Stage 0
Natural history mixed
- depends on size of lesion and diagnosis
- treat if becomes asymptomatic
- may benefit from bisphosphonates
Stage 1 / Normal X-ray, abnormal MRI
Forage: 80% G/E
Bisphosphonates
Stage 2 / Abnormal X-ray with cysts and sclerosis
A: As for Stage I
Mid-substance calcification of the rotator cuff
- part of a metaplasia secondary to hypoxia
2 groups of patients
Traumatic initial cause in 95%
M:F 2:1
Age of initial dislocation inversely related to recurrence rate
- patients younger than 20 have a redislocation rate of 90%
- between 20 - 40 years, redislocation rate of 60%
- patients > 40 years have a 10% rate of dislocation but a higher rate of cuff tears (up to 40% in patients > 60yrs)
- stabilise patient with beanbag or lateral rests
- apply skin traction to forearm
- place traction pole at foot of table opposite surgeon
- suspend arm with 10 lb weight
- abduction 60°
- forward flexion of 20°
- tilt top shoulder posteriorly 30° so that glenoid is parallel wwith bed
- mark bony landmark
- prep & free drape
1. Removal Loose body
2. Excison of osteophytes
- coronoid
- olecranon
- aiming to improve ROM / prevent impingement
Education
Lifestyle Management
- weight loss
- reduce sport
Physiotherapy
Orthotics
- walking stick
- braces
Pharmaceuticals
- NSAIDS
- acetominophen
- glucosamine
Injections
- cortisone
- hyaluronic acid
Osteochondritis Dissecans
- separation of avascular fragment of bone & cartilage
M : F = 2:1
Mean age 18 years
- can present as young as 9
4:1000
Developmental Anatomy
Knee joint first appears as a mesenchymal cleft at 8 weeks gestation
- ACL and PCL separate entities by week 10