Overuse Injuries

Question 1

Preventing overuse injuries?

Answer 1

• stretch prior to activity, shouldn’t hurt
• warm up prior to activity, break a sweat
• make sure you’re good enough in shape to participate
• ease back into activity
• don’t play through the pain

Question 2

Diff shoulder injuries?

Answer 2

• overuse: fatigued tendons and muscles
• subacute: fatigued tendons and muscles that now slowly begin to tear/wear out: pain is increasing
• acute: fell, threw too hard, swung too hard, now your shoulder hurts

Question 3

Diff overuse shoulder injuries? Presentation?

Answer 3

• tendonitis: irritation/inflammation of a tendon - pain down side of shoulder w/ overhead and behind back activity, nighttime pain
• tendonopathy: sick tendon, similar pain complaints, pain may have been evident for a longer period of time

Question 4

Tx of overuse shoulder injuries?

Answer 4

• make sure that is all it is: xrays and MRI
• NSAIDs
• ice
• PT
• corticosteroid injection

Question 5

What is a subacute shoulder injury? Dx, tx?

Answer 5

• progression of an overuse injury
• had occasional pain b/f, now it hurts worse and more frequently
• xrays for bones
• MRI for soft tissues
• if unremarkable:
  NSAIDs
  ice
  PT
  +/- corticosteroid injection

Question 6

Dx and tx for acute shoulder injury?

Answer 6

• XR and MRI

- tx depends on findings

Question 7

Workup for shoulder injuries? MRI indications?

Answer 7

• in general w/u for overuse, subacute, acute shoulder pain is all the same
• XRs are a must
• MRI indications: drop arm sign, external rotation lag sign, dislocation

Question 8

Concerning shoulder injuries - + findings?

Answer 8

• pain doesn’t improve w/ conservative management
• • findings on xrays: fx, arthritis
• • findigns on MRI: found something wrong- rotator cuff tear, labral tear, biceps tendon tear

Question 9

Tx of severe shoulder injury?

Answer 9

• shoulder arthroscopy

- clean up shoulder and repair torn tendons

Question 10

Recovery time for shoulder surgery?

Answer 10

worst case scenario is a cuff repair:

• 6 wks: healing phase- typically start therapy at 3 wks, full time sling 3 wks/part time 3 wks
• 6 wks: rehab and strengthening
• typically at 3-4 months: start resuming previous activities slowly

Question 11

3 sep compartments of the knee?

Answer 11

• patellofemoral
• medial
• lateral

Question 12

2 main types of cartilage in the knee?

Answer 12

• articular cartilage: thin lining of resilient CT that serves as padding and an ultra low friction surface
• meniscal cartilage: serve to deepen the contact of the femur on the tibia, provide stability, and distribute force
• jt reaction force in the knee is about 3x body wt when walking, this is absorbed by menisci and articular cartilage

Question 13

Problems w/ the knee?

Answer 13

• tendonitis
• meniscal tears
• ligament injuries
• cartilage injuries
• arthritis

Question 14

What is tendonitis?

Answer 14

• irritation/inflammation of tendon

- typically responds well to rest, ice, anti-inflammatories, and focused PT

Question 15

What is a meniscal tear? MOI?

Answer 15

• disruption of continuity of meniscus of the knee

- MOI: twisting, turning, deep knee bends, pivoting

Question 16

Sxs of a meniscal tear?

Answer 16

• focal pain, typically intermittent
• swelling
• nighttime pain
• pain w/ activity
• catching/locking

Question 17

Tx options for meniscal tear?

Answer 17

• PT, injections

- arthroscopic surgery: remove/fix the tear, 80-90% better by 6-8 wks

Question 18

Tx of ligament tears?

Answer 18

• ACL: fix in active, physical individual, no real age restriction, CI if significant arthritis
• PCL: fix when sx, CI if sig arthritis
• MCL: brace for 6 wks, wt bearing as tolerated
• LCL: brace, fix if part of complex of lateral injuries

Question 19

What is cartilage injury of the knee? Dx? Tx?

Answer 19

• damage to articular cartilage
• typically unclear of severity until time of arthroplasty
• variety of txs dependent on severity:
  smooth down
  microfracture
• cartilage transplant: tx for smaller, focal cartilage defects, an attempt to prevent the progression to osteoarthritis (not useful in degenerative arthritis)

Question 20

Tx of meniscus tear w/ mild/mod arthritis?

Answer 20

• rather common
• meniscus tear is the mechanical problem
• tx based on 6 wks of observation
• if sxs are improving, monitor
• if not or worsening, then consider viscosupplementation

Question 21

What is viscosupplementation?

Answer 21

• soln of hyaluronan
• lubricant and shock absorber in jts
• OA reduces body’s ability to produce hyaluronan
• w/o it pt experiences pain of OA as jt wears out
• longevity: varies from pt to pt, depending on number of factors: age, wt, stage of disease
• max benefits: can be seen up to 12 wks from last injection
• in general: beneficial effects last from 6 months to a year
• no CI to a repeat injection series

Question 22

Tx of medial and lateral epicondylitis?

Answer 22

- NICER:
anti-inflammatories
ice
compression
elevation
rest 

• for recalcitrant cases:
  consider steroid injection, platelet rich plasma injection
• most of the time these go away but some reqr surgery

Question 23

What is platelet rich plasma?

Answer 23

• high concentration of fxnly viable platelets and their assoc growth factors
• extracted from small amt of pt’s blood: 9-18 cc
• spun through a simple centrifugation process to for a dense suturable fibrin matrix scaffold
• delivered arthroscopically/open and placed directly into tear site to stimulate a reparative healing response for soft tissue and bone repair

Question 24

Applications for PDGF?

Answer 24

• direct liquid form injections of concentrated platelets for various tendonitis problems
• clot form applications w/ extended growth factor release for cuff repairs