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Apophyseal Injury

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161. Sever Disease (Follow-up)

injuries of the foot and ankle in the child and adolescent athlete. Phys Med Rehabil Clin N Am . 2008 May. 19 (2):347-71, ix. . Weiner DS, Morscher M, Dicintio MS. Calcaneal apophysitis: simple diagnosis, simpler treatment. J Fam Pract . 2007 May. 56 (5):352-5. . Clemow C, Pope B, Woodall HE. Tools to speed your heel pain diagnosis. J Fam Pract . 2008 Nov. 57 (11):714-23. . Irving DB, Cook JL, Young MA, Menz HB. Impact of chronic plantar heel pain on health-related quality of life. J Am Podiatr Med (...) . Is radiographic evaluation necessary in children with a clinical diagnosis of calcaneal apophysitis (sever disease)?. J Pediatr Orthop . 2011 Jul-Aug. 31 (5):548-50. . Brenner JS, American Academy of Pediatrics Council on Sports Medicine and Fitness. Overuse injuries, overtraining, and burnout in child and adolescent athletes. Pediatrics . 2007 Jun. 119 (6):1242-5. . Wu M, Fallon R, Heyworth BE. Overuse Injuries in the Pediatric Population. Sports Med Arthrosc Rev . 2016 Dec. 24 (4):150-158. . Perhamre S

2014 eMedicine Surgery

162. Anemia, Sickle Cell (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

163. Fracture, Pelvic (Diagnosis)

socket when the hip is driven backward in a motor vehicle accident. Occasionally, they occur in a pedestrian struck by a vehicle moving at a significant rate of speed. Pelvic avulsion fractures (see the image below) occur due to indirect trauma from sudden muscular contraction causing injury to the muscular attachment on the pelvis. These most often occur in skeletally immature athletes because of the inherent weakness of the pelvic apophyses. The three most common sites are the anterior superior (...) iliac spine (ASIS), the anterior inferior iliac spine (AIIS), and the ischial tuberosity because of contraction of the sartorius, rectus femoris, and hamstring muscles, respectively. [ ] Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse). Previous Next: Epidemiology Pelvic fractures make up approximately 3% of all skeletal injuries. Open pelvic fractures are rare and represent only

2014 eMedicine Emergency Medicine

164. 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 Emergency Medicine

165. Fracture, Pelvic (Overview)

socket when the hip is driven backward in a motor vehicle accident. Occasionally, they occur in a pedestrian struck by a vehicle moving at a significant rate of speed. Pelvic avulsion fractures (see the image below) occur due to indirect trauma from sudden muscular contraction causing injury to the muscular attachment on the pelvis. These most often occur in skeletally immature athletes because of the inherent weakness of the pelvic apophyses. The three most common sites are the anterior superior (...) iliac spine (ASIS), the anterior inferior iliac spine (AIIS), and the ischial tuberosity because of contraction of the sartorius, rectus femoris, and hamstring muscles, respectively. [ ] Pelvic apophyseal avulsion fracture of the ischial tuberosity due to contraction of the hamstring muscles. Courtesy of Wikipedia (https://de.wikipedia.org/wiki/Apophyse). Previous Next: Epidemiology Pelvic fractures make up approximately 3% of all skeletal injuries. Open pelvic fractures are rare and represent only

2014 eMedicine Emergency Medicine

166. Pediatrics, Sickle Cell Disease (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 Emergency Medicine

167. 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 Emergency Medicine

168. Osgood-Schlatter Disease (Follow-up)

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

169. Knee pain - assessment

Knee pain - assessment Knee pain - assessment - NICE CKS Clinical Knowledge Summaries Share Knee pain - assessment: Summary Knee pain is a common condition, particularly in older people. Possible causes include osteoarthritis of the knee, injuries (such as muscle strain and fractures), tumours, referred pain from the hip or lumbosacral spine, and bursitis. Risk factors for knee pain include increasing age, obesity, knee-straining work and participation in sport. A person presenting with knee (...) pain should be: Asked about a history of trauma. Asked to describe the history of the pain and/or injury (including, type and duration of pain, aggravating and relieving factors, history of swelling). An examination of the knee should be carried out. If there is a history of trauma, an assessment for injuries including fracture, tendon rupture, ligament tears, neurovascular damage, and septic arthritis is required. Red flags should be considered for: Infection (septic arthritis or osteomyelitis

2011 NICE Clinical Knowledge Summaries

170. Guidelines for Bone Scintigraphy in Children

osteoma G. Bone dysplasia and other metabolic diseases [11, 32] – Camurati-Engelmann disease – evaluating skeletal involvement (brown tumours) in children with hyperparathyroidism [33] H. Other clinical situations in paediatrics [8, 11, 34–36] – pain possibly due to bone pathology – limp or backache – fever of unknown origin – evaluating apophyseal activity in the mandibular condyles in children with mandibular asymmetry Contraindications Although uncommon in the paediatric age group, the possibility (...) findings. Nuklearmedizin 1991;30:265–71. 24. Gelfand MJ, Strife JL, Graham EJ, Crawford AH. Bone scintigraphy inslippedcapitalfemoralepiphysis.ClinNuclMed1983;8(12):613–5. 25. Bellah RD, Summerville DA, Treves ST, Micheli LJ. Low-back pain in adolescent athletes: detection of stress injury to the pars interarticularis with SPECT. Radiology 1991;180:509–12. 26. Chan WL, Carolan MG, Fernandes VB, Abbati DP. Planar versus SPET imaging in the assessment of condylar growth. Nucl Med Commun 2000;21(3):285–90

2010 European Association of Nuclear Medicine

171. 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

2015 FP Notebook

172. 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

2015 FP Notebook

173. 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

2015 FP Notebook

174. Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour (PubMed)

Avulsion fracture of the anterior superior iliac spine: misdiagnosis of a bone tumour Avulsion fractures of the anterior superior iliac spine are rare. This injury is usually seen in adolescents, as an avulsion fracture of the apophyses, a result of sudden vigorous contraction or repetitive contraction of the sartorius and tensor fasciae latae muscles. Treatment for this injury is usually conservative; however, surgical management has been reported in those with significant displacement. We

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2011 Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology

175. Pediatric running injuries. (PubMed)

Pediatric running injuries. As more children have become involved in athletic activities and running, there has been a significant increase in overuse injuries. The young athlete with open growth plates is vulnerable to unique overuse injuries involving the apophyses, articular cartilage, and growth plate. The physician caring for these young athletes needs to be aware of these conditions to diagnose and treat them appropriately. Physicians should also be aware of the risk of overtraining (...) and overuse injury in athletes participating in year-round sports and competition. Current guidelines for overuse injury prevention in young athletes are primarily based on consensus and expert opinion. Further research is needed to provide evidence-based guidelines for overuse injury prevention in young athletes and runners.Copyright 2010 Elsevier Inc. All rights reserved.

2010 Clinics in Sports Medicine

176. Use of Wii Fit (TM) to Increase Compliance With Home Exercises in Treating Patellofemoral Syndrome

derangement (i.e. meniscal, ligament injury); osteochondritis dissecans; severe apophysitis or tendinitis) that could interfere with rehabilitation exercises due to pain or instability from these conditions Individuals with history of knee surgery Individuals that have a Wii Fit TM video game at home Individuals for whom consent and assent is not obtained Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study (...) treatment consists of home exercises to increase muscular strength and flexibility. Adolescents are known to have poor compliance with treatments for chronic illnesses. There is a paucity of published literature surrounding the Wii TM Interactive Video Game. There has been one published report of the use of Wii Fit TM in rehabilitation where participants used the Wii Fit TM to train proprioception after ankle injury. Individuals that participated in the Wii Fit TM group found improvement

2009 Clinical Trials

177. A Comparison of Two Exercise Programs on Knee Motor Control

onset of symptoms and with at least one episode of pain in the past 12 months where pain was aggravated by at least two of the following: prolonged sitting, stairs, squat, running, kneeling and hopping/jumping currently asymptomatic for at least 8 weeks prior to assessment delay in the onset of VMO EMG relative to that of VL of greater than 10 ms during either the ascent or descent of a stair stepping task Exclusion Criteria: current knee pain history of knee surgery or other knee injury in previous (...) 12 months physiotherapy treatment for knee pain in the past 12 months history of patellar dislocation/subluxation clinical evidence of meniscal lesion, ligamentous instability, traction apophysitis around the patellofemoral complex, patellar tendon pathology, chondral damage, osteoarthritis and spinal referred pain current lower limb pathology affecting their ability to satisfactorily complete the testing or exercise protocol current use of non-steroidal anti-inflammatory or corticosteroid drugs

2008 Clinical Trials

178. Sever's Disease

research programme: an audit of injuries in academy youth football. Br J Sports Med. 2004 Aug38(4):466-71. ; Sever's injury: a clinical diagnosis. J Am Podiatr Med Assoc. 2013 Sep-Oct103(5):361-8. ; Can we make a diagnosis with radiographic examination alone in calcaneal apophysitis (Sever's disease)? J Pediatr Orthop B. 2010 Sep19(5):396-8. ; Ultrasonography of the calcaneus in Sever's disease. Indian Pediatr. 2005 Aug42(8):801-3. ; Childhood and adolescent sports-related overuse injuries. Am Fam (...) Sever's Disease Sever's Disease. Information about calcaneal apophysitis | Patient TOPICS Try our Symptom Checker TREATMENT RESOURCES Try our Symptom Checker PROFESSIONAL Upgrade to Patient Pro / / Search Sever's Disease Authored by , Reviewed by | Last edited 12 Feb 2016 | Certified by This article is for Medical Professionals Professional Reference articles are designed for health professionals to use. They are written by UK doctors and based on research evidence, UK and European Guidelines

2008 Mentor

179. Painful Hips In Children

thigh or knee pain. History should include previous injury (acute macrotrauma, repetitive microtrauma), surgery, neurological disorder, inflammatory joint disease or bleeding diathesis, as well as conditions associated with arthropathies, including psoriasis, acute uveitis and inflammatory bowel disease. Any other underlying developmental conditions (eg, Down's syndrome). Establish whether there is any possibility of tick exposure. Ask about developmental history, particularly noting late onset (...) to a moderate amount of radiation. Both CT and MRI provide good ability for multi-planar imaging. CT has the advantage of being able to be manipulated to make 3D reconstructions. MRI provides increased soft tissue contrast and more detailed evaluation of articular and epiphyseal cartilage, subchondral bone, periosteum, synovium and bone marrow elements. Technetium bone scan identifies areas of increased osteoblastic activity and can help localise infection and subtle areas of bone injury such as early

2008 Mentor

180. Heel Pain

. , . Achilles tendonitis is an acute condition and painful because of acute minor tears and associated inflammatory change. Achilles tendinosis is thought to be a chronic process which weakens the tendon and predisposes to tendon rupture. There is often overlap of the two conditions (the term 'tendinopathy' encompasses both conditions). See separate article. Calcaneal apophysitis ( ), which occurs most often in adolescents. Subcalcaneal bursitis. Neurological: . Trapped abductor digiti quinti nerve (...) . Assessment Always consider trauma in an acute presentation: Talar injuries often follow falls on to the feet or after violent dorsiflexion of the ankle. Calcaneal fractures usually follow a fall from height on to the heel. Fractures are often bilateral. There is swelling, bruising and tenderness over the calcaneum. There may be associated injuries to the knees, hips, pelvis, lumbar spine or cervical spine. Talar and calcaneal fractures should be referred for urgent orthopaedic assessment. Patients

2008 Mentor

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