The document provides information on common sport injuries affecting the upper and lower limbs. It discusses injuries such as impingement syndrome, frozen shoulder, tennis elbow, golfer's elbow, ACL injury, PCL injury, meniscal injury, and ankle sprain. For each injury, it describes the anatomy, mechanisms of injury, clinical features, diagnosis, and management approaches. The document is intended as part of a teaching module on sport injuries for medical students.
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
Hello everyone here I upload mckenzie exrercise basic details and some of its position.Its technique for use to cervical, Lumabar pain relief via particular position.Thank you.
Assessment and Management of Frozen ShoulderThe Arm Clinic
The Arm Clinic's Mr Mike Walton presents his thoughts on assessment and management of Frozen Shoulder. Presentation for The Arm Clinic educational event #stiffshoulder at The Wilmslow Hospital, 29th April 2016.
A brief topic presentation I made about Cubital Tunnel Syndrome, its definition, anatomy, causes, clinical features, risk factors, diagnosis, differential diagnosis and treatment. This presentation was done at the HSA staff in Cayman Islands
Hello everyone here I upload mckenzie exrercise basic details and some of its position.Its technique for use to cervical, Lumabar pain relief via particular position.Thank you.
Multiple sclerosis a devastating progressive condition cased due to demyelination and gliotic changes in CNS. Physiotherapy managemnet options available for most of the clinical features are enumerated
This is a short patient education and awarness presentation on tail bone pain (coccydynia). This presentation delivers a brief information on causes, diagnosis, investigations and treatment of tail bone pain,
Disclaimer:
This presentation is solely for educational purpose.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Multiple sclerosis a devastating progressive condition cased due to demyelination and gliotic changes in CNS. Physiotherapy managemnet options available for most of the clinical features are enumerated
This is a short patient education and awarness presentation on tail bone pain (coccydynia). This presentation delivers a brief information on causes, diagnosis, investigations and treatment of tail bone pain,
Disclaimer:
This presentation is solely for educational purpose.
Neurophysiological Facilitation of Respiration is a treatment technique used for respiratory care of patients with unconscious or non-alert, and ventilated, and also with a neurological condition
NPF is the use of external proprioceptive and tactile stimuli that produce reflex respiratory movement responses and that increase the rate and depth of breathing
Presentation of common upper limb fractures and dislocations. Covering all the injuries from many sides (Definition - Classification - Mechanisms of injury - Clinical features - Radiological studies - Management - Complications)
Arthroscopic Anterior Capsular Release for Idiopathic Frozen ShoulderApollo Hospitals
Frozen shoulder (Adhesive capsulitis) has been defined as a condition characterized by both active
and passive loss of motion. Zuckerman et al further classified Frozen shoulder into primary and secondary groups. Primary or idiopathic frozen shoulder has by definition no clear cause. The initial treatment consists of conservative
management with NSAID, Physiotherapy, intra-articular steroids or saline and in some instances manipulation under
anaesthesia. Once in a while there are cases which are refractory to conservative treatment and manipulation under anaesthesia has its risks like fractures and rotator cuff tears. Arthroscopic capsular release of stiff shoulders has been done providing excellent functional outcome and reproducible results.
Abstract
Objective: To assess the outcome of arthroscopic release in patients with cronicalchronic lateral epicondylitis. Materials and methods: Arthroscopic release in three patients with lateral epicondylitis was performed. The Mayo Elbow Performance Index (or Mayo Elbow Performance score) was used pre and post surgical treatment. Sample: Two females and one male. The patients were principal labourers and not athletes. Patients had significant pain and pain was the principal symptom that affected the score of the performance index.
Results: Scores on the performance index improved after surgery. No neurological complications were reported and early return to normal daily activities was noted.
Conclusion: Arthroscopic treatment was an alternative safe and effective method for treating chronic lateral epicondiyitis in three cases. This method makes it possible to simultaneously scan the articulation to diagnostic and treatment associated diseases. It is necessary most wide assays and comparative studies for establish sure treatment protocols.
Abstract
A total of 50 procedures were performed, 25 patients were treated using SpineView decompressor and 25 patients by Nucleoplasty using the Arthrocare Coblation technology. The total population had leg pain (sciatica), 30 of which had low back pain (discogenic pain) . Mean age of patients was 30 – 60 years. The mean follow-up period was 1 year. Follow up was done weekly for the first 2 months then monthly for the first year post-procedure according to Visual Analogue Scale , Urs Muller et.al.(2008) as well as featured neurological examination.
Analgesic consumption was stopped or reduced in 9 of the 15 patients with sciatica and low back pain treated with SpineView decompressor (60%) at 2 months (66%) 4months after the procedure, and in 9 of the 15 patients with sciatica and low back pain treated by Nucleoplasty using the Arthrocare Coblation technology (60%) at 2 months (66%) 4months after the procedure.
The patients who had sciatica only has shown reduction in analgesic consumption in 9 of the 10 patients who were treated with SpineView decompressor (90%) at 2 months, and in 2 of the 10 patients who were treated by Nucleoplasty using the Arthrocare Coblation technology (20%) at 2 months.
Our results encourage us to use SpineView decompressor in carefully selected patients with sciatica and small contained disc protrusion . Also we find that applying Nucleoplasty using the Arthrocare Coblation technology in those patients with low back pain and small contained disc protrusion can give satisfactory results. These results need further efforts and researches in order to be general recommendations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Ethanol (CH3CH2OH), or beverage alcohol, is a two-carbon alcohol
that is rapidly distributed in the body and brain. Ethanol alters many
neurochemical systems and has rewarding and addictive properties. It
is the oldest recreational drug and likely contributes to more morbidity,
mortality, and public health costs than all illicit drugs combined. The
5th edition of the Diagnostic and Statistical Manual of Mental Disorders
(DSM-5) integrates alcohol abuse and alcohol dependence into a single
disorder called alcohol use disorder (AUD), with mild, moderate,
and severe subclassifications (American Psychiatric Association, 2013).
In the DSM-5, all types of substance abuse and dependence have been
combined into a single substance use disorder (SUD) on a continuum
from mild to severe. A diagnosis of AUD requires that at least two of
the 11 DSM-5 behaviors be present within a 12-month period (mild
AUD: 2–3 criteria; moderate AUD: 4–5 criteria; severe AUD: 6–11 criteria).
The four main behavioral effects of AUD are impaired control over
drinking, negative social consequences, risky use, and altered physiological
effects (tolerance, withdrawal). This chapter presents an overview
of the prevalence and harmful consequences of AUD in the U.S.,
the systemic nature of the disease, neurocircuitry and stages of AUD,
comorbidities, fetal alcohol spectrum disorders, genetic risk factors, and
pharmacotherapies for AUD.
Report Back from SGO 2024: What’s the Latest in Cervical Cancer?bkling
Are you curious about what’s new in cervical cancer research or unsure what the findings mean? Join Dr. Emily Ko, a gynecologic oncologist at Penn Medicine, to learn about the latest updates from the Society of Gynecologic Oncology (SGO) 2024 Annual Meeting on Women’s Cancer. Dr. Ko will discuss what the research presented at the conference means for you and answer your questions about the new developments.
Ozempic: Preoperative Management of Patients on GLP-1 Receptor Agonists Saeid Safari
Preoperative Management of Patients on GLP-1 Receptor Agonists like Ozempic and Semiglutide
ASA GUIDELINE
NYSORA Guideline
2 Case Reports of Gastric Ultrasound
Knee anatomy and clinical tests 2024.pdfvimalpl1234
This includes all relevant anatomy and clinical tests compiled from standard textbooks, Campbell,netter etc..It is comprehensive and best suited for orthopaedicians and orthopaedic residents.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
New Directions in Targeted Therapeutic Approaches for Older Adults With Mantl...i3 Health
i3 Health is pleased to make the speaker slides from this activity available for use as a non-accredited self-study or teaching resource.
This slide deck presented by Dr. Kami Maddocks, Professor-Clinical in the Division of Hematology and
Associate Division Director for Ambulatory Operations
The Ohio State University Comprehensive Cancer Center, will provide insight into new directions in targeted therapeutic approaches for older adults with mantle cell lymphoma.
STATEMENT OF NEED
Mantle cell lymphoma (MCL) is a rare, aggressive B-cell non-Hodgkin lymphoma (NHL) accounting for 5% to 7% of all lymphomas. Its prognosis ranges from indolent disease that does not require treatment for years to very aggressive disease, which is associated with poor survival (Silkenstedt et al, 2021). Typically, MCL is diagnosed at advanced stage and in older patients who cannot tolerate intensive therapy (NCCN, 2022). Although recent advances have slightly increased remission rates, recurrence and relapse remain very common, leading to a median overall survival between 3 and 6 years (LLS, 2021). Though there are several effective options, progress is still needed towards establishing an accepted frontline approach for MCL (Castellino et al, 2022). Treatment selection and management of MCL are complicated by the heterogeneity of prognosis, advanced age and comorbidities of patients, and lack of an established standard approach for treatment, making it vital that clinicians be familiar with the latest research and advances in this area. In this activity chaired by Michael Wang, MD, Professor in the Department of Lymphoma & Myeloma at MD Anderson Cancer Center, expert faculty will discuss prognostic factors informing treatment, the promising results of recent trials in new therapeutic approaches, and the implications of treatment resistance in therapeutic selection for MCL.
Target Audience
Hematology/oncology fellows, attending faculty, and other health care professionals involved in the treatment of patients with mantle cell lymphoma (MCL).
Learning Objectives
1.) Identify clinical and biological prognostic factors that can guide treatment decision making for older adults with MCL
2.) Evaluate emerging data on targeted therapeutic approaches for treatment-naive and relapsed/refractory MCL and their applicability to older adults
3.) Assess mechanisms of resistance to targeted therapies for MCL and their implications for treatment selection
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Lung Cancer: Artificial Intelligence, Synergetics, Complex System Analysis, S...Oleg Kshivets
RESULTS: Overall life span (LS) was 2252.1±1742.5 days and cumulative 5-year survival (5YS) reached 73.2%, 10 years – 64.8%, 20 years – 42.5%. 513 LCP lived more than 5 years (LS=3124.6±1525.6 days), 148 LCP – more than 10 years (LS=5054.4±1504.1 days).199 LCP died because of LC (LS=562.7±374.5 days). 5YS of LCP after bi/lobectomies was significantly superior in comparison with LCP after pneumonectomies (78.1% vs.63.7%, P=0.00001 by log-rank test). AT significantly improved 5YS (66.3% vs. 34.8%) (P=0.00000 by log-rank test) only for LCP with N1-2. Cox modeling displayed that 5YS of LCP significantly depended on: phase transition (PT) early-invasive LC in terms of synergetics, PT N0—N12, cell ratio factors (ratio between cancer cells- CC and blood cells subpopulations), G1-3, histology, glucose, AT, blood cell circuit, prothrombin index, heparin tolerance, recalcification time (P=0.000-0.038). Neural networks, genetic algorithm selection and bootstrap simulation revealed relationships between 5YS and PT early-invasive LC (rank=1), PT N0—N12 (rank=2), thrombocytes/CC (3), erythrocytes/CC (4), eosinophils/CC (5), healthy cells/CC (6), lymphocytes/CC (7), segmented neutrophils/CC (8), stick neutrophils/CC (9), monocytes/CC (10); leucocytes/CC (11). Correct prediction of 5YS was 100% by neural networks computing (area under ROC curve=1.0; error=0.0).
CONCLUSIONS: 5YS of LCP after radical procedures significantly depended on: 1) PT early-invasive cancer; 2) PT N0--N12; 3) cell ratio factors; 4) blood cell circuit; 5) biochemical factors; 6) hemostasis system; 7) AT; 8) LC characteristics; 9) LC cell dynamics; 10) surgery type: lobectomy/pneumonectomy; 11) anthropometric data. Optimal diagnosis and treatment strategies for LC are: 1) screening and early detection of LC; 2) availability of experienced thoracic surgeons because of complexity of radical procedures; 3) aggressive en block surgery and adequate lymph node dissection for completeness; 4) precise prediction; 5) adjuvant chemoimmunoradiotherapy for LCP with unfavorable prognosis.
ARTIFICIAL INTELLIGENCE IN HEALTHCARE.pdfAnujkumaranit
Artificial intelligence (AI) refers to the simulation of human intelligence processes by machines, especially computer systems. It encompasses tasks such as learning, reasoning, problem-solving, perception, and language understanding. AI technologies are revolutionizing various fields, from healthcare to finance, by enabling machines to perform tasks that typically require human intelligence.
4. 4
1. Impingement Syndrome
Anatomy:
The shoulder consists of three
bones (humerus, scapula and
clavicle).
2 joints
(glenohumeral, acromioclavicular
).
2 articulations
(scapulothoracic, acromiohumer
al) that are joined by several
interconnecting ligaments and
layers of muscles.
6th MBBS - Surgery Module
28 October 2013
5. 5
1. Impingement Syndrome
Anatomy:
Rotator cuff is a group of muscles and their tendons
that act to stabilize the shoulder.
6th MBBS - Surgery Module
28 October 2013
6. 6
1. Impingement Syndrome
Muscle
Origin
Insertion
Action
Nerve Supply
Supraspinatus
Supraspinous
fossa of scapula
Greater
tubercle of
humerus
Abduct the
arm
Suprascapular nerve
Infraspinatus
Infracspinous
fossa of scapula
Greater
tubercle of
humerus
External
rotation
Suprascapular nerve
Teres Minor
Lateral border of
scapula
Greater
tubercle of
humerus
External
rotation
Axillary nerve
Subscapularis
Subscapular
fossa
Lesser tubercle
Internal
rotation
Upper and lower
subscapular nerves
6th MBBS - Surgery Module
28 October 2013
7. 7
1. Impingement Syndrome
Definition: Is a painful disorder which is thought to
arise from repetitive compression or rubbing of
the rotator cuff.
6th MBBS - Surgery Module
28 October 2013
9. 9
1. Impingement Syndrome
Grades:
Grade
Age
Cause
Mechanism
Grade I
18 – 30 years
Supraspinatus
tendinitis –
subacromial bursitis
overuse
Grade II
40 – 45 years
Supraspinatus
tendinitis –
subacromial bursitis –
partial tear - fibrosis
Overuse –
degeneration
(Osteoarthritis)
Grade III
Over 45 years
Supraspinatus
tendinitis –
subacromial bursitis –
progressive fibrosis –
disruption of the cuff
Overuse – Fall –
atrophic
degeneration in
the cuff
6th MBBS - Surgery Module
28 October 2013
10. 10
1. Impingement Syndrome
Clinical Features:
Pain.
Swelling.
Limitation of shoulder movement.
Muscle atrophy.
Tenderness over greater tuberosity.
6th MBBS - Surgery Module
28 October 2013
11. 11
1. Impingement Syndrome
Diagnosis:
Arthroscopy
Radiological
Examinations
Clinical Examinations
6th MBBS - Surgery Module
28 October 2013
12. 12
1. Impingement Syndrome
Diagnosis:
Clinical tests:
1. The painful arc: on active abduction, the
pain is aggravated as the arm transverses
an arc between 60° and 120°.
2. The impingement sign: The scapula is
stabilized with one hand while the other
raises the affected arm in flexion,
abduction and internal rotation. The test is
positive when the pain is elicited.
6th MBBS - Surgery Module
28 October 2013
14. 14
1. Impingement Syndrome
Diagnosis:
Invasive:
1. Arthrography: Dye is injected into
the glenohumeral joint and
postinjection radiographs are filmed
to assess the integrity of the
glenohumeral joint. If dye escapes
out of the joint and into the
subacromial space, it is diagnostic
of a full-thickness rotator cuff tear.
6th MBBS - Surgery Module
28 October 2013
15. 15
1. Impingement Syndrome
Diagnosis:
Invasive:
1. Arthroscopy: Minimally invasive visual surgical
procedure to assess shoulder pathology.
6th MBBS - Surgery Module
28 October 2013
16. 16
1. Impingement Syndrome
Management:
Conservative:
1. It consists of rest, heat, massage, NSAIDs, local
infiltration of hydrocortisone.
2. Exercises both active and passive.
3. Temporary immobilization.
6th MBBS - Surgery Module
28 October 2013
17. 17
1. Impingement Syndrome
Management:
Operative:
1. Failure of conservative treatment for three months.
2. Patients are young and active.
3. Increase loss of shoulder function.
Methods:
1. Excision of calcium deposits.
2. Repair of incomplete tear.
3. Acromioplasty.
6th MBBS - Surgery Module
28 October 2013
18. 18
2. Frozen Shoulder
(Adhesive Capsulitis)
Definition: it is a disorder characterized by progressive
pain and stiffness of the shoulder which usually resolves
spontaneously after about 18 months.
6th MBBS - Surgery Module
28 October 2013
19. 19
2. Frozen Shoulder
(Adhesive Capsulitis)
Etiology: Idiopathic
Risk Factors:
Diabetes.
Dupuytren‟s disease.
Hyperlipidemia.
Hyperthyroidism.
Cardiac disease.
Hemiplegia.
After recovery from neurosurgery.
6th MBBS - Surgery Module
28 October 2013
20. 20
2. Frozen Shoulder
(Adhesive Capsulitis)
Clinical Features:
Age 40 – 60 years.
70% of patients are women.
Pain gradually increases in severity and
often prevents sleeping on the
affected side.
After several months it begins to
subside.
Stiffness becomes an increasing
problem, continuing for another 6-12
months after pain has disappeared.
6th MBBS - Surgery Module
28 October 2013
21. 21
2. Frozen Shoulder
(Adhesive Capsulitis)
6th MBBS - Surgery Module
•Duration 9-15
months.
•Minimal pain
except at end of
ROM.
•Significant
limitation of ROM
with rigid end
feel.
Stage 3 (Thawing or Recovery)
•Duration 1-9
months.
•Pain with active
and passive
ROM.
•Significant
limitation with
flexion, abductio
n, external and
internal rotation.
Stage 2 (Frozen)
Stage 1 (Freezing)
Stages:
•Duration 15-24
months.
•Minimal pain.
•Progressive
improvement in
ROM
28 October 2013
22. 22
2. Frozen Shoulder
(Adhesive Capsulitis)
Diagnosis:
“Not every stiff or painful shoulder is a frozen shoulder. And
indeed there is some controversy over the criteria for
diagnosing frozen shoulder” (Zuckerman et al., 1994)
6th MBBS - Surgery Module
28 October 2013
23. 23
2. Frozen Shoulder
(Adhesive Capsulitis)
Diagnosis:
The diagnosis of frozen shoulder is clinical resting on
two characteristic features:
1. Painful restriction of the movement in the presence
of normal x-rays.
2. A natural progression through three successive
stages.
6th MBBS - Surgery Module
28 October 2013
24. 24
2. Frozen Shoulder
(Adhesive Capsulitis)
Management:
Conservative:
1. To relieve pain and prevent further stiffness.
2. Analgesics and anti-inflammatory drugs.
3. Reassure the patient that recovery is certain.
4. Pendulum exercises are encouraged.
5. Once the acute pain has subsided, manipulation
under general anesthesia may improve the range
of movement.
6th MBBS - Surgery Module
28 October 2013
25. 25
2. Frozen Shoulder
(Adhesive Capsulitis)
Management:
Operative:
1. Surgery doesn‟t have a well-defined role.
2. The main indication is prolonged and disabling
restriction of movement which fails to respond to
conservative treatment.
3. The rotator interval and coracohumeral ligament
are released and the coracoacromial ligament is
excised.
6th MBBS - Surgery Module
28 October 2013
26. 26
3. Tennis Elbow (Lateral
Epicondylitis)
Definition: Pain and tenderness over the lateral
epicondyle of the elbow (The bony insertion of the
common extensor tendons).
6th MBBS - Surgery Module
28 October 2013
28. 28
3. Tennis Elbow (Lateral
Epicondylitis)
Clinical Features:
Active individual of 30 or 40 years.
Gradual pain and localized to the lateral
epicondyle.
The elbow looks normal, and flexion and extension
are full and painless.
Pain can be elicited by:
1. Extending the elbow.
2. Pronating the forearm.
3. Passively flexing the wrist.
6th MBBS - Surgery Module
28 October 2013
29. 29
3. Tennis Elbow (Lateral
Epicondylitis)
Management:
Conservative:
1. Rest and physiotherapy.
2. Injection of the tender area with
corticosteroid and local anesthetic
relieves pain.
3. Using a brace centered over the
back of your forearm may also help
relieve symptoms of tennis elbow.
6th MBBS - Surgery Module
28 October 2013
30. 30
3. Tennis Elbow (Lateral
Epicondylitis)
Management:
Operative:
1. Persistent of symptoms for 6 to 12 months.
2. A few cases are sufficiently persistent or recurrent.
3. Release of lateral epicondylar muscles.
6th MBBS - Surgery Module
28 October 2013
31. 31
4. Golfer‟s Elbow (Medial
Epicondylitis)
Definition: Is very similar to Tennis Elbow but occurs on
the medial side of the elbow where the flexor origins
are effected.
6th MBBS - Surgery Module
28 October 2013
32. 32
4. Golfer‟s Elbow (Medial
Epicondylitis)
Mechanisms: overuse flingers flexion.
6th MBBS - Surgery Module
28 October 2013
33. 33
4. Golfer‟s Elbow (Medial
Epicondylitis)
Clinical Features:
Resisted wrist and finger flexion in pronation will
provoke the pain
6th MBBS - Surgery Module
28 October 2013
35. 35
1. ACL Injury
Anatomy:
Origin:
1. Medial and anterior aspect of the
tibial plateau.
Insertion:
1. Lateral femoral condyle.
Function:
1. provide approximately 85% of total
restraining force of anterior
translation.
2. Prevents excessive tibial medial
and lateral rotation.
6th MBBS - Surgery Module
28 October 2013
36. 36
1. ACL Injury
Definition: One of the most common knee injuries is
an anterior cruciate ligament sprain or tear.
Mechanisms:
Hyperextension force.
Twisting force on a semiflexed knee.
6th MBBS - Surgery Module
28 October 2013
37. 37
1. ACL Injury
Mechanisms:
Hyperextension force.
6th MBBS - Surgery Module
28 October 2013
38. 38
1. ACL Injury
Mechanisms:
Twisting force on a semiflexed knee.
6th MBBS - Surgery Module
28 October 2013
39. 39
1. ACL Injury
Clinical Features:
Immediately collapse and is painful.
Popping sensation felt or heard.
Swelling.
Giving away.
6th MBBS - Surgery Module
28 October 2013
40. 40
1. ACL Injury
Classification:
Ligaments sprain are classified in three degrees:
1. 1st Degree: Tear of only a few fibers of the ligament.
Minimal swelling, localized tenderness but little
functional disability.
2. 2nd Degree: Almost all the fibers of a ligament are
disrupted. Pain, swelling and inability to use the
limb. Joint movements are normal.
3. 3rd Degree: complete tear of the ligament
6th MBBS - Surgery Module
28 October 2013
41. 41
1. ACL Injury
Diagnosis:
Arthroscopy
Radiological
Examinations
Clinical Examinations
6th MBBS - Surgery Module
28 October 2013
43. 43
1. ACL Injury
Diagnosis:
Radiological Examinations:
1. Plain X-ray: to demonstrate bone avulsed or
associated fracture.
2. MRI
6th MBBS - Surgery Module
28 October 2013
44. 44
1. ACL Injury
Diagnosis:
Arthroscopy:
1. May be needed in cases where doubt
persists.
6th MBBS - Surgery Module
28 October 2013
45. 45
1. ACL Injury
Management:
Conservative:
1. Most cases of grades I and II.
2. The hematoma is aspirated and the knee is
immobilized in a commercially available knee
immobilizer.
3. After a few weeks, the adequate strength can be
regained by physiotherapy.
6th MBBS - Surgery Module
28 October 2013
46. 46
1. ACL Injury
Management:
Operative:
1. Indicated in multiple ligaments injured
knee, especially in young athletes.
2. Performed 2-3 weeks after injury after acute phase
subsided.
3. Methods:
a) Repair of the ligament: performed for fresh. Additional
reinforcement is provided by a fascial or tendon graft
(Tendon of Hamstring).
b) Reconstruction: in cases of ligament injuries presenting
late.
6th MBBS - Surgery Module
28 October 2013
47. 47
2. PCL Injury
Anatomy:
Origin:
1. The posterior intercondylar area of
the tibia.
Insertion:
1. Medial condyle of the femur.
Function:
1. keeps the tibia from moving
backwards too far.
6th MBBS - Surgery Module
28 October 2013
48. 48
2. PCL Injury
Definition: It is less common than ACL tears.
Mechanisms:
Backward force on tibia.
6th MBBS - Surgery Module
28 October 2013
49. 49
2. PCL Injury
Clinical Features:
Pain with swelling that occurs steadily and quickly
after the injury.
Swelling that makes the knee stiff and may cause a
limp.
Difficulty walking.
The knee feels unstable, like it may "give out”.
6th MBBS - Surgery Module
28 October 2013
50. 50
3. Meniscal Injury
Anatomy:
The semilunar cartilages are two crescentshaped plates of fibrocartilage placed on
condylar surface of the tibia
Functions:
1. Increase the stability of the knee.
2. Controlling the complex rolling and
gliding actions of the joint.
3. Distributing load during movement.
6th MBBS - Surgery Module
28 October 2013
51. 51
3. Meniscal Injury
Definition: Medial meniscus is more commonly injured
than the lateral and is usually associated with other
ligament injuries of the knee.
Mechanisms:
Medial meniscal:
1. In young: twisting force with the knee bent and
taking weight.
2. In middle age: fibrosis has decreased the mobility
of meniscus and hence tear occurs with less force.
6th MBBS - Surgery Module
28 October 2013
54. 54
3. Meniscal Injury
Clinical Features:
Usually a young person.
Pain (usually on the medial side).
Knee is „locked‟ in partial flexion.
Sometimes the knee gives way spontaneously.
6th MBBS - Surgery Module
28 October 2013
57. 57
3. Meniscal Injury
Diagnosis:
Arthroscopy:
1. May be needed in cases
where doubt persists.
6th MBBS - Surgery Module
28 October 2013
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3. Meniscal Injury
Management:
Conservative:
1. Indicated in patients soon after injury with no
locking.
2. If knee is locked, it is manipulated under general
anesthesia.
3. The is immobilized for 2-3 weeks followed by
physiotherapy.
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3. Meniscal Injury
Management:
Operative:
1. Indicated if the joint can‟t be unlocked and if
symptoms are recurrent.
2. Closed partial meniscectomy via an arthroscope is
better than total removal of the menisci by open
surgery.
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4. Ankle Sprain
Anatomy:
Ligaments of the ankle:
1. Anterior talofibular ligament.
2. Calcaneofibular ligament.
3. Posterior talofibular ligament.
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4. Ankle Sprain
Definition: Common injury in sport. If
improperly treated it may result in
chronic laxity, pain or delayed
recovery.
Mechanisms:
Inversion of supinated planter flexed
foot.
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4. Ankle Sprain
Clinical Features:
Anterior talofibular ligament commonly injured
followed by Calcaneofibular ligament.
The posterior talofibular ligament is rarely sprained.
Pain, swelling and tenderness over the affected
ligament.
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4. Ankle Sprain
Diagnosis:
Clinical:
1. Anterior Drawer Test: If the displacement of talus is
more than 8 mm anterior, it suggests laxity of the
anterior talofibular ligament.
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4. Ankle Sprain
Diagnosis:
Radiological Examinations:
1. X-ray : AP of the ankle to assess talar tilt.
2. Talar tilt test:
Examiner stabilizes the leg with one hand while inverting
plantar flexed heel with the other hand.
Alternatively, place the patient's leg in the lateral
position, hanging off the table.
A strap is applied around the ankle which courses
around the lateral side of the ankle.
A 4 kg wt is then applied which forces the ankle into
inversion and plantar flexion.
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4. Ankle Sprain
Diagnosis:
Radiological Examinations:
1. Talar tilt test: If the tilt is
more than 5°, it suggests
laxity of anterior talofibular
and calcaneofibular
ligaments
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4. Ankle Sprain
Management:
Grade I:
1. Ice therapy, compression bandage, foot
elevation, NSAIDs, are the recommended
treatment.
Grade II:
1. Long leg cast, range of motion
exercises, strengthening exercises are helpful.
Grade III:
1. Same lines as mentioned above and sometimes
may require surgical repair.
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History
A 25-year-old man was playing football for his local
team. While going in for a tackle he sustained a
twisting injury to his knee. There was no immediate
swelling. He continued to play for about ten
minutes to the end of the game but then
complained of some pain in the medial aspect of
his knee. He awoke the next day with a painful
swelling in the knee and so consults his general
practitioner.
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Examination
This young man has some mild
swelling,
associated
with
marked tenderness to palpation
over the medial joint line. He has
normal varus/valgus stability of
the knee and a negative
anterior draw and Lachman‟s
test. The range of motion is full. A
plain x ray shows good
preservation
of
the
joint
space, and MRI film is shown.
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Questions
What is the diagnosis?
What are the common clinical features of this injury?
How would you manage this injury?
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References
Textbook of Orthopedics (John Ebnezar).
Aply‟s System of Orthopedics and Fractures.
Essential of Orthopedics (RM Shenoy).
Essential Orthopedics (J.Maheshwari).
Field Guide to Fracture Management (Richard B.
Birrer).
Current Diagnosis and Treatment of Orthopedic
(Harry B. Skinner).
Essential Orthopedic and Trauma (David J. Dandy)
Pocket of Orthopedics and Fractures. (Ronald
McRae).
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