history

MCL Insufficiency

AetiologyTommy John Surgery

 

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

 

History

 

Initially

- lose velocity / accuracy

 

Develop medial pain

 

40% ulna nerve symptoms

 

Background

Aetiology

 

Intrinsic

- inflammatory

- degenerative

 

Extrinsic

- traumatic

- spur

 

Epidemiology

 

F > 40

 

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

 

Painful TKR

Differential Diagnosis of the Painful TKA 

 

Surgical Diagnosis  

 

1.  Prosthetic loosening and failure 

2.  Infection 

3.  Patellofemoral tracking problems  

4.  Instability 

5.  Recurrent intra-articular soft-tissue impingement / Component overhang  

 

Nonsurgical Diagnoses  

 

1.  Referred pain - Hip / Back  

Revison ACL Surgery

Graft selection

 

A.  Synthetic Grafts

 

Good initial results but unacceptably high failure rate with longer follow-up

 

Problems

 

1.   Too stiff (low ultimate strain) 

- poor resistance to abrasion

- ligament failure by attrition most common

 

2.  Recurrent synovitis, infection, loosening and osteolysis

 

B.  Autograft

 

Lateral Epicondylitis / Tennis Elbow

Incidence

 

Lateral : Medial 9:1

 

Epidemiology

 

4th & 5th decades

- M = F

- 75% dominant arm 

 

50% of regular tennis players

- especially > 2 hrs / week

 

Aetiology

 

Insertion pathology / Enthesopathy

 

Over-extension of the elbow with supination / pronation

 

Anatomy

 

Lateral epicondyle

Child Abuse / Non Accidental Injury

Definition

 

Any act or failure to act that

- results in or potentially results in harm / death / physical / emotional / sexual abuse

- by a parent or caretaker who is responsible for the child

 

4 types

 

Neglect 

Physical (punch / kick / bite / burn / shake)

Sexual 

Emotional

 

Risk factors

 

Chronic Ankle Instability

Definition

 

Chronic instability due to rupture of one or more parts of the lateral ligament

 

Anatomy

 

Progressive injury

1. Anterolateral capsule

2. ATFL

3. CFL

 

NHx

 

Can lead to ankle OA over time

 

Ankle OA Post Lateral Ligament Instability

 

Dislocation

Definition

 

Anterior displacement of peroneal tendons out of peroneal groove

 

Epidemiology

 

Most common in young adults

 

Acute injury often missed 

 

Aetiology

 

Congenital

 

3 % neonates

- resolves spontaneously

 

Traumatic  

 

Occurs following sporting activities

Tarsal Tunnel Syndrome

Definition

 

Entrapment neuropathy of posterior tibial nerve within the tibial tunnel

 

Anatomy

 

Taral Tunnel

 

Flexor Retinaculum 

- medial malleolus to posterior calcaneum

 

Tarsal tunnel

- roof is flexor retinaculum

- tibia anteriorly

Syndicate content