The MSK Minute Podcast Collection

Calcaneal apophysitis (Sever disease) is a common cause of heel pain, particularly in the athletically active child. Eighty-five children (137 heels) with calcaneal apophysitis were reviewed. Both heels were affected in 52 (61%) patients. The most common associated foot condition was pronation, occurring in 16 patients. Sixty-eight patients complained that pain was made worse by a specific sport, with soccer leading the list. All patients were treated with a physical therapy program of lower extremity stretching, especially of the heel cords, and ankle dorsiflexion strengthening...

OBJECTIVE: Non-specific heel pain (calcaneal apophysitis) is a common disorder, particularly in physically active growing children. Foot radiographs are usually obtained as part of the clinical evaluation in routine orthopaedic practice. However, there is still controversy about the specific findings on radiographs, and it is unclear what information is present on radiographs that may alter the diagnosis and management. The purpose of this study was to review a consecutive series of patients with the diagnosis of calcaneal apophysitis to assess the yield of routine radiographs of the foot...

BACKGROUND: Calcaneal apophysitis (Sever disease) is most often diagnosed clinically, and radiographic evaluation is believed to be unnecessary by many physicians. To evaluate the need for radiographic evaluation in children with a clinical diagnosis of calcaneal apophysitis, we determined the frequency of abnormal radiographic findings in a group of patients with this clinical diagnosis. METHODS: Clinical records and radiographs of all children between the age of 4 and 17 years who presented with a chief complaint of heel pain were retrospectively reviewed...

BACKGROUND: Calcaneal apophysitis, or Sever's disease, is a traction apophysitis. It is a frequent cause of heel pain in children. Knowledge about the exact incidence of calcaneal apophysitis in the general population, however, is lacking. DESIGN: Cross-sectional study. METHODS: From 34 general practices, records of patients between 6 and 17 years old, visiting the general practitioner (GP), were analysed. Diagnoses of calcaneal apophysitis were counted using computerised registration networks of GPs in 2008, 2009 and 2010...

BACKGROUND: Calcaneal apophysitis (Sever disease) has been reported to be the most common cause of heel pain in athletic children. OBJECTIVE: The study aim was to compare plantar pressure, plantar surface contact area, distribution of body weight across the lower extremities, and prevalence of gastrocnemius ankle equinus and gastrocnemius-soleus ankle equinus (which can cause decreases in ankle dorsiflexion range of motion) in children with and without Sever disease...

BACKGROUND: Calcaneal apophysitis is a frequent cause of heel pain in children and is known to have a significant negative effect on the quality of life in affected children. The most effective treatment is currently unknown. The purpose of this study is to evaluate 3 frequently used conventional treatment modalities for calcaneal apophysitis. METHODS: Three treatment modalities were evaluated and compared in a prospective randomized single-blind setting: a pragmatic wait and see protocol versus a heel raise inlay (ViscoHeel; Bauerfeind) versus an eccentric exercise regime under physiotherapeutic supervision...

This article reviews the evaluation of the hip including the clinical history and physical examination. As our understanding of hip pathology evolves, and arthroscopic and other minimally invasive operative techniques improve, the focus is shifting toward earlier identification of hip pathology. Risk factors for the development of arthritis are now well established and include femoral acetabular impingement, labral tearing, developmental dysplasia, and slipped capital femoral epiphysis. Emerging treatment options may address these conditions in the early stages and prevent or slow the progression of hip degeneration...

BACKGROUND: As our understanding of hip pathology evolves, the focus is shifting toward earlier identification of hip pathology. Therefore, it is vitally important to elucidate intra-articular versus extra-articular pathology of hip pain in every step of the patient encounter: history, physical examination, and imaging. QUESTIONS/PURPOSES: The objective was to address the following research questions: (1) Can an algorithmic approach to physical examination of a painful non-arthritic hip provide a more accurate diagnosis and improved treatment plan? (2) Does an anatomical layered concept of clinical diagnosis improve diagnostic accuracy? (3) What are the diagnostic tools necessary for the accurate application of a four-layer (osteochondral, inert, contractile, and neuromechanical) diagnosis? METHODS: An unrestricted computerized search of MEDLINE was conducted...

The adult patient who complains of anterior hip pain is a dilemma frequently encountered by the primary care physician. Detailed history taking, physical examination, and plain x-ray films are indicated for the initial evaluation. Anterior hip pain is often diagnosed as musculoskeletal strain/sprain and treated with a conservative regimen represented by the acronym NICER (nonsteroidal anti-inflammatory drugs, ice, compression, elevation, and rest) with or without physical therapy. On occasion, this therapy fails to eradicate the symptoms...

Hip pain is a common and disabling condition that affects patients of all ages. The differential diagnosis of hip pain is broad, presenting a diagnostic challenge. Patients often express that their hip pain is localized to one of three anatomic regions: the anterior hip and groin, the posterior hip and buttock, or the lateral hip. Anterior hip and groin pain is commonly associated with intra-articular pathology, such as osteoarthritis and hip labral tears. Posterior hip pain is associated with piriformis syndrome, sacroiliac joint dysfunction, lumbar radiculopathy, and less commonly ischiofemoral impingement and vascular claudication...

Hip pain is a common complaint among patients presenting to outpatient clinics. Stratifying patients based on age, acuity, and location of pain (extra-articular vs intra-articular) can help to aid in appropriate imaging and timely referral to an orthopedic surgeon. A thorough history and an organized physical examination combined with radiographs are usually sufficient to diagnose most hip complaints. If the diagnosis remains uncertain, magnetic resonance imaging, usually with intra-articular gadolinium, is the imaging modality of choice in diagnosing both intra-articular and extra-articular pathologies...

The differential diagnosis of groin pain is broad and complex. Therefore, it is essential to develop an algorithm when differentiating the hip as a cause of groin pain from other sources. Selective injections in and around the hip can be helpful when making the diagnosis but are only one part of the algorithm.

OBJECTIVE: To investigate the comparative effectiveness of all treatments for patellofemoral pain (PFP). DESIGN: Living systematic review with network meta-analysis (NMA). DATA SOURCES: Sensitive search in seven databases, three grey literature resources and four trial registers. ELIGIBILITY CRITERIA: Randomised controlled trials evaluating any treatment for PFP with outcomes 'any improvement', and pain intensity. DATA EXTRACTION: Two reviewers independently extracted data and assessed risk of bias with Risk of Bias Tool V...

BACKGROUND: Although common, mallet finger represents a spectrum of injuries for which there are many questions about the best form of treatment. A long-standing controversy continues as to strategies and techniques of treatment. This quantitative literature analysis is the first that makes use of an evidence-based evaluation process to pool across studies the outcomes of conservative versus surgical treatment of closed mallet finger injuries of both acute and chronic or recurrent types...

INTRODUCTION: Mallet injuries are common and usually treated conservatively. Various systematic reviews have found a lack of evidence regarding the best management, and it is unclear whether this uncertainty is reflected in current UK practice. METHODS: An online survey was developed to determine the current practice for the conservative treatment of mallet injury among specialist hand clinicians in the UK, including physiotherapists, occupational therapists and surgeons...

BACKGROUND: Mallet finger is a common injury. The aim of this review is to give an overview of the different treatment options of mallet injuries and their indications, outcomes, and potential complications. METHODS: A literature-based study was conducted using the PubMed database comprising world literature from January of 1980 until January of 2010. The following search terms were used: "mallet" and "finger." RESULTS: There are many variations in the design of splints; there are, however, only a few studies that compare the type of splints with one another...

BACKGROUND: Mallet finger is a common injury of the extensor tendon insertion causing an extension lag of the distal interphalangeal joint. METHODS: We reviewed the most current literature on the epidemiology, diagnosis, and management of mallet finger injuries focusing on the indications and outcomes of surgical intervention. RESULTS: Nonoperative management has been advocated for almost all mallet finger injuries; however, complex injuries are usually treated surgically...

PURPOSE: Excessive flexion at the distal interphalangeal (DIP) joint disrupts the extensor mechanism, leading to mallet finger injuries. The goal of management is to restore active DIP joint extension. We sought to learn which variables (treatment technique, injury type, time to presentation, adherence to treatment) affect clinical outcomes of pediatric mallet finger injuries. METHODS: A retrospective review was performed of patients who presented with mallet finger injuries during 2013 to 2017 at a large pediatric hospital...

PURPOSE: The current literature describes multiple surgical and nonsurgical techniques for the management of mallet finger injuries, and there is no consensus on the indications for surgical treatment. The objective of this study was to determine, through a literature review, if any conclusions can be drawn concerning the indications for surgery in mallet finger injuries; the treatment outcomes of surgical versus nonsurgical management; the most effective methods of surgical and nonsurgical treatment; and the most common treatment complications of mallet finger injuries...

CONTEXT: Fractures of proximal fifth metatarsal are one of the most common fractures of the foot. EVIDENCE ACQUISITION: A search of PubMed for studies on proximal fifth metatarsal fracture and Jones fracture focusing on the classification and management was performed. The reference list of the retrieved articles was searched for additional related studies. RESULTS: The vascular supply and soft tissue anatomy of the fifth metatarsal explains the increased risk of delayed union and non-union in fractures at the metaphyseal-diaphyseal junction...