This chapter presents a case scenario of a 45-year-old right-hand-dominant woman who is a recreational tennis player can no longer play. Magnetic resonance imaging (MRI) and ultrasonography have been used to evaluate the extent of disease, detect associated pathological processes, exclude other primary sources of elbow pain, and quantify the degree of tendon injury in lateral epicondylitis. MRI is beneficial in recalcitrant cases to localize lesions, to confirm the diagnosis of lateral epicondylitis, or to particularly aid in surgical planning. Many patients present seeking rapid improvement in symptoms, and clinicians are frequently asked about the use of injections, including glucocorticoid injections and treatments under study such as ultrasound-guided percutaneous tenotomy and platelet-rich plasma injections. The majority of patients with lateral epicondylitis can be managed with nonoperative treatments. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a case scenario of a 25-year-old patient who presents following a low-energy torsional trauma sustained to his left knee while playing recreational sports. The prevalence of trauma-related cartilage lesions ranges from 23 to 54%, with meniscal tears often accompanied by focal chondral pathology. Evaluation of cartilage pathology on magnetic resonance imaging is important to inform both the patient and the surgeon regarding potential treatment and management approaches to focal traumatic defects in the absence of generalized degenerative changes. Advances in cartilage preservation and restoration procedures have led to an increasing number of therapies available to the treating physician. Identification of prognostic factors for clinical outcomes following joint preservation surgery will lead to optimal patient selection and subsequent benefit from cartilage surgery. Medium-term clinical outcomes favor cell-therapy and transplantation-based procedures over other treatment strategies. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a case scenario of a 67-year-old woman with end-stage tricompartmental osteoarthritis of the knee, and who is otherwise independent, undergoes elective total knee replacement. Some knee surgeons advocate leaving the native patellar surface intact, others recommend routine resurfacing with a polyethylene component, while yet others recommend selective resurfacing based on one or more patient factors and/or intraoperative findings. The primary goals of total knee replacement surgery are to improve patients' quality of life on an elective basis, specifically in terms of reducing pain and functional limitations associated with degenerative disease of the Knee. Many patients with symptomatic osteoarthritis are otherwise healthy and independent in their community. The need to undergo reoperation following primary knee replacement surgery is an undesirable outcome for all involved. Patellar resurfacing is associated with lower reoperation rates following total knee arthroplasty, particularly for patella-related indications. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a clinical scenario of a 35-year-old self-employed male contractor with a history of extensor tendon injuries. The strength of an extensor tendon repair dictates which postoperative rehabilitation protocol may be implemented. The goal of extensor tendon repair is to create sufficient repair strength to prevent rupture, safely engage in postrepair therapy, and allow the patient to return to work and activities of daily living as soon as possible. Most experts would agree that a strong repair that will withstand tension during early range of motion protocols is advisable. Understanding the extent and severity of the injury could help predict the functional outcome of the patient's hand. This can further assist the patient, surgeon, therapist, and employer in directing care, rehabilitation, and return to work. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a case scenario of a 19-year-old motorbike rider who attempts a large jump whilst off-road racing in a country competition. A Lisfranc injury is a commonly missed diagnosis and this type of injury has the potential to lead to significant morbidity. Lisfranc injuries require prompt anatomical reduction and surgical fixation with plates and screws. A missed Lisfranc injury is reported to lead to progressive planovalgus deformity, instability, and post-traumatic arthritis. Multiple case reports and case series have reported on the sequelae of delayed or missed diagnosis in Lisfranc injuries. Primary arthrodesis is a viable treatment option, and has less cases of a need to remove hardware than those patients treated with internal fixation. Awareness of the immediate and late complications of Lisfranc injuries is essential. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a case scenario of a 53-year-old man who presents with an eight-month history of progressive numbness in the ulnar nerve distribution and weakness with fine motor tasks. Neuromuscular junction atrophy is an important consideration as the nerve recovers after release. Patients with mild symptoms required surgical management less often versus moderate to severe disease. Nonoperative management is primarily recommended for mild disease with symptoms only. The most common contemporary techniques are simple decompression versus anterior transposition of the ulnar nerve. Severe ulnar neuropathy resulting in intrinsic muscle dysfunction muscle recovery is variable following simple decompression or anterior transposition. High-quality evidence supports no significant difference in clinical and neurophysiological outcomes between simple decompression and anterior subcutaneous transposition. A distal nerve transfer has been described to augment ulnar-innervated intrinsic muscle recovery. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
Limb salvage and amputation impose different stressors on a patient's financial and emotional well-being. An understanding of the investment required in each intervention enables the clinician to better counsel patients. Appreciating the financial and psychological costs of limb salvage compared with amputation may assist patients with decision-making. A severe extremity injury is a life-altering event that affects quality of life and function. An important aspect of treatment includes managing patient expectations regarding recovery and ability to return to work. Salvage and amputation are equal in regard to in-hospital charges, duration of hospitalization, and duration of inpatient rehabilitation in most studies. Outcomes after salvage and amputation are equal, and the outcome does not improve from two to seven years after injury. Limb salvage patients have a higher risk of complications. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a clinical scenario of a 48-year-old male who went to an orthopedic surgeon with shoulder complaints. Subacromial pain syndrome (SAPS) causes pain, impairment in daily activities and work, and a clear and unambiguous anatomical substrate is lacking. SAPS is a clinical diagnosis and can be caused or accompanied with different traumatic or degenerative changes of the shoulder. Magnetic resonance imaging and ultrasound are widely used in investigating patients with complaints of their shoulder. The Hawkins–Kennedy test can be used for diagnosing SAPS because of its high sensitivity. It should be used combined with other shoulder tests because this will lead to rising sensitivity and specificity. The chapter also provides recommendations for implementing evidence-based practice in the clinical setting.
This chapter presents a case scenario of a 57 year-old female who presents with a painful total knee arthroplasty (TKA) 18 months postoperatively. TKA patients experiencing pain require significant healthcare resources to evaluate and manage. Investigating the painful TKA requires a systematic approach that ensures both intra- and extra-articular etiologies are assessed. Extra-articular causes of pain after TKA should be considered when infection and other intra-articular pathologies have been ruled out. A significant percentage of TKA patients have some complaint of pain related to the arthroplasty. A diagnostic test that assesses alignment of a TKA but also correlates it to biologic activity or inflammation at the bone–prosthetic interface would be very helpful. Single-photon emission computed tomography/computed tomography (SPECT/CT) imaging can potentially accomplish this. SPECT/CT may help to distinguish between aseptic and septic loosening more accurately than three-phase planar bone scintigraphy. The chapter provides recommendations for implementing evidence-based practice in the clinical setting.
