examination

Examination

Diagnostic Issues

 

Supraclavicular

- nerve root patterns of sensation and motor disturbance

 

Infraclavicular

- peripheral nerve root pattern / cord

 

Supraclavicular preganglionic

- dorsal scapular / long thoracic / suprascapular nerves injured

- Horner's

- lack of sensation supraclavicular

- no tinel's

 

Sportsman's Hernia

Definition

 

Groin pain in athletes

- secondary to tear in external oblique fascia

 

Epidemiology

 

Sports with aggressive adduction

- hockey / soccer

 

Pathology

 

Tears in external oblique fascia

- tend to be central

- around spermatic cord and ilioinguinal nerve

- pain may be from nerve entrapment

 

DDx

 

Adductor Longus Tear

MCL Insufficiency

AetiologyTommy John Surgery

 

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

 

History

 

Initially

- lose velocity / accuracy

 

Develop medial pain

 

40% ulna nerve symptoms

 

Background

Definition

 

A fixed equinus deformity of the forefoot in relation to the hindfoot 

- resulting in an abnormally high arch that fails to flatten with weight bearing

- deformity may be forefoot, hindfoot or combination

 

Foot CavusFoot Cavovarus

 

Aetiology

 

Background

Aetiology

 

Intrinsic

- inflammatory

- degenerative

 

Extrinsic

- traumatic

- spur

 

Epidemiology

 

F > 40

 

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

 

Background

DefinitionHallux Valgus Severe

 

Bunion

- medial prominence of head of 1st MT

 

Hallux Valgus

- medial deviation 1st MT

- lateral deviation of great toe

 

Anatomy

 

Metatarsal head

- has 2 grooves separating ridge (cristae)

 

Painful TKR

Differential Diagnosis of the Painful TKA 

 

Surgical Diagnosis  

 

1.  Prosthetic loosening and failure 

2.  Infection 

3.  Patellofemoral tracking problems  

4.  Instability 

5.  Recurrent intra-articular soft-tissue impingement / Component overhang  

 

Nonsurgical Diagnoses  

 

1.  Referred pain - Hip / Back  

ITB Friction Syndrome

Pathology

 

ITB rubbing on LFC

- long distance runners (slow running more at risk than fast)

- cyclists (seat too high, improper technique)

 

ITB becomes tight, especially posterior portion

 

Develop inflammed tissue under ITB

- synovium

- bursa

 

Aetiology

 

Overuse 

- sudden increase in distance

- hill running

- genu varum 

- improper shoe wear

Revison ACL Surgery

Graft selection

 

A.  Synthetic Grafts

 

Good initial results but unacceptably high failure rate with longer follow-up

 

Problems

 

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

 

2.  Recurrent synovitis, infection, loosening and osteolysis

 

B.  Autograft

 

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