Transcript Orthopedic Injuries - MASI - Mississippi Association of

Orthopedic InjuriesA Legal Perspective
Mississippi – Alabama – Tennessee – North Carolina
DIANE PRADAT PUMPHREY
[email protected]
Common Orthopedic Complaints
The Spine
• The spine consists of 26 vertebrae or separate bones
that are joined to permit the column to move forward,
backward and side to side. The spine is typically S
shaped to increase stability and strength.
• From the top, the spine consists of 7 cervical vertebrae,
12 thoracic vertebrae and 5 lumbar vertebrae.
• There are 5 smaller vertebrae that fuse to form the
sacrum and 4 that fuse to form the coccyx.
• The vertebrae all have the same basic structure which
includes an anterior body, central vertebral foramen
and a posterior vertebral arch.
The Anatomy of the Spine
Common Spinal Problems
• Back pain – either acute or chronic
• Acute pain due to injuries to muscles or soft
tissue.
• Chronic pain generally dull, aching and deep that
lasts longer than three months. This can be due
to specific anatomic abnormalities.
• Symptoms that require immediate attention are
when there is bowel or bladder dysfunction,
fever, weakness or numbness or pain that limits
or prohibits everyday activities.
The Back Injury
Normal Anatomy
Cross-section of Spine
Herniated Disc
Treatment
• For strain – which is a stretch injury to the
ligaments, tendons, and/or muscles of the low
back – rest, medication, heat, massage and
reconditioning exercises.
• For lumbar radiculopathy – nerve irritation that is
caused by damage to the discs between the
vertebrae – medical management to surgery.
• When there is unrelenting pain, severe
impairment of function or incontinence, surgery
may be necessary.
Surgical Procedures
• Laminotomy – removal of the herniated disc
through a small hole in the bone of the
lumbar spine surrounding the spinal cord.
• Laminectomy – removal of the herniated disc
after removal of the bony wall.
• Percutaneous discectomy – removal of
herniated disc with needle technique.
Neck Injury
Cervical Spine Anatomy
Cervical Spine X-ray
Neck Pain
• Neck pain that radiates down the arm is frequently caused
by a disc herniation or foraminal stenosis which is a
narrowing of the neural passageways.
• Neck pain related to certain activities is commonly caused
by foraminal stenosis.
• Arm pain with a lack of coordination is commonly caused
by cervical stenosis with myelopathy.
• Myelopathy is caused by narrowing of the spinal canal with
spinal cord dysfunction.
• Neck pain that is not intense and lasts for a few months
with occasional flare ups may be caused by disc
degeneration.
• Neck pain that is more pronounced in the morning or
evening is commonly caused by facet joint osteoarthritis.
MRI Herniated Cervical Disc
Fall Injuries
Anatomy of Elbow
Elbow Anatomy
• The elbow is made up of three bones. They are the
humerus, radius and ulna. The elbow bends and
straightens like a hinge. It allows the rotation of the
forearm.
• The elbow is held together by ligaments, muscles and
tendons and by the shape of the bones.
• The most common fracture that occurs is to the
olecranon.
• The goal of rehabilitation in any elbow fracture is to
regain full range of motion of the elbow. Most patients
return to normal within about 4 months, but full
healing can take more than a year.
Elbow X-ray
Fractured Elbow
Fall with Knee Injury
Knee Anatomy and Function
• The knee is the largest joint in the body. It is made of
the lower end of the thigh bone or the femur, which
rotates on the upper end of the shinbone or tibia and
the knee cap or patella. The knee cap slides in a
groove on the end of the femur. The knee has three
large ligaments that help control the motion of the
connecting bones and help brace the joint.
• The other important part of the knee is the meniscus
which is a wedge of cartilage between the femur and
the tibia which cushions the knee and helps absorb
shock during movement.
Knee Anatomy
Anatomy of Knee
Common Knee Injuries
• ACL injury – caused by changing direction rapidly,
slowing down when running and landing from a
jump may cause tears in the ACL.
• MCL injury – usually caused by a direct blow to
the outside of the knee.
• PCL injury – often caused by a blow to the front
of the knee or by making a misstep.
• Torn Cartilage – generally a torn meniscus which
is attached to the knee’s ligaments. The meniscus
can be torn with twisting, cutting, pivoting,
decelerating or with direct contact.
ACL Tear
Meniscus Tear
PCL Tear
Symptoms Knee Tear Injuries
• Pain
• Stiffness
• Catching or locking
• Sensation of knee “giving way”
• Limited range of motion
Knee X-ray
Arthroscopy
Questions