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- forefoot: metatarsals and phalanges
- midfoot: navicular, cuneiform, cuboid
- hindfoot: talus and calcaneous
heel pain therapy
- stretching exercises for foot
- silicone heel pad (best), heel cup (2nd), felt arch support (3rd)
- aristospan (triamcinolone): 5 mg/ml or 20 mg/ml. Dilute with 1% xylocaine. intra-artic.
5-15 mg (3/4 ml), intra-lesion. .5-1.0 mg.
- dalalone (dexomethasone): "less tissue necrosis", 8 mg/dl or 16 mg/dl. Usual 1
- Celestone soluspan (betamethosone): 6 mg/ml. shoulder/knee @ 6-12 mg, bursae 6 mg,
ganglion 3 mg. Dilute with 2 ml .5% marcaine. (Typically 1.5 ml celestone and 1.5 ml .5%
- CBC, ESR, ASO, UA (protein), Parvovirus B19 antibody
- history of strep?
- usually viral, may last weeks
- anserine bursitis: night pain over upper medial tibia 1.5" below joint line with a
negative valgus stress maneuver. If pain is severe, consider stress fracture. Ice massage,
hamstring stretch, avoid inducing activities.
- <30 minutes of morning stiffness is typical
- bone demineralization is atypical, consider RA
- ESR < 20
ref: Mgt of
Shoulder Impingement Syndrome and Rotator Cuff Tears - 2/15/98 AFP
- in athlete main d/dx tendinitis vs. rotator cuff tear. "Night Pain" -->
rotator tear. Test by arm frwrd 30 deg., thumb down, pt unable to resist force down when
abducted 90 deg --> rot. tear. If pain can injct xylocaine in subacroml space and test
- "persistent bursitis: suspect rotator cuff tear. Do arthrogram.
- swimmer's shoulder: coraco-acromion bursitis and rotator cuff tendinitis.
- impingement sign: arm flexed to 90 deg. then internally rotated (humoral head hits lig).
- calcific tendinitis: ultrasound helps in short term. To detect calcium may need AP
shoulder in neutral position and internal/external rotation. Once calcium extravasates
have severe inflammatory response lasting @ 2 weeks.
- AC seperation: no good operation, little bad effect. Sling for comfort for 2 weeks.
Author: John G. Faughnan.
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