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Apophyseal Injury

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61. 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

62. 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

63. Two cases of combined patellar tendon avulsion from the tibia and patella Full Text available with Trip Pro

Two cases of combined patellar tendon avulsion from the tibia and patella Avulsion fractures of the inferior pole of the patella and proximal tibial apophysis are independently rare injuries. They occur in children due to the relative weakness of the apophyseal cartilage compared to the ligaments and tendons. The combination of these two fractures, is exceedingly rare, with only a few previously described cases in the literature. Due to the infrequent presentation of this injury, careful (...) examination and consideration of advanced imaging is important for diagnosis and preoperative planning. Here we present two cases of combined sleeve fractures of the inferior pole of the patella and tibial apophysis, with discussion of the pathophysiology, classification, identification and management of the injury.© The Authors, published by EDP Sciences, 2018.

2018 SICOT-J

64. 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

66. 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

67. 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

68. Neck Pain

supervised instruction in active mobility exercise. C Clinicians may provide C1-2 self-sustained natural apophyseal glide (self-SNAG) exercise. Subacute For patients with subacute neck pain with headache: B Clinicians should provide cervical manipulation and mobilization. C Clinicians may provide C1-2 self-SNAG exercise. Chronic For patients with chronic neck pain with headache: B Clinicians should provide cervical or cervicothoracic manipu- lation or mobilizations combined with shoulder girdle and neck (...) Scale RCT: randomized controlled trial ROM: range of motion SEM: standard error of measurement SF-36: Medical Outcomes Study 36-Item Short-Form Health Survey SIGN: Scottish Intercollegiate Guidelines Network SNAG: sustained natural apophyseal glide SR: systematic review TENS: transcutaneous electrical nerve stimulation VAS: visual analog scale WAD: whiplash-associated disorder Journal of Orthopaedic & Sports Physical Therapy® Downloaded from www.jospt.org at on July 7, 2017. For personal use only

2017 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

69. Traumatic lumbar vertebral ring apophysis fracture with disk herniation in an adolescent Full Text available with Trip Pro

. 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

2017 Radiology Case Reports

70. Lateral Lumbar Interbody Fusion—Outcomes and Complications Full Text available with Trip Pro

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

2017 Current reviews in musculoskeletal medicine

71. 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

72. Cervical Spine XRay

: Cervical Spine XRay , C-Spine XRay , Cervical Spine XRay in Acute Traumatic Injury II. Efficacy: Blunt Trauma Inadequate for most patients ( is preferred) Adequate visualization of the entire is achieved in <30% of plain film C-Spine XRays Misses up to 16% of c-spine s in seriously injured, obtunded blunt patients However, NEXUS found that adequate 3-view C-Spine XRays have >99% for significant III. Indications: Acute Trauma Decision rules for imaging in general See See See Cases in which plain C-Spine (...) XRay may be adequate in Non-severe mechanism of injury (see ) and Adequate 3-view plain film C-Spine XRays can be obtained and Other CT imaging is not planned IV. Imaging: Views -Primary film : 60-80% of cervical s Must be adequate prior to other views (including visualization of C7-T1) AP C-Spine view V. Imaging: Views- Other Flexion-Extension XRay (F/E Views) Contraindications to flexion extension views Suspected cervical Subluxation Not recommended in Most injuries if visible on plain xray

2018 FP Notebook

73. Osteoarthritis

sclerosis (bone density increased) Subchondral cysts Marginal osteophytes IV. Risk Factors Age over 50 years old Female gender Prior joint injury Job duties with frequent squatting or bending Osteoarthritis Repetitive-impact sports (e.g. soccer, football) V. Etiologies Primary Weight bearing joints Hands Hips, s, and feet Stressors (single most important factor) Overuse injuries Secondary Acute or Chronic History of knee meniscectomy Congenital abnormalities Rheumatic Conditions Calcium pyrophosphate (...) ) First carpometacarpal joint (thumb) Cervical and Mechanisms Apophyseal joint and Osteophytes Disc degeneration Secondary affects Local muscle spasm Nerve root impingement with radiculopathy Cervical stenosis ( ) VIII. Labs: General (if indicated) Routine labs are not indicated in typical Osteoarthritis Obtain for unclear diagnosis Abnormal results suggest alternative diagnosis normal normal negative normal IX. Labs: Synovial Fluid (if indicated) appearance Clear fluid High viscosity and good mucin

2018 FP Notebook

74. 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

75. 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

76. Achilles tendinopathy

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: Pain in the back of the leg or heel which (...) : 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 be restarted when pain allows. Referral to physiotherapy

2016 NICE Clinical Knowledge Summaries

77. Acute childhood limp

or spina bifida (usually diagnosed before the child is walking), or . Primary anatomical abnormality, such as limb length discrepancy. Inflammatory muscle or joint disease, such as . Fracture or soft tissue injury Fracture or soft tissue injury Trauma is the most common cause of limping in children [ ; ] . Children have growth plates that are more susceptible to injury than ligaments. An apparent sprain in a child should raise suspicion of an injury to the growth plate. 'Toddler's fracture' is a subtle (...) and has no known cause. Systemic symptoms of lethargy and anorexia may be present. Often children with JIA are otherwise well and blood tests and X-rays may be normal. Be aware that there is a high risk of uveitis in children with JIA and this may be asymptomatic initially. If undiagnosed and untreated, uveitis can lead to loss of vision. [ ] Sever's disease Sever's disease Sever's disease or apophysitis of the calcaneus produces heel pain as a result of inflammation of the calcaneal apophysis

2015 NICE Clinical Knowledge Summaries

78. Osgood-Schlatter disease

spurt before the tibial tuberosity has completed ossification. At this time, the development of quadriceps strength, particularly in adolescents participating in sports that involve running and jumping, may exceed the ability of the tibial tuberosity to resist these forces. Healing and growth of avulsed fragments produces minimal to marked firm enlargement of the tibial tubercle, depending on the severity and frequency of injury. Bony fragments, known as 'ossicles', may occur in people with more (...) with persistent hip pain, limp, and possible referred pain to the knee. Trauma Traumatic knee injury — this is likely when knee pain starts suddenly after knee trauma and is associated with abnormal physical signs. Possible injuries include meniscal injuries, collateral and cruciate ligament injuries, stress fractures of the patella, tibial tuberosity fracture, and prepatellar and infrapatellar bursitis. Other causes Osteochondritis dissecans — this is caused by avascular necrosis of subchondral bone

2015 NICE Clinical Knowledge Summaries

79. 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

80. 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

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