[Treatment of tendinitis].
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Anti-Inflammatory Agents↗
Biomedical subjects
S Orava
Publications and source records attributed to S Orava.
Diagnosis and treatment of stress fractures located at the mid-tibial shaft in athletes.
Anterior mid-tibial stress fractures are a clinical problem. The diagnosis can be delayed because the normal radiographic anteroposterior and side views may only show thickening of the anterior cortex. Oblique views and tomography are often required. Isotope scan confirms the diagnosis and is the method of choice. The treatment varies from rest to operational intervention. A delayed union of this area of the tibia is a potential complication and is a high risk for an athlete, a complete fracture being the most serious complication. We present the results of conservative and operative treatment of 17 patients. Of these cases, nine progressed to a delayed union and operation was performed using transversal drilling with a 2.0-2.5 drill. We recommend a period of rest up till six months and surgical intervention with drilling of the hypertrophied cortex if there is any suspicion of a possibility of a delayed union. Also, if there is a long delay in the diagnosis, operative treatment is recommended. Biopsy is recommended during surgery for differential diagnosis.
Adolescent↗
Collagen synthesis in rat skeletal muscle during immobilization and remobilization.
The activities of prolyl 4-hydroxylase (PH) and galactosylhydroxylysine glucosyltransferase (GGT), which are both enzymes of collagen biosynthesis, and the concentration of hydroxyproline (Hyp) were measured in the soleus muscle (S) of rats after 3 and 42 days of cast immobilization. PH, GGT, and Hyp were also observed in S and tibialis anterior muscle (TA) at 0, 3, 7, and 14 days of remobilization after 7 days of cast immobilization. The activities of PH and GGT decreased significantly in shortened S after an immobilization of 3 days and were low thereafter. Immobilization for 7 days caused a decrease in the content of the soluble collagen in shortened S. Remobilization resulted in a rapid increase in the activities of collagen marker enzymes and the soluble collagen in S. In stretched TA, the specific activities of PH and GGT were increased significantly after 1 wk of immobilization and returned to the control levels during the remobilization period. The content of soluble collagen was above the control level after immobilization and returned to control level during the remobilization period in stretched TA. There were, at most, slight changes in the total content of insoluble collagen in S and TA. The results suggest rapid changes in the fractional synthesis rate of procollagen but, at most, slow changes in the stable content of muscular collagen during cast immobilization and remobilization. Muscle contractile activity and tension seem to be positive regulators of PH and GGT activities.
Animals↗
Diagnosis and treatment of delayed and non-union stress fractures in athletes.
Stress fractures in athletes usually heal well with merely rest and conservative treatment. It has been estimated that in Finland 400-500 athletic stress fractures occur annually per year. In sports clinic series stress fractures comprise 3.3 to 4.6 per cent of all overuse injuries. Delayed and non-union have been reported to occur in athletes quite often, up to 10 per cent of athletic stress fractures in Finland. The reason is on the one hand delayed diagnosis due to late consultation of expert physicians, and on the other hand too short a rest from hard physical activity. Delayed and non-union are most often seen in the hallux sesamoids, mid-tibial staft, base of fifth metatarsal, tarsal navicular and olecranon. The pars articularis of the fourth and fifth lumbar vertebra is a site of stress fracture and spondylolysis. In this report the diagnosis, symptoms and findings as well as the operative treatment of these overuse injuries is discussed.
Athletic Injuries↗
Overuse injuries of the Achilles tendon.
Among the 4,020 athletes (males 73%, females 27%) treated at the Department of Sports Medicine of the Deaconess Institute, Oulu, Finland in the period 1986-1989 there were 273 athletes with 330 of instances Achilles tendon overuse. Peritendinitis, tendinitis, partial rupture, retrocalcanear bursitis and insertiotendinitis were the most common diagnoses. Acute and subacute ailments were usually treated successfully by conservative means. 45.5% of the overuse injuries became chronic, failed to respond to conservative treatment and were treated surgically. The results were excellent or good in 86% of those operated on for chronic peritendinitis. The overall results were good in 69.3% of the patients.
Achilles Tendon↗
Operative treatment of typical overuse injuries in sport.
In this report 670 operations, performed in 643 patients were analyzed. The indication for the surgery was a chronic symptomatic overuse injury caused by sports and physical activity. 552 (82.4%) of the operations were performed in men and 118 (17.6%) in women. The mean age of the patients was 24 years. Almost 90 per cent of the patients had presented following competitive sports and ten per cent recreational sports. More than 91 per cent of the operations were performed for lower extremity problems. The knee, foot and ankle regions needed surgical treatment most often in this series. Tendon and tendon sheath operations formed the majority (32%) of the operations. Chronic Achilles tendon problems (159) formed the biggest group of the diagnoses. Chronic overuse injuries do not respond always to conservative treatment. Surgery is often needed in the final stage of an overuse injury. The results of these operations are good.
Adolescent↗
The hamstring syndrome--a new gluteal sciatica.
The condition in which pain is felt over the area at the ischial tuberosity and radiating down the back of the thigh is labelled the hamstring syndrome. The pain is typically incurred by assuming a sitting position, stretching the affected leg or/and running fast. The symptoms are caused by tight, tendinous structures of the hamstring muscle at the area of its insertion into the ischial tuberosity. Following division of these structures, complete relief is obtained.
Adolescent↗
The effects of preimmobilization training and immobilization on collagen synthesis in rat skeletal muscle.
The activities of prolyl 4-hydroxylase (PH) and galactosylhydroxylysyl glucosyltransferase (GGT), both enzymes of collagen biosynthesis, and the concentration of hydroxyproline (Hyp) were measured in soleus and tibialis anterior muscle after periods of 0, 7 and 21 days of immobilization following a swimming training for a period of three weeks in rats. After swimming, the specific activities of PH and GGT were increased by 25% (N.S.) and 53% (p less than 0.01), respectively, in the soleus muscle. In the tibialis anterior muscle PH was increased by 31% (p less than 0.01) after exercise. During the first week of immobilization, PH activity in the shortened soleus muscle was decreased by 21% (p less than 0.001) and by 65% (p less than 0.001) below the control level in the trained and non-trained groups, respectively. The difference between these two groups is significant (p less than 0.001). The specific activity of PH decreased to control level after one week of immobilization in the tibialis anterior muscle. Hyp concentration increased significantly (p less than 0.05) in the shortened soleus muscle after one week of immobilization due to rapid atrophy of non-collagenous proteins, whereas in the tibialis anterior muscle no significant increase was observed until after three weeks of immobilization. The results suggest that swimming, which contains only concentric muscle work and lacks eccentric and weight bearing components, is a positive regulator of collagen biosynthesis. The results suggest also that preimmobilization training may slow down the deadaptive changes caused by disuse during the first week of immobilization.
Animals↗
Athletes' leg pains.
The frequency and nature of exertion pains of the leg in athletes were studied in 2,750 cases of overuse injuries treated at the Sports Clinic of the Deaconess Institute of Oulu, Finland, during the years 1972-1977. 465 cases of exertion pain (18%) were located in the shin. The medial tibial syndrome was the most common overuse injury among these athletes, comprising 9.5% of all exertion injuries and 60% of the leg exertion pains. Together with stress fracture of the tibia, the second most common exertion pain of the leg, it accounted for 75% of the total leg pains. There are certain difficulties in differentiating between the medial tibial syndrome and stress fracture of the tibia. They both occur at the same site with similar symptoms. Radiological examination and isotope scanning are needed. The medial tibial syndrome is an overuse injury at the medial tibial border caused by running exercises. The pain is elicited by exertional ischaemia. The pathogenesis is explained by increased pressure in the fascial compartment of the deep flexor muscles due to prolonged exercise. Similar chronic ischaemic pains from exercise are also found in other fascial compartments of the leg, especially in the anterior compartment. The only treatment needed for stress fractures is rest from training. Fascial compartment pains also usually subside. If chronic fascial syndromes prevent training, fasciotomy is recommended as a reliable method to restore the athlete to normal training without pains.
Adolescent↗
[Painful lower leg conditions in sports].
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Adult↗
[Osteochondritis dissecans of the patella (author's transl)].
Five cases of osteochondritis dissecans patellae were seen and followed during years 1971--1978. Special interest was pointed to the site of the lesion, at which age the disease appeared, and to the physical activity of the patients. In one case only patellar subluxation could be confirmed. In two cases radioisotope (Tc99) szintigraphy was done with positive finding. The radiological finding was typical in all cases. The treatment was conservative in all cases but one. Loose body formed once in the series. Operative treatment should be directed only to the cases with persistent symptoms and/or loose bodies.
Adolescent↗
Exertion injuries in adolescent athletes.
A series of 147 cases of exertion injuries in less than or equal to 15 years old athletes is presented. All injuries occurred during training or athletic performances without trauma and caused symptoms that prevented athletic exercises. There were 67 girls (46%) and 80 boys (54%) in the material. About 90% of them had been training for more than one year before the onset of the symptoms; 65% were interested in track and field athletics, 13% in ball games, 11% in skiing, 4% in swimming, and 3% in orienteering. The rest were interested in other sports. About 33% of the injuries were growth disturbances or osteochondroses seen also in other children. About 15% were anomalies, deformities or earlier osteochondritic changes, which caused first symptoms during the physical exercise; 50% were typical overuse injuries that may bother adult athletes, too; 43% of the injuries were localized in ankle, foot and heel, 31% in knee, 8% in back and trunk, 7% in pelvic and hip region, and the rest in other parts of the body. The injuries were generally slight, no permanent disability was noticed. Rest and conservation therapy cured most cases; operative treatment was used in only eight cases.
Adolescent↗
Iliotibial tract friction syndrome in athletes--an uncommon exertion syndrome on the lateral side of the knee.
An uncommon exertion pain on the lateral side of the knee is described in 88 patients, in four of whom it was bilateral. The disorder is a result of the friction of the iliotibial tract over the lateral femoral epicondyle. The syndrome is the iliotibial tract friction syndrome of ITFS. All the patients in the material were active athletes or middle-aged joggers in regular training. The cases were seen over four years and four months. The mean age of them was approximately 25 years, and there were only nine women in the series. Th pain appeared usually after running and was localised on the outer femoral condyle, and often radiated downwards along the iliotibial tract. Conservative treatment and changes in training habits cured most cases. The disorder has not often been described in the literature, and seems to appear only in physically very active people, such as athletes or military recruits.
Adolescent↗
Stress fractures caused by physical exercise.
A series of 142 stress fractures caused by sporting activities and physical exercise is presented. 121 fractures occurred in athletes and 21 in non-competitive sportsmen. Distance runners presented with 68 fractures, skiers 12, sprinters 10, orienteering runners 9, vaulters 3, and football-players 3 fractures. Athletes engaged in other events had fewer stress fractures. 76 fractures occurred in the tibia, 26 in the metatarsal bones, 20 in the fibula, 5 in the femoral neck, 4 in the femoral shaft, and 2 in the metacapal bones, lower pubic arch and sesamoid bones of the first MTP-joint. There was one fracture of each of the following: the humeral shaft, the ulna, the vertebral arch of L 5, the tarsal navicular and the proximal phalanx of the fifth toe. The treatment was generally a pause in training for 4-6 weeks, on the average. Running caused most of the stress fractures; the rest followed jumping exercises. The athletes mostly developed stress fractures during a period of alteration from one training session to another or during the preparation period close to the competition season. Joggers usually developped stress fractures 2-4 months after the beginning of regular training.
Adolescent↗
Athlete exertion injuries.
Over a period of three years 829 cases of greater than or equal to 16-year-old athlete exertion injuries and syndromes were collected. There were 75 women and 754 men in the series. About 90% of the athletes had been training regularly for more than two years, and 75% of them trained 6 times a week or more. Approximately 52% of the injuries occurred in track and field athletics, about 17% in ball events, 13.6% in skiing, 7.4% in orienteering, and 4.7% in power events. Other sports were associated with fewer exertion injuries. 28.7% of the conditions occurred in the knee, 17% in the ankle, foot and heel, 14.8% in the leg, 8.2% in the back and trunk, 8.1% in the thigh, 7.4% in the achilles tendon. The rest were in the shoulder, neck and upper extremities. In 92% of the patients conservative treatment and rest were used. Only 8% of the cases were treated surgically.
Adolescent↗
Overexertion injuries in keep-fit athletes. A study on overexertion injuries among non-competitive keep-fit athletes.
During three years, 274 exertion injuries in middle-aged keep-fit athletes were collected. A keep-fit athlete was a person, who regularly took part in noncompetitive sports activities. Exertion injury was a nontraumatic pain syndrome in the musculo-skeletal system. In the material, there were 35 women and 239 men. Most of them were 30--39 years old. Most exertion injuries took place in July, August, and September. About 80% of the patients were joggers. 80% of them had been training regularly for more than one year. At the moment of occurence of the symptoms, 68% of the patients trained 3--5 times a week. Joggers ran approx. 40 km/week. About 30% of the injuries took place in the knee, 24% in the ankle, heel and foot, 17% in the leg, and 9% in the achilles tendon. Almost one fifth of the pain syndromes were chronic in nature. The majority responded well to rest and to conservative treatment. Fifteen cases were treated surgically. Most of the exertion injuries were typical exertion syndromes seen also in competitive athletes. Others were degenerative changes, organic anomalies etc., which revealed their first symptoms during regular keep-fit activities.
Adolescent↗
Avulsion fractures in athletes.
34 cases of avulsion fractures are described. Each fracture took place during athletic training or competition. Excepting six sportsmen participating in a general fitness programme, every patient was an active competitive athlete. There were six women and 28 men; their average age was 20.1 years, raised by a few middle-aged "fitness sportsmen". Most avulsion fractures took place in sprinters and hurdlers; next were middle and long distance renner, footballers, fitness joggers, skiers and ice-hockey players. The most usual location of a fracture was the anterior pelvic spines; avulsion fractures were also detected in various parts of lower limbs. There were fewer avulsion fractures in the area of the trunk and upper extremities. Roetgenologically, the diagnosis of an avulsion fracture is generally easy to make. However, the diagnosis is facilitated by knowing the mechanism of the injury, the technique of the athletic event, and some of the training methods. Generally, a fracture heals well, even if it requires both sufficient immobilisation and some delay in resuming physical exertion.
Adolescent↗
Management of injuries of the large intestine.
Blunt trauma accounted for 1/3 of the 32 patients operated upon for injuries of the large intestine and penetrating wounds for 2/3. Most of the blunt injuries (9/10) were caused by traffic accidents, and more than half of the penetrating ones (12/22) were stab wounds. The transverse colon was most commonly affected, followed by the ascending, descending and sigmoid colon, rectum and mesentery. Perforation of the small intestine was the most frequent associated intra-abdominal injury, occurring in 11 patients (34%). Most patients (22/32) underwent simple suture, 6 patients suture with proximal colostomy, 3 primary resection and one exteriorization, combined in all cases with broad-spectrum antibiotic coverage and drainage of the abdominal cavity. Injuries to the right and transverse colon were managed mainly with simple suture, and those to the left colon and rectum with suture and proximal colostomy. 50% of the patients had complications, most frequently wound infection and intra-abdominal abscess. The patients with simple suture had fewer complications than the others. In the absence of complicating factors injuries to the colon are best managed with simple suture, whereas in the presence of complicating factors and in injuries of the rectum, suture or resection with proximal colostomy, especially in cases of severe tissue destruction, remains the treatment of choice.
Accidents↗