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Webinar Wednesday 888 Work4U Work Comp Customer Service Department - PowerPoint PPT Presentation

Welcome to Athleticos Webinar Wednesday 888 Work4U Work Comp Customer Service Department Prompt and efficient scheduling Enhanced communication Easy to locate the closest clinic offering the service you need Speak


  1. Welcome to Athletico’s Webinar Wednesday

  2. 888 Work4U Work Comp Customer Service Department • Prompt and efficient scheduling • Enhanced communication • Easy to locate the closest clinic offering the service you need • Speak directly to an Athletico Work Comp customer service representative • Call: 888-8-WORK4U • Email: Work4U@athletico.com • Visit: www.athletico.com/Work4U

  3. Webinar Agenda Today’s Webinar is from 8:30am to 9:30am CST Agenda • 8:20 am - 8:30 am: Participants join call • 8:30 am: Host Introductions • 8:35 am: Dr Gross, Presentation begins • 9:20 am: Q & A led by Colleen Edmonson of Athletico • 9:30 am: Closing Remarks

  4. Participants If you have a question during the webinar you can enter your question in the Q & A section at the bottom of the page. At the end of the webinar our moderator will pose these questions to Dr Gross. Muted Lines/Operator Assisted Q & A In approximately 48-72 hours after the webinar those of you who have been logged in for the entire webinar will receive an email with the following materials: • Link to surveymonkey. This link is to the evaluation form which must be completed in order to receive your CEU. Once you complete the survey you will be routed to a link to receive your CEU’s. • 1.0 CEU for IL RN, IN Adjuster, CCMC, CRCC, MI RN, Texas Dept. of Insurance • IA RN will be mailed out after the event • A copy of the power point slides

  5. Today’s Speaker: Dr. Lyndon B Gross

  6. EARLY USE OF IMAGING STUDIES TO DIAGNOSE ACUTE WORKERS’ COMPENSATION KNEE INJURIES- CASE STUDIES Lyndon B. Gross, MD, PhD The Orthopedic Center of St. Louis

  7. COMMON KNEE PROBLEMS • Fractures • Tendon injuries • Ligament injuries • Meniscal injuries • Articular Cartilage injuries

  8. ANATOMY OF THE KNEE • Bones • Tendons • Ligaments • Meniscus • Articular Cartilage

  9. ARTICULAR CARTILAGE

  10. ARTICULAR CARTILAGE INJURIES • Difficult to diagnosis • Non-specific symptoms • No distinct physical findings • X-ray studies may be negative • MRI may help confirm examination – MRI Arthrogram • Arthroscopy most accurate

  11. ETIOLOGY OF CARTILAGE INJURIES Sports trauma, work-related trauma or • other injury 1,2 • Chronic instability 3 • Pathologic malalignment 3 • OCD 1 • Meniscal deficiency 3 • Obesity in the presence of moderate malalignment 4 1. Giffin J, et al. Operative Techniques in Orthopaedics. 2001;11:83-89. 2. Chu CR. Operative Techniques in Orthopaedics. 2001;11:70-75. 3. Cole B, et al. Operative Techniques in Orthopaedics. 2001;11:151-154. 4. Felson DT, et al. Arthritis Rheum . 2004;50:3904-3909 .

  12. HOW DO YOU KNOW????

  13. HISTORY • Age • Chief Complaint • Prior Treatment • Onset of Symptoms • Occupation • Mechanism of Injury • Number of Years • Location Working • Instability • Changes in Work • Mechanical Environment Symptoms • Impact on Work

  14. PHYSICAL EXAMINATION • Inspection • Range of Motion • Special Testing • Palpation • Neurovascular Examination

  15. RADIOGRAPHIC EVALUATION • Plain X-rays • MRI Scan • Bone Scan

  16. RADIOGRAPHIC EVALUATION • Plain X-Rays – Standing AP – 45 ° Flexion weight-bearing PA – Lateral – Merchant

  17. MAGNETIC RESONANCE IMAGING • MRI – Noninvasive – Sensitive – T1, T2, FSE, 3D SPGR, MRA

  18. RADIOGRAPHIC EVALUATION

  19. CASE #1

  20. HISTORY • Patient is a 40 y.o. male pilot for the local police department • While at work he missed a step and fell approximately 4ft onto concrete, hitting his left knee. • Patient was seen at occupational medicine • MRI ordered

  21. PHYSICAL EXAM • Swelling • Full ROM • Pain with ROM • Pain with flexion McMurray testing lateral knee • Tender to palpation anterolateral knee

  22. X-RAY STUDIES LATERAL VIEW WB AP VIEW

  23. X-RAY STUDIES FLEXION VIEW MERCHANTS VIEW

  24. MRI FINDINGS

  25. MRI FINDINGS

  26. TREATMENT ALGORITHM • Age • Occupation • Defect size • Surgical intervention with osteoarticular transplantation with allograft (cadaver tissue) to lateral femoral condyle

  27. SURGICAL INTERVENTION Arthroscopy

  28. OSTEOARTICULAR TRANSFER

  29. INITIAL POST OP TREATMENT • Non weight bearing 6 weeks • Hinge brace • CPM machine for 4 weeks • PT for ROM, strength, modalities

  30. PATIENT OUTCOME • Return to sit down duty: 3 wks post op • Full ROM, discontinued brace 6 wks, full weight bearing 9 wks post op • Work conditioning exit evaluation @ 6 months: ability to work HEAVY demand Returned to full duty 6 mo post op • • Released MMI 8 mo post op doing well had just completed police fitness testing

  31. CASE #2

  32. HISTORY • Second Opinion: Patient is a 57 y.o. male custodian at a local high school • He stated he slipped on a wet floor into the “splits” position and hyperextended his right knee.

  33. HISTORY Initial treatment: hamstring strain • Returned to full duty but continued to • complain of knee pain MRI of the knee and diagnosed with a • bone contusion • Cortisone injection and placed on crutches. • Continued pain • Second MRI performed • Second Opinion

  34. SECOND OPINION • Pain with weight bearing • Using crutches • Swelling • Medial pain

  35. PHYSICAL EXAM • Effusion • ROM 0-90 ◦ • Medial sided pain with ROM • Tender to palpation medially

  36. X-RAY STUDIES WB AP VIEW LATERAL VIEW

  37. X-RAY STUDIES PA FLEXION VIEW MERCHANTS VIEW

  38. MRI #1 FINDINGS 8 wks Post Injury

  39. MRI #1 FINDINGS 8 wks Post Injury

  40. MRI #2 FINDINGS 5 Months Post Injury

  41. MRI #2 FINDINGS 5 Months Post Injury

  42. TREATMENT ALGORITHM • Age • Occupation • Lesion size • Surgical intervention with a medial unicompartmental knee arthroplasty

  43. SURGICAL INTERVENTION

  44. POST OP X-RAYS

  45. PATIENT OUTCOME Returned to sit down duty 9 days • post op 8 wks post op ROM 0-120 ◦ with • some soreness, underwent knee aspiration and steroid injection • Regular Duty: 4 mo post op • Full Duty MMI: 5 mo post op

  46. Thank You!!

  47. Thank you for joining us … For those of you who were logged in for the entire presentation, you will be receiving an email within approximately 48-72 hours with a surveymonkey link. This link is to the evaluation for this webinar. You will need to complete the survey. At the end of the survey, you will taken to a link to retrieve your CEU’s (if asked, be sure to say “yes” when it takes you to the trusted site or you will not receive your CEU’s). **Remember only those who participated for the entire duration of the webinar are eligible to receive their CEU’s.

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