non operative management

ELMPOPI

Eduction

Life Style Modification

- vocational Counselling / ergonomic work environment

- activity modification

- home modifications

Pharmaceuticals

- symptomatic

- disease modification

Orthotics

Physiotherapy

-  local symptomatic

-  range of motion

Aetiology

Throwing injury

- seen in the throwing athlete

- repetitive microtrauma / valgus stress

- develop laxity

History

Initially

- lose velocity / accuracy

Develop medial pain

40% ulna nerve symptoms

Anatomy

Osseous canal between talus and calcaneum

- interosseous talo-calcaneal ligament

- cervical ligament

- joint capsule

- nerve endings / arterial anastomoses

Aetiology

Flat foot / overpronation

Inversion / sprain

Pathology

Pathology

ITB rubbing on LFC

- long distance runners (slow running more at risk than fast)

- cyclists (seat too high, improper technique)

ITB becomes tight, especially posterior portion

Develop inflammed tissue under ITB

- synovium

- bursa

Aetiology

Overuse 

- sudden increase in distance

- hill running

- genu varum 

- improper shoe wear

NHx

European Orthopaedic Paediatric Study JPO 1999

- 452 patients

- juvenile and adult

Findings

- stable lesion with cartilage intact and no dissection had good prognosis

- if signs dissection, surgical management better than non surgical

- sclerosis on x-ray poor prognostic sign

- lesions > 2cm poor prognosis

- 20% OCD in juveniles abnormal x-ray findings at 3 years (not benign process)

Non-operative Management

Natural history

Return to Sport

Shelbourne et al. Am J Sports Med 1999

- 133 patients with isolated PCL injuries followed for mean of 5 years

- 1/2 returned to sport at same level of play

- 1/3 returned to sport at lower level of play

https://pubmed.ncbi.nlm.nih.gov/10352760/

Agolley et al. Bone Joint J 2017

Issues

1.  Painful Bunion / Hallux valgus

2.  Metatarsalgia / MTPJ dislocation

3.  Claw toes

Symptoms

Complain of pain with prolonged standing

Complain feet tire easily

Examination

Overall alignment

Heel raises

Definition

Intra-articular proximal ulna fracture

Anatomy

Articulates with trochlea

- may have a central bare area

Triceps insertion

- via broad aponeurosis which blends with anconeus and CEO

Management

Non operative Management

Undisplaced fracture

- need to ensure triceps mechanism is intact