1/29. Femoral neck stress fracture presenting as gluteal pain in a marathon runner: case report.A case is described of a 50-year-old man with a femoral neck stress fracture presenting as gluteal pain. An operative pinning procedure of the femoral neck was performed for stabilization. Femoral neck stress fractures are often misdiagnosed early in their presentation. The signs and symptoms can mimic those of more commonly seen disorders. Appropriate physiatric history and physical examination, along with indicated studies, will help prevent misdiagnosis and potentially serious complications associated with musculoskeletal pathology.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/29. Decline in bone mineral density with stress fractures in a woman on depot medroxyprogesterone acetate. A case report.BACKGROUND: Depot medroxyprogesterone acetate is a popular contraceptive among young, physically active women. However, its administration has been linked to a relative decrease in estrogen levels. Since bone resorption is accelerated during hypoestrogenic states, there has been growing concern about the potential development of osteoporosis and fractures with the use of this contraceptive method. CASE: A physically active, 33-year-old woman demonstrated a 12.4% drop in femoral neck bone mineral density (BMD), 6.4% drop in lumbar BMD and 0.8% drop in total BMD with the subsequent development of a tibial stress fracture while on depot medroxyprogesterone acetate. Bone mineralization rapidly improved, and the stress fracture resolved with discontinuation of the medication. CONCLUSION: The long-term effects of depot medroxyprogesterone acetate on bone mineralization in physically active women should be evaluated more thoroughly.- - - - - - - - - - ranking = 0.84423236067174keywords = physical (Clic here for more details about this article) |
3/29. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 0.56282157378116keywords = physical (Clic here for more details about this article) |
4/29. Sacral stress fractures: an unusual cause of low back pain in an athlete.STUDY DESIGN: A case report of a sacral stress fracture causing low back pain in an athlete. OBJECTIVE: To document the occurrence of sacral stress fractures in athletes and to recommend it in the differential diagnosis of low back pain, especially in runners and volleyball players. SUMMARY OF BACKGROUND DATA: low back pain is common both in the general population and in athletes. athletes place high physical demands on their bodies, which often lead to stress fractures. Sacral stress fractures can cause back pain and are often not included in the differential diagnosis of back pain. methods: The authors were involved in the care and treatment of this patient and reviewed all medical records, radiologic tests, and related literature. RESULTS: In a 16-year-old volleyball player with a 4-week history of low back pain, magnetic resonance imaging of her pelvis revealed a stress fracture of the left sacral ala. She was treated with nonsteroidal anti-inflammatory agents, rest, and conditioning exercises and had a good functional outcome. CONCLUSION: Sacral stress fractures should be included in the differential diagnosis of athletes with low back pain, particularly runners and volleyball players. To the authors' best knowledge, this is the first report of a volleyball player with a sacral stress fracture. A review of the literature yielded 29 cases of sacral stress fractures in athletes, mainly runners.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
5/29. Sacral stress fracture in a female field hockey player.We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
6/29. hip pain related to femoral neck stress fracture in a 12-year-old boy performing intensive soccer playing activities--a case report.We describe the rare case of a 12-year-old boy complaining of repetitive severe pain in the left thigh, during physical activity related to a femoral neck stress fracture. Even though stress fractures are common in the adult athletic population, they occur rarely in children, with the epiphyseal growth plates still open. Diagnosis is delayed as only unspecific changes are found when conventional radiography is performed. For adequate treatment, early diagnosis by MRT or bone scintigraphy is essential. Conservative treatment will be effective through prevention of overuse.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
7/29. Longitudinal stress fracture of the tibia: two cases.Stress fracture of the tibia occurs in individuals who subject their extremities to repeated trauma. They can arise in otherwise healthy bone that is subjected to excessive loads (as in the marathon runner) or in abnormal bone that is subjected to minor loads (as in osteoporosis). These fractures may be anywhere along the tibial shaft and tend to be either transverse or oblique in orientation. We report two cases of stress fracture that ran longitudinally in the distal one third of the tibia. Both patients were healthy and did not describe excessive physical activity prior to fracture. Both describe a repetitive twisting action prior to fracture. Computed tomography was diagnostic in both cases following abnormal bone scans and normal plain radiographs. This unusual pattern of fracture has been reported on only four occasions in five patients in the literature.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
8/29. Stress fractures of the tarsal navicular.Tarsal navicular stress fractures present a difficult diagnostic and treatment dilemma for the orthopedic physician of an active individual. patients often complain of diffuse, poorly-defined symptoms and have a paucity of physical findings. Initial diagnostic evaluation often. fails to recognize navicular stress fractures which results in delayed diagnosis and treatment. A bone scan is sensitive in detecting this entity and the clinician should use this examination in any patient who is suspected of having a navicular stress fracture. After a navicular stress fracture is confirmed, a CT scan is required to identify the extent of the fracture. The progression of navicular stress fractures is fairly predictable; treatment can be tailored based on the needs of the individual as well as the stage of presentation. Nonsurgical and surgical options are effective treatments for this disorder.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
9/29. Stress fracture of the tarsal navicular.Stress fractures of the lower extremity are common among military members and athletes at all levels of participation. They typically occur when an individual begins a new or different type of physical training or during periods of abrupt increase in the level of training. Stress fractures represent an incomplete remodeling of bone that occurs secondary to repetitive mechanical loading. In response to this increased loading, the osteoclastic resorption of lamellar bone outpaces the ability of the osteoblasts to create new lamellar bone, eventually leading to structural failure. The following case report reviews the typical clinical presentation, imaging findings, and treatment of the tarsal navicular stress fracture.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
10/29. Bone stress injuries causing exercise-induced knee pain.BACKGROUND: No comprehensive studies of bone stress injuries in the knee based on magnetic resonance imaging findings have been published. PURPOSE: Assess the incidence, location, nature, and patterns of bone stress injuries in the knee in military conscripts with exercise-induced knee pain. STUDY DESIGN: Case series; Level of evidence, 4. methods: During a period of 70 months, 1330 patients with exercise-induced knee pain underwent magnetic resonance imaging of the knee. A total of 1577 knees were imaged; the images with bone stress injury findings were retrospectively reevaluated with respect to location and type of injury. The person-based incidence of bone stress injuries in the knee was calculated, based on the number of conscripts within the hospital's catchment area. RESULTS: Of the 1330 patients, 88 (7%) met the inclusion criteria, and 141 bone stress injuries were found in the 110 knees imaged. The incidence of bone stress injuries was 103 per 100 000 person-years. Of the patients, 25% had bilateral bone stress injuries; 28% had 2 solitary bone stress injuries in the same knee simultaneously, all situated in the femoral condyle and tibial plateau. The most common anatomical location for a bone stress injury was the medial tibial plateau (31%), which was also the most typical location for a more advanced injury. After the commencement of military service, a bone stress injury in the medial tibial plateau caused knee pain earlier than did a bone stress injury elsewhere in the knee (P = .014). CONCLUSION: The incidence of bone stress injuries in the knee with exercise-induced knee pain is relatively high in conscripts. Multiple and bilateral injuries can occur. For accurate diagnosis and to ensure appropriate treatment, magnetic resonance imaging is recommended as a routine imaging method when a physical activity can be regularly associated with the onset of symptoms.- - - - - - - - - - ranking = 0.28141078689058keywords = physical (Clic here for more details about this article) |
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