Академический Документы
Профессиональный Документы
Культура Документы
Preliminaries
Useful Resources and Acknowledgements
1. Atlas of Imaging in Sports Medicine (2nd ed.). Jock Anderson and
John W Read
2. Clinical Sports Medicine. Bruckner and Khan
3. American Academy of Orthopedic Surgeons Website.
www.aaos.org
4. Advanced Physiotherapy and Injury Prevention Website
www.advancedphysio.com.au, notes will be on website (show)
Acknowledgements Isobel Green, Jess Fidler
Introduce Colleagues
Purpose of these talks: educate, meet, value add
Who we treat
Imaging
When to Image
If it affects management
Diagnosis is uncertain
Demanding patient
To assist with determining prognosis
Red flags
Orange flags
Failed treatment
Red Flags
> 50 year old
Systemic symptoms
Significant morning stiffness
Known risk factors
Past history or family history
Noctural pain
Orange Flags
Disability disproportionate to mechanism
Failure to respond to conservative management
Multiple opinions
Anxious patient
Education
Significant trauma (fall over 1 metre)
IV drug use
Cord or cauda equina signs
History of use of oral corticosteroids
Grade 2
Grade 3
Case Study 1
42 year old coal-miner, twisted ankle felt pop, swelled
Case Study 1
Probable diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
Case Study No 1
Lateral ligament sprain
with a short period of protection via boot, brace or tape followed by series of exercises
designed to gradually restore range of motion, strength, proprioception
The Journal of Bone and Joint Surgery VOL. 73-A, NO. 2, FEBRUARY 1991 Summary.
After a critical review of these twelve studies, it is not difficult to select functional
treatment as the treatment of choice for acute complete tears of the lateral ligaments of
the ankle
in these were
chondral lesions in 20
patients,
traumatic synovitis in 19,
adhesions in nine and a
partial rupture of the
deltoid ligament in one.
Case Study 2
Soccer Player twisted ankle
(external rotation).
Presented unable to
weightbear with swelling
anterior ankle joint. ED
series x-rays patient told
no fracture. Reports no
swelling lateral ankle but
swelling anteriorally
Possible diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
Case Study 2
Injury to inferior tibiofibular ligaments (high ankle sprain)
tear/instability
PITFL does not cause diastasis and treated as per a typical
sprain
Case Study 3
51 year old female presents
Probable diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
problem
Biomechanics
Pathology
?Heel spur (FDB)
Time frame to recover
?referral on
Imaging?
Clinical tests
Management options
Case Study 4
62 year old woman,
Case Study 4
Acquired Pes Planus
Case Study 5
39 year old woman
Probable diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
Referral on?
Likely time frame to
recover?
Likelyhood of poor
outcome?
Tendon Facts
Types of tendon Pathology (Cook and Purdham BMJ 2008)
normal,
proliferative
failed healing
degenerative
rupture
Tendon sheath
Insertional and non-insertional tendinopathies
Tendon Facts
Most tendon pathologies we see in the non-athletic
Aeitiology
Genetic factors (more type 3 collagen, blood group O,)
Hypermobility
Higher incidence in diabetics
Increased with increasing age
Related to waist girth (BMI>30 3times greater likelyhood of
Tendon Facts
Degenerative tendon pathology is reversible
important
If pain in a sedentary person or is chronic we can embark
immediately on a resistance exercise program
If there is a bursae associated with the tendon then ultrasound is
worthwhile and if the bursae is inflamed consider an injection
If the tendinopathy is insertional and you are prescribing exercises
dont allow the tendon to stretch
Many of the traditional programs are not appropriate
Expect 6 -12 months in many cases
?GTN patches and other measures such as autologous blood,
polidocinol,
Case Study 6
15 year old boy, falls out of a
Probable diagnosis?
Clinical tests to confirm
diagnosis?
Further imaging required?
Lisfranc Injury
Although not common early management is crucial to long
term outcome
Referral on?
Likely time frame to recover?
Likelyhood of poor outcome?
Metatarsalgia
The term metatarsalgia is often used to describe pain in the
Assessment
Upright
Standing look at shoes, wear patterns, symmetry, muscle wasting, erythema, scarring,
arch height, toe position, knees, general posture, single leg heel raise
Walking normally, heels, toes,
Weightbearing dorsiflexion and calf length
Supine
sustentaculum tali, navicular, base of 5th met, dome of talus, individual bones
Active and passive movements (ankle, subtalar, transverse tarsal, midtarsal,
tarsometatarsal, forefoot, toes)
Resisted muscle tests
Special tests eg posterior impingement, syndesmotic ligaments, anterior drawer
Prone
Achilles tendon
Stress tests for ATFL and Syndesmosis
Gaitscan
Gaitscan
Indications for orthotics