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Dancer Injuries

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161. Ankle Impingement Syndrome (Overview)

Impingement Syndrome Updated: Sep 17, 2018 Author: Marc A Molis, MD, FAAFP; Chief Editor: Craig C Young, MD Share Email Print Feedback Close Sections Sections Ankle Impingement Syndrome Overview Background Ankle impingement is defined as a painful mechanical limitation of full ankle range of motion secondary to an osseous or soft-tissue abnormality. [ , , , , , ] Soft-tissue impingement lesions of the ankle usually occur as a result of synovial or capsular irritation secondary to injuries (...) , , or rheumatologic or degenerative disease states. Ankle impingement syndromes may also be congenital in origin. The leading causes of impingement lesions are posttraumatic injuries, usually ankle sprains, leading to chronic pain. Involved areas may include the anterolateral gutter, syndesmosis, and posterior ankle regions. In 1950, Glassman et al reported on 9 patients who presented with chronic persistent pain and swelling around the anterolateral aspect of the ankle following an inversion ankle sprain

2014 eMedicine.com

162. Achilles Tendon Pathology (Treatment)

Achilles Tendon Pathology (Treatment) Achilles Tendon Injuries: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MzkzLW92ZXJ2aWV3 processing > Achilles Tendon Injuries (...) Updated: Sep 12, 2018 Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Achilles Tendon Injuries Overview Practice Essentials Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined

2014 eMedicine Surgery

163. Turf Toe (Overview)

plantarflexion. This injury has been referred to as sand toe, in that it often occurs in beach volleyball players. The injury has also been known to occur in football players and dancers. A plantar foot with the MTP joints driven into exaggerated hyperflexion can result in tearing of the dorsal capsule. The anatomic structures that are damaged and the injury treatment required are different from those of classic turf toe and should be recognized as such. Previous Next: Etiology Bowers and Martin coined (...) ; Chief Editor: Vinod K Panchbhavi, MD, FACS Share Email Print Feedback Close Sections Sections Turf Toe Overview Background Although several variations exist, the classic definition of turf toe is a hyperdorsiflexion injury of the first metatarsophalangeal (MTP) joint. [ ] Since approximately the 1980s, turf toe has received increased attention in the media because of its effect on college-level and professional athletes. [ , , , , ] Turf toe injury is most commonly seen when an axial load

2014 eMedicine Surgery

164. Stress Fractures (Overview)

fracture--a preventable training injury. Mil Med . 1982 Apr. 147(4):285-7. . Rauh MJ, Macera CA, Trone DW, Shaffer RA, Brodine SK. Epidemiology of stress fracture and lower-extremity overuse injury in female recruits. Med Sci Sports Exerc . 2006 Sep. 38(9):1571-7. . Frusztajer NT, Dhuper S, Warren MP. Nutrition and the incidence of stress fractures in ballet dancers. Am J Clin Nutr . 1990 May. 51(5):779-83. . Nattiv A, Agostini R, Drinkwater B. The female athlete triad. The inter-relatedness (...) Author: Stefanos F Haddad, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB Share Email Print Feedback Close Sections Sections Stress Fractures Overview Background The stress , first described by Breithaupt in 1855, [ ] is a common overuse injury seen in athletes and military recruits. [ , ] The injury is usually seen in the lower extremities, but it has also been reported in the upper extremities and the ribs. The most common locations for stress fractures include the tibia, metatarsals, fibula

2014 eMedicine Surgery

165. Achilles Tendon Pathology (Follow-up)

Achilles Tendon Pathology (Follow-up) Achilles Tendon Injuries: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MzkzLW92ZXJ2aWV3 processing > Achilles Tendon Injuries (...) Updated: Sep 12, 2018 Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Achilles Tendon Injuries Overview Practice Essentials Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined

2014 eMedicine Surgery

166. Turf Toe (Diagnosis)

plantarflexion. This injury has been referred to as sand toe, in that it often occurs in beach volleyball players. The injury has also been known to occur in football players and dancers. A plantar foot with the MTP joints driven into exaggerated hyperflexion can result in tearing of the dorsal capsule. The anatomic structures that are damaged and the injury treatment required are different from those of classic turf toe and should be recognized as such. Previous Next: Etiology Bowers and Martin coined (...) ; Chief Editor: Vinod K Panchbhavi, MD, FACS Share Email Print Feedback Close Sections Sections Turf Toe Overview Background Although several variations exist, the classic definition of turf toe is a hyperdorsiflexion injury of the first metatarsophalangeal (MTP) joint. [ ] Since approximately the 1980s, turf toe has received increased attention in the media because of its effect on college-level and professional athletes. [ , , , , ] Turf toe injury is most commonly seen when an axial load

2014 eMedicine Surgery

167. Peroneal Tendon Pathology (Diagnosis)

Updated: Jan 25, 2019 Author: Rajesh Malhotra, MBBS, MS; Chief Editor: Thomas C Dowd, MD Share Email Print Feedback Close Sections Sections Peroneal Tendon Pathology Overview Background Disorders of the peroneal tendons are often overlooked as causes of lateral ankle pain and have been reported infrequently. These injuries may go unrecognized or may be misdiagnosed as ankle sprains. The three major pathologies of the peroneal tendons include the following: Tenosynovitis and tendinitis Peroneal tendon (...) sulcus is the superior peroneal retinaculum (SPR). The calcaneofibular ligament lies deep to the peroneal tendons just distal to the sulcus. The calcaneofibular ligament helps stabilize the peroneal tendons and is oriented in much the same direction as the SPR. Therefore, inversion injuries that damage the calcaneofibular ligament can also result in injury to the SPR. More distally (inferiorly), the tendons are restrained by the inferior peroneal retinaculum (IPR). The SPR is the primary restraint

2014 eMedicine Surgery

168. Hallux Rigidus (Diagnosis)

The pathophysiology of hallux rigidus is similar to that of degenerative arthritis in any joint. Overuse, injury, or abnormal joint mechanics lead to abnormal stresses on the articular cartilage. In an in-vitro study, Ahn et al used a magnetic tracking system to monitor the three-dimensional movement of the proximal phalanx while the toe position was changed from a neutral position to full extension. [ ] The contact distribution shifted dorsally with increasing degrees of extension. These data are consistent (...) with the observation that chondral erosions associated with hallux rigidus and degenerative arthritis initially affect the dorsal articular surface of the MT. [ ] Articular degenerative changes are associated with dehydration of the cartilage, which, in turn, is more susceptible to injury resulting from shear and compressive forces. The subchondral bone shares these stresses, which subsequently lead to increased subchondral bone density, formation of periarticular osteophytes, and, in severe cases, cystic changes

2014 eMedicine Surgery

169. Stress Fractures (Diagnosis)

fracture--a preventable training injury. Mil Med . 1982 Apr. 147(4):285-7. . Rauh MJ, Macera CA, Trone DW, Shaffer RA, Brodine SK. Epidemiology of stress fracture and lower-extremity overuse injury in female recruits. Med Sci Sports Exerc . 2006 Sep. 38(9):1571-7. . Frusztajer NT, Dhuper S, Warren MP. Nutrition and the incidence of stress fractures in ballet dancers. Am J Clin Nutr . 1990 May. 51(5):779-83. . Nattiv A, Agostini R, Drinkwater B. The female athlete triad. The inter-relatedness (...) Author: Stefanos F Haddad, MD; Chief Editor: Murali Poduval, MBBS, MS, DNB Share Email Print Feedback Close Sections Sections Stress Fractures Overview Background The stress , first described by Breithaupt in 1855, [ ] is a common overuse injury seen in athletes and military recruits. [ , ] The injury is usually seen in the lower extremities, but it has also been reported in the upper extremities and the ribs. The most common locations for stress fractures include the tibia, metatarsals, fibula

2014 eMedicine Surgery

170. Bunion (Follow-up)

to protect the extensor hallucis longus (EHL) and to avoid injury to the terminal portion of the medial branch of the superficial peroneal nerve, which passes over the first TMT joint. The osteotomy is performed 1-1.5 cm distal to the first TMT joint. The crescentic cut is made perpendicular to the plantar surface of the foot or at a 120° angle to the long axis of the first MT. Some literature supports either a concave distal or concave proximal cut orientation. Either way, care must be taken to avoid (...) of basal metatarsal closing-wedge osteotomies and Keller excision arthroplasties performed in patients aged 14-40 years, statistical analysis revealed significantly better clinical and radiologic outcomes after osteotomy; in fact, it was recommended that Keller arthroplasty be abandoned for the treatment of HV in young and active patients [ ] Previous Next: Less Invasive Techniques Various less invasive techniques have been developed in attempts to decrease soft-tissue injury (primarily), decrease

2014 eMedicine Surgery

171. Snapping Hip Syndrome (Follow-up)

of snapping hip syndrome is maintenance of good flexibility and strength in the hip and pelvis. [ ] Previous References Johnston CA, Wiley JP, Lindsay DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med . 1998 Apr. 25(4):271-83. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Jacobsen JS, Thorborg K, Soballe K, Ulrich-Vinther M. Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scand J Med & Sci (...) in Sports . 2012. 22:e140-e146. Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas muscle. Anatomical basis of anterior snapping of the hip. Surg Radiol Anat . 2001. 23(6):371-4. . Jacobs M, Young R. Snapping hip phenomenon among dancers. Am Correct Ther J . 1978 May-Jun. 32(3):92-8. . Hruska R. Pelvic stability: influences of lower-extremity kinematics. Biomechanics . June 1998. 6:23-9. Choi YS, Lee SM, Song BY, Paik SH, Yoon YK. Dynamic

2014 eMedicine.com

172. Corns (Follow-up)

in General Medicine . 7th ed. New York, NY: McGraw-Hill; 2008. 97. Kennedy CTC, Burd DAR. Mechanical and Thermal Injury. Burns T, Breathnach SM, Cox N, Griffiths CE, eds. Rook's Textbook of Dermatology . 7th ed. London, England: Blackwell Science; 2004. 22. Viegas SF, Torres FG. Cherry pitter's thumb. Case report and review of the literature. Orthop Rev . 1989 Mar. 18 (3):336-8. . Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J Dermatol . 1990 Jul-Aug. 29 (6):424-5. . Scott MJ Jr, Scott (...) arterial disease. A case report. J Am Podiatr Med Assoc . 1985 Nov. 75 (11):616-8. . Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br . 2000 Aug. 82(6):781-90. . Verbov JL, Monk CJ. Talar callosity--a little-recognized common entity. Clin Exp Dermatol . 1991 Mar. 16 (2):118-20. . Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and forefoot disorders in ballet and folk dancers. J Am Podiatr Med Assoc . 2007 Sep-Oct. 97 (5):385-8. . Baccouche D, Mokni M, Ben

2014 eMedicine.com

173. Metatarsal Stress Fracture (Diagnosis)

. This type of injury is seen in runners of all levels, as well as ballet dancers and gymnasts and patients with rheumatoid arthritis (RA), metabolic bone disease, and neuropathic conditions. [ , , ] Metatarsal stress fractures are also seen with increasing frequency in patients who engage in aerobics activities, particularly high-impact aerobics. Next: Epidemiology Frequency United States The incidence of stress fractures in the general population is unknown, as virtually all literature on the subject (...) is derived from a military population or advanced-level athletes. Stress fractures are estimated to constitute up to 16% of all injuries that are related to athletic participation; running is the cause in most of these cases. Most stress fractures (95%) involve the lower extremities, particularly the metatarsals. A study by Waterman et al reported the incidence rate for lower extremity stress fractures in the US military (not adjusted for sex, race, age, rank, and service branch), including

2014 eMedicine.com

174. Corns (Diagnosis)

a normal physiological response—proliferation of the stratum corneum. One of the primary roles of the stratum corneum is to provide a barrier to mechanical injury. Any insult compromising this barrier causes homeostatic changes and the release of cytokines into the epidermis, stimulating an increase in synthesis of the stratum corneum. When the insult is chronic and the mechanical defect is not repaired, hyperplasia and inflammation are common. [ ] With corns, external mechanical forces are focused (...) Tethered spinal cord syndrome [ ] Vascular occlusion syndromes [ ] (ie, verruca vulgaris) [ ] Faulty mechanics play a role. Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes; however, inappropriately shaped or constrictive footwear in the presence of bony prominences (eg, talar bone prominences [ ] ) may exacerbate corn formation. Furthermore, some disorders may alter the shape or sensation of the soles of the feet. Bony

2014 eMedicine.com

175. Bulimia (Follow-up)

nervosa (BN) have increased rates of major depressive disorder, substance abuse, anxiety disorders, bipolar II disorder, and sexual abuse; these conditions should be considered and managed as necessary. Mortality and morbidity associated with depression (suicidal thoughts or self-injury) and poor impulse control (eg, substance abuse, sexually transmitted diseases, unintended pregnancy, accidental injuries) should always be anticipated and assessed. Patients with BN who are depressed and who have (...) type, 28.2% of the individuals maintained the diagnosis of bulimia nervosa, purging type. Psychiatric comorbidities predicted poor outcome, specifically self-injurious behaviors. [ ] In 2008, a 10-year follow-up study was published that looked at parental psychopathology as a source of predicted outcome. The paper found that substance abuse in fathers and depression in mothers was associated with poor outcome. Obesity in mothers was associated with a better long-term outcome. [ ] Most eating

2014 eMedicine.com

176. Achilles Tendon Rupture (Follow-up)

Achilles Tendon Rupture (Follow-up) Achilles Tendon Injuries: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MzkzLW92ZXJ2aWV3 processing > Achilles Tendon Injuries (...) Updated: Sep 12, 2018 Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Achilles Tendon Injuries Overview Practice Essentials Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined

2014 eMedicine.com

177. Achilles Tendonitis (Follow-up)

Achilles Tendonitis (Follow-up) Achilles Tendon Injuries: Practice Essentials, Background, Anatomy 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=aHR0cHM6Ly9lbWVkaWNpbmUubWVkc2NhcGUuY29tL2FydGljbGUvMzA5MzkzLW92ZXJ2aWV3 processing > Achilles Tendon Injuries Updated (...) : Sep 12, 2018 Author: Anthony J Saglimbeni, MD; Chief Editor: Dean H Hommer, MD Share Email Print Feedback Close Sections Sections Achilles Tendon Injuries Overview Practice Essentials Achilles tendon pathologies include rupture and tendonitis. Many experts now believe, however, that tendonitis is a misleading term that should no longer be used, because signs of true inflammation are almost never present on histologic examination. Instead, the following histopathologically determined nomenclature

2014 eMedicine.com

178. Low Energy Availability in the Female Athlete (Diagnosis)

meals that are less energy dense may be an important means of avoiding low energy availability conditions and thus preventing the female athlete triad [ ] Musculoskeletal history A careful review of past and current musculoskeletal injuries in the female athlete should be conducted. There should be a focus on all stress fractures, as well as on other fractures. There is an increase in risk of stress fractures in females with a chronic energy deficit. Any injury that results in loss of training (...) should be considered if a patient's reproductive function is not restored with a trial of increased energy intake or if the findings on history and physical exam suggest other causes of . If the patient has signs of hyperandrogenism ( ), free and total testosterone can be tested to assess for androgen excess. [ ] In a 2016 study by Łagowska et al, nutritional status and dietary habits were analyzed in relation to testosterone levels in female athletes and ballet dancers with menstrual disorders

2014 eMedicine.com

179. Lumbosacral Radiculopathy (Diagnosis)

at multiple levels. Herniation of the intervertebral disc can cause impingement of the above neuronal structures, thus causing pain. The presence of disc material in the epidural space is thought to initially result in direct toxic injury to the nerve root by chemical mediation and then exacerbation of the ensuing intraneural and extraneural swelling, which results in venous congestion and conduction block. Notably, the size of the disc herniation has not been found to be related to the severity (...) with the upright position. Because each intervertebral disc is a fluid system, hydraulic pressure is generated whenever a load is placed on the axial skeleton. The hydraulic pressure mechanisms then multiply the force on the annulus fibrosus of the intervertebral disc to make it 3-5 times that which is exerted on the axial skeleton. Previous Next: Sport-Specific Biomechanics Dancers are prone to both acute and chronic back problems, including lumbosacral radiculopathy, which develop secondary

2014 eMedicine.com

180. Ankle Impingement Syndrome (Diagnosis)

Impingement Syndrome Updated: Sep 17, 2018 Author: Marc A Molis, MD, FAAFP; Chief Editor: Craig C Young, MD Share Email Print Feedback Close Sections Sections Ankle Impingement Syndrome Overview Background Ankle impingement is defined as a painful mechanical limitation of full ankle range of motion secondary to an osseous or soft-tissue abnormality. [ , , , , , ] Soft-tissue impingement lesions of the ankle usually occur as a result of synovial or capsular irritation secondary to injuries (...) , , or rheumatologic or degenerative disease states. Ankle impingement syndromes may also be congenital in origin. The leading causes of impingement lesions are posttraumatic injuries, usually ankle sprains, leading to chronic pain. Involved areas may include the anterolateral gutter, syndesmosis, and posterior ankle regions. In 1950, Glassman et al reported on 9 patients who presented with chronic persistent pain and swelling around the anterolateral aspect of the ankle following an inversion ankle sprain

2014 eMedicine.com

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