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14 Learn about this basic orthopedic disease.

Monday, June 7, 2021

Orthopedic disease

Learn about basic orthopedic diseases

Tarsal Tunnel Syndrome

Have you ever heard of tarsal tunnel syndrome?

If you are in a position to provide direct services to patients, you will need to know what this condition is all about. Tarsal sinus syndrome is characterized by tightening of the arteries and veins that pass through the tunnels on the inside of the foot, causing pain, numbness, and loss of muscle strength.

When does it happen?

There are no specific factors that cause it.

It has been confirmed that it can be caused by ganglions, bone spurs, and ankle sprains.

It is characterized by

Pain in the soles of the feet, strange sensations in the toes and soles of the feet, weakness in the muscles of the soles of the feet, and a burning sensation in the soles of the feet at night. To confirm the syndrome, the Tinel sign at the tarsal tunnel and the distribution of numbness in the sole of the foot are examined.

Case in point.

As this is a case that I experienced myself, I will only explain the mechanism of occurrence and the process of healing. I was able to confirm the syndrome as a complication of an ankle sprain in an elementary school athlete.

The patient complained only of numbness and pain, and recovered after one month of treatment. We are practicing post-treatment such as preventing the recurrence of sprain.

Shin splints

Have you ever heard of shin splints?

Shin splints, also known as overexertional neck pain, is a chronic sports injury and a disease that sports athletes should know about.

When does it happen?

Abnormal alignment of the lower limbs

Lowering of the medial arch of the foot, which may lead to hyperextension of the soleus and tibialis posterior muscles, which can also be called periostitis or laminitis.

It is also observed in cases where the range of motion of the ankle is limited.

It can also be caused by running in the winter.

It is characterized by

Pain is felt in the lower 1/3 of the medial side of the tibia, below the knee.

If the pain is mild, the patient does not visit a specialist or medical institution, but often the patient is diagnosed with a severe case. MRI imaging evaluation shows periostitis. In addition, intramedullary signals may indicate myositis, bone edema, hemorrhage, or microfracture.

The case is as follows

16-year-old male soccer player.

Soccer player. 1 week ago, pain appeared on the medial side of the right lower leg without cause. The pain was so severe when walking that he was unable to participate in sports activities. Hop step was not possible, and MRI images showed high signal around the tibial periosteum. The patient was instructed to rest, and was reexamined three weeks later with no evidence of osteogenesis.

Jones Fracture

Have you ever heard of "Jones fracture"?

The name of this disease appears in basic medicine, but it is not commonly known as a fracture. This is a fracture that can happen to both athletes and the general public, so let's take a look at what it is. Here is a brief introduction.

What is a Jones fracture?

It is a fatigue fracture of the base of the fifth metatarsal. It is located at the base of the fifth metatarsal (between the base of the little toe and the ball of the foot).

A fatigue fracture is a fracture caused by repetitive stress.

In what kind of sports are fatigue fractures seen?

Soccer

Basketball

Handball

American football

It is more likely to be seen in games that require a lot of "side stepping" and is therefore considered a fracture that is more likely to occur in sports.

Be careful in these situations

Sudden pain during normal activities such as stepping, turning, and stepping in.

If pain occurs in the area, think about it because it can occur regardless of trauma such as a fall or bump. It is a fracture that is difficult to heal, so it may happen again. In some sports, surgical treatment may be an option.

The diagnosis is

In the diagnosis, the site of pain is similar to that of peroneus brevis tendonitis, but although it can be identified by the tender site, it is necessary to check the details without making a snap judgment. In rare cases, patients have complained of pain in unrelated areas, and as a result of diagnostic imaging, it has been found that they have this disease.

Case

A 17-year-old male soccer player.

He complained of pain 3 months ago and was diagnosed with the syndrome.

After 3 months of immobilization in a cast, he returned to play and was considered to be completely cured. However, two weeks later, the pain reappeared, and after a second visit to the doctor, the patient was re-examined and a re-fracture was confirmed. Surgical treatment was considered, according to the patient.

Tibialis posterior tendon dislocation

Tibialis posterior tendon dislocation is when the tendon that runs behind the inner ankle is not in its original position. It often happens while playing sports, but if you think it's just a sprain or a misplaced muscle, it can be a serious condition.

When does it tend to happen?

It has been reported that it often occurs during turning movements.

It has been reported that it often occurs during turning movements, so it is important to pay attention to it in games where sudden turning movements are frequently performed (basketball, soccer, etc.).

It is characterized by

The tibialis posterior tendon is held in place by a band-like structure called the flexor digitorum brevis. It is a dislocation that occurs when the ankle is subjected to stress beyond the control of the flexor band in a turning motion, such as a sudden toe up and outward turn. Pan! And then, bam! The dislocation feeling and pain may lead to suspicion of this disease.

Case

Male, 25 years old

During motocross, I felt a "bang" sound behind the medial tibia when turning with my left foot on the ground. Tenderness in the affected area and signs of the tendon pushing forward during internal rotation were noted, and similar signs were noted during walking. After that, the patient repeatedly dislocated the tibia three to four times, and the pain was so severe that surgery was indicated.

Peroneal tendon dislocation

A peroneal tendon dislocation is a dislocation of the tendon that runs behind the outer ankle. Most of the time it can be determined by appearance, but sometimes it is mistaken for swelling and can be missed.

When does it happen?

When the foot is immobilized and the entire calf is subjected to an outward force, the upper peroneal muscle band, which holds the peroneal tendon in place, loosens or breaks.

It is characterized by

If there is severe swelling around the outer ankle at the time of injury, this is suspected.

Dislocation of tendons rarely occurs spontaneously.

Medical personnel may need to perform an induction test to confirm the presence of a dislocated tendon. It may occur in conjunction with an ankle sprain.

It is not always easy to determine that the ankle is badly swollen, or that it is a fracture. Tendon dislocation can be determined after the swelling goes down.

Cases

16-year-old male

A week ago, during a soccer game, I felt a pain in my outer ankle area with a "buzzing" sensation when I stepped on my foot. Although he was able to continue playing, the same symptoms kept recurring, and based on clinical findings and examination, it was determined that he had a dislocation. Surgery was indicated, and a dislocation of the peroneus longus tendon and a longitudinal rupture of the peroneus shortus tendon were found.

Fracture of the anterior process of the calcaneus and bifurcation ligament injury

A fracture of the anterior process of the calcaneus is a fracture that occurs in the anterior process of the heel bone. It is also a case where the attached bifurcated ligament is involved and tear fractures and ligament injuries can also occur.

When does it happen?

It happens when the ankle is twisted so that the inside of the thumb points upward.

It is characterized by

Localized tenderness in a specific area.

If the pain and swelling persist for several weeks after the sprain, this disease should be suspected. The pain and swelling may persist for several weeks after an internal sprain, and can be diagnosed by X-ray imaging.

Case

17-year-old female

She fell on a step and twisted her left ankle. She was unable to put weight on her left foot due to the pain, and had pain and swelling in the abdomen of her foot.

Examination revealed tenderness in the bifurcated ligament and a cleavage fracture  of the anterior process of the calcaneus.

Plantar tendonitis

Plantar tendonitis is an inflammation of the muscles and tendon membrane that extends from the heel bone to the sole of the foot. It is suspected in both children and adults when the sole of the foot hurts, but here are some of the characteristics of the condition.

What are the characteristics of this condition?

The sole of the foot is subjected to mechanical stress. People with flat feet are also susceptible. People with flat feet can also be affected.

It is characterized by

In many cases, treatment results are good even if pain occurs, but a complete cure is difficult. If the treatment is not successful, it may be considered for surgery.

In some cases, bone spurs form at the attachment of the tendon membrane (medial tuberosity of the calcaneus). In some cases, bone spurs form at the attachment of the tendon membrane (medial tuberosity of the calcaneus), which may be the cause of pain. In such cases, surgery may be necessary. It is also seen in athletes, and sometimes in people in their 40s and 50s who are very active.

Cases

47-year-old male

He had been experiencing pain in the bottom of his feet while running. The pain became more severe two days ago, and examination revealed tenderness at the attachment area and extension of the MTP joint induced the pain.

Discrete osteochondritis

Discrete osteochondritis is a condition in which the cartilage of a bone is subjected to some external force, resulting in lesions and inflammation. It can be triggered by a sprained ankle, so I would like you to know that it can happen to anyone.

When does it happen?

The lesion is caused by the force applied to the talus by a sprain.

The lesion occurs in the pulley area of the talus. Typically, there are two types of lesions: anterolateral and posteromedial.

It is characterized by

The most common complaint is that the ankle joint is painful to move, painful when putting weight on it, and a feeling of being caught. The most common complaints are

There is a lack of physical findings, and it may be detected only by X-ray imaging when an ankle sprain occurs. Depending on the lesion, surgical treatment may be recommended.

Case

14-year-old female

She was playing basketball and sprained her right foot four months ago. She visited a medical institution and found the syndrome by chance on an imaging test. She had no symptoms, but pain appeared in the ankle joint area three weeks ago, and pain occurred when she jumped or stepped on one foot. An MRI scan revealed a high signal area, and a CT scan was performed, which revealed that the lesion extended to the subchondral bone.

Berndt A. L.,Harty M. : Transchondral fractures(osteochondritis dissecans)of the talus,J Bone Joint Surg Am,41:988-1020,1959.

Painful external tibia

In this article, I would like to talk about painful external tibia, which may not sound familiar, but it is a condition that can be seen even in elementary school children.

It is a disease that should be known not only by those involved with elementary school students but also by medical personnel.

Outline

External tibia is a remnant of secondary ossification in the rough surface of the navicular bone (foot). The majority of patients are asymptomatic, but when pain appears for some reason, it is called "painful external tibia".

There is a method to determine the condition called Veitch's classification.

Type 1: Separated from the navicular bone and located within the tibialis posterior tendon

Type 2: Fibrous connection to the rough surface of the navicular bone

Type 3: Bony union with the navicular bone.

Clinical Findings

The patient himself may be concerned about the deformity of the foot and visit the doctor. In the early stages of the disease, the patient may experience motion pain, and in severe cases, pain on walking may occur. It can be caused by sprained ankle joint or exercise with new shoes. Some adults also have external tibia, but trauma may be the trigger for its detection.

Cases

22-year-old female

Sprained her left foot while playing handball.

Very severe pain appeared, making it difficult to walk. There was marked tenderness and swelling on the medial side of the scaphoid bone. We suspected a bone fragment avulsion of the outer tibia and found it on imaging examination. It was judged to be a traumatic rupture, and surgery was recommended.

Speckled Bone Disorder

Seed bone disorder is a problem with the pea-sized bone at the base of the thumb.

It can only be touched from the sole of the foot, but because of the plantar muscles, it is difficult to palpate and requires practice.

When does it happen?
Inflammation caused by the impact of repeatedly stepping on the ground while running, and the repetitive stretching of the thumbs during running are thought to be the causes.

About the characteristics

Pain is reported while walking or running. There is pain and swelling when pressing down on a small area. Pain is triggered when the thumb is extended upward.

Clinical points

A simple radiographic examination is necessary to differentiate it from a bifid seed bone. In severe cases, the patient may not be able to touch the ground. In severe cases, the patient may not be able to touch the ground. Pads are placed to protect the affected area, but they are not effective and rest is recommended. Keep in mind that the medial seed bone is prone to fatigue fractures. If pain is not relieved by conservative treatment, bone fragments can be removed hematopanically.

Similar Diseases

Turf toe
Caused by sprain of the first metatarsophalangeal joint. Occurs when the toe is caught in the grass and subjected to hyperextension. It causes damage to the sesamoid bone, joint capsule, and ligaments, and in severe cases, internal bleeding and joint instability are observed. In severe cases, internal bleeding and joint instability are observed. Cases caused by hyperflexion are also called reverse turf toe.

Extensor carpi radialis longus tendonitis

Extensor hallucis longus tendonitis is a condition that causes pain in the muscle that raises the thumb. The following is an introduction to this condition, which can occur whether you play sports or not.

When does it happen?
There is no definite cause, and the pain is felt from the thumb to the ankle and around 1/3 of the ankle. It has also been reported that tightening the laces of athletic shoes can cause inflammation.

Characteristics

The affected area is pain and tenderness around the dorsal navicular and metatarsal bones, so it is necessary to differentiate between fatigue fractures of the navicular and metatarsal bones. If the symptoms are severe, the patient may be able to hear a gripping snow sound when flexing the fingers. In severe cases, restriction of extension of the big toe may also be observed. In severe cases, restriction of extension of the big toe may also be seen. ・If shoes are considered to be a factor, check whether the laces are hitting the foot.

Case

17-year-old female
She was playing in a marching band and started to have pain in the back of her foot one week ago. The pain was located in the extensor hallucis longus tendon, and a grasping snow sound such as "guzu guzu" was observed due to automatic contraction.

Osgut-Schlatter disease

This article introduces the very famous Osgut disease, also known as Osgut, and this injury.

When does it happen?
It is said to be caused by excessive contraction of the quadriceps muscle before the closure of the epiphyseal cartilage during growth, which exerts excessive traction on the tibial tuberosity. The more often the muscles in the front of the thigh are subjected to force, the more likely they are to become affected. The more frequently the muscles in the front of the thigh are stressed, the more likely it is to occur.

Characteristics

It is characterized by pain in the rough surface of the tibia (the part that sticks out when the knee is bent), loss of mobility due to pain, and pain before and after exercise. Continued exercise in the presence of pain may lead to segmentation of the tibial tuberosity. If the bone fragment remains in the adult and causes pain, removal surgery may be indicated.

Case

Male, 18 years old
He complained of pain in the rough surface of the tibia during baseball practice and dashing for a month. Although tenderness and swelling were observed in the affected area, stretching of the quadriceps muscle did not induce pain. There was no difference in muscle strength during knee extension. Simple X-rays confirmed the diagnosis and showed bone fragment release. Five months had passed since then, and the pain had recurred one week before. This time, the pain was induced by stretching of the quadriceps muscle. Because of the prolonged symptoms and the patient's intention to continue playing baseball, we performed a surgical removal of the bone fragment. He was able to return to sports 1.5 months after the surgery, and his pain has decreased dramatically.

Iliotibial Ligamentitis

Iliotibial ligamentitis is a condition that occurs when the iliotibial ligament, which passes through the prominence of the femur, is subjected to the friction of repetitive motion. This is something that many people should know about, as it is said to be more common during running, but sometimes it is not.

When does it happen?
It is common among athletes in running and bicycle racing. It can be caused by repetitive injuries, so overuse may be considered, but there are other causes as well.

What are the characteristics?

The shortening of the iliotibial ligament is one of the factors, so it may be based on the shortening of the myofascial tension muscle and the gluteus medius muscle.

The risk of developing the disease is high in cases of abnormalities of the bony axis, such as O-leg and internal tibial torsion. The iliotibial ligament friction test (grasping test) is used to detect the syndrome. It can also be detected by the squatting test. Stretching of the iliotibial ligament is useful for prevention. Injury to the lateral meniscus is a common differential for this condition.

Cases

38-year-old male
Bicycle racing athlete.
He had been experiencing discomfort in the lateral part of the right knee for two months, and had motion pain and tenderness in the lateral femoral epicondyle.
Physical examination revealed a positive result, and it was determined that he had the syndrome. An MRI scan also confirmed the diagnosis.

Sinding-Larsen-Johansson disease

There may be some people who have never heard of this disease, but as a medical professional, it is a disease that you must know. It is important to differentiate Johansson's disease from other diseases, and if you can't differentiate it from other diseases, it is easy to miss a fracture.

When does it happen?
It tends to occur in boys in their teens, and is caused by frequent repetition of knee bending and extension. The pain is confined to the patella, the tip of the knee plate.

About the characteristics

Patients should be asked to point to the painful area to get a hint on how to identify it. As with jumper's knee, there may be no obvious trauma.
Since the tender areas are different, it is easy to differentiate from jumper's knee.
If it is accompanied by obvious trauma, consider a sleeve fracture. In general, conservative treatment is recommended. Although the imaging findings are similar to those of a sleeve fracture, this condition remits with rest, so it is possible to differentiate between the two.

Case

11-year-old male
He was a tennis player and had been experiencing pain when extending his knee for two weeks. The pain pointed to the lower end of the patella and he complained of pain when stretching the quadriceps. Imaging findings showed abnormal ossification at the lower end of the patella, and rest was indicated. The patient was re-examined two months later, and a tendency toward fusion was confirmed.

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