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Chronic Injury of Locomo tor System

This article provides an overview of chronic injuries of the locomotor system, including chronic soft tissue and cartilage injuries, entrapment syndrome of peripheral nerves, and related conditions such as bursitis, stenosing tenosynovitis, ganglion, lateral epicondylitis, frozen shoulder, avascular necrosis of the femoral head, chondromalacia patellae, and Legg-Perthe disease. The classification, causes, signs, symptoms, and various treatment options for each condition are discussed.

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Chronic Injury of Locomo tor System

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  1. Chronic Injury of Locomotor System HUANG, Shilong Department of Orthopedics, Tongji Hospital

  2. Chronic Injury of Locomotor System

  3. Classification Chronic Injury of Soft Tissue Cartilage chronic injury Classification chronic musculoskeletal injuries Entrapment Syndrome of Peripheral Nerve

  4. signs and symptoms Pain Specific site: pressure point, masses signs and symptoms Local inflammation is not obvious overuse Related with vocation, sitting position, work habits, etc.

  5. principle of treatment 1 2 3 4 3 5 Rest NASIDs Surgery Physical therapy, massage Corticosteroid injection

  6. Chronic Injury of Soft Tissues

  7. mechanical back pain muscle- or ligament-related injuries.

  8. Causes • Strained muscles • Sprained ligaments

  9. 1 2 pain obvious pressure point Signs and symptoms 3 musculus sacrospinalis contracture sign 4 radiating pain

  10. Treatment • Pain relief, Non Steroid Anti Inflammatory Drugs (NSAIDs) and Muscle relaxants. • (eperisone hydrochloride)

  11. Bursitis the inflammation of one or more bursae (small sacs) of synovial fluid in the body Example of Elbow Bursitis

  12. Signs and symptoms • Bursitis symptoms vary from local joint pain and stiffness, to stinging pain that surrounds the joint around the inflamed bursa. In this condition, the pain usually is worse during and after activity, and then the bursa and the surrounding joint become stiff the next morning.

  13. rest, ice, elevation, physiotherapy anti-inflammatory drugs and pain medication bursectomy Treatment

  14. Stenosing tenosynovitis Stenosing tenosynovitis (often called trigger finger, trigger thumb, stenosing tenovaginitis) is a painful condition caused by the inflammation (tenosynovitis) and progressive restriction of the superficial and deep flexors fibrous tendon sheath adjacent to A1 pulley at a metacarpal head.

  15. trigger finger Signs and symptoms Pain Catching Locking Swelling Treatment Modification of hand activities Corticosteroid injections Surgical release Causes overuse from chronic repetitive activities using the hand or the involved finger

  16. Surgical release

  17. Ganglion is a swelling that often appears on or around joints and tendons in the hand or foot.

  18. Treatment • Aspiration • Surgical treatments

  19. Lateral epicondylitis known as tennis elbow, is a condition where the outer part of the elbow becomes sore and tender.

  20. Causes • direct blows to the epicondyle • a sudden forceful pull • forceful extension

  21. Signs and symptoms 1.Pain on the outer part of elbow. 2.Gripping and movements of the wrist hurt. 3.Activities that use the muscles that extend the wrist.

  22. 1 2 prevent re-irritation of the tendon Corticosteroid injection Treatment 4 Surgery 3 NSAIDs

  23. Frozen shoulder • is a disorder in which the shoulder capsule, the connective tissue surrounding the glenohumeral joint of the shoulder, becomes inflamed and stiff, greatly restricting motion and causing chronic pain.

  24. 1 2 Female＞Male Left＞Right Commonly in quinquagenarian The joint becomes so tight and stiff that it is nearly impossible to carry out simple movements. Signs and diagnosis 3 The active range of motionare the same or almost the same as the limits to the passive range of motion 4 An arthrogram or an MRI scan may confirm the diagnosis

  25. Treatment • restoring joint movement and reducing shoulder pain, involving medications, physical therapy, and/or surgical intervention.

  26. Avascular Necrosis of Femoral Head

  27. avascular necrosis of the femoral head • is a disease where there is cellular death (necrosis) of bone components due to interruption of the blood supply.

  28. Causes post trauma vascular compression Causes caisson disease others alcoholism excessive steroid use

  29. Femur head showing a flap of cartilage (osteochondritis dissecans) due to avascular necrosis. Specimen from total hip replacement surgery.

  30. Signs and symptoms • Patients may have tenderness around the affected bone • Both active and passive joint movements may be restricted and painful. • Cause joint deformity and muscle wasting

  31. Diagnosis • X-ray images of avascular necrosis in the early stages usually appear normal • CT • MRI

  32. 1 2 5 conservative treatment core decompression total hip replacement Treatment 4 3 transplanting MSCs the free vascular fibular graft

  33. Chronic Trauma of Bone and Cartilage

  34. chondromalacia patellae Chondromalacia is due to an irritation of the undersurface of the kneecap.

  35. Signs and symptoms 1.Pain at the front/inner side of the knee is common in young adults 2.The pain of chondromalacia patellae is typically felt after prolonged sitting, like for a movie, and so it is also called "movie sign" or "theater sign."

  36. Treatment physiotherapy RICE (rest, ice, compression, elevation) Intra-articular injection cortisone (Careful) anti-inflammatory medications surgery (good outcomes without surgery)

  37. Legg-Perthe disease • Legg–Calvé–Perthes syndrome is a form of osteochondritis of the hip joint, where growth/loss of bone mass leads to some degree of collapse of the hip joint and to deformity of the ball of the femur and sometimes the surface of the hip socket.The disease is typically found in young children

  38. Entrapment Syndrome of Peripheral Nerve

  39. entrapment syndrome of peripheral nerve • It is a medical condition caused by direct pressure on a single nerve. Its symptoms include pain, tingling, numbness, and muscle weakness. The symptoms affect just one particular part of the body, depending which nerve is affected.

  40. carpal tunnel syndrome is an entrapment median neuropathy, causing paresthesia, pain, numbness, and other symptoms in the distribution of the median nerve due to its compression at the wrist in the carpal tunnel.

  41. 1 2 pressure on the median nerve at the wrist intrinsic factors that exert pressure within the tunnel Causes 3 extrinsic factors (pressure exerted from outside the tunnel)

  42. Treatment • Immobilizing braces • Localized corticosteroid injections

  43. Signs and symptoms numbness, tingling, or burning sensations in the thumb and fingers. Untreated Carpal Tunnel Syndrome

  44. Treatment • Carpal tunnel release surgery

  45. The End!

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