1. Chronic Injury of Locomotor System
HUANG, Shilong
Department of Orthopedics, Tongji Hospital

2. Chronic Injury of Locomotor System

3. Classification Classification Chronic Injury of Soft Tissue
Cartilage chronic injury
Classification
chronic musculoskeletal injuries
Entrapment Syndrome of Peripheral Nerve

4. signs and symptoms signs and symptoms Pain
Specific site: pressure point, masses
signs and
symptoms
Local inflammation
is not obvious
overuse
Related with vocation,
sitting position, work habits, etc.

5. principle of treatment1 2 3 4 5 3
Rest
NASIDs
Physical therapy, massage
Corticosteroid injection
Surgery

6. Chronic Injury of Soft Tissues

7. mechanical back pain
muscle- or ligament-related injuries.

8. Causes
Strained muscles
Sprained ligaments

9. Signs and symptoms 1 2 3 4 pain radiating pain obvious pressure point
musculus sacrospinalis contracture sign 4
radiating pain

10. Treatment
Pain relief, Non Steroid Anti Inflammatory Drugs (NSAIDs) and Muscle relaxants.
(eperisone hydrochloride)

11. Bursitis
the inflammation of one or more bursae (small sacs) of synovial fluid in the body
Example of Elbow Bursitis

12. Signs and symptoms
Bursitis symptoms vary from local joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint become stiff the next morning.

13. Treatment rest, ice, elevation, physiotherapy anti-inflammatory drugs
and pain medication
bursectomy

14. Stenosing tenosynovitis
Stenosing tenosynovitis (often called trigger finger, trigger thumb, stenosing tenovaginitis) is a painful condition caused by the inflammation (tenosynovitis) and progressive restriction of the superficial and deep flexors fibrous tendon sheath adjacent to A1 pulley at a metacarpal head.

15. Modification of hand activities Corticosteroid injections
trigger finger
Signs and symptoms
Pain
Catching
Locking
Swelling
Treatment
Modification of hand activities
Corticosteroid injections
Surgical release
Causes
overuse from chronic repetitive activities using the hand or the involved finger

16. Surgical release

17. Ganglion
is a swelling that often appears on or around joints and tendons in the hand or foot.

18. Treatment
Aspiration
Surgical treatments

19. Lateral epicondylitis
known as tennis elbow, is a condition where the outer part of the elbow becomes sore and tender.

20. Causes direct blows to the epicondyle a sudden forceful pull
forceful extension

21. Signs and symptoms 1.Pain on the outer part of elbow.
2.Gripping and movements of the wrist hurt.
3.Activities that use the muscles that extend the wrist.

22. Treatment 4 3 2 1 Surgery NSAIDs Corticosteroid injection
prevent re-irritation of the tendon

23. Frozen shoulder
is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

24. Signs and diagnosis 1 Female＞Male Left＞Right
Commonly in quinquagenarian 3
The active range of motionare the same or almost the same as the limits to the passive range of motion 2
The joint becomes so tight and stiff that it is nearly impossible to carry out simple movements. 4
An arthrogram or an MRI scan may confirm the diagnosis

25. Treatment
restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention.

26. Avascular Necrosis of Femoral Head

27. avascular necrosis of the femoral head
is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply.

28. Causes Causes post trauma vascular compression caisson disease others
alcoholism
excessive steroid use

29. Femur head showing a flap of cartilage (osteochondritis dissecans) due to avascular necrosis. Specimen from total hip replacement surgery.

30. Signs and symptoms
Patients may have tenderness around the affected bone
Both active and passive joint movements may be restricted and painful.
Cause joint deformity and muscle wasting

31. Diagnosis
X-ray images of avascular necrosis in the early stages usually appear normal CT
MRI

32. Treatment 1 2 5 3 4 conservative treatment transplanting MSCs
core decompression 5
total hip replacement 3 4
the free vascular fibular graft
transplanting MSCs

33. Chronic Trauma of Bone and Cartilage

34. chondromalacia patellae
Chondromalacia is due to an irritation of the undersurface of the kneecap.

35. Signs and symptoms
1.Pain at the front/inner side of the knee is common in young adults
2.The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so it is also called "movie sign" or "theater sign."

36. Treatment RICE (rest, ice, compression, elevation) Intra-articular
physiotherapy
RICE
(rest, ice,
compression,
elevation)
Intra-articular
injection cortisone
(Careful)
anti-inflammatory
medications
surgery
(good outcomes
without surgery)

37. Legg-Perthe disease
Legg–Calvé–Perthes syndrome is a form of osteochondritis of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and sometimes the surface of the hip socket.The disease is typically found in young children

38. Entrapment Syndrome of Peripheral Nerve

39. entrapment syndrome of peripheral nerve
It is a medical condition caused by direct pressure on a single nerve. Its symptoms include pain, tingling, numbness, and muscle weakness. The symptoms affect just one particular part of the body, depending which nerve is affected.

40. carpal tunnel syndrome
is an entrapment median neuropathy, causing paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel.

41. Causes 2 1 3 pressure on the median nerve at the wrist
intrinsic factors that exert pressure within the tunnel 1
pressure on the median nerve at the wrist 3
extrinsic factors (pressure exerted from outside the tunnel)

42. Treatment
Immobilizing braces
Localized corticosteroid injections

43. Untreated Carpal Tunnel Syndrome
Signs and symptoms
numbness, tingling, or burning sensations in the thumb and fingers.
Untreated Carpal Tunnel Syndrome

44. Treatment
Carpal tunnel release surgery

45. The End!