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PubMed2006

Osteochondroma causing diaphragmatic rupture and bowel obstruction in a 14-year-old boy.

Exostosis, also known as osteochondroma, results from a disorder of the growth-plate where bone grows away from the growth axis and forms an irregular projection. This abnormality most commonly occurs around the femur, scapula, humerus, and ribs. Although hemothorax and diaphragmatic rupture are known complications of exostosis growth, we present herein the first known report of an inward-facing exostosis in a 14-year-old boy with hereditary multiple exostosis causing diaphragmatic rupture and a bowel obstruction requiring operation. Most exostoses are asymptomatic and as such require no further treatment. However, when they are threatening to cause mass effects (such as frictional bursitis, local entrapment of vessels, and tendons or nerves) or symptomatic, surgical resection is the appropriate treatment.

Adolescent↗
PubMed1979

Locking of the metacarpophalangeal joint: a case report.

A case of an unusual cause of locking of the finger is described. This was brought about by the presence of an exostosis arising from the metacarpal bone, causing rupture of the capsule of the metacarpophalangeal joint with entrapment of the interosseus tendon.

Exostoses↗
PubMed1983

Localized rheumatologic diseases. Common diagnostic challenges.

Rheumatic pain is usually generalized, but in a variety of conditions it may present as localized and often remain so. These conditions include palindromic rheumatism, osteoarthritis, gout or pseudogout, seronegative spondyloarthropathy, septic arthritis, tendinitis and bursitis, radiculopathy and nerve entrapment, nodular growth, and tendon enlargement. When the presenting feature is focal pain in muscles, joints, or fibrous tissue, the differential diagnosis should include these considerations.

Arthritis, Infectious↗
PubMed1994

Common nonarticular syndromes in the elbow, wrist, and hand.

Nonarticular elbow, wrist, and hand discomfort commonly results from periarticular or tendon disorders or nerve entrapment. Physicians with a practical knowledge of upper extremity anatomy and mechanics and an awareness of the typical features of disease are best equipped to treat these often-encountered conditions. Therapy is based on an accurate diagnosis and should be tailored to each disorder.

Arm↗
PubMed2003

Magnetic resonance imaging of sports injuries of the elbow.

Many abnormalities seen in the elbow result from trauma, often from sports such as baseball and tennis. Elbow problems are frequently related to the medial tension-lateral compression phenomenon, where repeated valgus stress produces flexor-pronator strain, ulnar collateral ligament sprain, ulnar traction spurring, and ulnar neuropathy. Lateral compression causes osteochondral lesions of the capitellum and radial head, degenerative arthritis, and loose bodies. Other elbow abnormalities seen on magnetic resonance imaging include radial collateral ligament injuries, biceps and triceps tendon injuries, other nerve entrapment syndromes, loose bodies, osseous and soft-tissue trauma, arthritis, and masses, including bursae.

Athletic Injuries↗
PubMed2001

Chronic occupational repetitive strain injury.

OBJECTIVE: To review common repetitive strain injuries (RSIs) that occur in the workplace, emphasizing diagnosis, treatment, and etiology of these conditions. QUALITY OF EVIDENCE: A MEDLINE search from January 1966 to June 1999 focused on articles published since 1990 because RSIs are relatively new diagnoses. MeSH headings that were explored using the thesaurus included "cumulative trauma disorder," "overuse injury," and "repetitive strain injury." The search was limited to English articles only, and preference was given to randomized controlled trials. MAIN MESSAGE: Repetitive strain injuries result from repeated stress to the body's soft tissue structures including muscles, tendons, and nerves. They often occur in patients who perform repetitive movements either in their jobs or in extracurricular activities. Common RSIs include tendon-related disorders, such as rotator cuff tendonitis, and peripheral nerve entrapment disorders, such as carpal tunnel syndrome. A careful history and physical examination often lead to the diagnosis, but newer imaging techniques, such as magnetic resonance imaging and ultrasound, can help in refractory cases. Conservative management with medication, physiotherapy, or bracing is the mainstay of treatment. Surgery is reserved for cases that do not respond to treatment. CONCLUSION: Repetitive strain injury is common; primary care physicians must establish a diagnosis and, more importantly, its relationship to occupation. Treatment can be offered by family physicians who refer to specialists for cases refractory to conservative management.

Chronic Disease↗
PubMed2003

Meniscal repair with the Rapid Loc device: a cadaveric study.

The devices available for all-inside meniscal repair were evaluated using a cadaver model. Rapid Loc devices (Mitek, Westwood, Mass) were inserted arthroscopically into 8 fresh-frozen cadaveric knees (age range: 66-78 years) in the posterior regions of the menisci at 5- to 7-mm intervals. Forty-eight devices were placed (3 in each meniscus), and the knees were subsequently dissected to determine the location of the inserted devices. Devices were correctly inserted in 40 (833%) of 48 knees. No problems were noted with loss of fixation on the periphery of the meniscus. Entrapment of the popliteus tendon (3 of 8) and superficial medial collateral ligament (2 of 16) were the only major problems with the device.

Aged↗
PubMed1989

[Computed tomography of calcaneal fractures--comparison with conventional radiography].

Computed tomography (CT) and conventional radiography were compared in 52 calcaneal fractures. As for CT, direct coronal imagings were performed in all and direct axial imagings were added in 27 of them. Conventional radiography included lateral, axial, and Anthonsen (oblique) views. Overall CT detected 7 more of the incongruity of the posterior facet, 9 more of the bulging of the lateral wall, and 6 more of the fracture of the sustentaculum tali than conventional radiography. In addition the entrapment of the peroneal tendons between the calcaneal body and the fibular malleolus could be evaluated only with CT. These informations are indispensable for the proper treatment of the fractures and we conclude that CT is useful in evaluating calcaneal fractures.

Adult↗
PubMed1998

Cine magnetic resonance imaging of the subcoracoid region.

Cine magnetic resonance imaging (MRI) was used to define the normal space between the humeral head and coracoid process, known as the subcoracoid space, to quantify the subcoracoid space in symptomatic patients and identify the anatomic structures responsible for narrowing of this space. The study population was comprised of 50 normal volunteers and 75 patients with shoulder pain. All subjects underwent cine MRI of the shoulder using a shoulder-rotating device that allows progressive rotation of the glenohumeral joint in 10 degrees increments from internal to external rotation while scanning the shoulder in the axial plane. In asymptomatic patients, the normal interval between the lesser tuberosity and coracoid process (coracohumeral distance) averaged 11 mm in maximum internal rotation. In symptomatic patients, impingement or entrapment of the subscapularis tendon and other soft-tissue structures between the lesser tuberosity and the coracoid process in internal rotation was identified, and the mean distance between the lesser tuberosity and coracoid process measured 5.5 mm in maximum internal rotation. This new MRI technique for shoulder imaging is safe, easy to perform, noninvasive, and well-tolerated by patients. Cine MRI provides valuable information on the subcoracoid region not obtainable with other methods.

Humans↗
PubMed1985

Management of acute flexor tendon injury in the hand.

In this report, we have attempted to review the current state of the art with regard to the treatment of partial flexor tendon injuries, the strength of the flexor tendons and its relationship to complete tendon lacerations, and the importance of passive joint motion to improve tendon excursion. At this time, it appears that most partial flexor tendon injuries are best treated by nonsurgical repair and an early active assisted or passive range-of-motion exercise program for a period of 3 to 4 weeks. Protecting the hand up to a total of 10 to 12 weeks seems reasonable based on studies of tendon strength. Surgical intervention is necessary to prevent complications of triggering, entrapment, or rupture, which generally occur with lacerations of greater than 60%. We would reserve the repair of partial flexor tendon injuries to lacerations where tendon rupture, triggering, or entrapment would be expected. After flexor tendon repair, knowledge of the strength of tendons and the need for passive mobilization are important. There is not sufficient strength within the flexor tendon repair site to allow for active mobilization sooner than 17 days. Probably only with a lateral trap stitch similar to that described by Becker or with extremely well supervised and trusted patients can active motion be started this early. There is insufficient intrinsic tendon strength to consider active motion (without assistance) earlier than 3 1/2 to 4 weeks. Passive range of motion using the Kleinert-Atasoy or Durand technique before this period is important in not only increasing tendon gliding (or excursion) but also being a stimulus to improve flexor tendon healing strength.(ABSTRACT TRUNCATED AT 250 WORDS)

Adolescent↗
PubMed1983

Hand difficulties among musicians.

We describe our experience with 100 musicians in whom occupation-related difficulties developed. The majority, pianists, experienced hand difficulties in midcareer (average age, 31 years). These were described as "pain, tightening, or weakness" of the right hand or arm or drooping of the fourth or fifth fingers. These difficulties led to loss of control (34%) or diminished facility (18%), endurance (18%), or speed (18%) while playing trills, arpeggios, or octaves requiring fast, forte finger movements. Most commonly found were inflammatory disorders of tendon or joint (45%) or disorders of motor control (24%). Less likely were entrapment of peripheral nerves and noninflammatory tendon or joint disorders.

Adolescent↗
PubMed1986

Peroneal tendon injuries: CT analysis.

Computed tomographic (CT) evaluation of the peroneal tendons was obtained in 25 normal ankles and 30 abnormal ankles studied for trauma. The tendons and associated soft-tissue and bony structures, such as the calcaneofibular ligament, superior and inferior peroneal retinacula, fibular groove, and peroneal tubercle, which have heretofore evaded documentation on routine radiographs, are illustrated and discussed. Special attention is given to normal variations such as convex fibular tip and enlarged peroneal tubercle, which predispose the peroneal tendons to abnormal mechanical stresses. Examples of CT-established peroneal tendon abnormalities in the 30 cases examined are also demonstrated. These abnormalities include subluxation, dislocation, entrapment, and tenosynovitis of the peroneal tendons. The authors believe CT has proved to be an extremely useful and relatively noninvasive imaging tool for the evaluation of peroneal tendon injuries.

Adolescent↗
PubMed1993

Peripheral nerve entrapment, occupation-related syndromes and sports injuries, and bursitis.

A growing interest in nonarticular rheumatic conditions has been shown recently by the large number of articles published on the subject. In this review, three nerve entrapment syndromes and problems of four tendons of the ankle region are covered. Suprascapular neuropathy is underrecognized and, in many cases, may be treated conservatively. Entrapment of the radial and ulnar nerves may be caused by a variety of conditions, some of which are unusual. Tenosynovitis and rupture of the tendons of the ankle region, including the posterior tibial, anterior tibial, peroneus longus, and Achilles tendons, are reviewed.

Adult↗
PubMed1975

Iatrogenic entrapment of femoropopliteal saphenous vein bypass grafts by the gastrocnemius muscle.

Two patients are described in whom saphenous vein grafts placed distal to the knee joint were "entrapped" by the medial gastrocnemius tendon. In one, the superficial position of the graft was detected by postoperative angiography. In the other, a true aneurysm of the vein graft developed over a 3 year period. The similarity between the iatrogenic and congenital forms of the popliteal entrapment syndrome is noted.

Arterial Occlusive Diseases↗
PubMed1982

Intermittent claudication in an athlete--popliteal artery entrapment: a case report.

This case study reports a 26 year old female athlete who presented with a history of cramp-like right calf pain. She was limited to a walking distance of only three blocks. She had been referred to the Sports Medicine Clinic with a diagnosis of "shin splints". On examination of the pedal pulses it was found that the right posterior tibial pulse was absent. A diagnosis of popliteal artery entrapment was made which was confirmed by Doppler studies following treadmill walking and femoral arteriograms. Surgery was performed which included resection of the entrapped artery by the plantaris tendon and endarterectomy, plus patch graft angioplasty. The artery had been completely occluded. The patient resumed full activity pain free. This case report emphasizes that all leg pains in athletes are not variants of "shin splints". Popliteal artery entrapment is an uncommon condition that requires early detection. A detailed history and thorough examination of the peripheral pulses is essential to prevent long term sequelae of arterial deficiency.

Adult↗
PubMed2005

Arthroscopic tenodesis for lesions of the long head of the biceps.

OBJECTIVE: Resection of the intraarticular part of the long head of the biceps and tenodesis to decrease shoulder pain due to a pathologically altered biceps tendon and to improve shoulder function. INDICATIONS: Tenosynovitis. State of prerupture. Instability (subluxation or dislocation of tendon from intertubercular groove). Intraarticular entrapment secondary to hypertrophy of the long head of the biceps in the presence of an intact cuff. To be performed during arthroscopic cuff repair or during debridement of an irreparable cuff tear. CONTRAINDICATIONS: Very thin, frayed, almost ruptured biceps tendon. Complete rupture of the long head of the biceps. SURGICAL TECHNIQUE: Standard arthroscopy with 30 degrees scope inserted through the posterior portal. Detachment of the long head from the glenoid origin. Longitudinal opening of the bicipital groove. Exteriorization and doubling of the tendon. Drilling of a socket starting in the groove but perforating the posterior cortex only with a guide wire. Passing of the tendon in an anteroposterior direction and securing the anchorage with a bioresorbable PLA interference screw. RESULTS: Between 1997 and 1999, an arthroscopic tenodesis was performed in 43 patients. Minimum follow-up 2 years. The absolute Constant Score improved from 43 points preoperatively to 79 points at the time of follow-up. No loss of elbow extension or flexion; power of biceps after tenodesis 90% of opposite side. Early on, two failures of tenodesis occurred.

Adult↗
PubMedDate not supplied

Treatment of brachymetatarsia by distraction osteogenesis.

Metatarsal lengthening by distraction osteogenesis was performed on 17 brachymetatarsia patients with 39 metatarsal bones. To lengthen the first metatarsal in an attempt to prevent development of varus deformity of the hindfoot after lengthening, horizontal lengthening in the anterior direction was performed rather than lengthening through the anatomical axis. In addition, care was taken to ensure that the fourth metatarsal bone screw did not interpose with the fifth extensor tendon during the fourth metatarsal lengthening. Lengthening was successful except in 1 case with mean lengthening of 19.5 mm (48.8%) for the first metatarsal and 17.1 mm (36.2%) for the fourth metatarsal. Because of joint stiffness, plantar capsulotomy was performed on 7 cases, 6 of which had been previously operated on bilaterally. Varus deformity of the hindfoot after the first metatarsal lengthening and entrapment of the fifth extensor tendon after the fourth metatarsal lengthening was not detected in any case.

Adolescent↗