symptoms

Brailsford Disease

Definition

 

Adult form

- 45 year old females

- more severe than Kohler's

 

Symptoms

 

Intense pain +/- oedema & inflammation

- often pronounced limp

- marked flat foot with prominant navicular

 

Radiology

 

Navicular narrowed

- lateral part dense, sclerotic & thin

- occasional fracture line

Whiplash

Definition

 

Isolated posterior ligament injuries

- PLL / Posterior interspinous ligament / Paraspinal muscles

 

Excludes fracture / dislocation / HNP

 

Aetiology

 

MVA

Sport

Hyperflexion injuries

 

Symptoms

 

Large spectrum clinical presentation

- neck ache 

- nausea & vomiting 

- headache 

- visual symptoms

CRPS

Definition

 

Chronic Regional Pain Syndrome

 

CRPS 1

 

Sympathetically mediated pain syndrome

- excessive or exaggerated response of extremity to injury, surgery or disease

 

Manifested by

- intense or unduly prolonged pain

- vasomotor disturbances

- trophic changes

- delayed functional recovery

 

CRPS 2

 

Management

Incidence

 

Knee > Hip

- superficial position

- limited cover of well vascularised muscle 

- watershed area of skin blood supply anterior to the skin incision 

- much increased in fully constrained prosthesis 

 

Ideal < 1%

 

Risk Factors

 

Increased with

- revision

- prior infection

- RA / Psoriatic arthropathy

- DM

Postoperative discitis

SymptomsT45 discitis

 

Period of pain relief after disc surgery

- followed by increasing back pain & occasional leg pain

 

Pain may be disproportionate to physical findings

 

Low grade fever common

 

SLR & femoral stretch tests elicit pain in some cases 

 

Bloods

 

Capitellar OCD

Epidemiology

 

Adolescents & young adults

 

Usually between 12 - 21 years 

 

Throwing athletes / gymnasts

 

Little Leaguer's Elbow

- combination of capitellar OCD and MCL injury

- a repetitive throwing injury / seen in pitchers

 

Aetiology

 

1.  Trauma & Overuse

 

Common throwing sports / gymnastics

Meniscal Cysts

Epidemiology

 

Most common in lateral meniscus 9:1

 

Peak incidence 20-40

 

Aetiology

 

Probably 2° to infiltration of joint fluid into extra-articular tissues

- almost always associated with horizontal cleavage tear

- creates a flap valve in lateral 1/3 of LM

 

Symptoms

 

Usually present with pain

- activity related

 

May notice lump

Infection

Risk factors

 

Patient 

 

Advanced age

Immunosuppression - steroids / Rheumatoid / DM

Malnutrition - Lymphocyte count / Transferrin / Albumin

Vascular disease

Obesity

Poor skin i.e. psoriasis

Previous infection in joint

Infection elsewhere - i.e. UTi

Prolonged hospital admission

Revision surgery

 

Operative Factors

 

Preoperative