Orthopedics

  • Tensor fascia lata syndrome:
  • Patellofemoral Pain Syndrome:
    • Really tight hamstrings and quadriceps. Weak/decrease muscle mass of quadriceps lead to chronic pain in anterior knees, especially with stairs. Pain is worse when person goes from inactivity to activity.
    • NSAIDs: Meloxicam
    • Patient needs to be referred to Physical Therapy. Encourage patient to stretch his legs regularly and to maintain regular exercise.
    • X-rays of knees: Good joint space and no abnormalities. Arthritis is very low on the differential due to normal knee x-rays and young age.
    • http://www.hopkinsortho.org/patellofemoralpain.html
      • Patellofemoral syndrome: Chronic anterior knee discomfort. Ex plan: The patient was referred to Physical Therapy. He also has GERD, so he is encouraged to only use OTC Ibuprofen PRN. He is encouraged to use OTC Tylenol PRN for pain. He is encouraged to stretch his legs regularly and to maintain regular exercise.
      • Directions/Information for patient: You have been referred to Physical Therapy today. They will teach you stretches and strength building exercises for your legs. You are encouraged to stretch your legs regularly and to maintain regular exercise.
  • Iliotibial Band Syndrome:
  • Posterior tibial tendinitis of the leg: (“too many toes sign” = when looking at the standing person from behind, see more toes than expected)
    • Provide the patient a written prescription for a long leg walking orthotic boot.
    • Instruct the patient to take Ibuprofen PRN for pain and to apply ice to the ankle.
    • The patient is also referred to Podiatry for further evaluation and treatment.
    • The patient would also likely benefit from physical therapy.
  • Osgood–Schlatter disease:
    • Inflammation of the patellar ligament at the tibial tuberosity (painful)
      • Painful lump just below the knee.
      • Remits spontaneously.
      • Symptomatic treatment with NSAIDs.
    • Most often seen in young adolescents (<18 years old), male predominance.
    • Risk factors include overuse and adolescent growth spurts.
    • X-ray: may show calcification or irregular ossification at tendon insertion.

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