Iontophoresis, as commonly used in physical therapy, is a modality best defined by which of the following descriptions?
Induction of muscle contraction facilitating metabolic byproduct removal
Transcutaneous delivery of medication with electrical current
Transmission of high frequency acoustic waves to soft tissues
A low level laser treatment
Utilization of pulsed magnetic fields for recalcitrant muscle pain
DMSO is used by some massage therapists, holistic medical providers, some trainers and from taking Gracie jiu-jitsu, I've learned the Gracie family utilizes it with crushed Vitamin C, tumeric and even NSAIDS topically combined with massage as they believe the DMSO does facilitate transdermal delivery of the combined substance to areas that are sore or injured. It's been passed down through generations so there must be some benefit otherwise they would not keep it in their bag of tricks. Personally, I have never used it mostly because the garlic smell associated with it, but there are many people that attend my MMA facility, both professional fighters and your average member, that have used it in combination with various substances and swear by its ability to decrease swelling and inflammation and get them back to full function faster than without it.You are correct in saying that is primarily used by horse trainers and for the same reasons. Therefore, the best place to purchase it is at a horse supply or Tractor Supply store.
agree with anon - sounds rather dubious
Ligaments of the Knee
based on the description of the medial structures of the knee, would it be safe to say that the pes anserinus separates layer 1 and 2.
All of the following are predisposing factors for lateral patellar dislocation in a native knee EXCEPT?
Excess femoral internal rotation
Excess external tibial rotation
Lateral femoral condylar hypoplasia
Insufficiency of the vastus lateralis
Dr. Anonymous - The J sign doesn't necessarily rule out an MPFL tear. An intact medial soft tissue envelope with appropriate tension would help prevent the J sign if the bony constraint and alignment are intact and not pathologic. If there is a J sign, there may be an MPFL tear if the medial retinacular structures and bony engagement of the patellofemoral joint recenter the patella during flexion. The lateral to medial translation of the J may occur at a different point Id assume, but unless the patellofemoral joint remained dislocated during flexion, it would recenter itself in the trochlea at some point.
Here's my understanding of the patellofemoral joint: in full extension the patella lies at the upper end of the trochlea and enters its groove as flexion begins. Once engaged, the patella is held in place by two mechanisms. The first is its contact with the lateral edge of the trochlea, which acts as a lateral buffer, and the second is the soft-tissue tension which prevents it slipping laterally.
In the normal knee, from 0° to 30° of flexion, the median ridge of the patella lies lateral to the center of the trochlea; it moves medially to become centered in the trochlear groove at between 30° and 60° of flexion. As flexion proceeds the patella is more deeply engaged in the trochlea and is held firmly by soft-tissue tension. When the knee is flexed beyond 90°, it tilts so that its medial facet articulates with the medial femoral condyle.
Here's a great video of a J sign: https://www.youtube.com/watch?v=FynIg-KbJAE
Arthroscopic Management Of Anterior Instability - Dr. Christopher Ahmad
Arthroscopic Management Of Anterior Instability. To view more videos, and to learn more about The Center for Shoulder, Elbow and Sports Medicine, please visit our site at http://cses.cumc.columbia.edu/.To learn more about Columbia Orthopedics visit our website http://www.columbiaortho.org.
Thank you for that video.
does the presence of J-sign only exclude MPFL tear? coz MPFL is involved in engaging the patella into trochlea in the early flexion of 20 deg. If MPFL is torn, there should not be J-sign. Am I right or I misunderstand the concept? Thanks
what is the reason for poor prognosis of the lateral femoral condyle and patella lesions?
A 72-year-old man reports progressive pain and restriction of motion in his left shoulder. His active and passive motion are restricted to 90 degrees of forward elevation and neutral external rotation. Based on his radiograph shown in Figure A and physical exam, where is glenoid wear most likely to exist?
The AP radiograph may not be crucial for the above scenario to pick the "best response". It may be reasonable to list the current IR motion (passive and active), as this will direct the examinee to choose central versus posterior glenoid wear. Central wear is the most common, followed by eccentric posterior glenoid wear. Walch's classification scheme and percentages remain viable 17 years later.
An athlete who sustains a head injury should be removed from competition for each of the following findings EXCEPT:
Symptoms lasting more than 15 minutes
Recurrence of symptoms with exertion
History of prior concussion
Low baseline neuropsychological testing
Agree the history of concussion statement is somewhat vague. Maybe prior concussion in the same game, season etc should be specified...
J Am Acad Orthop Surg. 1999 Nov-Dec;7(6):389-402.
There is chronic inflammation in tendinopathy http://bjsm.bmj.com/content/50/4/216 - and mast cells as one example have been noted to be increased in patellar tendinopathy https://www.ncbi.nlm.nih.gov/pubmed/18308880 - not sure surgery can be justified using any evidence also
Clin Sports Med. 2017 Jan;36(1):1-8. Epub 2016 Oct 4.
Neuromuscular retraining intervention programs: do they reduce noncontact anterior cruciate ligament injury rates in adolescent female athletes?Noyes FR, Barber-Westin SDArthroscopy. 2014 Feb. pii: S0749-8063(13)01161-4. doi: 10.1016/j.arthro.2013.10.009. 30. (2). :245-55PMID: 24388450 (Link to Abstract)
Thoracic Outlet Syndrome
I think the physical examination is a bit vague, I wrote a clearer physical examination:WrightShoulder abducted to 90º, external rotated arm, elbow flexed no more than 45º and neck rotated away from the affected side, a positive test results in weak or loss of radial pulse and/or reproduction of symptoms.AdsonShoulder abducted 30º and maximally extended with the neck extended and rotated towards the affected side, then the patient is asked to inhale deeply, a positive test results in weak or loss of radial pulse and/or reproduction of symptoms.Modified AdsonSimilar to Adson but with the neck extended and rotated away from the affected side.RoosShoulder abducted 90º, externally rotated arm and elbow flexed 90º, the patient is asked to close & open hands repeatedly while hands are overhead for 1 minute, a positive tests results in reproduction of symptoms (numbness, cramping, weakness) or inability to complete procedure.
A 76-year-old man has a two-year history of shoulder pain which no longer responds to non-operative treatments. A radiograph is shown in Figure A. He has forward flexion to 80 degrees and abduction to 70 degrees. An example of his belly push examination is shown in Figure B. What is the most appropriate surgical procedure?
Arthroscopic debridement and subacromial decompression
Open rotator cuff repair
Total shoulder arthroplasty
Reverse shoulder arthroplasty
i take it that was a negative belly press test showing us that he has a good subscap, which is obviously necessary for good outcomes post RTSA.
Outlet (subacromial) Impingement
This topic is a tad out of date. In terms of definition the use of 'impingement' is disappearing and being replaced by 'cuff tendinopathy/disease' as the aetiology appears far more related to intrinsic tendon failure than 'impingement'. In terms of clinical examination the painful arc test should be mentioned - https://www.ncbi.nlm.nih.gov/pubmed/23982370 . In terms of treatment acromioplasty is poorly evidenced, recent evidence shows no long term benefit over physiotherapy (Ketola papers).
Demonstrates Ober test for IT band syndrome
A patient sustains a full thickness tear of their teres minor. Which of the following test/signs would most likely be positive in this patient?
Belly press test
Internal rotation lag sign
in the explanation--does it mean "posterior infraspinatus" instead of "posterior supraspinatus"?
A 19-year-old male complained of right elbow pain 4 months ago after pitching in a collegiate baseball game. He underwent a period of rest and forearm strengthening and now has recurrence of pain during a throwing interval program. A MRI is shown in Figure A. What is the next most appropriate step in management?
Open ECRB tendon release and removal of the diseased tendon with repair of the tendon remnant
Arthroscopic debridement of lesion and osteotochondral autograft transplant from ipsilateral knee
Excision of the diseased tendon and reattachment of the origin of the flexor-pronator muscle group to the medial epicondyle
Open reconstruction of the ligament using ipsilateral palmaris longus tendon
Diagnostic elbow arthroscopy, removal of posteromedial olecranon osteophytes and débridement of chondromalacia
In a high level throwing athlete would you consider using a tendon other than the palmaris from his throwing arm?? I realize they are not of that much value to the majority of us, but to the wannabe or professional "thrower" they may be a little more significant. Just curious.
A 31-year-old professional bodybuilder reports right shoulder pain with cross-body adduction as well as point tenderness at the acromioclavicular joint. Based on the radiograph shown in Figure A, which treatment is likely to provide the most successful result?
Glenohumeral joint injection
Periscapular muscle strengthening
Arthroscopic resection of the distal clavicle
Dr. McCulloch--If you are pretty sure that the AC joint is the problem, and your intention is to resect the distal clavicle, how aggressively are you going to address additional intraarticular pathology identified at the time of GH arthroscopy. Would you address a labral or SLAP tear (other than to debride it) if you really thought the pain was coming from the AC joint? What about a 7mm articular sided, or 4mm bursal sided RCT?