided, and four phases of rehabilitation: immobilization, maximum protection, moderate protection, and minimum protection. Each phase focuses on specific goals like regaining range of motion, strengthening muscles, improving gait, and resuming normal activities. Precautions are provided to prevent dislocation and protect the new hip joint at each stage of recovery.
Bone tumours can be benign or malignant. Benign tumours include osteoid osteoma, osteoma, and haemangioma which typically have well-defined borders and do not metastasize. Malignant tumours such as multiple myeloma, Ewing sarcoma and osteosarcoma are poorly defined, invasive and can metastasize. Treatment depends on the type and severity of the tumour and may include surgery, chemotherapy, radiation therapy or palliative care. Physiotherapy can aid in pain relief, improving function and mobility, and maintaining quality of life for patients with bone tumours.
Upper crossed syndrome is a postural condition caused by prolonged forward head positioning from activities like computer use, driving, and phone use. It involves tightness in the upper trapezius and levator scapula muscles crossing with tightness in the pectoralis muscles, and weakness in the deep cervical flexors crossing with weakness in the middle and lower trapezius. Exercises like foam rolling, rows, and chin tucks can help correct muscle imbalances, as can improving posture awareness and taking breaks from aggravating activities.
The posterior cruciate ligament (PCL) is one of the four major ligaments of the knee. It connects the posterior intercondylar area of the tibia to the medial condyle of the femur. The PCL prevents the femur from sliding off the anterior edge of the tibia and prevents hyperextension of the knee. Injuries to the PCL typically occur from direct blows to the flexed knee, falling on the knee, or hyperextension injuries. Treatment involves rest, bracing, and physical therapy, with surgery required for complete tears.
Shin splints are caused by fatigue and trauma to the muscles and tendons in the lower leg and ankle area from the excessive force exerted during activities like running and dancing. Athletes, runners, dancers, and aggressive walkers are most at risk. To avoid shin splints, one should use good quality shoes, gradually increase exercise intensity, rest when needed, and watch for proper form and terrain. Treatments include resting, icing, anti-inflammatory drugs, arch supports, exercises and compression sleeves.
This document discusses limb length discrepancy (LLD), including its definition, causes, effects, evaluation, and management. LLD is when one lower limb is noticeably longer than the other. It is classified as structural or functional. LLD of 2.5 cm or more can cause back/hip/knee pain and gait abnormalities. Evaluation involves history, exam including block testing, and imaging like scansograms. LLD can be managed non-surgically with shoe lifts for small discrepancies or surgically with epiphysiodesis or bone lengthening depending on the severity.
This document provides information on various types of hand orthosis including their objectives, indications, and principles. It describes static and dynamic orthosis used to immobilize, support, correct deformities, and facilitate motion of the wrist, fingers, and thumb. Examples include cock-up splints, gauntlet immobilization splints, and dynamic wrist extension splints. Biomechanical principles like three point pressure and stress distribution are discussed. Contraindications and importance of physical therapy evaluation and training are also summarized.
Physiotherapy for Rickets and OsteomalaciaSreeraj S R
Rickets and osteomalacia are metabolic bone diseases caused by a deficiency of vitamin D or calcium. Rickets occurs in children and is characterized by the failure of mineralization of the osteoid matrix in bones. The most common cause is vitamin D deficiency. Osteomalacia occurs in adults and results from impaired mineralization of bone. Symptoms include bone pain and muscle weakness. Physical therapy can help treat related impairments through exercises and manual techniques while ensuring medical management addresses the underlying deficiency.
Lumbarization and sacralization are spinal anomalies where the typical number of vertebrae in the lumbar or sacral spine is altered. Lumbarization occurs when the first sacral segment is not fully fused, appearing as a sixth lumbar vertebra. Sacralization is when the fifth lumbar vertebra is fused to the sacrum, appearing as one fewer lumbar vertebra. These conditions can cause lower back pain and biomechanical strain. Treatment may include medications, injections, physiotherapy including stretching, strengthening, and stabilization exercises, and in some cases surgery.
Bicipital tendonitis is inflammation of long head of the biceps tendon under the bicipital groove.
In early stage, tendon becomes red and swollen, as tendonitis develops the tendon sheath can thicken.
In late stage, often become dark red in color due to inflammation.
Functional re-education aims to retrain patients' movements and activities that they already know but cannot properly perform due to illness or injury. The goal is to increase independence through a tailored program of progressive exercises. Exercises may include rolling, sitting, kneeling, standing, and walking activities. Principles include thorough assessment, task-specific treatment, and avoiding discouragement to build confidence and independence over time.
This document discusses principles of tendon transfers for restoring lost movement. It outlines key principles such as having supple joints before transfer, using a donor tendon with adequate excursion and strength, adhering to principles of synergy and straight line of pull. The timing of transfers depends on the likelihood of nerve recovery but can be done early to aid recovery. Contraindications include a lack of suitable donor muscles or transfers for joints with stiffness. Classification systems like Sunderland and Seddon are used to describe nerve injuries requiring tendon transfers.
This document discusses Guillain-Barré syndrome (GBS), including its definition, clinical features, assessment scales, and phases. It defines GBS as an acute/subacute symmetrical motor neuropathy involving more than one peripheral nerve. The phases of GBS are described as the acute, plateau, and recovery phases. For each phase, goals of physical therapy and examples of interventions are provided, such as chest physiotherapy, positioning, stretching, and strengthening exercises to address weaknesses and functional limitations during the different stages of GBS.
This document discusses shoulder impingement syndrome, including its anatomy, causes, symptoms, diagnosis, stages, and treatment approaches. It provides details on the rotator cuff muscles, signs and symptoms of impingement, external and internal factors that can lead to impingement, stages of the syndrome, common tests used for diagnosis, goals of treatment, and manual therapy, therapeutic exercise, and preventative measures used in treatment.
This document outlines physiotherapy management for patients with AIDS. The goals of treatment are to relieve pain, increase strength and endurance, and improve cardiovascular, pulmonary, and immune function. Interventions may include exercises, manual therapy, balance training, PNF, and desensitization techniques. Precautions like protective barriers and hand washing are important. A 12-week program combines aerobic exercise, resistance training, and manual therapy sessions 2-3 times per week.
Physiotherapy for CONGENITAL TALIPES EQUINOVARUS Sreeraj S R
The document discusses congenital club foot (CCF), also known as congenital talipes equinovarus (CTEV). CCF is a deformity occurring in the ankle, subtaloid, and mid-tarsal joints. There are several theories for its causes, and its severity depends on the degree of displacement, while resistance to treatment depends on soft tissue rigidity. The deformity can be categorized into four components: cavus, adductus, varus, and equinus (CAVE). Treatment aims to fully correct the deformity early on through non-operative methods like serial casting or the Ponseti method, which involves weekly manipulation and casting. Education of parents on care and follow-up is
The elbow complex is designed to provide mobility and stability for the hand. It consists of three joints - the humeroulnar joint between the humerus and ulna, the humeroradial joint between the humerus and radius, and the superior and inferior radioulnar joints. These joints allow for flexion-extension, pronation, and supination movements. The elbow is stabilized by ligaments and muscles like the biceps brachi, triceps, and pronators. Common problems affecting the elbow include tennis elbow, golfer's elbow, nursemaid's elbow, and cubital tunnel syndrome.
Upper Limb Orthotics - Dr Sanjay Wadhwamrinal joshi
This document summarizes a presentation on upper limb orthotics. It begins by defining orthotics as externally applied devices that modify the neuro-musculoskeletal system. It then discusses objectives of orthotics like support and correction. Various upper limb conditions that may require orthotics are listed, along with types of orthotics. Design features, examples of specific orthotics, and evidence-based research on orthotics effectiveness are also summarized. The presentation aims to provide an overview of upper limb orthotics for rehabilitation purposes.
Turf toe is an injury to the big toe caused by sudden forced extension of the toe upwards beyond its normal range of motion. This can occur during sports on hard artificial surfaces when an athlete's foot is forcibly stopped by their shoe gripping the ground. It damages the ligaments and joint capsule of the big toe, causing pain, swelling, and reduced motion. Treatment focuses on RICE and may include immobilization, physical therapy, or surgery for severe cases. Prevention involves wearing shoes with better support and limiting time on hard artificial surfaces.
A 13-year-old footballer has pain in both knees, with a hard, bony protuberance felt at the tibial tuberosity. This is likely Osgood-Schlatter disease, a common inflammation of the patellar ligament attachment on the tibial tuberosity in children aged 10-15. It is caused by repetitive quadriceps contraction through the patellar tendon. Diagnosis is typically clinical without imaging. Treatment focuses on conservative measures like rest, ice, compression, and elevation, along with analgesics to relieve pain and inflammation.
A 32-year-old male cross country runner presented with severe left knee pain after tripping over a log during a run and landing on his flexed knee. He was unable to bear weight on his left leg since the incident and experienced significant pain. On examination, his left knee was tender to palpation with swelling over the anterior knee and a 5 cm mass above the distal femur. He had difficulty flexing his knee and could not fully extend it. An urgent orthopedic consultation was recommended for surgical repair within 7-10 days to treat a suspected patellar tendon rupture with an avulsion fracture.
This document provides an overview of patellofemoral pain syndrome. It defines the syndrome and discusses relevant anatomy, biomechanics, causes, clinical evaluation, imaging, and treatment options. Regarding treatment, non-operative options including rehabilitation are usually successful for 90% of cases. Surgical techniques are reserved for the remaining 10% and include arthroscopic procedures such as debridement and lateral release as well as bony procedures like tibial tubercle transfer to address malalignment issues.
Osgood-Schlatter disease is an irritation of the patellar ligament at the tibial tuberosity that commonly occurs in adolescent athletes during periods of rapid growth. It is caused by small repetitive injuries to the tibial tuberosity before skeletal maturity. Symptoms include a painful swelling and bump over the shin. Conservative treatment includes rest, bracing, anti-inflammatories, and physiotherapy. The condition typically resolves on its own once skeletal maturity is reached.
This document discusses a case of a 13-year-old footballer presenting with pain in both knees. Upon examination, a hard bony protrusion was felt at the tibial tuberosity in both legs. The tibial tuberosity provides attachment for the patellar ligament and is a common site for Osgood-Schlatter disease. This condition occurs in young athletes and involves inflammation of the tibial tuberosity. The diagnosis can be made clinically and confirmed with x-rays. Treatment is typically conservative with RICE therapy, medications, and physical therapy. The patient's symptoms are consistent with Osgood-Schlatter disease and conservative care is indicated.
This document discusses acid-base disorders and their physiology, regulation, and treatment. It begins by introducing acid-base balance and pH in the body. It then covers the chemical buffer systems that help regulate pH, as well as the roles of respiration and the kidneys. It discusses different types of acid-base disorders like metabolic acidosis and alkalosis, respiratory acidosis and alkalosis, and mixed disorders. Interpretation of blood gas analysis and various approaches for analyzing acid-base status are also outlined. Throughout, compensation mechanisms and typical treatment approaches for each disorder are described.
A 30-year old female presented to the emergency room with a laceration and bleeding in her right hand after falling on glass. She was right hand dominant and worked in telemarketing. Physical examination would focus on the extent of the laceration and potential injury to flexor tendons and nerves. Flexor tendon injuries can lead to loss of finger flexion and grip strength if not repaired properly. The goals of reconstruction are to anatomically repair the tendons with limited motion restrictions and adhere to post-operative rehabilitation to regain function and prevent complications like adhesions.
This document discusses radial nerve palsy and tendon transfers to restore function after radial nerve injury. It begins by describing the anatomy and functions of the radial nerve. Radial nerve palsy results in loss of wrist, finger, and thumb extension. Tendon transfers can restore this function, such as using the palmaris longus tendon to restore thumb extension via transfer to the extensor pollicis longus. Post-operative rehabilitation focuses on protecting the tendon transfers during early mobilization and strengthening exercises.
This document discusses principles of tendon transfers. Tendon transfers involve reattaching a functioning tendon to replace a paralyzed or injured tendon. Key points include indications such as nerve injuries or ruptured tendons. Donor tendons should match the amplitude, power, and function needed. Proper tensioning and protection are important surgically and post-operatively in rehabilitation to train the tendon and patient. Overall, tendon transfers aim to restore function through redistributing muscle forces.
This document discusses tendon transfers, which involve detaching the tendon of a functioning muscle and reattaching it to replace the function of a paralyzed muscle. The key points are:
1. Tendon transfers work to correct issues like instability, imbalance, lack of coordination, and restore function.
2. They are indicated for paralyzed muscles due to nerve injury, neurological disease, or nerve repair with early transfer. They are also used for injured tendons or muscles.
3. General principles include only restoring functional hand motion, considering patient factors, ensuring the recipient site is suitable, matching the donor muscle properties to the function being replaced, and properly tensioning and positioning the transfer.
The document discusses the anatomy, functions, and fractures of the patella bone. It describes the patella's location in front of the knee joint and role in improving knee extension. Common types of patellar fractures include open and closed fractures caused by direct impacts or twisting forces. Treatment involves immobilization, physical therapy to regain motion, and sometimes surgery like internal fixation using screws, plates or wires if the fracture is unstable. Post-operative rehabilitation focuses on early range of motion and weight bearing exercises while avoiding resisted extension for 6-12 weeks to allow healing.
Patella fractures and extensor mechanism injuries Hamid Hejrati
The document summarizes patella fractures and extensor mechanism injuries. It begins by discussing the history of surgical treatment and advances in fixation techniques. It then covers mechanisms of injury, physical exam findings, imaging studies, fracture classification, and treatment approaches. Fractures are classified as displaced or nondisplaced, and treatment depends on factors like fragment separation, articular displacement, and integrity of the extensor mechanism. Nondisplaced fractures are typically treated nonoperatively while displaced fractures often require open reduction and internal fixation techniques like tension band wiring.
Peripheral nerve injuries can be classified in several ways, including the Seddon and Sunderland systems. The Seddon system categorizes injuries as neurapraxia (transient block), axonotmesis (lesion in continuity), or neurotmesis (complete division). Sunderland further subclassifies injuries based on the anatomical structures involved. The document discusses various mechanisms of nerve injuries, principles of nerve surgery including neurolysis, repair, grafting and transfers. It also covers prognostic factors and options for reconstructing nerve defects like grafts and conduits.
This comprehensive lecture by Dr. Anthony Perez discusses the epidemiology, presentation, management and preventive strategies against surgical site infections
This document discusses peripheral nerve injuries, including:
1. It describes the different types and causes of peripheral nerve injuries, including trauma, disease, ischemia, and radiation.
2. It outlines the primary and secondary injury mechanisms and classifies nerve injuries using the Seddon and Sunderland classifications based on the anatomical disruption.
3. It explains the neuronal degeneration and regeneration process after a nerve injury.
Fluid and electrolyte management is important for perioperative care. Key points include:
1. Body water is divided into intracellular fluid and extracellular fluid. Common IV fluids contain different electrolyte concentrations and osmolarities.
2. Crystalloids expand plasma volume but leave the intravascular space quickly, while colloids remain intravascular longer but do not correct electrolyte deficiencies.
3. Perioperative fluid management aims to replace pre-existing deficits, normal maintenance needs, and abnormal surgical losses like blood loss, third spacing, and insensible losses. Close monitoring of fluid status is important.
This document discusses fluids and electrolytes, covering several key points in 3 sentences or less:
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1. Jumpers Knee
(Patella Tendinitis)
Every athlete has experienced pain in the knees at some point. The stress of
repetitive motion in running or cycling, sprinting up and down a basketball court,
football field or back and forth on a tennis court puts a lot of wear and tear on one
of the bodies biggest joints. A little soreness from time to time is normal, but
sever pain could mean the onset of jumper’s knee or patella tendinitis.
Patella What…?
The patellar tendon connects the kneecap (patella) to the shinbone (tibia). Its
very important job is to help your muscles extend your knee to say, kick a ball,
run hill intervals or jump in the air for a rebound.
Patellar tendinitis (or PT for short in case) commonly afflicts athletes who play
sports that involve frequent jumping like basketball or volleyball, hence the name
jumper’s knee. It is not limited to those types of athletes, however.
What A Pain In The Knee
If you are an athlete or very active, pain in your knees is not something you are
unfamiliar with. It possible you won’t even realize you have a problem until you
start engaging in physical activity. After an intense workout you might feel some
discomfort in the knee and not realize this is a common first symptom of PT.
Often times the pain from PT will subside after a few minutes of physical activity,
like during your warm up, so it’s not unusual for athletes to dismiss the pain and
continue doing the very thing that is causing it.
So the pain goes away a few minutes after you start your workout and if it returns
later, you will most likely write it off to being hardcore. This kind of neglect is the
worse thing you can do because you are only exacerbating the problem. If you
don’t take action, though, the pain can increase.
Besides pain, other early symptoms of jumper’s knee are swelling beneath the
kneecap and an unstable feeling in the joint. Left untreated, eventually patella
tendinitis will start to interfere with your daily activities and make climbing the
stairs or getting out of your Lazy Boy difficult.
It’s time to call your doctor and treat the symptoms of PT right away if you want
to avoid worse, more permanent damage to the tendon, surgery.
A Stress Mess
Your doctor will tell you that patella tendinitis is an overuse injury. The stress
inflicted on the patellar tendon from repetitive jumping, running, or bending your
2. knees in pursuit of personal glory causes tiny tears to develop in the tendon.
There are other risks factors that can lead to PT. If you have tight leg muscles,
which reduces flexibility in your quadriceps (quads) or hamstrings (hammies) you
increase the stress on the patellar tendon.
An injury unrelated to your knee could cause a muscle imbalance to occur. Say a
stress fracture in your ankle or hip pain, which alters your run gait or the way you
move in anyway. You can also become muscularly unbalanced if you are always
engaging activities that keep your muscles in one plane of motion like cycling or
running. The quads and calves may become overdeveloped leaving you with
weaker hammies or hip abductors. The resulting uneven pull on your tendons
can cause tendinitis.
When the imbalance starts to wear on the patellar tendon and those tiny tears
start to multiply inflammation and pain are the result.
Athletes and other really active types are usually their own worst enemy because
they are conditioned to “push through the pain.” However, being “hardcore” and
ignoring the painful warning signs your body screams at you can make the tears
in your tendon larger and larger until it can no longer perform its job and
suddenly your sleeping on the couch because your bedroom is on the second
floor.
Other symptoms of PT are pain before, during and after your workouts. Swelling,
the knee joint locking up, and instability. If taking a few days off from your more
strenuous workouts and RICE (rest, ice, compression and elevation) doesn’t
relieve the symptoms, then you have a problem.
Patellar tendinitis is just one stop away from the more sever pain train called
patellar tendinopathy, which is degeneration of the tendon, so get yourself to a
doctor right away.
Be A Boy/Girl Scout
You’ve heard the motto, “always be prepared, right? That is a good one to heed
before you see your doctor for debilitating knee pain.
Before you head to your appointment you can find some relief from your
symptoms with rest (duh) and ice. This will not fix the problem, if you just return
to the sports and activities that caused the problem too soon.
Your family doctor might do an exam and then refer you to a sports medicine
specialist and this is really the best way to go. These doctors have advanced
training in diagnosing and treating musculoskeletal problems.
Tell your doctor in great detail all the symptoms you are having, when the pain
3. first started, not just when you couldn’t make it up the stairs anymore. Have a list
of all your past sports injuries and medical conditions you have been diagnosed
with and all the medications, including supplements you are taking when you go
to your appointment.
Be sure to note any injuries you may have sustained to other parts of the body,
and not necessarily while doing something sporty. If you twisted your ankle trying
to avoid stepping on the cat or wrenched your back loading your daughter’s Girl
Scout Cookies into the back of the mini-van don’t keep it to yourself. These
seemingly unrelated injuries, might be related, after all, so don’t disregard them.
Examination Station
So what should you expect during your examination? Since pain from PT is
usually concentrated on the front of your knee, a little bit below your kneecap, the
doctor will probably start there. He/she will apply pressure to different areas of
the knee to determine your pain center and level and see if it is anywhere else
around the knee.
The next step is probably some imaging tests. An X-ray, will not show a patellar
tendon problem, but could reveal bone issues that might be contributing to it. An
ultrasound will use waves to create an image of your knee so that your physician
can see exactly if and where you have tears in your tendon. An MRI is rolling out
the big guns, but it will give you the most complete, detailed image of your knee
and tendon, revealing even the tiniest tears.
Jumpers knee has four categories or grades:
1. Grade one: The pain is only present after training or a workout. This is
when you stop engaging in strenuous physical activity, elevate the leg,
apply ice, and take it easy for a couple of days.
2. Grade two: Pain is experienced before and after strenuous activity but it
goes away after a warm up. Do all of the above, but more frequently.
3. Grade three: The pain is always present and starts to inhibit your
performance. At this point it is probably a good idea to seek medical
treatment.
4. Grade four: The pain is present all the time and inhibits normal everyday
activities (stairs, standing after prolonged sitting) You are in trouble and on
your way to permanent damage that rest, pain relievers and ice can’t fix.
Good News and Bad News
4. The bad news is, you have patellar tendinitis. The good news is you only have
patellar tendinitis, not the more sever tendonopathy. The even better news is;
there are a lot of non-surgical, minimally invasive treatments that you can try that
will probably clear up the problem.
First, you can take a pain reliever and anti-inflammatory like ibuprofen (brand
names are Advil or Motrin). For longer-term relief try naproxen (Aleve).
Next, you need to do a variety of physical therapies to get rid of PT symptoms
and strengthen the knee since it and the tendon have weakened when
surrounding muscles attempted to compensate for your injury.
Therap-knee
Stretching is key. You should already be stretching after intense workouts, but if
you haven’t now is the time to adopt a very good habit of doing so. Regular,
steady stretches will reduce muscle spasms, cramps, and lengthen leg muscles
that can become knotted and tight from constantly contracting during prolonged
strenuous physical activity.
Some standing stretches you can try are:
• Hamstring stretch – Place your foot on something flat, stable and only
hip high. Fully extend your knee and then bend slowly forward until you
feel a stretch in the back of your thigh and knee. Hold it for at least 20
seconds.
• Quadricep Stretch – Hold on to something sturdy and stable for balance.
Then lean backwards slightly while bringing your foot up towards your
gluteus maximus (buttocks). Pull your foot as close to your glute as
possible keeping your knees together so that you feel the stretch in the
front of your thigh
• Calf Stretch – A foot or two away from a wall, lean into it placing your
hands or forearms against while keeping first one foot and then the other
flat so that you feel a stretch down the back of your calf
• IT Band (iliotibial band) – Since this band runs down the side of your leg
and is in direct contact with your knee it is important to stretch it. You can
use a foam roller to apply pressure and stretch it or do a standing stretch.
Cross your right foot over your left and shift you weight to the left foot Next
rock you hips gently back and forth until you feel a stretch down the side
of your leg. Switch legs.
There is a right way and a wrong way to stretch. Do not bounce during your
5. stretches. Ease into them and hold them for several seconds at just the point
where you feel tension and maybe slight discomfort. Before you begin the
stretches warm up your muscles with five minutes of light cardio such as a spin
bike or just marching in place.
Ice and compression can be especially beneficial in reducing inflammation and
pain. Putting an ice pack on the knee on a regular basis will reduce swelling and
increase the knee’s mobility. You can also try some kind of knee support like a
jumpers knee support strap (infrapatellar strap) that encircles the leg just below
the kneecap. This changes the angle of the tendon against the kneecap, thus
changing the distribution of the force away from the tendon, and directs it through
the strap instead.
Eccentricities
Strengthening exercises are the next step in rehabilitating your knee. Muscular
imbalances may leave crucial leg muscles weak which will increase strain on the
patellar tendon. Eccentric stretches are muscle-tendon contractions such as
lowering your leg slowly while you extend your knee.
You can typically lower more weight than lift it, which is part of the concept
behind eccentric exercises. For example, it is easier to lower the dumbbells in a
squat. It is crucial to perform the exercises with proper form and under the
guidance of a trainer if you are not well versed in doing those kinds of exercises.
Good old fashion lunges, with lighter weights to start, that you can gradually add
to, also help rehabilitate your knee without putting added stress on the tendon.
Be sure to use good form and perform the movements slowly at first.
Some other really good strengthening exercises for PT are wall squats, and step
ups.
More Good News
For an athlete, being forced into a prolonged period of inactivity can feel like
torture. The good news is with PT you don’t necessarily have to cease and desist
from all training.
It is a good idea to stop doing whatever it was you were doing at the onset of the
knee pain and take a couple of days off. Use that time to apply frequent ice
packs to the injured area, wear a compression sleeve if you have it and do lots
and lots of stretching.
To keep up your cardiovascular fitness you can go swimming. This will work your
upper body and core, challenge your heart and lungs but not put any additional
stress on your injured knee. Only do free style flutter kicks, not breaststroke
6. swimming, though, because of the way it distends your knee.
You can also ride a stationary recumbent or upright bike, just be sure to position
the seat a little higher or farther back and keep the tension very light. You also
ride your regular bike outside, but may need to move your saddle higher and
always stay in an easy gear.
Of course if you feel any pain in your knee, stop exercising and take some more
downtime.
What The Doctor Orders
If your symptoms persist or get worse despite rest, ice, stretching and
strengthening exercises, your doctor can help. He/she will probably start with the
least invasion procedures that will have minimal side effects.
One option for reducing inflammation and relieving PT pain is Inotophersis. A
corticosteroid is spread on the skin of your knee, especially just beneath it. Then
a device with a very low electrical charge is used to push the medication past the
skin into the inflamed tissue below.
A corticosteroid injection is using a syringe to administer a cortisone medication
to reduce inflammation directly into the affected area. This can rapidly reduce
joint pain and restore full function to your knee almost immediately. There is a
very low risk of allergic reaction, so discuss that with your doctor first, but
generally this treatment is quick, and has relatively few side effects. However
some patients report that the injections are painful. The injections can only be
repeated every three months because there is an increased risk of joint damage
if you do more than that.
Platelet-rich plasma injections have also been used to treat the symptoms of
persistent patellar tendinitis. The plasma is injected into people with PT in hopes
that it will promote new tissue formation and heal the damage tendon. RPR, as
it’s known, is a relatively new procedure but is showing great promise in using
cutting edge technology, and the body’s own natural ability to heal itself.
Last Resort
If the damage to the tendon is so bad that nothing has worked to relieve the pain
and returned your knee and you back to normal activities then it’s time to
consider surgery. It really is a last resort and is rarely need to treat anything but
the worst cases of patellar tendinitis which by the time surgery is being
considered it has become tendinopathy.
7. Those who can benefit from surgery have damaged or torn the tendon to the
point that has started to degenerate. Thanks to technology, surgery can be
minimally invasive and still get great results.
During surgery the doctor will attempt to repair the worst of the tears in the
tendon. If the tendon has ruptured and needs to be reattached this is done by
passing the tendon through holes drilled in the kneecap. Sometimes graft tissue
is necessary to ensure the tendon is the right length.
There is a new surgical procedure that is less invasive. Using ultrasound, doctors
can perform what is called longitudinal tenotomies (cutting the tendon), which will
stimulate a healing response in the uninjured part of the tendon. It’s generally
treated as an outpatient surgery, too.
As is the case with almost any surgery there are risks and complications that you
need to consider. The most common problem associated with patellar tendon
surgery is weakness and a loss of motion. Scar tissue can accumulate and
cause stiffness in the joint and some patients will never regain full range of
motion in the knee. Post-surgical physical therapy and rehabilitation are crucial in
keeping this from happening.
Infection has also been reported. Any time a wound is created in the body there
is risk of germs and bacteria getting into the tissue. The risk of infection is
particular high in patellar tendon repair surgery. Surgeons will make every effort
to minimize the risk by using sterile surgical techniques and give the patient a
dose of antibiotics to prevent infection. If a patient does develop a post-surgical
infection this can slow down the healing process.
Embolus or blood clots are also a serious risk of surgery for a damaged tendon.
Usually blood clots form in vessels that have been damaged by surgery,
obstructing them. However they can migrate to other areas of the body and a
prevent blood from reaching vital organs like the lungs, heart and brain.
Of course there is always a risk of a bad reaction to anesthesia. While this is rare
it is something you should discuss with your doctors before you undergo surgery
to repair your patellar tendon.
Perhaps the worst part about undergoing surgery for PT is the prolonged time ti
takes to recover, anywhere from six to nine months. You will not be able to bend
your knee for at least five or six weeks after surgery. After a couple of weeks you
may be able to stand on your leg but must absolutely not bend the recovering
knee.
After surgery it is critical that patients begin physical therapy and rehabilitation to
restore range of motion and strengthen the muscles. This will be prescribed by
your doctor after about six to eight weeks. It can be a pretty grueling process and
8. will require patience and diligence in following your physical therapists
instructions, applying ice to reduce swelling, using compression and elevating
your leg as much as possible.
If you stick to the post surgical recovery plan and intense physical therapy it is
possible to have a complete recovery.
To avoid the pain and misery of patellar tendinitis prevention is your best friend.
Do not play through or push past pain. As soon as you notice knee pain take a
break from whatever your doing, apply ice to the area and rest.
Keep all the muscles in your leg strong by conditioning and strengthening all the
different muscle groups. Strong thigh muscles are essential for avoiding tendon
damage. Regularly doing wall squats, one leg squats and other eccentric
exercises will also help prevent the onset of PT.
Improve your form. Whatever your sport of workout of choice, be sure you do it
with proper form. Wear well fitting shoes, learn how to lift weights properly, make
sure you are stretching correctly, not bouncing through the stretch, and always
warm your muscles up before you stretch them.
With a few lifestyle changes and vigilance when it comes to monitoring pain you
can avoid the pain of jumper’s knee and keep on keeping on.