MSK Final Exam Part 1 PDF

Management of joint dislocations Lec.2 MSL Dr.Sarkawt S.Kakai Understanding Joint Dislocations: Definition: • A joint dislocation refers to the complete separation of two or more bones at an articulating joint, disrupting the normal alignment of the joint surfaces. Causes: • Dislocations commonly...

Management of joint dislocations Lec.2 MSL Dr.Sarkawt S.Kakai Understanding Joint Dislocations: Definition: • A joint dislocation refers to the complete separation of two or more bones at an articulating joint, disrupting the normal alignment of the joint surfaces. Causes: • Dislocations commonly result from trauma, falls, sports injuries, or motor vehicle accidents. Commonly Dislocated Joints: • Some frequently dislocated joints include the shoulder, elbow, finger, hip, knee, and ankle. Clinical Assessment: History: Gathering information about the mechanism of injury, previous dislocations, and associated symptoms. Physical Examination: Evaluating for deformity, swelling, bruising, loss of motion, and neurovascular status. Imaging: X-rays, CT scans, or MRIs may be necessary to confirm the diagnosis, assess associated fractures, and determine the optimal reduction technique. Reduction Techniques Closed Reduction: • A non-surgical technique involving the manual manipulation of the dislocated joint back into its normal position. This is usually performed under anesthesia or sedation. Open Reduction: • Surgical intervention may be necessary when closed reduction fails, or there are complicating factors such as fractures or severe soft tissue injuries. Post-Reduction Care Immobilization: • The joint is typically immobilized using splints, casts, or braces to prevent re-dislocation and promote healing. Physical Therapy: • Early mobilization and rehabilitation are essential for restoring joint function, preventing stiffness, and strengthening surrounding muscles. Pain Management: • Analgesics and anti-inflammatory medications may be prescribed to manage pain and reduce inflammation. Complications and Considerations • Recurrent Dislocations: • Some joints, like the shoulder, are more prone to recurrent dislocations and may require additional interventions. • Neurovascular Compromise: • Caution in monitoring neurovascular status is crucial to prevent complications such as nerve or blood vessel damage. • Compartment Syndrome: • In cases of severe dislocations with associated soft tissue injuries, compartment syndrome may develop and require immediate intervention. • Chronic unreduced dislocation: • Pain, deformity, shortening and decreased ROM Rehabilitation and Long-Term Followup • Gradual Range of Motion: • Physical therapy focuses on restoring joint range of motion gradually and safely. • Strength and Stability: • Exercises that strengthen the muscles around the joint are essential to prevent future dislocations. • Psychological Support: • Patients may experience anxiety or fear of re-injury, and counseling or support groups can be beneficial. Prevention • Protective Gear: • In sports and high-risk activities, appropriate protective gear can reduce the risk of joint dislocations. • Safety Measures: • Educating individuals about safety measures and fall prevention, especially in the elderly, is crucial. Shoulder Dislocation • Anterior (90%) • Posterior (4-10%) • Laxation erecta - true inferior Shoulder reduction techniques Relocation prevented by • Static forces • Joint capsule / lip of glenoid • Dynamic forces • Rotator cuff • Biceps • Trapezius / deltoid • Pectoralis • Hippocratic NO single best technique • Kocher’s • Milch • Stimson’s Hip dislocation Posterior (90%) Anterior (10%) Axial load in flexed adducted hip Load on abducted externally rotated hip Position: Flexion / adduction / internal rotation Position: Flexion / abduction / external rotation Knee dislocation Use position of tibia as reference Anterior (most common) Posterior Medial / lateral / rotational Suspect • Hyperextension • Force to anterior tibia with knee flexed • Valgus / varus / rotational forces • High injury force • Multiple ligamentous injury and Vascular injury Elbow dislocation • 2nd most common large joint dislocation • Simple • Complex • Radial head # • Coronoid # • Terrible triad • https://padlet.com/sarkawts83/jointdislocation-classification-aw1hjlhs2cj02ser Total Hip Replacement A total hip replacement is a surgical procedure where a damaged hip joint is replaced with an artificial joint. In this presentation, we'll explore the history, b enefits, risks, and alternativ es for this common procedure. Dr.Sarkawt S.Kakai History of Total Hip R eplacement Ancient Times 1800s The concept of replacing joints dates back to ancient Egypt where artificial fingers were created frombronze and gold and attached with linen. Surgeons developed joint prostheses made of ivory, silver, and platinum, but the materials were not strong enough, and the surgeries often failed. 1940s to 1960s Today Sir John Charnley developed the modern design for total hip replacement, using a prosthesis made of metal and plastic. The procedure has come a long way, with recent advances including minimally invasive techniques and robotic-assisted surgeries. Types of hip replacement surgery: • With a total hip replacement, a portion of the pelvis and the head of the thighbone are completely removed. • When only the femoral head is replaced with a prosthesis, the surgery is called a partial hip replacement (hemiarthroplasty) Indication • Osteoarthritis of the hip, which is the most common indication • Rheumatoid arthritis • Injury/fracture • Hip osteonecrosis, or when blood flow to bone is reduced and bone tissue dies as a result • Neglected hip dislocation or DDH Designs include Femoral component • cemented • press-fit (uncemented) Acetabular components • cemented • press-fit (uncemented) Bearing surfaces • polyethylene • metal • ceramic Various Surgery Techniques • Posterior approach • Lateral approach • Direct anterior approach: This is sometimes called muscle-sparing hip replacement Procedure of Total Hip Replacement 1 Step 1: Incision T he surgeon makes an incision over the hip joint to expose the damaged bone and cartilage. 2 Step 2: Preparation of the Joint T he damaged bone is removed, and the socket and femur are shaped to fit the prosthesis. 3 Step 3: Implantation T he prosthesis is inserted into the joint and secured with screws, cement, or both. 4 Step 4: Post-Operative Care T he patient is monitored for pain, infection, and mob ility. Physical therapy is started to encourage recovery and rehab ilitation. Benefits and Outcomes of Total Hip Replacement Pain Relief Mobility Total hip replacement can offer Patients often report increased improved pain relief, especially mobility and range of motion, The modern prosthetic hip can for patients with advanced allowingthemto performdaily last up to 20 years or more, arthritis or other degenerative activities with greater ease. providinglong-term benefits conditions. Longevity of Prosthetic Hip and improved quality of life. Risks and Complications of Total Hip Replacement 1 Potential Risks 2 Complications Management Risks of the procedure include infection, nerve Complications such as implant looseningor wear damage, blood clots, and dislocation of the can require revision surgery and should be closely prosthetic joint. monitored by the patient and surgeon. Alternatives to Total Hip Replacement Non-Surgical Alternatives Comparison of Outcomes Future Advancements Alternatives to total hip replacement While these alternatives may be Exciting advancements in total hip include pain medications, physical effective for some patients, they often replacement technology include 3D therapy, weight loss, and use of cannot provide the same level of printing, personalized implants, and assistive devices such as canes or long-term improvement as total hip minimally invasive robotic-assisted walkers. replacement and may not be surgeries. appropriate for all patients. Conclus ion The Benefits The R isks Total hip replacement has provided many patients with While the risks of the procedure are present, they can be improved mobility and quality of life, and recent managed with proper pre-operative care and post- technological advancements continue to offer promising operative monitoring, as well as regular follow-up visits outcomes. with the surgeon. • https://www.orthobullets.com/recon/5036/tharehabilitation?hideLeftMenu=true Total Knee Replacement Dr.Sarkawt S.Kakai KHCMS Orthro. & Trauma Introduction to Total Knee Arthroplasty Total Knee Arthroplasty, also known as knee replacement surgery, is a surgical procedure to replace a damaged or worn knee joint with an artificial joint. It is usually performed to relieve pain and restore function in patients with severe knee arthritis or joint damage. The artificial joint, made of metal and plastic components, mimics the natural movement of the knee joint. Anatomy of the Knee Anatomy of the Knee ● The knee joint is composed of the femur, tibia, and patella. ● The femur is the thigh bone, the tibia is the shin bone, and the patella is the kneecap. ● The knee joint is supported by ligaments, including the anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), medial collateral ligament (MCL), and lateral collateral ligament (LCL). ● The knee also contains menisci, which are C-shaped pieces of cartilage that act as shock absorbers. Why Total Knee Arthroplasty? 1 2 3 Relieves pain Enhances quality of life Improves function Procedure steps of Total Knee Arthroplasty Metal implants are placed on the ends of the thigh bone and shin bone, and a spacer is inserted between them. An incision is made in the front of the knee to access the knee joint. The damaged cartilage and bone are removed from the surfaces of the knee joint. The incision is closed, and a drain may be placed to remove fluid. Types Post-Operative Care Early P.O Mid-P.O Late P.O • Should focus on pain management, wound care, and preventing complications such as infection and blood clots. • Physiotherapy interventions may include gentle range of motion exercises and ambulation with the assistance of a walker or crutches. • Patients should continue with pain management and wound care. • Physiotherapy interventions may include strengthening exercises, balance training, and functional activities to promote independence in daily tasks. • Patients should focus on achieving full range of motion, strength, and function. • Physiotherapy interventions may include more advanced exercises, agility training, and gradual return to normal activities. Role of Physiotherapy in Rehabilitation Benefits of Physiotherapy Techniques Used in Physiotherapy Improves range of motion Manual therapy Strengthens muscles Therapeutic exercises Reduces pain and inflammation Electrotherapy Enhances functional abilities Joint mobilization Common Challenges in Physiotherapy 1 2 3 Limited hands-on experience during training Time management Complex patient cases How to Overcome Challenges Challenges Strategies • Limited range of motion • Regular physical therapy sessions • Muscle weakness • • Pain and swelling Gradual increase in range of motion exercises • Fear of movement • Strengthening exercises for the muscles around the knee • Pain management techniques Future Trends in Knee Arthroplasty Trends in Knee Arthroplasty Advancements in technology and surgical techniques are expected to drive the future of knee arthroplasty. Conclusion: The Importance of Physiotherapy in Total Knee Arthroplasty Key Takeaways ● Physiotherapy plays a critical role in the rehabilitation process after total knee arthroplasty. ● Physiotherapy helps improve range of motion, strength, and function of the knee joint. ● Active participation in physiotherapy sessions leads to better outcomes and faster recovery. ● Physiotherapy also helps reduce pain and swelling, and improves overall quality of life.