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Sports Hernia

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321. Repetitive Head Injury Syndrome (Diagnosis)

intracranial pressure (ICP), and eventual herniation. This herniation may involve the medial temporal lobe and may occur medially across the falx cerebri or inferiorly through the tentorium. Herniation can also force the cerebellar tonsils to move inferiorly through the foramen magnum. The athlete's condition rapidly worsens, and brainstem failure occurs in 2-5 minutes. Previous Next: Sport-Specific Biomechanics The brain is protected by bone and is cushioned by tough meninges and cerebrospinal fluid (...) . However, this second impact causes cerebral edema and herniation, leading to collapse and death within minutes. Only 17 cases of confirmed SIS have been reported in the medical literature. Thus, the true risk and pathophysiology of SIS has not been clearly established. Importantly, even if the effects of the initial brain injury have already resolved (6-18 mo post injury), the effect of multiple concussions over time remains significant and can result in long-term neurologic and functional deficits

2014 eMedicine.com

322. Neutrophilia (Diagnosis)

can occur. Neutrophilia in severe burns is accompanied by a shift to the left in the differential and the presence of degenerative forms, including toxic granulation and Dohle bodies. Postoperatively, neutrophilia occurs for 12-36 hours as a result of tissue injury–related increases in adrenocortical hormones. Leukocytosis can also occur in intestinal obstruction and strangulated hernia. Neutrophil activation during cardiopulmonary bypass (CPB) surgery may occur because of the release (...) -reactive protein and erythrocyte sedimentation rate could be helpful. In hematologic diseases, it is so important to take a peripheral blood smear to assess the abnormal shape of the cells. Bone marrow study is of great value to rule out some malignancies. Previous References Syu GD, Chen HI, Jen CJ. Differential Effects of Acute and Chronic Exercise on Human Neutrophil Functions. Med Sci Sports Exerc . 2011 Nov 29. . Gratacap RL, Rawls JF, Wheeler RT. Mucosal candidiasis elicits NF-?B activation

2014 eMedicine.com

323. Lumbosacral Spine Acute Bony Injuries (Diagnosis)

Jul-Aug. 23(4):507-9. . Saal JA. Common American football injuries. Sports Med . 1991 Aug. 12(2):132-47. . Virgin HW. Football injuries to the skeletal system. Compr Ther . 1985 Jan. 11(1):19-24. . Bowerman JW, McDonnell EJ. Radiology of athletic injuries: football. Radiology . 1975 Oct. 117(1):33-6. . Gray BL, Buchowski JM, Bumpass DB, Lehman RA, Mall NA, Matava MJ. Disc Herniations in the National Football League. Spine (Phila Pa 1976) . 2013 Sep 10. . Nagashima M, Abe H, Amaya K, Matsumoto H (...) , Yanaihara H, Nishiwaki Y, et al. Risk Factors for Lumbar Disc Degeneration in High School American Football Players: A Prospective 2-Year Follow-up Study. Am J Sports Med . 2013 Sep. 41(9):2059-64. . Schroeder GD, McCarthy KJ, Micev AJ, Terry MA, Hsu WK. Performance-Based Outcomes After Nonoperative Treatment, Discectomy, and/or Fusion for a Lumbar Disc Herniation in National Hockey League Athletes. Am J Sports Med . 2013 Aug 16. . Wilson F, Gissane C, Gormley J, Simms C. Sagittal plane motion

2014 eMedicine.com

324. Lumbosacral Radiculopathy (Diagnosis)

Radiculopathy Updated: Jan 25, 2018 Author: Gerard A Malanga, MD; Chief Editor: Craig C Young, MD Share Email Print Feedback Close Sections Sections Lumbosacral Radiculopathy Overview Background Some of the major causes of acute and chronic low back pain (LBP) are associated with radiculopathy. However, radiculopathy is not a cause of back pain; rather, nerve root impingement, disc herniation (see the image below), facet arthropathy, and other conditions are causes of back pain. [ , , ] Sagittal magnetic (...) resonance image showing loss of intervertebral disc height at L5/S1. Herniations of the nucleus pulposus are noted at L4/5 and L5/S1. Courtesy of Barton Branstetter, MD. Lumbosacral radiculopathy, like other forms of radiculopathy, results from nerve root impingement and/or inflammation that has progressed enough to cause neurologic symptoms in the areas that are supplied by the affected nerve root(s). For excellent patient education resources, visit eMedicineHealth's . Also, see eMedicineHealth's

2014 eMedicine.com

325. Lumbar Disk Problems in the Athlete (Diagnosis)

, the anterior vertebral endplates approximate, increasing the pressure of the disc posteriorly. The most common disc herniation is directed posteriorly toward the foraminal window, where the nerve roots exit the spinal canal. As such, a common mechanism of herniation in athletes is combined flexion, rotation, and compression of the spine. Football, wrestling, hockey, gymnastics, tennis, and golf are some sports in which this injury mechanism commonly occurs. In the presence of a disc herniation, forward (...) . In this scenario, there is no contact between the nucleus and the extradiscal space. Disc extrusion describes a ruptured annulus with some expelled nucleus that remains attached to the disc. Sequestered disc or complete prolapse describes a nucleus that is expelled from the disc and is no longer attached. Previous Next: Sport-Specific Biomechanics In cycling, an incorrect seat position may predispose an individual to disc herniation. Running can cause wear and tear to the vertebral discs secondary

2014 eMedicine.com

326. Lumbosacral Disc Injuries (Diagnosis)

, Wang JC. Lumbar disc arthroplasty. Spine J . 2005 Jan-Feb. 5(1):95-103. . Krych AJ, Richman D, Drakos M, Weiss L, Barnes R, Cammisa F, et al. Epidural steroid injection for lumbar disc herniation in NFL athletes. Med Sci Sports Exerc . 2012 Feb. 44(2):193-8. . Peul WC, van den Hout WB, Brand R, Thomeer RT, Koes BW. Prolonged conservative care versus early surgery in patients with sciatica caused by lumbar disc herniation: two year results of a randomised controlled trial. BMJ . 2008 Jun 14. 336 (...) (7657):1355-8. . . Saal JS, Saal JA. Management of chronic discogenic low back pain with a thermal intradiscal catheter. A preliminary report. Spine . 2000 Feb 1. 25(3):382-8. . Iwamoto J, Sato Y, Takeda T, Matsumoto H. The return to sports activity after conservative or surgical treatment in athletes with lumbar disc herniation. Am J Phys Med Rehabil . 2010 Dec. 89(12):1030-5. . Hsu WK, McCarthy KJ, Savage JW, Roberts DW, Roc GC, Micev AJ, et al. The Professional Athlete Spine Initiative: outcomes

2014 eMedicine.com

327. Lumbosacral Discogenic Pain Syndrome (Diagnosis)

injuries in athletes. Jordan BD, Tsairis, Warren TF, eds. Sports Neurology . Rockfield, Calif: Aspen Publishers; 1989. 159-179. Takahashi H, Suguro T, Okazima Y, et al. Inflammatory cytokines in the herniated disc of the lumbar spine. Spine . 1996 Jan 15. 21(2):218-24. . Taylor JR. The development and adult structure of lumbar intervertebral discs. J Man Med . 1990. 43-47. Troup JD, Martin JW, Lloyd DC. Back pain in industry. A prospective survey. Spine . 1981 Jan-Feb. 6(1):61-9. . Vadas P, Stefanski E (...) loading activities involved in sports. Back pain is second only to the common cold as a cause of lost time from work and results in more lost productivity than any other medical condition. It has been estimated to result in 175.8 million days of restricted activity annually in the United States, and at any given time, 2.4 million Americans are disabled secondary to . Of these 2.4 million Americans, one half are chronically disabled. Data from the National Ambulatory Medical Care Survey from 1989-1990

2014 eMedicine.com

328. Mechanical Low Back Pain (Diagnosis)

. The image below illustrates a at multiple levels, one of the causes of LBP. Magnetic resonance image of the lumbar spine. This image demonstrates a herniated nucleus pulposus at multiple levels. See , a Critical Images slideshow, to help diagnose and manage this common problem. Signs and symptoms An important part of the physical examination is the general observation of the patient. The patient presents with pain in the low back region and often places his or her whole hand against the skin to indicate (...) , the other investigations did not find a significant connection between a sedentary lifestyle and LBP. Chen and coauthors concluded that a sedentary lifestyle alone does not lead to LBP. In a birth cohort study from 1980-2008, Rivinoja et al investigated whether lifestyle factors, such as smoking, being overweight or obese, and participating in sports, at age 14 years would predict hospitalizations in adulthood for LBP and sciatica. [ ] The authors found that 119 females and 254 males had been

2014 eMedicine.com

329. Massage, Traction, and Manipulation (Diagnosis)

to cerebrovascular complications. Furthermore, patients with advanced rheumatoid arthritis or connective tissue disorders may be at risk for . Other relative contraindications for traction in the cervical or lumbar spine include the following: Midline herniated nucleus pulposus Acute torticollis Restrictive lung disease Active peptic ulcer Hernia Aortic aneurysm Pregnancy Akbino et al monitored systolic and diastolic blood pressure, heart rate, rate pressure product, and electrocardiography (ECG) at 5-, 10 (...) cause an increase in interdiskal pressure. Therefore, evidence is inconclusive, with much information favoring at least temporary reduction of the herniated component of an abnormal lumbar disk with concomitant traction. Some theories on the physiologic effects of traction suggest that stimulation of proprioceptive receptors in the vertebral ligaments and monosegmental muscles may alter or inhibit abnormal neural input from those structures. As with other theories to explain the physiology

2014 eMedicine.com

330. Mondor Disease (Diagnosis)

of Mondor's disease, following excision of an accessory breast]. Harefuah . 2011 Dec. 150(12):893-4, 937, 936. . Hogan GF. Mondor's disease. Arch Intern Med . 1964 Jun. 113:881-5. . Vincenza Polito M, De Cicco P, Apicella R. Tight Bra in a 34-Year-Old Woman: An Unusual Cause of Mondor's Disease. Ann Vasc Dis . 2014. 7(2):149-51. . . Tröbinger C, Wiedermann CJ. Bodybuilding-induced Mondor's disease of the chest wall. Phys Ther Sport . 2017 Jan. 23:133-135. . Alvarez-Garrido H, Garrido-Rios AA, Sanz-Munoz C (...) ):39. . Kadioglu H, Yildiz S, Ersoy YE, Yücel S, Müslümanoglu M. An unusual case caused by a common reason: Mondor's disease by oral contraceptives. Int J Surg Case Rep . 2013 Aug 3. 4(10):855-857. . Losanoff JE, Basson MD, Salwen WA, Sochaki P. Mondor's disease mimicking a Spigelian hernia. Hernia . 2008 Jan 9. . Kondo T. Traumatic funicular phlebitis of the thoracic wall resembling Mondor's disease: a case report. J Med Case Reports . 2011 Mar 30. 5(1):127. . . Schuppisser M, Khallouf J, Abbassi

2014 eMedicine.com

331. Quadriceps Injury (Diagnosis)

at the conjoined muscle tendon junction ( ). The partial tear of the quadriceps most commonly affects the indirect (distal) head of the rectus femoris. Fascial rupture usually occurs anteriorly at the mid thigh and causes a muscle hernia. Next: Epidemiology Frequency United States Although quadriceps strains are common, minimal information about the frequency with respect to specific sports is available. As for quadriceps contusions, the most detailed frequency data came from the US Military Academy at West (...) Point, [ ] and the distribution per year was reported as follows: rugby 4.7%, karate and judo 2.3%, football 1.6%, and all other sports fewer than 1%. Quadriceps muscle hernias are believed to be more common in soccer, basketball, and rugby. A study by Eckard et al that analyzed data from the NCAA Injury Surveillance Program from 2009 to 2015 found that the on quadriceps strain injury rate was 1.07/10 000 athlete-exposures. Almost 78% of quadriceps strains were sustained during practice, however

2014 eMedicine.com

332. Scrotal Trauma (Diagnosis)

for secondary testis torsion and managed per that algorithm (see ). [ , ] Painless hematoceles, especially in the pediatric population, can occur with abdominal injury (splenic laceration) and a persistent patent processus vaginalis (ie, indirect inguinal hernia) (see ). Surgical care of scrotal trauma has evolved minimally since the early descriptions by Galen. The only significant shift in surgical care has been the use of early skin grafting (reducing the duration of thigh pouches for testicles (...) , agricultural) accidents Blunt injury may result from the following: Sports Motor vehicle accidents Assault Penetrating injury (low velocity) may result from the following: Assaults Animal attacks Motor vehicle accidents Self-mutilation High-velocity penetrating injury is most often the etiology in military casualties. Previous Next: Epidemiology Scrotal trauma accounts for less than 1% of all traumas in the United States annually. The peak age range for this injury is 10-30 years. The right testis

2014 eMedicine.com

333. Pathophysiology of Chronic Back Pain (Diagnosis)

studies have indicated that any correlation between clinical symptoms and radiological signs of degeneration is minimal or nonexistent. [ , , , , , ] Inflammatory arthropathy, metabolic bone conditions, and fibromyalgia are cited in others as the cause of chronic spine-related pain conditions. [ , ] Although disk herniation has been popularized as a cause of spinal and radicular pain, asymptomatic disk herniations on computed tomography (CT) and magnetic resonance imaging (MRI) scans are common (...) sciatica. When interviewed approximately 5 years later, the lifetime prevalence had increased from 42% to 59%. Sciatica due to lumbar intervertebral disk herniations usually resolves with conservative treatment. However, it leads to surgery more often than back pain alone. In a published review of more than 15,000 disk operations, the most common surgical level was L4-5 (49.8%), followed by L5-S1 (46.9%); only 3.4% were performed at levels higher than these. Surgical treatment for lumbar diskogenic

2014 eMedicine.com

334. Osteitis Pubis (Diagnosis)

, a blood culture Imaging studies that may be helpful include the following: Plain radiography Bone scanning (technetium-99m) Single-photon emission computed tomography (SPECT) Magnetic resonance imaging (MRI) Computed tomography (CT) Other studies that may be considered are as follows: Aspiration of the pubic symphysis for culture, when the patient is febrile but blood cultures are negative Herniography, when a sports hernia is a strong consideration Treatment Rest and time are the primary healing (...) Musculoskelet Rehabil . 2012 Jan 1. 25(4):225-30. . Garvey JF, Read JW, Turner A. Sportsman hernia: what can we do?. Hernia . 2010 Feb. 14(1):17-25. . Lloyd-Smith R, Clement DB, McKenzie DC, Taunton JE. A survey of overuse and traumatic hip and pelvic injuries in athletics. Phys Sportsmed . 1985. 18(10):131-41. Westlin N. Groin pain in athletes from southern Sweden. Sports Med Arthroscopy Rev . 1997. 5:280-4. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes. Results

2014 eMedicine.com

335. Osteitis Pubis (Diagnosis)

, a blood culture Imaging studies that may be helpful include the following: Plain radiography Bone scanning (technetium-99m) Single-photon emission computed tomography (SPECT) Magnetic resonance imaging (MRI) Computed tomography (CT) Other studies that may be considered are as follows: Aspiration of the pubic symphysis for culture, when the patient is febrile but blood cultures are negative Herniography, when a sports hernia is a strong consideration Treatment Rest and time are the primary healing (...) Musculoskelet Rehabil . 2012 Jan 1. 25(4):225-30. . Garvey JF, Read JW, Turner A. Sportsman hernia: what can we do?. Hernia . 2010 Feb. 14(1):17-25. . Lloyd-Smith R, Clement DB, McKenzie DC, Taunton JE. A survey of overuse and traumatic hip and pelvic injuries in athletics. Phys Sportsmed . 1985. 18(10):131-41. Westlin N. Groin pain in athletes from southern Sweden. Sports Med Arthroscopy Rev . 1997. 5:280-4. Holt MA, Keene JS, Graf BK, Helwig DC. Treatment of osteitis pubis in athletes. Results

2014 eMedicine.com

336. Laser Discectomy (Diagnosis)

for valid outcome studies supporting the efficacy of new treatment techniques. Percutaneous laser disc decompression (PLDD) will gain wide acceptance only if it is demonstrated statistically to be a safe and effective alternative treatment for lumbar disc herniation. Epiduroscopic laser neural decompression is considered an effective treatment alternative for chronic refractory low-back or lower-extremity pain, including lumbar disc herniation, lumbar spinal stenosis, and failed back surgery syndrome (...) that cannot be alleviated with existing noninvasive conservative treatment. [ ] PLDD performed with computed tomographic (CT) and fluoroscopic guidance appears to be a safe and cost-effective treatment for herniated intervertebral discs and is being used with increasing frequency. [ ] It is minimally invasive, can be performed in an outpatient setting, requires no , results in no scarring or spinal instability, shortens the rehabilitation time, is repeatable, and does not preclude open surgery should

2014 eMedicine.com

337. Pubovaginal Sling (Diagnosis)

experience SUI when participating in sports. Female SUI may be broadly subcategorized into types I, II, and III, as follows: Type I SUI is defined as urine loss occurring in the absence of urethral hypermobility. This is the mildest form of SUI. Type II SUI is defined as urine loss occurring due to urethral hypermobility. This is also known as genuine stress urinary incontinence (GSUI). Type III SUI is defined as urine leakage occurring from an intrinsic sphincter deficiency (ISD). ISD is a more complex (...) is removed the morning after the operation. One ampule of indigo carmine is administered intravenously. Cystoscopy is performed to confirm that suspension sutures have not traversed bladder. Clear efflux of blue urine indicates ureteral patency. Potential complications include injury to the urethra, bladder, or ureters during the dissection. Bowel injury may occur during the insertion of the suprapubic tube; however, this injury is rare. Abdominal hernia formation is another potential risk. If the sling

2014 eMedicine.com

338. Ochronosis (Diagnosis)

of alkaptonuria. Clin Kidney J . 2012 Aug. 5 (4):352-5. . Ranganath LR, Cox TF. Natural history of alkaptonuria revisited: analyses based on scoring systems. J Inherit Metab Dis . 2011 Dec. 34 (6):1141-51. . Zhao BH, Chen BC, Shao de C, Zhang Q. Osteoarthritis? Ochronotic arthritis! A case study and review of the literature. Knee Surg Sports Traumatol Arthrosc . 2009 Jul. 17(7):778-81. . Vilboux T, Kayser M, Introne W, et al. Mutation spectrum of homogentisic acid oxidase (HGD) in alkaptonuria. Hum Mutat (...) , Menter A. Ochronosislike pigmentation from hydroquinone bleaching creams in American blacks. Arch Dermatol . 1985 Jan. 121(1):105-8. . Zawar VP, Mhaskar ST. Exogenous ochronosis following hydroquinone for melasma. J Cosmet Dermatol . 2004 Dec. 3(4):234-6. . Gurkanlar D, Daneyemez M, Solmaz I, Temiz C. Ochronosis and lumbar disc herniation. Acta Neurochir (Wien) . 2006 Aug. 148(8):891-4; discussion 894. . Abate M, Salini V, Andia I. Tendons Involvement in Congenital Metabolic Disorders. Adv Exp Med

2014 eMedicine.com

340. Incontinence, Urinary: Nonsurgical Therapies (Diagnosis)

deficit appears. S2-S5 nerve root injury (herniation) can cause bladder dysfunction. can develop in patients with a large centrally protruding disk. Symptoms include bilateral leg pain and weakness, saddle anesthesia, urinary retention or incontinence, and fecal retention or incontinence. It is important to recognize this syndrome early because there is a high risk for chronic neurologic deficits if treatment is delayed. Hemi–cauda equina syndrome (from a herniated lumbar disk) can also manifest

2014 eMedicine.com

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