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Several risk factors of CMC OA of the thumb are known. Each of these risk factors does not cause CMC OA by itself, but acts as a predisposing factor influencing the process of OA in some way. Risk factors include: female gender, suffering from obesity, repetitive heavy manual labor, familial predisposition and hormonal changes, such as menopause.
Treatment generally consists of rest, followed by a controlled exercise program, based on clinical and ultrasound findings. Many other treatments related to tendon and ligament injuries have been tried. (See tendinitis)
CMC OA is the most common form of OA affecting the hand. Dahaghin et al. showed that about 15% of women and 7% of men between 50 and 60 years of age suffer from CMC OA of the thumb. However, in about 65% of people older than 55 years, radiologic evidence of OA was present without any symptoms. Armstrong et al. reported a prevalence of 33% in postmenopausal women, of which one third was symptomatic, compared to 11% in men older than 55 years. This shows CMC OA of the thumb is significantly more prevalent in women, especially in postmenopausal women, compared to men.
First options for treatment are conservative, using hot or cold packs, rest and NSAID's at first. If no improvement is made, a splint or brace can be used to keep the deviated arm straight. When none of the conservative treatments work surgical intervention is designated.
Treatment generally includes the following:
- Sometimes pharmacologic therapy for initial disease treatment
- Physical therapy
- Occupational therapy
- Use of appropriate assistive devices such as orthoses
- Surgical treatment
Surgical management options include extensive cervical laminectomy with or without an additional posterior arthrodesis, anterior decompression and arthrodesis, and posterior cervical laminoplasty. Treatment decisions can be made based on a grading systems devised by Hirabayashi et al., supplemented by the Nurick myelopathy classification system.
Post-traumatic wrist osteoarthritis can be treated conservatively or with a surgical intervention. In many patients, a conservative (non-surgical) approach is sufficient. Because osteoarthritis is progressive and symptoms may get worse, surgical treatment is advised in any stage.
"Physiolysis"
Purpose of the treatment is the removal of the epiphysis that causes the abnormal growth of the wrist. This is done by making a small incision at the volar-radial side. This approach passes the Flexor pollicis longus and Palmaris longus and leaves the Median nerve and Radial artery protected. Then the Pronator quadratus muscle is found and detached from the radius. Here a cut into the bone will find the abnormal epiphysis. When the epiphysis is clearly defined more bone is removed so the radius is in its normal position and prevents a new bone bar from forming. This is the end of the physiolisis. This is always combined with a Vickers Ligament release.
"Dome osteotomy"
Purpose of this treatment option is to straighten the abnormal radius. To do this, an 8 cm incision is made from the wrist crease at the palmair radial side. The approach is made passing the Flexor carpi radialis with detachment of the Pronator quadratus muscle from the radius. Now the Vickers ligament release is done. After this the periosteum is elevated and a crescent-shaped osteotomy, concave at the end, is marked on the bone. Now the radius is cut dome shaped and straightened. The distal end of the radius stays attached to the ulna. The dome shape of the osteotomy allows adequate bony contact for stability and a subperiosteal void for rapid healing.
"Vickers Ligament Release"
This ligament causes the wrist to deform even more. The purpose of this release is to release the tension and leave the wrist straight in further growth. In both physiolysis and dome osteonomy there should be a clear view of the abnormal.
To resolve the problem, the affected arm is moved in a way that causes the joint to move back into a normal position. The two main methods are hyperpronation and a combination of supination and flexion. Hyperpronation has a higher success rate and is less painful than a supination-flexion maneuver.
For stage I, normally, nonsurgical treatment is sufficient. This type of therapy includes the use of splint or cast immobilization, injections of corticosteroid in the pain causing joints and the use of a systemic non-steroidal anti-inflammatory drug to reduce pain and improve the functional use of the affected joint. However, the amount of pain that can be suppressed by nonsurgical therapy is limited and with the progression of the wrist osteoarthritis surgical treatment is inevitable.
In stage I surgical treatment often consists of neurectomy of the posterior interosseous nerve and is often combined with other procedures. In the case of a SLAC, the scapholunate ligament can be reconstructed in combination with a radial styloidectomy, in which the radial styloid is surgically removed from the distal radius. In the case of a SNAC, the scaphoid can be reconstructed by fixating the scaphoid with a screw or by placing a bone graft(Matti-Russe procedure)to increase the stability of the scaphoid.
This method should be used within the first 48–72 hours after the injury in order to speed up the recovery process.
Heat: Applying heat to the injured area can cause blood flow and swelling to increase.
Alcohol: Alcohol can inhibit your ability to feel if your injury is becoming more aggravated, as well as increase blood flow and swelling.
Re-injury: Avoid any activities that could aggravate the injury and cause further damage.
Massage: Massaging an injured area can promote blood flow and swelling, and ultimately do more damage if done too early.
An effective rehabilitation program reduces the chances of reinjury and of other knee-related problems such as patellofemoral pain syndrome and osteoarthritis. Rehabilitation focuses on maintaining strength and range of motion to reduce pain and maintain the health of the muscles and tissues around the knee joint.
With rest and quadriceps flexibility exercises the condition settles with no secondary disability. Sometimes, if the condition does not settle, calcification appears in the ligament. This condition is comparable to Osgood-Schlatter’s disease and usually recovers spontaneously. If rest fails to provide relief, the abnormal area is removed and the paratenon is stripped.
The use of surgery to treat a Jefferson fracture is somewhat controversial. Non-surgical treatment varies depending on if the fracture is stable or unstable, defined by an intact or broken transverse ligament and degree of fracture of the anterior arch. An intact ligament requires the use of a soft or hard collar, while a ruptured ligament may require traction, a halo or surgery. The use of rigid halos can lead to intracranial infections and are often uncomfortable for individuals wearing them, and may be replaced with a more flexible alternative depending on the stability of the injured bones, but treatment of a stable injury with a halo collar can result in a full recovery. Surgical treatment of a Jefferson fracture involves fusion or fixation of the first three cervical vertebrae; fusion may occur immediately, or later during treatment in cases where non-surgical interventions are unsuccessful. A primary factor in deciding between surgical and non-surgical intervention is the degree of stability as well as the presence of damage to other cervical vertebrae.
Though a serious injury, the long-term consequences of a Jefferson's fracture are uncertain and may not impact longevity or abilities, even if untreated. Conservative treatment with an immobilization device can produce excellent long-term recovery.
Two types of treatment options are typically available:
- Surgery
- Conservative treatment (rehabilitation and physical therapy)
Surgery may impede normal growth of structures in the knee, so doctors generally do not recommend knee operations for young people who are still growing. There are also risks of complications, such as an adverse reaction to anesthesia or an infection.
When designing a rehabilitation program, clinicians consider associated injuries such as chipped bones or soft tissue tears. Clinicians take into account the person's age, activity level, and time needed to return to work and/or athletics. Doctors generally only recommend surgery when other structures in the knee have sustained severe damage, or specifically when there is:
- Concurrent osteochondral injury
- Continued gross instability
- Palpable disruption of the medial patellofemoral ligament and the vastus medialis obliquus
- High-level athletic demands coupled with mechanical risk factors and an initial injury mechanism not related to contact
Supplements like glucosamine and NSAIDs can be used to minimize bothersome symptoms.
Most commonly due to anterior shoulder dislocation caused by hyperabduction and external rotation of the arm. Usually in young men who play contact sports (E.g. rugby, football, volleyball, basketball, etc.). Frequent anterior (frontward) subluxation also poses a great risk factor.
Most patients suffer from only mild symptoms. Symptoms typically last approximately 13 months. Of patients without myelopathy at initial presentation, only 29% of them will develop myelopathy within 30 years.
Humeral avulsion of the glenohumeral ligament (HAGL) is defined as an avulsion (tearing away) of the inferior glenohumeral ligament from the anatomic neck of the humerus. In other words, it occurs when we have disruption of the ligaments that join the humerus to the glenoid.
HAGL tends to occur in 7.5-9.3% of cases of anterior shoulder instability. Making it an uncommon cause of anterior shoulder instability.
Avulsion of this ligamentous complex may occur in three sites: glenoid insertion (40%), the midsubstance (35%) and the humeral insertion (25%).
Treatment is aimed at achieving a stable, aligned, mobile and painless joint and to minimize the risk of post-traumatic osteoarthritis. To achieve this operative or non-operative treatment plans are considered by physicians based on criteria such as patient characteristics, severity, risk of complications, fracture depression and displacement, degree of injury to ligaments and menisci, vascular and neurological compromise.
For early management, traction should be performed early in ward. It can either be Skin Traction or Skeletal Traction. Depends on the body weight of patient and stability of the joint. Schantz pin insertion over the Calcaneum should be done from Medial to lateral side.
Later when condition is stable. Definitive plan would be Buttress Plating and Lag Screw fixation.
Future research with regard to medial knee injuries should evaluate clinical outcomes between different reconstruction techniques. Determining the advantages and disadvantages of these techniques would also be beneficial for optimizing treatment.
Ross et al. (2002), "Curb: A Collection of Plantar Tarsal Soft Tissue Injuries", in "Proceedings of the American Association of Equine Practitioners", 48(337-342)
In most people, ligaments (which are the tissues that connect bones to each other) are naturally tight in such a way that the joints are restricted to 'normal' ranges of motion. This creates normal joint stability. If muscular control does not compensate for ligamentous laxity, joint instability may result. The trait is almost certainly hereditary, and is usually something the affected person would just be aware of, rather than a serious medical condition. However, if there is widespread laxity of other connective tissue, then this may be a sign of Ehlers-Danlos syndrome.
Ligamentous laxity may also result from injury, such as from a vehicle accident. It can result from whiplash and be overlooked for years by doctors who are not looking for it, despite the chronic pain that accompanies the resultant spinal instability. Ligamentous laxity will show up on an upright magnetic resonance imaging (MRI), the only kind of MRI that will show soft tissue damage. It can be seen in standing stress radiographs in flexion, extension, and neutral views as well, and also digital motion X-ray, or DMX.
An advantage to having lax ligaments and joints is the ability to withstand pain from hyperextension; however, this is also a disadvantage as a lack of perceived pain can prevent a person from removing the ligament from insult, leading to ligament damage. This can also lead to death if you tear the wrong ligament. People with hypermobile joints (or "double-jointed" people), almost by definition, have lax ligaments.
If the displacement at fracture is less than 2 mm, it may be managed conservatively. However, displacement requires open reduction and internal fixation, especially when displacement is over 2 mm.
The Segond fracture is a type of avulsion fracture (soft tissue structures tearing off bits of their bony attachment) of the lateral tibial condyle of the knee, immediately beyond the surface which articulates with the femur.
Originally described by Dr. Paul Segond in 1879 after a series of cadaveric experiments, the Segond fracture occurs in association with tears of the anterior cruciate ligament (ACL) (75–100%) and injury to the medial meniscus (66–75%), lateral capsular ligament (now known as the Anterolateral ligament, or ALL), as well as injury to the structures behind the knee.
A rare, mirror image of the Segond fracture has also been described. The so-called "reverse Segond fracture" can occur after an avulsion fracture of the tibial component of the medial collateral ligament (MCL) in association with posterior cruciate ligament (PCL) and medial meniscal tears.
Segond fracture is typically the result of abnormal varus, or "bowing", stress to the knee, combined with internal rotation of the tibia. Reverse Segond fracture, as its name suggests, is caused by abnormal valgus, or "knock-knee", stress and external rotation.
Originally thought to be a result of avulsion of the medial third of the lateral collateral ligament, the Segond fracture has been shown by more recent research to relate also to the insertion of the iliotibial tract (ITT) and the anterior oblique band (AOB), a ligamentous attachment of the fibular collateral ligament (FCL), to the midportion of the lateral tibia and to be associated with avulsion by the anterolateral ligament (ALL). (Roberts CC, Towers JD, Spangehl MJ et-al. Advanced MR imaging of the cruciate ligaments. Radiol. Clin. North Am. 2007;45 (6): 1003-16, vi-vii.)"