10 COMMON ORTHOPAEDIC INJURIES I.M. Doctor, M.D. My Office My City, State

2 The information in this presentation was provided to the presenter by the American Academy of Orthopaedic Surgeons and may be modified. Endorsement of this presentation by the AAOS is not implied or inferred. Thank you to A. Herbert Alexander, MD for his significant contributions to the content of this presentation.

3 What is an orthopaedic surgeon?  MD or DO who specializes in treatment and health maintenance of musculoskeletal system (bones, joints, ligaments, muscles, tendons, cartilage and spine)

4 What is an orthopaedic surgeon?  The expert in treating the musculoskeletal system  The expert in maintaining musculoskeletal health

5 Educating an Orthopaedic Surgeon  College  Medical School  Orthopaedic Internship and Residency  Fellowship (optional)  2 Years Practice TOTAL 4 5 (1) 2 16 years!

6 What do orthopaedic surgeons do?  Diagnose  Treat  Medication  Physical Therapy  Exercise  Brace  Surgery  Prevent

7 Common Orthopaedic Injuries 1. Ankle Sprain 2. Plantar Fasciitis 3. Tennis Elbow 4. ACL Tear 5. Meniscus Tear 6.Shoulder Dislocation 7.Rotator Cuff Tear 8.Stress Fractures 9.Carpal Tunnel Syndrome 10.Distal Radius Fracture

8 Acute vs. Overuse Injuries  Acute - sudden trauma such as sprains, strains, bruises, and fractures  Overuse - series of repeated small injuries

9 Children vs. Adults Growth plates are weaker than ligaments. ChildAdult

10 Ankle Sprain  Ligament injury  Ankle pain, tenderness, swelling One or more of these ligaments can be torn or stretched. Twisting force Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

11 Ankle Sprain

12 Ankle Sprain  R.I.C.E.  Rehabilitation  Anti-inflammatory  Brace Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

13 Plantar Fasciitis  Microtears of plantar fascia  Painful heel

14 Plantar Fasciitis  Tape heel, arch  Customized orthotics  Stretching  Massage  Exercises

15 Plantar Fasciitis - Treatment  Warm up well before sports or activities  Ice heel, minutes after sports or stretching  Anti-inflammatories  Night splint  Massage

16 Plantar Fasciitis  Prepare before running  Wear good, supportive shoes  Arch support  Keep feet strong  Avoid activities that cause heel pain  See orthopaedic surgeon if pain persists

17 Tennis Elbow Lateral epicondyle

18 Tennis Elbow  Warm up, stretch before play  Correct, maintained equipment  Condition beforehand  Evaluate cause

19 ACL Injury  Direct blow to knee  Non-contact injury, with foot planted and an and attempted change in direction  Landing on straight leg  Making abrupt stops

20 ACL Tear Normal anatomyHyperextension Femur Anterior cruciate ligament Anterior cruciate ligament tears Patella Tibia Fibula Femur slips Illustration reproduced with permission from The Body Almanac, Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

21 ACL Tear  Treatment – surgical  Incidence of ACL much higher among female athletes  Combination of causal factors

22 ACL Tear- Prevention  Land safely from jumps  Practice cutting maneuvers  Use little steps to stop  Strengthening exercises

23 Meniscus Tear  Helps knee joint carry weight, glide, and turn  Twisting injury  Football and other contact sports

24 Meniscus Tear  Pain  Giving way  Locking  Clicking  Swelling

25 Meniscus Tear Normal meniscusTorn meniscus

26 Normal Shoulder Reproduced with permission from Thompson WO, Warren RF, Barnes RP, Hunt S: Shoulder Injuries in Schenck RC (ed): Athletic Training and Sports Medicine, 3 rd Edition. Rosemont, IL American Academy of Orthopaedic Surgeons, 1999

27 Traumatic Shoulder Dislocation

28 Traumatic Shoulder Dislocation  Intense pain  Shoulder looks out of place or locked in certain positions  Muscle spasms  Bruises, swelling, numbness, weakness

29 Traumatic Shoulder Dislocation Reproduced with permission from: Soft Tissue Trauma, in Bernstein J (ed):Musculoskeletal Medicine. Rosemont, IL American Academy of Orthopaedic Surgeons, 2003

30 Traumatic Shoulder Dislocation  Closed grip pull-downs  Rotation exercises  Resistance exercises  Surgery

31 Rotator Cuff Tear

32 Rotator Cuff Tear  Shoulder pain  Worse at night  Weakness  Catching  Limited motion

33 Rotator Cuff Tear  Treatment  Rest  Cold & heat  Sling  Physical Therapy  NSAIDS  Injection  Surgery

34 Rotator Cuff Tear Prevention Avoid repetitive activities with the arm at shoulder level or higher

35 Stress Fractures Lateral malleolus Tibia Fibula Metatarsals Medial malleolus Phalanges Talus Calcaneus Talus Midfoot (tarsals) Ankle joint (tibiotalar joint) Illustration reproduced with permission from The Body Almanac, American Academy of Orthopaedic Surgeons, 2003

36 Stress Fractures  “Micro-cracks”  Pain  “Overuse”

37 Carpal Tunnel Syndrome  Median nerve  Transverse carpal ligament  Flexor tendons

38 Numbness Tingling Pain Clumsiness Carpal Tunnel Syndrome

39 Carpal Tunnel Syndrome

40 Carpal Tunnel Syndrome  Splint or brace at night  Cortisone injections  Anti-inflammatories  Surgery to release ligament

41 Distal Radius Fracture  Also known as wrist fracture  Fall on outstretched hand  Snowboarders, skaters  Nondisplaced - cast  Displaced - surgery

42 Normal Wrist

43 Distal Radius Fracture

44 Wrist Fracture – Cast Care  Keep it dry  Don’t pull out the padding  Don’t stick objects inside  Keep dirt, sand & powder out  Don’t break off or trim edges

45 Wrist Fracture – Cast Care Signs of trouble:  Increased pain & feeling cast is too tight  Numbness or tingling in the hand  Burning or stinging  Excessive swelling in the hands and fingers  Loss of active movement of fingers  Loosening

46 Training errors Less-than-optimal environment Improper technique Overuse Injuries & Boomeritis ®

47 Overuse Injuries  Change intensity, duration, frequency  Warm up  Heat before, ice after  Cross train  Technique

48 Boomeritis ®  Exercise - key, but...  Bike accidents prevail  Mortality > children  < 50% wear helmets

49 tendinitis bursitis sprains strains Boomeritis ®

50 Treatment

51 Treatment  R.I.C.E.  Alter or stop sports activities  Physical therapy & medication  Surgery may be warranted

52 When to See the Physician  Inability to play  Decreased ability to play  Visible deformity  Severe pain

53 Preventing Sports Injuries  Know and abide by rules  Wear appropriate protective gear  Know how to use equipment  Never “play through pain”

54 Skilled Instruction Wear safety gear! Preventing Sports Injuries

55 Preventing Sports Injuries Warm up & stretching are two separate steps!

56 Preventing Sports Injuries Warm up: zMarching zWalking or jogging zMimic the sport

57 Preventing Sports Injuries  You should NOT feel pain  Hold stretch 30 seconds  Relax into the stretch Stretching:

58 10% Rule Don’t Increase Activity by More Than 10% Per Week Overuse Injuries

59 American Academy of Orthopaedic Surgeons 6300 N. River Road Rosemont, IL Resources

60 What are your questions and concerns? 10 Common Orthopaedic Injuries

61 Remember, your orthopaedic surgeon can help get you back in the game! 10 Common Orthopaedic Injuries