DOCSLIB.ORG

Disclosures Overview Acute Hemarthrosis

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Disclosures Overview Acute Hemarthrosis Disclosures • Founder, RunSafe™ Common Injuries of the Knee • Founder, SportZPeak Inc. and Shoulder • Sanofi, Investigator initiated grant A n t h o n y L u k e MD, MPH, CAQ (Sport Med) University of California, San Francisco Primary Care Medicine: Update 2017 Overview Acute Hemarthrosis • Highlight common 1) ACL (almost 50% in children, >70% in presentations adults) • Knee 2) Fracture (Patella, tibial plateau, Femoral • Shoulder supracondylar, Physeal) • Discuss basics of 3) Patellar dislocation conservative and surgical management • Unlikely meniscal lesions 1 Emergencies Urgent Orthopedic Referral 1. Neurovascular injury •Fracture 2. Knee Dislocation • Patellar Dislocation – Associated with multiple ligament injuries • “Locked Joint” - unable to fully extend the (posterolateral) knee (OCD or Meniscal tear) – High risk of popliteal artery injury • Tumor – Needs arteriogram 3. Fractures (open, unstable) 4. Septic Arthritis Anterior Cruciate Ligament (ACL) Anterior Cruciate Ligament (ACL) Tear Tear Mechanism Symptoms • Landing from a • Audible pop heard or felt jump, pivoting or • Pain and tense swelling in decelerating minutes after injury suddenly • Feels unstable (bones • Foot fixed, valgus shifting or giving way) stress • “O’Donaghue’s Unhappy Triad” = Medial meniscus tear, MCL injury, ACL tear • Lateral meniscus tears Double fist sign more common than medial 2 ACL physical exam Special Tests ACL LOOK • Effusion (if acute) • Lachman's test – test at 20° FEEL Sens 81.8%, Spec 96.8% • “O’Donaghue’s Unhappy Triad” = Medial meniscus tear, MCL • Anterior drawer – test at injury, ACL tear 90° • Lateral meniscus tears more Sens 22 - 41%, Spec 97%* common than medial • Lateral joint line tender - • Pivot shift femoral condyle bone bruise Sens 35 - 98.4%*, Spec 98%* Malanga GA, Nadler SF. MOVE Musculoskeletal Physical • Maybe limited due to effusion Examination, Mosby, 2006 or other internal derangement * - denotes under anesthesia X-ray MRI • Usually non- • Sens 94%, Spec 84% diagnostic for ACL tear ACL tear signs • Can help rule in or • Fibers not seen in out injuries continuity • Edema on T2 films • Segond fracture – • PCL – kinked or avulsion over Question mark sign lateral tibial plateau 3 MRI Initial Treatment • Sens 94%, Spec 84% • Referral to Orthopaedics/Sports Medicine for ACL tear • Consider bracing, crutches ACL tear signs • Begin early Physical Therapy • Lateral femoral corner bone bruise on T2 • Analgesia usually NSAIDs • May have meniscal tear (Lateral > medial) ACL Tear Treatment Meniscus Tear Conservative Surgery Mechanism Symptoms • No reconstruction • Reconstruction • Occurs after twisting •Catching • Physical therapy • Depends on activity injury or deep squat • Medial or lateral knee • Hamstring demands • Patient may not recall pain strengthening Reconstruction allows • Proprioceptive training better return to sports specific injury • Usually posterior • ACL bracing Reduce chance of aspects of joint line controversial symptomatic meniscal tear • Swelling • Patient should be Less giving way asymptomatic with symptoms ADL’s • Recovery ~ 6-9 months Shea KG, et al. AAOS evidence based reivew, J Bone Joint Surg Am, 2015 4 Special Tests: Meniscus Modified McMurray Testing Fowler PJ, Lubliner JA. Arthroscopy 1989; 5(3): 184-186. Test Sensitivity Specificity • Flex hip to 90 Joint line tender 85.5% 29.4% degrees • Flex knee Hyperflexion 50% 68.2% • Internally or externally Extension block 84.7% 43.75% rotate lower leg with rotation of knee McMurray Classic 28.75% 95.3% (Med Thud) • Fully flex the knee McMurray Classic (Lat 50% 29% with rotations pain) Appley (Comp/Dist) 16% / 5% Courtesy of Keegan Duchicella MD X-ray MRI • May show joint space • MRI for specific exam narrowing and early osteoarthritis changes • Look for fluid (linear bright signal on T2) • Rule out loose bodies into the meniscus 5 Arthroscopy Benefit? Exercise as Good as Arthroscopy? • An RCT showed that physical therapy vs • RCT found that patients with degenerative arthrosopic partial meniscectomy had meniscus tears but no signs of arthritis on similar outcomes at 6 months imaging treated conservatively with • 30% of the patients who were assigned to supervised exercise therapy had similar physical therapy alone, underwent surgery outcomes to those treated with within 6 months. arthroscopy with 2 year follow up. – Katz JN et al. N Engl J Med. 2013 – Sihvonen R et al; N Engl J Med. 2013 Kise NJ et al., BMJ, 2016 Medial Collateral Ligament (MCL) Meniscal Tear Treatment Injury Conservative Surgery Mechanism Symptoms • Often if degenerative • Operate if internal • Valgus stress to • Pain medially tear in older patient derangement partially flexed knee • May feel unstable • Similar treatment to symptoms • Blow to lateral leg with valgus mild knee osteoarthritis • Meniscal repair if possible • Analgesia • Physical therapy • General Leg Strengthening 6 Medial Collateral Ligament (MCL) MRI Injury Physical Exam • Tender medially over • X-ray non-diagnostic MCL (often (rarely avulsion) proximally) • MRI not usually • May lack ROM necessary “pseudolocking” • Rule out meniscal • Valgus stress test tear Posterior Cruciate Ligament (PCL) MCL Treatment Injury Conservative Surgery Mechanism Symptoms • Analgesia • Rarely needs surgery • Fall directly on knee • Pain with activities • Protected motion with foot plantarflexed • “Disability” > +/- hinged brace • “Dashboard injury” “Instability” +/- crutches • Early physical therapy 7 Posterior Cruciate Ligament (PCL) PCL Treatment Injury Physical Exam Conservative Surgery • Sag sign • Acute: hinged • May require surgery Sens 79%, Spec 100% post-op brace in if complete Grade 3 extension (0-10° tear and symptomatic • Posterior drawer test flexion) Sens 90%, Spec 99% • Crutches • Needs urgent surgery Rubenstein et al., Am J Sports Med, 1994; 22: 550-557 • Early physical if lateral side is therapy unstable postero- X-ray- often non-diagnostic lateral corner injury MRI is test of choice Early and urgent referral!! Patellofemoral Pain PFP Syndrome • Excessive Symptoms • Tender over facets of compressive forces • Anterior knee pain patella over articulating • Worse with bending surfaces of PFP joint • Apprehension sign (5x body wt), stairs suggests possible (3x body wt) instability Mechanism • Crepitus under • Too kneecap loose/hypermobile • May sublux if loose • X-rays may show • Too tight – XS lateral deviation or tilt pressure 8 Treatment Options What’s Hip? Too Loose/Weak Surgical (RARE) • Strengthen quads (Vastus Medialis Obliquus) • Last resort • Correct alignment (+/-orthotics) • Lateral release • Support (McConnell Taping, • Patellar Bracing) realignment Too Tight • Stretch hamstring, quadriceps, hip flexor • Strengthen quads, hip abductors • Correct alignment (+/-orthotics) Prevalence of Knee Osteoarthritis Cartilage Damage • As the number of persons over age 65 years, prevalence estimated to double to more than 70 million by 2030. • The incidence of knee OA in the United States is 240 per 100,000 person-years. Outerbridge Classification, 1961 9 Arthroscopy Arthroscopy Osteoarthritis What is Osteoarthritis? • OA is a disease characterized by Superficial Zone cartilage Transition Zone degeneration • Cartilage loss and Radial Zone OA symptoms are preceded by damage to the collagen- Tidemark Calcified cartilage proteoglycan (PG) Subchondral bone plate matrix Vascular plexus 10 Concepts Diagnosis - History Arthritis Symptoms • Pain • Irreversible Articular • Mechanical Cartilage Change – Grinding • Cure Not Possible –Catching • Try To Maintain Activity – Locking Level – Giving Way • Swelling Diagnosis - Radiographs In FWB Extension XR 11 Treatment Options • Conservative • Surgical Try Conservative Management Conservative Treatment First • Lifestyle Unloader Brace • Shoe Wear • Off Load Arthritic • Brace Wear Compartment • Rehabilitation/PT • Pain Relief Lindenfield, et al Pollo / HSS, AJSM 2002 12 Conservative Treatment Platelet Rich Plasma ? Medications • Platelet-rich plasma injections contain high concentration of platelet-derived growth factors, which regulate some • NSAID / Tylenol biologic processes in tissue repair. • Analgesics • Glucosamine / Chondroitin • A meta-analysis of 10 studies demonstrated that platelet- rich plasma injections reduced pain in patients with knee • Steroid injections OA more efficiently than placebo and hyaluronic acid • Viscosupplementation injections. However, 9 of the 10 studies had a high risk (Hyaluronic Acid of bias, and the underlying mechanism of biologic injections) healing is unknown. Laudy AB et al. Br J Sports Med. 2015 Surgical Treatment Arthroscopy Arthroscopy for OA • Prospective, Randomized Placebo • Used for Internal Controlled Study Derangement • 165 VA Patients Symptoms • Placebo vs Lavage vs Debridement had similar Knee Specific Pain • Treat Focal Lesions Scores at 1 and 2 years follow up • Remove loose bodies Moseley, New Engl J Med, 2002 • No difference in outcomes: WOMAC, • Temporizing SF-36 Physical component summary score • High Demand Kirkley, New Engl J Med, 2008 • No Malalignment 13 High Tibial Osteotomy High Tibial Osteotomy Technique Opening Wedge Results Good To Excellent • 73% - 95% @ 5 yrs • 45% - 80% @ 10 yrs • 30% – 46% @ 20 yrs • Jevsevar DS. Treatment of osteoarthritis of the knee: evidence-based guideline, 2nd edition. J Am Acad Orthop Surg. 2013 Unicondylar Arthroplasty Total Knee Arthroplasty Results 5-year survival rate was 87.8% Replace All Joint Surfaces (95% CI, 87.3% to 88.3%) • Significant negative influence Excellent, Reliable Pain
Load more

Recommended publications
  • Injuries to the Lower Extremity
    InjuriesInjuries toto thethe LowerLower ExtremityExtremity MostMost commoncommon duedue toto applicationapplication ofof largelarge loads.loads. ImportantImportant becausebecause ofof thethe rolerole onon thethe lowerlower extremityextremity inin locomotionlocomotion HipHip AnatomyAnatomy Ball & Socket (3D) Ligament support Iliofemoral pubofemoral ischiofemoral ligamentum teres Joint capsule: labrum HipHip MusclesMuscles Flexion Extension Abduction Adduction Int. Rotation Ext. Rotation Adductors X X Tensor XXX fascia Gluteus XX Max Gluteus XX Medius Gluteus XX Minimus Gracilis X Ilopsoas X Pectinuous X X X Piriformis + + X Hamstrings X Sartorius X Rectus X Femoris HipHip fracturesfractures High energy forces falls car accidents pelvic (side impacts) high mortality rates Femoral neck fractures > 250,000 women 3 times likely to get fracture HipHip fracturesfractures Young people: high energy impacts Mechanism direct impact lateral rotation of leg Stress fractures femur Dynamic models of falls impact forces 3-10 kN HipHip LuxationLuxation (dislocation)(dislocation) Not common: hip stability High forces Most cases posterior dislocation Car accidents: dashboard Anterior inferior dislocation 10-20% of hip dislocation Force abduction Abduction, flexion and ext. rotation (obturator) Hip retroversion (toe-in) Congenital dislocation (infants) ThighThigh injuriesinjuries Three muscular compartments Ant. Medial anterior medial posterior Quadriceps contusion blunt trauma extensive hematoma swelling increase
    [Show full text]
  • Triple Dislocation Around the Knee Joint – a Case Report
    ical C lin as Chew et al., J Clin Case Rep 2019, 9:9 C e f R o l e a p n o r r t u s o J Journal of Clinical Case Reports ISSN: 2165-7920 Case Report Open Access Triple Dislocation around the Knee Joint – A Case Report Chew E1, Sharma A2 and Gupte C2 1Epsom and St Helier NHS Trust, Dorking Road, Epsom KT18 7EG, UK 2Imperial College Healthcare NHS Trust, South Wharf Road, Paddington, London W2 1NY, UK Abstract Dislocation of the knee is a serious and potentially limb threatening injury. There are 3 types of dislocation around the knee joint: patellofemoral, tibiofemoral and tibiofibular. Tibiofemoral dislocation is the variant that is deemed the most serious, with a higher risk of compromise to the popliteal artery and common peroneal nerve. Although simultaneous dislocations of two types have been described, there has been no such description of all three types occurring simultaneously. In this case we present a case of simultaneous dislocations of all 3 articulations around the knee. Diagnosis was achieved with clinical examination, plain films, CT and MRI scans. Management consisted of initial surgical debridement and reduction with stabilisation of the affected joints. Keywords: Knee; Dislocation; Trauma; Orthopaedic Surgery was unaffected and maintained its normal motor and sensory function throughout. She was then transferred by air ambulance to our specialist Introduction knee trauma unit where she underwent repeat secondary survey and The knee is a synovial joint formed by the articulations of the patella, radiological investigations including, MRI and CT. femur and tibia.
    [Show full text]
  • Diagnosis and Treatment of Multiligament Knee Injury: State of the Art Gilbert Moatshe,1,2,3 Jorge Chahla,2,4 Robert F Laprade,2,5 Lars Engebretsen1,3
    Journal of ISAKOS: Joint Disorders & Orthopaedic Sports Medicine Publish Ahead of Print, published on March 8, 2017 as doi:10.1136/jisakos-2016-000072 State of the Art J ISAKOS: first published as 10.1136/jisakos-2016-000072 on 8 March 2017. Downloaded from Diagnosis and treatment of multiligament knee injury: state of the art Gilbert Moatshe,1,2,3 Jorge Chahla,2,4 Robert F LaPrade,2,5 Lars Engebretsen1,3 1Oslo University Hospital and ABSTRact diagnostic workup and treatment plan is mandatory University of Oslo, Oslo, Norway when dealing with these injuries. The purpose of 2 Multiligament knee injuries constitute a complex and Steadman Philippon Research this article is to review specific focused principles Institute, Vail, Colorado, USA challenging entity, not only because of the diagnosis 3OSTRC, The Norwegian School and reconstruction procedure itself, but also because of of multiligament knee injuries, classification, diag- of Sports Sciences, Oslo, Norway the rehabilitation programme after the index procedure. nosis, treatment options and rehabilitation guide- 4Hospital Britanico de Buenos A high level of suspicion and a comprehensive clinical lines for addressing these complex injuries. Key Aires, Buenos Aires, Argentina and radiographic examination are required to identify information and articles on these injuries can be 5The Steadman Clinic, Vail, Colorado, USA all injured structures. Concomitant meniscal, chondral found in box 1 and box 2 respectively. and nerve injuries are common in multiligament injuries Correspondence to necessitating a detailed evaluation. Stress radiographs Classification Dr Robert F LaPrade, The are valuable in evaluating patients preoperatively Schenck described the most widely used classifica- Steadman Philippon Research and postoperatively.
    [Show full text]
  • Management of Knee Dislocation Prior to Ligament Reconstruction: What Is the Current Evidence? Update of a Universal Treatment Algorithm
    European Journal of Orthopaedic Surgery & Traumatology https://doi.org/10.1007/s00590-018-2148-4 GENERAL REVIEW • KNEE - BIOMECHANICS Management of knee dislocation prior to ligament reconstruction: What is the current evidence? Update of a universal treatment algorithm Alexander Maslaris1 · Olaf Brinkmann1 · Matthias Bungartz1 · Christian Krettek2 · Michael Jagodzinski2 · Emmanouil Liodakis2 Received: 25 August 2017 / Accepted: 3 February 2018 © Springer-Verlag France SAS, part of Springer Nature 2018 Abstract Traumatic knee dislocation is a rare but potentially limb-threatening injury. Thus proper initial diagnosis and treatment up to final ligament reconstruction are extremely important and a precondition to successful outcomes. Reports suggest that evidence-based systematic approaches lead to better results. Because of the complexity of this injury and the inhomogeneity of related literature, there are still various controversies and knowledge gaps regarding decision-making and step-sequencing in the treatment of acute multi-ligament knee injuries and knee dislocations. The use of ankle-brachial index, routine or selective angiography, braces, joint-spanning or dynamic external fixation, and the necessity of initial ligament re-fixation during acute surgery constitutes current topics of a scholarly debate. The aim of this article was to provide a comprehensive literature review bringing light into some important aspects about the initial treatment of knee dislocation (vascular injury, neural injury, immobilization techniques) and finally develop an accurate data-based universal algorithm, enabling attending physicians to become more acquainted with the management of acute knee dislocation. Keywords Knee dislocation · MLKI · Initial management · Protocol · Vascular injury · Nerve injury · Immobilization · Fixator · Brace · Cast Introduction Traumatic knee dislocation (KD) is a rare injury, reach- ing incidences between 0.001% of general population and 0.072% of orthopaedic traumata [1–6].
    [Show full text]
  • The Acutely Dislocated Knee: Evaluation and Management
    The Acutely Dislocated Knee: Evaluation and Management Jeffrey A. Rihn, MD, Peter S. Cha, MD, Yram J. Groff, MD, and Christopher D. Harner, MD 02/25/2021 on BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= by http://journals.lww.com/jaaos from Downloaded Abstract Downloaded Acute knee dislocations are uncommon orthopaedic injuries. Because they often spon- (within 3 weeks of injury).6,8,13,14 Most taneously reduce before initial evaluation, the true incidence is unknown. Dislo- of the principles of evaluation and from http://journals.lww.com/jaaos cation involves injury to multiple ligaments of the knee, resulting in multidirec- management of the patient with an tional instability. Associated meniscal, osteochondral, and neurovascular injuries acutely dislocated knee are well es- are often present and can complicate management. The substantial risk of associ- tablished;15 recent advances have cen- ated vascular injury mandates that vascular integrity be confirmed by angiography tered on improvements in surgical in all suspected knee dislocations. Evaluation and initial management must be per- technique. by BhDMf5ePHKav1zEoum1tQfN4a+kJLhEZgbsIHo4XMi0hCywCX1AWnYQp/IlQrHD3i3D0OdRyi7TvSFl4Cf3VC4/OAVpDDa8KKGKV0Ymy+78= formed expeditiously to prevent limb-threatening complications. Definitive manage- ment of acute knee dislocation remains a matter of debate; however, surgical recon- struction or repair of all ligamentous injuries likely can help in achieving the return Classification
    [Show full text]
  • Leg Problems in Athletes
    ACMS Team Physician CourseSan AntonioFeb 2015 LEG PROBLEMS IN ATHLETES Marlene DeMaio, MD Prof, Dept of Orthopaedic Surgery, Marshall University VAMC Huntington, WV LEG PROBLEMS • LIMB THREATENING Approach – AcuteEmergency treatment – ChronicUrgent workup and treatment S1.totalprosports.com • NOT LIMB THREATENING Approach – Usually chronic – Systematic work up Edc2.healthtap.com – Comprehensive treatment Limb Threatening Leg Disorders • Loss of oxygenation – Vascular compromise – Amputation – Crush Injury – Acute compartment syndrome • Vascular compromise – NEVER ASSUME ARTERIAL SPASM – Vessel compression or injury (tear, laceration) • From bone fragment or bone displacement • Associated with KNEE dislocation Limb Threatening Leg Problems EXTREME SPORTS – NO VEHICLES • Jumpers – Bungee jumpers – Helo skiers – Parachuters • Skate boarders • Skiers • Parasailers INJURY COMBINATIONS • Any lower extremity fracture → acute compartment syndrome • Mechanism of injury • Other injuries • Immobilization • Compressive Dressings Injury Combinations – Medial tibial plateau fractures → knee dislocation – Femoral shaft fracture → knee dislocation (Giannoudis, J Ortho Trauma 2005) www.trauma.org Knee Dislocation IMMEDIATEMENT ASSESSMENT: Vascular status TREATMENT: Reduce and stabilize (Knee immobilizer) Restore blood flow Manage compartment syndrome BEWARE: posterolateral dislocations Photo from C. Roberts, MD Limb Threatening Leg Problems • Acute compartment syndrome – Multiple trauma versus isolated injury – ATLS • Even for isolated trauma • ABC’s
    [Show full text]
  • Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction
    UW HEALTH SPORTS REHABILITATION Rehabilitation Guidelines for Knee Multi-Ligament Repair/Reconstruction The knee joint is comprised of an A B articulation of three bones: the femur Medial (thigh bone), tibia (shin bone), Collateral Ligament Lateral and patella (knee cap). The femur (MCL) Collateral has a medial (inside) and a lateral Ligament (outside) condyle that forms a radial (LCL) or rounded bottom that comes together, forming a trochlear groove for the patella to move. The medial and lateral condyle sit on top of the Fat LM Fat Pad tibia, which has a flat surface called Pad MM the tibial plateau. The knee also is comprised of two Fibula menisci, which are fibro-cartilaginous structures and each meniscus Figure 1 a: Medial or inner view of the knee showing the medial collateral ligament, is thinner towards the center of b: Lateral or outer view of the knee showing the lateral collateral ligament. the knee and thicker toward the Image property of Primal Pictures, Ltd., primalpictures.com. Use of this image without authorization from Primal Pictures, Ltd. is prohibited. periphery of the knee, giving it a wedge-shaped appearance. The Femur medial meniscus forms a “c” shape and is located between the medial ACL femoral condyle and the medial ACL LCL aspect of the tibia. The lateral meniscus forms an oval shape and is PCL located between the lateral femoral condyle and the lateral aspect of the MM LM tibia. The menisci act to improve stability between the tibia and the Menisci MCL Tibia femur secondary to its wedge shape that acts to limit translation.
    [Show full text]
  • Complex Knee Injuries
    Journal of Orthopaedic Education219 Original Article Volume 3 Number 2, July- December 2017 DOI:http://dx.doi.org/10.21088/joe.2454.7956.3217.16 Complex Knee Injuries R.B. Uppin1, S.K.Saidapur2, ChintanN. Patel3 Author Affiliation: 1Professor, Dept. of Orthopaedics, KLE Academy of Higher Education, J.N. Medical College &Dr.PrabhakarKoreHospitalandMedicalResearchCenter,Belgaum–590010,Karnataka,India. 2Assistant Professor 3Postgraduate Student, Dept. of Orthopaedics, J.N. Medical College, Belagavi, Karnataka 590010, India. CorrespondingAuthor: R.B. Uppin, Professor, Dept. of Orthopaedics, KLE Academy of Higher Education, J.N. MedicalCollege&Dr.PrabhakarKoreHospitalandMedicalResearchCenter,Belgaum–590010,Karnataka,India. E-mail: [email protected] Received: 05October2017, Accepted on: 12October2017 Abstract AsquotedbyReneDescartes[1]“Thehumanbodyisamachinewhosemovementsaredirectedbysoul”; andkneebeingacomplexjointwithmyriadligamentsandstabilityandmayleadtovaryingdegreeof impairments.Managementoffourcomplexkneejointinjuriesfollowingtraumaarediscussedinthisarticle. Keywords:Injuries;Myriadligaments. Introduction Greatstabilitymainlydependsontheintegrityofthe ligamentousstructures. Thekneejointisthelargestandmostcomplicated synovialjointinthebody.Kneejointisamodified- hingediarthrodialsynovialjoint[2]witharticulation betweenthefemurandtibiawhichisweightbearing andthearticulationbetweenthepatellaandfemur whichallowsthepullofquadricepsfemorismuscle tobedirectedanteriorlyoverthekneetothetibia withouttendonwear.Thefibro-cartilagenous
    [Show full text]
  • ACR Appropriateness Criteria® Acute Trauma to the Knee
    Revised 2019 American College of Radiology ACR Appropriateness Criteria® Acute Trauma to the Knee Variant 1: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. No focal tenderness, no effusion, able to walk. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee May Be Appropriate ☢ Bone scan with SPECT or SPECT/CT knee Usually Not Appropriate ☢☢☢ CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ CT knee without IV contrast Usually Not Appropriate ☢ MR arthrography knee Usually Not Appropriate O MRA knee without and with IV contrast Usually Not Appropriate O MRA knee without IV contrast Usually Not Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O MRI knee without IV contrast Usually Not Appropriate O US knee Usually Not Appropriate O Variant 2: Adult or child 5 years of age or older. Fall or acute twisting trauma to the knee. One or more of the following: focal tenderness, effusion, inability to bear weight. Initial imaging. Procedure Appropriateness Category Relative Radiation Level Radiography knee Usually Appropriate ☢ Bone scan with SPECT or SPECT/CT knee Usually Not Appropriate ☢☢☢ CT knee with IV contrast Usually Not Appropriate ☢ CT knee without and with IV contrast Usually Not Appropriate ☢ CT knee without IV contrast Usually Not Appropriate ☢ MR arthrography knee Usually Not Appropriate O MRA knee without and with IV contrast Usually Not Appropriate O MRA knee without IV contrast Usually Not Appropriate O MRI knee without and with IV contrast Usually Not Appropriate O MRI knee without IV contrast Usually Not Appropriate O US knee Usually Not Appropriate O ACR Appropriateness Criteria® 1 Acute Trauma to the Knee Variant 3: Adult or skeletally mature child.
    [Show full text]
  • Board Review for Anatomy
    Board Review for Anatomy John A. McNulty, Ph.D. Spring, 2005 . LOYOLA UNIVERSITY CHICAGO Stritch School of Medicine Key Skeletal landmarks • Head - mastoid process, angle of mandible, occipital protuberance • Neck – thyroid cartilage, cricoid cartilage • Thorax - jugular notch, sternal angle, xiphoid process, coracoid process, costal arch • Back - vertebra prominence, scapular spine (acromion), iliac crest • UE – epicondyles, styloid processes, carpal bones. • Pelvis – ant. sup. iliac spine, pubic tubercle • LE – head of fibula, malleoli, tarsal bones Key vertebral levels • C2 - angle of mandible • C4 - thyroid notch • C6 - cricoid cartilage - esophagus, trachea begin • C7 - vertebra prominence • T2 - jugular notch; scapular spine • T4/5 - sternal angle - rib 2 articulates, trachea divides • T9 - xiphisternum • L1/L2 - pancreas; spinal cord ends. • L4 - iliac crest; umbilicus; aorta divides • S1 - sacral promontory Upper limb nerve lesions Recall that any muscle that crosses a joint, acts on that joint. Also recall that muscles innervated by individual nerves within compartments tend to have similar actions. • Long thoracic n. - “winged” scapula. • Upper trunk (C5,C6) - Erb Duchenne - shoulder rotators, musculocutaneous • Lower trunk (C8, T1) - Klumpke’s - ulnar nerve (interossei muscle) • Radial nerve – (Saturday night palsy) - wrist drop • Median nerve (recurrent median) – thenar compartment - thumb • Ulnar nerve - interossei muscles. Lower limb nerve lesions Review actions of the various compartments. • Lumbosacral lesions - usually
    [Show full text]
  • Patellofemoral Unloader Knee Brace
    Patellofemoral Unloader Knee Brace A Major Qualifying Project Submitted to the Faculty of WORCESTER POLYTECHNIC INSTITUTE in partial fulfilment of the requirements for the Degree of Bachelor of Science Submitted By: James Junker Matthew Liberacki Brianna Owen Olivia Wisniewski Advisors Ambady, Sakthikumar Department of Biomedical Engineering Sabuncu, Ahmet C Department of Mechanical Engineering 1 Table of Contents Table of Contents Table of Contents .....................................................................................................................................2 Table of Figures .......................................................................................................................................4 Table of Tables .........................................................................................................................................6 Authorship .................................................................................................................................................7 Acknowledgements .................................................................................................................................8 Abstract ......................................................................................................................................................9 1. Introduction ................................................................................................................................... 10 2. Literature Review .......................................................................................................................
    [Show full text]
  • BOOKS ATHLETIC HEAD and SPINE INJURIES SHOULDER
    BOOKS Micheli: Oxford Textbook of Sports Medicine -excellent overview of all conditions and diagnosis. limited surgical technique. Garret: Principles and Practice of Sports Medicine -Classic surgeons text written by former UNC chair and Duke Sport’s Surgeon Snyder: Shoulder Arthroscopy -bread and butter, first generation shoulder scoping Jackson: Reconstructive Knee Surgeries -older, but classic for open surgery of knee. Andrews: Arthroscopic Surgery -classic "old school" intro to Arthroscopy (all joints) OKU: Sports, General, Shoulder & Elbow -essential for boards ATHLETIC HEAD and SPINE INJURIES 1. On-the-Field Management of Athletic Head Injuries. Pierre Durand, Jr and Gregory J. Adamson. J Am Acad Orthop Surg May/June 2004; 12:191-195. 6. Concussion in Sports. Am J Sports Med. 1999 Sep-Oct;27(5):676-87.E. Wojtys, D. Horda, G. Landry, et al. SHOULDER Rotator Cuff 18. Predictors of failure of nonoperative treatment of chronic, symptomatic, full-thickness rotator cuff tears. Dunn WR, et al. J Shoulder Elbow Surg. 2016 Aug;25(8):1303-11. Patient’s perception of the effectiveness of PT predicts failure of conservative therapy. 27. Clinical and structural outcomes after arthroscopic single-row versus double-row rotator cuff repair: a systematic review and meta-analysis of level I randomized clinical trials.Millett PJ, Warth RJ, Dornan GJ, Lee JT, Spiegl UJ. J Shoulder Elbow Surg. 2014 Apr;23(4):586-97. Single- row repairs resulted in significantly higher re-tear rates compared with double-row repairs, especially with regard to partial-thickness re-tears. 39. Clinical results of arthroscopic superior capsule reconstruction for irreparable rotator cuff tears.
    [Show full text]