Injury to the ACL

Injury to the ACL is one of the most common types of knee injuries, especially in athletes. This type of injury can occur when the knee is in a stationary position and knocked either sideways or backwards causing motion other than normal flexion and extension.

There are varying degrees of ACL injury from a little tear to completely tearing in half. The symptoms of an ACL injury include:
-"popping" of the knee when it is hit
-pain in lateral or posterior aspects of the knee
-swelling of the knee
-inability to properly support the bodies weight

-limited range of motion

For diagnosis of ACL injury, MRI is the most useful imaging technique. There are several treatment options available for injury to the ACL including physical therapy and surgery, these of course are dependant upon the severity of the injury.

All of my information for this blog was found at webmd.com
My images were found at factotem.org/.../Knee-MRI-and-Xray-images.shtml

<-----Normal ACL

<-----Torn ACL

Shoulder Dislocation

The most common type of shoulder dislocation is anterior dislocation which occurs when the shoulder is moved too far superiorly and posteriorly. Most of the time this happens with some type of fall or running into something too hard. Unfortunately though it can also happen just by reaching for something too high or rotating the shoulder too far backward. Dislocation of the shoulder is the most common type of joint dislocation in the entire body.

Symptoms of a shoulder dislocation include severe pain in the shoulder (DUH!), difficulty moving the affected arm even the slightest bit, and a "mushy" feeling when the shoulder is touched from the side as the humeral head is no longer located in the correct place. It almost feels like the bone has been taken out completely.

For most people, this type of injury means a trip to the hospital where x-rays will be ordered to confirm type and severity of the dislocation. The delay of treatment not only means severe suffering for the patient but can cause permanent damage to the tendons, blood vessels, muscles, and nerves that surround the shoulder joint. While x-rays are the most common diagnostic tool for shoulder dislocations, CT and MRI are both beneficial to evaluate occult fractures or other tissue injuries that may have occurred.

Most shoulder dislocations can be fixed in the emergency room. The patient is given conscious sedation to help them relax and allow the physician to relocate the joint. Of course in more severe cases, the patient must go under general anesthetic and an orthopedic surgeon will relocate the joint under fluoro in surgery.

After a shoulder dislocation has been reduced, the patient will be put in a sling, given pain medication, and most often follow up with an orthopedic doctor. Some injuries can even require physical therapy. The worst part about a shoulder dislocation is that it will most likely happen again due to weakening of the muscles and ligaments that surround the shoulder.

houstonshoulderclinic.com

imagingpathways.health.wa.gov.au

sumerdoc.blogspot.com

emedecinehealth..com/shoulder_dislocation

For this pathology blog I thought I would write about shoulder dislocations as my husband suffers from chronic dislocation of his left shoulder. Approximately 6 years ago he fell and dislocated his left shoulder while working. Since then, he's dislocated it approximately 10 times. The first time it happened, he went to a urgent care facility and they put it in a sling and gave him some pain medication. He had all ready managed to get his shoulder back in place before he arrived. He followed up with an orthopedic surgeon but was basically told they could do nothing for him. So, due to the underlying injuries that occurred to his shoulder ligaments and muscles, every once in a while he'll move his arm too far up and back and out it pops. Luckily for him, he is able to lay flat on the floor get it back in to place. Sounds horrible I know but it's better than making a trip to the emergency room. His shoulder is sore for a few days afterwards but otherwise he suffers no ill effects.... for now anyway... no telling how bad of shape his shoulder will be in as he gets older and continues his very physically demanding job. My husband is kind of accident prone if I've never talked about his adventures before!

Ovarian Cysts

I decided for this week's pathology blog to write about a case which I actually saw while I was working. A patient came to the ER complaining of severe abdominal pain. A pelvic ultrasound was performed and it was determined that she had a 12 cm ovarian cyst. A CT was the performed to take a closer look. The image on the left is a sagittal reformatted image of this patient's exam. The report read that this was too large to be a simple cyst and was most likely a neoplasm. The patient had a complete hysterectomy the next day and that's all I know about this particular case.

Ovarian cysts are most often tiny fluid collections that form in or on the outside of the ovaries in many women. From what I have learned from the Radiologists at the hospital where I work, they are actually quite common. Most are small and don't cause any symptoms or harm to the women who have them. For those that do experience symptoms they usually include abdominal pain, abnormal vaginal bleeding, pain during intercourse, or weight gain. The most common type of ovarian cyst is a functional cyst which often forms while a woman is having her period.

Ovarian cysts most often go unnoticed until they rupture causing severe abdominal/pelvic pain, fever, nausea, and vomiting. Usually a pain medication is prescribed to help with this until symptoms go away.

The most common diagnostic tool for diagnosing ovarian cysts is a pelvic ultrasound. But like the patient I mentioned earlier, CT or MRI can be useful in diagnosing more large and complex cysts.

Most ovarian cysts go away on their own and no treatment is needed. For others, surgery is necessary to remove the cysts. There is no way to prevent an ovarian cyst and some women are unfortunately just more likely to get them than others.

The image used in this blog is from OMHS and my information was found on womenshealth.gov

Splenic Laceration

For this week's blog I decided to write about splenic lacerations because they fascinate me. It's so crazy to me that a laceration means removal of an organ! How is it possible that we have an organ that we can totally live without?

Injuries to the spleen are the most common abdominal injury after many forms of trauma including motor vehicle accidents, serious falls and sports injuries.

A lacerated spleen can present with many symptoms depending on the severity of the injury. The most common symptoms include right upper quadrant (RUQ) pain and rebound abdominal tenderness. A paler than normal complexion and low blood pressure can also be signs of a laceration to the spleen.

The most commonly used diagnostic exam for the diagnosis of a lacerated spleen is a CT of the abdomen with IV contrast. The use of IV contrast is very important to determine the severity of the injury.

I was surprised to find that there are actually multiple treatment options for a patient with a splenic laceration. I had always thought that removal of the spleen was the only option. But this is not the case. In fact, a splenectomy is often the last step in the treatment of this injury. One type of treatment is splenic angioembolization under fluoro, but not all hospitals have the facilities and staff necessary to perform this type of procedure. If this type of treatment is chosen, a surgeon and OR staff must be on standby if the injury is determined to be too severe for embolization. When surgery is deemed necessary, and exploratory laparotomy is performed to determine severity and helps the doctor decide whether the spleen can be repaired of if it needs to be removed. Follow up CT scans are necessary to determine if repair was successful and make sure there is no re-bleeding.

The most common problem associated with splenic lacerations is the increased chance of infection for the patient after treatment. Patients are encouraged to receive the pneumococcus vaccine after surgery and to take preventitive antiobiotics before any type of invasive surgery. These treatments of course are if a patient's spleen can be saved. If the spleen is removed, a patient must remain on medications such as steroids to promote platelet production and be continuously monitored for infection and blood loss. If these things are not monitored closely, a patient can suffer serious consequences, even death.

I found my image for this blog on ajronline.org and my information on emedicine.medscape.com

Pulmonary Embolism

Since one of my favorite exams to do is a chest angio, I thought that for this blog I would talk about pulmonary emboli.

A pulmonary embolism occurs when a blood clot from somewhere in the body travels into the pulmonary arteries and causes a blockage. A person can have one or many PE's at the same time and most of the clots originate in the legs and travel upwards into the lungs.

Some symptoms of a pulmonary embolus include chest pain, shortness of breath, irregularly fast heartbeat, wheezing, and swelling of the legs among others. Some of the risk factors for the development of a pulmonary emobolus include recent surgery, lack of activity such as a person flying in an airplane or a person who is on bed rest, and history of a heart attack or stroke. Women who are pregnant or who have just given birth are also more susceptible to the development of a PE. Another possible sign of a pulmonary embolism is an elevated D-Dimer blood test.

The most widely used radiologic test for the diagnosis of a pulmonary embolism is at CTA of the chest or chest angio. A nuclear medicine lung scan can also be used if the patient is allergic to contrast or has lab work that makes a chest angio contraindicated.

While most pulmonary embolisms are not fatal they can lead to serious complications such as pulmonary hypertension and damage to the muscles of the heart when left untreated.

The most common treatment for a PE is a combination of the drugs heparin and warfarin. Even after the clot has gone away most patients will continue anticoagulant therapy for the rest of their lives in order to prevent development of another clot. Other treatments include clot dissolving medications or placement of an IVC filter which prevents clots from travelling from the legs to the lungs.

I found my information at mayoclinic.org and my picture from ajronline.org

Herniated Nucleus Pulposus of the Lumbar Spine

For the final pathology blog of the semester I decided to find out some more information on a herniated nucleus pulposus. This disorder, where the soft spongy center of our intervertebral discs pushes out into our spinal canal, is often very painful. This disorder also goes by many other names such as lumbar radiculopathy, herniated intervertebral disc, slipped disc or ruptured disc. While a herniated nucleus pulposus can occur anywhere in the spine, it is more likely to occur in our lumbar spine region, 15 times more likely!



There can be many causes of a herniated nucleus pulposus. Any type of trauma to the body such as a car wreck or fall or even from putting too much strain on our lumbar spine area such as incorrectly lifting something too heavy or twisting our spine the wrong way.



A herniated nucleus pulposus can lead to compression of our spinal nerves often causing lower back, leg, and pelvic pain, or even numbness in the legs just to name a few. The demographic most likely to suffer from a herniated nucleus pulposus are middle aged men who engage in a lot of heavy physical activity.



Initially, treatment for a herniated nucleus pulposus includes rest and pain medication followed by physical therapy. If this does not relieve the patient's symptoms, sugery to remove to bulging disc would be required.



I found my information for this blog on http://www.umm.edu/ and my picture

Thoracic Compresson Fracture

A compression fracture of the thoracic spine most often happens when there is too much pressure placed on the body of a vertebrae. The most common causes of a thoracic compression fracture are osteoporosis, car accidents, falls, or some type of metastases.

When a thoracic vertebrae is compressed, it most often takes on the shape of a wedge which you can see in the image to the left. Sometimes this wedging can be severe enough that the fractured vertebral body has nowhere to go and ends up pushing out into the spinal canal and compressing the spinal cord.

Thoracic compression fractures are usually pretty apparent right away. They often cause pain not only in the back itself but also in the legs and arms. In some cases when the spinal nerves surrounding the vertebrae are involved in the injury weakness and numbness of the legs and arms can also occur.

The most common treatments for thoracic compression fractures are pain medicines, a lowering of a patient's activity level, or wearing a brace. Surgery is very unlikely for compression fractures unless the case is extremely severe.

CT is usually the modality of choice for the imaging of these types of fractures but MRI can be used in order to determine if surrounding nerves or ligaments are involved.

I found my information for this blog at www.umm.edu/spinecenter and my image at www.learningradiology.com