Head Shoulders Knees and Back Tommy Kern MD

Head, Shoulders, Knees, and Back Tommy Kern, MD thomas-kern@live. com (918)398 -1253

Disclosure l Dr. Kern has made no disclosures of financial interests with any company or companies, and has indicated no conflicts of interest.

Objectives l Learn everything about Sports Medicine in 1 hour, with detailed analysis of anatomy and human physiology of the brain, shoulder, knee, and back

Objectives Learn everything about Sports Medicine in 1 hour OR l How to assess and treat a concussion l Practical aspects of evaluation of shoulder, knee, and back pain l

What is a concussion? A biomechanical insult that leads to a neuro-metabolic cascade of events l This basically means: l l Swelling and inflammation occur l Metabolic crisis occurs (increase in glucose demand decrease in energy)

Concussions Which sports have highest risk?

I think that an athlete might have a concussion, what do I do?

How do you treat a concussion?

To Image or Not To Image That is the question

To Image or Not To Image That is the question Red Flag Symptoms

Why don’t concussion patients get better?

Goals of Concussion Treatment

• Impingement • Rotator cuff tear • Adhesive Capsulitis • AC joint arthritis

Shoulder Anatomy

Shoulder Evaluation l History provides the most information !!!!

History Pain Description: l Location l Injury or not l Acute or chronic Aggravating and relieving factors l Restriction in ROM l

Physical Exam l Inspection/Palpation l Subacromial l AC joint bursa

Physical Exam l Inspection/Palpation l Subacromial l AC bursa joint l Range of motion

Physical Exam l Inspection/Palpation l Subacromial l AC bursa joint l Range of motion l Strength l Rotator cuff l Supraspinatus test

Remember: The function of the RC is to “seat” the humerus Without a healthy rotator cuff, the humerus “floats”, rides up, and compresses / inflames the RC tendons Without it, humerus “floats” in the join

Treatment l RICE

Treatment RICE l Medication l

Treatment RICE l Medication l Injection l

Treatment RICE l Medication l Injection l Therapy l l Rotator Cuff l Scapula l Range of motion

Treatment RICE l Medication l Injection l Therapy l l Rotator Cuff l Scapula l Range of motion l Surgery

• Arthritis • Meniscus tear • Ligament tear • Pes Anserine bursitis

Knee Anatomy

Knee Evaluation l What provides the most information?

History Pain Description: l Location Injury or not Locking, catching, shifting, giving out Aggravating and relieving factors Ability to weight bear l Most important question? l l

History Pain Description: l Location Injury or not Locking, catching, shifting, giving out Aggravating and relieving factors Ability to weight bear l Is it Christiano Ronaldo? l l

Physical Exam l Inspection/Palpation l l l Effusion Joint line tenderness Pes anserine

Physical Exam l Inspection/Palpation l l Effusion Joint line tenderness Pes anserine Stability l l Lachman’s Valgus and Varus stress

Physical Exam l Inspection/Palpation l l Stability l l l Effusion Joint line tenderness Pes anserine Lachman’s Valgus and Varus stress Strength l Quadriceps and Patella tendon rupture

Treatment l RICE

Treatment RICE l Medication l l NSAIDs l Tylenol

Treatment RICE l Medication l Injection l

Treatment RICE l Medication l Injection l Therapy l l VMO l Closed chain

Treatment RICE l Medication l Injection l Therapy l l VMO l Closed l chain Advanced imaging

Treatment RICE l Medication l Injection l Therapy l l VMO l Closed chain Advanced imaging l Surgery l

• Disc herniation • Lumbar radiculopathy • Lumbar strain • Facet syndrome

Back Anatomy

Back Evaluation l What provides the most information?

History Pain Description: l l l Location Injury or not Locking, inability to move Radicular pain Numbness or tingling Weakness or giving out

Physical Exam l Inspection/Palpation l l l Spinal tenderness SI joint Piriformis

Physical Exam l Inspection/Palpation l l Spinal tenderness SI joint Piriformis Range of Motion l l Flexion and extension Straight leg raise

Physical Exam l Inspection/Palpation l l Range of Motion l l l Spinal tenderness SI joint Piriformis Flexion and extension Straight leg raise Strength l Lower extremities

Physical Exam l Inspection/Palpation l l Range of Motion l l l Flexion and extension Straight leg raise Strength l l Spinal tenderness SI joint Piriformis Lower extremities Reflexes l l Achilles Patella

Treatment l RICE

Treatment RICE l Medication l l Steroids or NSAIDs l Opioids l Gabapentin

Treatment RICE l Medication l l Steroids or NSAIDs l Opioids l Gabapentin l Therapy

Treatment RICE l Medication l l Steroids or NSAIDs l Opioids l Gabapentin l Therapy • Imaging • X-ray • CT • MRI

Treatment RICE l Medication l l Steroids or NSAIDs l Opioids l Gabapentin l Therapy • Imaging • X-ray • CT • MRI • Injection • LESI • Piriformis • SI joint

Treatment RICE l Medication l l Steroids or NSAIDs l Opioids l Gabapentin l Therapy • Imaging • X-ray • CT • MRI • Injection • LESI • Piriformis • SI joint • Surgery

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