Meniscal Tears

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A torn meniscus is an injury to one or more of the two meniscal cartilages within the the knee. The two menisci consist of medial and lateral mensicus. A tear to the meniscal cartilage is often the result of an any activity that causes forceful twisting or rotating of the knee joint. These activities can include aggressive pivoting, sudden stops, sudden turns, kneeling, deep squatting, of lifting something heavy. In older adults, degenerative changes associate with age can result in in torn meniscus.

Symptoms that may be present with torn meniscus:

A popping sensation

Swelling or stiffness

Knee instability

Pain, especially with twisting or rotating the knee

Difficulty fully extending the knee

Feeling of as if the knee was locked in place.

In athletes, a torn meniscus can also be accompanied with a tear or injury to the ACL.

Test and Diagnosis:

A physical exam by a physician can often be the first sign of a torn meniscus. This exam will likely be followed by a radiograph of the knee, and even an MRI of the knee joint. MRI is the preferred imaging modality to evaluate the extent of a previously determined meniscal tear.

Treatment Options:

Treatment for meniscal tears often start with a conservative approach of rest, ice, OTC pain relievers, physical therapy, and/or orthotic devices such as arch supports and shoe inserts. If symptoms persist, surgical intervention maybe necessary. This can involve either an arthroscopic repair of the torn menisci, or trimming of the menisci. The surgery usually allows patients to go home the same day, with full recovery taking several weeks or months.

Prevention:

Regular exercises to strengthen the knee joint is beneficial.

Use proper protective gear during athletic activity.

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Carpal Tunnel Syndrome

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The Carpal Tunnel is a passageway on the palmer surface of the wrist that allows for and protects the Median nerve as it passes through the wrist into the hand. Carpal Tunnel Syndrome is caused by anything or aspect that causes the space within the tunnel to become reduced; thus compressing the Median nerve. This compression can be a result of the tunnel getting smaller, or contents within the tunnel getting bigger.

Some known risk factors associated with Carpal Tunnel Syndrome are:

Heredity - inherited physical conditions such as shape of the wrist may make an individual more susceptible to having the condition, as well as having other members in the family having had the condition too.

Gender - women are 3 times more likely to have the condition.

Health Condition - thyroid problems, diabetes, obesity, rheumatoid arthritis, end stage kidney disease, pregnancy, oral contraceptives or menopause can all increase the risk of having Carpal Tunnel Syndrome

Compression of the Median nerve can stem from:

rheumatoid arthritis, diabetes, thyroid disorders, menopause, pregnancy, trauma to the hand and wrist, genetic disposition, and prolonged repetitive flexing and extending of the bones/tendons within the hand and wrist.

Symptoms that accompany Carpal Tunnel Syndrome include:

Tingling and numbness in the fingers and hand (especially thumb, index, middle, and ring fingers), pain radiating or extending up the arm into the shoulder or down into the palm of the hand, (usually occurs on the palmer surface of the hand), and weakness in the hand. As the condition worsens, the symptoms increase with severity as well.

In efforts to diagnosis Carpel Tunnel Syndrome a physician might order:

Electromyogram - Electromyography measures the tiny electrical discharges produced in muscles. A thin-needle electrode is inserted into the muscles your doctor wants to study. An instrument records the electrical activity in your muscle at rest and as you contract the muscle.

Nerve conduction study - two electrodes are taped to your skin. A small shock is passed through the median nerve to see if electrical impulses are slowed in the carpal tunnel.

Routine diagnostic imaging exams such as x-rays, MRI, and/or CT aren't commonly used to diagnosis Carpal Tunnel Syndrome, but might be ordered to rule out any other diseases related to the patients symptoms.

Treatment for Carpal Tunnel Syndrome include:

Anti-inflammatory medications, Rest, Immobilization, Corticosteroid injections, and possible even surgery to "release" the ligament impingement on the Median nerve.

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AVN of the Hip

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Avascular Necrosis (AVN) is the death of bone tissue as a result of the lack of blood supply to the bone and its surrounding tissue; in this case, specifically the hip area. This blood supply often leads to collapse of the bone, and if it occurs in a joint space - the collapse of the entire joint.

Causes of AVN:

Trauma to the hip

Steroid Use

Heavy Drinking

Sickle Cell Anemia

Gaucher's disease

Lupus

Decompression disease - bends

Cancer tx - chemo/radiation therapy.

Symptoms of AVN of the hip:

Pain in the groin, thigh, and knee. This pain usually worsens with standing or walking.

Testing for AVN

Hip Radiographs, early stages of AVN may not be a prominent on radiographs as compared to later stages of AVN being evident of radiographs.

MRI of the hip can show early bone degeneration's that may be a result of AVN.

Laboratory test such as bone biopsy may also be used as additional resources.

TX:

Medications - NSAIDS - for pain relief

Rest - restriction of physical activities

Physical Therapy to improve range of motion

Surgery such as decompression, bone reshaping, bone transplant, and joint replacement

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Polycystic Kidney Disease

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Polycystic Kidney Disease is an autosomal dominant genetic disorder. It is the most frequent cause of renal failure among adults. It is also responsible for 6-8% of dialysis patients in the United States. Polycystic Kidney Disease is a multisystemic progressive disorder that is characterized by the formation and enlargement of renal cysts in the kidney and other adjacent abdominal organs such as: liver, pancreas, and spleen. It is also characterized by the bilateral cystic dilation of the renal tubules, which may lead to end-stage renal disease. Hepatic cysts, cerebral aneurysms, and cardiac valvular abnormalities are also possible. The disease can be classified either PKD1 and PKD2. PKD1 is expressed as an abnormality in the short arm of chromosome 16. PKD2 is expressed as an abnormality in the long arm of chromosome 4.

PKD is slightly more severe in males than in females.
PKD symptoms generally increase with age.
The major causes of morbidity is the progressive renal dysfunction, and results in grossly enlarged kidneys and kidney failure.
Over half of patients with PKD undergo kidney transplant by the age of 60 years old.

Signs/Symptoms:
A decrease in urine concentration.
Hypertension
Abdominal Pain - flank or back: related to kidney enlargement, cystic enlargement, bleeding, perinephic hematoma, or urinary tract infections.
Hematuria
Palpable bilateral abdominal flank mass
Pallor
Uremic fetor
Dry skin
Edema

Testing
Lab Tests such as serum chemistry profile; including calcium and phosphorus, a complete blood cell count, urinalysis, urine culture, uric acid determination, and intact parathryoid hormone value.

Ultrasound is the most widely accepted imaging technique for diagnosis of PKD because it does not use radiation or contrast material. It can diagnosis cysts up 1-1.5cm, as well as detect extrarenal abdominal features.
CT scan is a more sensitive imaging modality because it can detect renal cysts as small as 0.5cm but because of the use of radiation and contrast material it is not routinely used for diagnosis.
MRI is more sensitive than either ultrasound or CT, especially in determining the difference between PKD and Renal Cell Carcinoma. It is also the best imaging tool for monitoring kidney size after the patient has undergone treatment in order to assess progress.
Intravenous Urography (IVP) was once the most widely used and popular tool for diagnosing PKD. However, with the evolution of ultrasound, IVP has been replaced mainly because of its requirements of contrast material and radiation doses.

Medical Therapy for treatment of PKD
Control Blood Pressure
Use of ACE inhibitors
Control associated disorders hyperkalemia, hyperphosphatemia, hypocalcemia, hyperparathyroidism, acidosis).
Treat urinary tract infections
Reduce abdominal pain, avoid use of anti-inflammatory NSAIDS
Patients with PKD and End Stage Renal Disorder may need to undergo hemodialysis, peritoneal dialysis, or renal transplantation.

Surgical Intervention for treatment of PKD
Surgical drainage of infected cysts may be necessary if the infection has not responded to antibiotics. This is often done under the guidance of ultrasound.
Surgical removal of one or more renal cysts for pain management purposes.

Prognosis
PKD patients should maintain a low sodium diet, and avoid any contact sports that would apply direct trauma to the kidney's. These patient's should have their blood pressure regularly monitored as well as renal ultrasounds every 1-2 years. PKD1 patients will typically require renal replacement therapy by the age of 53, whereas, PKD2 patients will usually hold until 68.

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Pneumonia

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Pneumonia is an infection of one or both of the lungs caused by either a virus, bacteria, or fungus. Over 3 Million Americans each year will be diagnosed with a form of pneumonia; approximately 5% will die each year from this disease.

Signs and Symptoms of pneumonia usually begin with cold like symptoms which then develop into a high fever, shaking chills, and a productive cough. Pneumonia patients may suffer from shortness of breath, and sharp chest pain during deep inspirations. They may also develop headaches, muscle aches, and cyanosis.

Pneumonia is often first suspected after a physician has listened to a patient's chest and breath sounds and hears coarse breathing, wheezing, faint breaths, and/or crackling sounds. A chest x-ray is usually performed to confirm the physicians finding, and provide a diagnosis of pneumonia. Other test such as sputum samples, blood tests, and/or bronchoscopies.

There are various types and forms of pneumonia, and treatment of pneumonia depends on the type of pneumonia the patient has. Many treatments begin with antibiotics such as: penicillin, amoxicillin, clavulanic acid, erythromycin, azithromycin, and clarithromycin just to name a few. At times, steriods are often used to treat pneumonia as well. There are also two available vaccines for specific forms of pneumonia.

Pneumonia can be a life-threatening disease for elderly, children, COPD patients, heart disease, diabetes, and certain cancers.

Lumbar Spine Spinal Stenosis

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Lumbar Spinal Stenosis occurs when either the vertebral foramen or the spinal canal at the level of the lumber vertebrae begins to narrow which then can cause painful nerve compression.

Anything that narrows or constricts the spinal canal can be a cause of lumbar spinal stenosis. The number one cause of spinal stenosis is a result of normal aging process - Degenerative Arthritis. Degenerative arthritis causes spinal stenosis because it causes the normal spinal space to narrow by either bone spurs, degenerative disc disease, or the hypertrophy of lumbar ligaments. Other causes of lumber spinal stenosis are:

Tumors

Infections

Any metabolic bone disorders such as Paget's disease.

Signs and symptoms of lumbar spinal stenosis are commonly severe low back pain, weakness and numbness in the legs, and pain in the legs. Usually symptoms of spinal stenosis worsen with prolonged walking, standing, and bending backwards. Bending backwards increases the narrowing of the spinal column causing symptoms to increase. For this reason, most patient's find more comfort in walking with a walker which allows the posture of the spine to be bent forward which decreases the nerve compression from the spinal stenosis. The symptoms of lumbar spinal stenosis will increase and worsen as time goes on, and can often result in loss of bladder control, loss of bowel function, and decreased sexual sensation.

Diagnosis of lumbar spinal stenosis begins with a thorough physical examination by the patients doctors. This allows the doctor to evaluate the patients symptoms in order to distinguish the symptoms of lumbar spinal stenosis from those of other neurological disorders. Next, the physicians will likely order lumbar spine and possibly hip radiographs. The physician will evaluate the disc height, any bone spurs, and spinal stability. However, the final deciding factors when diagnosing lumbar spinal stenosis are CT scans and MRI scans. These scans along with contrast administration allows for the spinal nerves in the lumbar spine to be visualized in order to see if there is any nerve compression from the spinal stenosis.

Lumbar spinal stenosis can be treated with medications. Anti-inflammatory and cortical steroid medications are the primary form of medicinal treatments geared towards reduced in the compression of nerves as a result of lumbar spinal stenosis. Physical therapy is also a recommended treatment. Finally if medication or physical therapy are not successful in reducing pain and symptoms, surgery is an option.

The main goal of surgery for lumbar spinal stenosis is to remove the structure that are causing the compression of the nerves. This surgery is usually spinal decompression surgery, which is often accompanied with a lumbar spinal fusion surgery depending on the number of compressed structures that need to be removed. Surgery for lumbar spinal stenosis is often more successful in removing the pain and numbness in the legs as opposed to relieving the actual back pain.

http://www.medicinenet.com/lumbar_stenosis/page4.htm

Thoracic Spine Compression FX

Thoracic Spinal Cord Compression Fx's commonly occur in the lower t-spine since the upper t-spine is stabilized by the rib cage attachments. Spinal cord compression fx's occur when the vertebral body of spinal cord collapse resulting in acute back pain that causes a decrease mobility and general health.

The most common motion that causes the vertebral body to collapse is a forward bend with downward pressure on the spinal column. Osteoporosis can also be a contributing factor to pts with t-spine compression fx's The osteoporotic t-spine can cause a pt's spine to form an exaggerated kyphotic curve of upper t-spine related to the back pain causing the shoulders to slump forward. Traumatic injuries such as an MVA, fall, or a forceful landing from a jump can all also cause t-spine compression fx's. Metastatic disease can also cause a t-spine compression fx. The spread of cancer to the vertebral body causes a weakening in the bony structure allowing a compression fx to present.

AP and Lateral radiographs are the best form of identifying t-spine compression fx's. This form of radiography is the best why to completely visualize the entire aspect of the vertebral body. Next, a multislice axial CT scan with reformats in the frontal and sagittal plane of the t-spine are useful to examine any pathology that may be affecting the spinal canal. MRI is used only in spinal cord compression fx pt's that have any resulting neurologic deficiencies. Lastly, an Nuclear Medicine bone scan may also be ordered to determine the age and nature of the t-spine compression fx.

Most t-spine compression fx are treated with pain medication, physical therapy, decreasing activity, bracing, and/or a form of surgical fixation.

Some t-spine compression fx may require the use of a vertebroplasty or kyphoplasty intervention. This procedure is done either in a surgical suite or in an interventional radiography suite. In a vertebroplasty, a medical grade cement is injected in the vertebral body at the site of the fx to stabilize the vertebrae in relieve pain. In a kyphoplasty, a balloon is inserted in the fx site in order to reinstate the original shape of the vertebral body, and then inject the medical grade cement into the vertebrae. This is also in efforts to rebuild the vertebral body to its original form and relieve pain.

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http://emedicine.medscape.com/article/397896-overview

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