Head, Shoulders, Knees, and Back

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?




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?





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



Range of motionRange of motion



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


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


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


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



StabilityStability Lachman’sLachman’s Valgus and Varus stressValgus and Varus stress



StabilityStability Lachman’sLachman’s Valgus and Varus stressValgus and Varus stress

StrengthStrength Quadriceps and Patella tendon Quadriceps and Patella tendon

rupturerupture

TreatmentTreatment

RICERICE

TreatmentTreatment


NSAIDsNSAIDsTylenolTylenol

TreatmentTreatment

RICERICEMedicationMedication InjectionInjection

TreatmentTreatment


VMOVMOClosed chainClosed chain

TreatmentTreatment



Advanced imagingAdvanced imaging

TreatmentTreatment



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


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


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




StrengthStrength Lower extremitiesLower extremities

ReflexesReflexes AchillesAchilles PatellaPatella

TreatmentTreatment

RICERICE

TreatmentTreatment


Steroids or NSAIDsSteroids or NSAIDsOpioidsOpioidsGabapentinGabapentin

TreatmentTreatment



TherapyTherapy

TreatmentTreatment



TherapyTherapy

• Imaging• X-ray• CT• MRI

TreatmentTreatment



TherapyTherapy


• Injection• LESI• Piriformis• SI joint

TreatmentTreatment



TherapyTherapy


• Injection• LESI• Piriformis• SI joint

• Surgery

Books I Like Books I Like (and prices via Amazon)(and prices via Amazon)

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Head, Shoulders, Knees, and Back