history

Definition

Palmar Fibromatosis 

Aetiology

AD with variable penetration

Pathogenesis

Murrell's Theory of Pathogenesis

1. Microvascular ischaemia

Aetiology

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

Aetiology

Intrinsic

- inflammatory

- degenerative

Extrinsic

- traumatic

- spur

Epidemiology

F > 40

Associations 60% of cases  

- hypertension

- diabetes

- obese

- trauma 

- prior surgery

- steroids

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  

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

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

- anconeus from posterior face

- ECRB and EDC from anterior face (CEO)

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

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

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

Definition

Entrapment neuropathy of posterior tibial nerve within the tibial tunnel

Anatomy

Flexor Retinaculum 

- medial malleolus to posterior calcaneum

Tarsal tunnel

- roof is flexor retinaculum

- tibia anteriorly