head, shoulders, knees, and back tommy kern, md [email protected] (918)398-1253
TRANSCRIPT
Head, Shoulders, Head, Shoulders, Knees, and BackKnees, and Back
Tommy Kern, MDTommy Kern, [email protected]
(918)398-1253(918)398-1253
DisclosureDisclosure
Dr. Kern has made no disclosures Dr. Kern has made no disclosures of financial interests with any of financial interests with any company or companies, and has company or companies, and has indicated no conflicts of interest.indicated no conflicts of interest.
ObjectivesObjectives
Learn everything about Sports Medicine Learn everything about Sports Medicine in 1 hour, with detailed analysis of in 1 hour, with detailed analysis of anatomy and human physiology of the anatomy and human physiology of the brain, shoulder, knee, and backbrain, shoulder, knee, and back
ObjectivesObjectives
Learn everything about Sports Medicine Learn everything about Sports Medicine in 1 hourin 1 hour
ORORHow to assess and treat a concussionHow to assess and treat a concussionPractical aspects of evaluation of Practical aspects of evaluation of
shoulder, knee, and back painshoulder, knee, and back pain
What is a concussion?What is a concussion?
A biomechanical insult that A biomechanical insult that leads to a neuro-metabolic leads to a neuro-metabolic cascade of eventscascade of events
This basically means:This basically means:Swelling and inflammation Swelling and inflammation
occuroccurMetabolic crisis occursMetabolic crisis occurs
(increase in glucose demand (increase in glucose demand and decrease in energy)and decrease in energy)
ConcussionsConcussionsWhich sports have highest risk?Which sports have highest risk?
ConcussionsConcussionsWhich sports have highest risk?Which sports have highest risk?
ConcussionsConcussionsWhich sports have highest risk?Which sports have highest risk?
ConcussionsConcussionsWhich sports have highest risk?Which sports have highest risk?
I think that an athlete might have a I think that an athlete might have a concussion, what do I do?concussion, what do I do?
I think that an athlete might have I think that an athlete might have a concussion, what do I do?a concussion, what do I do?
How do you treat a How do you treat a concussion?concussion?
How do you treat a concussion?How do you treat a concussion?
To Image or Not To ImageTo Image or Not To ImageThat is the questionThat is the question
To Image or Not To ImageTo Image or Not To ImageThat is the questionThat is the question
Red Flag Symptoms
Why don’t concussion patients Why don’t concussion patients get better?get better?
Why don’t concussion patients Why don’t concussion patients get better?get better?
Why don’t concussion patients Why don’t concussion patients get better?get better?
Why don’t concussion patients Why don’t concussion patients get better?get better?
Why don’t concussion patients Why don’t concussion patients get better?get better?
Goals of Concussion TreatmentGoals of Concussion Treatment
Goals of Concussion TreatmentGoals of Concussion Treatment
• Impingement
• Rotator cuff tear
• Adhesive Capsulitis
• AC joint arthritis
Shoulder AnatomyShoulder Anatomy
Shoulder EvaluationShoulder Evaluation
HistoryHistory provides the most information !!!! provides the most information !!!!
HistoryHistory
Pain Description:Pain Description:
LocationLocation
Injury or notInjury or not
Acute or chronicAcute or chronic
Aggravating and Aggravating and relieving factorsrelieving factors
Restriction in ROMRestriction in ROM
Physical ExamPhysical Exam
Inspection/PalpationInspection/PalpationSubacromial bursaSubacromial bursaAC jointAC joint
Physical ExamPhysical Exam
Inspection/PalpationInspection/PalpationSubacromial bursaSubacromial bursaAC jointAC joint
Range of motionRange of motion
Physical ExamPhysical Exam
Inspection/PalpationInspection/PalpationSubacromial bursaSubacromial bursaAC jointAC joint
Range of motionRange of motionStrengthStrength
Rotator cuffRotator cuffSupraspinatus testSupraspinatus test
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
TreatmentTreatment
RICERICE
TreatmentTreatment
RICERICEMedicationMedication
TreatmentTreatment
RICERICEMedicationMedication InjectionInjection
TreatmentTreatment
RICERICEMedicationMedication InjectionInjectionTherapyTherapy
Rotator CuffRotator CuffScapulaScapulaRange of motionRange of motion
TreatmentTreatment
RICERICEMedicationMedication InjectionInjectionTherapyTherapy
Rotator CuffRotator CuffScapulaScapulaRange of motionRange of motion
SurgerySurgery
•Arthritis
•Meniscus tear
•Ligament tear
•Pes Anserine bursitis
Knee AnatomyKnee Anatomy
Knee EvaluationKnee Evaluation
What provides the most information?What provides the most information?
HistoryHistory
Pain Description:Pain Description:
LocationLocation Injury or notInjury or not Locking, catching, shifting, Locking, catching, shifting,
giving outgiving out Aggravating and relieving Aggravating and relieving
factorsfactors Ability to weight bearAbility to weight bear
Most important question?Most important question?
HistoryHistory
Pain Description:Pain Description:
LocationLocation Injury or notInjury or not Locking, catching, shifting, Locking, catching, shifting,
giving outgiving out Aggravating and relieving Aggravating and relieving
factorsfactors Ability to weight bearAbility to weight bear
Is it Christiano Ronaldo?Is it Christiano Ronaldo?
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
EffusionEffusion Joint line tendernessJoint line tenderness Pes anserinePes anserine
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
EffusionEffusion Joint line tendernessJoint line tenderness Pes anserinePes anserine
StabilityStability Lachman’sLachman’s Valgus and Varus stressValgus and Varus stress
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
EffusionEffusion Joint line tendernessJoint line tenderness Pes anserinePes anserine
StabilityStability Lachman’sLachman’s Valgus and Varus stressValgus and Varus stress
StrengthStrength Quadriceps and Patella tendon Quadriceps and Patella tendon
rupturerupture
TreatmentTreatment
RICERICE
TreatmentTreatment
RICERICEMedicationMedication
NSAIDsNSAIDsTylenolTylenol
TreatmentTreatment
RICERICEMedicationMedication InjectionInjection
TreatmentTreatment
RICERICEMedicationMedication InjectionInjectionTherapyTherapy
VMOVMOClosed chainClosed chain
TreatmentTreatment
RICERICEMedicationMedication InjectionInjectionTherapyTherapy
VMOVMOClosed chainClosed chain
Advanced imagingAdvanced imaging
TreatmentTreatment
RICERICEMedicationMedication InjectionInjectionTherapyTherapy
VMOVMOClosed chainClosed chain
Advanced imagingAdvanced imagingSurgerySurgery
•Disc herniation
•Lumbar radiculopathy
•Lumbar strain
•Facet syndrome
Back AnatomyBack Anatomy
Back EvaluationBack Evaluation
What provides the most information?What provides the most information?
HistoryHistory
Pain Description:Pain Description:
LocationLocation Injury or notInjury or not Locking, inability to moveLocking, inability to move Radicular painRadicular pain Numbness or tinglingNumbness or tingling Weakness or giving outWeakness or giving out
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
Spinal tendernessSpinal tenderness SI jointSI joint PiriformisPiriformis
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
Spinal tendernessSpinal tenderness SI jointSI joint PiriformisPiriformis
Range of MotionRange of Motion Flexion and extensionFlexion and extension Straight leg raiseStraight leg raise
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
Spinal tendernessSpinal tenderness SI jointSI joint PiriformisPiriformis
Range of MotionRange of Motion Flexion and extensionFlexion and extension Straight leg raiseStraight leg raise
StrengthStrength Lower extremitiesLower extremities
Physical ExamPhysical Exam Inspection/PalpationInspection/Palpation
Spinal tendernessSpinal tenderness SI jointSI joint PiriformisPiriformis
Range of MotionRange of Motion Flexion and extensionFlexion and extension Straight leg raiseStraight leg raise
StrengthStrength Lower extremitiesLower extremities
ReflexesReflexes AchillesAchilles PatellaPatella
TreatmentTreatment
RICERICE
TreatmentTreatment
RICERICEMedicationMedication
Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin
TreatmentTreatment
RICERICEMedicationMedication
Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin
TherapyTherapy
TreatmentTreatment
RICERICEMedicationMedication
Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin
TherapyTherapy
• Imaging• X-ray• CT• MRI
TreatmentTreatment
RICERICEMedicationMedication
Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin
TherapyTherapy
• Imaging• X-ray• CT• MRI
• Injection• LESI• Piriformis• SI joint
TreatmentTreatment
RICERICEMedicationMedication
Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin
TherapyTherapy
• Imaging• X-ray• CT• MRI
• Injection• LESI• Piriformis• SI joint
• Surgery
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DiscussionDiscussion