Orthosports Orthopaedic Update 2012
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Chief Complaint
Chief Complaint Please choose the primary reason you are coming to our office. Complaints are listed alphabetically. Please do not select more than 5 complaints. Upper Back: Thigh/Hip: Calf: o Asthma o Arterial insufficiency o Left calf pain o Bronchitis o Left hip pain o Left leg cramps o Emphysema o Left hip tendonitis o Left leg numbness o Left Flank Pain o Left leg cramps o Left leg pain o Midback pain o Left leg numbness o Left leg weakness o Left leg pain o Leg cramps Lower Back: o Left leg weakness o Leg numbness o Fatigue o Left post. thigh pain o Leg weakness o Left flank pain o Left thigh pain o Varicose veins o Low back pain o Sciatica o Venous insufficiency o Low back spasm o Venous insufficiency o Arterial insufficiency o Lumbar arthritis o Right hip pain o Right calf pain o Menstrual cramps o Right hip tendonitis Right leg o Right leg cramps o Nervousness cramps o Right leg numbness o Pain during BM o Right leg numbness o Right leg pain o Right flank pain o Right leg pain o Right leg weakness o Sacroiliac pain o Right leg weakness o Sciatica o Right post. thigh pain Neck: o Stiffness o Right thigh pain o Bronchitis o Whole body pain o Clavicular pain Head: Buttocks: o Cold o Agitation o Bleeding during BM o Coughing o Anxiety attack o Bursitis of hip o Dysphagia o Cold o Gluteal pain o Goiter o Diminished concentration o Hemorrhoids o Hoarseness o Dizziness o Left gluteal pain o Neck pain o Dysphagia o Left hip pain o Neck spasm o Ear pain o Left post. -
Bunion Basics
WHAT IS A BUNION? A bunion is a “bump” on the outer edge of your big toe and forms when the bone or tissue at the big toe joint moves out of place. You may have a bunion if this area of your foot is red, swollen, or painful. BUNION BASICS WHY DO I HAVE A BUNION? Blame your genetics first, but your footwear next! Bunions tend to run in families, specifically among those who have the foot type prone to developing a bunion. If you have flat feet, low arches, arthritis, or inflammatory joint disease, you can develop a bunion. Footwear choices play a role too! Wearing shoes that are too tight or cause the toes to be squeezed together, like many stylish peep-or pointed-toe shoes, aggravates a bunion-prone foot. WHAT CAN I DO ABOUT MY BUNION? If you’ve noticed the beginnings of a bunion, avoid high heels over two inches with tight toe-boxes. You can also use a bunion pad inside of your shoes to provide some protection. WHO CAN HELP WITH MY BUNION? Today’s podiatrist is the bunion expert and can help you Beat Bunion Blues! There are several treatment options available, including the following: – Padding and taping to minimize pain and keep the foot in a normal position, reducing stress and pain. – Anti-inflammatory medications and cortisone injections can be prescribed to ease acute pain and inflammation. – Physical therapy can relieve bunion pain, and ultrasound therapy is a technique for treating bunions and their associated soft tissue involvement. – Orthotics or shoe inserts may be useful in controlling foot function to prevent worsening of a bunion. -
The Pathomechanics of Plantar Fasciitis
Sports Med 2006; 36 (7): 585-611 REVIEW ARTICLE 0112-1642/06/0007-0585/$39.95/0 2006 Adis Data Information BV. All rights reserved. The Pathomechanics of Plantar Fasciitis Scott C. Wearing,1 James E. Smeathers,1 Stephen R. Urry,1 Ewald M. Hennig2 and Andrew P. Hills1 1 Institute of Health and Biomedical Innovation, Queensland University of Technology, Kelvin Grove, Queensland, Australia 2 Biomechanik Labor, University Duisburg-Essen, Essen, Germany Contents Abstract ....................................................................................585 1. Anatomy of the Plantar Fascia ............................................................586 1.1 Gross Anatomy of the Plantar Fascia...................................................586 1.2 Histological Anatomy of the Plantar Fascia .............................................589 1.2.1 Neuroanatomy ................................................................590 1.2.2 Microcirculation ...............................................................590 1.2.3 The Enthesis ...................................................................590 2. Mechanical Properties of the Plantar Fascia ................................................592 2.1 Structural Properties ..................................................................593 2.2 Material Properties ...................................................................593 3. Mechanical Function of the Plantar Fascia .................................................594 3.1 Quasistatic Models of Plantar Fascial Function ..........................................594 -
Hallux Valgus
MedicalContinuing Education Building Your FOOTWEAR PRACTICE Objectives 1) To be able to identify and evaluate the hallux abductovalgus deformity and associated pedal conditions 2) To know the current theory of etiology and pathomechanics of hallux valgus. 3) To know the results of recent Hallux Valgus empirical studies of the manage- ment of hallux valgus. Assessment and 4) To be aware of the role of conservative management, faulty footwear in the develop- ment of hallux valgus deformity. and the role of faulty footwear. 5) To know the pedorthic man- agement of hallux valgus and to be cognizant of the 10 rules for proper shoe fit. 6) To be familiar with all aspects of non-surgical management of hallux valgus and associated de- formities. Welcome to Podiatry Management’s CME Instructional program. Our journal has been approved as a sponsor of Continu- ing Medical Education by the Council on Podiatric Medical Education. You may enroll: 1) on a per issue basis (at $15 per topic) or 2) per year, for the special introductory rate of $99 (you save $51). You may submit the answer sheet, along with the other information requested, via mail, fax, or phone. In the near future, you may be able to submit via the Internet. If you correctly answer seventy (70%) of the questions correctly, you will receive a certificate attesting to your earned credits. You will also receive a record of any incorrectly answered questions. If you score less than 70%, you can retake the test at no additional cost. A list of states currently honoring CPME approved credits is listed on pg. -
Plantar Plate Pathology: a Review Article
MOJ Orthopedics & Rheumatology Plantar Plate Pathology: A Review Article Abstract Review Article The plantar plate is a thick fibrocartilage tissue located at the ball of the foot. Volume 6 Issue 6 - 2016 Pathology of the plantar plate is frequently missed or misdiagnosed and additionally, can be challenging to treat. Current surgical techniques include direct and indirect repairs. The purpose of this article is to help better understand and review the evaluation and treatment of plantar plate tears. Texas Sports Medicine Institute, USA Keywords: Plantar plate; lesser metatarsophalangeal joint; Weil metatarsal osteotomy; Lachman drawer; Kelikian pushup test *Corresponding author: Michael Maier, Texas Sports Medicine Institute, 7830 W, Grand Parkway S, Suite 280 Richmond, TX 77406, USA, Tel: 281-633-4940; Email: Introduction Received: October 05, 2016 | Published: December 14, 2016 and rupture are common sources of forefoot pain and deformity. FirstPlantar discussed plate in pathology the 1980s, including numerous inflammation, terms are used attenuation, to describe this condition including metatarsalgia, pre-dislocation syndrome, When the plantar plate ruptures and dorsal displacement of the lesser metatarsophalangeal joint (MTPJ) instability, and crossover proximal phalanx occurs, the ability of the intrinsic and extrinsic toe deformity [1]. It is important to recognize that these diagnoses musculature to provide dynamic stability of the lesser MTPJs are common manifestations of plantar plate dysfunction. is impaired. Changes of the biomechanical axes of the primary The second MTPJ is the most frequently affected with the incidence of this condition highest among women over the age longusflexors resultof the inlesser a defective MTPJs restraint(the interosseous to prevent muscles) dorsal subluxation in addition of 50 [2]. -
MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular Joints (TMJ) MRI - W/O Contrast
MUSCULOSKELETAL MRI Temporomandibular Joints (TMJ) Temporomandibular joints (TMJ) MRI - W/O Contrast . CPT Code 70336 • Arthritis • TMJ disc abnormality • Osteonecrosis (AVN) Temporomandibular joints (TMJ) MRI - W and W/O Contrast . CPT Code 70336 • Arthritis/Synovitis • Mass/Tumor Chest Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W/O Contrast . CPT Code 71550 • Rib fracture, costochondral cartilage injury • Muscle, tendon or nerve injury Chest Wall/Rib, Sternum, Bilateral Pectoralis Muscles, Bilateral Clavicles MRI - W and W/O Contrast . CPT Code 71552 • Mass/Tumor • Infection Upper Extremity (Non-Joint) Scapula MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Scapula MRI - W and W/O Contrast . CPT code 73220 • Mass/Tumor • Infection Humerus, Arm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Humerus, Arm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Forearm MRI - W/O Contrast . CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Forearm MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection Hand MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Hand MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Finger(s) MRI - W/O Contrast. CPT Code 73218 • Fracture • Muscle, tendon or nerve injury Finger(s) MRI - W and W/O Contrast . CPT Code 73220 • Mass/Tumor • Infection • Tenosynovitis Upper Extremity (Joint) Shoulder MRI - W/O Contrast. CPT Code 73221 • Muscle, tendon (rotator cuff) or nerve injury • Fracture • Osteoarthritis Shoulder MRI - W Contrast (Arthrogram only; no IV contrast) . CPT Code 73222 • Labral (SLAP) tear • Rotator cuff tear Shoulder MRI - W and W/O Contrast . -
Meniscus Tear
291 North Fireweed Soldotna, AK 99669 907-262-6454 www.kenaipeninsulaortho.com ______________________________________________________________________________________ Orthopaedic Surgeon: Hand and Wrist Specialist: Henry G. Krull, M.D. Edwin D. Vyhmeister, M.D. Meniscus Tear The meniscus is the rubbery, soft cartilage cushion in the knee. There are two of the C-shaped cushions in each knee, a medial (inner) and lateral (outer) meniscus. They sit between the two bones that form the knee joint, and function to cushion and support the knee. The meniscus can tear with injury or degeneration, or a combination of both. The medial meniscus is torn about 10X more frequently than the lateral meniscus. In young people, the meniscus usually tears with an injury. In older people, the cartilage can degenerate (weaken) with age, and can tear with or without an injury; spontaneous tears can occur. Meniscal tears can occur in association with other injuries to the knee. Symptoms: Pain is the usual symptom of complaint with a meniscus tear. There is often a noticeable “pop.” Swelling and stiffness can also occur. Mechanical symptoms are common—clicking, popping, and locking. Sometimes there is just a feeling that something is wrong inside the knee. Pain can be sharp, or can be dull and aching. Meniscus tears do not heal, but sometimes the symptoms dissipate. Chronic, intermittent symptoms is very common. Meniscal tears can cause a feeling of instability, or can cause the knee to buckle or give way. Cause: Injuries, particularly with sports, are a common cause of meniscal tears in young people. As people age, the meniscus tissue weakens through the normal degenerative process, and tears can occur spontaneously, or with simple activities, such as getting up from a chair, and changing direction while walking. -
Regenexx Corporate Brochure
COMMON CONDITIONS TREATED • neck and back bulging, collapsed, herniated, ruptured, slipped, or torn disc; degenerative disc disease; disc extrusion or protrusion; chronic back, neck, disc, or nerve pain • shoulder arthritis, labral tear or degeneration, recurrent shoulder dislocation, rotator cuff tear, rotator cuff tendonitis, joint replacement • elbow arthritis, instability, nerve entrapment (ulnar nerve), tennis elbow or golfer’s elbow • hand and wrist arthritis, carpal tunnel syndrome, instability, trigger finger, cml joint • hip arthritis, osteonecrosis, bursitis, labral/labrum tear, tendinopathy, joint replacement, avascular necrosis • knee arthritis; instability; sprain or tear of the ACL/PCL, MCL/LCL; meniscus tear, tendinopathy, joint replacement • ankle and foot instability, arthritis, bunions, ligament sprain or tear, plantar fasciitis, achilles tendinopathy Regenexx is the pioneer of interventional orthopedic National Clinic Network to Support Client treatments for musculoskeletal conditions in the Needs United States. These non-surgical procedures use a • FDA Compliant (CFR21 Part 1271) patient’s adult stem cells or blood platelets to initiate • Standardized Procedures and Protocol Quality healing of damaged tissues, tendons, ligaments, Assurance Program cartilage, spinal disc and bone. Our orthobiologic • Nationwide network of clinics and physicians to approach is the result of scientific advancements to support corporate client operations heal orthopedic injuries, treat arthritis and repair • Flexible Lab Platform delivering multiple joint degenerative conditions without the need for customized protocols surgery. • Experienced partners with self-funded companies Regenexx procedures use precisely guided, needle Research and Data Driven To Continuously based injections to concentrate healing factors in Improve Efficacy the precise area of damage while leaving a patient’s • Published over 30 times more research than any musculoskeletal structure intact. -
Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079)
Local Coverage Article: Billing and Coding: Injections - Tendon, Ligament, Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma (A57079) Links in PDF documents are not guaranteed to work. To follow a web link, please use the MCD Website. Contractor Information CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Noridian Healthcare Solutions, A and B MAC 01111 - MAC A J - E California - Entire State LLC Noridian Healthcare Solutions, A and B MAC 01112 - MAC B J - E California - Northern LLC Noridian Healthcare Solutions, A and B MAC 01182 - MAC B J - E California - Southern LLC Noridian Healthcare Solutions, A and B MAC 01211 - MAC A J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01212 - MAC B J - E American Samoa LLC Guam Hawaii Northern Mariana Islands Noridian Healthcare Solutions, A and B MAC 01311 - MAC A J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01312 - MAC B J - E Nevada LLC Noridian Healthcare Solutions, A and B MAC 01911 - MAC A J - E American Samoa LLC California - Entire State Guam Hawaii Nevada Northern Mariana Created on 09/28/2019. Page 1 of 33 CONTRACTOR NAME CONTRACT TYPE CONTRACT JURISDICTION STATE(S) NUMBER Islands Article Information General Information Original Effective Date 10/01/2019 Article ID Revision Effective Date A57079 N/A Article Title Revision Ending Date Billing and Coding: Injections - Tendon, Ligament, N/A Ganglion Cyst, Tunnel Syndromes and Morton's Neuroma Retirement Date N/A Article Type Billing and Coding AMA CPT / ADA CDT / AHA NUBC Copyright Statement CPT codes, descriptions and other data only are copyright 2018 American Medical Association. -
Bunion Surgery - Orthoinfo - AAOS 6/10/12 3:20 PM
Bunion Surgery - OrthoInfo - AAOS 6/10/12 3:20 PM Copyright 2001 American Academy of Orthopaedic Surgeons Bunion Surgery Most bunions can be treated without surgery. But when nonsurgical treatments are not enough, surgery can relieve your pain, correct any related foot deformity, and help you resume your normal activities. An orthopaedic surgeon can help you decide if surgery is the best option for you. Whether you've just begun exploring treatment for bunions or have already decided with your orthopaedic surgeon to have surgery, this booklet will help you understand more about this valuable procedure. What Is A Bunion? A bunion is one problem that can develop due to hallux valgus, a foot deformity. The term "hallux valgus" is Latin and means a turning outward (valgus) of the big toe (hallux). The bone which joins the big toe, the first metatarsal, becomes prominent on the inner border of the foot. This bump is the bunion and is made up of bone and soft tissue. What Causes Bunions? By far the most common cause of bunions is the prolonged wearing of poorly fitting shoes, usually shoes with a narrow, pointed toe box that squeezes the toes into an unnatural position. Bunions also may be caused by arthritis or polio. Heredity often plays a role in bunion formation. But these causes account for only a small percentage of bunions. A study by the American Orthopaedic Foot and Ankle Society found that 88 percent of women in the U.S. wear shoes that are too small and 55 percent have bunions. Not surprisingly, bunions are nine times more common in women than men. -
Common Disorders of the Knee
7/27/2017 Common Disorders of Disclosures the Knee Carlin Senter, MD I have nothing to disclose. Associate Professor Primary Care Sports Medicine UCSF Medicine and Orthopaedics UCSF Essentials of Primary Care August 8, 2017 Knee: Top 3 referral diagnoses from Objectives primary care IM to ortho (at UCSF in 2011) 1. Osteoarthritis (OA) Upon completion of this session, participants should be able to: 2. Anterior knee pain 1. List 4 exam maneuvers for meniscus tear • Patellofemoral pain syndrome 2. List the diagnostic criteria for knee OA • Chondromalacia patella 3. Identify 5 non operative treatment options for knee OA • Patellar tendinopathy 4. Identify indications for surgery for patient with meniscus tear 3. Meniscus tear ‒ Without knee OA ‒ With knee OA 5. Generate a differential diagnosis for chronic anterior knee pain 1 7/27/2017 Case #1 All of the following tests, if positive, would raise concern for a meniscus tear except… 25 y/o man with medial-sided pain and swelling of the R knee for 6 A. Joint line tenderness weeks since he twisted the knee playing soccer. No locking, no instability. B. Pain when he stands and pivots on the knee C. Pain when you axially load and rotate the knee D. Pain when you flex the R knee and extend the R hip with the patient lying on his left side. E. Pain when he squats 4 tests for meniscus tear Joint line tenderness 1. Isolated joint line tenderness 2. McMurray 3. Thessaly 4. Squat Medial: Sensitivity 83%, Specificity 76% Lateral: Sensitivity 68%, Specificity 97% (Konan et al. -
Clinical Guidelines: Foot / Ankle
Clinical Guidelines: Foot / Ankle Plantar Fasciitis/Heel spurs: Initial Evaluation: History includes usually atraumatic plantar medial heel pain, worst first thing in the morning or after prolonged sitting. Exam includes tenderness with deep palpation of the plantar medial heel. Squeezing the heel bone side to side is NOT tender, but if present could represent a calcaneal stress fracture. X-rays may or may not reveal a heel spur, but the spur is NOT the source of the pain despite podiatry frequently referring to this as “heel spur syndrome.” Follow-up: The plantar fascia is the soft tissue under our foot that runs from the heel to the toes, much like the palm of our hand; it is the sole of our foot. The plantar fascia stretch includes crossing your legs and dorsiflexing the ankle and stretching the toes into extension. This is the most effective stretch. A night splint is imperative for improvement and should be used at night for 6 weeks. Cortisone injections and physical therapy can be helpful. NSAIDS and a frozen water bottle rolled on the plantar foot could be used with the above treatment, but the most effective treatment is a night splint. Referral: 90% of heel pain resolves with non-op treatment, but make a referral to a foot / ankle ortho surgeon with any atypical heel pain or failure of 6-8 weeks of non-operative treatment. Atypical heel pain usually gets an MRI, but classic plantar fasciitis does not. Bunion (hallux valgus): Initial Treatment: Bunion deformity includes a bump on the medial side of the big toe, the big toe going the wrong way, and a widened forefoot.