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Radiographic Imaging In Sternoclavicular Dislocations

August 30, 2008 By 3 Comments

Radiological imaging is very important part of diagnosis making of sternoclavicular injuries. In addition to routine xray views,special views have been developed to confirm the injury. Sometimes imaging additional to Xrays might be necessary.

Anteroposterior and Lateral Views
Anteroposterior x-rays of the chest or sternoclavicular joint may show sternoclavicular joint displaced as compared with the normal side. Lteral x-rays are difficult to interpret due to overlapping of structures.

Heinig View
Patient is in supine position, the x-ray tube is placed approximately 30 inches from the involved sternoclavicular joint and the central ray is directed tangential to the joint and parallel to the opposite clavicle. The cassette is placed against the opposite shoulder and centered on the manubrium.

Hobbs View
The patient is seated at the x-ray table,leaning forward in a way that the nape of his flexed neck is almost parallel to the table and lower anterior rib cage against the cassette  on the table. The x-ray source is above the nape of the neck.

Serendipity View
The patient is positioned on his back and the tube is tilted at a 40-degree angle off the vertical centering over sternum with cassette under patient’s upper shoulders and neck.

In children, the distance from the tube to the cassette is 45 inches and  in adults 60 inches.

If the  sternoclavicular joint is dislocated anteriorly, the affected clavicle will appear to be displaced and riding higher. If it is dislocated posteriorly, it will appear to be lower.

CT Scan

CT scan is the best modality  to study  the sternoclavicular joint injury. It clearly distinguishes injuries of the joint from fractures of the medial clavicle and defines minor subluxations of the joint. Opposite joint should also be included in the study for a comparitive analysis.

Popularity: 3% [?]

Filed Under: Fractures-Dislocations, Shoulder Girdle Injuries Tagged With: , , , , , ,

Nonsurgical Management in Osteochondritis Dissecans

August 29, 2008 By Leave a Comment

Treatment of  Osteochondritis Dissecans in children under 12 years of age is nonoperative. Arthroscopy is reserved for the cases in which the fragment has become detached.

If the lesion is in a non-weight bearing area or it involved only a portion of the weight-bearing area of a joint it is observed with serial radiograms made every six to eight weeks to determine its natural course.

Protection from weight-bearing is not required unless the lesion begins to separate and symptoms persist.

In case the weight bearing is prohibited, it is resumed gradually with aid of crutches providing partial support.

Generally, a period of three months is required for healing of the lesion.

In case of suspected seapration of fragment, bone imaging with technetium-99m and computed tomographic studies should be carried out.

If osteochondritis dissecans in a child fails to respond to nonsurgical management, arthroscopic examination and drilling of the osteochondritic lesion are recommended.

Indications of arthroscopy

Arthroscopy  directly visualizes the involved area and determines its exact location and size, and the degree of articular cartilage separation.

Arthroscopy is indicated in osteochondritis dissecans in patients 12 years of age and older in whom the weight-bearing area is involved with a lesion over 1 cm. in diameter.

Arthroscopic examination is also indicated in case of late diagnosis.

In children under 12 years of age arthroscopy should be done when, there is no radiographic or clinical evidence of improvement after a reasonable period of non operative treatment, or if the lesion becomes partially or completely detached.

Popularity: 1% [?]

Filed Under: Joints Tagged With: , , , , , , , , ,

Coccygodynia or Coccydynia or Tail Bone Pain- Causes and Treatment

August 26, 2008 By 12 Comments

The coccyx is the rudimentary tail bone of lower animal forms. It is a cone shape section of spine composed of four or five segments. These segments tend to fuse with growth. The sacrococcygeal junction remains movable throughout life.

The coccyx is in constant motion because of its muscular attachments, especially in the act of defecation. Coccyx moves forward and acts as shock absorber when pressure is exerted against posterior aspect of bone in sitting.

Pain about the coccyx results from local conditions and is widely known as coccygodynia.

A fall, hit or obstetric trauma can result in sprain of sacrococcygeal ligaments. The acts of sitting and defecation continually strain the already injured ligaments. This results in constant discomfort and increasing on sitting or defecation.

Subluxation of sacrococcygeal joint is another cause of pain. If untreated it leads to narrowing and sclerosis over years. On sitting on hard surface, a pressure point develops over the tip of the bone.

Fracture and dislocation of coccyx leads to a painful pseudoarthrosis or a degenerative arthritis with stiff sacrococcygeal joint.

Painful tender nodules and glomus tumor are other causes of coccygodynia.

The treatment of coccygodynia includes

  • Hot sitz baths
  • A rubber ring or pillow to be used while sitting
  • Injection of local anesthetic about the joint.
  • Manipulation of coccyx under anesthesia
  • Coccygectomy or removal of cocccyxin resistant cases.

Popularity: 3% [?]

Filed Under: Back Pain

Clinical Presentation and Imaging Finding of Osteochondritis Dissecans

August 25, 2008 By Leave a Comment

The usual presenting complaints are

  • Intermittent pain in the joint on strenuous physical activity
  • Stiffness
  • Swelling
  • Clicking and locking of the joint
  • Limp

When the knee joint is involved, “giving way” of the knee is a frequent complaint.

Physical Findings

These depend on the joint involved, the duration of the disease, and whether or not the fragment has become detached.

An important finding is localized tenderness over the lesoinal area. [Read more...]

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Filed Under: Joints Tagged With: , , , , , , , , , , ,

Pathology of Osteochondritis Dissecans

August 24, 2008 By 4 Comments

The initial change takes place in the bone. A segment of the bone undergoes avascular necrosis. The changes in the overlying cartilage are secondary.

Initially the cartilage overlying an area of dissecans appears to be normal, but with loss of subchondral bony support, it undergoes degenerative changes-softening, fibrillation, fissring and it loses its sheen.

Local trauma can cause separation of the subchondral bony fragment. [Read more...]

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Filed Under: Non Traumatic Disorders Tagged With: , , , , , , ,

What is Osteochondritis Dissecans and What Causes It

August 23, 2008 By Leave a Comment

Osteochondritis dissecans is a condition in which a segment of articular cartilage with its underlying subchondral bone graudually separates from the surrounding osteocartilaginous tissue.

The separation of the fragment may be partial or complete.

The osteochondral segment may remain in situ, it may become partially detached, or it may become completely detached and lodge in the contiguous joint as a loose body. It is important to differentiate the word dissecans from dessicans, the latter being derived from desiccare, “to dry up”.

The disease was first described in 1870 by Sir James Paget and the term osteochondritis dissecans was given in 1887 by Konig. [Read more...]

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Filed Under: Joints Tagged With: , , , , , ,

Neuropathic Joint Disease or Charcot Joint in Children

August 22, 2008 By Leave a Comment

This condition was described by Charcot, in 1868. He described it as a bizarre destruction of the knee joints with indolent swelling and instability in patients of tabes dorsalis> He proposed that the disease resulted from traumatization of a joint deprived of sensation.

Later Steindler classified the condition into the condition into the destructive, atrophic and hypertrophic proliferative forms.

Charcot-like changes in joints are seen in patients who have absence or depression of pain and proprioceptive sensation and who take part in extended continuous physical activity.

As a consequence their joints sustain repeated trauma. [Read more...]

Popularity: 1% [?]

Filed Under: Joints, Pediatric Disorders Tagged With: , , , , , , , , ,

Sternoclavicular Injuries-Clinical Presentation

August 20, 2008 By 1 Comment

Sternoclavicular injuries are rare. The literature quotes incidence to be 3%. Anterior dislocations of the sternoclavicular joint are much more common than are posterior ones. The ratio of anterior dislocations to posterior dislocations of the sternoclavicular joint of approximately 20 to 1.

Sternoclavicular joint can be mild, moderate, and severe

Mild Injury-Sprain

Mild injury is equivalent to sprain.

The ligaments of the joint are intact. There is mild to moderate amount of pain, particularly with movement of the upper extremity. The joint may be slightly swollen and tender to palpation, but instability is not noted. [Read more...]

Popularity: 1% [?]

Filed Under: Shoulder Girdle Injuries Tagged With: , , , , ,

Sternoclavicular Dislocation-Mechanisms of Injury

August 19, 2008 By Leave a Comment

First case report of posterior dislocation of the sternoclavicular joint was describd by Rodrigues in 1843.

Injuries to the sternoclavicular joint are rare injuries. They could be anterior or posterior. Anterior dislocations are best treated nonoperatively and posterior dislocations, which is life threatening should be promptly diagnosed and reduced. Special x-rays are usually required to make the diagnosis and the computed tomography scan will present the clearest findings of the fracture or dislocation.

Mechanism of Injury

Either direct or indirect force can produce a dislocation of the sternoclavicular joint. Because the sternoclavicular joint is subject to practically every motion of the upper extremity and the joint is small and incongruous but the ligamentous supporting structure is strong and designed to make the joint less dislocatable.

A traumatic dislocation of the sternoclavicular joint usually occurs only after tremendous forces, either direct or indirect, have been applied to the shoulder.

Direct Injury

When a force is applied directly to the anteromedial aspect of the clavicle, the clavicle is pushed posteriorly behind the sternum and into the mediastinum. Anatomically, it is essentially impossible for a direct force to produce an anterior sternoclavicular dislocation.

Indirect Force

A force act indirectly on the sternoclavicular joint from the anterolateral or posterolateral aspects of the shoulder. This is the most common mechanism of injury to the sternoclavicular joint.

If the shoulder is compressed and rolled forward, an ipsilateral posterior dislocation results. if the shoulder is compressed and rolled backward, an ipsilateral anterior dislocation results.

One of the most common causes of injury is a pile-on in a football game. A player falls on the ground, landing on the lateral shoulder; before he can get out of the way, several players pile on top of his opposite shoulder, which applies significant compressive force on the clavicle down toward the sternum.

Other types of indirect forces that can produce sternoclavicular dislocation are

  • A cave-in on a ditch digger
  • A person is pinned between a vehicle and a wall
  • Fall on the outstretched abducted arm, which drives the shoulder medially

The most common cause of dislocation of the sternoclavicular joint is vehicular accidents folllowed by sports.

Popularity: 3% [?]

Filed Under: Dislocations, Shoulder Girdle Injuries Tagged With: , , , ,

Syringomyelocele and Myelocele

August 16, 2008 By Leave a Comment

Syringomyelocele

In this condition the central canal of the spinal cord is dilated and the spinal cord lies within the sac together with the peripheral nerves arising from the cord.

This is the rarest variety of spina bifida.

Gross neurological deficits and paralytic manifestations are present.

Myelocele

This is the gravest form of spina bifida, in which besides the bony defect there is also defect of development of the spinal cord. The development is arrested before the time of closure of the neural furrow. So that the posterior part of the spinal cord is not developed.

The elliptical raw surface of the neural furrow can be seen, deep to which lies the anterior part of the spinal cord. At the top end of the defect the central canal of the spinal cord opens on the surface and discharges the cerebrospinal fluid constantly.

Majority of the cases are still born. Even if a few born alive, they die within a few days from infection of the cord and meninges.

Popularity: 1% [?]

Filed Under: Pediatric Disorders, Spine Tagged With: , , , , , , , ,
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