common injuries to the knee, leg, ankle
DESCRIPTION
leg, ankle, support, lower extermities, orthopaedic, surgery, trauma, sport, daily activityTRANSCRIPT
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Common Injuries to the Knee
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ANTERIOR CRUCIATE INJURIES
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ACL injuries also commonly occur with hyperextension of the knee, deceleration and valgus stress.
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INDICATIONS FOR SURGERY:
Complete tear; associated meniscal pathology
Well motivated person who will do the rehab program; physiologically young
Unwilling to change lifestyle; job and sports require twisting, cutting
Minimal evidence of DJD
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WHEN TO DO SURGERY : Wait at least 3-4 weeks after injury
•Decrease the swelling
•Decrease Quad inhibition
•Decrease hamstring overfiring
•Decrease scarring
•Increase ROM; decrease stiffness
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SURGERIES PERFORMED1. Bone-tendon-bone with middle 1/3 of patellar tendon
2. Semitendinosis and gracilis: fold them in ½ so have a 4 tendon bundle
3. Allograph: bone-tendon-bone patellar tendon from cadaver
Key in surgery is correct isometric placement of the graph.
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80-90% of patients have a good result with surgery going back to previous levels of activity. Some complications that may arise and give a less than favorable result are:
• Patellar tendonitis
• Patellofemoral pain/chondromalacia
• Limited ROM at extremes; loss of even a few degrees of terminal extension is a problem
• Stretching out of graph
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COLLATERAL LIGAMENT INJURIES
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MCL tears: most common mechanism is a blow to the outside of the knee followed by planting of the foot and twisting of the knee.
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There is a high risk of injury to the medial meniscus with MCL tears.
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KNEE REHAB
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PATELLOFEMORAL PAIN SYNDROME
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The patella must have balanced muscular forces around it to ride properly in the femoral groove.
The VMO should fire before the VL.
The VMO/VL ratio should be 1:1
Tight ITB, hamstrings and calf can disrupt muscular balance.
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OTHER FACTORS CAUSING PFPS:
1. Overpronation
2. Anteversion
3. Weak Hip ER & ABD
4. Tibial Varum
5. Increased Q angle
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ILIOTIBIAL BAND SYNDROME
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Complains of pain on knee flexion
May complain of snapping
Pain gets worse on ROM from full flexion to full extension.
Often result of: genu varum; over pronation; femoral anteversion; spinal problems.
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SHIN SPLINTS
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Most common area affected is antereomedial shin.
Starts out as muscle/tendon injury
Can progress to periosteal injury
Can end up as a stress fracture
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ANKLE SPRAINS
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Ottawa ankle rules
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JOBST INTERMITTENT COMPRESSION DEVICE
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ROM exercises
Strengthening
Proprioception
Agility
Running/jumping
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Syndesmotic
Injury
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ACHILLES TENDONITIS
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ACHILLES TENDON RUPTURE
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LONG REHAB: Average 6-9 months
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PLANTAR FASCITIS
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Over pronation
Pes cavus foot
Tight calf muscles
Tibial varum
Anteversion
Weak ER of hip
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Pharmacology
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DRUGS USED FOR MUSCULOSKELETAL
PATHOLOGY• Analgesics
• Drugs that directly affect the healing process
• Drugs that do both
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NON STEROIDAL ANTIINFLAMMATORY
DRUGS (NSAIDS)• Treatment of inflammatory arthritic
diseases
• Treatment of the “itises”
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NSAIDS: SIDE EFFECTS
• Gastrointestinal Irritation and Ulceration
• Decreased Blood Clotting
• Kidney Trouble
• Other
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Common NSAIDs (OTC)Bayer (aspirin)
Tylenol (acetaminophen)
Aleve or Naprosyn (naproxen)
Advil (ibuprofen)
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Common NSAIDS (Rx)
• Celebrex (celecoxib)• Voltaren (diclofenac)• Lodine (etodolac)• Nalfon (fenoprofen)• Indocin (indomethacin)
• Orudis, Oruvail (ketoprofen)
• Toradol (ketoralac)• Daypro (oxaprozin)• Relafen
(nabumetone)• Clinoril (sulindac)• Tolectin (tolmetin)• Vioxx (rofecoxib
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Dosing
Depends on Goal
Avoid negative drug reactions
Trial and Error
Every patient has a different response
Must keep blood levels constant for antiinflammatory response
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CORTICOSTEROIDS
• Synthetic derivative of cortisol
• Mobilizes energy stores
• Circulatory changes
• Changes in liver and kidney function
• Subdue inflammation and immune response
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ACTION
• Stabilizes cell membranes which decreases release of inflammatory mediators
• Inhibits migration of inflammatory cells that are attracted to the injured area.
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INDICATIONS
• INFLAMMATORY DISEASES: RA, Lupus, Ankylosing Spondylitis
• NO! Acute musculoskeletal injuries
• ???? Chronic musculoskeletal injuries
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ADMINISTRATION
• ORAL: Used in tx of diseases which affect multiple joints; Dose pack for chronic musculoskeletal problems
• LOCAL INJECTION: Used for tendinitis, bursitis, fasciitis
• TOPICAL USE: Dermatologic effects only
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SIDE EFFECTS: ORAL
• Osteoporosis: pathologic fractures• Avascular Necrosis• Disturb fat and carbo metabolism: increase risk
of diabetes; increased fat distribution in trunk and face
• Hypertension due to NA and H20 retention• Steroid myopathy• Steroid psychosis
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SIDE EFFECTS: LOCAL INJECTION
• No systemic effects
• False sense of recovery
• Local tendon/muscle atrophy: rupture
• Skin changes
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ANALGESICS
• Allow early initiation of rehab
• Improve quality of life for persons with chronic pain
• Allow patients to tolerate surgery
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NON-NARCOTIC
• Acetaminophen: Has central nervous system effect through cental inhibition of prostaglandins
• Aspirin: Has peripheral effect through peripheral inhibition of prostaglandins
• NSAIDS: Have analgesic effect on nervous system as well as decreased inflammation
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NARCOTIC
• Common property: bind to opioid receptors in brain
• Results in significant elevation of pain threshold; can be addictive
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INDICATIONS
• Mild/moderate musculoskeletal pain: non-narcotics; acetaminophen first choice; NSAIDS may be more logical if inflammation is causing pain, ie acute injuries and inflammatory arthritis
• Osteoarthritis: acetaminophen• Chronic musculoskeletal pain:
acetaminophen
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Continued……
• Acute postoperative pain: narcotics; can be given IV or IM
• Chronic, Severe pain: narcotics
See Table 3 for commonly used analgesic drugs
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SIDE EFFECTS
• ACETAMINOPHEN: generally safe; liver toxicity
• ASPIRIN/NSAIDS: as previously covered
• NARCOTICS: respiratory suppression; sedation, nausea and vomiting; urinary retention; euphoria/dependence
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ANTIBIOTICS
• Used to treat or prevent bacterial infections which can occur postoperatively or post compound fracture
• Classified based on chemical structure and effectiveness against certain bacteria (Table 4)
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INDICATIONS FOR USE
• Use drug best suited to fully eradicate the bacteria causing the infection
• Infection must be cultured to determine what kind it is
• Sometimes used prophylactically at time of surgery; mostly with patients with compromised immune system
• Always used with patients with open fractures