Ep-PAINE-nym



Thompson’s Test

Other Known AliasesSimmond’s Test

Definitionpassive accessory movement test of the ankle to test for a ruptured achilles tendon

Clinical Significance To perform, place the patient in a pron position or kneeling on the injured extremity’s knee without supporting the foot and ankle. The grasp the muscle belly of the gastrocnemius and observe for passive plantarflexion. A positive test results in inability to plantarflex and confirms a complete rupture of the achilles tendon.

HistoryNamed after Theodore Thompson (1902-1986), an American orthopaedic surgeon who received his medical doctorate from Johns Hopkins University in 1928. Prior to enrolling at Hopkins, he was involved in a traumatic arm injury working at a steel mill where his arm went through a planer. Luckily, a local orthopaedic surgeon, knowing Thompson want to go into medicine, did not amputate and reconstructed his arm to regain full function. His career achievements include heading the amputation center at Walter Reed Hospital during World War II and becoming president of the American Academy of Orthopaedic Surgeons in 1954. He described his eponymous finding in 1962 in two separate articles….which was AFTER Franklin Adin Simmonds (1910-1983), a British orthopaedic surgeon, published the same findings in 1957. Thompson did however acknowledge and reference Simmonds in his 1962 paper. Depending on what side of the pond you trained on will determine how you learned the name of this test.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. THOMPSON TC, DOHERTY JH. Spontaneous rupture of tendon of Achilles: a new clinical diagnostic test. The Journal of trauma. 1962; 2:126-9. [pubmed]
  7. THOMPSON TC. A test for rupture of the tendo achillis. Acta orthopaedica Scandinavica. 1962; 32:461-5. [pubmed]
  8. Simmonds FA. The diagnosis of the ruptured achilles tendon. The Practitioner. 1957;179(1069-1074):56-58 [article]
  9. Physiopaedia. Thompson Test. https://www.physio-pedia.com/Thompson_Test

#50 – Rotator Cuff Injuries



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Epidemiology

  • Up to 30% of the US population report having “shoulder pain”
    • 11 cases per 1000 patients per yearRotator cuff pathology is the most common reason patients seek treatment
  • Rotator cuff injuries also account for up to 40,000 surgeries per year in the US
  • Increases prevalence with age

Risk Factors

  • Repetitive, overhead activities
    • Swimming, weightlifting, tennis, throwing
  • Subacromial impingement
  • Scapular instability or dyskinesis
  • Older age
  • Diabetes
  • Hyperlipidemia and statin use
  • Trauma

Anatomy

  • There are four muscles of the rotator cuff
    • Supraspinatus (most commonly injured)
    • Infraspinatus
    • Subscapularis
    • Teres minor
  • The main function of the rotator cuff muscles is to assist in abduction and external rotation of the shoulder
    • Subscapularis assists internal rotation
  • Also compresses humeral head into the glenoid fossa
    • Stabilizes the glenohumeral joint
    • Counterbalances the elevating force of the deltoid

Mechanisms of Injury

  • Intrinsic mechanisms
    • Emphasize injury within the tendon that decrease integrity over time
      • Overload        
        • During eccentric muscle contraction in overhead activities
      • Degeneration
        • Microtears and calcifications from aging
        • Hypovascularity of the tendons
  • Extrinsic mechanisms
    • Emphasize compressive forces from structures surrounding the rotator cuff that can lead to impingement
      • Acromion, coracoclavicular ligaments, coracoid process
      • Glenohumeral instability

Signs and Symptoms

  • Pain with overhead activities and night pain
    • Over lateral deltoid
  • Weakness
    • Can be apparent even in asymptomatic individuals

Physical Examination

  • Need to evaluate the entire shoulder for other differential diagnoses, including:
    • Biceps tendonitis
    • Labral tears
    • Cervical radiculopathy
    • Thoracic outlet syndromes
  • Inspection
    • Chronic pathology can show atrophy of supraspinatus and infraspinatus
    • Asymmetric movement on active range of motion
      • Particularly with the scapula
  • Palpation
    • Tenderness of affected muscle
    • Focal subacromial tenderness
  • Range of Motion
    • Pain is usually elicited with:
      • 90o abduction
      • Internal rotation
    • Passive range of motion is better than active
  • Rotator cuff specific maneuvers include:

Diagnostic Studies

  • Plain radiographs are generally not helpful, but can be useful for:
    • Assessment when there is no response to conservative therapy
    • Recurrent rotator cuff tendinopathy
    • Anatomical evaluation prior to subacromial or glenohumeral joint injection
  • Ultrasound
    • Rapidly being considered the new gold standard
      • Allows for visualization of tendons in motion
      • Allows for comparison to contralateral side
  • Magnetic Resonance Imaging
    • Considered when:
      • Ruling out a tear when conservative therapy fails
      • Assess for a tear if clinically suspected
      • Aid in the diagnosis when pathology is unclear
    • Findings suggested of tears are:
      • Discontinuity on T1-weighted image and fluid signal on T2-weighted images
      • Fluid in the subacromial space on T2 images
      • Loss of subacromial fat plane on T1
      • Proliferative spur formation of acromion or AC joint

Treatment

  • Conservative Treatment for tendinopathy or chronic, partial tears
    • Cryotherapy
    • Rest
    • NSAIDs
    • Physical therapy (minimum of 6 weeks)
      • Initial stage – mobility
      • Second stage – strength
      • Third stage – function
    • Corticosteroid injections
  • Indications for Surgical Management
    • Acute, full-thickness tears in normal rotator cuff
    • New functional deficit with a known, partial tear
Arthroscopic Repair
“Full” Open Repair
“Mini” Open Repar

Cottage Physician



References

  1. Oh LS, Wolf BR, Hall MP, Levy BA, Marx RG. Indications for rotator cuff repair: a systematic review. Clinical orthopaedics and related research. 2007; 455:52-63. [pubmed]
  2. Teunis T, Lubberts B, Reilly BT, Ring D. A systematic review and pooled analysis of the prevalence of rotator cuff disease with increasing age. Journal of shoulder and elbow surgery. 2014; 23(12):1913-1921. [pubmed]
  3. Lin TT, Lin CH, Chang CL, Chi CH, Chang ST, Sheu WH. The effect of diabetes, hyperlipidemia, and statins on the development of rotator cuff disease: a nationwide, 11-year, longitudinal, population-based follow-up study. The American journal of sports medicine. 2015; 43(9):2126-32. [pubmed]
  4. Mehta S, Gimbel JA, Soslowsky LJ. Etiologic and pathogenetic factors for rotator cuff tendinopathy. Clinics in sports medicine. 2003; 22(4):791-812. [pubmed]
  5. Sørensen AK, Bak K, Krarup AL, et al. Acute rotator cuff tear: do we miss the early diagnosis? A prospective study showing a high incidence of rotator cuff tears after shoulder trauma. Journal of shoulder and elbow surgery. ; 16(2):174-80. [pubmed]
  6. Kim HM, Teefey SA, Zelig A, Galatz LM, Keener JD, Yamaguchi K. Shoulder strength in asymptomatic individuals with intact compared with torn rotator cuffs. The Journal of bone and joint surgery. American volume. 2009; 91(2):289-96. [pubmed]
  7. Lew HL, Chen CP, Wang TG, Chew KT. Introduction to musculoskeletal diagnostic ultrasound: examination of the upper limb. American journal of physical medicine & rehabilitation. 2007; 86(4):310-21. [pubmed]
  8. Roy JS, Braën C, Leblond J, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. British journal of sports medicine. 2015; 49(20):1316-28. [pubmed]
  9. Rees JD, Wilson AM, Wolman RL. Current concepts in the management of tendon disorders. Rheumatology (Oxford, England). 2006; 45(5):508-21. [pubmed]
  10. Ainsworth R, Lewis JS. Exercise therapy for the conservative management of full thickness tears of the rotator cuff: a systematic review. British journal of sports medicine. 2007; 41(4):200-10. [pubmed]

PAINE #PANCE Pearl – Orthopaedics



Question

31yo male was involved in a pedestrian vs car accident and presents as a trauma transfer to your facility 3 hours after the injury. On initial presentation, the patient is in extreme distress and pain. Physical examination shows decreased dorsalis pedis and posterior tibial pulses, significant swelling, decreased sensation in the lower leg, and increased pain with passive dorsiflexion. Radiograph reveals a minimally displaced proximal tibia and fibula fracture.

  1. What is your main concern at this point?
  2. How do you test for it?
  3. What do you do about it?

Ep-PAINE-nym



Lachman’s Test

Other Known Aliasesnone

Definitionpassive accessory movement test of the knee performed to identify the integrity of the anterior cruciate ligament

Clinical Significance Place the patient’s knee in about 20-30 degrees flexion and externally rotated slightly. The examiner should place one hand behind the tibia and the other on the patient’s thigh. It is important that the examiner’s thumb be on the tibial tuberosity. On pulling the tibia anteriorly, an intact ACL should prevent forward translational movement of the tibia on the femur. A positive test is > 2mm of movement compared to the unaffected knee.

HistoryNamed after John Lachman (1919-2007), who was an American orthopaedic surgeon and received his medical doctorate from the Temple University School of Medicine in 1945. He was described as a prolific teacher, mentor, and surgeon making his mark across students, faculty, and patients over illustrious career. As a testament to this, his eponymous test was published by one of his colleagues who named and attributed it to him in 1987.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Gurtler RA, Stine R, Torg JS. Lachman test evaluated. Quantification of a clinical observation. Clinical orthopaedics and related research. 1987; [pubmed]
  7. Physiopaedia. Lachman Test. https://www.physio-pedia.com/Lachman_Test

Ep-PAINE-nym



Osgood-Schlatter Disease

Other Known Aliases – tibial tubercle apophysitis

Definitiontraction apophysitis of the proximal tibial tubercle at the insertion of the patellar tendon.

Clinical SignificanceMost commonly occurs in adolescents as a result of overuse stress in athletics requiring explosive running, jumping, or cutting. This places an extreme amount of stress on the tibial tubercle and may lead to a chronic avulsion. As the new healing callous is laid down, a pronounced deformity may develop.

HistoryNamed after two physician who contemporaneously published on this condition in the same year. Robert Bayley Osgood (1873-1956), was an American orthopaedic surgeon, and received his medical doctorate from Harvard University in 1899. Dr. Osgood spent his entire career practicing in Boston at Massachusetts General Hospital and teaching at the Harvard Medical School. Carl Schlatter (1863-1934), was a Swiss physician and surgeon, and received his medical doctorate from the University of Zurich in 1889. Dr. Schlatter was a skilled surgeon and had a primary interest in trauma and causality medicine during World War I. Both physicians were well respected educators and professors of their time and both published their findings of this condition in 1903.


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Osgood RB. Lesions of the tibia tubercle occurring during adolescence.
    Boston Medical and Surgical Journal. 1903;148: 114-117. [article]
  7. Schlatter CB. Verletzungen des schnabelförmigen Forsatzes der oberen Tibiaepiphyse. Beiträge zur klinischen Chirurgie, 1903;38: 874-887. [article]

Ep-PAINE-nym



Maisonneuve Fracture

 

Other Known Aliasesnone

 

Definitionspiral fracture of the proximal third of the fibula caused by pronation with external rotation

 

Image result for maisonneuve

Clinical SignificanceThis injury is a sequelae of significant ankle trauma with disruption of the distal tibiofibular syndesmosis and can be unstable.  It is also one of the criteria of the Ottawa Rules of the Ankle so you don’t miss these

 

History – Named after Jules Germain François Maisonneuve (1809-1897), a French surgeon who studied under Guillaume Dupuytren in the mid-1800s.  He first reported this injury pattern in 1840 in the article entitled Recherches sur la fracture du Péroné.  He was also the first surgeon to advocate the use of external fixation in the management of ankle fractures


References

  1. Firkin BG and Whitwirth JA.  Dictionary of Medical Eponyms. 2nd ed.  New York, NY; Parthenon Publishing Group. 1996.
  2. Bartolucci S, Forbis P.  Stedman’s Medical Eponyms.  2nd ed.  Baltimore, MD; LWW.  2005.
  3. Yee AJ, Pfiffner P. (2012).  Medical Eponyms (Version 1.4.2) [Mobile Application Software].  Retrieved http://itunes.apple.com.
  4. Whonamedit – dictionary of medical eponyms. http://www.whonamedit.com
  5. Up To Date. www.uptodate.com
  6. Maisonneuve, J. G. (1840). Recherches sur la fracture du péroné. Paris. France: Loquin & Cie.

PAINE #PANCE Pearl – Musculoskeletal



Question

 

What rheumatologic disease can be summed up the phrase “can’t see, can’t pee, can’t climb a tree”?

 



Answer

 

The triad of ocular symptoms (conjunctivitis, uveitis, episcleritis, keratitis), genitourinary symptoms (dysuria, urethritis, cervicitis) and musculoskeletal symptoms (arthritis, enthesitis, dactylitis) are diagnostic of reactive arthritis.

 

Image result for cant see cant pee cant climb a tree