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

Welcome to Athletico’s Webinar Wednesday

888 Work4U

Work Comp Customer Service Department

• Prompt and efficient scheduling
• Enhanced communication
• Easy to locate the closest clinic
• ffering 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

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

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

Today’s Speaker:

• Dr. Lyndon B Gross

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

COMMON KNEE PROBLEMS

• Fractures
• Tendon injuries
• Ligament injuries
• Meniscal injuries
• Articular Cartilage injuries

ANATOMY OF THE KNEE

• Bones
• Tendons
• Ligaments
• Meniscus
• Articular Cartilage

ARTICULAR CARTILAGE

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

ETIOLOGY OF CARTILAGE INJURIES

• Sports trauma, work-related trauma or
• ther injury1,2
• Chronic instability3
• Pathologic malalignment3
• OCD1
• Meniscal deficiency3
• Obesity in the presence of moderate

malalignment4

• 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.

HOW DO YOU KNOW????

HISTORY

• Chief Complaint
• Onset of Symptoms
• Mechanism of Injury
• Location
• Instability
• Mechanical

Symptoms

• Age
• Prior Treatment
• Occupation
• Number of Years

Working

• Changes in Work

Environment

• Impact on Work

PHYSICAL EXAMINATION

• Inspection
• Range of Motion
• Special Testing
• Palpation
• Neurovascular Examination

RADIOGRAPHIC EVALUATION

• Plain X-rays
• MRI Scan
• Bone Scan

RADIOGRAPHIC EVALUATION

• Plain X-Rays

–Standing AP –45° Flexion weight-bearing PA –Lateral –Merchant

MAGNETIC RESONANCE IMAGING

• MRI

–Noninvasive –Sensitive –T1, T2, FSE, 3D SPGR, MRA

RADIOGRAPHIC EVALUATION

CASE #1

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

PHYSICAL EXAM

• Swelling
• Full ROM
• Pain with ROM
• Pain with flexion McMurray

testing lateral knee

• Tender to palpation

anterolateral knee

X-RAY STUDIES

WB AP VIEW LATERAL VIEW

X-RAY STUDIES

FLEXION VIEW MERCHANTS VIEW

MRI FINDINGS

MRI FINDINGS

TREATMENT ALGORITHM

• Age
• Occupation
• Defect size
• Surgical intervention with
• steoarticular transplantation

with allograft (cadaver tissue) to lateral femoral condyle

SURGICAL INTERVENTION

Arthroscopy

OSTEOARTICULAR TRANSFER

INITIAL POST OP TREATMENT

• Non weight

bearing 6 weeks

• Hinge brace
• CPM machine for 4

weeks

• PT for ROM,

strength, modalities

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

CASE #2

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.

• 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

HISTORY

SECOND OPINION

• Pain with weight bearing
• Using crutches
• Swelling
• Medial pain

PHYSICAL EXAM

• Effusion
• ROM 0-90◦
• Medial sided pain with ROM
• Tender to palpation medially

X-RAY STUDIES

WB AP VIEW LATERAL VIEW

X-RAY STUDIES

PA FLEXION VIEW MERCHANTS VIEW

MRI #1 FINDINGS

8 wks Post Injury

MRI #1 FINDINGS

8 wks Post Injury

MRI #2 FINDINGS

5 Months Post Injury

MRI #2 FINDINGS

5 Months Post Injury

TREATMENT ALGORITHM

• Age
• Occupation
• Lesion size
• Surgical intervention with a

medial unicompartmental knee arthroplasty

SURGICAL INTERVENTION

POST OP X-RAYS

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

Thank You!!

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.