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What is a quadriceps tendon tear?

Tendons are strong cords of fibrous tissue that attach muscles to bones. The quadriceps tendon works with the muscles in the front of your thigh to straighten your leg.

Quadriceps tendon tears can be either partial or complete. Small tears of the tendon can make it difficult to walk and participate in other daily activities. A large tear of the quadriceps tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function.

Causes and risk factors

Quadriceps tendon tears are not common. They most often occur among middle-aged people who play running or jumping sports. A quadriceps tear often occurs when there is a heavy load on the leg with the foot planted and the knee partially bent. Think of an awkward landing from a jump while playing basketball. The force of the landing is too much for the tendon and it tears. Tears can also be caused by falls, direct force to the front of the knee, and lacerations (cuts).

Symptoms

When a quadriceps tendon tears, there is often a tearing or popping sensation. Pain and swelling typically follow, and you may not be able to straighten your knee. Additional symptoms include:

  • An indentation at the top of your kneecap where the tendon tore
  • Bruising
  • Tenderness
  • Cramping
  • Your kneecap may sag or droop because the tendon is torn
  • Difficulty walking due to the knee buckling or giving way

Diagnosis and treatment

Your doctor will consider several things when planning your treatment, including:

  • The type and size of your tear
  • Your activity level
  • Your age

Most small, partial tears respond well to nonsurgical treatment including immobilization and physical therapy.

Most people with complete tears will require surgery to repair the torn tendon. Surgical repair reattaches the torn tendon to the top of the kneecap. People who require surgery do better if the repair is performed soon after the injury. Early repair may prevent the tendon from scarring and tightening into a shortened position.

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What's a patellar tendon tear?

Tendons are strong cords of fibrous tissue that attach muscles to bones. The patellar tendon works with the muscles in the front of your thigh to straighten your leg.

Small tears of the tendon can make it difficult to walk and participate in other daily activities. A large tear of the patellar tendon is a disabling injury. It usually requires surgery and physical therapy to regain full knee function.

Causes and risk factors

A very strong force is required to tear the patellar tendon.

Falls – Direct impact to the front of the knee from a fall or other blow is a common cause of tears.

Cuts – often associated with this type of injury.

Jumping – The patellar tendon usually tears when the knee is bent and the foot planted, like when landing from a jump or jumping up.

A weakened patellar tendon is more likely to tear. Several things can lead to tendon weakness such as patellar tendinitis, chronic disease, and steroid use.

Patellar tendon tear symptoms

When a patellar tendon tears there is often a tearing or popping sensation. Pain and swelling typically follow, and you may not be able to straighten your knee. Additional symptoms include:

  • An indentation at the bottom of your kneecap where the patellar tendon tore
  • Bruising
  • Tenderness
  • Cramping
  • Your kneecap may move up into the thigh because it is no longer anchored to your shinbone
  • Difficulty walking due to the knee buckling or giving way

Patellar tendon tear diagnosis and treatment

Your doctor will consider several things when planning your treatment, including:

  • The type and size of your tear
  • Your activity level
  • Your age

Very small, partial tears respond well to nonsurgical treatment including immobilization and physical therapy. Most people require surgery to regain knee function. Surgical repair reattaches the torn tendon to the kneecap. People who require surgery do better if the repair is performed soon after the injury. Early repair may prevent the tendon from scarring and tightening into a shortened position.

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What is a medial collateral ligament (MCL) injury?

Your knee ligaments connect your thighbone to your lower leg bones. The medial collateral ligament (MCL) and lateral collateral ligament (LCL) are found on the sides of your knee. Three bones meet to form your knee joint: your thighbone (femur), shinbone (tibia), and kneecap (patella). Your kneecap sits in front of the joint to provide some protection. Because the knee joint relies just on these ligaments and surrounding muscles for stability, it is easily injured. Any direct contact to the knee or hard muscle contraction — such as changing direction rapidly while running — can injure a knee ligament.

Causes and risk factors

Knee ligament sprains or tears are a common sports injury.  Athletes who participate in direct contact sports like football or soccer are more likely to injure their collateral ligaments. The MCL is injured more often than the LCL. Due to the more complex anatomy of the outside of the knee, if you injure your LCL, you usually injure other structures in the joint, as well.

Symptoms

  • Pain at the sides of your knee. If there is an MCL injury, the pain is on the inside of the knee; an LCL injury may cause pain on the outside of the knee.
  • Swelling over the site of the injury.
  • Instability — the feeling that your knee is giving way.

Diagnosis and treatment

Injuries to the MCL rarely require surgery. If you have injured just your LCL, treatment is similar to an MCL sprain. But if your LCL injury involves other structures in your knee, your treatment will address those, as well.

Ice. Icing your injury is important in the healing process. The proper way to ice an injury is to use crushed ice directly to the injured area for 15 to 20 minutes at a time, with at least 1 hour between icing sessions. Chemical cold products (“blue” ice) should not be placed directly on the skin and are not as effective.

Bracing. Your knee must be protected from the same sideways force that caused the injury. You may need to change your daily activities to avoid risky movements. Your doctor may recommend a brace to protect the injured ligament from stress. To further protect your knee, you may be given crutches to keep you from putting weight on your leg.

Physical therapy. Your doctor may suggest strengthening exercises. Specific exercises will restore function to your knee and strengthen the leg muscles that support it.

If the collateral ligament is torn in such a way that it cannot heal or is associated with other ligament injuries, your doctor may suggest surgery to repair it.

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What is De Quervain’s tenosynovitis?

De Quervain’s tenosynovitis (dih-kwer-VAINS ten-oh-sine-oh-VIE-tis) is a painful condition affecting the tendons on the thumb side of your wrist. If you have de Quervain’s tenosynovitis, it will probably hurt when you turn your wrist, grasp anything or make a fist.

Causes and risk factors

Chronic overuse of your wrist is commonly associated with this condition. Tendons are rope-like structures that attach muscle to bone. When you grip, grasp, clench, pinch or wring anything in your hand, two tendons in your wrist and lower thumb normally glide smoothly through the small tunnel that connects them to the base of the thumb. Repeating a particular motion day after day may irritate the sheath around the two tendons, causing thickening and swelling that restricts their movement.

  • If you’re between the ages of 30 and 50, you have a higher risk of developing de Quervain’s tenosynovitis than do other age groups, including children.
  • The condition is more common in women.
  • The condition may be associated with pregnancy.
  • Lifting your child repeatedly involves using your thumbs as leverage and may also be associated with the condition.
  • Jobs or hobbies that involve repetitive hand and wrist motions may contribute.

Symptoms

  • Pain near the base of your thumb
  • Swelling near the base of your thumb
  • Difficulty moving your thumb and wrist when you’re doing something that involves grasping or pinching
  • A “sticking” or “stop-and-go” sensation in your thumb when moving it

Treatment

Treatment for De Quervain’s tenosynovitis is aimed at reducing inflammation, preserving movement in the thumb and preventing recurrence. If you start treatment early, your symptoms should improve within four to six weeks. If your De Quervain’s tenosynovitis starts during pregnancy, symptoms are likely to end around the end of either pregnancy or breast-feeding. If your case is more serious, your doctor may recommend outpatient surgery.

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Grand Rounds - Feb. 18, 2022
"Multiple Myeloma"

Speaker: Kanwarpal S. Kahlon, MD. Division of Hematology-Oncology, UCLA.

 

 

Objectives

  1. Demonstrate an awareness of the epidemiology, clinical presentation, laboratory, and diagnostic evaluation.
  2. Differentiate multiple myeloma from other paraprotein disorders and plasma cell dyscrasias: monoclonal gammopathy of undetermined significance (MGUS), smoldering multiple myeloma (SMM), Waldenstrom Macroglobulinemia (WM), plasmacytoma, primary amyloidosis, and POEMS Syndrome.
  3. Acquire an awareness of risk stratification, staging, prognosis and therapeutic options for Multiple Myeloma.
  4. Recognize and manage medical complications.
  5. Describe age, gender, racial, ethnic and socioeconomic factors in the incidence, manifestation, and management of Multiple Myeloma.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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As part of its ongoing effort to ensure all people feel welcome at its facilities, St. Charles Health System has named Dr. Shilo Tippett as its first manager of caregiver inclusion and experience.

Tippett will oversee the organization’s work to establish and grow a culture of inclusion, diversity, equity and acceptance (IDEA) for St. Charles patients and employees – work that is central to the health system’s vision of creating America’s healthiest community, together, said Jody Saffert, director of People and Organizational Development for St. Charles.

“We already had a grassroots effort of caring, compassionate and committed caregivers who wanted St. Charles to be a more inviting and inclusive place to work and receive care,” he said. “Securing resources and action behind this commitment is what advocates of this work want and need to see. It can’t just be words on paper – action is needed.”

Tippett is a Central Oregon native, a resident of Madras and a member of the Confederated Tribes of Warm Springs. Before taking her new job, she spent seven years practicing as a clinical psychologist at St. Charles’ Madras Family Care Clinic, where she had daily interactions with the people in her community. But when she saw that the health system was hiring an IDEA manager, she knew it was her opportunity to make a broader impact on St. Charles and the region it serves.

“There’s a lot of research showing that bringing in more people with different backgrounds and experiences brings more creative ideas and satisfaction to a workplace,” Tippett said. “And the more diversity we have among our caregivers, the stronger we’ll be and the better care we’ll provide for our patients.”

Bringing more diverse workers to a predominantly white area will be a challenge, but Tippett believes St. Charles’ status as Central Oregon’s largest employer means the organization has an opportunity to make an outsized impact on the community by leading the way.

“If we start to set the tone for what diversity and inclusion looks like in our communities, we are definitely going to make a difference,” she said. “It's not going to happen overnight, of course. It’s going to take a sustained effort. But when I think about how much St. Charles can accomplish on this front and how we can affect Central Oregon, I’m excited about it.”

Tippett will work closely with the health system’s IDEA Council, a group of caregivers that formed five years ago to focus on IDEA-related initiatives at St. Charles. The caregivers are passionate about the work, but they all fit it in around their other personal and professional duties, said Carlos Salcedo, co-chair of the council. That means people come and go as they are able, which has affected the group’s ability to keep projects moving forward.

With Tippett on board and dedicated to the cause, Salcedo expects the IDEA Council to gain and maintain momentum on projects such as improving the health system’s interpretation and translation services. At the same time, he cautioned against expecting one person to shoulder all of the work.

“We’ve identified her as a person to lead this effort, but that doesn’t mean it’s completely on her to do it. That’s not representative of an organization that’s equitable,” he said. “It’s on all of us to show up and do the work.”

Tippett is intent on gaining traction, however. One of her primary goals in her new role is to increase what she calls the health system’s “belonging score,” which measures how much caregivers feel like they are welcome at St. Charles, that they are heard by leadership and that their ideas are valued. Toward that end, she and her team are developing programs to educate managers and physicians on inclusivity, incorporating IDEA concepts into the health system’s orientation for new caregivers and annual education requirements for all caregivers, and investing in IDEA training for key roles within the organization.

“We’re doing more than just talking about this stuff,” Tippett said. “We’re taking action.”

Saffert said he’s excited not only that St. Charles has someone on board to lead IDEA work, but also about what Tippett brings to the position.

“Her clinical psychology background, her experience as a behavioral health provider, her lived experience within Central Oregon and her passion for inclusion and equity make her the ideal person for this role,” he said. “Also, her desire to learn and to be an inspirational activist makes her the perfect candidate to help with this ongoing, worthy journey of creating a welcoming and inviting place for all.”

That’s a journey supported by St. Charles’ top leadership, the Executive Care Team, including President and CEO Joe Sluka.

“More than a century ago, the women who founded St. Charles promised Central Oregon that this organization would care for all people, or it would care for none,” Sluka said. “I am proud of the work we are doing to be a health system that is inclusive, diverse, equitable and accepting, and I believe it’s our next step toward upholding that commitment to care for all.”

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Thanks to Valentine’s Day, the month of February is closely associated with hearts – more precisely, the well-known heart shape, usually in hues of pink or red.

But did you know February is also officially American Heart Month, according to the Centers for Disease Control? This time we’re talking about the actual heart – the muscular organ inside our chest that pumps blood throughout the body, carrying oxygen to our cells.

That’s important work, which is why the CDC sets aside February as a time for all people to focus on their cardiovascular health.

At St. Charles, we have a talented staff of cardiologists and caregivers at our Heart and Lung Center who provide cutting-edge and life-saving care every day to people with heart ailments. We are thankful for the incredible work they do.

I’d also like to use this opportunity to highlight the St. Charles Foundation’s Children’s Heart Fund, which offers a wide range of support services to families of children with congenital heart disease. Those services may include simple but vital help such as gas cards, food and lodging through the Ronald McDonald house, or it may mean complex assistance, such as providing the family with a case manager to help with care coordination and community services, or coordination of neurodevelopmental follow-up for at-risk children.

That’s a mouthful, so let me state it clearly: The Children’s Heart Fund helps families of kids with congenital heart disease when they need it most. By alleviating other stressors, it frees up parents to focus completely on their top priority: the health of their child.

The Children’s Heart Fund does tremendous work year-round, but February is when it makes its major fundraising push, and I believe it deserves your support. I would encourage you to watch the video below, then visit our Children’s Heart Fund fund web page to learn more about how you can help.

I wish you a very happy (and healthy) heart month.

Sincerely,
Joe

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Grand Rounds - Feb. 11, 2022
"Anxiety Disorders for the Primary Care Physician"

Speaker: Steven L. Schandler, PhD. Emeritus Professor of Psychology, Crean College of Health and Behavioral Sciences, Chapman University, Orange, CA; Laboratory and Service Chief (Retired, 32-years), VA Medical Centers, Long Beach, CA and North Hills, CA.

 

 

Objectives

  1. Identify the signs and symptoms of anxiety disorders.
  2. Evaluate psychological, biological, and sociological factors influencing anxiety behaviors.
  3. Employ appropriate treatment interventions.
  4. Refer to a specialist, when necessary.
  5. Apply strategies and techniques to help patients manage their anxiety.
  6. Assess the cultural considerations of patients with anxiety disorders.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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DAISY Award winners honored for extraordinary nursing

Four St. Charles Health System nurses have been honored with The DAISY Award for Extraordinary Nurses®, recognizing the outstanding, compassionate nursing care they provide patients and families every day:

  • Bend: Page Ogden, Lactation
  • Madras: Emily O'Hearn, Family Birthing Center
  • Prineville: Jennifer Lewis Welch, Float
  • Redmond: Jessica Aragon, Medical Services

Nominated by patients, families and colleagues, the award recipients were chosen by a committee at St. Charles.

The nurses—who represent all four St. Charles hospitals in Bend, Redmond, Madras and Prineville—were recognized with a ceremony on their respective units and presented with a certificate, a pin and a "healer's touch" sculpture by their hospital’s chief nursing officer. The DAISY honorees will also receive ongoing benefits, such as special rates for tuition and ANCC certification. 

The DAISY Foundation is a not-for-profit organization that was established in memory of J. Patrick Barnes by members of his family. Patrick died at the age of 33 in late 1999 from complications of Idiopathic Thrombocytopenic Purpura (ITP), a little known but not uncommon auto-immune disease. (DAISY is an acronym for Diseases Attacking the Immune System.) The care Patrick and his family received from nurses while he was ill inspired this unique means of thanking nurses for making a profound difference in the lives of their patients and patient families.

"When Patrick was critically ill, our family experienced first-hand the remarkable skill and care nurses provide patients every day and night,” said Bonnie Barnes, FAAN, president and co-founder of The DAISY Foundation. “Yet these unsung heroes are seldom recognized for the super-human, extraordinary, compassionate work they do. The kind of work the nurses at St. Charles are called on to do every day epitomizes the purpose of The DAISY Award.”

This is one initiative of The DAISY Foundation to express gratitude to the nursing profession. Additionally, DAISY offers J. Patrick Barnes Grants for Nursing Research and Evidence-Based Practice Projects, The DAISY Faculty Award to honor inspiring faculty members in schools and colleges of nursing and The DAISY in Training Award for nursing students. More information is available at http://DAISYfoundation.org.

About St. Charles Health System

St. Charles Health System, Inc., headquartered in Bend, Ore., owns and operates St. Charles Bend, Madras, Prineville and Redmond. It also owns family care clinics in Bend, La Pine, Madras, Prineville, Redmond and Sisters. St. Charles is a private, not-for-profit Oregon corporation and is the largest employer in Central Oregon with more than 4,500 caregivers. In addition, there are more than 350 active medical staff members and nearly 200 visiting medical staff members who partner with the health system to provide a wide range of care and service to our communities.

 

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Grand Rounds - Feb. 4, 2022
"CRISPR for Clinicians"

Speaker: Wayne Grody, MD PhD. Departments of Pathology & Laboratory Medicine, Pediatrics, and Human Genetics UCLA School of Medicine; Director, Molecular Diagnostic Laboratories and Clinical Genomics Center UCLA Medical Center.

 

 

Objectives

  1. Describe the function of CRISPR technology.
  2. Define how it works and how it is being used in the research lab.
  3. Describe one or two examples of clinical applications of CRISPR to the human disease for diagnosis or treatment.
  4. Identify some of the pitfalls of using this technology in the clinic.

Accreditation: St. Charles Health System is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. St. Charles Health System designates this live activity for a maximum of 1.0 AMA PRA Category 1 Credit(s)TM.

The period to claim credit for this activity expires one year after its original publication. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Claim Credit

Target Audience: Physicians, Nurses, Pharmacists, Allied Health Professionals

Accessibility/Program Questions: St. Charles Health System encourages persons with disabilities to participate in its programs and activities. If you anticipate needing any type of accommodation or have questions about the physical access provided, please contact Continuing Medical Education at [email protected].

Oher CME or Clerkship questions: also contact Continuing Medical Education at [email protected].

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