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Apophyseal Injury

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41. Acutely Limping Child Up To Age 5

of acute limping in children is a minor traumatic injury [8]. Unfortunately, particularly in younger children, it is common that the pain cannot be accurately localized to one focal area. When there is no concern for infection and pain cannot be localized through history or physical examination, an imaging strategy designed to first localize the source of the pain and subsequently better characterize the cause is typically pursued. Radiography Lower Extremities In children <4 years of age, it is common (...) case it is important to exclude an underlying fracture. Clinical examination and history may allow localization of the pain or injury to a specific area, which allows a more focused imaging evaluation [26]. Radiography Lower Extremity Targeted radiographs of the areas of concern have a role in evaluating for possible fracture [12,26-29]. Negative radiographs do not completely exclude the possibility of a nondisplaced fracture. Dunbar et al [30] first described ACR Appropriateness Criteria ® 6

2018 American College of Radiology

42. CRACKCast E176 – Pediatric Musculoskeletal Disorders

spondylolisthesis: Grade 1 with no neuro deficits = rest for 60-90 days. [31] List 4 common apophyseal injuries in children. The apophysis is a cartilaginous structure that serves as a site for insertion of tendons on the growing bone. It has its own growth plate, with a slower rate of growth than the nearby epiphyseal plate. Apophysitis is unique to patients with skeletal immaturity and involves inflammation of this actively growing bone prominence, which is under great tensile stress. Little leaguer’s elbow (...) ] The growth plate is the weakest part of the bone and is more likely to separate before the adjacent tendon or ligament tears, thereby making sprains uncommon. Of supracondylar fractures, 95% are of the extension type. Displaced fractures are at risk for neurovascular injury and compartment syndrome; the anterior interosseous branch of the median nerve (“A-OK sign”) and the brachial artery are most commonly involved. Developmental dysplasia of the hip affects 1% of children ; all children who are not yet

2018 CandiEM

43. CRACKCast E057 – Knee and Lower Leg

CRACKCast E057 – Knee and Lower Leg CRACKCast E057 – Knee and Lower Leg - CanadiEM CRACKCast E057 – Knee and Lower Leg In , by Adam Thomas January 9, 2017 This episode of CRACKCast covers Chapter 57 of Rosen’s Emergency Medicine, Knee and Lower Leg. Continuing on with the orthopaedic chapters and objectives, this episode reviews the relevant approaches to knee and lower leg injuries that are actionable in the emergency department setting. Shownotes – Also check out the EM Cases Rapid Review (...) videos on Occult Knee Injuries and Rosen’s in Perspective “Most complex joint in the body” Flexion, extension, rotation, gliding, rolling Joins the two longest levers in the body (tibia and femur) Main ER goals: Identify repairable vascular injuries Reducing dislocations Stabilizing fractures Giving antibiotics when needed Has two joints: Tibio-femoral Femur = two condyles These articulate with the tibia, cushioned with the medial and lateral menisci Four strong ligaments anchor the tibia

2017 CandiEM

44. Back Pain ? Child

and has been positively associated with clinical symptomatology [23,24]. Resolution of signal abnormalities suggests a response to therapy and potential prevention of progression to fracture [22,37]. It remains uncertain whether MRI or bone scan with SPECT is preferred in the evaluation of suspected spondylolysis [38]. Abnormalities on MRI such as apophyseal injuries, spondylolysis, and disc disease have been shown to be associated with back pain in the pediatric athlete [39]. MRI can evaluate (...) radiculopathy elicited by both spondylolytic and nonspondylolytic causes and may demonstrate additional etiologies, including apophyseal fractures, intraspinous ligamentous injury, discogenic injury, Scheuermann disease, and compartment syndromes [8,31,40]. If contrast is administered, precontrast images are needed to assess enhancement. MRI of the spine in the clinical setting of back pain should always be performed with fat-saturated imaging techniques. There is little use for performing an MRI

2016 American College of Radiology

45. The effect of repetitive flexion and extension fatigue loading on the young porcine lumbar spine, a feasibility study of MRI and histological analyses (PubMed)

causes concurrent MRI and histological changes in the growth zones and endplates, which could be a first sign of fatigue and an explanation for the disc, apophyseal and growth zone injuries seen among adolescent athletes.

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2017 Journal of experimental orthopaedics

47. Diagnosis and Treatment of Adult Isthmic Spondylolisthesis

vertebra relative to the next caudal segment as a result of an abnormality in the pars interarticularis. When symptomatic, this causes a variable clinical syndrome of back and/or lower extremity pain, and may include varying degrees of neurologic deficits at or below the level of the injury. Work Group Consensus Statement What is the likelihood that spondylolysis (unilateral and/or bilateral, identified in adolescence or adulthood) will progress to become a symptomatic spondylolisthesis (...) is the anterior translation of one lumbar vertebra relative to the next caudal segment as a result of an abnormality in the pars interarticularis. When symptomatic, this causes a variable clinical syndrome of back and/or lower extremity pain, and may include varying degrees of neurologic deficits at or below the level of the injury. Work Group Consensus Statement In the general adult population, the incidence of isthmic spondylolisthesis ranges between 3.7% and 8%. Definition for ADult i sthmic s pon

2014 North American Spine Society

48. Fascial Distortion Model Manual Therapy and Painful Shoulder Syndrome

will receive manual treatment complies with Mulligan Concept method. Other: Mulligan Concept Patients will receive manual treatment according to Mulligan Concept procedures: MWM- Mobilization With Movement- application can be defined as the application of a sustained passive force/glide. NAG - Natural Apophyseal Glide - application can be defined as the oscillatory mobilization techniques from the middle to the end of the range of motion. SNAG- Sustained Natural Apophyseal Glide- They are weight bearing (...) the functionality after the treatment of a shoulder injury. The test is divided into four subscales: pain (15 points), activities of daily living (20 points), strength (25 points) and range of motion: forward elevation, external rotation, abduction and internal rotation of the shoulder (40 points). The higher score, the higher the quality of the function. Change from baseline Quality Of Life Questionnaire SF- 36v2 at 3 months [ Time Frame: 1'st day, 3 months after treatment ] The SF-36 is a 36 item

2018 Clinical Trials

49. PDCN for Treatment of Cervical Vertigo

(SNAGs plus PJMs) Not Applicable Detailed Description: Vertigo ranks among the most common complaints in medicine and have a considerable personal impact, affecting 15-35% of the general population at some point in their lives. The combination of neck disorders with vertigo or dizziness was formally coined "cervical vertigo" by Ryan and Cope in 1955. The precise incidence of cervical vertigo is controversial but it is estimated that 20-58% of patients who sustain closed-head injuries or whiplash (...) consecutive pockets within the disc. Other Name: PDCN Active Comparator: Manual Therapy Participants who are allocated to this group will undergo manual therapy treatments containing two kinds: sustained natural apophyseal glides (SNAGs) plus passive joint mobilisations (PJMs) Procedure: Manual Therapy (SNAGs plus PJMs) (1) sustained natural apophyseal glides (SNAGs): Use the methods described in Mulligan BR. Manual therapy "NAGS", "SNAGS", "MWMS" etc. 5th ed. Wellington, New Zealand: Plane View Services

2018 Clinical Trials

50. 24 Month Follow-up of Patients With Osgood Schlatter (OSD)

Study Details Study Description Go to Brief Summary: Osgood Schlatter is a common knee condition, affecting approximately 10% of adolescents. OSD is thought to be a growth related pain conditon, and thus resolve after maturation. Despite this, there a lack of prospective data investigating whether this is in fact the case. Condition or disease Intervention/treatment Osgood-Schlatter Disease Apophysitis Other: Activity modification Detailed Description: This is a prospective cohort study of 51 (...) of pain killers [ Time Frame: 24months ] Participants will be asked if they use painkillers to manage their knee pain (y/n). If yes, they will be asked how often. knee injury and osteoarthritis outcomes score (KOOS) sport and activity subscale [ Time Frame: 24 months ] knee injury and osteoarthritis outcomes score (KOOS) subscale sport and activity. Minimum 0 points, maximum 100points, with 100 points being the best possible score. Sports participation [ Time Frame: 24 months ] Participants

2018 Clinical Trials

51. Popcast! Pelvic Avulsion Fractures

Popcast! Pelvic Avulsion Fractures Popcast! Pelvic Avulsion Fractures – PEMBlog Search for: Search for: Popcast! Pelvic Avulsion Fractures Pop goes the apophysis! In teenage athletes the apophyseal cartilage is the weak point along the pelvic rim. Learn about these common injuries in this edition of PEM Currents, the Pediatric Emergency Medicine podcast. Find more great educational content at Follow me on Twitter Listen Subscribe References By | 2018-10-18T14:20:01-04:00 October 19th, 2018

2018 PEM Blog

52. Achilles tendinopathy

. Repetitive strain and microtrauma to the Achilles tendon during activities such as running and jumping make it susceptible to injury and degeneration. Achilles tendinopathy is thought to occur when the normal tendon healing response fails, leading to disorganised proliferation of cells and vessels and degeneration of collagen. Complications of Achilles tendinopathy include tendon rupture, time off work, and decreased participation in sports. Typical symptoms and signs of Achilles tendinopathy include (...) of Achilles tendinopathy in primary care includes: Explanation that symptoms normally take 12 weeks to resolve. Identification and appropriate management of underlying causes and contributory factors, such as discontinuing fluroquinolone antibiotics. Advice on use of cold packs or ice after acute injury. Simple analgesia (such as paracetamol) for pain relief. Advice on an initial period of rest or relative rest (stopping high impact activities, such as running) until pain subsides. Exercise can

2016 NICE Clinical Knowledge Summaries

53. Fracture Fridays: Pop! Goes the apophysis (Re-post)

injuries are sustained acutely, and this particular one mimics a “pulled” hamstring. They may be related to overuse, and chronic stress. Because the muscles are stronger that the apophyseal anchor in pubertal patients, the bone gives way at the point of hamstring insertion as opposed to the ligament or muscle. Patients often feel a “pop” and the pain is immediate, and exacerbated by movement. These injuries occur mostly in the pelvis and lower extremities. The history is invariably similar regardless (...) . On exam he has full range of motion of his back, hips, knees and ankles. There is no neurological deficit and he has normal perfusion of the limb. He ambulates with a slight limp. There is minimal tenderness to palpation in the area of the ischial tuberosity. After a dose of ibuprofen you obtain the following X-Ray. The patient’s X-Ray that you ordered and are now interpreting The Diagnosis The X-Ray is diagnostic for an ischial apophysis avulsion injury. A what you ask? These types of avulsion

2017 PEM Blog

54. Fracture Fridays: The worst case of Osgood-Schlatter ever

This is clearly a painful injury. Patents will experience immediate and immense pain and have significant swelling/effusion from hemarthroses and surrounding fluid. It should be differentiated from patellar dislocation, knee dislocation and Osgood-Schlatter disease. Recall that patellar dislocations will generally find the patella displaced laterally with the knee held in a flexed position. A free floating patella with a straight leg position indicates that the patellar tendon has pulled away from (...) the inferior pole of the patella, or less often the apophysis. This case shows a much more significant avulsion, whereby a large portion of the tibia itself was avulsed away. A knee dislocation is an orthopedic emergency, and will see the tibia/fibula displaced posteriorly. This has a high risk of arterial compromise and reduction must be attended to emergently. Osgood-Schlatter is apophysitis of the tibial tubercle – where the patellar ligament inserts into the tibia. CT scans can help better define

2017 PEM Blog

55. [Acute tibial tubercle avulsion fractures].

[Acute tibial tubercle avulsion fractures]. The tear-off of the apophysis of the proximal tibia is a rare injury (< 1 % of all apophysal lesions). It mainly affects male adolescents (14,6 years). Main causes are concentric and eccentric stress during sport activity. Morbus Osgood-Schlater seems to be a predisposing factor.Up-to-date survey of pathogenesis, diagnostics and treatment strategies.Literature research (level III and IV studies) as well as own results.The affected patients are mostly (...) male (97 %), type III fractures are most frequently seen (48 %). Accompanying injuries are not to be missed (10 %). The treatment usually consists of surgery by means of an open reposition and internal refixation, recently also minimal invasi. The results are mainly very good to good, approximately 95 % reach their old level of activity again. Almost one third of the patients develop a mostly slight complication.The acute tear-off of the apophysis of the proximal tibia is an infrequent disease

2017 Der Orthopade

56. Maitland Mobilization Versus Mulligan Mobilization in Sub-Acute and Chronic Non-Specific Neck Pain

: experimental study Condition or disease Intervention/treatment Phase Nonspecific Neck Pain Other: mulligan mobilization Other: maitland mobilization Not Applicable Detailed Description: 44 patients with sub-acute or chronic neck pain will be randomized into Maitland group: 22 patients receive central postro anterior or unilateral postero anterior. Mulligan group: 22 patients receive sustain natural apophyseal glides. The treatment will be 2 times /week for three weeks. Measurement will be taken pre (...) information, Layout table for eligibility information Ages Eligible for Study: 20 Years to 50 Years (Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: • Patients aged between 20 to 50 years. Neck pain more than one week without radicular symptoms. Pain on posterior neck from superior nuchal line to first thoracic vertebra. Exclusion Criteria: • Patient contraindicate to mobilization (pregnancy, whiplash injury, tumor, fracture, metabolic diseases, rheumatoid

2017 Clinical Trials

57. Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent (PubMed)

. Apophyseal ring fracture is an uncommon cause of back pain with radiculopathy in adolescents and athletes. High degree of suspicion is necessary to differentiate these injuries from disc herniation so as to further guide appropriate conservative or surgical management. The common cause of back pain in this population is related to musculoskeletal injuries. Lumbar disc herniation contributes to negligible number of cases in this age group, as against that seen in the adult population. An important (...) Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent We present a case of a 15-year-old male with history of back pain and bilateral lower limb radiculopathy due to fall. The magnetic resonance imaging scan showed disc bulge at L2-L3 level causing compression on contained nerve roots. In this case, computed tomography scan was indispensable for diagnosis and classification of the vertebral apophyseal fracture and to guide appropriate further management

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2017 Radiology Case Reports

58. Lateral Lumbar Interbody Fusion—Outcomes and Complications (PubMed)

to other approaches including the preservation of the anterior and posterior annular/ligamentous structures, insertion of wide cages resting on the dense apophyseal ring bilaterally, and augmentation of disc height with indirect decompression of neural elements. Favorable long-term outcomes and a reduced risk of visceral/vascular injuries, incidental dural tears, and perioperative infections have been reported. However, approach-related complications such as motor and sensory deficits remain a concern

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2017 Current reviews in musculoskeletal medicine

59. An Update of Comprehensive Evidence-Based Guidelines for Interventional Techniques in Chronic Spinal Pain - Part 2 - Guidance and Recommendations

injections. IV. i mpLanTabLeS • The evidence is fair for spinal cord stimulation (SCS) in managing patients with failed back surgery syndrome (FBSS) and limited for implantable intrathecal drug administration systems. V. a nTiCoaguLaTion • Ther e is good evidence for risk of thromboembolic phenomenon in patients with antithrombotic therapy if discontinued, spontaneous epidural hematomas with or without traumatic injury in patients with or without anticoagulant therapy to discontinue or normalize INR (...) ) criteria (40) and detailed methodology of guideline development. The reviews were developed based on contemporary practices of systematic review development including guidance from the IOM (1,9-40). I. PREAMBLE 1.0 ChRonIC PAIn Chronic pain is defined as a complex and multifac- torial phenomenon with pain that persists 6 months after an injury and/or beyond the usual course of an acute disease or a reasonable time for a comparable injury to heal, that is associated with chronic pathologic processes

2013 American Society of Interventional Pain Physicians

60. Hip Avulsion Fracture

Athletes most often affected: Hurdler, Sprinter s occur at apophyses IV. Symptoms Sudden onset of Occurs with sudden burst of intensity (e.g. race end) V. Signs Limp may be present Provocative maneuvers Pain with passive and active muscle Tenderness to palpation Specific apophysis sites of tenderness Pain over anterior superior iliac spine Rapid sartorius contraction in jumping sports Sartorius tendon avulsion Pain over anterior inferior iliac spine Strong rectus femoris contraction in soccer Rectus (...) Contrast with calcified tendon in chronic injury VII. Management Conservative therapy for ASIS or AIIS avulsion Cold Therapy s Crutch walking as needed Return to sport when able to participate without pain Orthopedic evaluation for Ischial Tuberosity Fracture ORIF for large fragments: >1 to 2 cm VIII. References Images: Related links to external sites (from Bing) These images are a random sampling from a Bing search on the term "Hip Avulsion Fracture." Click on the image (or right click) to open

2018 FP Notebook

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