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A patellar fracture is also referred to as a broken knee cap. It is most often caused by a fall directly onto the knee. The fracture can also occur when the quadriceps are fully contracted against a quick flexion in the knee joint. Patellar fractures are broken into several types depending on the mechanisms of the injury. Patellar fractures account for 1% of all skeletal injuries. Depending on the nature of the fracture, the pathology can either be treated conservatively with a cast or surgically with screws, pins, and wires to hold the pieces of bone together. Patellar fractures with displacement of the bones of greater than 2 millimeters require surgery. If the bones are still in their correct order and non-displaced then the fracture can be treated without surgery. X-ray, bone scan, magnetic resonance imaging (MRI), and computed tomography (CT) scan are common tests completed in order to determine the severity of the injury. Patellar fracture rehabilitation typically has duration of six weeks. Immediately following the fracture, the patient needs to keep the knee in a straight position to allow for proper healing. Once the knee is strong enough, stretching and weight bearing exercises can be implemented to regain strength and range of motion.
The calcaneus, commonly called the heel, articulates with the talus and with the subtalar joint. The Achilles tendon attaches on the posterior calcaneus causing it to be at risk for injury when the calcaneus is fractured. During an abrupt contraction it can break off part of the calcaneus, causing an avulsion fracture. There are two different classifications of calcaneal fractures. Intra-articular fractures involve any of the three subtalar articulating surfaces and are most commonly the result of a combination of shear and compression forces. The second, extra-articular, includes fractures of the calcaneal body, anterior process, sustinaculum tali and superior tuberosity. These usually occur because of a blunt force trauma or a sudden twisting motion and are commonly treated conservatively. Non-articular fractures of the calcaneus that involve the Achilles tendon, however, must be surgically repaired. Isolated Achilles tendon injuries can either be treated conservatively following the Rest, Ice, Compression, and Elevation (RICE) principle, Non Steroidal Anti-Inflammatory Drugs (NSAIDS), using a heel life and progressive strengthening and stretching exercises, or by surgery. Return to play could take from a couple weeks to months depending on severity. Rehabilitation of calcaneal fractures is similar whether the progression is traditional immobilization or early mobilization. The treatment goals are to restore heel height and length, realign the posterior facet of the subtalar joint, and restore the mechanical axis of the hindfoot. There are three phases to achieve these goals. Phase two and three are compatible between early mobilization and traditional immobilization. However, the first phases differ. When using early mobilization prevention of contracture and loss of motion at the ankle and foot joints are taken into consideration. This process typically requires 14 weeks. Therefore, when a patient endures a calcaneal fracture with Achilles tendon involvement both injuries and all rehabilitation protocols must be considered by the orthopedist when constructing the rehabilitation program.
A Lisfranc fracture/dislocation, usually occurring between the first and second metatarsals on the medial cuneiform in the forefoot, is best treated through the surgical intervention of open reduction and internal fixation using either screw fixation or Kirschner wire (K-wire) fixation. This injury is mainly caused by low-energy sports-related activities or high-energy motor vehicle and industrial accidents. In order for the joint to heal properly, surgical treatment is required. The use of K-wire fixation is becoming a popular treatment. The K-wires are stainless steel pins used to hold the bone fragments together during healing time and then removed after the fracture/dislocation has healed. The first two weeks postoperatively are a non-weight bearing period while the athlete is in a rigid, short, leg splint. For an eight-week period following that, the athlete is limited to partial weight bearing while wearing a walking boot. During this time, it is essential for the athlete to begin working on their range of motion and strength. It is critical that they maintain their cardiovascular fitness through non-weight bearing or partial weight bearing activities. Once they are permitted to fully bear weight they may begin a complete rehabilitation program consisting of range of motion, strengthening, and proprioceptive and neuromuscular control exercises, as well as balance training and progression to agility and sport specific activities.
A clavicle fracture, group II, type II, classified on the gray scale is a fracture of the distal 1/3 clavicle, medial to the coracoclavicular ligaments. These fractures often require surgical treatment because of the high rate of non-union. Internal fixation with a plate and screw technique is often the chosen technique to repair the damaged clavicle. After surgery, a sling is worn for three to four weeks. Rehabilitation starts after surgery beginning with rest, ice, elevation, and stabilization of the area. While the athlete is in the sling, strengthening to the elbow, wrist and hand is done to prevent atrophy to those muscles. When the sling is removed, rehabilitation for this injury would begin with shoulder range-of-motion exercises and progress to flexibility, coordination, endurance, and strength training. A clavicle fracture often takes six to eight weeks to heal. A full recovery from this injury is expected. The recovery time is 6 to 12 weeks and at this time the athlete may return to their sport.
A quadriceps tendon rupture within the knee joint is a traumatic injury that, if not surgical repaired and intensively rehabilitated, will end an athlete’s career. When the quadriceps tendon ruptures, the patella loses its ability to attach to the quadriceps muscle. Without the quadriceps tendon’s ability to attach the quadriceps muscle to the patella, the athlete is unable to straighten their knee and the knee is not able to fully support the body because of the inability of the knee to extend. However, full recovery from a quadriceps tendon rupture is very possible. After surgical intervention, a complete rehabilitation program is vital to the full recovery of the athlete. The rehabilitation of a quadriceps tendon rupture has to be treated extremely conservatively at the start of the program. As the program progresses it is important to first focus on range-of-motion exercises and then move onto strength, endurance, and proprioceptive exercises. After almost 6 months of concentrated rehabilitation, the athlete should be able to focus on sport-specific functional movements and be able to get back to full participation with at least 85% to 90% strength as compared to the uninjured knee joint.
The posterior cruciate ligament (PCL) runs posteriorly to the anterior cruciate ligament (ACL) as it distends from the femur to the tibia. The PCL acts as a posterior stabilizer of the knee. If there is sufficient posterior laxity in an individual it will be important to evaluate the integrity of the ligament through the posterior drawer test or Godfrey’s test. If posterior sag is indicated through one of these two tests, a magnetic resonance imaging (MRI) should be ordered to show the true integrity of the ligament. Controversy continues to arise over which graft is best to use for reconstruction of the PCL. A transtibial or tibial inlay technique can be used. Either a single or double bundle of the patella tendon, Achilles tendon, hamstring tendons, and/or quadriceps tendons can be used for the replacement of the damaged PCL. The surgical procedure also depends on the extent of damage to surrounding structures of the knee. Post-operative rehabilitation following PCL reconstruction depends primarily on the physician and patient. A patient should be cleared for return to normal activities around six months post-surgery. This paper details the necessary rehabilitation techniques and the appropriate times to perform these rehabilitation exercises in correspondence to the patient’s progress throughout the rehabilitation regime.
Distal radial fractures typically involve the last few centimeters of the radius and are commonly caused by falling on an outstretched hand. Women are more succeptable to this injury, especially as they age. Associated fractures of the ulnar styloid and perilunate fracture dislocations are common with a distal radial fracture. Upon evaluation, special attention should be given to the neurovascular status of the involved arm due to association of compartment syndrome with the injury. External fixation is required for unstable fractures and involves the use of pins placed in the second metacarpal and radius to immobilize and distract. Immobilization lasts five to eight weeks followed by mobilization. Initial rehabilitation involves reducing pain and edema and increasing finger range of motion. The use of rest, ice, compression and elevation as well as other therapeutic modalities are essential to early stages of successful stages of repair. Extension, radial deviation, and supination are important to emphasize and can be attempted using active, active-assisted, and passive techniques. Restoration of strength and wrist function occurs after successful restoration of range of motion (ROM) in the joint. Successful rehabilitation requires compliance from the athlete and support from the therapist as the injury is progressed from surgery through rehabilitation.
A transverse fracture is not common for the cervical spine and is usually a result of lateral flexion. The injury can result in a loss of function and feeling to the muscles in the arms, specifically the wrist and elbow extensors if the spinal roots C6 or C7 are affected by the injury. In surgery the surgeon can obtain a bone graft and fuse the vertebrae. Another surgical procedure that may be used to stabilize the spine is a wire fixation. Rehabilitation begins with restoring motion to all parts of the body to prevent atrophy. Performing muscle tensing exercises the same day as surgery helps to obtain this goal. Out-patient care focuses on returning functional control with proprioception for all parts of the body. Rehabilitation is not complete until neuromuscular control, range-of-motion (ROM), strength, endurance, balance, cardiovascular fitness, and functional activities to the athlete have been restored. Within pain limits the early goal is ROM exercises for the neck that progress toward strengthening exercises with no pain. Meeting 5 days a week allows close monitoring of the athlete’s progress. It is important not to be too aggressive with a cervical spine injury.
A posterior lateral corner injury with associated biceps tendon avulsion is a traumatic injury an athlete can receive while participating in athletic sporting events. The purpose of this study is to compare different surgical methods as well as anatomy, mechanism of injury, and rehabilitation for the reconstruction of the lateral corner of the knee with an associated biceps femoris tendon avulsion. Data were collected in a research setting. The validity and reliability of surgical techniques for posterior lateral reconstruction are well known in the field of sports medicine. Results show that common anatomical structures impacted by a posterior lateral corner injury are the fibular collateral ligament, popliteus tendon, and popliteofibular ligament. The avulsion of the biceps femoris tendon is a less common injured structure. There have been successful outcomes in surgeries that used autografts, allografts, and synthetic grafts to reconstruct damaged structures. After all forms of surgery, the patient is immobilized in extension for the first week. After the first week range of motion (ROM) exercises are performed with the objective of achieving full ROM before strengthening exercises are performed. Patients should return to full activity in six to nine months.
Elbow dislocations are fairly uncommon injuries that usually result by falling on an outstretch hand. A dislocation with no accompanying bone injury is called a simple dislocation and one with an accompanying bone or ligamentous injury is called a complex dislocation. Elbow dislocations are medical emergencies and need to be reduced quickly because of the possibility of decreased circulation to the distal arm. Surgery is needed for complex dislocations in order to restore stability and function. If the radial head is damaged, it can be repaired with screws or a metallic implant. If the coronoid process of the ulna is damaged, it can be repaired with screws or sutures. Rehabilitation from the injury is very critical so that full function can be restored. Since the elbow is splinted immediately following surgery, active range of motion of the shoulder and wrist is important. Once the splint is removed, it is important to restore range of motion of the elbow then strengthen the surrounding structures. Range of motion can be performed passively, actively, and with joint mobilizations. Return to play following surgery usually happens within a 18-26 week time frame.
A sports hernia is defined as a tear in the muscles of the lower abdomen. This can lead to an avulsion of the abdominal muscles pulling away from the bones of the pelvic girdle. Diagnosis of a Sports Hernia is determined by a thorough history and evaluation. The surgical procedure to repair a Sports Hernia is primarily a laparoscopic technique. A rehabilitation program will be set up with various exercises. Rehabilitation is broken down into four stages. First stage is rest, which takes place the first four weeks. Week 5 to 7 is working on range of motion exercises, followed by week 8 through 11 adding strengthening exercises to the ROM. From 12 weeks on, the patient can return to full weight-lifting exercises and can be cleared for sport participation. The rehabilitation program is established by setting goals with the patient to encourage compliance and allow them to return to the activities of daily living, or be able to participate in sports again.
Data from U.S. Department of Health and Human Services (2005) show a nearly three-fold increase in overweight children. This problem is associated with physical inactivity, which many claim is preventable. Whitehead (1991) suggests, “that children are born intrinsically motivated to be physically active. That motivation if kept alive by physical success, freedom, and fun will do more than promote the fitness behaviors that add years to life, it will maintain the physical zest that adds life to the years.” Furthermore, research implies that a child’s level of physical activity “depends on experiencing the intrinsic satisfactions of skill improvement, personal accomplishment, and excitement rather than being a result of extrinsic factors, such as winning, getting rewards, or pleasing others” (Whitehead, 1991). Currently, the predominant method to motivate youth to be physically active is an extrinsically based Presidential Fitness Challenge (PFC). The PFC consists of 5 events; children are tested and then evaluated according to normative PFC data. Does this physical fitness testing positively motivate children? To answer this question, this study examined the effect of the PFC on intrinsic motivation in children.
Osteochondral defects can be treated with various techniques including abrasion, drilling, microfracture, osteochondral autografts, osetochondral allografts, congrocyte, periosteum and perichondrium transplantation. Although the traditional resurfacing technique of microfracture is safe and effective for treating articular cartilage defects of the knee joint, it does not restore normal hyaline cartilage and has a short-term success rate. Knee microfractures help by acting as a cushion to the articulating surfaces of the joint and are frequently performed on athletes. Most patients see improvement post surgery and are able to return to play in an average of four months. A rehabilitation program allows the knee to heal and regain full range of motion, and can speed cartilage re-growth. The purpose of this research is to review the surgical procedure of microfracture as a result of cartilage defects and to develop a rehabilitation program that includes exercises used as well as the appropriate adjustments made to the exercises as the athlete or patient progresses.
The shoulder is categorized as a ball and socket joint but with more ligamentous and muscle stabilization than that of the hip joint. The humeral head is ideological spherical articulating with the glenoid fossa. The shoulder is primarily stabilized by the coracohumeral, glenohumeral, and coracromial ligaments as well as rotator cuff and deltoid muscles. Some indications preceding surgery include osteoarthritis with glenoid cartilage loss as well as deltoid and rotator cuff dysfunction and pain. Shoulder hemiarthroplasty is effective at treating proximal humeral fractures. Shoulder hemiarthroplasty is comparable to shoulder arthroplasty, which is the complete reconstruction of the shoulder, where hemiarthroplasty is only partial shoulder reconstruction. Post-operative procedures include immobilization of the shoulder for 4 to 5 days, releasing the patient 2 to 3 days post-surgery. Rehabilitation for this surgery begins with achieving PROM followed by appropriate progressions of rehab to return the patient to normal activity.
From start to finish, diagnosing, treating, and rehabilitating a torn ACL can be a long process for any individual, especially an athlete. ACL is the primary restraint to forward motion and is critical to knee stability. Although the injury is not life-threatening, the debilitating effects post-surgery can be stressful. A variety of technological methods are used to diagnose a torn ACL. A physical examination and a history of the patient are initially required. Next, the physician can use an X-ray, MRI, or KT 1000 to make the final diagnosis. When the ligament is torn or significantly damaged it must be surgically repaired. ACL reconstruction is a fairly common surgical procedure that uses a variety of surgical methods to repair a damaged ACL. The surgical procedure uses a combination of open surgery and arthroscopy. Some surgical methods include extra-articular and intra-articular procedures. Depending on the individual, an ACL reconstruction surgery takes about two hours. Following the surgery, an intense rehabilitation program must be implemented immediately. The rehabilitation process from an ACL surgery can be both painful and extensive for the patient.
The plantar fascia functions as the main support system for the longitudinal arch of the foot. Differential diagnosis shows that there are various pathologies that accompany chronic heel and arch pain. Plantar fasciitis is an inflammatory condition that occurs as a result of over stressing the plantar fascia. There are many conservative techniques that are used to treat plantar fasciitis such as rest, stretching of the plantar fascia and the gastroc-soleus complex, muscle strengthening, orthotics, massage, gait analysis, and anti-inflammatory drugs. However, when these less invasive modalities fail to alleviate pain and reduce inflammation, surgical intervention can be implemented to correct the problem. An endoscopic plantar fascia release may be performed to provide relief from reoccurring heel and arch pain. Post-surgical rehabilitation, although similar to conservative treatment, is important for further reduction of symptoms as well as prevention of reoccurrences. An appropriate rehabilitation protocol should be established including goals, treatments, and exercises to ensure a full recovery and return to play for the athlete.
The frequency of ankle injuries in athletes can occasionally cause sports medical personnel to overlook the possibilities of an unusual but potentially devastating injury. Maisonneuve fractures can be difficult to diagnose because the causes and symptoms are misleading. Specific actions must be taken by the sports medicine professionals to assure that the injured athlete is treated properly. Because Maisonneuve fractures involve multiple injuries to the bones, ligaments, and capsules of the ankle joint and lower leg, surgical repair of the ligaments and bones is necessary. Post-surgical treatment involves a precise rehabilitation plan that combines many treatments involving range of motion, strengthening, and proprioception improvement. However, the large amount of damage to the ankle joint in a Maisonneuve fracture can make the rehabilitation process much more detailed and precautionary than a normal ankle fracture or ligament tear. Becoming familiar with the etiologies, pathologies, procedures, and rehabilitation techniques involved with a Maisonneuve fracture will allow sports medicine professionals to improve their ability to recognize and treat the effects of this potentially debilitating injury during the short and long-term without any lingering issues.
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