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202 results for

Apophyseal Injury

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141. Hip Tendonitis and Bursitis (Follow-up)

Tendonitis and Bursitis Follow-up Updated: Oct 12, 2018 Author: Jeffrey Rosenberg, MD; Chief Editor: Sherwin SW Ho, MD Share Email Print Feedback Close Sections Sections Hip Tendonitis and Bursitis Follow-up Return to Play Patients with chronic hip overuse injuries are often frustrated by the lack of progress and delayed return to play. These individuals must be educated from the first day that a prolonged recovery is usual. Complete painless ROM needs to return before the patient should start (...) Other than worsening or returning pain, few complications of the overuse injury exist. Educating the athletes will remind them of the long-term nature of these injuries. As we age, our tendons age and degenerate, making recovery from these injuries more difficult. If the patient's injury is not responding to treatment as quickly as expected, the physician should reconsider the diagnosis (see Differentials and Other Problems to Be Considered). Of paramount importance is reconsidering whether intra

2014 eMedicine.com

142. Sickle Cell Anemia (Diagnosis)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine.com

143. Lumbar Spine Fractures and Dislocations (Diagnosis)

acute fractures are or vertebral endplate fractures caused by sudden axial loading, transverse process avulsion by the origin of the psoas muscle, spinous process avulsions, and acute fracture of the pars interarticularis from hyperextension. Vertebral body compression is more common in patients with decreased bone density. [ , ] In adolescents, it is relatively common to find endplate fractures or apophyseal avulsion fractures. All of these injuries generally are stable and heal with immobilization (...) > Lumbar Spine Fractures and Dislocations Updated: Oct 16, 2018 Author: Federico C Vinas, MD; Chief Editor: Jeffrey A Goldstein, MD Share Email Print Feedback Close Sections Sections Lumbar Spine Fractures and Dislocations Overview Background Each year, more than 150,000 persons in North America sustain fractures of the vertebral column. Injuries to the thoracolumbar and lumbar spine constitute most of these fractures. The immediate neurologic damage that accompanies the bony destruction results

2014 eMedicine Surgery

144. Kyphosis (Diagnosis)

of Scheuermann disease is still imprecisely defined. Scheuermann postulated that the condition resulted from avascular necrosis of the apophyseal ring. Other theories include histologic abnormalities at the endplate, osteoporosis, [ ] and mechanical factors that affect spinal growth. [ ] A Danish study demonstrated an important genetic component to the entity. [ ] Postural kyphosis is present when accentuated kyphosis is observed without the characteristic 5° of wedging over three consecutive vertebral (...) , and one had a wound infection. No permanent neurologic injuries occurred. Video-assisted thoracoscopic release followed by posterior arthrodesis has been successful. In one study, deformity correction was 84.8° to 45.3° in patients with thoracic kyphosis associated with Scheuermann disease. [ ] Mean loss of correction was 1.6°, and one hook pulled out. No cases of junctional kyphosis were observed. In a retrospective study, anterior-posterior correction was compared with posterior-only instrumentation

2014 eMedicine Surgery

145. K&ouml (Diagnosis)hler Disease (Diagnosis)

or secondary centers of ossification; almost all of the epiphyses, apophyses, and small bones can be implicated. [ ] In Köhler disease, AVN of the navicular bone occurs. The etiology of these conditions is not well known, but vascular accidents, coagulation anomalies, and heredity have been implicated. [ ] The most common osteochondroses are Kienbock, and Panner diseases. Surgery is not indicated for Köhler disease; treatment is nonoperative (see ). Next: Pathophysiology Vascularization of the navicular (...) ; this clinical entity has been rarely reported in the years since. Dharamsi and Carl reported a case of isolated bilateral Köhler disease of the patella in a male athlete aged approximately 7 years. [ ] Previous Next: Etiology The etiology of Köhler disease, like those of the other osteochondroses, is unknown, but the condition is thought to result from compressive stress-related injury at a critical time of growth. [ ] Vascular insults, retarded bone age, and genetic predilection have also been implicated

2014 eMedicine Surgery

146. Fracture, Pelvic (Treatment)

and analgesics as needed. Do not place a urinary catheter until urethral injury has been ruled out or determined to be unlikely by physical examination or retrograde urethrography. Pelvic apophyseal avulsion fractures are generally managed conservatively with rest and ice, followed by incremental protected weight-bearing with crutches until symptoms improve. Afterwards, progression to light stretching and full weight-bearing can proceed as tolerated with eventual return to full sports participation once full (...) of the left hemipelvis and a characteristic sacral buckle fracture. Note the concomitant left sacroiliac joint diastasis. The lateral force vector continued across the pelvis to produce external rotation of the right hemipelvis and diastasis of the right sacroiliac joint. The combination of injuries resulted in a windswept pelvis. Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse). of 5

2014 eMedicine Emergency Medicine

147. Osgood-Schlatter Disease (Treatment)

however both groups reported symptom relief with no adverse outcomes. [ ] Long-term immobilization is typically contraindicated, because it may result in increased knee stiffness in mild cases, thus predisposing the athlete to additional sports-related injuries. However, if a patient is noncompliant, the clinician may recommend immobilization in a knee brace for a minimum of 6 weeks. The brace should be removed daily, but only for stretching and strengthening exercises. Inform the patient to avoid (...) of the extensor mechanism. Open reduction and internal fixation (ORIF) usually is recommended, depending on the size and displacement of the fragment as well as the phase of apophyseal closure. Indications for surgery Occasionally, adults have a large ossicle and an overlying bursa, which may cause pain with kneeling. If so, treatment consists of excision of the bursa, ossicle, and any prominence. [ ] Contraindications for surgery The real question is whether or not surgery is ever indicated in the growing

2014 eMedicine Emergency Medicine

148. Pediatrics, Sickle Cell Disease (Diagnosis)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Emergency Medicine

149. Cervical Facet Syndrome (Diagnosis)

, , and , and . Next: Epidemiology Frequency United States Aprill and Bogduk estimated the prevalence of cervical facet joint pain by reviewing the records of patients who had presented with neck pain for at least 6 months secondary to some type of injury. [ ] These patients underwent discography, facet joint nerve blocks, or both at the request of the referring physicians. A total of 318 patients were investigated, and 26% of the patients had at least one symptomatic facet joint. However, only 126 patients (...) , but there was often a painful disc at the same level. This finding is not surprising when one considers how the facet joints and discs are intimately involved in motion of the cervical spine. Cervical facet joint pain is a common sequela of whiplash injury. Barnsley and Lord et al studied the prevalence of chronic cervical facet joint pain after whiplash injury using double-blind, controlled, diagnostic blocks of the facet joints. [ ] The joints were blocked randomly with either a short-acting or long-acting

2014 eMedicine.com

150. Cervical Disc Disease (Diagnosis)

Updated: Mar 21, 2018 Author: Michael B Furman, MD, MS; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Cervical Disc Disease Overview Practice Essentials Cervical disc disorders encountered in physiatric practice include (HNP), (DDD), and internal disc disruption (IDD). HNP (seen in the image below) is defined as localized displacement of nucleus, cartilage, fragmented apophyseal bone, or fragmented anular tissue beyond the intervertebral disc space. [ ] Most (...) of the herniation is made up of the annulus fibrosus. DDD involves degenerative annular tears, loss of disc height, and nuclear degradation. IDD describes annular fissuring of the disc without external disc deformation. can result from nerve root injury in the presence of disc herniation or stenosis, most commonly foraminal stenosis, leading to sensory, motor, or reflex abnormalities in the affected nerve root distribution. [ , ] Sagittal magnetic resonance imaging (MRI) scan demonstrating cervical

2014 eMedicine.com

151. Ankylosing Spondylitis and Undifferentiated Spondyloarthropathy (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.com

152. 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.com

153. Osgood-Schlatter Disease (Treatment)

however both groups reported symptom relief with no adverse outcomes. [ ] Long-term immobilization is typically contraindicated, because it may result in increased knee stiffness in mild cases, thus predisposing the athlete to additional sports-related injuries. However, if a patient is noncompliant, the clinician may recommend immobilization in a knee brace for a minimum of 6 weeks. The brace should be removed daily, but only for stretching and strengthening exercises. Inform the patient to avoid (...) of the extensor mechanism. Open reduction and internal fixation (ORIF) usually is recommended, depending on the size and displacement of the fragment as well as the phase of apophyseal closure. Indications for surgery Occasionally, adults have a large ossicle and an overlying bursa, which may cause pain with kneeling. If so, treatment consists of excision of the bursa, ossicle, and any prominence. [ ] Contraindications for surgery The real question is whether or not surgery is ever indicated in the growing

2014 eMedicine Surgery

154. Medial Humeral Condyle Fracture (Treatment)

-term studies and does not appear to be a major issue with these fractures. 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 Pediatr Orthop . 1986 (...) . . Karlsson MK, Herbertsson P, Nordqvist A, Besjakov J, Josefsson PO, Hasserius R. Comminuted fractures of the radial head. Acta Orthop . 2010 Apr. 81 (2):224-7. . Haxhija EQ, Mayr JM, Grechenig W. [Treatment of medial epicondylar apophyseal avulsion injury in children]. Oper Orthop Traumatol . 2006 Jun. 18(2):120-34. . Hoppenfeld S, Murthy VL. Treatment and Rehabilitation of Fractures . Philadelphia: Lippincott Williams & Wilkins; 2000. Media Gallery Schematic of two types of medial condyle fractures

2014 eMedicine Surgery

155. Idiopathic Scoliosis (Treatment)

of the nerve injury risks of sublaminar wires. Pedicle screws have also become a popular anchor for the rods used in posterior scoliosis fusion procedures. [ ] They offer the potential advantage of increased strength (and possibly power of correction) while at the same time introducing added insertion-technique complexity and different neurologic complication risks. A very real and major increase in the overall cost of instrumentation constructs that include many pedicle screws is the case when (...) are not often directly visualized during posterior surgical approaches for scoliosis, but they must not be forgotten. These muscles include the trapezius, the rhomboid major, the rhomboid minor, and the latissimus dorsi. Using an animal model, Kawaguchi et al showed that significant posterior muscle injury can be induced by the pressure exerted by surgical retractors. [ ] This certainly makes a case for intermittent removal and replacement of such retractors during the course of posterior spinal surgery

2014 eMedicine Surgery

156. Growth Plate (Physeal) Fractures (Treatment)

cause significant genu recurvatum. The image below illustrates a procurvatum deformity of the proximal tibia after repair of a proximal tibia apophyseal avulsion. Growth plate (physeal) fractures. Procurvatum of proximal tibia after open reduction and internal fixation of proximal tibia apophysis injury. If the fracture is nondisplaced or an anatomic stable reduction can be obtained with closed manipulation, treatment consists of an above-knee cast for 4 weeks. Generally, displaced apophyseal (...) =aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMTI2MDY2My10cmVhdG1lbnQ= processing > Growth Plate (Physeal) Fractures Treatment & Management 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 Treatment Approach Considerations Salter-Harris (SH) I and SH II growth plate (physeal) injuries usually can be managed adequately with closed manipulative reduction. Upon reduction, these injuries are typically stable, and casting suffices. At times

2014 eMedicine Surgery

157. Sickle Cell Anemia (Overview)

by a spinal artery branch) results in the characteristic H vertebrae of sickle cell disease. The outer portions of the plates are spared because of the numerous apophyseal arteries. Osteonecrosis of the epiphysis of the femoral head is often bilateral and eventually progresses to collapse of the femoral heads. This same phenomenon is also seen in the humeral head, distal femur, and tibial condyles. Infarction of bone and bone marrow in patients with sickle cell disease can lead to the following changes (...) and an inability to deal with infective encapsulated microorganisms, particularly Streptococcus pneumoniae, ensue, leading to an increased risk of sepsis in the future. Chronic hemolytic anemia SCD is a form of hemolytic anemia, with red cell survival of around 10-20 days. Approximately one third of the hemolysis occurs intravascularly, releasing free hemoglobin (plasma free hemoglobin [PFH]) and arginase into plasma. PFH has been associated with endothelial injury including scavenging nitric oxide

2014 eMedicine Pediatrics

158. Diaphyseal Femur Fractures (Treatment)

polytrauma patients) with these fractures. Surgery for diaphyseal femur fracture should be reserved for those able to tolerate the appropriate procedure for their circumstance. Young children can often be treated successfully with noninvasive measures; thus, surgery can be avoided. Definite indications include polytrauma patients, especially those with head and chest injuries, and those with injuries to multiple limbs or those otherwise unable to care for themselves to maximize postoperative independence (...) . Most others are surgical candidates because of the lower incidence of complication and the higher union rates with surgery. Those who should not be treated surgically include patients too unstable to tolerate the procedure and children weighing less than 80 lb. No one can argue with the high success rate of reamed locked antegrade nailing. However, patients with femoral-shaft fractures often present with a multitude of injuries including head and chest trauma. Laboratory studies have shown

2014 eMedicine Surgery

159. Tibial Tubercle Fracture (Overview)

. [ , , ] This condition should be distinguished from , a chronic apophysitis of the tibial tuberosity due to recurrent traction injury. Nondisplaced type I injuries can be managed conservatively by cast immobilization in a long leg cast in full-knee extension. All other injuries are best treated by open reduction and internal fixation (ORIF) with cast immobilization for 6-8 weeks. (See .) Next: Anatomy The extensor complex of the thigh exerts its force through the ligamentum patellae on the tibial tuberosity. During (...) its histogenesis, the tibial tuberosity is an anterior extension of the proximal tibial epiphysis separated from the rest of the tibia by the growth plate. As the growth plate closes in late puberty, it is transiently replaced by fibrocartilaginous elements, which predispose it to traction injury as a result of its weaker tensile strength. Previous Next: Pathophysiology The proximal tibia has two ossification centers, the proximal tibial epiphysis and the tibial tuberosity, which are separated

2014 eMedicine Surgery

160. Sever Disease (Overview)

Sever Disease (Overview) 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

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