non operative management

Lateral Epicondylitis / Tennis Elbow

Incidence

 

Lateral : Medial 9:1

 

Epidemiology

 

4th & 5th decades

- M = F

- 75% dominant arm 

 

50% of regular tennis players

- especially > 2 hrs / week

 

Aetiology

 

Insertion pathology / Enthesopathy

 

Over-extension of the elbow with supination / pronation

 

Anatomy

 

Lateral epicondyle

- anconeus from posterior face

- ECRB and EDC from anterior face (CEO)

Osteoarthritis

Non Operative Management

 

Options / ELM POPI

 

Education

Lifestyle Management

- weight loss

- reduce sport

Physiotherapy

Orthotics

- walking stick

- braces

Pharmaceuticals

- NSAIDS

- acetominophen

- glucosamine

Injections

- cortisone

- hyaluronic acid

 

Management Options

NHx

 

Natural History of ACL deficient knee is variable

- functional instability 15% - 90%

- progression to OA is variable

 

Depends on level of patient demands / activity

 

1.  Late meniscal injury in ACL deficient knee

 

15-25%

 

2.  Function

 

Daniels Am J Sports Med 1994

- 292 ACL defecients knees

AVN

 

SONK              vs                          Atraumatic AVN

 

>55                                              Often mid 30's

Bunionette

Definition

 

Painful prominence of lateral eminence of 5th metatarsal head 

 

Coughlin Classification 

 

Type I deformity 

- prominent lateral condyle 5th metatarsal head

- lateral condylectomy

 

Type II deformity 

- lateral bowing of 5th metatarsal

- chevron osteotomy

 

Hallux Rigidus

Definition

 

Painful restriction of dorsiflexion of the great toe 

- secondary to degenerative changes in MTPJ

- initially pain and synovitis

- osteophytes don't form medially or on plantar aspect

 

Epidemiology 

 

Two peaks

1.  Adolescence F > M

2.  Middle Age M > F

 

Aetiology

 

Often Idiopathic

 

Trauma

Insertional Achilles Tendinopathy

Definition

 

Inflammation of achilles tendon; insertional or noninsertional

 

Spectrum

 

Tendonitis / Tendonosis / Rupture

 

Anatomy

 

Triceps surae

- medial and lateral gastrocnemius

- soleus

- surrounded by paratenon which allows gliding and supplies nutrition

 

Inserts middle 1/3 calcaneal tuberosity

- 2 x 2 cm area

- 90o rotation distally

 

Retrocalcaneal bursa (x2)

Achilles Tendon Rupture

AnatomyAchilles tendon anatomy

 

Gastrocnemius tendon 10-25 cm long

- soleus 3-10 cm

- inserts superior calcaneal tuberosity

- fibres spiral 90°

- fibres that lie medially in proximal portion become posterior distally

- allows elastic recoil & energy storage

 

Plantaris present in 90% population

- medial to T Achilles

 

Poor blood supply midportion

- mesotenal vessels