Physical Address

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Hallux Valgus

KEY FACTS Hallux Valgus Hallux valgus is defined principally by the intermetatarsal angle; the distal metatarsal articular angle can also weigh on treatment decisions; the hallux valgus angle is the least relevant to treatment. Etiology is likely multifactorial with genetics playing a large role. Associated symptoms (metatarsalgia, hammer toes, etc.) are very relevant and can sway treatment decisions. Surgery is ultimately done in order to relieve…

Diabetic Foot

KEY FACTS Diabetes mellitus is a multisystem disease resulting from defects in insulin secretion &/or resistance to insulin action, which culminates in systemic hyperglycemia, which can have negative effects, especially when chronically elevated. The total prevalence of diabetes in the USA was 30.3 million people (9.4% of the population) in 2015, an increase of 50% since 2002. It is estimated that ~ 30% of all diabetics…

Cavus/Neuromuscular Foot

KEY FACTS The foot is a complex “machine” consisting of many bones and joints kept in a fine balance by many extrinsic (leg) and intrinsic (foot) muscles. Any disruption of the precise muscle balance leads to progressive deformity of the involved joints. If the imbalance arises prior to skeletal maturity, bone growth will be abnormal, and bones and joints will become dysplastic. The shape of the…

Flatfoot

KEY FACTS Arch height is widely variable in the population. A “low-arched foot” is not necessarily pathologic. Acquired flatfoot refers to an abnormal loss of the arch with pain. Acquired flatfoot is a common end point of many etiologies. Posterior tibial tendon (PTT) dysfunction is the most common cause of the adult acquired flatfoot. Other causes include neuropathic (Charcot) degeneration, neuromuscular disease, inflammatory disease, and trauma…

Orthotics and Prosthetics

KEY FACTS The use of orthotic devices varies in a fairly significant way depending on the training and background of the prescribing practitioner. Various practitioners, including orthopaedic surgeons, podiatrists, physical therapists, and more, prescribe orthotics for various pathologies, and there are widely varying opinions about best practices. With that being said, there are pathologies that unquestionably benefit from orthotics, and there are many themes in terms…

Physical Examination and Imaging

KEY FACTS A thorough physical examination includes the following components: Inspection Palpation Assessment of motion Strength testing Examination of vascular status Stability assessment Evaluation of alignment Assessment for gastrocnemius contracture Assessment of 1st-ray mobility Inspect for swelling, scars, skin condition, pigmented lesions, calluses, and shoe condition. Describe all tenderness anatomically. Proper positioning of the foot and limb is essential for an accurate and reproducible physical exam,…

Anatomy and Biomechanics

KEY FACTS The foot and ankle comprise a complex “machine” consisting of 26 bones and joints working together. The individual parts do not work in isolation. The ankle and hindfoot are 1 part of this machine, allowing the foot to adapt to uneven terrain, while the rest of the body remains upright. Ankle joint is the principal joint for plantar flexion The hindfoot joints (subtalar, talonavicular,…

Arthroscopic Management of Other Hip Disorders

Introduction Complications of the posterior and posterolateral aspects of the hip have been extremely uncommon. A comprehensive understanding of the anatomy, biomechanics, clinical evaluation, and diagnostic strategies allows the physician to interpret the vast array of pathologies routinely encountered in the lateral and posterior hip. The comprehensive physical examination will help sort out the levels of pathology of the hip, including pathology involving the osseous, capsulolabral,…

Intraoperative and Postoperative Complications With Arthroscopic Management of Femoroacetabular Impingement

Introduction Hip arthroscopy is a commonly performed procedure used to treat intra- and extraarticular disorders of the hip. Since 2010, there has been a significant rise in the number of hip arthroscopies performed. This is because of a multitude of factors: a better understanding of complexities of intra- and extraarticular hip disease, significant improvements in surgical instrumentation and techniques, and an overall increase in the number…

Preoperative Complications With Hip Arthroscopy

Introduction Hip arthroscopy can be fraught with complications if preoperative planning and indications are taken lightly. The accurate diagnosis of pathology around the hip can be both challenging and crucial to the success of arthroscopic hip procedures. Because abdominal, neurological, urological, extraarticular, and intraarticular pathology can all present with referred pain to the hip, the clinician must carefully correlate the patient’s history, physical examination, and diagnostic…

Complications After Elbow Arthroscopy for Elbow Osteochondritis Dissecans

Introduction Arthroscopy is gaining popularity as a procedure to treat intraarticular elbow pathology. The unique anatomy and size of the elbow joint make it a technically challenging joint to safely scope, with a higher potential risk of complications. Nelson et al. reported that, after 417 consecutive elbow arthroscopy procedures, they had an overall complication rate of 14%, with a major complication rate of 4.8% and a minor…

Complications with Elbow Arthroscopy

Introduction Advancements in elbow arthroscopy have led to an increase in its use. As surgeons have become more familiar with the technique, and instrumentation has become more intuitive, indications for its use are ever expanding. Indications include aiding in diagnosis, debridement for osteoarthritis, loose body removal, synovectomy, irrigation and debridement for septic arthritis, chondroplasty, contracture release, osteochondral lesions, microfracture, lateral epicondylitis treatment, instability, and others. Because…

Posterolateral Instability Reconstruction

Introduction Posterolateral rotator instability (PLRI) of the elbow describes the subluxation of the proximal ulna and radial head in a posterolateral direction relative to the distal humerus. Insufficiency of the lateral collateral ligament (LCL) complex has been implicated in the pathogenesis, eventually leading to instability of the elbow. Studies have shown that in addition to the entire complex, which includes the lateral ulnar collateral ligament (LUCL),…

Ulnar Collateral Ligament Reconstruction

Introduction Injuries to the ulnar collateral ligament (UCL) were previously career-ending injuries in high-level pitchers. Since Dr. Frank Jobe first performed ulnar collateral ligament reconstruction (UCLR) in 1974, there have been many variations of the technique which have allowed competitive athletes to return to play at a high level. Although UCLR has shown a high rate of return to play and athlete satisfaction, complications associated with…

Distal Biceps Repair

Introduction Anatomic repair and reconstruction of the distal biceps tendon footprint is the treatment of choice among patients who desire a return to full elbow flexion and supination strength after distal biceps rupture. Although good to excellent results are achieved in the majority of patients after distal biceps repair, the surgical complication rate varies from 16% to 26%. Careful preoperative planning may mitigate some common pitfalls…

Acromioclavicular Surgery

Introduction Acromioclavicular (AC) joint and associated coracoclavicular (CC) ligament injuries frequently occur in active individuals when they fall directly onto their shoulder in an adducted position. The Rockwood classification is the most commonly used system for categorizing AC injuries, and helps to determine appropriate treatment. Nonoperative management of grade I and II injuries with a brief period of immobilization followed by a progressive return to activities…

Superior Labrum Anterior to Posterior Tears and Proximal Biceps Pathology

Introduction Superior glenoid labrum tears were initially described by Andrews et al. in 1985 in a series of overhead athletes. This injury was further defined by Snyder et al. 5 years later with the terminology as it is known today, superior labrum anterior to posterior (SLAP) tear. The initial classification system was defined at that time, and has since been expanded. The diagnosis and treatment of SLAP tears…

Intraoperative and Postoperative Issues With Acromioplasty and Distal Clavicle Excision

Introduction The complex osteology of the shoulder predisposes it to a variety of pathological states, several of which can be related to impingement of soft tissues between osseous surfaces. Additionally, repeated overhead weight-bearing activities can predispose the glenohumeral articulation and its surrounding joints to arthritic changes that can manifest clinically as pain and dysfunction. Subacromial impingement syndrome and acromioclavicular (AC) joint disease are widely recognized sources…

Intraoperative and Postoperative Issues With Subscapularis Repair

Introduction The subscapularis muscle is the largest and most powerful rotator cuff muscle, accounting for as much as 53% of the force generated around the glenohumeral joint by the rotator cuff complex. Despite this, the subscapularis typically receives less attention than the other muscles of the rotator cuff with regard to repair, as a result of the lower likelihood of tearing in isolation. However, improvements in…

Intraoperative and Postoperative Issues With Open Rotator Cuff Repair

Introduction Open rotator cuff repair is becoming a less prevalent technique for rotator cuff surgery; nonetheless, clinical situations still arise where this technique may be preferred to arthroscopic repair. These scenarios include revision surgery for failed arthroscopic repairs and massive, chronic tears in younger and more active patients. For this reason, it is important for orthopedic surgeons to be aware of and know how to manage…