Panel: Return to Play - Akron Children's Hospitalreaction/Coccydynia pain •Occurrence •Clinical...
Transcript of Panel: Return to Play - Akron Children's Hospitalreaction/Coccydynia pain •Occurrence •Clinical...
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Panel: Return to Play
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Panel: Return to Play • Moderator: Joe Congeni, M.D.; Akron Children’s Hospital
• Kerwyn Jones, M.D.; Akron Children’s Hospital
• Derrick Eddy, M.D.; Akron Children’s Hospital
• Amy Krahe, PT, MPT, OCS; Akron Children’s Hospital
• Mike Johnson, AT, ATC; Akron Children’s Hospital
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Lower leg pain
• Tibial stress fracture
– Clinical presentation
– Imaging
• Compartment Syndrome
– Clinical presentation
– Imaging
• PAES
– Clinical presentation
– Imaging
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Tibial stress fracture
• On field findings and assessment
– Concomitant sxs; thorough history
– When to refer…
• Periostitis
• Stress reaction
• Stress fracture
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Tibial stress fracture
• Conservative management
– Rest, relative rest, physical therapy
– Multi-factorial treatment team
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Tibial stress fracture
• MD clinical exam
• Diagnostic testing
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Tibial stress fractures
• Chronic tibial pain
• Sports decisions
• Orthopedic involvement
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Compartment Syndrome
• On field findings; chief complaints
• Considerations on causative factors
– Volume
– Biomechanics
– Anatomic
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Compartment Syndrome
• Diagnostic testing
– Exertional pressure
testing
– Dynamic MRI
• Surgical referral
• Surgical procedures
• Prognosis?
Left Lower Leg Right
Pre-exertion Anterior
Pre-exertion Lateral
Pre-exertion Deep Posterior
Pre-exertion Superficial Posterior
1 Minute Anterior
1 Minute Lateral
1 Minute Deep Posterior
1 Minute Superficial Posterior
5 Minute Anterior
5 Minute Lateral
5 Minute Deep Posterior
5 Minute Superficial Lateral
Pre-exertion should be < 15 mmHg
1 min post-exertion should be < 30 mmHg
5 min post-exertion should be < 20 mmg
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Popliteal Artery Entrapment
(PAES)
• Signs and Symptoms?
• Diagnosis of exclusion?
• Differentiation from previous
two diagnoses?
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PAES
• Diagnostic testing
– ABI with exercise
– Ultrasound
– PVR
– Dynamic MRA
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PAES
• Surgical intervention
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Buttocks Pain
• Proximal hamstring/Apophyseal avulsion
– Clinical presentation
– Imaging
• Sacral stress reaction
– Clinical presentation
– Imaging
• Labral pathology
– Clinical presentation
– Imaging
• Piriformis syndrome
– Clinical presentation
– Imaging
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Proximal hamstring
pain/Apophyseal avulsion
• Clinical presentation
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Proximal hamstring
pain/Apophyseal avulsion
• Diagnostic imaging
– Radiographs
– Ultrasound
– MRI
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Sacral stress
reaction/Coccydynia pain
• Occurrence
• Clinical presentation
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Sacral stress
reaction/Coccydynia pain
• Diagnostic imaging
• Treatment approach
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Piriformis Syndrome
• Does it exist?
• Concomitant pathology
• Clinical exam findings
• Imaging?
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Piriformis Syndrome
• Conservative treatment
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Hip labral pathology
• Internal vs. external hip pathology
• Clinical exam
• Diagnostic imaging and % of false
positives
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Hip labral pathology
• Conservative vs. surgical interventions
• Prognosis