The Achilles Tendon
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Shoulder Sprain a Sprain Is a Stretch And/Or Tear of a Ligament, a Strong Band of Connective Tissue That Connect the End of One Bone with Another
INDUSTRYADVANTAGE THERAPY UPDATE April 2016 A Courtesy Publication for the Monett area HR/Safety Community Sprains & Strains: What’s the difference? Does seeing the term “shoulder injury” at a glance make you cringe? In the work comp world, shoulder injuries can turn into costly claims involving surgery and long-term rehabilitation. Often times, shoulder injuries begin as sprains or strains and can be treated with conservative, non-operative treatment. In this month’s Industry Update, we’ll review sprains and strains as well as other factors that can contribute to shoulder injuries in the workplace. Shoulder Sprain A sprain is a stretch and/or tear of a ligament, a strong band of connective tissue that connect the end of one bone with another. In the shoulder complex, common sprains involve the supporting ligaments of the joint between the end of the collar bone and the shoulder blade - the acromioclavicular (AC) joint. Shoulder sprains can occur during repetitive reaching or lifting activities, or with falls onto the shoulder. Treatment for mild sprains includes RICE (Rest, Ice, Compression, Elevation) and exercises to improve muscle balance, preserve joint mobility, and provide support for ligaments. Shoulder Strain A strain is an injury to a muscle and/or tendons. Tendons are fibrous cords of tissue that attach muscles to the bone. Typical symptoms of a strain include pain, muscle spasm, muscle weakness, swelling, inflammation, and cramping. Strains are common when a pushed, pulled, or lifted object suddenly gives way. They can also be wear-and- tear injuries or a result from reaching out during a fall. -
Achilles Tendinitis Causes, Symptoms, Prevention & Treatment by Dr
ACHILLES TENDINITIS CAUSES, SYMPTOMS, PREVENTION & TREATMENT BY DR. ERIK NILSSEN 855.998.FOOT Schedule Consultation ACHILLES TENDINITIS: CAUSES, SYMPTOMS, PREVENTION & TREATMENT Your Achilles tendon is your body’s largest tendon that connects your heel bone to your calf muscles. You use it to run, walk, and jump. It is prone to Achilles tendinitis, which is a condition caused by degeneration and overuse, and is quite common. Achilles tendinitis causes you to suffer with pain down the back of your leg close to the heel. / 2 NILSSENORTHOPEDICS.COM | 855-998-FOOT ACHILLES TENDINITIS: CAUSES, SYMPTOMS, PREVENTION & TREATMENT Schedule Consultation ACHILLES TENDINITIS: CAUSES, SYMPTOMS, PREVENTION & TREATMENT What is Achilles Tendinitis? To put it simply, it is inflammation of your tendon. There are a couple forms of Achilles tendinitis, which are determined primarily by the area of the tendon that is experiencing inflammation. There are two common types. Noninsertional Achilles Tendinitis. Patients who are between the ages of 30 and 40 with an increased level of activity tend to suffer with Noninsertional Achilles tendinitis. Patients with noninsertional Achilles tendinitis are often treated with non-surgical therapy and are able to gradually increase activity. Insertional Achilles Tendinitis. When the area that the heel bone and Achilles tendon connects becomes painful with swelling, this is known as Insertional Achilles tendinitis. There are both non-surgical and surgical treatment options for insertional Achilles / 3 NILSSENORTHOPEDICS.COM | 855-998-FOOT Schedule Consultation ACHILLES TENDINITIS: CAUSES, SYMPTOMS, PREVENTION & TREATMENT Causes of Achilles Tendinitis Often individuals who are poorly conditioned have the higher risk of developing this condition. Other causes include: • Sudden activity increase. -
The 7 Step Shin Splints Treatment System
The Step SShhiinn SSpplliinnttss Treatment System By Brad Walker TM The 7 Step Shin Splints Treatment System Fix Your Shin Splints Once and For All and get back to Pain Free Running Quickly and Safely. Walker, Bradley E., 1971 7 Step Shin Splints Treatment System™ Copyright © 2012 The Stretching Institute™ All rights reserved. Except under conditions described in the copyright act, no part of this publication may in any form or by any means (electronic, mechanical, micro copying, photocopying, recording or otherwise) be reproduced, stored in a retrieval system or transmitted without prior written permission from the copyright owner. Inquires should be addressed to the publisher. Disclaimers The exercises presented in this publication are intended as an educational resource and are not intended as a substitute for proper medical advice. Please consult your physician, physical therapist or sports coach before performing any of the exercises described in this publication, particularly if you are pregnant, elderly or have any chronic or recurring muscle or joint pain. Discontinue any exercise that causes you pain or severe discomfort and consult a medical expert. Cover picture/s supplied by iStockphoto. The Stretching Institute has purchased the non-exclusive, non-transferable, non-sub licensable right to reproduce the cover picture/s an unlimited number of times in online and electronic publications, and web advertisements. Exercise graphics used with permission from the Physigraphe V2 Pro Clip Art CD-ROM available at ExRx.net. Copyright -
The Painful Heel Comparative Study in Rheumatoid Arthritis, Ankylosing Spondylitis, Reiter's Syndrome, and Generalized Osteoarthrosis
Ann Rheum Dis: first published as 10.1136/ard.36.4.343 on 1 August 1977. Downloaded from Annals of the Rheumatic Diseases, 1977, 36, 343-348 The painful heel Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthrosis J. C. GERSTER, T. L. VISCHER, A. BENNANI, AND G. H. FALLET From the Department of Medicine, Division of Rheumatology, University Hospital, Geneva, Switzerland SUMMARY This study presents the frequency of severe and mild talalgias in unselected, consecutive patients with rheumatoid arthritis, ankylosing spondylitis, Reiter's syndrome, and generalized osteoarthosis. Achilles tendinitis and plantar fasciitis caused a severe talalgia and they were observed mainly in males with Reiter's syndrome or ankylosing spondylitis. On the other hand, sub-Achilles bursitis more frequently affected women with rheumatoid arthritis and rarely gave rise to severe talalgias. The simple calcaneal spur was associated with generalized osteoarthrosis and its frequency increased with age. This condition was not related to talalgias. Finally, clinical and radiological involvement of the subtalar and midtarsal joints were observed mainly in rheumatoid arthritis and occasionally caused apes valgoplanus. copyright. A 'painful heel' syndrome occurs at times in patients psoriasis, urethritis, conjunctivitis, or enterocolitis. with inflammatory rheumatic disease or osteo- The antigen HLA B27 was present in 29 patients arthrosis, causing significant clinical problems. Very (80%O). few studies have investigated the frequency and characteristics of this syndrome. Therefore we have RS 16 PATIENTS studied unselected groups of patients with rheuma- All of our patients had the complete triad (non- toid arthritis (RA), ankylosing spondylitis (AS), gonococcal urethritis, arthritis, and conjunctivitis). -
Management of Rotator Cuff Tendinopathy
Management of rotator cuff tendinopathy Jeremy Lewis PhD FCSP MMACP Consultant Physiotherapist, Central London Community Healthcare NHS Trust, London, UK; Professor of Musculoskeletal Research, Faculty of Education and Health Sciences, University of Limerick, Ireland; Reader in Physiotherapy, School of Health and Social Work, University of Hertfordshire, Hatfield, UK; Sonographer Rotator cuff (RC) tendinopathy is characterised by shoulder pain and weakness most commonly experienced during shoulder external rotation and elevation. Assessment is complicated by the lack of diagnostic accuracy of the special orthopaedic tests and the poor correlation between structural changes identified on imaging and symptoms. Clinicians and people suffering with the symptoms of RC tendinopathy should derive considerable confidence that the outcomes achieved with an appropriately graduated exercise programme are equal to those achieved with surgery for RC tendinopathy, as well as atraumatic partial and full thickness RC tears. Education is an essential component of rehabilitation. Outcomes may also be enhanced by clinically sub-grouping RC tendinopathy presentations and directing treatment strategies according to the clinical presentation as against a generic “one size fits all” approach. There are substantial deficits in our knowledge regarding RC tendinopathy that need to be addressed to further improve clinical outcomes. Learning outcomes has at least equivalent outcome to surgical intervention, with the added generalised benefits of exercise http://www.youtube. 1 Review a presented model for the assessment and com/watch?v=aUaInS6HIGo , a faster return to work and at a management of rotator cuff tendinopathy. lower cost than surgery. This evidence relates to those diagnosed 2 Consider consistent evidence supporting an with subacromial pain syndrome (Lewis 2011), rotator cuff exercise based approach for management that is tendinopathy (Holmgren et al 2012) and atraumatic partial and equivalent to surgical outcomes. -
Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment
Rotator Cuff and Subacromial Impingement Syndrome: Anatomy, Etiology, Screening, and Treatment The glenohumeral joint is the most mobile joint in the human body, but this same characteristic also makes it the least stable joint.1-3 The rotator cuff is a group of muscles that are important in supporting the glenohumeral joint, essential in almost every type of shoulder movement.4 These muscles maintain dynamic joint stability which not only avoids mechanical obstruction but also increases the functional range of motion at the joint.1,2 However, dysfunction of these stabilizers often leads to a complex pattern of degeneration, rotator cuff tear arthropathy that often involves subacromial impingement.2,22 Rotator cuff tear arthropathy is strikingly prevalent and is the most common cause of shoulder pain and dysfunction.3,4 It appears to be age-dependent, affecting 9.7% of patients aged 20 years and younger and increasing to 62% of patients of 80 years and older ( P < .001); odds ratio, 15; 95% CI, 9.6-24; P < .001.4 Etiology for rotator cuff pathology varies but rotator cuff tears and tendinopathy are most common in athletes and the elderly.12 It can be the result of a traumatic event or activity-based deterioration such as from excessive use of arms overhead, but some argue that deterioration of these stabilizers is part of the natural aging process given the trend of increased deterioration even in individuals who do not regularly perform overhead activities.2,4 The factors affecting the rotator cuff and subsequent treatment are wide-ranging. The major objectives of this exposition are to describe rotator cuff anatomy, biomechanics, and subacromial impingement; expound upon diagnosis and assessment; and discuss surgical and conservative interventions. -
Shoulder Conditions Diagnosis and Treatment Guideline
Shoulder Conditions Diagnosis and Treatment Guideline TABLE OF CONTENTS I. Review Criteria for Shoulder Surgery II. Introduction III. Establishing Work-Relatedness A. Shoulder Conditions as Industrial Injuries B. Shoulder Conditions as Occupational Diseases IV. Making the Diagnosis A. History and Clinical Exam B. Diagnostic Imaging V. Treatment A. Conservative Treatment B. Surgical Treatment VI. Specific Conditions A. Rotator Cuff Tears B. Subacromial Impingement Syndrome without a Rotator Cuff Tear C. Calcific tendonitis D. Labral tears including superior labral anterior-posterior (SLAP) tears E. Acromioclavicular dislocation F. Acromioclavicular arthritis G. Glenohumeral dislocation H. Tendon rupture or tendinopathy of the long head of the biceps I. Glenohumeral arthritis and arthropathy J. Manipulation under anesthesia K. Diagnostic arthroscopy VII. Post-operative Treatment and Return to Work VIII. Specific Shoulder Tests IX. Functional Disability Scales for Shoulder Conditions X. References 1 Hyperlink update September 2016 I. REVIEW CRITERIA FOR SHOULDER SURGERY Criteria for Shoulder Surgery A request may be AND this has been done If the patient has AND the diagnosis is supported by these clinical findings: appropriate for (if recommended) Surgical Procedure Diagnosis Subjective Objective Imaging Non-operative care Rotator cuff tear repair Acute full-thickness Report of an acute Patient will usually have Conventional x-rays, AP and May be offered but not rotator cuff tear traumatic injury within 3 weakness with one or true lateral or axillary view required Note: The use of allografts months of seeking care more of the following: and xenografts in rotator Forward elevation AND cuff tear repair is not AND Internal/external MRI, ultrasound or x-ray covered. -
Gluteal Tendinopathy
Gluteal Tendinopathy What is a Gluteal Tendinopathy? In lying Up until recently hip bursitis was diagnosed as the main Either on your bad hip or with bad cause of lateral hip pain but recent studies suggest that an hip hanging across body like so irritation of the gluteus muscle tendon is the likeliest cause. The tendon attaches onto a bony prominence (greater trochanter) and it is here that the tendon is subject to All these positions lead to increase friction of the tendon, compressive forces leading to irritation. can cause pain and slow the healing process. This can result in pain over the lateral hip which can refer down the outside For sleeping you might like to try these positions: of the thigh and into the knee. How common is it? Gluteal tendinopathy is relatively common affecting 10-25% of the population. It is 3 times more prevalent in women than men and is most common in women between the ages of 40 and 60. One of the reasons for this is women It is also important to modify your activity. Avoid or reduce tend to have a greater angle at their hip joint increasing things that flare up your pain, this could be climbing stairs compressive forces on the tendon. or hills or those longer walks/runs. Signs and Symptoms Exercise Therapy • Pain on the outside of your hip, can refer down outside of the thigh to the knee This is best administered by a Physiotherapist to suit the • Worse when going up and/or down stairs individual but below is a rough guide to exercises which • Worse lying on affected side (and sometimes on the can help a gluteal tendinopathy. -
Elbow Rehab UCL Sprain Non Operative.Pages
Conservative Treatment Following Ulnar Collateral Ligament Sprains Of the Elbow Phase I Immediate Motion Phase Post-Injury days 0 - 7 Goals 1. Increase ROM 2. Promote healing of ulnar collateral ligament 3. Retard muscular atrophy 4. Decrease pain and inflammation 5. 1 week post-injury initiate cardiovascular conditioning program with modifications for injury per the ClevelandIndians Physical Development Program (start at Week 1 in manual) Activities 1. Brace (optional) - non-painful ROM (20 →90 degrees) 2. AAROM, PROM elbow, wrist and shoulder (non-painful ROM and no shoulder ER stretching) 3. Initiate Isometrics - wrist and elbow musculature, gripping exercises 4. Ice, compression 5. Initiate shoulder strengthening ( no internal rotation ) - CAUTION: avoid stressing medial elbow Phase II Intermediate Phase Post-Injury Weeks 2 - 4 Goals 1. Increase ROM 2. Improve strength and endurance 3. Decrease pain and inflammation 4. Promote stability 5. 2 weeks post-injury initiate upper/lower body strength program with modifications for injury per the Cleveland Indians Physical Development Program (start at Week 1 in manual) Criteria to Progress to Phase II 1. No Swelling 2. Acute pain is diminished Activities 1. ROM exercises - gradual increase in motion ( 0 → 135 degrees) • 5 degrees of extension, 10 degrees of flexion 2. Initiate isotonic exercises • wrist curls • wrist extension • pronation/supination • biceps/triceps 3. Advance shoulder strengthening • external rotation • internal rotation (Week 3) • supraspinatus 4. Ice, compression Phase III Advanced Strengthening phase Post-Injury Weeks 5 - 6 Criteria to progress to Phase III 1. Full AROM 2. No pain or tenderness 3. No increase in laxity 4. Strength 4/5 in the elbow flexors/extensors Goals 1. -
Current Trends in Tendinopathy Management
Best Practice & Research Clinical Rheumatology 33 (2019) 122e140 Contents lists available at ScienceDirect Best Practice & Research Clinical Rheumatology journal homepage: www.elsevierhealth.com/berh 8 Current trends in tendinopathy management * Tanusha B. Cardoso a, , Tania Pizzari b, Rita Kinsella b, Danielle Hope c, Jill L. Cook b a The Alphington Sports Medicine Clinic, 339 Heidelberg Road, Northcote, Victoria, 3070, Australia b La Trobe University Sport and Exercise Medicine Research Centre, La Trobe University, Corner of Plenty Road and Kingsbury Drive, Bundoora, Victoria, 3083, Australia c MP Sports Physicians, Frankston Clinic, Suite 1, 20 Clarendon Street, Frankston, Victoria, 3199, Australia abstract Keywords: Tendinopathy Tendinopathy (pain and dysfunction in a tendon) is a prevalent Management clinical musculoskeletal presentation across the age spectrum, Rehabilitation mostly in active and sporting people. Excess load above the ten- Achilles tendinopathy don's usual capacity is the primary cause of clinical presentation. Rotator cuff tendinopathy The propensity towards chronicity and the extended times for recovery and optimal function and the challenge of managing tendinopathy in a sporting competition season make this a difficult condition to treat. Tendinopathy is a heterogeneous condition in terms of its pathology and clinical presentation. Despite ongoing research, there is no consensus on tendon pathoetiology and the complex relationship between tendon pathology, pain and func- tion is incompletely understood. The diagnosis of tendinopathy is primarily clinical, with imaging only useful in special circum- stances. There has been a surge of tendinopathy treatments, most of which are poorly supported and warrant further exploration. The evidence supports a slowly progressive loading program, rather than complete rest, with other treatment modalities used as adjuncts mainly targeted at achieving pain relief. -
Plantar Fasciitis Thomas Trojian, MD, MMB, and Alicia K
Plantar Fasciitis Thomas Trojian, MD, MMB, and Alicia K. Tucker, MD, Drexel University College of Medicine, Philadelphia, Pennsylvania Plantar fasciitis is a common problem that one in 10 people will experience in their lifetime. Plantar fasciopathy is an appro- priate descriptor because the condition is not inflammatory. Risk factors include limited ankle dorsiflexion, increased body mass index, and standing for prolonged periods of time. Plantar fasciitis is common in runners but can also affect sedentary people. With proper treatment, 80% of patients with plantar fasciitis improve within 12 months. Plantar fasciitis is predominantly a clinical diagnosis. Symp- toms are stabbing, nonradiating pain first thing in the morning in the proximal medioplantar surface of the foot; the pain becomes worse at the end of the day. Physical examination findings are often limited to tenderness to palpation of the proximal plantar fascial insertion at the anteromedial calcaneus. Ultrasonogra- phy is a reasonable and inexpensive diagnostic tool for patients with pain that persists beyond three months despite treatment. Treatment should start with stretching of the plantar fascia, ice massage, and nonsteroidal anti-inflamma- tory drugs. Many standard treatments such as night splints and orthoses have not shown benefit over placebo. Recalcitrant plantar fasciitis can be treated with injections, extracorporeal shock wave therapy, or surgical procedures, although evidence is lacking. Endoscopic fasciotomy may be required in patients who continue to have pain that limits activity and function despite exhausting nonoperative treatment options. (Am Fam Physician. 2019; 99(12):744-750. Copyright © 2019 American Academy of Family Physicians.) Illustration by Todd Buck Plantar fasciitis (also called plantar fasciopathy, reflect- than 27 kg per m2 (odds ratio = 3.7), and spending most ing the absence of inflammation) is a common problem of the workday on one’s feet 4,5 (Table 1 6). -
Bone Edema After Ankle Sprain and Update
ISSN: 2574-1241 DOI: 10.26717/BJSTR.2019.13.002435 M Ballester. Biomed J Sci & Tech Res Mini Review Open Access Bone Edema After Ankle Sprain and Update M Ballester*1, G Lucar1 and Shahdad Saeedi2 1Consorci Sanitari del Maresme Hospital de Mataró, Barcelona, Spain 2MedStar Georgetown University Hospital, Washington, US Received: January 23, 2019; Published: January 25, 2019 *Corresponding author: M Ballester, Consorci Sanitari del Maresme Hospital de Mataró, Barcelona, Spain Mini Review sustaining an ankle sprain is made on a T2-weighted image which Acute ankle sprains are one of the most common musculoskeletal shows increased signal intensity and decreased signal intensity injuries. Studies in both the United States and European countries on a T1-weighted image. The location and pattern of the osseous have shown that 30% of all athletic injuries involve ankle sprains injury has been studied by Labovitz being most frequently found in [1]. Patients often present to their primary care physician or the medial talar dome. emergency department from the lateral ankle pain and instability With appropriate treatment following an ankle sprain the that at 1-year follow-up after conservative treatment, 5% to 33% clinical prognosis of bone edema is usually favorable. The initial after a plantarflexion inversion injury. A systematic review showed treatment algorithm after an ankle sprain can be superior to making the patient non-weightbearing and allowing them to bear weight of the patients still experience pain and instability, 34% of patients incomplete recovery from their initial injury [2]. It is critical for us to reduce joint stiffness. The actual evidence does not show that reported at least one recurrent sprain and 15% to 64% reported bone marrow edema after an ankle sprain is a prognostic factor for lateral ankle sprain such as peroneal tendon tears, osteochondral recovery [3].