tulsa bone & joint antoine (tony) jabbour, md orthopaedic sports medicine surgeon knee and...
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TULSA BONE & JOINTANTOINE (TONY) JABBOUR, MDORTHOPAEDIC SPORTS MEDICINE SURGEONKNEE AND SHOULDER SUBSPECIALTYCHAPTER 20 PAIN SYNDROMESCHAPTER 21 NERVE INJURIESCHAPTER 22 LIGAMENT INJURIESCHAPTER 23 ATHLETIC INJURIESCHAPTER 24 PEDIATRIC
MUSCULOSKELETAL ABNORMALITIES
TONY JABBOUR, MD SPORTS MEDICINE
CHAPTER 20CHRONIC PAIN SYNDROMES
Pain lasting greater than 6 weeks.Associated psychiatric diagnosis (cause vs
effect).If no structural disease present, consider MALINGERING.
TONY JABBOUR, MD SPORTS MEDICINE
FIBROMYALGIAControversial diagnosis.Syndrome of:
1. Diffuse musculoskeletal pain.2. Sleep disturbance.3. Exhaustion.
Most common cause of generalized musculoskeletal pain in female 20-25 years old.
Physical examination normal except for disproportionate tenderness to palpation.
X-rays and labs are within normal limits.TONY JABBOUR, MD SPORTS MEDICINE
FIBROSITISACR criteria from 1990. Chronic widespread pain both sides of body, above and below waist. 11-18 tender point spots.
TONY JABBOUR, MD SPORTS MEDICINE
EPIDEMIOLOGYFemales 10 x more often than males.No known objective markers of the disease.No genetic predisposition.
TONY JABBOUR, MD SPORTS MEDICINE
CLINICAL PRESENTATION20-55 YEAR OLD FEMALE.Pain over entire body especially neck,
shoulders and low back pain.Poor sleep 75%.Headaches.Numbness.Tender points of palpation.
TONY JABBOUR, MD SPORTS MEDICINE
OTHER CONDITIONS CONFUSED WITH FIBROMYALGIADepression.Irritable bowel syndrome.Chronic fatigue syndrome.
TONY JABBOUR, MD SPORTS MEDICINE
ETIOLOGYUnknown.
TONY JABBOUR, MD SPORTS MEDICINE
TREATMENTDifficult.Psychologically prepare patient for chronicity
of symptoms.No drugs currently indicated (Analgesics and
Anti-depressants).Physical Therapy.Lidocaine trigger point injections.
TONY JABBOUR, MD SPORTS MEDICINE
COMPLEX REGIONAL PAIN SYNDROMESynonyms : RSD/Algodystrophy/Causalgia/Shoulder-Hand
Syndrome/Sudek’s dystrophy.Disorder of extremities characterized by severe and
continuous pain, decreased range of motion and demineralization of adjacent bony structures.
Vasomotor instability (changes in skin color and temperature.
1994 WHO coined term “Complex Regional Pain Syndrome”.
Two Types: Type 2 – symptoms are attributable to nerve lesions.
Type 1 – no nerve lesions.TONY JABBOUR, MD SPORTS MEDICINE
LABSWithin normal limits.
TONY JABBOUR, MD SPORTS MEDICINE
CLINICAL PRESENTATION20-25 years of age female after wrist
fracture, no peripheral nerve injury.
TONY JABBOUR, MD SPORTS MEDICINE
THREE STAGESACUTE
Several weeks to several months, there is increasing pain, decreased range of motion and edema. Warmth initially, then coolness.
Sensitivity to light touch.
TONY JABBOUR, MD SPORTS MEDICINE
MIDDLE (DYSTROPHIC PHASE)Three to six months after injury.Increased soft tissue edema secondary to
increased regional sympathetic activity.Skin changes (thickening, brawny changes).Early atrophy.
TONY JABBOUR, MD SPORTS MEDICINE
THIRD STAGE (LATE ATROPHIC PHASE)Most severe.Hair falling out, nails brittle.Decreased range of motion with
contractures.X-rays – demineralization and osteoporosis.
TONY JABBOUR, MD SPORTS MEDICINE
PATHOPHYSIOLOGYNot well understood.
TONY JABBOUR, MD SPORTS MEDICINE
TREATMENT
Early mobilization, aggressive physical therapy.Non-steroidal anti-inflammatories,
corticosteroids.Regional nerve blocks (decreased overactivity
of sympathetic nervous system; 2/3 respond favorably).
Surgical sympathectomies.Spinal cord stimulation.Intrathecal Baclofen.
TONY JABBOUR, MD SPORTS MEDICINE
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