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Usually, a SCFE causes groin pain, but it may cause pain in only the thigh or knee, because the pain may be referred along the distribution of the obturator nerve. The pain may occur on both sides of the body (bilaterally), as up to 40 percent of cases involve slippage on both sides. After a first SCFE, when a second SCFE occurs on the other side, it typically happens within one year after the first SCFE. About 20 percent of all cases include a SCFE on both sides at the time of presentation.
Signs of a SCFE include a waddling gait, decreased range of motion. Often the range of motion in the hip is restricted in internal rotation, abduction, and flexion. A person with a SCFE may prefer to hold their hip in flexion and external rotation.
The most common symptom is pain over the heel area, especially when the heel is palpated or squeezed. Patients usually have a history of recent trauma to the area or fall from a height. Other symptoms include: inability to bear weight over the involved foot, limited mobility of the foot, and limping. Upon inspection, the examiner may notice swelling, redness, and hematomas. A hematoma extending to the sole of the foot is called "Mondor Sign", and is pathognomonic for calcaneal fracture. The heel may also become widened with associated edema due to displacement of lateral calcaneal border. Involvement of soft tissue (tendons, skin, etc.,) should be evaluated because soft tissue injury has been associated to serious complications (see below).
Failure to treat a SCFE may lead to: death of bone tissue in the femoral head (avascular necrosis), degenerative hip disease (hip osteoarthritis), gait abnormalities and chronic pain. SCFE is associated with a greater risk of arthritis of the hip joint later in life. 17-47 percent of acute cases of SCFE lead to the death of bone tissue (osteonecrosis) effects.
People usually present with a history of an injury and localized pain. There is often a deformity in the wrist with associated swelling. Numbness of the hand can occur because of compression on the median nerve across the wrist (carpal tunnel syndrome). The wrist deformity often limits motion of the fingers.
People often describe pain as being “inside the knee cap.” The leg tends to flex even when relaxed. In some cases, the injured ligaments involved in patellar dislocation do not allow the leg to flex almost at all.
Swelling, deformity, tenderness and loss of wrist motion are normal features on examination of a person with a distal radius fracture. Examination should rule out a skin wound which might suggest an open fracture. It is imperative to check for loss of sensation, loss of circulation to the hand, and more proximal injuries to the forearm, elbow and shoulder. The most common associated neurological finding is decreased sensation over the thenar eminence due to associated median nerve injury.
A classic "dinner fork" deformity may be seen in dorsally angulated fractures due to dorsal displacement of the carpus. The reverse deformity may be seen in volarly angulated fractures.
Nine out of ten hip dislocations are posterior. The affected limb will be in a position of flexion, adduction, and internally rotated in this case. The knee and the foot will be in towards the middle of the body. A sciatic nerve palsy is present in 8%-20% of cases.
Signs and symptoms of a dislocation or rotator cuff tear such as:
- Significant pain, which can sometimes be felt past the shoulder, along the arm.
- Inability to move the arm from its current position, particularly in positions with the arm reaching away from the body and with the top of the arm twisted toward the back.
- Numbness of the arm.
- Visibly displaced shoulder. Some dislocations result in the shoulder appearing unusually square.
- No bone in the side of the shoulder showing shoulder has become dislocated.
In an anterior dislocation the limb is held by the patient in externally rotated with mild flexion and abduction. Femoral nerve palsies can be present, but are uncommon.
A calcaneal fracture is a break of the calcaneus (heel bone). Symptoms may include pain, bruising, trouble walking, and deformity of the heel. It may be associated with breaks of the hip or back.
It usually occurs when a person lands on their feet following a fall from a height or during a motor vehicle collision. Diagnosis is suspected based on symptoms and confirmed by X-rays or CT scaning.
If the bones remain normally aligned treatment may be by casting without weight bearing for around eights weeks. If the bones are not properly aligned surgery is generally required. Returning the bones to their normal position results in better outcomes. Surgery may be delayed a few days as long as the skin remained intact.
About 2% of all fractures are calcaneal fractures, however, they make up 60% of fractures of the mid foot bones. Undisplaced fractures may heal in around three months while more significant fractures can take two years. Difficulties such as arthritis and decreased range of motion of the foot may remain.
Tibial plateau fractures typically presents with knee effusion, swelling of the knee soft tissues and inability to bear weight. The knee may be deformed due to displacement and/or fragmentation of the tibia which leads to loss of its normal structural appearance. Blood in the soft tissues and knee joint (hemarthrosis) may lead to bruising and a doughy feel of the knee joint. Due to the tibial plateau's proximity to important vascular (i.e. arteries, veins) and neurological (i.e. nerves such as peroneal and tibial) structures, injuries to these may occur upon fracture. A careful examination of the neurovascular systems is imperative. A serious complication of tibial plateau fractures is compartment syndrome in which swelling causes compression of the nerves and blood vessels inside the leg and may ultimately lead to necrosis or cell death of the leg tissues.
Supracondylar humerus fractures typically result from a fall on to an outstretched arm, usually leading to a forced hyperextension of the elbow. Typically, this is an isolated injury to the elbow (no injuries elsewhere). Children with this injury present with pain and swelling about the elbow. Motion at the elbow and at the wrist make the pain worse. With mild or moderate fracture displacement, there may be deformity at the elbow.
People with olecranon fractures present with intense elbow pain after a direct blow or fall. Swelling over the bone site is seen and an inability to straighten the elbow is common. Due to the proximity of the olecranon to the ulnar nerve, the injury and swelling may cause numbness and tingling at the 4th and 5th fingers. Examination can bring out a palpable defect at the site of the fracture.
A supracondylar humerus fracture is a fracture of the distal humerus just above the elbow joint. The fracture is usually transverse or oblique and above the medial and lateral condyles and epicondyles. This fracture pattern is relatively rare in adults, but is the most common type of elbow fracture in children. In children, many of these fractures are non-displaced and can be treated with casting. Some are angulated or displaced and are best treated with surgery. In children, most of these fractures can be treated effectively with expectation for full recovery. Some of these injuries can be complicated by poor healing or by associated blood vessel or nerve injuries with serious complications.
A tear of a meniscus is a rupturing of one or more of the fibrocartilage strips in the knee called menisci. When doctors and patients refer to "torn cartilage" in the knee, they actually may be referring to an injury to a meniscus at the top of one of the tibiae. Menisci can be torn during innocuous activities such as walking or squatting. They can also be torn by traumatic force encountered in sports or other forms of physical exertion. The traumatic action is most often a twisting movement at the knee while the leg is bent. In older adults, the meniscus can be damaged following prolonged 'wear and tear' called a degenerative tear.
Tears can lead to pain and/or swelling of the knee joint. Especially acute injuries (typically in younger, more active patients) can lead to displaced tears which can cause mechanical symptoms such as clicking, catching, or locking during motion of the knee joint. The joint will be in pain when in use, but when there is no load, the pain goes away.
A tear of the medial meniscus can occur as part of the unhappy triad, together with a tear of the anterior cruciate ligament and medial collateral ligament.
A patellar dislocation is a knee injury in which the patella (kneecap) slips out of its normal position. Often the knee is partly bent, painful and swollen. The patella is also often felt and seen out of place. Complications may include a patella fracture or arthritis.
A patellar dislocation typically occurs when the knee is straight and the lower leg is bent outwards when twisting. Occasionally it occurs when the knee is bent and the patella is hit. Commonly associated sports include soccer, gymnastics, and ice hockey. Dislocations nearly always occur away from the midline. Diagnosis is typically based on symptoms and supported by X-rays.
Reduction is generally done by pushing the patella towards the midline while straightening the knee. After reduction the leg is generally splinted in a straight position for a few weeks. This is then followed by physical therapy. Surgery after a first dislocation is generally of unclear benefit. Surgery may be indicated in those who have broken off a piece of bone within the joint or in which the patella has dislocated multiple times.
Patellar dislocations occur in about 6 per 100,000 people per year. They make up about 2% of knee injuries. It is most common in those 10 to 17 years years old. Rates in males and females are similar. Recurrence after an initial dislocation occurs in about 30% of people.
Based on the stability, the displacement and the comminution of the fracture. It is composed of three types, and each type is divided in two subtypes: subtype A (non-comminuted) and subtype B (comminuted).
- Type I: Non-displaced fracture – It can be either non-comminuted ones (Type IA) or comminuted (Type IB).
- Type II: Displaced, stable fractures – In this pattern, the proximal fracture fragment is displaced more than 3 mm, but the collateral ligaments are intact. That is why there is no elbow instability. It can be either non-comminuted ones (Type IIA) or comminuted (Type IIB).
- Type III: Displaced instable fracture – In this case, the fracture fragments are displaced and the forearm is instable in relation to the humerus. It is a fracture -dislocation. It also may be either non-comminuted (Type IIIA) or comminuted (Type IIIB).
A tibial plateau fracture is a break of the upper part of the tibia (shinbone) that involves the knee joint. Symptoms include pain, swelling, and a decreased ability to move the knee. People are generally unable to walk. Complication may include injury to the artery or nerve, arthritis, and compartment syndrome.
The cause is typically trauma such as a fall or motor vehicle collision. Risk factors include osteoporosis and certain sports such as skiing. Diagnosis is typically suspected based on symptoms and confirmed with X-rays and a CT scan. Some fractures may not be seen on plain X-rays.
Pain may be managed with NSAIDs, opioids, and splinting. In those who are otherwise healthy, treatment is generally by surgery. Occasionally, if the bones are well aligned and the ligaments of the knee are intact, people may be treated without surgery.
They represent about 1% of broken bones. They occur most commonly in middle aged males and older females. In the 1920s they were called a "fender fracture" due to their association with people being hit by a motor vehicle while walking.
The onset of the condition is usually gradual, although some cases may appear suddenly following trauma.
- Knee pain - the most common symptom is diffuse peripatellar pain (vague pain around the kneecap) and localized retropatellar pain (pain focused behind the kneecap). Affected individuals typically have difficulty describing the location of the pain, and may place their hands over the anterior patella or describe a circle around the patella (the "circle sign"). Pain is usually initiated when load is put on the knee extensor mechanism, e.g. ascending or descending stairs or slopes, squatting, kneeling, cycling, running or prolonged sitting with flexed (bent) knees. The latter feature is sometimes termed the "movie sign" or "theatre sign" because individuals might experience pain while sitting to watch a film or similar activity. The pain is typically aching with occasional sharp pains.
- Crepitus (joint noises) may be present
- Giving-way of the knee may be reported
Fractures are commonly obvious, since femoral fractures are often caused by high energy trauma. Signs of fracture include swelling, deformity, and shortening of the leg. Extensive soft-tissue injury, bleeding, and shock are common. The most common symptom is severe pain, which prevents movement of the leg.
Osgood–Schlatter disease causes pain in the front lower part of the knee. This is usually at the ligament-bone junction of the patellar ligament and the tibial tuberosity. The tibial tuberosity is a slight elevation of bone on the anterior and proximal portion of the tibia. The patellar tendon attaches the anterior quadriceps muscles to the tibia via the knee cap.
Intense knee pain is usually the presenting symptom that occurs during activities such as running, jumping, squatting, and especially ascending or descending stairs and during kneeling. The pain is worse with acute knee impact. The pain can be reproduced by extending the knee against resistance, stressing the quadriceps, or striking the knee. Pain is initially mild and intermittent. In the acute phase, the pain is severe and continuous in nature. Impact of the affected area can be very painful. Bilateral symptoms are observed in 20–30% of people.
Many rotator cuff tears are asymptomatic. They are known to increase in frequency with age and the most common cause is age-related degeneration and, less frequently, sports injuries or trauma. Both partial and full thickness tears have been found on "post mortem" and MRI studies in those without any history of shoulder pain or symptoms. However, the most common presentation is shoulder pain or discomfort. This may occur with activity, particularly shoulder activity above the horizontal position, but may also be present at rest in bed. Pain-restricted movement above the horizontal position may be present, as well as weakness with shoulder flexion and abduction.
Chondromalacia patellae is a term sometimes treated synonymously with PFPS. However, there is general consensus that PFPS applies only to individuals without cartilage damage, thereby distinguishing it from chondromalacia patellae, a condition characterized by softening of the patellar articular cartilage. Despite this academic distinction, the diagnosis of PFPS is typically made clinically, based only on the history and physical examination rather than on the results of any medical imaging. Therefore, it is unknown whether most persons with a diagnosis of PFPS have cartilage damage or not, making the difference between PFPS and chondromalacia theoretical rather than practical. It is thought that only some individuals with anterior knee pain will have true chondromalacia patellae.
An unhappy triad (or terrible triad, "horrible triangle", O'Donoghue's triad or a "blown knee") is an injury to the anterior cruciate ligament, medial collateral ligament, and medial meniscus. Analysis during the 1990s indicated that this 'classic' O'Donoghue triad is actually an unusual clinical entity among athletes with knee injuries. Some authors mistakenly believe that in this type of injury, acute tears of the medial meniscus always present with a concomitant lateral meniscus injury. However, the 1990 analysis showed that lateral meniscus tears are more common than medial meniscus tears in conjunction with sprains of the ACL.
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%).