Orthopedic Injuries- A Legal Perspective

1. Orthopedic Injuries-A Legal Perspective Mississippi – Alabama – Tennessee – North Carolina Diane Pradat Pumphrey dpumphrey@wilkinstipton.com

2. Common Orthopedic Complaints

3. The Spine • The spine consists of 26 vertebrae or separate bones that are joined to permit the column to move forward, backward and side to side. The spine is typically S shaped to increase stability and strength. • From the top, the spine consists of 7 cervical vertebrae, 12 thoracic vertebrae and 5 lumbar vertebrae. • There are 5 smaller vertebrae that fuse to form the sacrum and 4 that fuse to form the coccyx. • The vertebrae all have the same basic structure which includes an anterior body, central vertebral foramen and a posterior vertebral arch.

4. The Anatomy of the Spine

5. Common Spinal Problems • Back pain – either acute or chronic • Acute pain due to injuries to muscles or soft tissue. • Chronic pain generally dull, aching and deep that lasts longer than three months. This can be due to specific anatomic abnormalities. • Symptoms that require immediate attention are when there is bowel or bladder dysfunction, fever, weakness or numbness or pain that limits or prohibits everyday activities.

6. The Back Injury

8. Normal Anatomy

9. Cross-section of Spine

11. Herniated Disc

14. Treatment • For strain – which is a stretch injury to the ligaments, tendons, and/or muscles of the low back – rest, medication, heat, massage and reconditioning exercises. • For lumbar radiculopathy – nerve irritation that is caused by damage to the discs between the vertebrae – medical management to surgery. • When there is unrelenting pain, severe impairment of function or incontinence, surgery may be necessary.

15. Surgical Procedures • Laminotomy – removal of the herniated disc through a small hole in the bone of the lumbar spine surrounding the spinal cord. • Laminectomy – removal of the herniated disc after removal of the bony wall. • Percutaneous discectomy – removal of herniated disc with needle technique.

16. Neck Injury

18. Cervical Spine Anatomy

19. Cervical Spine X-ray

21. Neck Pain • Neck pain that radiates down the arm is frequently caused by a disc herniation or foraminalstenosis which is a narrowing of the neural passageways. • Neck pain related to certain activities is commonly caused by foraminalstenosis. • Arm pain with a lack of coordination is commonly caused by cervical stenosis with myelopathy. • Myelopathy is caused by narrowing of the spinal canal with spinal cord dysfunction. • Neck pain that is not intense and lasts for a few months with occasional flare ups may be caused by disc degeneration. • Neck pain that is more pronounced in the morning or evening is commonly caused by facet joint osteoarthritis.

22. MRI Herniated Cervical Disc

23. Fall Injuries

26. Anatomy of Elbow

27. Elbow Anatomy • The elbow is made up of three bones. They are the humerus, radius and ulna. The elbow bends and straightens like a hinge. It allows the rotation of the forearm. • The elbow is held together by ligaments, muscles and tendons and by the shape of the bones. • The most common fracture that occurs is to the olecranon. • The goal of rehabilitation in any elbow fracture is to regain full range of motion of the elbow. Most patients return to normal within about 4 months, but full healing can take more than a year.

28. Elbow X-ray

29. Fractured Elbow

30. Fall with Knee Injury

31. Knee Anatomy and Function • The knee is the largest joint in the body. It is made of the lower end of the thigh bone or the femur, which rotates on the upper end of the shinbone or tibia and the knee cap or patella. The knee cap slides in a groove on the end of the femur. The knee has three large ligaments that help control the motion of the connecting bones and help brace the joint. • The other important part of the knee is the meniscus which is a wedge of cartilage between the femur and the tibia which cushions the knee and helps absorb shock during movement.

32. Knee Anatomy

33. Anatomy of Knee

34. Common Knee Injuries • ACL injury – caused by changing direction rapidly, slowing down when running and landing from a jump may cause tears in the ACL. • MCL injury – usually caused by a direct blow to the outside of the knee. • PCL injury – often caused by a blow to the front of the knee or by making a misstep. • Torn Cartilage – generally a torn meniscus which is attached to the knee’s ligaments. The meniscus can be torn with twisting, cutting, pivoting, decelerating or with direct contact.

35. ACL Tear

36. Meniscus Tear

37. PCL Tear

38. Symptoms Knee Tear Injuries • Pain • Stiffness • Catching or locking • Sensation of knee “giving way” • Limited range of motion

39. Knee X-ray

40. Arthroscopy

42. Questions