Degenerative Lumbar Spine

Key Points Back pain worse with leaning forward = discogenic back pain Leg pain worse with leaning forward = herniated disc Back pain worse with extension = posterior elements (spondy) Leg pain worse with extension = stenosis Nicotine has increased effect of disc deterioration Vibratory 4-5 Hz (Truck Drivers) Most disc herniations are L4/5, L5/S1 (90+%) next up is L3/4…

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Degenerative Cervical Spine

Cervical Spondylosis degenerative changes facet arthropathy begins @ 40 years of age, by 60-70 years most men and women have it symptoms can be discogenic neck pain, radiculopathy, and/or myelopathy As disc ages decrease in disk hydration decreased chondroitin sulfate increased keratin sulfate Inflammatory mediators IL-1 TNF-alpha Most common at C5-6, next at C4-5 How to Classify Stenosis acquired or…

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Tibial Shaft Fractures | Lower Extremity Trauma

  Usually classified by location (proximal, middle, distal) AO/OTA Classification of Shaft Fractures (see Figure) proximal, middle, or distal Types A, B, and C Oestern & Tscherne Classification of Soft Tissue Injury (Closed) C-0: little or no soft tissue injury C-I: superficial abrasion C-II: deep, contaminated abrasion with local contusion damage to skin or muscle C-III: extensive skin contusion or crushing…

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Tibial Plateau Fractures | Lower Extremity Trauma

Tibial Plateau Fractures Schatzker Classification I - Lateral plateau split young people with good bone lateral meniscus tear trapped in fracture II- Lateral plateau split-depression valgus blow with axial loading age > 40 III - Lateral plateau depression (tend to be stable) IV - Medial plateau fracture (15% of plateau fractures) less common associated with LCL injury pattern most commonly…

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Patella & Knee | Lower Extremity Trauma

Patella the patella is a pulley, redirecting forces to the tibia your first choice should never be a total patellectomy, as this results in a 33% extension strength loss Classification based on pattern non displaced transverse - can be unstable, especially if gapped proximal pole distal pole stellate vertical - not very unstable Conservative Treatment displaced <2mm at the articular…

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Pars Defects, Spondylolysis, Spondylolisthesis | Lumbar Spine

Lumbar Spine Anatomy lamina superior/inferior articular processes (aka facet joint) spinous process transverse process Scotty dog (on oblique x-rays) - Look for pars defect nose - transverse process front leg - inferior articular process neck - pars interarticularis ear - superior articular process Biomechanics of soccer kick approach limb swing -hyperextension foot plant - hyperextension hip flexion, knee extension, and…

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