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202 results for

Apophyseal Injury

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121. Elbow Trauma, Pediatric

right elbow (B) and a previous view of the left elbow obtained when the patient was 10 years of age (C). These injuries resemble Salter-Harris type I, III, and II fractures, respectively, though the Salter-Harris classification is usually applied to injuries of the epiphyses rather than those of the apophyses. For those injuries that include a small portion of the metaphysis, care must be taken to distinguish medial epicondyle fracture (usually an extraarticular injury) from medial condyle fracture (...) radiographs in the setting of acute trauma may be challenging for many emergency department physicians, orthopedic surgeons, and radiologists. Diagnostic difficulties stem both from the complex developmental anatomy of the elbow and from significant differences between children and adults in the patterns of injury after elbow trauma. [ , , , ] Standard radiographic evaluation of the elbow includes imaging in the anteroposterior (AP) and lateral views. Other views may also be helpful, such as the internal

2014 eMedicine Radiology

122. Growth Plate (Physeal) Fractures (Diagnosis)

(Physeal) Fractures Updated: Jul 13, 2017 Author: Steven I Rabin, MD; Chief Editor: Jeffrey D Thomson, MD Share Email Print Feedback Close Sections Sections Growth Plate (Physeal) Fractures Overview Background Growth plate (physeal) fractures may be defined as disruptions in the cartilaginous physis of long bones that may or may not involve epiphyseal or metaphyseal bone. [ ] Injuries to the physes are more likely to occur in an active pediatric population than sprains or ligament injuries are, in part (...) be different in children as compared with adults; percutaneous Kirschner wire (K-wire) fixation may be stable enough, and prevention of iatrogenic injury to the physis is of significant importance. When growth deformity is possible, the treating provider must predict the degree of expected remodeling, and this requires an understanding of the specific fracture. Assessment of bone age using the Greulich-Pyle atlas and charts can give an estimate of remaining growth. Fractures in the metaphysis, closer

2014 eMedicine Surgery

123. Pelvic Fractures (Diagnosis)

or with apophyseal avulsion fractures of the iliac wing or ischial tuberosity resulting from an athletic injury. Low-energy pelvic fractures in the elderly frequently result from falls while ambulating, which are highlighted by stable fractures of the pelvic ring. Elderly patients also may present with insufficiency fractures, typically of the and anterior pelvic ring. [ ] High-energy pelvic fractures most commonly occur after motor vehicle crashes. Other mechanisms of high-energy pelvic fractures include (...) : George V Russell Jr, MD; Chief Editor: William L Jaffe, MD Share Email Print Feedback Close Sections Sections Pelvic Fractures Overview Background Unstable pelvic fractures typically occur as a result of high-energy injuries. Associated organ system injuries are observed commonly with pelvic fractures because of the energy imparted to the patient. Head, chest, and abdominal injuries frequently occur in association with pelvic fractures. Fractures of the extremities and also can occur in patients

2014 eMedicine Surgery

124. Medial Humeral Condyle Fracture (Diagnosis)

of injury for medial epicondyle fractures [ , ] have been proposed for an acute injury. All of them result in a partial or complete separation of the apophyseal fragment from the rest of the humerus. The first mechanism of injury is a direct blow on the posterior medial aspect of the epicondyle that may be associated with fragmentation of the avulsed bone. The second mechanism is a pure avulsion injury produced by the flexor muscles of the forearm (see the image below). This avulsion may occur (...) fractures appear to do worse if the epicondyle is excised than if they are treated nonsurgically. Previous References Rockwood CA, Wilkins KE, Beaty JH. Apophyseal injuries of the distal humerus. Fractures in Children . 3rd ed. Philadelphia: Lippincott-Raven; 1996. 800-19. Behrman MJ, Shelton ML. Fracture of the medial condyle of the humerus in an elderly patient. J Orthop Trauma . 1990. 4(1):98-101. . Bensahel H, Csukonyi Z, Badelon O. Fractures of the medial condyle of the humerus in children. J

2014 eMedicine Surgery

125. Atlantoaxial Instability (Diagnosis)

rotatory subluxation are shown in the image below. Shown are 4 types of atlantoaxial rotatory subluxation. Because the cervical spine has multiple synovial-lined articulations, RA can manifest itself in the upper cervical spine. [ , ] In a person with AAI, the rheumatoid process affects the articular cartilage of the apophyseal joints, even the type II articular cartilage in the transverse ligament. [ ] In addition, the rheumatoid pannus and the associated inflammation can weaken the transverse (...) for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery . 2013 Aug. 60 Suppl 1:82-91. . Haid RW Jr. C1-C2 transarticular screw fixation: technical aspects. Neurosurgery . 2001 Jul. 49(1):71-4. . Naseer R, Bailey SI. Atlantoaxial instability treated with transarticular screw fixation. Int Orthop . 2001. 25(4):268-71. . Henriques T, Cunningham BW, Olerud C, Shimamoto N, Lee GA, Larsson S, et al. Biomechanical comparison of five different atlantoaxial posterior fixation

2014 eMedicine Surgery

126. Osteoarthritis (Diagnosis)

in previously intact joints and having no apparent initiating factor. Some clinicians limit the term primary osteoarthritis to the joints of the hands (specifically, the DIP and PIP joints and the joints at the base of the thumb). Others include the knees, hips, and spine (apophyseal articulations) as well. As underlying causes of osteoarthritis are discovered, the term primary, or idiopathic, osteoarthritis may become obsolete. For instance, many investigators believe that most cases of primary (...) , obesity may be an inflammatory risk factor for osteoarthritis. Obesity is associated with increased levels (both systemic and intra-articular) of adipokines (cytokines derived from adipose tissue), which may promote chronic, low-grade inflammation in joints. [ ] Other causes Trauma or surgery (including surgical repair of traumatic injury) involving the articular cartilage, ligaments, or menisci can lead to abnormal biomechanics in the joints and accelerate osteoarthritis. In individuals who have

2014 eMedicine Surgery

127. Osgood-Schlatter Disease (Diagnosis)

traction (traction apophysitis) on the anterior portion of the developing ossification center leads to multiple subacute microavulsion fractures and/or tendinous inflammation, resulting in a benign, self-limited disturbance manifested as pain, swelling, and tenderness. The most common long-term ramifications of OSD are pain on kneeling as an adult and the cosmesis of a bony prominence on the anterior knee. Less common complications are the persistence of a painful ossicle requiring surgical excision (...) persist for 2-3 years until the tibial growth plate closes. Previous Next: Patient Education Inform patients about activities that aggravate Osgood-Schlatter disease and about the self-limiting nature of the condition. For patient education information, see the , the , and the , as well as . Previous References Pommering TL, Kluchurosky L. Overuse injuries in adolescents. Adolesc Med State Art Rev . 2007 May. 18(1):95-120, ix. . Smith JM, Varacallo M. Osgood Schlatter Disease. StatPearls [Internet

2014 eMedicine Surgery

128. Pelvic Fractures (Overview)

or with apophyseal avulsion fractures of the iliac wing or ischial tuberosity resulting from an athletic injury. Low-energy pelvic fractures in the elderly frequently result from falls while ambulating, which are highlighted by stable fractures of the pelvic ring. Elderly patients also may present with insufficiency fractures, typically of the and anterior pelvic ring. [ ] High-energy pelvic fractures most commonly occur after motor vehicle crashes. Other mechanisms of high-energy pelvic fractures include (...) : George V Russell Jr, MD; Chief Editor: William L Jaffe, MD Share Email Print Feedback Close Sections Sections Pelvic Fractures Overview Background Unstable pelvic fractures typically occur as a result of high-energy injuries. Associated organ system injuries are observed commonly with pelvic fractures because of the energy imparted to the patient. Head, chest, and abdominal injuries frequently occur in association with pelvic fractures. Fractures of the extremities and also can occur in patients

2014 eMedicine Surgery

129. Osteoarthritis (Overview)

in previously intact joints and having no apparent initiating factor. Some clinicians limit the term primary osteoarthritis to the joints of the hands (specifically, the DIP and PIP joints and the joints at the base of the thumb). Others include the knees, hips, and spine (apophyseal articulations) as well. As underlying causes of osteoarthritis are discovered, the term primary, or idiopathic, osteoarthritis may become obsolete. For instance, many investigators believe that most cases of primary (...) , obesity may be an inflammatory risk factor for osteoarthritis. Obesity is associated with increased levels (both systemic and intra-articular) of adipokines (cytokines derived from adipose tissue), which may promote chronic, low-grade inflammation in joints. [ ] Other causes Trauma or surgery (including surgical repair of traumatic injury) involving the articular cartilage, ligaments, or menisci can lead to abnormal biomechanics in the joints and accelerate osteoarthritis. In individuals who have

2014 eMedicine Surgery

130. Osgood-Schlatter Disease (Overview)

traction (traction apophysitis) on the anterior portion of the developing ossification center leads to multiple subacute microavulsion fractures and/or tendinous inflammation, resulting in a benign, self-limited disturbance manifested as pain, swelling, and tenderness. The most common long-term ramifications of OSD are pain on kneeling as an adult and the cosmesis of a bony prominence on the anterior knee. Less common complications are the persistence of a painful ossicle requiring surgical excision (...) persist for 2-3 years until the tibial growth plate closes. Previous Next: Patient Education Inform patients about activities that aggravate Osgood-Schlatter disease and about the self-limiting nature of the condition. For patient education information, see the , the , and the , as well as . Previous References Pommering TL, Kluchurosky L. Overuse injuries in adolescents. Adolesc Med State Art Rev . 2007 May. 18(1):95-120, ix. . Smith JM, Varacallo M. Osgood Schlatter Disease. StatPearls [Internet

2014 eMedicine Surgery

131. Atlantoaxial Instability (Overview)

rotatory subluxation are shown in the image below. Shown are 4 types of atlantoaxial rotatory subluxation. Because the cervical spine has multiple synovial-lined articulations, RA can manifest itself in the upper cervical spine. [ , ] In a person with AAI, the rheumatoid process affects the articular cartilage of the apophyseal joints, even the type II articular cartilage in the transverse ligament. [ ] In addition, the rheumatoid pannus and the associated inflammation can weaken the transverse (...) for the management of acute cervical spine and spinal cord injuries: 2013 update. Neurosurgery . 2013 Aug. 60 Suppl 1:82-91. . Haid RW Jr. C1-C2 transarticular screw fixation: technical aspects. Neurosurgery . 2001 Jul. 49(1):71-4. . Naseer R, Bailey SI. Atlantoaxial instability treated with transarticular screw fixation. Int Orthop . 2001. 25(4):268-71. . Henriques T, Cunningham BW, Olerud C, Shimamoto N, Lee GA, Larsson S, et al. Biomechanical comparison of five different atlantoaxial posterior fixation

2014 eMedicine Surgery

132. Ankylosing Spondylitis (Overview)

) and transforming growth factor-β (TGF-β), are also important in the inflammatory process by leading to fibrosis and ossification at sites of enthesitis. [ , , ] The initial presentation of AS generally relates to the SI joints; involvement of the SI joints is required to establish the diagnosis. SI joint involvement is followed by involvement of the discovertebral, apophyseal, costovertebral, and costotransverse joints and the paravertebral ligaments. Early lesions include subchondral granulation tissue (...) spondylitis. J Rheumatol . 1999 Apr. 26(4):971-4. . Anwar F, Al-Khayer A, Joseph G, Fraser MH, Jigajinni MV, Allan DB. Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J . 2011 Mar. 20(3):403-7. . . Baraliakos X, Hermann KG, Landewé R, Listing J, Golder W, Brandt J, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau

2014 eMedicine Surgery

133. Growth Plate (Physeal) Fractures (Overview)

(Physeal) Fractures Updated: Jul 13, 2017 Author: Steven I Rabin, MD; Chief Editor: Jeffrey D Thomson, MD Share Email Print Feedback Close Sections Sections Growth Plate (Physeal) Fractures Overview Background Growth plate (physeal) fractures may be defined as disruptions in the cartilaginous physis of long bones that may or may not involve epiphyseal or metaphyseal bone. [ ] Injuries to the physes are more likely to occur in an active pediatric population than sprains or ligament injuries are, in part (...) be different in children as compared with adults; percutaneous Kirschner wire (K-wire) fixation may be stable enough, and prevention of iatrogenic injury to the physis is of significant importance. When growth deformity is possible, the treating provider must predict the degree of expected remodeling, and this requires an understanding of the specific fracture. Assessment of bone age using the Greulich-Pyle atlas and charts can give an estimate of remaining growth. Fractures in the metaphysis, closer

2014 eMedicine Surgery

134. Ankylosing Spondylitis

of a solid midline, vertical, dense line on frontal radiographs (see the image below). Interspinous ossification. Frontal radiograph shows T12-L2 lateral syndesmophytes and interspinous ligament ossification extending from the T12 to L1 and L2 to L4 levels. The apophyseal and costovertebral joints frequently are affected by erosions and eventually undergo fusion (see the image below). Vertebral fusion. Lateral radiograph shows solid ankylosis of all cervical facet joints from C2 downwards. Extensive (...) anterior and posterior syndesmophytes are noted. Complete fusion of the vertebral bodies by syndesmophytes and other related ossified areas produces bamboo spine (see the image below). Bamboo spine. Frontal radiograph shows complete fusion of the vertebral bodies. Extensive facet joint ankylosis and posterior ligamentous ossification produce the trolley track appearance. Calcifications of the disk may occur at single or multiple levels; they are usually associated with apophyseal joint ankylosis

2014 eMedicine Radiology

135. Sever Disease (Diagnosis)

Sever Disease (Diagnosis) Calcaneal Apophysitis (Sever Disease): Background, Pathophysiology, Etiology Edition: No Results No Results Please confirm that you would like to log out of Medscape. If you log out, you will be required to enter your username and password the next time you visit. https://profreg.medscape.com/px/getpracticeprofile.do?method=getProfessionalProfile&urlCache=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTIzNzQ3Ny1vdmVydmlldw== processing > Calcaneal Apophysitis (...) (Sever Disease) Updated: Jan 28, 2019 Author: Mark A Noffsinger, MD; Chief Editor: Vinod K Panchbhavi, MD, FACS Share Email Print Feedback Close Sections Sections Calcaneal Apophysitis (Sever Disease) Overview Background Sever disease, first described in 1912, [ , ] is a painful inflammation of the apophysis (calcaneal apophysitis). [ ] It is classified with the child and adolescent nonarticular osteochondroses. [ , , , ] (The other disease in this group is Iselin disease, which is inflammation

2014 eMedicine Surgery

136. Ankylosing Spondylitis (Diagnosis)

) and transforming growth factor-β (TGF-β), are also important in the inflammatory process by leading to fibrosis and ossification at sites of enthesitis. [ , , ] The initial presentation of AS generally relates to the SI joints; involvement of the SI joints is required to establish the diagnosis. SI joint involvement is followed by involvement of the discovertebral, apophyseal, costovertebral, and costotransverse joints and the paravertebral ligaments. Early lesions include subchondral granulation tissue (...) spondylitis. J Rheumatol . 1999 Apr. 26(4):971-4. . Anwar F, Al-Khayer A, Joseph G, Fraser MH, Jigajinni MV, Allan DB. Delayed presentation and diagnosis of cervical spine injuries in long-standing ankylosing spondylitis. Eur Spine J . 2011 Mar. 20(3):403-7. . . Baraliakos X, Hermann KG, Landewé R, Listing J, Golder W, Brandt J, et al. Assessment of acute spinal inflammation in patients with ankylosing spondylitis by magnetic resonance imaging: a comparison between contrast enhanced T1 and short tau

2014 eMedicine Surgery

137. Paraspinal Injections: Facet Joint and Nerve Root Blocks

injury to the vertebral artery, direct the needle into the posterior portion of the foramen. Do not advance the needle beyond the outer portion of the foramen; in fact, the needle can be placed outside the foramen with similar efficacy and less risk. The injection of contrast medium is critical to outline the nerve root (see image below). Contrast should never fill vessels, and it does not normally fill the subarachnoid space. The total volume of the local anesthetic and steroid should be smaller (...) injury from the needle tip. Regardless of the cause, in this author's opinion, contrast injection is recommended to at least potentially reduce the risk of intravascular injection, especially given the necessity, in today's environment, of practicing somewhat defensively. Spinal anesthesia may occur if local anesthetic is inadvertently injected into the nerve root sleeve. Prompt recognition of this potentially disastrous complication is vital during cervical procedures, because the patient's

2014 eMedicine Radiology

138. Rheumatoid Arthritis, Spine

border of the body of C7. A CHI of less than 2 mm is a sensitive predictor of neurologic deficit. These plain radiographic measurements, along with dynamic flexion-extension views provide a reliable and efficient means of assessing spinal involvement of rheumatoid disease and targeting at-risk patients, as well as selecting those who warrant further radiologic studies with a view to surgical stabilization. Thoracic and lumbar spinal involvement RA changes in the apophyseal joints of the thoracic (...) (flexed position) MRIs be obtained in patients with RA in whom cervical subluxation is suspected when routine MRI findings in the neutral position are normal. [ ] Others recommend functional MRI as a preoperative examination. [ ] Pathologic series have suggested that cord atrophy in rheumatoid cervical myelopathy results from repeated traction injury as a result of compression, stretch, and movement as opposed to an inflammatory process per se. This is unsurprising considering that the atlantoaxial

2014 eMedicine Radiology

139. Cervical Facet Syndrome (Follow-up)

28, 2018 Author: Robert E Windsor, MD, FAAPMR, FAAEM, FAAPM; Chief Editor: Craig C Young, MD Share Email Print Feedback Close Sections Sections Cervical Facet Syndrome Follow-up Return to Play Return to play is an individualized process for athletes with cervical facet joint syndrome. No specific time frame exists for a particular injury. Safe return to play is allowed after the appropriate sport-specific rehabilitation program is completed and the athlete demonstrates full pain-free ROM (...) and proper neutral spine posture with sport-specific activities. Despite the extensive amount of literature regarding the surgical management of sport-related diseases of the cervical spine, there is a paucity of information concerning the indications for returning to sports after such procedures. Nonsurgical traumatic diseases include sprain/strain, spear tackler's spine, and "stingers." Ligamentous injuries should be treated and observed with great caution. Radiographs in the neutral, flexed

2014 eMedicine.com

140. The Approach to the Painful Joint (Follow-up)

spine, ask the patient to touch the chin to the chest (flexion) and then look up at the ceiling (extension). For lateral flexion, ask the patient to touch an ear to the shoulder. For lateral rotation, ask the patient to touch the chin to a shoulder. During lateral rotation and flexion, pain that occurs on the ipsilateral side of the neck is bony in origin (eg, from apophyseal joint disease), whereas pain on the contralateral side is muscular or ligamentous in origin. With the thoracic spine (...) polyarthritis include the following: Traumatic osteoarthritis (see ) Hypertrophic pulmonary osteoarthropathy Amyloidosis (see ) Differential diagnoses for regional musculoskeletal pain Shoulder Referred pain may derive from cervical disorders, Pancoast tumor of the lung, subphrenic pathology, or entrapment neuropathies and brachial neuritis (see ). Rotator cuff tendinitis (see ) [ ] is inflammation of the rotator cuff tendons, arising acutely as a result of a recognizable injury (throwing) or insidiously

2014 eMedicine.com

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