ANTERIOR CRUCIATE LIGAMENT TEAR

AN ANTERIOR CRUCIATE LIGAMENT OF ACL TEAR IS A TEAR TO ONE OF THE FOUR MAJOR LIGAMENTS IN THE KNEE. ACL TEARS ARE A RESULT OF EXCESSIVE MOTION. THESE ARE MOST OFTEN SPORTS RELATED, BUT CAN ALSO BE A RESULT OF A MOTOR VEHICLE ACCIDENT, OR FALL.

SYMPTOMS OF AN ACL TEAR INCLUDE A FEELING OF THE KNEE GIVING OUT, A "POP" IN THE KNEE, PAIN, AND SWELLING. ON PHYSICAL EXAMINATION THE PHYSICIAN WILL NOTICE AN INSTABILITY OF THE KNEE JOINT. A MRI IS THE STANDARD TEST TO DIAGNOSE AN ACL TEAR.

IF THERE IS A COMPLETE TEAR OF THE ACL, SURGERY IS RECOMMENDED. A TORN ACL CAN NOT BE REPAIRED, SO ANOTHER TENDON OR LIGAMENT FROM EITHER A DONOR CADAVER, OR TAKEN FROM THE PATIENT IS GRAFTED TO REPLACE THE ACL.

ROTATOR CUFF TEAR

A TEAR OF THE ROTATOR CUFF IS A TEAR OF ONE OR MORE OF THE FOUR MUSCLES AND THEIR ASSOCIATED TENDONS THAT ARE IN THE SHOULDER. THESE TEARS CAN BE EITHER CHRONIC OR ACUTE. CHRONIC TEARS ARE CAUSED BY EXCESSIVE OVERHEAD ACTIVITIES SUCH AS A BASEBALL PITCHER OR A PAINTER. ACUTE TEARS ARE CAUSED BY A SUDDEN, POWERFUL RAISING OF THE ARMS AGAINST RESISTANCE SUCH AS HEAVY LIFTING OR CUSHIONING A FALL.

SYMPTOMS OF A ROTATOR CUFF TEAR INCLUDE SHOULDER PAIN THAT CAN RADIATE DOWN THE ARM. LACK OF MOBILITY IN THE ARM. AND THE INABILITY TO RAISE THE INJURED ARM OVERHEAD.

MRI HAS BECOME THE TEST OF CHOICE FOR MOST SUSPECTED ROTATOR CUFF TEARS. MRI IS ABLE TO IDENTIFY ALL ROTATOR CUFF INJURIES FROM DEGENERATIVE TO PARTIAL TO COMPLETE TEARS.

TREATMENT FOR PARTIAL TEARS USUALLY INVOLVES MEDICATION FOR THE PAIN AND THERAPY. COMPLETE TENDON TEARS ARE REPAIRED SURGICALLY WITH A 95% SUCCESS RATE.

HIP FRACTURE

CAUSES:
A HIP FRACTURE CAN OCCUR DUE TO SEVERAL CAUSES. THE MOST FREQUENT ARE FALL, TRAUMA OR BLOW TO THE HIP REGION, SUCH AS IN A MOTOR VEHICLE ACCIDENT. A SPONTANEOUS HIP FRACTURE CAN ALSO OCCUR FROM A GRADUAL LOSS OF MINERALS IN THE BONE WHICH LEADS TO A DECREASE IN BONE DENSITY.
SYMPTOMS:
SYMPTOMS OF A HIP FRACTURE ARE SEVERE HIP/GROIN PAIN, IMMOBILITY IMMEDIATELY AFTER A FALL, UNABLE TO BEAR WEIGHT, AND THE AFFECTED LEG BEING SHORTER AND OR TURNED LATERALLY.
TEST:
MOST FRACTURED HIPS WILL SHOW UP ON XRAYS. CT IS DONE TO DIAGNOSE A HAIRLINE FRACTURE, TO BETTER DEMONSTRATE A KNOWN FRACTURE, AND TO AID A SURGEON IN THE PLANNING A COURSE OF TREATMENT.
TREATMENT:
SURGERY IS REQUIRED ON ALMOST ALL FRACTURED HIPS. DEPENDING ON THE SIGHT AND SEVERITY OF THE FRACTURE SCREWS OR NAILS MAY BE PLACED TO HOLD THE FRACTURE TOGETHER. A PLATE MAY ALSO BE USED ON THE PROXIMAL FEMUR TO AID IN HEALING AND ADD STABILITY. IF THE HEAD AND NECK OF THE FEMUR A SEVERELY DAMAGED AND UNABLE TO BE REDUCED, THE SURGEON MAY REMOVE THEM AND REPLACE THE JOINT IN A PROCEDURE CALLED A HEMIARTHROPLASTY.

APPENDICITIS

APPENDICITIS IS A CONDITION WHEN THE APPENDIX BECOMES INFLAMED AND FILLS WITH PUS. THIS CAN BE CAUSED BY A VIRAL INFECTION, BUT IS MOST OFTEN THE RESULT OF AN OBSTRUCTION OF THE OPENING TO THE APPENDIX BY FOOD OR FECAL MATTER.

SYMPTOMS OF APPENDICITIS INCLUDE PAIN THAT STARTS IN THE MID-ABDOMEN, THEN OVER THE COURSE OF SEVERAL HOURS TRAVELS TO THE RIGHT LOWER ABDOMEN. THE PAIN BECOMES SHARPER OVER TIME AND SETTLES IN THE RIGHT LOWER QUADRANT OF THE ABDOMEN. TENDERNESS OVER THIS AREA, NAUSEA, VOMITING, FEVER, AND ABDOMEN SWELLING ARE ADDITIONAL SYMPTOMS THAT ACCOMPANY APPENDICITIS. IF THE APPENDIX RUPTURES ITS CONTENTS SPILL INTO THE ABDOMINAL CAVITY. THIS CAUSES AN INFLAMMATION KNOWN AS PERITONITIS. THIS IS A VERY SERIOUS INFECTION THAT REQUIRES IMMEDIATE MEDICAL ATTENTION AS IT CAN BE FATAL.

DIAGNOSES OF APPENDICITIS WOULD USUALLY START WITH A PHYSICAL EXAMINATION OF THE PATIENT. A BLOOD TEST WOULD BE ORDERED TO CHECK IF THE WHITE BLOOD COUNT IS HIGH. IF AN APPENDICITIS IS SUSPECTED, A CT OF THE ABDOMEN AND PELVIS IS THE MOST COMMONLY ORDER WITH ORAL AND IV CONTRAST.

TREATMENT OF ACUTE APPENDICITIS IS ALMOST ALWAYS SURGICAL REMOVAL OF THE APPENDIX IN A PROCEDURE KNOWN AS AN APPENDECTOMY.

PULMONARY EMBOLISM

A PULMONARY EMBOLISM OR PE, IS A CONDITION WHEN ONE OR MORE ARTERIES IN THE LUNGS BECOME BLOCKED. THIS IS CAUSED BY BLOOD CLOTS THAT TRAVEL TO THE LUNGS FROM OTHER BODY PARTS, USUALLY THE LEGS. THIS IS COMMONLY ASSOCIATED WITH PEOPLE WHO SUFFER FROM DEEP VEIN THROMBOSIS OR DVT.

SYMPTOMS

SYMPTOMS OF A PE USUALLY INCLUDE A SUDDEN SHORTNESS OF BREATH, CHEST PAIN, AND A COUGH THAT MAY PRODUCE A BLOOD-TINGED SPUTUM.

TESTS

ONE OF THE FIRST TEST TO CHECK FOR A PE IS A BLOOD TEST CALLED D-DIMER. THIS TEST CAN SUGGEST THE LIKELIHOOD OF BLOOD CLOTS. IF A PE IS SUSPECTED, A NUCLEAR MEDICINE TEST, A VENTILATION-PERFUSION SCAN OR V/Q SCAN, CAN ALSO BE ORDERED. THE V/Q SCAN USES SMALL AMOUNTS OF RADIOACTIVE MATERIAL TO STUDY THE AIR AND BLOOD FLOW TO THE LUNGS. AN CTA CHEST SCAN IS A MORE PRECISE TEST TO EVALUATE A POSSIBLE PE. AFTER I.V. CONTRAST IS INJECTED AT A RATE OF 3-5 ML PER SECOND A HELICAL SCAN IS PERFORMED. AXIAL, CORONAL, AND SAGITTAL IMAGES ARE USED TO DIAGNOSE A PE.

TREATMENT

A PE IS USUALLY TREATED WITH MEDICATION. BLOOD THINNING ANTICOAGULANTS ARE THE MOST COMMON. IF THE BLOOD CLOT IS NOT DISSOLVING ON ITS OWN, THROMBOLITICS CAN BE GIVEN TO HELP THE BLOOD CLOT DISSOLVE MORE QUICKLY. IF A PATIENT CAN NOT BE GIVEN MEDICATION, A VEIN FILTER IS SOMETIMES PLACED IN THE INFERIOR VENA CAVA TO HELP PREVENT ANY BLOOD CLOTS FROM REACHING THE LUNGS.