1/18. Intra-articular dislocation of the patella: two cases and literature review.Intra-articular dislocation of the patella remains uncommon and is generally thought to be a problem of young adolescent males. This report reminds emergency physicians that it can occur in the arthritic knee, and it should be considered in the differential diagnosis of locked knee in the elderly. Closed reduction should be attempted in these cases, because the dislocation is liable to be held in place by osteophytes rather than impaction of the patella deep in the intercondylar notch and a good functional outcome can be expected.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/18. Cactus thorn arthritis: case report and review of the literature.synovitis secondary to penetrating plant thorn injuries is an infrequently reported event. Despite its wide geographic distribution, thorns from the prickly pear cactus (Optunia ficusindica) are a rare source of this type of inflammatory arthritis. We hereby present an unusual case of an individual who developed an acute monoarthritis of the knee shortly after sustaining a penetrating cactus thorn injury. The clinical and pathophysiologic features of cactus thorn arthritis are reviewed and the unusual features present in this individual are highlighted. Treatment options, with an emphasis on rapid diagnosis and therapeutic interventions, are discussed. Increased physician awareness and recognition of this unusual but not rare entity are essential as a means of improving clinical outcome.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/18. rheumatology: 14. diagnosis and management of anterior knee pain.A 32-year-old male runner visits his family physician in late spring complaining of pain in his knees over the past month. The pain is mostly anterior but is not well localized. It is aggravated by running, especially on hills, but subsides after the patient stops running. The patient has kept fit during the winter by swimming and occasional cross-country skiing. He has no history of obvious trauma or a noticeable injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/18. Bilateral metachronous rupture of the patellar tendon.We present a case of a 37-year-old man who sustained a rupture of his left patellar tendon approximately 48 hours after rupturing his right patellar tendon. This temporal pattern illustrates two important aspects of patellar tendon injury-that rupture of the degenerated patellar tendon may occur without any prodromal warning and that it may elude detection even if the patient is examined by several physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/18. Lessons from the other side of the knife.The overall success or failure of knee arthroplasty is predicated on the successful combination of patient selection, meticulous surgical technique, and prosthetic design. Discussions regarding the outcome of knee arthroplasty frequently focus on the implants used and the surgical technique employed, with a less frequent focus on patient profile. However, the patient experience was further highlighted to me when I became the patient and experienced the consequences of knee arthroplasty firsthand. This experience offered me a greater insight into patient expectations, the importance of preoperative counseling, the severity of perioperative pain, and the issues involved in the rehabilitative period. Joint arthroplasty outcomes are dependent on the harmony existing between the patient's perioperative status, expectation level, motivational status, physician diagnostic and surgical skill, and the design characteristics of the prosthesis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/18. Isolated anterolateral proximal fibular head dislocation.A 28-year-old woman fell and sustained an isolated anterolateral dislocation of the proximal fibula. This injury generally presents with a characteristic history and associated physical examination and radiographic findings, but the subtle nature of the salient findings contributes to a high degree of misdiagnosis. Emergency physicians should be familiar with this injury because early reduction reduces long-term morbidity.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/18. Meniscal injury in the anterior cruciate-deficient knee. A rationale for clinical decision-making.Meniscal injury is common in acute or chronic anterior cruciate ligament insufficiency. The patterns of meniscal lesions are predictable in the acute and chronically unstable knee. The early incidence of meniscal injury is high and increases with time. Meniscal repair has become increasingly successful. Techniques for anterior cruciate ligament reconstruction have also improved, and with more progressive rehabilitation programmes, this has become a more tolerable procedure for both patients of highly athletic lifestyles and more moderate recreational athletes. The decision-making process for the sports medicine physician requires an overall assessment of many variables. A delicate balance of factors such as age, sex, joint laxity, activity level, individual motivation, social circumstances, associated meniscal, collateral ligament and/or chondral damage may sway the surgeon towards a nonoperative or operative decision. At the present time, a 'cook book' answer to each case presented is not available. As in all of medicine, each patient is an entity that requires an individual evaluation and a specific course of treatment. This review aims to help in this decision-making process. Future prospective studies investigating the many variables mentioned will hopefully objectively delineate guidelines for the choice of the most effective therapeutic regimen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/18. diagnosis of medial knee pain: atypical stress fracture about the knee joint.STUDY DESIGN: Resident's case problem. BACKGROUND: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. diagnosis: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. DISCUSSION: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/18. Bone scintigraphic findings in recruits after short periods of nonweight-bearing ambulation. A report of two cases.Two military recruits with suspected stress fractures underwent scintigraphy after brief periods of nonweight-bearing ambulation. Their scans showed a dramatic, diffuse increase of activity over the asymptomatic weight-bearing foot, with areas of increased focal activity. Our reported cases illustrate how gait changes can be reflected in scintigraphy and the difficulty in evaluating areas of increased focal scintigraphic activity in the feet. The physician should see the bone scan and not rely on a written report when evaluating a trainee for possible stress fracture.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
10/18. Acute septic arthritis due to acremonium.A case of acremonium species arthritis in a previously healthy child is reported. This fungus has frequently been implicated in cases of mycetoma and keratomycosis in the tropics, and invasive disease has occurred almost exclusively in immunocompromised patients. The acute presentation of this illness and its successful treatment with IV amphotericin-B are highlighted to alert physicians to this pathogen.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
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