Overuse Injuries

Question 1

Shoulder

• Describe overuse, subacute, and acute
• Dx
• Tx

Answer 1

Overuse: fatigued tendons and muscles

Subacute: fatigued tendons and muscles that now slowly begin to tear/wear out. progression of an overuse injury

Acute: fell, threw too hard, swung too hard

Dx

• xrays and MRI
• indications for MRI: drop arm sign, external rotation lag sign, dislocation

Tx

• NSAIDs, Ice, PT
• corticosteroid injection

Question 2

Shoulder

• concerning findings on xray
• concerning findings on MRI
• Tx
• recovery

Answer 2

• concerning findings on xray
• -fracture
• -Arthritis
• concerning findings on MRI
• -rotator cuff tear
• -labral tear
• -biceps tendon tear
• Tx
• -shoulder arthroscopy
• -repair torn tendons
• Recovery
• -6 weeks healing phase (start therapy at 3 weeks)
• -6 weeks rehab
• -6 weeks strengthening

Question 3

What are they two main types of cartilage in the knee?

Answer 3

Articular cartilage: think lining of resilient connective tissue 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, distribute force

Question 4

Meniscal tear

• MOI
• Sx
• Tx

Answer 4

MOI

• twisting
• turning
• deep knee bends
• pivoting

Sx

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

Tx

• PT
• Injection
• Arthroscopic surgery

Question 5

ACL
-when do we fix this?

PCL
-when do we fix this?

MCL
-Tx

LCL
-Tx

Cartilage injury
-Tx

Answer 5

ACL

• fix in active, physical individual
• CI if significant arthritis

PCL

• fix when symptomatic
• CI if significant arthritis

MCL
-brace for 6 weeks, weight bearing as tolerated

LCL

• Brace
• fix if part of a complex of lateral injuries

cartilage injury

• depends on severity…
• “smooth down”
• cartilage transplant (for smaller defects)

Question 6

What is viscosupplementation?

Answer 6

• a solution of hyaluronan, which is the lubricant and shock absorber in joints. Without it, the pt experiences pain of OA as the joint wears out.
• inject it into the joint, beneficial effects can last from 6m to a year

Question 7

Elbow

-lateral and medial epicondylitis Tx

Answer 7

Tx

• RICE
• NSAIDs

may consider corticosteroid injection or platelet rich plasma if recalcitrant cases. most of the time these go away.

Question 8

What is platelet rich plasma?

Answer 8

• high concerntraion of functionally viable platelets and their associated growth factors
• delivered arthroscopically/open and placed directly into the tear site to stimulate a reparative healing response for soft tissue and bone repair
• used for tendonitis, cuff repair, etc.