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Chronic

Chronic injuries

injuries of

of locomotor

locomotor

system

system

Chronic Chronic injuries injuries of of locomotor locomotor system system Zongqiang Huang Zongqiang Huang

Zongqiang Huang

Zongqiang

Huang

Soft

Soft tissue

tissue

Cartilage

Cartilage

Bone

Bone

nerve

nerve

Trigger finger

A trigger finger or thumb results from constriction of a flexor tendon sheath which produces swelling of the corresponding tendon.

Repeated friction leads to localized tendon hypertrophy and nodule formation.

There is a tender nodule at the base of the affected finger over the metacarpophalangeal joint. The finger can usually be flexed but extension is difficult, producing a ‘trigger’ or flicking motion as the nodule passes through the constriction. Treatment options include the injection of hydrocortisone and local anaesthetic Simple division of the sheath.

Adhesive Capsulitis

Adhesive

Capsulitis of

of the

the

Shoulder

Shoulder

The

The shoulder

shoulder capsule

capsule becomes

becomes

contracted and

contracted

and thickened

thickened

AA dramatic

dramatic decrease

decrease inin shoulder

shoulder

ROM(range

ROM(range of

of motion)

motion)

InIn many

cases there

there isis spontaneous

spontaneous

many cases

resolution after

resolution

after 1-3

1-3 years

years and

and motion

motion isis

re-gained

re-gained

Physical Exam

Physical

Exam

Physical

Physical exam

exam helps

helps identify

identify which

which portion

portion of

of

the capsule

the

capsule isis most

most affected;

affected;

External

External rotation

rotation w/

w/ armarm adducted:

adducted: tests

tests for

for

contracture of

contracture

of the

the antero-superior

antero-superior portion

portion of

of

the capsule;

the

capsule;

External

External rotation

rotation w/

w/ armarm abducted:

abducted: tests

tests for

for

contracture of

contracture

of the

the antero-inferior

antero-inferior portion

portion of

of the

the

capsule;

capsule;

Internal

Internal rotation:

rotation: tests

tests for

for contracture

contracture of

of

posterior capsule;

posterior

capsule;

Tenderness

Tenderness

ROM

ROM

Treatment

Treatment

NSAIDS/steroids

NSAIDS/steroids

Intra-articular

Intra-articular steroid

steroid injection

injection

Physical

Physical therapy

therapy

Tennis elbow- Lateral

Epicondylitis

A tear of a number of the fibres of the common origin of the forearm extensor muscles over the lateral epicondyle.

It is usually caused by wringing of clothes and similar repetitive actions rather than tennis.

There is a localized tender area, mainly over the lateral epicondyle

Gripping will usually exacerbate the pain, as will extension of the second and third fingers against resistance.

Treatment

Treatment

Injection of hydrocortisone and local anaesthetic into the tender area will relieve the pain in over 80% of cases but may have to be repeated.

A support around the forearm just below the elbow is often successful.

In very severe cases operation and freeing of the extensor origin is necessary.

Chondromalacia of

Chondromalacia

of the

the Patella

Patella

Softening

Softening && fissuring

fissuring of

of articular

articular hyaline

hyaline

cartilage;

cartilage;

May

May result

result from

from anan excessive

excessive load

load onon

patellofemoral

patellofemoral joint,

joint, but

but disuse

disuse may

may bebe

aa contributing

contributing factor

factor

Most

Most common

common inin young

young women

women

Arthroscopy

Arthroscopy

Clinical

Clinical Features

Features and

and Exam

Exam

Anterior

Anterior knee

knee pain,

pain, esp.

esp. while

while climbing

climbing

stairs

stairs

Compression

Compression of

of patella

patella may

cause pain

pain

may cause

along medial

along

medial && lateral

lateral retinacula

retinacula &&

patellar ligament

patellar

ligament

Compression

Compression of

of the

the patella

patella during

during flexion

flexion

&& extension

extension of

of knee

knee may

may elicits

elicits crepitation

crepitation

and discomfort

and

discomfort

Treatment

Treatment

Reduced

Reduced strenuous

strenuous activities

activities

Exercises

Exercises toto stretch

stretch && strengthen

strengthen quadriceps

quadriceps

muscle

muscle are

are started

started

NSAIDS

NSAIDS

Legg Calve Perthes Disease

A self limiting hip disorder caused by a varying degree of ischemia and subsequent necrosis of the femoral head

Avascular necrosis of nucleus of proximal femoral epiphysis,

Abnormal growth of the physis Remodeling of regenerated bone

loss of blood supply to the epiphysis is thought to be the essential lesion;

Usually

Usually seen

seen inin 44 toto 88 yryr old

old boy

boy with

with

delayed skeletal

delayed

skeletal maturity;

maturity;

Male

Male toto female

female ratio:

ratio: 4-5

4-5 toto 1;

1;

UpUp toto 12%

12% of

of cases

are bilateral

bilateral but

but will

will

cases are

bebe at

at different

different stages

stages && are

are asymmetric

asymmetric

Age

Age isis the

the key

key toto the

the prognosis

prognosis -- after

after 88

yr represents

yr

represents poor

poor prognosis;

prognosis;

Clinical

Clinical Presentation

Presentation

Pain

Pain (often

(often knee

knee pain)

pain)

Effusion

Effusion (from

(from synovitis)

synovitis)

AA limp

limp

Limited

Limited abduction

abduction of

of hip

hip && limited

limited internal

internal

rotation inin both

rotation

both flexion

flexion && extension

extension

Radiographic Evaluation

Radiographic

Evaluation

Bone

Bone scans

are highly

highly sensitive

sensitive for

for

scans are

Perthes disease

Perthes

disease

Ossific

Ossific nucleus

nucleus fails

fails toto grow

grow and

and looks

looks

smaller;

smaller;

Ossific

Ossific nucleus

nucleus isis small,

small, dense,

dense, and

and

uniform;

uniform;

Epiphysis

Epiphysis isis seen

seen toto fragment;

fragment;

Treatment

Treatment

Principles

Principles of

of treatment

treatment are

are maintenance

maintenance

of ROM

of

ROM && containment

containment of

of femoral

femoral head

head

through the

through

the evolution

evolution of

of healing

healing of

of the

the

epiphysis;

epiphysis;

Keeping

Keeping hip

hip abducted

abducted and

and internally

internally

rotated byby traction

rotated

traction or

or bracing

bracing

AA proximal

proximal varus

varus osteotomy

osteotomy

Excision

Excision of

of extruded

extruded portion

portion of

of head

head for

for

hinge abduction

hinge

abduction

Acetabular

Acetabular osteotomy:

osteotomy: Chiari

Chiari osteotomy

osteotomy

toto cover

cover femoral

femoral head;

head;

Carpal tunnel

syndrome

Narrowing of the carpal tunnel.

A previous fracture, osteoarthritis or synovial thickening in pregnancy or conditions such as rheumatoid arthritis.

Symptoms

Symptoms and

and signs

signs

Pinching

Pinching or

or compression

compression of

of this

this nerve

nerve byby the

the

transverse carpal

transverse

carpal ligament

ligament

Wrist

Wrist pain

pain and

and tingling

tingling inin the

the hand

hand

Weakness

Weakness inin grip

grip and

and aa feeling

feeling of

of incoordination

incoordination

Numbness

Numbness inin the

the radial

radial three

three and

and aa half

half fingers

fingers and

and

weakness

weakness

atrophy

atrophy of

of the

the thenar

thenar muscles.

muscles.

Treatment

Treatment

Rest with a splint

Anti-inflammatory drugs

Surgery

Piriformis

Piriformis syndrome

syndrome

The

The piriformis

piriformis muscle

muscle assists

assists inin

abducting and

abducting

and laterally

laterally rotating

rotating the

the thigh

thigh

The

The piriformis

piriformis muscle

muscle irritates

irritates the

the sciatic

sciatic

nerve, causing

nerve,

causing pain

pain inin the

the buttocks

buttocks and

and

referring

referring pain

pain along

along the

the course

course of

of the

the

sciatic

sciatic nerve.

nerve.

Pain

Pain deep

deep inin the

the buttocks,

buttocks, which

which isis made

made

worse byby sitting,

worse

sitting, climbing

climbing stairs,

stairs, or

or

performing

performing squats.

squats.

Stretching

Stretching the

the muscle

muscle often

often duplicates

duplicates the

the

pain.

pain.

Having

Having the

the patient

patient lielie down,

down, flex

flex the

the knee

knee toto

1010 -- 2020 degrees

degrees and

and then

then have

have the

the patient

patient

attempt toto externally

attempt

externally rotate

rotate the

the leg

leg against

against

resistance.

resistance.

Direct

Direct tenderness

tenderness will

will bebe found

found inin the

the region

region

ofof the

the piriformis

piriformis tendon

tendon over

over the

the buttock

buttock

region.

region.

Treatment

Treatment

Rest

Rest

Massage

Massage Therapy

Therapy

piriformis

piriformis stretching:

stretching: Internal

Internal Rotation

Rotation ofof the

the

leg

leg

Local

Local injection

injection of

of corticosteroid

corticosteroid

Surgery

Surgery

Thank

Thank you

you