Few techniques of Relocation of Anterior Shoulder Dislocation

a. Kocher Method- Traction, External Rotation, Adduction, Internal Rotation

b. Hippocrates method

c. Stimpson's method- 4-6 kg weight suspended from wrist. In most cases, this gradual traction overcomes muscle spasm and reduction achieved in 20-25 minutes.

d. Milch Method- Does not usually require anesthesia or sedation. Patient supine, steady downward traction applied at elbow; combined with slow, gradual external rotation and abduction of limb

(image source: Netter's concise orthopedics Anatomy) 

e. Traction- Counter Traction Method

Tennis Elbow- Diagnosis and Management

Diagnosis

1. Tender lateral epicondyle

2. Pain with passive wrist flexion 

3. Pain with resisted wrist extension  

Management- Rest, Ice pack, NSAIDs

1. Activity Modification- Avoid activities that exacerbates symptoms

2. Counter Force Brace- Placed on forearm 6-10 cm distal to elbow joint

3. Physical Therapy 

a. Wringing Exercise- Roll up the hand towel. With arms extended, grasp towel with the wrist of    affected side placed in slight flexion. Exert maximum wring pressure- first fully flexing wrist for 10 seconds, then fully extending the wrist for 10 seconds. Alternate flexion extension between hands. 

Perform twice a day, 10 seconds in each direction, increasing 5 secs each week till 60 seconds.

 b.  Weights Exercise- Using handheld weights or dumbells, muscles are strengthened. Start with 0.5 kg, increase gradually to 5 kg depending upon the patient. Flexion extension repeated 10 times, done twice with 1 minute rest in between

         
c. Glucocorticoid injection- Effective but high rate of recurrence. Maximum 2 times is recommended.

If not getting better or getting worse, orthopedics referral.          

Plantar Fascitis

The most common cause of heel pain is plantar fascitis. Its common symptom is pain when a person takes initial steps after a period of inactivity or after prolonged weight bearing. It is also precipited by increase in recent weight bearing activity. The pain can be reproduced when pressing/provocating the proximal insertion of the plantar fascia. There is positive windlass test ( specificity of almost 100%). The tarsal tunnel test as well as other tests of peripheral nerve entrapment should be negative to establish the diagnosis. 

Once you have established that your patient has plantar fascitis, you should first tell him to avoid flat shoes and barefoot walking. You should also advise them on performing various stretching exercises for plantar fascia and calf muscles which can be done at home. Also one needs to avoid whatever activities like excessive running, dancing or jumping that causes the pain. Soft silicone heel shoe inserts will be of great help. 

Regarding the pharmacological therapies, NSAIDS for 2-3 weeks is beneficial. Similarly, injecting the tender areas of the plantar region with glucocorticoids and local anesthetic ( 1ml each) has proved to be beneficial for the patients.

Some home exercises for Plantar Fascitis

 Figure B shows feeling for the tension on the plantar fascia. This stretch to be done till the count of 10, repeated 10 times, 2 to 3 times a day.

 Pull the top part of your foot with a towel. Maintain the stretch for 10-30 seconds, 5 times each session, twice a day.

Point and flex the foot. Make circles rotating your ankle