Overuse Injuries in Elite Athletes

Total Page:16

File Type:pdf, Size:1020Kb

Overuse Injuries in Elite Athletes ATHLETES: OVERUSE MRI of Overuse INJURIES VERY COMMON Injury in the Elite Athlete • Muscle William B. Morrison, M.D. Associate Professor of • Joints Radiology Thomas Jefferson • Tendon University Hospital Philadelphia, PA USA • Ligament • Bone [email protected] How is this Relevant to My Practice? • High performance athletes get similar injuries as ‘regular’ people… but: – More of them, & at a younger age MUSCLE / SOFT TISSUE – More commonly imaged – Secondary gain involved INJURY • All the cases here are high performance athletes – but most injuries are conventional • Exceptions – Some weird sport-specific patterns of stress and other injuries – Acute injuries as opposed to overuse •Overuse –DOMS Muscle Injury Delayed Onset Muscle • Acute injury Soreness (DOMS) – Tendon – Myotendinous junction • All athletes are susceptible if they – Muscle belly change training regimen • Athletes tend to work out intensely – leads to muscle injury • Rarely imaged (“no pain no gain”) – Weightlifting / aerobic exercise – 24hr later – soreness – Can be severe, even look like a tear 1 Acute Muscle Injury • Direct → muscle belly, esp quadriceps T2 – esp rugby, football • Indirect → myotendinous junction – eccentric contraction – sudden acceleration / DOMS: Lateral gastrocnemius deceleration Finding can be subtle, even with T2 and fat sat Professional football player Acute Injury – T1 Quadriceps hematoma Muscle belly injury Myotendinous Unit Hit with helmet • Myotendinous Junction – ‘weak link’ of normal myotendinous complex T2 – Common place for injury – Most common mechanism: eccentric contraction (muscle lengthens and contracts at the same High time) T1 = blood Gastrocnemius tear: Grade 1 Muscle Strain “V” sign • Ill-defined edema T2 T1 STIR Weishaupt D, JCAT 2001; 25:677 2 Gd Gd can help identify Grade 2 Muscle Strain subtle muscle injury AKA “Partial Tear” STIR Professional baseball player Grade 1 strain Sartorius m. Marathon Runner Quadratus Femoris Strain Small Grade 2 Strain – NFL Player High performance athletes often get routine injuries in unusual locations Grade 3 Muscle Strain Grade 3 Strain • Complete tear Rectus femoris – Fluid, blood common – Retraction – balled up muscle may be perceived as a mass – Degree of dysfunction varies • Hamstrings, rectus femoris, tibialis anterior – loss has little effect on ADL STIR perfomance 3 Sportsman’s Hernia Adductor avulsion Pubic symphysis capsule injury Sportsman’s Hernia Rectus abdominis strain ::Groin pain medially ::Actually a ‘grab bag’ of diagnoses -Adductor injury -Pubic symphysis inj -Rectus abdominis strain -actual hernia Chronic Injury Marathon Runner Bone resorption Loss of cortex Looks like clavicular osteolysis Corresponding MRI Edema only / predominantly at distal clavicle Classic in Weightlifters Other Muscle Pathology Dysfunction related to nerve impingement Compartment syndrome Clavicular Osteolysis 4 Radial Tunnel Syndrome Compartment Syndrome Gd helps find subtle areas of muscle involvement! • Confined fascial compartment – Lower leg > thigh – Most common: anterior compartment • Acute and chronic forms – Acute: tibial fx, hematoma, vascular injury, infection Elbow nerve impingement – Chronic: Muscle hypertrophy / overexertion syndromes -Many types • Increased compartmental pressure (>30mm Hg) -Etiology • Decreased bloodflow into compartment ::muscle hypertrophy (wt lifters) – Clinical: pain/swelling, weakness, decreased sensation ::upper extremity endurance athletes (esp tennis) • Late: Muscle infarction T2 FSE fatsat Chronic Exercise-induced Compartment Syndrome Anterior compartment Pre-Gd Bursitis Gd can help show subtle variations in muscle vascularity Post-Gd Adventitial Bursitis Friction related Exquisitely painful Activity-specific locations TENDONS Professional Ballet dancer Also note stress fx of sesamoid 5 TENDON TENDINOSIS PATHOPHYSIOLOGY • Thickening, increased signal (T1, PD, T2) • Degeneration Example of friction: Distal biceps -primary (overuse injury) Mechanical-pronation leads to impingement between radius -direct frictional effect and ulna • Hypovascular-critical zone – Tendons without sheaths are susceptible • Achilles, biceps, cuff, etc. – Between myotendinous jct and insertion • ‘Normal tendons don’t tear’ Distal biceps -esp in weightlifters 2 TENDON TEAR LATERAL EPICONDYLITIS Adjacent marrow edema -Chronic, severe, refractory cases Epicondylitis ::Especially in racquet / club sports COMPLETE TEAR: USUALLY ::Lateral= tennis elbow ASSOCIATED WITH RETRACTION – e.g., biceps: retracts, bulging muscle (‘popeye’ arm) Muscle edema (esp ECR brevis) IMPINGEMENT MEDIAL EPICONDYLITIS Rotator Cuff • “Golfer’s elbow” Tendinosis and Tear •Lateral acromial downslope: –Predisposes to impingement –Esp. common in overhead throwing sports TEAR 2 6 --Impingement is nearly Undersurface Partial Lesions at the Tendinosis always involved “watershed zone” Hypoxic Degeneration --Underlying degeneration Thickness Tear --“Acute tear” extremely uncommon Professional basketball player Lesions at the Tendinosis “watershed zone” Tendinosis Mucoid Degeneration Painful Enthesopathy Edematous spur =high likelihood of sx Professional basketball player Patellar Tendinosis / Tear Tendinosis / Tear Pro Basketball Player 7 Iliotibial Band Friction Syndrome Long Distance Runner OVERUSE INJURIES IN ADOLESCENT ATHLETES Delayed Union of Apophyses Medial Apophysis Stress Avulsive Stress Ischeal Apophysis Old Osgood-Schlatter Gymnast Extensor mechanism pathology AKA “Jumper’s knee” Esp. common in basketball 8 Cartilage Lesions Microfracture – NBA Player JOINTS Medial compartment symptoms prevent play S/P MICROFRACTURE 7 MONTH FOLLOW-UP 13 MONTHS LATER Playing without Recurrent symptoms symptoms OSTEOCHONDRAL LESIONS OSTEOCHONDRAL LESION OF THE TALUS Panner’s disease Esp. in basketball Esp. in adolescent pitchers 35 month follow up -interval detachment of Chronic osteochondral injury of capitellum fragment Underlying focus of AVN 9 OCD KNEE OCD phalanx Detached Ballet Dancer Professional Baseball Player Synovitis in Elbow Plicas and Bodies POSTERIOR SPURS, INTRA- Posterolateral Elbow Plica ARTICULAR BODIES Baseball Pitcher 10 ANKLE JOINT Impingement Joint Impingement Anterior impingement: and Instability large spurs limit dorsiflexion -esp in soccer, kicking sports Anterolateral Impingement Posterior Impingement Esp. in ballet “meniscus syndrome” “Os Trigonum Syndrome” -following tear of lateral -big os ligaments -fluid at interval -scar tissue forms in recess -leads to impingement, cartilage -cystic change erosion, pain Hip Impingement Posterior Labral Tear Basketball Player Chronic Unidirectional Posterior Instability Subluxation 11 Chronic Multidirectional Instability Combined Anterior and Posterior Instability Capsular Injury ANTERIOR DISLOCATION POSTERIOR CAPSULAR OSSIFICATION “BENNETT LESION” Soccer – capsular “Turf Toe” injury superomedial Football players -esp. due to artificial turf -Tear of plantar plate 1st MTP -Often acute on chronic DORSAL HOOD INJURY Boxer LIGAMENTS FASCIA 12 ELBOW MCL INJURY T T NORMAL MCL partial tear “T sign” CHRONIC INJURY PLANTAR FASCIITIS Flexor tendon pulley injury Esp. in runners Acute on chronic Esp. common in rock climbers Plantar Fascia Medial Tibial Stress Tear Syndrome • AKA “shin splints” • Avulsive injury medial tibial myofascial attachment • Running, overuse • Fascial or periosteal edema along anteromedial tibia • Occasional marrow edema • Most common: normal MRI T2 Anderson MW. Radiology 1997; 207:826 13 Stress Fracture • Fatigue: ‘people in fatigues’ – Normal bone undergoing BONE abnormal stress – Young people • Insufficiency – Abnormal bone (eg, osteoporotic), normal stresses – Older population Etiology of Stress Fracture Stress 40 Response • During early phase of a new 35 no linear component activity, muscle 30 steadily increases 25 muscl e strength 20 bone • Bone must 15 undergo a phase of 10 osteoclastic 5 resorption first 0 12345678 “At risk period” weeks Stress Fracture Stress Fracture Late – Propagation across shaft Atypical locations: periostitis may be mistaken for tumor 14 Tibial Stress Fracture Multiple Foci Stress Classic in runners Fracture Late – Thick periostitis 18 year old male Fatigue fracture Classic Fatigue Fracture Persistent pain in hip 2nd Metatarsal Shaft History of recent increase in activity Olecranon stress in gymnast Atypical Sports-specific Locations 15 GYMNAST WITH DISTAL RADIAL / ULNAR PHYSEAL STRESS Capitate stress Bilaterally Gymnast STRESS Humeral stress pitcher RESPONSE Ballerina Stress forearm in female softball Stress femur player nba 16 Sesamoiditis AVN Sesamoid Likely an end stage of stress T1 T2 -Hyperemia likely due to chronic repetitive injury -Prob along spectrum of stress, AVN -Sesamoid high on T2, STIR surrounding ST edema -Mostly preserved T1 signal T1 T2 AVN metacarpal head (post op) Pro boxer QUESTIONS? Dynamic Gd demonstrates viability of remaining bone 17.
Recommended publications
  • Tennis Elbow Handout 503-293-0161
    ® ® sports INjury medicine department 9250 SW Hall Blvd., Tigard, OR 97223 Tennis Elbow Handout 503-293-0161 WHAT IS IT? Lateral Epicondylitis Tennis elbow, also known as lateral epicondylitis, is one of the most common painful conditions of the elbow. Inflammation and (Tennis Elbow) pain occur on and around the outer bony bump of the elbow where the muscles and tendons attach to the bone. These structures are responsible for lifting your wrist up so this condition can occur with many activities, not just tennis. Humerus (arm bone) Area of pain Tendon lateral epicondyle WHAT ARE THE SYMPTOMS? Most commonly you will have pain & tenderness on the outer side of the elbow and this pain may even travel down the forearm. Often there is pain and/or weakness with gripping and lifting activities. You may also experience difficulty with twisting activities during sports or even opening the lid of a jar. WHY DOES IT HURT? It hurts because you are putting tension on a place where the tissue is weakened, which is usually due to a degenerative process that seems to take a long time for your body to recognize and heal. WHY DO I HAVE IT? This is a common problem and unfortunately we don’t know why some people get this condition and others do not. Surprisingly, it is not at all clear that it comes from overuse or something that you did “wrong”. There is no doubt that if you do have tennis elbow, it will bother you more to do certain things, but that does not necessarily mean it was caused by those activities.
    [Show full text]
  • Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 19 and Other Musculoskeletal Conditions
    Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 19 and Other Musculoskeletal Conditions Medical Policy An Independent Licensee of the Blue Cross and Blue Shield Association. Title: Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions Professional Institutional Original Effective Date: July 11, 2001 Original Effective Date: July 1, 2005 Revision Date(s): November 5, 2001; Revision Date(s): December 15, 2005; June 14, 2002; June 13, 2003; October 26, 2012; May 7, 2013; January 28, 2004; June 10, 2004; April 15, 2014 April 21, 2005; December 15, 2005; October 26, 2012; May 7, 2013; April 15, 2014 Current Effective Date: April 15, 2014 Current Effective Date: April 15, 2014 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care. Treating health care providers are independent contractors and are neither employees nor agents of Blue Cross and Blue Shield of Kansas and are solely responsible for diagnosis, treatment and medical advice. If your patient is covered under a different Blue Cross and Blue Shield plan, please refer to the Medical Policies of that plan.
    [Show full text]
  • Pathologies of the Elbow
    Elbow Lateral Epicondylitis (tennis elbow) PathologyPathology 3030 –– 5050 yearsyears oldold RepetitiveRepetitive micro-traumamicro-trauma ChronicChronic teartear inin thethe originorigin ofof thethe extensorextensor carpicarpi radialisradialis brevisbrevis Lateral Epicondylitis (tennis elbow) MechanismMechanism ofof InjuryInjury OveruseOveruse syndromesyndrome causedcaused byby repeatedrepeated forcefulforceful wristwrist andand fingerfinger movementsmovements TennisTennis playersplayers ProlongedProlonged andand rapidrapid activitiesactivities Lateral Epicondylitis (tennis elbow) ClinicalClinical SignsSigns andand SymptomsSymptoms IncreasedIncreased painpain aroundaround laterallateral epicondyleepicondyle TendernessTenderness inin palpationpalpation CETCET TestsTests AROM;AROM; PROMPROM ResistedResisted teststests LidocaineLidocaine Treatment of Tennis Elbow Medial Epicondylitis (golfer’s elbow) PathologyPathology 3030 -- 5050 yearsyears oldold RepetitiveRepetitive micromicro traumatrauma toto commoncommon flexorflexor tendontendon Medial Epicondylitis (golfer’s elbow) MechanismsMechanisms ofof injuryinjury ThrowingThrowing aa baseballbaseball RacquetballRacquetball oror tennistennis SwimmingSwimming backstrokebackstroke HittingHitting aa golfgolf ballball Medial Epicondylitis (golfer’s elbow) ClinicalClinical signssigns andand symptomssymptoms IncreasedIncreased painpain overover medialmedial epicondyleepicondyle TendernessTenderness onon palpationpalpation CFTCFT TestsTests AROM;AROM; PROMPROM ResistedResisted
    [Show full text]
  • A Patient's Guide to Tennis Elbow (Lateral Epicondylitis)
    Dr. Edward Kelly www.edwardkellymd.com A Patient’s Guide To Tennis Elbow (Lateral Epicondylitis) WHAT IS TENNIS ELBOW? Tennis elbow is breakdown and degeneration of tendons which attach to the outside (or lateral side) of the elbow. The muscles which work the hand and wrist begin as tendons which attach on a bony prominence on the lateral side of the elbow. This prominence is the lateral epicondyle of the humerus, so tennis elbow is degeneration of the tendons that attach to the lateral epicondyle (and so it is also called “lateral epicondylitis”). The pain can radiate into the forearm and occasionally into the hand. WHAT CAUSES IT? Tennis elbow typically is caused by repetitive gripping and grasping activities or occasionally from direct trauma to the outside of the elbow. Examples include when someone increases the amount of squeezing or gripping they perform, such as trimming the hedge or playing more tennis than usual. Once the tendons get injured it can be difficult to eradicate because those tendons are used every time the hand grips or squeezes. IS IT A SERIOUS CONDITION? Tennis elbow can be a painful and debilitating problem but does not lead to serious problems, like arthritis. However, x-rays or an ultrasound scan may be necessary in some cases to evaluate the elbow joint. An examination by a physician in the office will confirm the diagnosis of lateral epicondylitis. Lateral epicondylitis is the type of condition that will never get so bad that treatment cannot be performed. In many cases, it will resolve over time with non-operative treatments.
    [Show full text]
  • Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions
    Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis Page 1 of 62 and Other Musculoskeletal Conditions Medical Policy An Independent licensee of the Blue Cross Blue Shield Association Title: Extracorporeal Shock Wave Therapy (ESWT) for Plantar Fasciitis and Other Musculoskeletal Conditions Professional Institutional Original Effective Date: July 11, 2001 Original Effective Date: July 1, 2005 Revision Date(s): November 5, 2001; Revision Date(s): December 15, 2005; June 14, 2002; June 13, 2003; October 26, 2012; May 7, 2013; January 28, 2004; June 10, 2004; April 15, 2014; April 14, 2015; April 21, 2005; December 15, 2005; August 4, 2016; January 1, 2017; October 26, 2012; May 7, 2013; August 10, 2017; August 1, 2018; April 15, 2014; April 14, 2015; July 17, 2019, March 11, 2021 August 4, 2016; January 1, 2017; August 10, 2017; August 1, 2018; July 17, 2019, March 11, 2021 Current Effective Date: August 10, 2017 Current Effective Date: August 10, 2017 State and Federal mandates and health plan member contract language, including specific provisions/exclusions, take precedence over Medical Policy and must be considered first in determining eligibility for coverage. To verify a member's benefits, contact Blue Cross and Blue Shield of Kansas Customer Service. The BCBSKS Medical Policies contained herein are for informational purposes and apply only to members who have health insurance through BCBSKS or who are covered by a self-insured group plan administered by BCBSKS. Medical Policy for FEP members is subject to FEP medical policy which may differ from BCBSKS Medical Policy. The medical policies do not constitute medical advice or medical care.
    [Show full text]
  • Pediatric MSK Protocols
    UT Southwestern Department of Radiology Ankle and Foot Protocols - Last Update 5-18-2015 Protocol Indications Notes Axial Coronal Sagittal Ankle / Midfoot - Routine Ankle Pain Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD SPAIR T1 FSE Injury, Internal Derangement Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR STIR Talar OCD, Coalition Protocol Indications Notes Axial Coronal Sagittal Ankle / Midfoot - Arthritis Arthritis Axial = In Relation to Leg "Footprint" (Long Axis to Foot) PD SPAIR PD SPAIR T1 FSE Coronal = In Relation to Leg (Short Axis Foot) STIR T1 SPIR POST T1 SPIR POST Protocol Indications Notes Axial Coronal Sagittal Foot - Routine Pain, AVN Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD FSE T1 FSE Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR PD SPAIR STIR Protocol Indications Notes Axial Coronal Sagittal Foot - Arthritis Arthritis Axial = In Relation to Leg "Footprint" (Long Axis to Foot) T1 FSE PD SPAIR STIR Coronal = In Relation to Leg (Short Axis Foot) PD SPAIR T1 SPIR POST 3D WATS T1 SPIR POST Protocol Indications Notes Axial Coronal Sagittal Great Toe / MTP Joints Turf Toe Smallest Coil Possible (Microcoil if Available) PD FSE T1 FSE PD FSE Sesamoiditis FoV = Mid Metatarsal Through Distal Phalanges PD SPAIR PD SPAIR PD SPAIR Slice thickness = 2-3 mm, 10% gap Axial = In relation to the great toe (short axis foot) Coronal = In relation to the great toe (long axis foot / footprint) Appropriate Coronal Plane for Both Ankle and Foot Imaging UT Southwestern Department
    [Show full text]
  • Hughston Health Alert US POSTAGE PAID the Hughston Foundation, Inc
    HughstonHughston HealthHealth AlertAlert 6262 Veterans Parkway, PO Box 9517, Columbus, GA 31908-9517 • www.hughston.com/hha VOLUME 24, NUMBER 3 - SUMMER 2012 Normal knee anatomy Fig. 1. Anterior knee Inside... pain can be caused by patellofemoral syndrome, • Orthopaedic Components: Quadriceps often called “cyclist’s knee,” muscle What makes a total knee implant? or by patellar tendinitis. • Tennis and Back Pain • Glucosamine and Chondroitin Femur • New Heat Policies - Summer 2012 Patella (kneecap) Imbalances in strength and • Hughston Clinic tone of the lower body Patellar can result in excessive tendon Fibula compressive forces Tibia across the joint. (shinbone) Cycling Overuse Injuries of the Knee Patellofemoral syndrome Compression and shearing across the cartilage of the Quadriceps The economy and higher gas prices are patella can lead to loss of muscle straining wallets and making cycling a more cartilage and the beginning attractive mode of transportation. Health of arthritis. Calf enthusiasts use cycling as a low-impact muscles exercise to improve overall fitness and Patella minimize knee pain. Cities throughout the (kneecap) country are turning old, abandoned railroad Damaged lines into miles of beautiful biking trails and cartilage Femur adding bike lanes to existing roads. In essence, Trochlear cycling is becoming one of the nation’s most groove popular pastimes. Patellar tendinitis Cycling has many health benefits; you Front Quadriceps Cross section of can tone your muscles, improve your view muscle a bent knee cardiovascular fitness, and burn as many as of bent 300 calories an hour during a steady ride. knee People often turn to cycling as a form of Fibula Femur exercise and enjoyment because it is a low- Tibia (thighbone) impact exercise that is easy on the knees.
    [Show full text]
  • Download Versus Arthritis
    Elbow pain Elbow pain information booklet Contents How does the elbow work? 4 What causes elbow pain and stiffness? 6 Should I see a healthcare professional? 8 What can I do to help myself? 9 How are elbow problems diagnosed? 12 What treatments are there for elbow pain? 14 Specific elbow conditions 18 Glossary 26 Research and new developments 27 Keeping active with elbow pain 28 Where can I find out more? 32 We’re the 10 million people living with arthritis. We’re the carers, researchers, health professionals, friends and parents all united in Talk to us 33 our ambition to ensure that one day, no one will have to live with the pain, fatigue and isolation that arthritis causes. We understand that every day is different. We know that what works for one person may not help someone else. Our information is a collaboration of experiences, research and facts. We aim to give you everything you need to know about your condition, the treatments available and the many options you can try, so you can make the best and most informed choices for your lifestyle. We’re always happy to hear from you whether it’s with feedback on our information, to share your story, or just to find out more about the work of Versus Arthritis. Contact us at [email protected] Words shown are explained in the glossary on p.26. Registered office: Versus Arthritis, Copeman House, St Mary’s Gate, Chesterfield S41 7TD in bold Registered Charity England and Wales No. 207711, Scotland No. SC041156.
    [Show full text]
  • Desarrollo De La Podología En España
    Desarrollo de la podología en España Virginia Novel Martí ADVERTIMENT. La consulta d’aquesta tesi queda condicionada a l’acceptació de les següents condicions d'ús: La difusió d’aquesta tesi per mitjà del servei TDX (www.tdx.cat) i a través del Dipòsit Digital de la UB (diposit.ub.edu) ha estat autoritzada pels titulars dels drets de propietat intelꞏlectual únicament per a usos privats emmarcats en activitats d’investigació i docència. No s’autoritza la seva reproducció amb finalitats de lucre ni la seva difusió i posada a disposició des d’un lloc aliè al servei TDX ni al Dipòsit Digital de la UB. No s’autoritza la presentació del seu contingut en una finestra o marc aliè a TDX o al Dipòsit Digital de la UB (framing). Aquesta reserva de drets afecta tant al resum de presentació de la tesi com als seus continguts. En la utilització o cita de parts de la tesi és obligat indicar el nom de la persona autora. ADVERTENCIA. La consulta de esta tesis queda condicionada a la aceptación de las siguientes condiciones de uso: La difusión de esta tesis por medio del servicio TDR (www.tdx.cat) y a través del Repositorio Digital de la UB (diposit.ub.edu) ha sido autorizada por los titulares de los derechos de propiedad intelectual únicamente para usos privados enmarcados en actividades de investigación y docencia. No se autoriza su reproducción con finalidades de lucro ni su difusión y puesta a disposición desde un sitio ajeno al servicio TDR o al Repositorio Digital de la UB.
    [Show full text]
  • Information to Users
    INFORMATION TO USERS This manuscript has been reproduced from the microfilm master. UMI films the text directly from the original or copy submitted. Thus, some thesis and dissertation copies are in typewriter free, i ^ e others may be from any type of computer printer. The quality of this reproduction is dependent upon the quality of the copy submitted. Broken or indistinct print, colored or poor quality illustrations and photographs, print bleedthrough, substandard margins, and improper alignment can adversely afreet reproduction. In the unlikely event that the author did not send UMI a complete manuscript and there are missing pages, these will be noted. Also, if unauthorized copyright material had to be removed, a note will indicate the deletion. Oversize materials (e.g., maps, drawings, charts) are reproduced by sectioning the original, beginning at the upper left-hand comer and continuing from left to right in equal sections with small overlaps. Each original is also photographed in one exposure and is included in reduced form at the back of the book. Photographs included in the original manuscript have been reproduced xerographically in this copy. Higher quality 6” x 9” black and white photographic prints are available for any photographs or illustrations appearing in this copy for an additional charge. Contact UMI directly to order. UMI A Bell & Howell Information Compaiy 300 North Zeeb Road, Ann Arbor MI 48106-1346 USA 313/761-4700 800/521-0600 PHYSIOLOGIC RESPONSES TO INFLAMMATION IN ISOLATED EQUINE JOINTS DISSERTATION Presented in Partial Fulfilment of the Requirements for the Degree of Doctor of Philosophy in the Graduate School of The Ohio State University B y Joanne Hardy, D.V.M., M.S.
    [Show full text]
  • Elbow Pain? We Staff Board Certified Specialists in the Areas of Orthopedics, Sports, Geriatric, and Neurologic Physical Therapy
    Delaware Physical Therapy Clinic Know your elbow • The elbow is comprised of three bones: The Humerus or upper arm bone University of Delaware The Radius Open to the public and the Ulna Physical Therapy is Ranked #1 in the Nation by US Do you suffer from News and World Report! elbow pain? We staff Board Certified Specialists in the areas of Orthopedics, Sports, Geriatric, and Neurologic physical therapy. • Muscles around your elbow both bend and straighten your elbow, the commonly known Biceps and Triceps, but also help you bend and straighten your wrist • These muscles are often irritated and break down with overuse and can lead 540 S. College Ave., Suite 160 to a variety of different conditions Newark, DE 19713 • Tennis Elbow (Lateral Epicondylitis) Phone: (302) 831-8893 • Golfer’s Elbow (Medial Epicondylitis) Fax: (302) 831-4468 • Thrower’s Elbow www.udptclinic.com • Carpal Tunnel Other conditions treated by PTs include: The University of Delaware is an equal opportunity/ • Traumatic injury like Fracture, sprains, affirmative action employer and Title IX institution. For and strains the University’s complete non-discriminiation statement, please visit www.udel.edu/aboutus/ Most conditions can be treated legalnotices. conservatively by a Physical. Elbow Pain How Can Physical Therapy Help Elbow pain? Lateral Epicondylitis or “Tennis Elbow” is pain over the outside of the elbow commonly • Stretching & Strengthening - increase developed with overuse or breakdown of strength and flexibility of the muscles/soft the muscles and tendons that lift your wrist. tissue important to healing. This pain is worsened by spending extended • Manual treatments for loosening of periods of time typing or using a mouse, muscle and tight structures or to improve overly gripping objects or altering one’s motion of the joints in the elbow, wrist, tennis equipment or technique.
    [Show full text]
  • Harkness Center for Dance Injuries' Patient Medical History Form
    Page 1 of 6 HARKNESS CENTER FOR DANCE INJURIES’ PATIENT MEDICAL HISTORY FORM Date: ________ / ________ / ________ Name: __________________________________________ Thigh: femur fracture stress fracture muscle strain / tear other_______________ Date of Birth: _______ / _______ / _______ Hip / Pelvis: arthritis hip flexor strain Sex: M F bursitis labral tear dislocation osteitis pubis fracture snapping hip growth plate injury stress fracture Race: African-American Asian Caucasian other _______________ Hispanic Other: __________ Lumbar-Sacral Spine (low back): arthritis sciatica disc herniation/protrusion scoliosis facet syndrome spinal stenosis fracture spondylolysis Orthopedic History: pinched nerve spondylolisthesis CHECK any orthopedic injury you have had and sacroiliac sprain / dysfunction other _______________ describe below. ALSO CIRCLE any injury that caused you to Cervical / Thoracic Spine (neck / mid back)/Ribs: completely stop dance activity, meaning class, rehearsal arthritis spinal stenosis or performance for two or more days. disc herniation/protrusion spondylolisthesis facet syndrome spondylolysis fracture thoracic outlet syndrome Ankle / Foot: pinched nerve whiplash arthritis fracture scoliosis other _______________ impingement morton’s neuroma os trigonum plantar fasciitis Shoulder: sesamoiditis sprain acromioclavicular joint impingement stress fracture tendinitis sprain/separation labral tear other________________ arthritis mechanical instability Lower Leg / Shin:
    [Show full text]