Orthopaedics Presentation 1

8/6/2019 Orthopaedics Presentation 1

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Orthopaedics


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WHAT IS OCCUPATIONAL

THERAPY?

Occupational therapy is a profession concernedwith promoting health and well being through

occupation. The primary goal of occupational therapy is to

enable people to participate in the activities ofeveryday life.

Occupational therapists achieve this outcome byenabling people to do things that will enhancetheir ability to participate or by modifying theenvironment to better support participation.


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What is physical therapy? It is defined as a system for assessing

problems of function of musculoskeletal

and neurophysiological origin includingthose of pain and of psychosomatic natureof dealing with and of preventing them orby natural methods based on manual

therapy, movements and physical agencies.


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Introduction Orthopaedics surgery is made up of

physicians and other healthcare

professionals who provide comprehensiveorthopaedics services.

Their expertise provides treatment andcare of diseases, injuries, fractures, and

pain. Orthopaedists also design rehabilitationprograms for the physically disabled andparticipate in ongoing musculoskeletalresearch.


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Definition of Orthopaedics

It is the branch of medicine concerned

with diseases, injuries, and conditions of

the musculoskeletal system - relating tothe body's muscles and skeleton, and

including the joints, ligaments, tendons,

and nerves.


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Common Orthopaedic

Disorders Arthritis

OA

Rheumatoid Arthritis Osteoporosis

Anklosing spondylitis

Puget's disease of the bone

Bursitis

Elbow Pain and Problems

Cubital Tunnel Syndrome


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Tennis Elbow (Lateral Epicondylitis)

Golfers or Baseball Elbow (Medical

Epicondylitis)

Fibromyalgia

Foot Pain and Problems

Fractures Low back pain

Common Orthopaedic

Disorders


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Hand pain and problems

Carpal Tunnel Syndrome

Knee Pain and problems Ligament Injuries to the knee

Torn Meniscus

Neck Pain and problems

Scoliosis

Shoulder pain and problem

Soft tissue injuries

Common Orthopaedic

Disorders


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What is arthritis?

Arthritis is inflammation of a joint - the pointwhere two or more bones meet.

In arthritis, inflammation occurs in the

damaged area of a joint.

Damage may be caused by any number of

conditions, including trauma, infection,

neurogenic disturbances, degenerative joint

disease, metabolic disturbances, or for

unknown reasons.

Arthritis is usually chronic, which means

that it rarely changes, or it progresses

slowly.


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Causes of Arthritis Specific causes for most forms of

arthritis are not yet known.


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Clinical feature of arthritis Pain

Swelling

Limited movement in joints and

connective tissues in the body.

Redness

warmth.


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What are the parts of a joint?

Joints are the areas where two bonesmeet.

Most joints are mobile, allowing thebones to move.

Joints consist of the following:

Cartilage

Synovial membrane

Ligaments Tendons, Bursas and Meniscus.

Synovial fluid

Femur - tibia - patella.


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Cartilage Cartilage, is a smooth protective layer

which allows the bones to glide

smoothly upon each other, lines thebones inside the joint. In arthritis, this

smooth lining becomes damaged.


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Synovial membrane It is a tissue called the synovial

membrane lines the joint and seals

it into a joint capsule.

The synovial membrane secretessynovial fluid (a clear, sticky fluid)

around the joint to lubricate it.


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Ligaments, tendons and bursas Ligaments - strong ligaments (tough,

elastic bands of connective tissue)

surround the joint to give support andlimit the joint's movement.

Tendons - tendons (another type oftough connective tissue) on each sideof a joint attach to muscles thatcontrol movement of the joint.

Bursas - fluid-filled sacs, called bursas,between bones, ligaments, or otheradjacent structures help cushion thefriction in a joint.


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Synovial fluid - a clear, sticky fluid

secreted by the synovialmembrane.

Femur - the thighbone.

Tibia - the shin bone.

Patella - the kneecap.

Meniscus - a curved part ofcartilage in the knees and other

joints.


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What are the most common types of arthritis?

The three most prevalent forms ofarthritis include the following:

OA

fibromyalgia

rheumatoid arthritis - an


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Other forms of arthritis

o gout - a result of a defect in body chemistry(such as uric acid in the joint fluid), this painfulcondition most often attacks small joints,especially the big toe. It can usually be

controlled with medication and changes in diet.o systemic lupus erythematosus (lupus) - a

very serious, chronic, autoimmune disordercharacterized by periodic episodes of

inflammation of and damage to the joints,tendons, other connective tissues, and organs,including the heart, lungs, blood vessels, brain,kidneys, and skin.


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H

ow is arthritis diagnosed? In addition to a complete medical history

and physical examination, diagnosticprocedures for arthritis may include the

following: X-rays or other imaging procedures (to show

the extent of damage to the joint)

Blood tests and other laboratory tests,including the following:

1. Antinuclear antibody (ANA) test - to checklevels of antibodies in the blood.

2. Arthrocentesis or joint aspiration (to removea sample of the synovial fluid to determine if

crystals, bacteria, or viruses are present)


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1. Complete blood count (to determine ifwhite blood cell, red blood cell, and platelet

levels are normal)2. Creatinine (to monitor for underlying

kidney disease)

3. Erythrocyte sedimentation rate (to detect

inflammation).4. Hematocrit (to measure the number of red

blood cells)

5. Rheumatoid factor test (to determine if

rheumatoid factor is present in the blood)6. Urinalysis (to determine levels of protein,

red blood cells, white blood cells, andcasts)

7. White blood cell count (to determine levelof white blood cells in the blood).


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What is OA?

It is the most common form of arthritis inelderly people.

It represent a major cause of morbidity, chronic

pain and increases health care usage.

It is a chronic, degenerative, joint disease thataffects mostly middle-aged and older adults.

It is characterized by the breakdown of joint

cartilage and adjacent bone in the neck, lower

back, knees, hips, and/or fingers.

The disease is also known as degenerative

arthritis or degenerative joint disease.


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Causes of OA

It can be classified as primary orsecondary.

Primary OA has an unknown cause secondary OA is caused by another

disease, infection, injury, or deformity.


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Several risk factors are associated with OA,including the following:

Age.

Heredity- slight joint defects or laxity of the

joint and genetic defects may contribute to thedevelopment of OA.

Obesity- excessive weight can put unduestress on such joints as the knees over time.

Injury/overuse- significant injury to a joint,such as the knee, can later result in OA.

Injury may also result from repeated overuseor misuse over a period of time.

Causes of OA


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Diagnoses of OA

In addition to a complete medical historyand physical examination, diagnostic

procedures for OA may include thefollowing:

X-ray - a diagnostic test which usesinvisible electromagnetic energy beams toproduce images of internal tissues, bones,and organs onto film.

Joint aspiration - involves a removal offluid from the swollen bursa to excludeinfection or gout as possible causes.


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The goals of treatment

The goals of treatment for OA are to

reduce joint pain and stiffness, and

improve joint movement.


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Treatment for OATreatment may include: Specific treatment for OA will be determined by

your physician based on:

The age, overall health, and medical history. Exercise- aerobic exercise, and stretching and

strengthening exercises may help reduce the

symptoms of and pain associated with OA.

Heat treatment help to reduce pain.


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Physical and occupational therapy may help to

reduce joint pain, improve joint flexibility when

performing daily activities, and reduce jointstrain.

Weight maintenance may help to prevent or

reduce the symptoms of OA.

Medication for specific symptoms may include

pain relievers (in pill form or topical cream) and

anti-inflammatory medications, if inflammation is

present. Injections of thick liquids into the joints to

maintain normal joint fluid.

Joint surgery may be necessary to repair or

replace a severely damaged joint.


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Rheumatoid Arthritis


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What is rheumatoid

arthritis? It is a chronic, autoimmune disease, is the most

crippling form of arthritis and affects approximately 2.1million Americans.

It is characterized by painful and stiff joints on bothsides of the body that may become enlarged anddeformed.

It is affects more women than men (75 percent ofpersons with rheumatoid arthritis are women).

The disease most often occurs between the ages of 20and 45.

Patients with rheumatoid arthritis often also haveosteoporosis, a progressive deterioration of bone

density.


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Juvenile rheumatoid arthritis

Juvenile rheumatoid arthritis (JRA) is a

form of arthritis in children ages 16 or

younger that causes inflammation andstiffness of joints for more than six weeks.

Unlike adult rheumatoid arthritis, which is

chronic and lasts a lifetime, children often

outgrow juvenile rheumatoid arthritis.

However, the disease can affect bone

development in the growing child.


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Causes of rheumatoid

arthritis? The exact cause of rheumatoid arthritis is not known.

It is an autoimmune disorder, which means the body'simmune system attacks its own healthy cells and

tissues.

The response of the body causes inflammation in andaround the joints, which then may lead to adestruction of the skeletal system.

It is also may have devastating effects to otherorgans, such as the heart and lungs.

Researchers believe certain factors, includingheredity, may contribute to the onset of the disease.


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Symptoms of rheumatoid arthritis

The joints most commonly affected byrheumatoid arthritis are in the hands,

wrists, feet, ankles, knees, shoulders, andelbows.

The disease typically causes inflammationsymmetrically in the body, meaning thesame joints are affected on both sides ofthe body.

Symptoms of rheumatoid arthritis maybegin suddenly or gradually.


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Common symptoms of

rheumatoid arthritis. inflamed, painful joints

stiff joints

enlarged and/or deformed joints (such asfingers bent toward the little finger and/orswollen wrists)

frozen joints (joints that freeze in one

position) cysts behind the knees that may rupture,

causing lower leg swelling and pain


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Hard nodules (bumps) under the skin near

affected joints.

low-grade fever. Inflamed blood vessels (vasculitis) may occur

occasionally, leading to nerve damage and leg

sores.

Inflamed membranes around the lungs (pleurisy),

the sac around the heart (pericarditis), or

inflammation and scarring of the lungs

themselves, that may lead to chest pain, difficulty

breathing, and abnormal heart function.

Common symptoms of

rheumatoid arthritis.

C t f


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Swollen lymph nodes.

Sjgren's syndrome (dry eyes and mouth).

Eye inflammation.

Morning stiffness that lasts longer than one hour for at

least six weeks.

Three or more joints that are inflamed for at least sixweeks.

Presence of arthritis in the hand, wrist, or finger joints

for at least six weeks. The symptoms of rheumatoid arthritis may resemble

other medical conditions or problems, including acuterheumatic fever, Lymph disease, psoriatic arthritis, gout,osteoarthritis and ankylosing spondylitis.

Common symptoms of

rheumatoid arthritis.


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Diagnosis of rheumatoid arthritis

Diagnosis of rheumatoid arthritis may be difficult in

the early stages, because symptoms may be very

subtle and go undetected on x-rays or blood tests.

In addition to a complete medical history and physical

examination, diagnostic procedures for rheumatoid

arthritis may include the following: x-ray - a diagnostic test which uses invisible

electromagnetic energy beams to produce images of

internal tissues, bones, and organs onto film.

joint aspiration - involves a removal of fluid from theswollen bursa to exclude infection or gout as possible

causes.


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Biopsy (of nodules tissue) - a procedure in

which tissue samples are removed (with a

needle or during surgery) from the bodyfor examination under a microscope; to

determine if cancer or other abnormal

cells are present.

Blood tests (to detect certain antibodies,called rheumatoid factor, and other

indicators for rheumatoid arthritis)

Diagnosis of rheumatoid arthritis


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Introduction

Theanterior cruciate ligament) ACL) is probablythe most commonly injured ligament of the knee.

In most cases, the ligament is injured by peopleparticipating in athletic activity.

As sports have become an increasingly importantpart of day-to-day life over the past few decades,the number ofACL injuries has steadily increased.

This injury has received a great deal of attentionfrom orthopedic surgeons over the past 15 years,

and very successful operations to reconstruct thetorn ACL have been invented.


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ACL


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Introduction

Theposterior cruciate ligament) PCL) is

one of the less commonly injured ligaments

of the knee. Understanding this injury anddeveloping new treatments for it have

lagged behind the other cruciate ligament in

the knee, theanterior cruciateligament) ACL), probably because there are

far fewerPCL injuries than ACL injuries.


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Anterior and PosteriorCruciate

Ligament

Thenormal posterior cruciate

ligament (PCL (is easily

viewed as a dark wavy line

running from the femur to the

tibia .

Torn anterior cruciate ligament

(ACL)


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PCL tear (right slide(


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The case:

A 57-year-old woman presented with left

knee pain after falling off of a stool.

A R di l i C S d


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Answer to Radiologic Case Study

Knee Dislocation

Figure 1 :Consecutive sagittal proton density MRI of the left knee

shows a torn PCL (A,B) andACL (C).Anterior translation of the tibia

(D)Figure 2 :Consecutive coronal T2 MRI of the left knee shows an

intact lateral collateral ligament (A).

Tears of the MCL and lateral meniscus can be seen, as well as lateral

translation of the tibia (B-D )


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Foot Pain and Problems


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Anatomy of the foot

The foot is one of the most complex partsof the body, consisting of 38 bones

connected by numerous joints, muscles,tendons, and ligaments.

The foot is susceptible to many stresses.

Foot pain and problems can cause pain,inflammation, or injury, resulting inlimited movement and mobility.


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What are the different types of foot

problems? Foot pain is often caused by improper foot function.

Improperly fitted shoes can worsen and, in some cases,

cause foot problems.

Shoes that fit properly and give good arch support can

prevent irritation to the foot joints and skin.

There are many types of foot problems that affect the

heels, toes, nerves, tendons, ligaments, and joints of the

foot. The symptoms of foot problems may resemble other

medical conditions and problems.


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What are heel spurs?

A heel spur is a bone growth on the heel bone,particularly on the underside forepart of the heelbone where the bone connects to the plantar fascia.

If the plantar fascia, a long band of connectingtissue running from the heel to the ball of the foot,is over-stretched, it can cause a bone growth, orspur, to develop.

This connective tissue holds the arch together andacts as a shock absorber during activity.

The pain results from the stress and inflammationof the plantar fascia pulling on the bone.


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Ankle joint fractures

These fractures may be serious and

require immediate medical attention.

Ankle fractures usually require a cast,and some may require surgery if the

bones are too separated or misaligned.


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metatarsal bone

fractures Fractures of the metatarsal bones, located

in the middle of the foot, often do not

require a cast. A stiff-soled shoe may be all that is

needed for support as the foot heals.

Surgery sometimes is needed to correct

misaligned bones or fractured segments.


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Sesamoid bone

fractures

The Sesamoid bones are two small, round bones

at the end of the metatarsal bone of the big toe.

Usually, padded soles can help relieve pain.

However, sometimes, the Sesamoid bone may

have to be surgically removed.


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Toe fractures

Fractures of the middle toes can heal without a

cast.

Fractures of the big toe or little toe may requirea cast and/or surgery.


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What is foot pain?

Foot pain can be debilitating to an active

lifestyle.

Foot pain can have many sources, fromfractures and sprains to nerve damage.

Listed below are three common areas of pain in

the foot and their causes:


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pain in the ball of the

foot Pain in the ball of the foot, located on the

bottom of the foot behind the toes, may be

caused by nerve or joint damage in that area. In addition, a benign (non-cancerous) growth,

such as Morton's neuroma, may cause the pain.

Corticosteroid injections and wearing

supportive shoe inserts may help relieve thepain. Sometimes, surgery is necessary.


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plantar fasciitis Plantar fasciitis is characterized by severe pain in the

heel of the foot, especially when standing up after resting.

The condition is due to an overuse injury of the solesurface (plantar) of the foot and results in inflammation

of the fascia, a tough, fibrous band of tissue that connectsthe heel bone to the base of the toes.

Plantar fasciitis is more common in women, people whoare overweight, people with occupations that require alot of walking or standing on hard surfaces, people with

flat feet, and people with high arches. Walking orrunning, especially with tight calf muscles, may alsocause the condition.


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Treatment

Treatment may include:

o rest

o ice pack applications

o nonsteroidal anti-inflammatory medications

o stretching exercises of the Achilles tendons

and plantar fascia


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Achilles tendon injury

The Achilles tendon is the largest tendonin the human body. However, this tendonis also the most common site of rupture

or tendonitis, an inflammation of thetendon due to overuse.

Achilles tendonitis is caused by overuseof the tendon and calf muscles.Symptoms may include mild pain after

exercise that worsens gradually, stiffnessthat disappears after the tendon warmsup, and swelling.


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Treatment

o rest

o nonsteroidal anti-inflammatorymedications

o supportive devices and/or bandages forthe muscle and tendon

o stretching

o massage

o ultrasoundo strengthening exercises

surgery


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What is a fracture?

A fracture is a partial or complete break in the

bone. When a fracture occurs, it is classified as

either open or closed: Open fracture (Also called simple fracture) - the

bone exits and is visible through the skin, or a

deep wound that exposes the bone through the

skin. Closed fracture (Also called compound fracture)

- the bone is broken, but the skin is intact.


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Types of Fractures

transverse - the break is in a straight line across the bone.

spiral - the break spirals around the bone; common in atwisting injury.

oblique - diagonal break across the bone.

compression - the bone is crushed, causing the brokenbone to be wider or flatter in appearance.

comminuted - the break is in three or more pieces and

fragments are present at the fracture site. segmental - the same bone is fractured in two places, so

there is a "floating" segment of bone.


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What causes a

fracture? Fractures occur when there is more force

applied to the bone than the bone can

absorb.

Bones are weakest when they are twisted.

Breaks in bones can occur from falls,

trauma, or as a result of a direct blow orkick to the body.


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What are the symptoms

of a fracture? pain in the injured area.

swelling in the injured area.

obvious deformity in the injured area.

difficulty using or moving the injured

area in a normal manner.

warmth, bruising, or redness in the

injured area.


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Diagnosed OF fracture

In addition to a complete medical history

(including asking how the injury occurred) and

physical examination, diagnostic procedures fora fracture may include the following:

X-ray

Magnetic resonance imaging (MRI)

Computed tomography scan (Also called a CT or

CAT scan.


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Complication related to the

fracture itself Infection

Delayed union

Non-union

A vascular necrosis

Mal-union

Shortening


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Causes of Non-union

Infection of the bone.

Inadequate blood supply to one or both fragments.

Excessive shearing movement between the fragments.

Interposition of soft tissue between the fragments. Loss of apposition between the fragments (including over-

distraction by traction apparatus.

Dissolution of the fracture hematoma by synovial fluid (in

fractures within joints). The presence of corroding metal in the immediate vicinity of

the fracture.

Destruction of the bone by a tumor (in pathological fracture).


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Types of bone grafts

Autogenous grafts- obtained from another

part of the patients body.

Allograft; homogenous graft- obtained fromanother human subject.

Heterogeneous grafts- obtained from animals


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Complications attributable to

associated injury Injury to major blood vessels

Injury to nerves

Injury to viscera

Injury to tendons

Injuries and post-traumatic affections of joints

Fat embolism


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Treatment for a

fracture Specific treatment for a fracture will be

determined by your physician based on:

your age, overall health, and medical history

The goal of treatment is to control the pain,

promote healing, prevent complications, and

restore normal use of the fractured area.


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Types of fractures


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Fracture ulna and radius


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Four fracture of the wrist


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Rolando Fracture

Comminuted

Intra-articular

Fracture through base ofthumb

Prognosis: worse than

Bennett's fracture

(difficult to reduce)

Bennett's Fracture


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Bennett's Fracture

Intra-articular

fracture/dislocation of base

of 1st metacarpal

Small fragment of 1st

metacarpal continues to

articulate with trapezium

Lateral retraction of 1st

metacarpal shaft byabductor pollicis longus


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Barton's Fracture

Intra-articular fracture

of the dorsal margin

of the distal radius Extends into radio-

carpal joint


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Colles' Fracture

Extra-articular fracture of the

distal radius

Does not extend into joint

space

Dorsal angulations with radial

and dorsal displacement of

distal fragment

Frequently associated withfracture of ulnar styloid


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Colles fracture


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Tibia fractures


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Fracture Femur


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Conversion of arthrodesis to THR

Arthrodesed hip 30 years previously


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Typical Hip Fracture: Adult


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Fracture Reconstruction and Hip

Replacement


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Surgical treatment


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Revision hip replacement with

bulk allografting


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Profix Total Knee Replacement


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Compression fracture

Normal vertebra Compression fracture


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Fracture Humorous


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Anatomy of the carpal bone


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Fracture of metacarpal bone


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Fracture cervical vertebral

Left clavicle fracture


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Left clavicle fracture


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Fracture styloid


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Fracture dislocation


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Fracture skull


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Fracture scaphoid


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Fracture ankle


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Shoulder Pain and Problems

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