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Family Practice, Physical Medicine and Rehabilitation
Physical Medicine and Rehabilitation
Orthopedic Surgeon, Sports Medicine
Family Practice, Sports Medicine
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Family Practice, Sports Medicine
Arthroscopy Identifies Wrist Ligament Tears in Young Athletes
More and more children and adolescents are experiencing sports injuries only seen in adults up until now. In this report, surgeons from Children's Hospital in Boston review the treatment of ligament tears in the wrist in children. Results of treatment usually used for adults are measured and reported.
Thirty-two children ages six to 17 were treated for painful ligament tears in the wrist. Most had a sports-related injury while playing football, hockey, or basketball. Some were involved in gymnastics, cheerleading, or rollerblading.
They followed the same treatment protocol as for an adult. Conservative care of cast immobilization followed by physical therapy. Surgery was delayed by at least six months. When pain persisted past that amount of time, then arthroscopic surgery was done.
The surgeon looked inside the wrist to assess the full extent of damage done. The main ligament involved was the scapholunate ligament. This ligament connects two of the wrist bones together (the scaphoid and the lunate). In all but one case, there was more than one ligament damaged. In many cases, two or more ligaments had been torn. In half the cases, bone damage was seen where the ligament(s) had been pulled away from the bone.
The surgeon removed any loose fragments of tissue or bone from the area and scraped away fibrous scar tissue. Tiny holes were drilled in the bone to help speed up healing. In a few cases, open surgery was needed to repair complete tears of the ligam...
Bone Bruises in Athletes' Knees
Did you know that the bone can get bruised? Now that we have technology like magnetic resonance imaging (MRI), discoveries like bone bruising are possible. What does it look like on the MRI? MRIs are made of signals that show up as an image on the computer screen. The signals have various levels of intensity from light to dark. Changes in the signal pattern alert the radiologist to any problems.
In the case of bone bruises, blood pooling, fluid build up (swelling), and increased blood flow to the area show up on the MRI. Water that moves seen within the bone marrow (center of the bone) is another sign of bone bruising. If the injury is severe enough, there can even be tiny fracture lines in the bone referred to as microfractures.
Traumatic bone bruises of the knee are the subject of this article written by two orthopedic surgeons. One surgeon is from Harvard Medical School (Boston). The other hails from Vanderbilt Sports Medicine Center at the Vanderbilt University Medical Center in Nashville, Tennessee.
Bone bruises of the knee from trauma in athletes affect the subchondral bone. This is the first layer of bone underneath the cartilage of the knee. The most common injury associated with bone bruising is a rupture of the anterior cruciate ligament (ACL).
You've probably heard of ACL injuries. The ACL is one of two ligaments that criss-cross each other inside the knee. An injury severe enough to pull the ligament off the bone where it attaches can also cause bone bruising. In fact, 80 per cent of all patients who suffer an ACL rupture also have evidence of bone bruising on MRIs.
Without the ACL to hold the tibia (lower leg bone) from sliding too far under the femur (thigh bone) the impact of the injury, the loss of the ligament, and the movement of bone-on-bone leaves the site of the rupture bruised. In fact, there's even a telltale sign on the bone called the footprint that shows where the impact left the bruise.
Studies have shown that the severity of bone bruising is a direct result of the energy of the injury. Contact injuries (the athlete is hit by another player or falls and makes contact with the ground) have more energy behind them than noncontact injuries (the foot is planted on the ground and the player makes a sudden change in direction).
Recognizing the fact that bone bruising occurs is a fairly new discovery. Knowing what happens in the long-term is unclear. Repeat MRIs show that the bruising goes away over time (usually within 60 days).
Studies done so far don't show any problem with returning to normal function after a bone bruise. Most athletes are back on the field within six months' time. The real question on everyone's minds is whether or not the bruising will result in arthritis later.
We know that damage to the articular cartilage lining the joint is a poor prognostic sign -- that means when the cartilage is damaged, it's very likely there will be problems with arthritis later. As...
Hip Injuries in Athletes
Sports medicine physicians and orthopedic surgeons see all kinds of injuries in the athletic population. One of the less common but very challenging areas of injury to evaluate is the hip. More specifically, the lateral hip (along the side of the upper thigh/buttock area) gets our attention today.
To help professionals involved with lateral hip pain in athletes, the authors of this article provide a review of the area anatomy. Besides the hip joint itself, which is very complex, there are various ligaments, muscles, connective tissue, bursae, blood vessels, and nerves to consider.
Suggestions are offered for the examination, which includes taking a good patient history and conducting a thorough physical exam. For example, there are six bursae in and around the hip that must be examined carefully. These structures are designed to keep tendons and other soft tissues from rubbing against the bone underneath. It is not uncommon for one or more bursae to become painfully inflamed.
Each muscle group must be inspected and palpated. Any changes in the way the patient moves or walks might be traced back to a specific muscle or muscle group. Posture, hip range of motion, and specific sites of tenderness provide helpful clues to what is going on.
Making the diagnosis is based on an understanding of what happened, how it happened, clinical presentation (signs and symptoms), and the results of specific tests. It's really a differential diagnosis meaning the physician sorts through all the possible problems that could be present. Using the information collected so far, the doctor rules out those that don't fit the description. Then further tests are done until the final diagnosis is made.
Some of the most common choices in the differential diagnosis include: hip pointer, greater trochanter bursitis, iliotibial band syndrome, snapping hip syndrome, tendon tears, and meralgia paresthetica. Let's take a closer look at each of these conditions.
Athletes who collide with others or who take the force of a helmeted head into the lateral hip can end up with a hip pointer. This injury or contusion is visible as blood under the skin leaves a large bruise. It is treated with a leave it alone approach. Ice, rest, and compression help the body complete its natural course of healing.
Bursitis is best treated by finding out what is causing the friction in the first place and dealing with that problem. It could be tight, inflexible muscles, tendons, or fascia. Stretching, strengthening, and manual therapy under the supervision of a physical therapist may be advised. Or it could be a postural or alignment problem such as a leg length difference, unsupported flat feet, or even broken down running shoes.
Sometimes a tendon (e.g., the iliotibial band along the outside of the leg) snaps over the bone underneath. This condition is called iliotibial (IT) band syndrome or snapping hip syndrome. The IT band can be so tight that movement ca...