Sports medicine

Knee and shoulder

Most problematic joint
Sx is done through arthroscopic technique
Anterior cruciate
ligament

Restrain the tibia
from forward
excursion below
the femur
ACL injury
Instabilty of the knee
Lachman test
Slightly extended knee
use to evaluate the
injury
Assess AP stability
MRI
Dx
Autograft or allograft
Placed throgh tunnels
w/ in the tibia and femur
Central slip of patellar
tendon , including a
portion of the bony
attachment from both
tibialeminence and of
the patellaritself
Posterior cruciate
ligament

Restrain
posterior sliding
movement of the
tibia below the
femur
PCL injury
Better tolerated than ACL
Posterior drawers test
Slightly flexed knee
Assess the stability of the tibia by passive manipulation


Medial collateral
ligament

Restrain the knee
from bending in a
valgus direction
Lateral collateral
ligament

Restrain the
knee from varus
angulation
Menisci
Two large articular
surface of the condyles
articulate with the
cartilage of the tibial
platue
Crescent shape
Serve to giude femoral
condyle s motion and to
more evenly distributed
load across the joint
Menisci
Medial>lateral(torn)
Radial and longitudinal
are common
Symtoms :
Swelling
Pain (weight bearing)
Locked knee
Treatment :
resection & reshaping of
the torn area (small)
Mescal repair(large)
using arthroscopic
technique

Menisci
Treatment :
resection &
reshaping of the torn
area (small)
Meniscal
repair(large) using
arthroscopic
technique

Ligamentous
injuries of the
knee
MCL
Injury will occur
after excessive valgus
stress of the knee
non operative
treatment

LCL
Injury is much less
common than MCL
Non operative
treatment

Shoulder
Shoulder dislocation
and shoulder
instability
Most frequently dislocated joint
of the body
From a major or minor
Posteriorly, inferiorly and
anteriorly
Local pain
Internally rotated shoulder
Mng
Relocation of the shoulder with
the pt in supine by subjecting the
arm to gentle traction in a
position of slight abduction
Sedation is needed
Sling (after)
Prolonged immobility is not
recommended
Recurrent (coommon)

Impingement syndrome
After ninor ttrauma, repetitve injury
andsometime w/o an identifiable inciting event
Simple bursitis, tendonitis
Pain (ant)
Diagnosis
Documenting leakage of contrast in a shoulder
arthrogram
MRI(definitive), UTZ(less accurate)
Acromioclavicular
joint
Vulnerable to
ligament
injury(sprain)
Acromioclavicula
r sprain (shoulder
separation)
Treatment(sympt
omatic)
Spaine
Spinal trauma
Most challenging in ortho sx
Assess neurologic status
if pt is neurologically intact
-assess spinal stabiity
if pt is neurologically deficit
-spinal cord compression??
Occipital cervical dislocation
Dislocation of the occiput on the occipital
condyleof atlast (C1)
Few survive
-traction of the spine is contraindicated
-tx is consist of stabilization and fusion is
situ using a screw plate or rod screw device
spanning from occiput to mid cervical spine
Fracture of C1
(jefferson fracture)
Result in a lateral
spread of lateral
masses of C1(visible
on AP view)
It increase the size
of spinal canal(raley
cause neurologic
injury)


Fracture of the
C2(odontoid fracture)
Type 1
-avulsion fracture at the tip of
odontoid
-managed symptomatically
w/expected satisfactory outcome

Type 2
- fracture through the base
-heal poorly
-tx is surgical

Type 3
- when fracture extend into the body
of C2
- tx: brace
Hangmans fracture
of C2
Fracture occur
through
interarticularis of C2

Management is
immobilization using
cervico
thoracicorthosis or
internal fixation
Compression fracture of the cervical
spine
This refer to an axial load injury with failure of
the end plate, but preservation of posterior
cortex of vertebral body
Occur in C3 to C7
Burst fracture of the cervical spine
Posterior cortex of the vertebral body is
fracture
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