1. Head, Shoulders, Knees, and Back Tommy Kern, MD thomas-kern@live.com (918)398-1253

2. Disclosure Dr. Kern has made no disclosures of financial interests with any company or companies, and has indicated no conflicts of interest. Dr. Kern has made no disclosures of financial interests with any company or companies, and has indicated no conflicts of interest.

3. Objectives Learn everything about Sports Medicine in 1 hour, with detailed analysis of anatomy and human physiology of the brain, shoulder, knee, and back Learn everything about Sports Medicine in 1 hour, with detailed analysis of anatomy and human physiology of the brain, shoulder, knee, and back

4. Objectives Learn everything about Sports Medicine in 1 hour Learn everything about Sports Medicine in 1 hourOR How to assess and treat a concussion How to assess and treat a concussion Practical aspects of evaluation of shoulder, knee, and back pain Practical aspects of evaluation of shoulder, knee, and back pain

5. What is a concussion? A biomechanical insult that leads to a neuro-metabolic cascade of events A biomechanical insult that leads to a neuro-metabolic cascade of events This basically means: This basically means: Swelling and inflammation occur Swelling and inflammation occur Metabolic crisis occurs Metabolic crisis occurs (increase in glucose demand and decrease in energy)

6. Concussions Which sports have highest risk?

10. I think that an athlete might have a concussion, what do I do?

12. How do you treat a concussion?

14. To Image or Not To Image That is the question

15. Red Flag Symptoms

16. Why don’t concussion patients get better?

21. Goals of Concussion Treatment

23. Impingement Rotator cuff tear Adhesive Capsulitis AC joint arthritis

24. Shoulder Anatomy

25. Shoulder Evaluation History provides the most information !!!! History provides the most information !!!!

26. History Pain Description: Location Location Injury or not Injury or not Acute or chronic Acute or chronic Aggravating and relieving factors Aggravating and relieving factors Restriction in ROM Restriction in ROM

27. Physical Exam Inspection/Palpation Inspection/Palpation Subacromial bursa Subacromial bursa AC joint AC joint

28. Physical Exam Inspection/Palpation Inspection/Palpation Subacromial bursa Subacromial bursa AC joint AC joint Range of motion Range of motion

29. Physical Exam Inspection/Palpation Inspection/Palpation Subacromial bursa Subacromial bursa AC joint AC joint Range of motion Range of motion Strength Strength Rotator cuff Rotator cuff Supraspinatus test Supraspinatus test

30. Remember: The function of the RC is to “seat” the humerus Without it, humerus “floats” in the join Without a healthy rotator cuff, the humerus “floats”, rides up, and compresses / inflames the RC tendons

31. Treatment RICE RICE

32. Treatment Medication Medication

33. Treatment RICE RICE Medication Medication Injection Injection

34. Treatment RICE RICE Medication Medication Injection Injection Therapy Therapy Rotator Cuff Rotator Cuff Scapula Scapula Range of motion Range of motion

35. Treatment RICE RICE Medication Medication Injection Injection Therapy Therapy Rotator Cuff Rotator Cuff Scapula Scapula Range of motion Range of motion Surgery Surgery

36. Arthritis Meniscus tear Ligament tear Pes Anserine bursitis

37. Knee Anatomy

38. Knee Evaluation What provides the most information? What provides the most information?

39. History Pain Description: Location Location Injury or not Injury or not Locking, catching, shifting, giving out Locking, catching, shifting, giving out Aggravating and relieving factors Aggravating and relieving factors Ability to weight bear Ability to weight bear Most important question? Most important question?

40. History Pain Description: Location Location Injury or not Injury or not Locking, catching, shifting, giving out Locking, catching, shifting, giving out Aggravating and relieving factors Aggravating and relieving factors Ability to weight bear Ability to weight bear Is it Christiano Ronaldo? Is it Christiano Ronaldo?

41. Physical Exam Inspection/Palpation Inspection/Palpation Effusion Effusion Joint line tenderness Joint line tenderness Pes anserine Pes anserine

42. Physical Exam Inspection/Palpation Inspection/Palpation Effusion Effusion Joint line tenderness Joint line tenderness Pes anserine Pes anserine Stability Stability Lachman’s Lachman’s Valgus and Varus stress Valgus and Varus stress

43. Physical Exam Inspection/Palpation Inspection/Palpation Effusion Effusion Joint line tenderness Joint line tenderness Pes anserine Pes anserine Stability Stability Lachman’s Lachman’s Valgus and Varus stress Valgus and Varus stress Strength Strength Quadriceps and Patella tendon rupture Quadriceps and Patella tendon rupture

44. Treatment RICE RICE

45. Treatment Medication Medication NSAIDs NSAIDs Tylenol Tylenol

46. Treatment RICE RICE Medication Medication Injection Injection

47. Treatment RICE RICE Medication Medication Injection Injection Therapy Therapy VMO VMO Closed chain Closed chain

48. Treatment RICE RICE Medication Medication Injection Injection Therapy Therapy VMO VMO Closed chain Closed chain Advanced imaging Advanced imaging

49. Treatment RICE RICE Medication Medication Injection Injection Therapy Therapy VMO VMO Closed chain Closed chain Advanced imaging Advanced imaging Surgery Surgery

50. Disc herniation Lumbar radiculopathy Lumbar strain Facet syndrome

51. Back Anatomy

52. Back Evaluation What provides the most information? What provides the most information?

53. History Pain Description: Location Location Injury or not Injury or not Locking, inability to move Locking, inability to move Radicular pain Radicular pain Numbness or tingling Numbness or tingling Weakness or giving out Weakness or giving out

54. Physical Exam Inspection/Palpation Inspection/Palpation Spinal tenderness Spinal tenderness SI joint SI joint Piriformis Piriformis

55. Physical Exam Inspection/Palpation Inspection/Palpation Spinal tenderness Spinal tenderness SI joint SI joint Piriformis Piriformis Range of Motion Range of Motion Flexion and extension Flexion and extension Straight leg raise Straight leg raise

56. Physical Exam Inspection/Palpation Inspection/Palpation Spinal tenderness Spinal tenderness SI joint SI joint Piriformis Piriformis Range of Motion Range of Motion Flexion and extension Flexion and extension Straight leg raise Straight leg raise Strength Strength Lower extremities Lower extremities

57. Physical Exam Inspection/Palpation Inspection/Palpation Spinal tenderness Spinal tenderness SI joint SI joint Piriformis Piriformis Range of Motion Range of Motion Flexion and extension Flexion and extension Straight leg raise Straight leg raise Strength Strength Lower extremities Lower extremities Reflexes Reflexes Achilles Achilles Patella Patella

58. Treatment RICE RICE

59. Treatment Medication Medication Steroids or NSAIDs Steroids or NSAIDs Opioids Opioids Gabapentin Gabapentin

60. Treatment RICE RICE Medication Medication Steroids or NSAIDs Steroids or NSAIDs Opioids Opioids Gabapentin Gabapentin Therapy Therapy

61. Treatment RICE RICE Medication Medication Steroids or NSAIDs Steroids or NSAIDs Opioids Opioids Gabapentin Gabapentin Therapy Therapy Imaging X-ray CT MRI

62. Treatment RICE RICE Medication Medication Steroids or NSAIDs Steroids or NSAIDs Opioids Opioids Gabapentin Gabapentin Therapy Therapy Imaging X-ray CT MRI Injection LESI Piriformis SI joint

63. Treatment RICE RICE Medication Medication Steroids or NSAIDs Steroids or NSAIDs Opioids Opioids Gabapentin Gabapentin Therapy Therapy Imaging X-ray CT MRI Injection LESI Piriformis SI joint Surgery

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65. Discussion