Spina Bifida and Pain Management

Induration

• Changes to tissue beneath the surface
• Decreased range of motion (ROM)
• Pain management

Spina Bifida

• Birth defect due to incomplete closure of bone and membrane around the spinal cord
• Varies in severity, with symptoms including:
• Leg weakness/paralysis
• Orthopedic issues
• Bowel/bladder issues
• Neurological issues
• All types involve myelomeningocele (MMG)

Types of Spina Bifida

• Occulta (least severe)
• Meningocele (most severe)
• Myelomeningocele (most severe)

Humeral Fractures

• Common upper extremity fracture
• Causes:
• Osteoporosis
• Aging
• Injury
• Symptoms:
• Humeral displacement and location
• Loss of wrist extension and dorsum hand sensation in ⅕ cases (20%) due to radial nerve damage
• Treatment:
• Closed reduction (manual)
• Open reduction internal fixation (ORIF)
• Sling immobilization and mobilization
• Surgical repair

Thoracic Outlet Syndrome

• Causes:
• Trauma
• Repetitive use
• Pregnancy
• Anatomical differences
• Poor posture
• Symptoms:
• Pain in the shoulders and neck
• Numbness and tingling
• Coldness in the fingers
• Weakened grip
• Thumb atrophy
• Treatment:
• Non-surgical: rest, activity modification
• Surgical: cutting out part of the rib to open up space

Fracture of the Shoulder

• Causes:
• Floor level falls
• Sports injuries
• MVA
• Symptoms:
• Pain, swelling, and bruising at the shoulder
• Deformity
• Grinding sensation
• Treatment:
• Non-surgical: immobilization, ice, NSAIDs
• Surgical: plates, screws, internal fixation

Elbow Disorders

Medial Epicondylitis

• Inflammation of the medial tendon of the elbow
• Causes:
• Repetitive use of the wrist and forearm
• Symptoms:
• Pain on the medial aspect of the elbow
• Weakness
• Stiffness
• Treatment:
• NSAIDs
• Rest
• Ice
• ROM exercises
• OT/PT

Lateral Epicondylitis

• Inflammation of the lateral tendon of the elbow
• Causes:
• Repetitive use of the wrist and forearm
• Symptoms:
• Pain or burning on the lateral side of the elbow
• Weak grip strength
• Treatment:
• NSAIDs
• Rest
• Ice
• ROM exercises
• OT/PT

Complete UCL Rupture

• Causes:
• Repetitive use
• Fall on an outstretched arm
• Symptoms:
• Pain at the medial elbow
• “Pop” after throwing
• Tenderness
• Swelling
• Inability to throw or perform activity
• Numbness in the ring and pinky fingers
• Treatment:
• Non-surgical: NSAIDS, ice, therapy
• Surgical: Tommy John surgery

Posterior Olecranon Osteophyte

• Formation of bone spurs on the posterior olecranon
• Symptoms:
• Pain in the elbow with no mechanism of injury
• Decreased ROM
• Catching or locking of the elbow joint with movement
• Treatment:
• Surgery to remove bone spurs and debridement of osteophytes
• PT/OT### Hand and Wrist Disorders
• Splint: a preventative measure for thumb tendons, often used in combination with steroids and ice/heat to reduce pain and inflammation
• Ganglion cysts: small, painless, non-cancerous lumps often found near tendons and joints in the wrist and hand
• Swan-neck deformity: a deformity of the MCP joint caused by rheumatoid arthritis, characterized by flexion of the PIP joint and extension of the DIP joint
• Boutonniere deformity: a deformity of the MCP joint caused by a forceful blow to the dorsum of the bent PIP joint, characterized by extension of the PIP joint and flexion of the DIP joint
• Dupuytren's contracture: a condition caused by thickening of the fascia in the palm, leading to lumps, nodules, and cords that pull fingers inward

Arthritic Diseases

• Rheumatoid arthritis: an autoimmune disorder causing inflammation and joint damage, often resulting in bilateral involvement and joint deformity
• Osteoarthritis: a degenerative joint disease causing joint pain, stiffness, and limited mobility
• Fibromyalgia: a chronic condition characterized by widespread muscle pain, fatigue, and sleep disturbances
• Gout: a metabolic disorder causing sudden and severe joint pain, often in the big toe, due to uric acid crystal buildup

Skeletal Features

• Cramp: a sudden, involuntary contraction of a muscle or group of muscles
• Fasciculation: a visible, involuntary twitch of a muscle or group of muscles
• Spasmodic contraction: an involuntary, painful contraction of a muscle or group of muscles

Distal Radius Fractures

• Falling on an outstretched hand can cause distal radius fractures
• Symptoms include loss of sensation, strength, and range of motion (ROM)
• Treatment options include open reduction (manual), open reduction internal fixation, splint or cast, and immobilization and mobilization with a schedule that varies depending on the case

Scaphoid Fractures

• Wrist hyperextension and radial deviation can cause scaphoid fractures
• Symptoms include pain and tenderness that intensifies when trying to pinch or grasp objects
• Non-displaced fractures can be treated with a non-surgical approach, including a thumb spike splint for 8-10 weeks, and may require an additional 6-8 weeks if the fracture is more distal
• Displaced fractures require surgical treatment with a splint for 2-4 weeks

Other Orthopedics

Chronic Neck Pain

• Causes of chronic neck pain include cervical degenerative disc disease, cervical osteoarthritis, spinal stenosis, and thoracic outlet syndrome
• Symptoms of chronic neck pain include pain, stiffness, decreased ROM, headache, and crepitus (moving a joint and hearing it pop or crack)
• Treatment options include non-surgical approaches such as rest, NSAIDs, modalities, exercise, and OT/PT, as well as surgical approaches such as repair of the disc and nucleus pulposus

Cervical Degenerative Disc Disease

• Wear and tear on the cervical spine can cause cervical degenerative disc disease
• Symptoms include pain, stiffness, decreased ROM, and herniated discs
• Treatment options include non-surgical approaches such as rest, NSAIDs, modalities, exercise, and OT/PT, as well as surgical approaches such as repair of the disc and nucleus pulposus

Cervical Osteoarthritis

• Aging can lead to increased stiffness in the discs and abnormal growths on the bones of the neck
• Symptoms include pain, stiffness, decreased ROM, headache, and crepitus
• Treatment options include non-surgical approaches such as rest, NSAIDs, modalities, exercise, and OT/PT, as well as surgical approaches such as repair of the disc and nucleus pulposus

Spinal Stenosis

• Narrowing of the spinal cord can cause spinal stenosis
• Symptoms include pain, numbness, and possible myelopathy (weakness and decreased coordination in the arms or legs)
• Treatment options include non-surgical approaches such as OT/PT, NSAIDs, and surgical approaches such as cervical depression

Thoracic Outlet Syndrome

• Trauma, repetitive use, pregnancy, and anatomical differences can cause thoracic outlet syndrome
• Symptoms include pain in the shoulders and neck, numbness and tingling, and coldness in the fingers
• Treatment options include non-surgical approaches such as rest, activity modification, and surgical approaches such as cutting out part of the rib to open up space

Fracture of the Shoulder

• Floor-level falls, sports injuries, and MVA can cause fractures of the shoulder
• Symptoms include pain, swelling, and deformity, as well as grinding sensation
• Treatment options include non-surgical approaches such as immobilization, ice, and NSAIDs, as well as surgical approaches such as plates, screws, and internal fixation

Elbow Disorders

Medial Epicondyli

• Inflammation of the medial tendon of the elbow can cause medial epicondyli
• Symptoms include pain, weakness, and stiffness, and are usually dominant in the hand
• Treatment options include non-surgical approaches such as NSAIDs, rest, ice, ROM, taping, and OT/PT

Lateral Epicondyli

• Inflammation of the lateral tendon of the elbow can cause lateral epicondyli
• Symptoms include pain, weakness, and stiffness, and are usually dominant in the hand
• Treatment options include non-surgical approaches such as NSAIDs, rest, ice, ROM, brace, and OT/PT

Complete UCL Rupture

• Repetitive use, falls, and direct injury can cause complete UCL rupture
• Symptoms include pain, swelling, and deformity, as well as numbness in the ring and pinky fingers
• Treatment options include non-surgical approaches such as NSAIDs, ice, and therapy, as well as surgical approaches such as Tommy John surgery

Posterior Olecranon Osteophyte

• Formation of bone spurs on the posterior olecranon can cause posterior olecranon osteophyte
• Symptoms include pain, decreased ROM, and catching or locking of the elbow joint
• Treatment options include surgical approaches such as removing bone spurs and debridement of osteophytes

Elbow Dislocation

• Falls on an outstretched arm can cause elbow dislocation
• Symptoms include partial or complete dislocation, pain, and deformity
• Treatment options include non-surgical approaches such as relocation and immobilization, as well as surgical approaches such as repair of ligaments and external hinge

Radial Head Fracture

• Falls on an outstretched arm or in conjunction with elbow fractures can cause radial head fracture
• Symptoms include pain, swelling, and decreased ROM
• Treatment options include non-surgical approaches such as rest, sling, and NSAIDs, as well as surgical approaches such as removing bone fragments and repair of ligaments

Olecranon Bursitis

• Direct injury, prolonged pressure, infection, and other medical problems can cause olecranon bursitis
• Symptoms include painful elbow, edema, redness, and warm skin
• Treatment options include non-surgical approaches such as antibiotics, NSAIDs, and elbow pods, as well as surgical approaches such as removing the bursa and splinting

Elbow Arthritis

• Breakdown of cartilage on the articulating surfaces of bones can cause elbow arthritis
• Symptoms include pain, decreased ROM, locking or grating sensation, and edema
• Treatment options include non-surgical approaches such as NSAIDs, OT/PT, and corticosteroids, as well as surgical approaches such as arthroscopy or joint replacement

Ulnar Nerve Entrapment

• Subluxed nerve, prolonged pressure, swelling, and direct injury can cause ulnar nerve entrapment
• Symptoms include pain, numbness, and weakened grip, as well as atrophy or hand musculature
• Treatment options include non-surgical approaches such as modifying activities, nerve glide, and NSAIDs, as well as surgical approaches such as cubital tunnel release and transportation of the ulnar nerve