The aim of this presentation is to explain the background of Achilles Insertional Tendinopathy and Haglund's Triad, the rationale of conservative treatment and finally the therapeutic exercise evidence based approach.
The document discusses management of arthritic hand conditions. It summarizes three common procedures for arthritic wrist conditions:
1) Stage I involves radial styloidectomy.
2) Stage II involves proximal row carpectomy or four corner fusion with scaphoidectomy to maintain motion or strength, respectively.
3) Salvage procedures include total wrist fusion to fuse all arthritic joints for good strength without motion.
The document evaluates these procedures and their outcomes based on literature. It also provides details of techniques for four corner fusion and proximal row carpectomy.
1. The document discusses abnormalities and diseases that can affect the facet and sacroiliac joints, including congenital abnormalities, degenerative changes, trauma, infections, tumors, and metabolic diseases.
2. It provides details on anatomy, innervation, diagnosis, and treatment of facet joint and sacroiliac joint arthropathies. Diagnosis involves history, exam, imaging, and diagnostic injections.
3. Treatment includes non-pharmacological approaches like exercise and manual therapy, medications, and interventional procedures like injections and radiofrequency ablation. Surgery is rarely needed for facet joint disease.
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.
1. The document discusses the anatomy and biomechanics of the foot, including the arches and their supporting structures.
2. It then focuses on flat foot, its types and causes, as well as posterior tibial tendon dysfunction which is a common cause of acquired flat foot in adults.
3. Treatment options for flat foot include conservative measures as well as various surgical procedures depending on the severity and underlying cause, such as arthrodesis and tendon transfers.
Osteomyelitis is an inflammation of bone and bone marrow that is typically caused by bacterial or fungal infections. It can develop from odontogenic infections, trauma, or infections that spread from other sites. In the jaws, osteomyelitis most commonly results from contiguous spread of dental infections. Staphylococcus aureus and streptococci are common causative organisms. The pathogenesis involves vascular compromise of the bone which leads to necrosis, formation of sequestra, and new bone formation around infected areas. Treatment requires antibiotics, surgery to remove infected bone, and reconstruction.
This document outlines an introduction to basic joint mobilizations for sports and massage therapists. It includes the itinerary for the workshop, which involves learning the theory of joint mobilizations, practicing assessments, and practicing different joint mobilization techniques. The document covers topics such as the definition of a joint mobilization, anatomy of synovial joints, types of synovial joints, physiological and accessory joint movements, assessment of range of motion and end feels, contraindications to joint mobilizations, and Maitland's grading system for joint mobilizations.
This document provides an overview of rotator cuff injuries, including anatomy, causes, symptoms, diagnosis, and treatment. It describes how the rotator cuff is composed of four tendons that stabilize the shoulder joint. Rotator cuff tears occur when one or more of these tendons becomes damaged and can range from partial to full thickness. Symptoms may include shoulder pain that is worsened with movement. Diagnosis involves physical examination along with imaging tests like x-rays, MRI, or ultrasound. Treatment options include non-operative measures like medication and physical therapy or surgical repair if conservative treatment fails.
Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) are caused by repetitive microtrauma from activities like gripping or flexion/extension. This causes tendon degeneration and inflammation. Patients experience pain worsened with associated motions. Diagnosis is clinical with imaging to rule out other causes. Initial treatment focuses on rest, bracing, NSAIDs, and physical therapy. Corticosteroid injections and surgery are considered if conservative options fail.
The document discusses management of arthritic hand conditions. It summarizes three common procedures for arthritic wrist conditions:
1) Stage I involves radial styloidectomy.
2) Stage II involves proximal row carpectomy or four corner fusion with scaphoidectomy to maintain motion or strength, respectively.
3) Salvage procedures include total wrist fusion to fuse all arthritic joints for good strength without motion.
The document evaluates these procedures and their outcomes based on literature. It also provides details of techniques for four corner fusion and proximal row carpectomy.
1. The document discusses abnormalities and diseases that can affect the facet and sacroiliac joints, including congenital abnormalities, degenerative changes, trauma, infections, tumors, and metabolic diseases.
2. It provides details on anatomy, innervation, diagnosis, and treatment of facet joint and sacroiliac joint arthropathies. Diagnosis involves history, exam, imaging, and diagnostic injections.
3. Treatment includes non-pharmacological approaches like exercise and manual therapy, medications, and interventional procedures like injections and radiofrequency ablation. Surgery is rarely needed for facet joint disease.
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.
1. The document discusses the anatomy and biomechanics of the foot, including the arches and their supporting structures.
2. It then focuses on flat foot, its types and causes, as well as posterior tibial tendon dysfunction which is a common cause of acquired flat foot in adults.
3. Treatment options for flat foot include conservative measures as well as various surgical procedures depending on the severity and underlying cause, such as arthrodesis and tendon transfers.
Osteomyelitis is an inflammation of bone and bone marrow that is typically caused by bacterial or fungal infections. It can develop from odontogenic infections, trauma, or infections that spread from other sites. In the jaws, osteomyelitis most commonly results from contiguous spread of dental infections. Staphylococcus aureus and streptococci are common causative organisms. The pathogenesis involves vascular compromise of the bone which leads to necrosis, formation of sequestra, and new bone formation around infected areas. Treatment requires antibiotics, surgery to remove infected bone, and reconstruction.
This document outlines an introduction to basic joint mobilizations for sports and massage therapists. It includes the itinerary for the workshop, which involves learning the theory of joint mobilizations, practicing assessments, and practicing different joint mobilization techniques. The document covers topics such as the definition of a joint mobilization, anatomy of synovial joints, types of synovial joints, physiological and accessory joint movements, assessment of range of motion and end feels, contraindications to joint mobilizations, and Maitland's grading system for joint mobilizations.
This document provides an overview of rotator cuff injuries, including anatomy, causes, symptoms, diagnosis, and treatment. It describes how the rotator cuff is composed of four tendons that stabilize the shoulder joint. Rotator cuff tears occur when one or more of these tendons becomes damaged and can range from partial to full thickness. Symptoms may include shoulder pain that is worsened with movement. Diagnosis involves physical examination along with imaging tests like x-rays, MRI, or ultrasound. Treatment options include non-operative measures like medication and physical therapy or surgical repair if conservative treatment fails.
Lateral epicondylitis (tennis elbow) and medial epicondylitis (golfer's elbow) are caused by repetitive microtrauma from activities like gripping or flexion/extension. This causes tendon degeneration and inflammation. Patients experience pain worsened with associated motions. Diagnosis is clinical with imaging to rule out other causes. Initial treatment focuses on rest, bracing, NSAIDs, and physical therapy. Corticosteroid injections and surgery are considered if conservative options fail.
Osteoarthritis is one of the most common degenerative conditions that comes with aging and almost every clinician comes across in day to day practice.The slideshow helps in understanding the approach to a patient with OA before planning a surgical intervention
Trochanteric bursitis refers to inflammation of fluid-filled sacs located around the greater trochanter bone on the outside of the hip. It commonly causes deep aching pain on the outside of the hip and thigh that increases with activity and is worse when lying on the affected side. Risk factors include trauma, hip arthritis, back problems, obesity, and other conditions that alter gait or hip movement. Treatment focuses on rest, NSAIDs, physiotherapy, steroid injections, or occasionally surgery.
A 35-year-old female runner had been experiencing pain in her right foot and heel for 8 months. She had tried various treatments without success, including orthotics, physical therapy, chiropractic, and cortisone injections. The doctor performed a movement assessment using the SFMA technique and found several areas of dysfunction, including decreased ankle mobility and spinal and hip issues. The patient was treated with soft tissue work, muscle activation exercises, breathing exercises, and class 4 low-level laser therapy over multiple sessions. This comprehensive, movement-based treatment approach resolved her plantar fasciitis symptoms.
1. Avascular necrosis of the femoral head, also known as osteonecrosis, refers to the death of bone cells in the femur due to interrupted blood supply, leading to structural changes and collapse of the femoral head.
2. It most commonly affects adults aged 30-70 years old and is seen more often in males. Common causes include fractures of the femoral neck, hip dislocations, chronic alcoholism, and steroid use.
3. Early diagnosis is important as imaging like MRI can detect osteonecrosis before changes are evident on x-ray. X-rays may eventually show signs like sclerosis, cysts, flattening of the femoral head. Bone scans can also help detect early changes through decreased
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Spondylolisthesis is the slipping of one vertebra over another. It is commonly caused by dysplastic, isthmic, degenerative or traumatic conditions. It most often occurs at the L4-L5 or L5-S1 levels and presents with lower back pain, neurogenic claudication or radiculopathy. Imaging studies can classify and grade the spondylolisthesis. Conservative treatment includes rest, medications and physical therapy while surgical treatment is considered for progressive neurological deficits or severe, persistent pain.
Ankle & Foot Physiotherapy Management SRSSreeraj S R
This document discusses common ankle injuries including sprains and fractures. It describes the ligaments surrounding the ankle and classifications of ankle sprains. The acute, subacute, and maturation stages of rehabilitation are outlined with goals, interventions, and sample exercises described for each stage. Criteria for return to activity are provided, with warnings about potential increases in pain or inflammation. References are listed at the end.
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
DISH: Diffuse Idiopathic Skeletal Hyperostosis of the spineSpiro Antoniades
This document discusses diffuse idiopathic skeletal hyperostosis (DISH), a condition characterized by excessive bone formation along the sides of the spine. It provides diagnostic criteria for DISH, including flowing bone formation along at least four contiguous vertebrae while maintaining disk height. Risk factors include age, metabolic syndrome, and high BMI. Symptoms may include back pain, stiffness, dysphagia, and neurological stenosis. Imaging shows characteristic bone formation patterns, and differential diagnoses include ankylosing spondylitis and other arthritic conditions. Treatment involves NSAIDs, bisphosphonates, and other medications to reduce inflammation.
Post traumatic myositis ossificans dr. k. prashanthPrashanth Kumar
This document discusses myositis ossificans, a condition where heterotopic bone forms in soft tissue, most often muscle, following trauma. Key points include:
- It is characterized by the development of mature bone in non-osseous tissues like muscle. Adolescents and young men are most commonly affected.
- Trauma is the most common precipitating factor. The pathogenesis involves cellular injury, necrosis, and proliferation of fibroblasts and mesenchymal cells that form bone.
- Radiographs show calcifications and ossification developing over weeks. Histopathology shows zones of ossification.
- Treatment involves rest, splinting, NSAIDs, and physical therapy to prevent loss of range
Pp for lumbarization and sacralization by Dr Dhruv Taneja Assistant ProfessorDhruv Taneja
Lumbarization is a condition where the first sacral vertebra appears like a lumbar vertebra rather than being fused with the sacrum. This occurs when the first and second sacral segments fail to fuse during development. A lumbarized S1 vertebra may have its own disc or an underdeveloped disc space, making it difficult to accommodate and more prone to injury with age. Sacralization is a related condition where the fifth lumbar vertebra fuses with the sacrum, reducing mobility and increasing stress on the L4 vertebra. Both conditions can potentially lead to back pain and disc problems.
Deformities of hand in rheumatoid arthritisorthoprince
Rheumatoid arthritis can cause deformities of the fingers including intrinsic plus, swan neck, and buttonhole deformities. Swan neck deformity involves flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. Buttonhole deformity is the reverse, with flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Both deformities result from muscle imbalance and can be caused by synovitis, tendon damage, or capsular changes within the finger joints. Surgical correction may involve synovectomy, tendon releases or reconstructions, and joint mobilization or fusion depending on the severity and chronicity of the
The document discusses physiotherapy for hip joint arthritis. It describes clinical tests and symptoms for hip arthritis including limited internal rotation and pain. It outlines a 3-phase treatment approach focusing initially on pain relief, then restoring range of motion and strength, and finally maintaining full function. Exercises provided for each phase target the hips, thighs, and low back. Precautions are discussed for both pre-and post-operative periods, including the use of assistive devices and avoidance of certain motions.
This document discusses the diagnosis and treatment of calcaneus malunions by Dr. Rajiv Shah. It describes evaluating patients through history, physical exam, and radiology to identify pain generators and the degree of injury. Classification systems are discussed but found lacking, as each case requires understanding all reasons for pain. Treatment options include conservative care, revision fixation, realignment through osteotomy with or without fusion, joint sacrificing procedures like arthrodesis with osteotomy, and arthrodesis. Surgical planning considers multiple factors, and late or complex cases may require multiple extensive procedures to address pain, impingements, deformities and arthritis. The document emphasizes addressing injuries early through surgery to reduce difficulties of late salvage procedures.
The document discusses various types of arthritis that can affect the hands, including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, gout, and psoriatic arthritis. It provides details on the clinical presentation, radiographic findings, and distinguishing characteristics of each condition. Radiographs are included to illustrate features such as joint space narrowing, osteophyte formation, erosions, and periarticular changes that help differentiate the arthritides.
The document provides a detailed overview of plantar fasciitis, including its definition, symptoms, causes, anatomy, examination, differential diagnosis, and treatment. It is a painful inflammatory process of the plantar fascia, which is the connective tissue on the sole of the foot. Common symptoms include pain along the bottom of the heel that is usually worst with the first steps in the morning or after periods of rest. Treatment focuses on reducing inflammation, improving flexibility, and strengthening the foot through various exercises, with surgery considered as a last resort if other treatments are unsuccessful.
Osteonecrosis of the femoral head, also known as avascular necrosis, refers to bone cell death caused by disrupted blood flow to the femoral head. It commonly affects young adults and can lead to hip joint replacement. Early diagnosis using MRI is important. Staging systems classify the extent of involvement and structural changes, from pre-collapse changes seen on bone scan to late stage joint space narrowing. While no treatment reliably stops progression, core decompression and bone grafting may delay collapse in early stages. Once collapse occurs, osteoarthritis usually develops, necessitating joint reconstruction or replacement.
Rehab in Hip Instability The Battle 2022 Castrocaro Terme.pdfNicola Taddio
A very interesting and evidence based presentation about the so called "Hip Microinstability" about epidemiology, pathology, clinical presentation, conservative vs surgical management and finally rehabilitative treatment
This document summarizes the evaluation and treatment of anterior knee pain. Anterior knee pain accounts for up to 74% of knee pain in sport with adolescents and has a higher incidence in females. It can be difficult to treat and 40% of patients have unsatisfactory outcomes at 12 months if not treated early. Possible causes include impaired quadriceps function, excessive femoral internal rotation, impaired soft tissue restraints, and abnormal patellofemoral joint anatomy. Non-operative treatments are structure dependent but generally include education, unloading the pain generator, correcting foot biomechanics, and muscle retraining.
Osteoarthritis is one of the most common degenerative conditions that comes with aging and almost every clinician comes across in day to day practice.The slideshow helps in understanding the approach to a patient with OA before planning a surgical intervention
Trochanteric bursitis refers to inflammation of fluid-filled sacs located around the greater trochanter bone on the outside of the hip. It commonly causes deep aching pain on the outside of the hip and thigh that increases with activity and is worse when lying on the affected side. Risk factors include trauma, hip arthritis, back problems, obesity, and other conditions that alter gait or hip movement. Treatment focuses on rest, NSAIDs, physiotherapy, steroid injections, or occasionally surgery.
A 35-year-old female runner had been experiencing pain in her right foot and heel for 8 months. She had tried various treatments without success, including orthotics, physical therapy, chiropractic, and cortisone injections. The doctor performed a movement assessment using the SFMA technique and found several areas of dysfunction, including decreased ankle mobility and spinal and hip issues. The patient was treated with soft tissue work, muscle activation exercises, breathing exercises, and class 4 low-level laser therapy over multiple sessions. This comprehensive, movement-based treatment approach resolved her plantar fasciitis symptoms.
1. Avascular necrosis of the femoral head, also known as osteonecrosis, refers to the death of bone cells in the femur due to interrupted blood supply, leading to structural changes and collapse of the femoral head.
2. It most commonly affects adults aged 30-70 years old and is seen more often in males. Common causes include fractures of the femoral neck, hip dislocations, chronic alcoholism, and steroid use.
3. Early diagnosis is important as imaging like MRI can detect osteonecrosis before changes are evident on x-ray. X-rays may eventually show signs like sclerosis, cysts, flattening of the femoral head. Bone scans can also help detect early changes through decreased
Knee pain is an extremely common complaint, and there are many causes.
Family physicians, Orthopedic surgeons and internist, Pediatricians and other doctors frequently encounter patients with knee pain.
Spondylolisthesis is the slipping of one vertebra over another. It is commonly caused by dysplastic, isthmic, degenerative or traumatic conditions. It most often occurs at the L4-L5 or L5-S1 levels and presents with lower back pain, neurogenic claudication or radiculopathy. Imaging studies can classify and grade the spondylolisthesis. Conservative treatment includes rest, medications and physical therapy while surgical treatment is considered for progressive neurological deficits or severe, persistent pain.
Ankle & Foot Physiotherapy Management SRSSreeraj S R
This document discusses common ankle injuries including sprains and fractures. It describes the ligaments surrounding the ankle and classifications of ankle sprains. The acute, subacute, and maturation stages of rehabilitation are outlined with goals, interventions, and sample exercises described for each stage. Criteria for return to activity are provided, with warnings about potential increases in pain or inflammation. References are listed at the end.
This document discusses the assessment of the cervical spine. It begins with an introduction to the anatomy and biomechanics of the cervical spine. It then describes taking a patient history, including questions about pain and symptoms. The examination involves observation, palpation, range of motion testing, muscle strength testing, sensory testing, and special tests like Spurling's test. Diagnostic imaging options like x-rays, CT scans, and MRI are also discussed.
DISH: Diffuse Idiopathic Skeletal Hyperostosis of the spineSpiro Antoniades
This document discusses diffuse idiopathic skeletal hyperostosis (DISH), a condition characterized by excessive bone formation along the sides of the spine. It provides diagnostic criteria for DISH, including flowing bone formation along at least four contiguous vertebrae while maintaining disk height. Risk factors include age, metabolic syndrome, and high BMI. Symptoms may include back pain, stiffness, dysphagia, and neurological stenosis. Imaging shows characteristic bone formation patterns, and differential diagnoses include ankylosing spondylitis and other arthritic conditions. Treatment involves NSAIDs, bisphosphonates, and other medications to reduce inflammation.
Post traumatic myositis ossificans dr. k. prashanthPrashanth Kumar
This document discusses myositis ossificans, a condition where heterotopic bone forms in soft tissue, most often muscle, following trauma. Key points include:
- It is characterized by the development of mature bone in non-osseous tissues like muscle. Adolescents and young men are most commonly affected.
- Trauma is the most common precipitating factor. The pathogenesis involves cellular injury, necrosis, and proliferation of fibroblasts and mesenchymal cells that form bone.
- Radiographs show calcifications and ossification developing over weeks. Histopathology shows zones of ossification.
- Treatment involves rest, splinting, NSAIDs, and physical therapy to prevent loss of range
Pp for lumbarization and sacralization by Dr Dhruv Taneja Assistant ProfessorDhruv Taneja
Lumbarization is a condition where the first sacral vertebra appears like a lumbar vertebra rather than being fused with the sacrum. This occurs when the first and second sacral segments fail to fuse during development. A lumbarized S1 vertebra may have its own disc or an underdeveloped disc space, making it difficult to accommodate and more prone to injury with age. Sacralization is a related condition where the fifth lumbar vertebra fuses with the sacrum, reducing mobility and increasing stress on the L4 vertebra. Both conditions can potentially lead to back pain and disc problems.
Deformities of hand in rheumatoid arthritisorthoprince
Rheumatoid arthritis can cause deformities of the fingers including intrinsic plus, swan neck, and buttonhole deformities. Swan neck deformity involves flexion of the distal interphalangeal joint and hyperextension of the proximal interphalangeal joint. Buttonhole deformity is the reverse, with flexion of the proximal interphalangeal joint and hyperextension of the distal interphalangeal joint. Both deformities result from muscle imbalance and can be caused by synovitis, tendon damage, or capsular changes within the finger joints. Surgical correction may involve synovectomy, tendon releases or reconstructions, and joint mobilization or fusion depending on the severity and chronicity of the
The document discusses physiotherapy for hip joint arthritis. It describes clinical tests and symptoms for hip arthritis including limited internal rotation and pain. It outlines a 3-phase treatment approach focusing initially on pain relief, then restoring range of motion and strength, and finally maintaining full function. Exercises provided for each phase target the hips, thighs, and low back. Precautions are discussed for both pre-and post-operative periods, including the use of assistive devices and avoidance of certain motions.
This document discusses the diagnosis and treatment of calcaneus malunions by Dr. Rajiv Shah. It describes evaluating patients through history, physical exam, and radiology to identify pain generators and the degree of injury. Classification systems are discussed but found lacking, as each case requires understanding all reasons for pain. Treatment options include conservative care, revision fixation, realignment through osteotomy with or without fusion, joint sacrificing procedures like arthrodesis with osteotomy, and arthrodesis. Surgical planning considers multiple factors, and late or complex cases may require multiple extensive procedures to address pain, impingements, deformities and arthritis. The document emphasizes addressing injuries early through surgery to reduce difficulties of late salvage procedures.
The document discusses various types of arthritis that can affect the hands, including osteoarthritis, rheumatoid arthritis, calcium pyrophosphate deposition disease, gout, and psoriatic arthritis. It provides details on the clinical presentation, radiographic findings, and distinguishing characteristics of each condition. Radiographs are included to illustrate features such as joint space narrowing, osteophyte formation, erosions, and periarticular changes that help differentiate the arthritides.
The document provides a detailed overview of plantar fasciitis, including its definition, symptoms, causes, anatomy, examination, differential diagnosis, and treatment. It is a painful inflammatory process of the plantar fascia, which is the connective tissue on the sole of the foot. Common symptoms include pain along the bottom of the heel that is usually worst with the first steps in the morning or after periods of rest. Treatment focuses on reducing inflammation, improving flexibility, and strengthening the foot through various exercises, with surgery considered as a last resort if other treatments are unsuccessful.
Osteonecrosis of the femoral head, also known as avascular necrosis, refers to bone cell death caused by disrupted blood flow to the femoral head. It commonly affects young adults and can lead to hip joint replacement. Early diagnosis using MRI is important. Staging systems classify the extent of involvement and structural changes, from pre-collapse changes seen on bone scan to late stage joint space narrowing. While no treatment reliably stops progression, core decompression and bone grafting may delay collapse in early stages. Once collapse occurs, osteoarthritis usually develops, necessitating joint reconstruction or replacement.
Rehab in Hip Instability The Battle 2022 Castrocaro Terme.pdfNicola Taddio
A very interesting and evidence based presentation about the so called "Hip Microinstability" about epidemiology, pathology, clinical presentation, conservative vs surgical management and finally rehabilitative treatment
This document summarizes the evaluation and treatment of anterior knee pain. Anterior knee pain accounts for up to 74% of knee pain in sport with adolescents and has a higher incidence in females. It can be difficult to treat and 40% of patients have unsatisfactory outcomes at 12 months if not treated early. Possible causes include impaired quadriceps function, excessive femoral internal rotation, impaired soft tissue restraints, and abnormal patellofemoral joint anatomy. Non-operative treatments are structure dependent but generally include education, unloading the pain generator, correcting foot biomechanics, and muscle retraining.
This newsletter provides summaries of recent sports medicine publications related to the shoulder, hip, knee, ankle, and general orthopaedic topics. It announces collaborations between the British Orthopaedic Sports Trauma and Arthroscopy Association (BOSTAA) and the American Orthopaedic Society for Sports Medicine to publish the open access Orthopaedic Journal of Sports Medicine. The newsletter lists the BOSTAA board members and past presidents and their objectives to advance research and clinical practice in sports medicine.
Fuzzy knee proprioception would be of benefitKHALIFA ELMAJRI
This summary provides the key points from the document in 3 sentences:
The document discusses how osteoarthritis may begin with pathology in the subchondral bone that causes problems transmitting mechanical signals to neurological signals, leading to reduced proprioception and joint control. Improved implant designs that add slots to allow remaining healthy cartilage to function could help preserve mechanical signal qualities. Targeted minimally invasive interventions and implant designs that better simulate cartilage's transmission of mechanical stress may provide new ways to manage arthritic knees by improving subchondral bone's ability to translate mechanical signals to neurological signals.
The document describes a research assignment to search the CINAHL database for information on exploration, diagnosis and manipulative therapy of the ankle joint. It instructs to search both freely and using descriptors, limit to peer-reviewed publications from 2010 onwards, export references to Mendeley, create a Vancouver style bibliography, and set up a weekly alert. The process carried out is then described, including searching descriptors, applying filters, exporting references and creating the bibliography.
This document provides biographical information about Dr. Christina Kabbash, an orthopaedic surgeon who specializes in foot and ankle surgery. It details her education, training, certifications, professional experience, publications, lectures, honors and awards, and professional affiliations.
This document summarizes the basic principles of primary total knee arthroplasty. The goal is to reestablish the normal mechanical axis with a stable prosthesis. This requires proper bone resection and soft tissue balance. The femoral component should be aligned with 5-10 degrees of valgus and 0-10 degrees of flexion. The tibia should be resected at 90 degrees to the long axis. There are three main bone cuts: the proximal tibia, distal femur, and posterior femur. Each cut influences the gaps differently. Proper resection and implant thickness are needed for stability and function. Adherence to these basic principles ensures successful outcomes.
The document provides instructions for a task in CINAHL regarding ankle joint exploration, diagnosis and manipulative therapy. It includes searching by subject headings and free text, limiting to 2010 onwards and peer-reviewed articles. It details exporting references to Mendeley and creating a weekly alert to receive updates on the topic. The task is to be published on a blog along with the process.
The document provides instructions for a task in CINAHL regarding ankle injuries. It includes searching in CINAHL for information on physical examination, diagnosis, and manipulative therapy of the ankle joint from 2010 onwards. It also includes exporting references to Mendeley and creating a weekly alert for new information on the topic.
A posterior leaf spring orthosis is designed to assist with dorsiflexion during the swing phase of gait. It is indicated for patients with dorsiflexor weakness due to various neurological or muscular causes, such as stroke, cerebral palsy, spinal cord injury, or muscular dystrophies. The orthosis uses a trimmed upright at the malleoli level to keep the foot in dorsiflexion during swing phase and allow plantar flexion in stance phase. It is lightweight, low-cost, and can be used immediately or with personal shoes while waiting for custom orthotics.
This document provides instructions for completing a seminar task in CINAHL involving searching for information on "Exploration, diagnosis and manipulative therapy in the ankle joint", limiting results to 2010-2017, exporting results to Mendeley to create a Vancouver style bibliography, creating an alert for weekly news, and publishing the process in a blog. It then describes the process of conducting a free text search in CINAHL and searching by descriptors, applying filters, exporting results to Mendeley, and creating the bibliography.
The document discusses a seminar task involving searching the CINAHL database for information on "Exploration, diagnosis and manipulative therapy of the ankle joint" using both free text searching and controlled vocabulary (descriptors). It provides step-by-step instructions on constructing searches, applying filters, exporting results to Mendeley, and creating a weekly alert on the topic. Keywords and their translations to controlled vocabulary are identified. Search strategies and results are presented.
A. Apollonio - L. Benedetti Valentini - M. Catalano - F. Conti - A. D'Alessandro - M.
Danese - L. Irace - C. Pratesi - E. Rescigno - R. Serra
11.00 – 13.00 Joint symposium with Italian Society of Vascular Surgery (SICVE)
Vascular access for hemodialysis
President: G. Botta
Chairmen: L. Bagnato - S. Novo
G. Arpaia: Native arteriovenous fistula
L. Traina: Prosthetic arteriovenous graft
S. Camilli: End
Dr EG Penserga discusses developments in hand osteoarthritis - from disease mechanisms to treatment propositions. Presented during the Joint RA OA SIG Symposium held at the F1 Hotel last 28 Nov 2014.
This curriculum vitae summarizes the professional experience and qualifications of Masato Tanaka, MD. It includes his personal details, education history, licensure, academic appointments, hospital appointments, memberships, honors, research interests, and publications. Tanaka graduated from Okayama University Medical School in 1988 and 1994. He is an Associate Professor at Okayama University Hospital specializing in orthopedic surgery, with a focus on spine surgery.
Pandey KK, Agrawal AC.Partial Fibulectomy for ununited fracture of the tibia ...Dr K K Pandey
This article describes a surgical technique of partial fibulectomy for treating ununited tibia fractures with nondraining (quiescent) infection. The technique involves removing a 1-1.5 cm section of the fibula to increase compressive forces across the tibia fracture site. It was performed on 5 patients with ununited tibial fractures, on average 5 months after their initial open injuries. All fractures united within 3-7 months after partial fibulectomy while weight bearing in a cast. There were no major complications. The authors conclude that partial fibulectomy is a simple option for managing ununited tibia fractures with nondraining infection.
This document describes conducting a search in the CINAHL database to find academic publications related to manual therapy, physical examination, and diagnosis of ankle injuries from 2010 onwards. It outlines developing search terms, performing both free-text and controlled vocabulary searches, applying filters, and exporting the results to Mendeley for citation management and weekly email alerts. Key steps included searching for terms like "musculoskeletal manipulations", "physical examination", and "ankle joint"; applying filters for academic publications from 2010 onward; conducting searches using descriptors; and creating a weekly search alert to share results.
Similar to The Battle 2021 Castrocaro Terme (Italy). Achilles Insertional Tendinopathy and Haglund's Triad: conservative approach (20)
The Battle Sport Traumatology 2023 Castrocaro Terme FC.pdfNicola Taddio
In this presentation the author analyzes the various problems relating to the functional and mechanical instability of the ankle which has suffered a lesion of the lateral ligaments, the complications, failures and short and long term outcomes in order to have a 360 degree vision of the problem , the possible solutions and the correct management to avoid them.
Traumatologia prevenzione e riabilitazione nello sci alpino 2018Nicola Taddio
Dopo una breve introduzione relativa all' epidemiologia dello sci sia a livello agonistico che a livello amatoriale vengono passati in rassegna i principali infortuni ed in particolare le lesioni capsulo legamentose del ginocchio Legamento Crociato Anteriore in primis ..... illustrandone la storia naturale il trattamento conservativo quello chirurgico e la riabilitazione pre-post trauma e chirurgia e le possibilità di prevenire queste lesioni
This document discusses several topics related to total knee arthroplasty (TKA), including:
1. Expectations for recovery after TKA are often misaligned between patients and surgeons, with over 50% of patients expecting higher levels of function than surgeons.
2. Moderate sports and physical activity after TKA do not appear to negatively impact implant durability or increase revision rates in the short or medium term. High-impact sports should still be avoided.
3. Knee rehabilitation protocols must account for numerous patient-specific variables to optimize outcomes, such as age, BMI, pre-operative activity level, type of implant, and adherence to home exercises. A one-size-fits-all approach is inadequate.
Starting from a clinical case where a professional soccer player tear your acl with a concomitant ramp lesion and a detatchment of the lateral meniscus and popliteo fibular ligament we spek about the acl rehab and the not usual knee injury rehabilitation.
from the annual The Battle Sports Medicine Congress helded in Cesena (ITA) Technogym Village
Recomendações da OMS sobre cuidados maternos e neonatais para uma experiência pós-natal positiva.
Em consonância com os ODS – Objetivos do Desenvolvimento Sustentável e a Estratégia Global para a Saúde das Mulheres, Crianças e Adolescentes, e aplicando uma abordagem baseada nos direitos humanos, os esforços de cuidados pós-natais devem expandir-se para além da cobertura e da simples sobrevivência, de modo a incluir cuidados de qualidade.
Estas diretrizes visam melhorar a qualidade dos cuidados pós-natais essenciais e de rotina prestados às mulheres e aos recém-nascidos, com o objetivo final de melhorar a saúde e o bem-estar materno e neonatal.
Uma “experiência pós-natal positiva” é um resultado importante para todas as mulheres que dão à luz e para os seus recém-nascidos, estabelecendo as bases para a melhoria da saúde e do bem-estar a curto e longo prazo. Uma experiência pós-natal positiva é definida como aquela em que as mulheres, pessoas que gestam, os recém-nascidos, os casais, os pais, os cuidadores e as famílias recebem informação consistente, garantia e apoio de profissionais de saúde motivados; e onde um sistema de saúde flexível e com recursos reconheça as necessidades das mulheres e dos bebês e respeite o seu contexto cultural.
Estas diretrizes consolidadas apresentam algumas recomendações novas e já bem fundamentadas sobre cuidados pós-natais de rotina para mulheres e neonatos que recebem cuidados no pós-parto em unidades de saúde ou na comunidade, independentemente dos recursos disponíveis.
É fornecido um conjunto abrangente de recomendações para cuidados durante o período puerperal, com ênfase nos cuidados essenciais que todas as mulheres e recém-nascidos devem receber, e com a devida atenção à qualidade dos cuidados; isto é, a entrega e a experiência do cuidado recebido. Estas diretrizes atualizam e ampliam as recomendações da OMS de 2014 sobre cuidados pós-natais da mãe e do recém-nascido e complementam as atuais diretrizes da OMS sobre a gestão de complicações pós-natais.
O estabelecimento da amamentação e o manejo das principais intercorrências é contemplada.
Recomendamos muito.
Vamos discutir essas recomendações no nosso curso de pós-graduação em Aleitamento no Instituto Ciclos.
Esta publicação só está disponível em inglês até o momento.
Prof. Marcus Renato de Carvalho
www.agostodourado.com
Here is the updated list of Top Best Ayurvedic medicine for Gas and Indigestion and those are Gas-O-Go Syp for Dyspepsia | Lavizyme Syrup for Acidity | Yumzyme Hepatoprotective Capsules etc
Histololgy of Female Reproductive System.pptxAyeshaZaid1
Dive into an in-depth exploration of the histological structure of female reproductive system with this comprehensive lecture. Presented by Dr. Ayesha Irfan, Assistant Professor of Anatomy, this presentation covers the Gross anatomy and functional histology of the female reproductive organs. Ideal for students, educators, and anyone interested in medical science, this lecture provides clear explanations, detailed diagrams, and valuable insights into female reproductive system. Enhance your knowledge and understanding of this essential aspect of human biology.
Integrating Ayurveda into Parkinson’s Management: A Holistic ApproachAyurveda ForAll
Explore the benefits of combining Ayurveda with conventional Parkinson's treatments. Learn how a holistic approach can manage symptoms, enhance well-being, and balance body energies. Discover the steps to safely integrate Ayurvedic practices into your Parkinson’s care plan, including expert guidance on diet, herbal remedies, and lifestyle modifications.
8 Surprising Reasons To Meditate 40 Minutes A Day That Can Change Your Life.pptxHolistified Wellness
We’re talking about Vedic Meditation, a form of meditation that has been around for at least 5,000 years. Back then, the people who lived in the Indus Valley, now known as India and Pakistan, practised meditation as a fundamental part of daily life. This knowledge that has given us yoga and Ayurveda, was known as Veda, hence the name Vedic. And though there are some written records, the practice has been passed down verbally from generation to generation.
TEST BANK For Community Health Nursing A Canadian Perspective, 5th Edition by...Donc Test
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Rasamanikya is a excellent preparation in the field of Rasashastra, it is used in various Kushtha Roga, Shwasa, Vicharchika, Bhagandara, Vatarakta, and Phiranga Roga. In this article Preparation& Comparative analytical profile for both Formulationon i.e Rasamanikya prepared by Kushmanda swarasa & Churnodhaka Shodita Haratala. The study aims to provide insights into the comparative efficacy and analytical aspects of these formulations for enhanced therapeutic outcomes.
Muktapishti is a traditional Ayurvedic preparation made from Shoditha Mukta (Purified Pearl), is believed to help regulate thyroid function and reduce symptoms of hyperthyroidism due to its cooling and balancing properties. Clinical evidence on its efficacy remains limited, necessitating further research to validate its therapeutic benefits.
share - Lions, tigers, AI and health misinformation, oh my!.pptxTina Purnat
• Pitfalls and pivots needed to use AI effectively in public health
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The Battle 2021 Castrocaro Terme (Italy). Achilles Insertional Tendinopathy and Haglund's Triad: conservative approach
1. VII INTERNATIONAL CONGRESS
SPORTTRAUMATOLOGY
“THE BATTLE”
11-12Dicembre
2020
FACULTY
SEGRETERIA ORGANIZZATIVA
E PROVIDER ECM Congredior s.r.l. - Provider ECM n. 737
Corso Amendola n. 45 - 60123 Ancona
tel. 071 2071411 - fax 071 2075629
www.congredior.it • info@congredior.it
spalla
anca
ginocchio
PRESIDENTE
Giuseppe PORCELLINI
Università degli Studi di Modena e Reggio Emilia
COMITATO SCIENTIFICO
COMITATO D’ONORE
F. BORRA, Forlì
F. CATANI, Modena
G. NANNI, Bologna
P. PALADINI, Cattolica (RN)
G. PORCELLINI, Modena
F. RUSSO, Roma
P. M. TONINO, Chicago (USA)
R. ZINI, Cotignola (RA)
E. SANSAVINI, Presidente GruppoVilla Maria
G. MALAGÒ, Presidente Coni
C.A. PORRO, Rettore Università di Modena e Reggio Emilia
N. ALESSANDRI, PresidenteTechnogym
F. PIGOZZI, Presidente Federazione Internazionale
di Medicina dello Sport
M. CASASCO, Presidente Federazione Medico Sportiva Italiana
SPORTEADOLESCENTI:prevenzioneecura
F. ACCADBLED, Francia
G. ADDESSI, Roma
P. ADRAVANTI, Parma
E. ADRIANI, Roma
L. AROSIO, Lissone (MB)
G. BELTRAMI, Parma
P. BENELLI, Pesaro
F. BENAZZO, Pavia
M. BIGONI, Milano
G. N. BISCIOTTI, Qatar
D. BORRA, Forlì
A. CACCHIO, L’Aquila
E. CALVO, Spagna
F. CAMPI, Forlì
M. CAPASSO, Venezuela
A. CASTAGNA, Milano
F. CATANI, Modena
A. COMBI, Pavia
F. COMBI, Milano
D. CRETA, Bologna
F. CUZZOLIN, Cesena
D. DALLARI, Bologna
L. DALLARI, Modena
A. DE CARLI, Roma
F. DELLA VILLA, Bologna
R. DI MICELI, Bologna
F. DI PIETTO, Napoli
R. FABBRICINI, Roma
C. FALDINI, Bologna
C. FANTINI, Cervia
F. FANTON, Roma
G. FIUMANA, Forlì
A. FOGLIA, Civitanova Marche
M. FOGLI, Ferrara
U. GRANACHER, Germania
M. GREGO, Caserta
S. GUMINA, Roma
M. KOCHER, USA
LIOI, Forlì
B. W. KIBLER, USA
F. LIJOI, Forlì
R. LISI, Frosinone
J. W. LOCKHART, USA
G. MEROLLA, Cattolica (RN)
G. MIGLIACCIO, Cagliari
G. MONETTI, Bologna
M. MONZONI, Monza
F. MUSARRA, Pesaro
G. NANNI, Bologna
M. NOVI, Pisa
P. PALADINI, Cattolica
L. PALOMBA, Todi
M. PANASCÌ, Roma
A. PELLEGRINI, Modena
M. PHILIPPON, USA
A. PIERUCCI, Pisa
G. PORCELLINI, Modena
F. RANDELLI, Milano
A. ROMEO, USA
F. RUSSO, Roma
G. RUSSO, Roma
E. SABETTA, Reggio Emilia
A. SACCHI, Fusignano (RA)
A. SALSI, Bologna
N. SANTORI, Roma
G. SEVERINI, Roma
G.B. SISCA, Bologna
N. TADDIO, Padova
L. TARALLO, Modena
M. TARANTINO, Roma
M. TURATI, Monza
J. VELASCO, Bologna
G. VITTI, USA
S. ZAFFAGNINI, Bologna
M. ZANAZZO, Biella
G. A. ZANOLI, Ferrara
R. ZINI, Cotignola (RA)
LIBERA
ASSOCIAZIONE
MEDICI ITALIANI
DEL CALCIO
MEDIA TECH PARTNER
Con il Patrocinio di
EVENTO FAD
LIVE STREAMING
Ancona 2013
San Marino 2014
Roma 2016 Cesena 2017 Cattolica 2018 Cesena 2019
Castrocaro 2020
Castrocaro 2021
VII INTERNATIONAL CONGRESS
SPORTTRAUMATOLOGY
“THE BATTLE”
11-12Dicembre
2020
FACULTY
spalla
anca
PRESIDENTE
Giuseppe PORCELLINI
Università degli Studi di Modena e Reggio Emilia
COMITATO SCIENTIFICO
COMITATO D’ONORE
F. BORRA, Forlì
F. CATANI, Modena
G. NANNI, Bologna
P. PALADINI, Cattolica (RN)
G. PORCELLINI, Modena
F. RUSSO, Roma
P. M. TONINO, Chicago (USA)
R. ZINI, Cotignola (RA)
E. SANSAVINI, Presidente GruppoVilla Maria
G. MALAGÒ, Presidente Coni
C.A. PORRO, Rettore Università di Modena e Reggio Emilia
N. ALESSANDRI, PresidenteTechnogym
F. PIGOZZI, Presidente Federazione Internazionale
di Medicina dello Sport
M. CASASCO, Presidente Federazione Medico Sportiva Italiana
SPORTEADOLESCENTI:prevenzioneecura
F. ACCADBLED, Francia
G. ADDESSI, Roma
P. ADRAVANTI, Parma
E. ADRIANI, Roma
L. AROSIO, Lissone (MB)
G. BELTRAMI, Parma
P. BENELLI, Pesaro
F. BENAZZO, Pavia
M. BIGONI, Milano
G. N. BISCIOTTI, Qatar
D. BORRA, Forlì
A. CACCHIO, L’Aquila
E. CALVO, Spagna
F. CAMPI, Forlì
M. CAPASSO, Venezuela
B. W. KIBLER, USA
F. LIJOI, Forlì
R. LISI, Frosinone
J. W. LOCKHART, USA
G. MEROLLA, Cattolica (RN)
G. MIGLIACCIO, Cagliari
G. MONETTI, Bologna
M. MONZONI, Monza
F. MUSARRA, Pesaro
G. NANNI, Bologna
M. NOVI, Pisa
P. PALADINI, Cattolica
L. PALOMBA, Todi
M. PANASCÌ, Roma
A. PELLEGRINI, Modena
LIBERA
ASSOCIAZIONE
MEDICI ITALIANI
DEL CALCIO
Con il Patrocinio di
EVENTO FAD
LIVE STREAMING
4. Tendinopathy: do we get the right picture ?
Unknown factors
Onset of symptoms
Surgery
Risk Factors
Injury ?
Overuse ?
Metabolic disorders ?
Histology
Biochemistry
Molecular Biology
Natural History of Tendinopathy
http://www.nicolamaffulli.com/ N. Maffulli, Corso Nazionale della SICSG, Società Italiana di
Chirurgia della Spalla e del Gomito, S. Patrignano (RN) 2007
5. Healthy tendon vs tendinopathy
Revisiting the continuum model of tendon pathology: what is its merit in clinical practice and research?
Cook JL, Rio E, Purdam CR, Docking SI.
Br J Sports Med. 2016 Oct;50(19):1187-91. doi: 10.1136/bjsports-2015-095422. Epub 2016 Apr 28. Free PMC article. Review.
6. Rescue plan for Achilles: Therapeutics steering the fate and functions of stem cells in tendon
wound healing.
Schneider M, Angele P, Järvinen TAH, Docheva D.
Adv Drug Deliv Rev. 2018 Apr;129:352-375. doi: 10.1016/j.addr.2017.12.016. Epub 2017 Dec 24. Free article. Review.
Tendon Healing Process
7. Deciphering the pathogenesis of tendinopathy: a three-stages process.
Fu SC, Rolf C, Cheuk YC, Lui PP, Chan KM.
Sports Med Arthrosc Rehabil Ther Technol. 2010 Dec 13;2:30. doi: 10.1186/1758-2555-2-30. Free PMC article.
Failed Healing Response
8. Biomechanics and pathophysiology of overuse tendon injuries: ideas on insertional tendinopathy.
Maganaris CN, Narici MV, Almekinders LC, Maffulli N.
Sports Med. 2004;34(14):1005-17. doi: 10.2165/00007256-200434140-00005.Review.
Recent biomechanical
studies indicate that strain
patterns in tendons may not
be uniform, as tendons show
stress-shielded areas and
areas subjected to
compressive loading at the
enthesis.
These areas correspond to
the sites where tendinopathic
characteristics are typically
seen.
This indicates that some
tendinopathies may,
paradoxically, be considered
as 'underuse' lesions despite
the common beliefs that they
are overuse injuries.
Overuse or Underuse Condition
9. Distinguishing Achilles tendinopathy based on location of the symptoms. Insertional Achilles tendinopathy is
localised within the first 2 cm of the attachment of the Achilles tendon on the calcaneus (left side figure) and
midportion Achilles tendinopathy is localised >2 cm above this attachment (right side figure).
Dutch multidisciplinary guideline on Achilles tendinopathy.
de Vos RJ, van der Vlist AC, Zwerver J, Meuffels DE, Smithuis F, van Ingen R, van der Giesen
F, Visser E, Balemans A, Pols M, Veen N, den Ouden M, Weir A.
Br J Sports Med. 2021 Jun 29:bjsports-2020-103867. doi: 10.1136/bjsports-2020-103867. Online ahead of print. Free article.
Achilles Tendinopathy
Within 2 cm from insertion > 2 cm from insertion
10. The anatomical footprint of the Achilles tendon: a cadaveric study.
Ballal MS, Walker CR, Molloy AP.
Bone Joint J. 2014 Oct;96-B(10):1344-8. doi: 10.1302/0301-620X.96B10.33771.
11. Why heel spurs are traction spurs after all.
Zwirner J, Singh A, Templer F, Ondruschka B, Hammer N.
Sci Rep. 2021 Jun 24;11(1):13291. doi: 10.1038/s41598-021-92664-4. Free PMC article.
Different shapes of the posterior calcaneal surface are depicted on museum samples of the Department of Anatomy Dunedin, New
Zealand. The upper row displays the superior (SF), middle (MF) and inferior facet (IF) of the posterior calcaneal surface in a
posterior view. The posteriorly protruding spine separates the MF and the IF (coloured in red). The lower row shows the
corresponding lateral view of the samples shown above. Red arrow, barely protruding spine; black arrow, protruding spine; white
arrow, protruding spine with posterior spurs; a, anterior; i, inferior; l, lateral; m, medial; p, posterior; s, superior.
The posterior calcanear surface
12. S.E.C.: Synovio Entheseal Complex
The concept of a "synovio-entheseal complex" and its implications for understanding joint
inflammation and damage in psoriatic arthritis and beyond.
McGonagle D, Lories RJ, Tan AL, Benjamin M.
Arthritis Rheum. 2007 Aug;56(8):2482-91. doi: 10.1002/art.22758. Free article.
Calcaneus
Bone
Achilles Tendon
Diagrammatic representation of the synovio-entheseal
complex, using the Achilles tendon enthesis organ to
illustrate the concept. The synovial membrane (SM), which
is intimately related to the enthesis (E) itself, lines much of
the retrocalcaneal bursa (B), except in the region where
the sesamoid fibrocartilage (SF) in the deep part of the
tendon presses against the periosteal fibrocartilage (PF)
covering the superior tuberosity. Macrophages (M) are an
integral part of the synovium, and their anatomic proximity
to fibrocartilage adjacent to insertions could contribute to
an inflammatory response in relation to degenerative
changes (DC) in the walls of the bursa or at the enthesis
itself. Although a young healthy enthesis is probably
avascular, blood vessel invasion (VI) of the enthesis is
common in older individuals (24). The blood vessels may
come from the underlying bone at sites of focal absence of
the subchondral bone plate (FAB), as depicted, or they may
invade from tissue on the surface of the tendon, including
synovium
13. Enthesis Organ
This is a diagram of the Achilles tendon enthesis organ. The arrowheads show the point of attachment of the tendon to bone. The enthesis
is closely integrated into the bone. Additional shock absorbing fibrocartilage termed periosteal fibrocartilage (which lines the bone) and
sesamoid fibrocartilage (which lines undersurface of the tendon) are shown in sea blue. The bursa forms part of the enthesis organ. The
bursa is lined by synovium which nourishes the fibrocartilages. This component of the enthesis is called the synovio-entheseal complex.
The "enthesis organ" concept: why enthesopathies may not present as focal
insertional disorders.
Benjamin M, Moriggl B, Brenner E, Emery P, McGonagle D, Redman S.
Arthritis Rheum. 2004 Oct;50(10):3306-13. doi: 10.1002/art.20566. Free article.
Michael Benjamin is an
Emeritus Professor at
Cardiff University (UK)
Dennis McGonagle
is a Academic
Professor
Rheumatology at the
University of Leeds.
Achilles Tendon
Calcaneus Bone
Synovio
Enthesis
Complex
14. Kager Fat Pad
The functional anatomy of Kager's fat pad in relation to retrocalcaneal problems and other
hindfoot disorders.
Theobald P, Bydder G, Dent C, Nokes L, Pugh N, Benjamin M.
J Anat. 2006 Jan;208(1):91-7. doi: 10.1111/j.1469-7580.2006.00510.x. Free PMC article.
1. Kager Fat Pad (KFP)
2. Wedge extension of KFP
3. Muscle fibers of gastroc-soleus complex
4. Anterior aspect of tendo Achilles
5. Retrocalcaneal bursal space
15. Pressure changes in the Kager fat pad at the extremes of ankle motion suggest a potential
role in Achilles tendinopathy.
Malagelada F, Stephen J, Dalmau-Pastor M, Masci L, Yeh M, Vega J, Calder J.
Knee Surg Sports Traumatol Arthrosc. 2020 Jan;28(1):148-154. Epub 2019 Jun 29.
Kager Fat Pad
This study has demonstrated
changes in pressure experienced
by both the retrocalcaneal bursa
and the midportion area of the KFP
in contact with the Achilles tendon.
Significantly increased pressure is found at the extremes of ankle
motion. This finding supports the concept that the KFP acts as a
shock-absorber
and could suggest a proprioceptive or feedback role of the KFP that
should be considered during physiotherapy protocols. The KFP is closely
related to the FHL muscle and the Achilles tendon with the plantaris and
an arterial branch embedded in its substance whenever pre- sent. These
findings and the accurate dynamic description help to understand the
function of the KPF and may have implications in heel pain related
conditions.
16. Fat Pads and tendinopathy
Fat pads adjacent to tendinopathy: more than a coincidence?
Ward ER, Andersson G, Backman LJ, Gaida JE.
Br J Sports Med. 2016 Dec;50(24):1491-1492. Epub 2016 Aug 23.
Is it merely a curiosity that fat pads are found adjacent to the area of
tendon affected by tendinopathy?
We propose that fat pads share an anatomical and functional relationship
with their adjacent tendons and may therefore contribute to the
pathogenesis of tendinopathy.
Fat pads and tendons have a shared blood supply,and cytokines produced
in the fat pad have only a short distance to travel in order to affect the
tendon.
Fat pads lubricate, insulate, protect and provide structural support for
tendons. However, the functional significance of the fat pad is often
overlooked.
In an early study of fat pad function, the distal tip
of Kager's fat pad migrated into the retrocalcaneal
bursa during ankle movement in healthy
individuals, but not in an individual with a hindfoot
disorder.
This ‘variable plunger’ mechanism minimises
pressure changes within the bursa during ankle
movement.
19. The pain of tendinopathy: physiological or pathophysiological?
Rio E, Moseley L, Purdam C, Samiric T, Kidgell D, Pearce AJ, Jaberzadeh S, Cook J.
Sports Med. 2014 Jan;44(1):9-23. doi: 10.1007/s40279-013-0096-z. Review.
Tendon pain remains an enigma …
One Finger Pain …… (J.Cook)
The only thing we know is if the patient
have a pain have a brain …… (L. Moseley)
Morning and pain after rest ….. (C. Purdam)
The most breakages occurs in painless
tendons …… (E. Rio)
Pain monitoring model …… (K. Silbernagel)
Painful Exercise…… (H.Alfredson)
20. A tendon “hole” not
explain chronic
tendon pain
Shoulder pain: can one label satisfy everyone and everything ?
Cools AM, Michener LA.
Br J Sports Med. 2017 Mar;51(5):416-417. Epub 2016 Nov 2.
Achilles Tendon Pain
Pain vs Tendinopathy: the missing link
21. A new integrative model of lateral
epicondylalgia.
Coombes BK, Bisset L, Vicenzino B.
Br J Sports Med. 2009 Apr; Review.
22. Pain Management
(A) Physical Therapy
(B) Drugs Therapy
A Mechanism-Based Approach to Physical Therapist Management of Pain.
Chimenti RL, Frey-Law LA, Sluka KA.
Phys Ther. 2018 May 1;98(5):302-314. Free PMC article. Review
26. The differences in viscoelastic properties of subtendons result from the anatomical
tripartite structure of human Achilles tendon - ex vivo experimental study and modeling.
Ekiert M, Tomaszewski KA, Mlyniec A.
Acta Biomater. 2021 Apr 15;125:138-153. Epub 2021 Mar 4.
Tripartite Structure of Achilles Tendon
Eccentric
29. Nonoperative treatment of insertional Achilles tendinopathy: a systematic review.
Zhi X, Liu X, Han J, Xiang Y, Wu H, Wei S, Xu F.
J Orthop Surg Res. 2021 Mar 30;16(1):233. doi: 10.1186/s13018-021-02370-0. Free PMC article.
RESULTS: 23 studies (containing 35 groups)
were eligible for the final review.
TREATMENTS: included eccentric training,
extracorporeal shockwave therapy (ESWT),
injections, and combined treatment.
OUTCOME: visual analog scale (VAS),
Victorian Institute of Sport Assessment-
Achilles questionnaire, AOFAS, satisfaction
rate, and other scales were used to assess the
clinical outcome.
CONCLUSION: Current evidence for
nonoperative treatment specific for insertional
Achilles tendinopathy favors ESWT or the
combined treatment of ESWT plus eccentric
exercises.
What tell us Literature
30. Functional Outcomes of Insertional Achilles Tendinopathy Treatment: A Systematic Review.
Jarin IJ, Bäcker HC, Vosseller JT.
JBJS Rev. 2021 Jun 14;9(6). doi: 10.2106/JBJS.RVW.20.00110
RESULTS:
• 1,457 abstract were reviewed;
• 54 studies with 2,177 patients met the inclusion
criteria;
• Among the 54 studies, 6 operative techniques and 6
nonoperative treatments
CONCLUSIONS:
• Eccentric exercises and low-energy extracorporeal
shockwave therapy (ESWT) have the greatest
evidence for the initial management of insertional
Achilles tendinopathy.
• ESWT has been increasingly studied in recent years,
but more high-quality evidence is needed.
• Operative treatment with tenotomy, debridement,
retrocalcaneal bursectomy, and calcaneal
exostectomy is effective. Flexor hallucis longus
tendon transfer may benefit cases of more severe
disease.
• Minimally invasive procedures have a potential role
in the treatment algorithm and require more rigorous
study.
What tell us Literature
31. What tell us Literature
Treatment for insertional Achilles tendinopathy: a systematic review.
Wiegerinck JI, Kerkhoffs GM, van Sterkenburg MN, Sierevelt IN, van Dijk CN.
Knee Surg Sports Traumatol Arthrosc. 2013 Jun;21(6):1345-55. Review.
The patient satisfaction is high in all
surgical studies (avg 89%).
It is not possible to draw conclusions
regarding the best surgical treatment for
insertional Achilles tendinopathy.
ESWT seems effective in patients with
non-calcified insertional Achilles
tendinopathy.
Although both eccentric exercises resulted
in a decrease in VAS score, full range of
motion eccentric exercises shows a
low patient satisfaction compared to floor
level exercises and other conservative
treatment modalities.
????
32. ESWT vs Exercise
Shockwave Therapy Plus Eccentric Exercises Versus Isolated Eccentric Exercises
for Achilles Insertional Tendinopathy: A Double-Blinded Randomized Clinical Trial.
Mansur NSB, Matsunaga FT, Carrazzone OL, Schiefer Dos Santos B, Nunes CG, Aoyama BT, Dias Dos Santos PR, Faloppa F, Tamaoki MJS.
J Bone Joint Surg Am. 2021 Jul 21;103(14):1295-1302. doi: 10.2106/JBJS.20.01826.
Extracorporeal
shockwave therapy
does not potentiate
the effects of
eccentric
strengthening in
the management of
Achilles insertional
tendinopathy.
33. Which treatment is most effective for patients with Achilles tendinopathy? A living systematic
review with network meta-analysis of 29 randomised controlled trials.
van der Vlist AC, Winters M, Weir A, Ardern CL, Welton NJ, Caldwell DM, Verhaar JAN, de Vos RJ.
Br J Sports Med. 2021 Mar;55(5):249-256. doi: 10.1136/bjsports-2019-101872. Epub 2020 Jun 10.Free PMC article.
Most effective treatment at 3 months
34. Which treatment is most effective for patients with Achilles tendinopathy? A living systematic
review with network meta-analysis of 29 randomised controlled trials.
van der Vlist AC, Winters M, Weir A, Ardern CL, Welton NJ, Caldwell DM, Verhaar JAN, de Vos RJ.
Br J Sports Med. 2021 Mar;55(5):249-256. doi: 10.1136/bjsports-2019-101872. Epub 2020 Jun 10.Free PMC article.
Most effective treatment at 12 months
37. Current Clinical Concepts: Conservative Management of Achilles Tendinopathy.
Silbernagel KG, Hanlon S, Sprague A.
J Athl Train. 2020 May;55(5):438-447. doi: 10.4085/1062-6050-356-19. Epub 2020 Apr 8.Free PMC article. Review.
38. Pain Monitoring Model
Continued sports activity, using a pain-monitoring model, during rehabilitation in patients with
Achilles tendinopathy: a randomized controlled study.
Silbernagel KG, Thomeé R, Eriksson BI, Karlsson J.
Am J Sports Med. 2007 Jun;35(6):897-906. Epub 2007 Feb 16.
39. Monitorare il dolore
e la risposta al carico
Dolore durante l’ esercizio
0 = Nessun dolore 10 = peggior dolore immaginabile
Monitorare i sintomi per 24-48-72 ore dopo l’ esercizio
Il dolore può presentarsi rapidamente dopo l’ esercizio ma
non deve aumentare di intensità il giorno o i giorni dopo
40. “It is more important to know what sort of
person has a disease than to know what sort of
disease a person has.”
(Hippocrates)