Joint Sprains Research Articles

Treatment with neridronate in children and adolescents with osteogenesis imperfecta: Data from open-label, not controlled, three-year Italian study

IntroductionThe present study assessed the long-term efficacy and safety of intravenous (i.v.) neridronate in children and adolescents affected by osteogenesis imperfecta (OI). Methods55 young patients (mean age 12.6±3.9years) affected by OI were included in the study. Neridronate was administered by i.v. infusion at a dose of 2mg/kg (maximum dose of 100mg) at intervals of three-months for three years. Dual X-ray absorptiometry of the lumbar spine, hip and ultradistal and proximal radius were evaluated every 6months. Blood calcium, phosphate, albumin, fasting urinary calcium/creatinine ratio were obtained at baseline and every 3months. Serum bone turnover markers total and bone alkaline phosphatase were performed every 12months in a proportion of patients. ResultsMean lumbar spine and total hip bone mineral density (BMD) and bone mineral content significantly increased from baseline compared to all subsequent time points (p<0.001). Mean ultradistal radius BMD significantly increased from month 18 (p=0.026). Levels of bone turnover markers significantly decreased from baseline to all post-baseline observation time points. There was no statistically significant effect on fracture risk (p=0.185), although a significant reduction was observed in the mean number of fractures occurring during treatment compared to pre-treatment values. The most frequent adverse events were arthralgia, fever, joint sprain. An acute phase reaction was reported in 26 (22.8%) patients. None of the reported serious adverse events was considered as treatment-related. ConclusionLong-term i.v. neridronate treatment has positive effects on BMD, bone turnover markers and fracture risk with a good safety profile.

A 1-Year Prospective Analysis of Ice Climbing Injuries.

To describe rates, patterns, and causes of acute injuries in an increasingly popular outdoor sport. Prospective cohort study. One winter season ranging from November 2011 to March 2011. Seventy ice climbers from 13 different countries and various performance levels. Participants were asked to complete a monthly Internet-based survey regarding their completed hours of training and competitions and eventual sustained injuries. During 4275 hours of ice climbing, 42 injuries occurred, of which 81.0% were defined as mild, 16.6% as moderate, and 2.4% as severe. The calculated injury rate was 9.8 injuries per 1000 hours of sports exposure. Intermediate ice climbers had a significantly higher injury risk compared with advanced ice climbers (odds ratio, 2.55; 95% confidence intervals, 1.17-5.54; P = 0.018). About 73.8% of all injuries occurred on a frozen waterfall, icicles, or icefalls, whereas 4.8% occurred on artificial ice walls. The head was the most injured body part (47.6%), followed by the knee (14.3%) and the shoulder (11.9%). The most common types of injuries were abrasions (38.1%), contusions (35.7%), and joint sprains (7.1%). Falling ice was the main circumstance leading to injury (59.5%). All athletes with a head injury wore a helmet; however, only 35.0% mentioned they used protective goggles. Ice climbing is a sport with moderate risk for injury with most of the reported injuries being of minor severity. However, severe and fatal injuries, although less common, also occur. Advanced ice climbers with greater experience and skill level have a lower overall injury risk.

INJURIES IN ELITE AUSTRALIAN FEMALE CRICKETERS

BackgroundCricket Australia has a well-established injury surveillance program for its elite male players and has published regular reports. Whilst injury data has been collected for the elite female players, it...

Long-term Effects of Neridronate in Adults with Osteogenesis Imperfecta: An Observational Three-Year Italian Study.

The aim of this study was to assess the long-term efficacy and safety of i.v. neridronate in the treatment of osteogenesis imperfecta (OI). One hundred and fourteen patients affected by OI were included in the study. Neridronate was administered by i.v. infusion at the dosage of 2mg/kg, up to a maximum of 100mg at three-month intervals for 3years. Dual X-ray absorptiometry of the lumbar spine, hip, and ultradistal and proximal radius were evaluated every 6months. Blood calcium, phosphate, albumin, fasting urinary calcium/creatinine ratio, total serum alkaline phosphatase, and bone alkaline phosphatase were obtained at baseline and every 3months. The mean lumbar spine and total hip BMD significantly increased from baseline to any time point (p < 0.001). The mean ultradistal radius BMD significantly increased from baseline only at month 18 (p = 0.026), 30 (p = 0.046), and 36 (p = 0.013), respectively. The mean proximal radius BMD did not change during the whole observation. The levels of bone turnover markers significantly decreased from baseline to any post-baseline observation time. The study was not able to find any statistically significant effect on fracture risk (p = 0.185). The percentage of patients with fractures was unaltered during treatment as compared to the 3-year period before treatment. The most common AEs were fragility fractures, back pain, arthralgia, fever, and joint sprain. An acute phase reaction was reported in 26 (22.8%) patients. None of the reported SAEs were considered as treatment-related. Long-term treatment with i.v. neridronate has positive effects on BMD and bone turnover markers with a good safety profile, although no significant effect on the risk of fracture was observed.

Preventing chronic pain after acute jaw sprain or strain

Preventing chronic pain after acute jaw sprain or strain

Epidemiology of Acromioclavicular Joint Sprains in 25 National Collegiate Athletic Association Sports

Background: No previous studies have described the incidence of acromioclavicular (AC) joint injuries in a large sample of National Collegiate Athletic Association (NCAA) student-athletes. Such data are needed to understand the injury prevalence, mechanisms of injury, and recovery patterns in NCAA student-athletes. Purpose: To describe the epidemiology of AC joint sprain injuries in 25 NCAA championship sports. Study Design: Descriptive epidemiology study. Methods: AC joint sprains were analyzed from the NCAA Injury Surveillance Program during the 2009-2010 to 2014-2015 academic years. AC joint sprain injury rates, rate ratios, and injury proportion ratios (IPRs) were reported with 95% CIs. Results: In the 25 NCAA sports examined during the 2009-2010 to 2014-2015 academic years, a total of 844 AC joint sprains were reported, for a rate of 1.72 per 10,000 athlete-exposures (AEs). The majority of AC joint sprains were reported in football (50.4%, n = 425). Most AC joint sprains occurred in competitions (66.0%, n = 557), and the competition rate was 8.58 times the practice rate (95% CI, 7.44-9.89). In sex-comparable sports (ie, soccer, basketball, ice hockey, lacrosse, baseball/softball, indoor track, outdoor track, cross-country, tennis, and swimming and diving), the AC joint sprain rate in men was 4.67 times that of women (95% CI, 3.56-6.14). Most AC joint sprains were caused by player contact (54.7%, n = 462), followed by surface contact (29.0%, n = 245). Of all AC joint sprains, 47.5% resulted in a time loss of <24 hours, and 5.9% were severe. In addition, 9.7% were recurrent, and only 1.0% required surgery. In sex-comparable sports, male athletes had a larger proportion of injuries due to player contact than did female athletes (IPR, 1.50; 95% CI, 1.06-2.13); female athletes had a larger proportion of injuries due to surface contact than male athletes (IPR, 1.55; 95% CI, 1.01-2.38). Also, compared with women, men had a larger proportion of AC joint sprains that were recurrent (IPR, 10.29; 95% CI, 1.45-72.90). Conclusion: The highest rates of AC joint sprains occurred in men’s football, ice hockey, and wrestling as well as women’s ice hockey. Most AC joint sprains across all sports occurred because of a contact mechanism, particularly from player-player contact. Further research into the specific activities and exposures at the time of injury may lend a better understanding of the causation of these injuries and lead to appropriate interventions to decrease their incidence and severity.

Prospective observational study of midtarsal joint sprain: Epidemiological and ultrasonographic analysis

IntroductionFoot and ankle injuries (FAI) are very common, with about 6000 cases per day in France. Unlike lateral ankle sprain (LAS), the diagnosis of midtarsal joint sprain (MJS, also known as Chopart's joint sprain) is not widely known. This prospective study aims to detail the epidemiology of MJS and compare it to LAS. Patients and methodThe study was conducted within our institution over a period of 16 months. Patients with clinical signs predictive of MJS without radiographic bone lesion underwent ultrasound assessment. MJS was diagnosed in case of at least 1 lesion of the dorsal midtarsal joint ligaments. ResultsA total of 2412 patients consulted for FAI; 188 had clinical and radiographic criteria for ultrasound examination. Eighty-two cases of MJS were diagnosed (3.4% of FAIs). Sports injuries were more frequent in MJS (P=0.04), and mechanisms more varied than in LAS, with inversion injury in 75% of cases and plantar hyperflexion in 22%. Sprain was severe in 70% of cases, with complete ligament tear. Clinical and ultrasound analyses correlated in only 40% of cases of MJS, versus 98% for LAS. ConclusionMJS is frequent, difficult to diagnose clinically, and often severe. Clinical presentation and injury mechanisms differ from ankle sprain. Ultrasound seems to be an indispensable tool in diagnosis.

Midtarsal joint sprain: Comparative study of functional vs. orthopedic treatment

Midtarsal joint sprain: Comparative study of functional vs. orthopedic treatment

Effects of plate stiffness on first metatarsophalangeal joint motion during unanticipated cutting and resisted sled pushing in football players

Turf toe, first metatarsophalangeal joint (MTPJ) sprain, is a debilitating injury in football players that is likely the result of excessive dorsiflexion of the hallux. Understanding in-cleat motion of the MTPJ with increased magnitudes of midsole stiffness may help to identify footwear modifications for treatment and injury risk. The purpose was to determine the effects of plate stiffness on in-cleat (anatomical) and footwear MTPJ motion during football–specific movements. Male football players (n = 13) performed two tasks, unanticipated side cutting and weighted sled pushing, with two identical football-specific cleats with different magnitudes of plate stiffness. An electromagnetic motion analysis system with 2 mm sensors was used to assess anatomical (mounted on the foot) and footwear (mounted on the cleat) MTPJ dorsiflexion and ankle dorsiflexion. Repeated measures ANOVAs (p < 0.05) were used to assess statistical differences. Footwear measured MTPJ dorsiflexion was significantly decreased with the stiff cleat compared to the control cleat during side cut (p = 0.04) and weighted sled push (p = 0.02) tasks. However, anatomical measured MTPJ dorsiflexion was not statistically different between cleat conditions (p > 0.05). Anatomical ankle dorsiflexion was increased with the stiff cleat compared to control cleat (p = 0.003). In conclusion, Kinematic footwear differences exist between two football cleats with distinctive magnitudes of plate stiffness. Anatomical MPTJ dorsiflexion, however, was not statistically different between cleats.

Quantifying the forefoot bending stiffness of cleated American football shoes using the Football American Shoe Tester (FAST)

In American football, hyper-dorsiflexion of the first metatarsophalangeal (first MTP) joint is the predominant mechanism of first MTP joint sprains (turf toe). The risk of acute first MTP joint sprain has been found to increase as first MTP joint angle increases. The bending resistance of the shoe dictates the proportion of an externally applied load that can be passed into the shoe (i.e. not through the first MTP joint) and thus may influence the magnitude of flexion imparted to the first MTP joint and hence the risk of injury. The current study introduces the Football American Shoe Tester (FAST), a flexion apparatus designed to measure the bending resistance of American football shoes at angles of forefoot dorsiflexion from 15° to 75°. The FAST was used to quantify the forefoot bending behaviour of a range of American football shoes. Thirty different models of US size 12 shoes were tested. Linearized bending stiffness ranged from 0.27 to 0.8 Nm/deg, while peak torque ranged from 11.8 to 25.5 N m. The testing revealed characteristic differences in torque-angle response across shoe models and quantified the extent of shoe stiffening at angles of dorsiflexion beyond those studied in the past.

The Epidemiology of Acromioclavicular (AC) Joint Sprain in 25 National Collegiate Athletic Association Sports

No previous studies have described the incidence of acromioclavicular (AC) joint injury in a large-sample of National Collegiate Athletic Association (NCAA) student-athletes. Such research is needed to understand the injury prevalence, injury mechanisms, and recovery patterns in NCAA student-athletes. PURPOSE: To describe the epidemiology of AC joint sprain injuries in 25 NCAA championship sports. METHODS: AC joint sprains from the NCAA Injury Surveillance Program were analyzed for the 2009/2010-2014/15 academic years. AC joint sprain injury rates, rate ratios (RR), and injury proportion ratios (IPR) were reported with 95% confidence intervals (CI). The RRs were also compared between sex-comparable sports (i.e., soccer, basketball, ice hockey, lacrosse, baseball/softball, indoor track, outdoor track, cross country, tennis, and swimming and diving). RESULTS: During the study period, a total of 844 AC joint sprains were reported, for a rate of 1.72/10000 athlete-exposures (AE). The highest rates of AC joint sprain occurred in Men’s Ice Hockey (6.40/10000AE) and Football (3.79/10000AE) and Women’s Ice Hockey (2.12/10000AE). The AC joint sprain rate was higher in competition than practice (6.15 vs. 0.72/10000AE; RR=8.58; 95%CI: 7.44, 9.89). Most AC joint sprains were due to player contact (54.7%, n=462), followed by surface contact (29.0%, n=245). Overall, 71.1% of AC joint sprains resulted in time loss of less than 1 week. In sex-comparable sports, the AC joint sprain rate was higher in men than women (1.85 vs. 0.40/10000AE; RR=4.67; 95%CI: 3.56, 6.14). In sex-comparable sports, males had a larger proportion of injuries due to player contact than females (54.1% vs. 36.1%; IPR=1.50; 95%CI: 1.06, 2.13); females had a larger proportion of injuries due to surface contact than males (31.1% vs. 20.1%; IPR=1.55; 95%CI: 1.01, 2.38). CONCLUSIONS: Overall, most AC joint sprains were due to contact, particularly with other players. Differences in mechanisms in sex-comparable sports highlight rule differences between men’s and women’s sports and is an area of future exploration. Further research into the specific activities and exposures at the time of injury may lend a better understanding of the causation of these injuries and lead to appropriate interventions to decrease their incidence and severity.

Use of infrared thermography for the diagnosis and grading of sprained ankle injuries

Ankle joint sprains are a common medical condition estimated to be responsible for 15–25% of all musculoskeletal injuries worldwide. The pathophysiology of the lesion can represent considerable time lost to injury, as well as long-term disability in up to 60% of patients. A percentage between 10% and 20% may complicate with chronic instability of the ankle joint and disability in walking, contributing to morbidity and poor life quality. Ankle sprains can be classified as grade I, II, or III, based on the extent of damage and number of ligaments affected. The diagnostic grading is important for setting further treatment and rehabilitation, since more severe injuries carries risk of recurrence, added morbidity and decrease in life quality.The aim of this work was to evaluate the adequacy of infrared thermography as a potential complimentary diagnostic tool of the distinct lesions grades. Evaluation of different thermographic values of the ankle region (in both affected and non-affected foot) was conducted for this purpose.The principal results to be highlighted are that some of the regions, namely anterior view for non defined time after injury analysis, and anterior, frontal, posterior and anterior talofibular ligament regions and proximal calcaneofibular ligament regions in acute lesions (herein defined as less than 6h post-traumatic event) presented consistent profiles of variation. The analyses were performed considering affected and non-affected ankles results on plotted graphics representing termographic evaluation and grading of these lesions performed using ultrasound by experimented medical radiologists. An increase in temperature values was observed when progressing from mild to severe ankle sprain injuries, with these regions presenting lower values for the affected ankle when compared to the non-affected ankle in all the analysis performed. The remaining analysed regions did not present the same variations. Statistical analysis using Kruskal–Wallis tests for non-parametric samples, however, did not confer statistical significance to the differences encountered in the graphics analysis (p>0.05).The major conclusions were that thermographic analysis of ankle sprain injuries might have some potential to be used clinically, especially in acute settings such as those that occur in hospital emergency areas and in sports practice. There is currently no practical technology to be used for grading ankle sprain lesions, with the gold standard being magnetic resonance imaging. Thermography provides results rapidly and without the need for extensive equipment operating expertise. Based on scientific data present in the literature, this is the first description of the use of this technology with such an objective regarding ankle sprain lesions. Further work is needed, nonetheless, to amplify the sample number with the herein chosen parameters and possibly use dynamic thermography.

Tackle-injury epidemiology in &lt;i&gt;koshuis&lt;/i&gt; rugby players at Stellenbosch University

Background. The tackle is an important component of rugby union. The tackle situation carries the highest risk for injury for both the ball carrier and tackler. Little is known about the epidemiology of tackle injuries in koshuis rugby players.Objectives. To (i) calculate the tackle-related injury rate, (ii) determine if the tackler or ball carrier is more susceptible to injury, and (iii) determine the most common location and type of injury during tackles.Methods. Data were collected by means of injury report forms from the medical centre during koshuis matches of 2012 and 2013. All data collected were captured into an online database. Only data related to tackle injuries were evaluated for this retrospective, descriptive epidemiological study.Results. The tackle led to 61% of all injuries (11.4 injuries/1 000 playing hours). The tackler sustained 23% more injuries than the ball carrier. Injuries to the face (3.1 injuries/1 000 playing hours, 95% confidence interval (CI) 2.8 - 3.3) were most prevalent. The most common type of injury was lacerations (3.4 injuries/1 000 playing hours, 95% CI 3.2 - 3.7).Conclusion. The tackle contributed to 61% of all injuries, making it the most dangerous phase of play. The tackler is more at risk than the ball carrier, especially for injuries to the face, with lacerations having the highest prevalence. For the ball carrier the location of the most injuries was the head, although joint sprains were the most common type of injury for the ball carrier.

Value of ultrasonography in assessment of recent injury of anterior talofibular ligament in children.

IntroductionSprained ankle is a very common injury in children. Proper treatment of ligament injuries enables full recovery. X-ray and US examinations are commonly available diagnostic methods.Material and methodsTwo hundred and six children (113 girls and 93 boys, mean age 10.6) with recent ankle joint sprain (up to 7 days of injury) were subject to a retrospective analysis. All patients underwent an X-ray and US examination of the ankle joint within 7 days of injury. In 19 patients, anterior talofibular ligament reconstruction was conducted.ResultsX-ray failed to visualize a pathology in 129 children (63%); in 24 patients (12%), avulsion fracture of the lateral malleolus was found, and in 36 cases (17%), effusion in the talocrural joint was detected. Ultrasonography failed to visualize a pathology in 19 children (9%); in 60 patients (29%), it showed avulsion fracture of the lateral malleolus involving the attachment of the anterior talofibular ligament (ATFL); in 34 cases (17%), complete ATFL tear was detected, and in 51 patients (25%), partial ATFL injury was found. Other injuries constituted 19%. The surgeries conducted to repair the anterior talofibular ligament (19) confirmed the US/X-ray diagnoses in 100% of cases. Avulsion ATFL injury, i.e. the one that involves the ligament attachment site, is usually found in younger children (median: 8 years of age). Complete ATFL tears (not involving the attachment site) concern older children (median: 14 years of age).ConclusionsSince X-ray is of limited value in diagnosing ankle joint pathologies in recent sprain injuries in children, soft tissue imaging, i.e. ultrasonography, is the basic examination to assess the ligament complex. Avulsion fractures, which involve the ATFL attachment site and are usually found in younger children, are a consequence of the incomplete ossification and require urgent diagnosis and orthopedic consultation.

Occupational injuries of teachers and educational staff at special schools with multiple and severely handicapped children in Rhineland-Palatinate (Germany): results of a cross-sectional study.

The present study aimed to describe the prevalence, type, and influencing factors of occupational injuries of staff working at special schools with multiple and severely handicapped pupils in Southwestern Germany. This cross-sectional study was carried out between August 2010 and August 2012 at 13 special schools with focus on motoric and/or holistic development of handicapped pupils in Rhineland-Palatinate (Germany). Participants were interviewed using a written questionnaire. There were 395 participants (response proportion: 59.7%) in our study, with 390 being eligible for statistical analysis. Respondents were on average 45 years old and mainly female (86.9%). The 12-month injury prevalence was 16.9%. Joint dislocations, sprains, and torn ligaments (41.6%) were the main types of injuries. Pupils (59.8%) and auxiliary equipment (12.2%) were identified as the main causes of injury by the respondents. Multivariable logistic regression analysis showed that washing pupils (using auxiliary equipment) (aOR, 3.93; 95% CI, 1.66-9.31) and daily physical strain due to unexpected conduct of pupils (aOR, 3.70; 95% CI, 1.20-11.37) were the main influencing factors for an occupational injury. Almost one in five persons suffered an occupational injury in the previous 12 months. Nursing activities, including close contact with pupils, were identified as the most important factors for an injury. In order to prevent injuries at special schools, a multifaceted approach is necessary. This includes sufficient supply of auxiliary devices including proper technical maintenance. Furthermore, regular participation in training for manual handling of heavy loads and schooling on the technical use of auxiliary devices should be encouraged.

Epidemiology of musculoskeletal pain in a pediatric emergency department.

The objectives of this study were (1) to determine the percentage of emergency department (ED) visits due to musculoskeletal pain (MSP) by children 3-14 years of age during a period of 1 year; (2) to determine the most frequent presenting complaints; and (3) to characterize their etiology. A cross-sectional study was performed on children aged 3-14(11/12) years attended at the ED of a tertiary hospital due to MSP. The demographic and clinical characteristics of the patients were reviewed 5 days each month for 12 consecutive months. Study days were selected by computer-generated simple random sampling. Out of 4,531 visits to the ED, 826 were due to MSP (18.2 %; 95 % CI 17.1-19.4 %). When compared with children with no skeletal complaints, children with MSP had a similar sex distribution but were older (mean ± SD 7 ± 3.5 years vs 9.9 ± 3.1 years; p < 0.0001). The most common complaints were pain at the wrist (19 %), ankle (19 %) and finger (15 %). The most common etiology was trauma (88.4 %), including contusions (38 %), fractures (21 %) and sprains (18 %). Children with hip (6.7 ± 3 years; p < 0.0001) and elbow (7.8 ± 3.5 years; p < 0.0001) complaints were younger than children with pain in other locations, whereas children with wrist pain (10.5 ± 2.6 years; p < 0.002) and joint sprains (10.7 ± 2.7 years; p < 0.0001) were older. Fractures were more frequent in boys (64 vs 36 %, p = 0.008; OR 1.6; CI 1.1-2.2). Visits to the ED due to MSP increased with age. Pain at three locations represented 50 % of the presenting complaints. Trauma was the principal etiology, but fractures only represented one-fifth of the total.

Differences in anatomical within cleat toe dorsiflexion compared to footwear measured toe dorsiflexion during football movements

First metatarsophalangeal joint (MTPJ) sprain (turf toe) is commonly caused by extreme MTPJ dorsiflexion and results in significant loss of participation in American football (Frimenko et al., 2012...

Effects of Ankle Dorsiflexion Flexibility on Forefoot and Toe Plantar Loading During a Weighted Sled Push

First metatarsophalangeal (MTP) joint sprain is an injury increasing in prevalence in football players resulting in a significant loss of participation time. Investigation of the unique plantar loading strategies in football may help identify critical components that predispose an athlete to MTP joint sprains. Furthermore, limitations in ankle dorsiflexion range of motion may increase the loading on the plantar side of the forefoot and hallux during late stance of athletic movements. PURPOSE: Therefore, the purpose was to examine the effects of ankle dorsiflexion range of motion on forefoot and toe plantar loading during a weighted sled-pushing task. METHODS: Subjects were dichotomized into low dorsiflexion (LD; n=5, height 178.7cm, mass 79.2kg, age 16.8yrs) and high dorsiflexion (HD; n=9, height 175.3cm, mass 79.6kg, age 17.9yrs) range of motion based on the mean value of 8.8cm. Ankle dorsiflexion range of motion was assessed during the standing knee-to-wall test. In-cleat plantar pressure distribution was measured during a weighted (75% of the subject’s body mass) sled-pushing task on a synthetic turf field while wearing standard football cleats. Force time integral was calculated for 9 specific regions and normalized to total foot force time integral. ANOVA (p<0.05) was used to determine the group differences in the relative load for each foot region. Only the forefoot and toe regions were analyzed as those regions had the majority of the total foot loading during the task. RESULTS: Significantly greater relative loading was found under the hallux in subjects who had decreased ankle dorsiflexion range of motion (LD 24.4±6.8%, HD 18.1±3.8%, p=0.044). In contrast, the subjects with greater dorsiflexion range of motion loaded the medial forefoot significantly more (LD 14.3±4.3%, HD 19.7±3.7%, p=0.029). CONCLUSIONS: Greater hallux loading was found during a task that required a large magnitude of MTP joint extension in football players who exhibited decreased ankle dorsiflexion range of motion. Future studies should determine whether interventions aimed at increasing ankle dorsiflexion modify hallux loading. The authors would like to acknowledge funding support from adidas International, Inc.

A Case of Change in Work Out as the Presenting Symptoms of Multiple Myeloma

HISTORY: A 56 year-old active black male presented with 5 months of worsening chronic pain: right hip pain changed location and low back pain flared. His pain had not responded to maintenance exercises (weightlifting, running, stationary cycling), dry needle, massage, stretch, or anti-inflammatories. Past medical history included lumbar disc bulge, lumbar spondylolysis, right superior labral tear, sports lifting-related Osgood-Schlatter’s, cervical laminectomy, chronic right rectus femoris strain. PHYSICAL EXAMINATION: Compared to examination seven months prior, physical examination was significant for decrease in lumbar spine flexion, extension, lateral lean, and rotation and normal symmetric strength testing over the bilateral lower extremities. Forward bending as if to tie shoes, lifting objects, and walking several blocks reproduced his pain. DIFFERENTIAL DIAGNOSIS: 1.Lumbar vertebral body fracture 2.Herniated disc 3.Lumbar or sacroiliac joint sprain or dysfunction 4.Lumbar paraspinal muscles strain 5.Malignancy - primary or secondary 6.Infection - osteomyelitis TESTS AND RESULTS: Serum protein electrophoresis: elevated IgM level Bone marrow biopsy #1: smoldering multiple myeloma Bone scan #1: negative. Lumbosacral x-ray: stable spondylolysis MRI lumbosacral spine: stable lumbar disc bulge, new L2 infiltrative lesion. Non-contrast CT: L2 lytic process with pathologic fracture Bone scan #2: photopenic foci at L2 and right scapula Skeletal survey #1: negative Bone marrow biopsy #2: plasma cell neoplasm Skeletal survey #2: lesions at L2, left pelvis, bilateral proximal femurs as well as bilateral osteoarthrosis of glenohumeral joints and left sacroiliitis FINAL WORKING DIAGNOSIS: Stage 2 multiple myeloma TREATMENT AND OUTCOMES: 1.Radiation and chemotherapy 2.Clamshell TLSO for lumbar lordosis 3.Simplifed exercise program: upright stationary cycle, overhead reach, back extension stretches. Focus on core strength, hip flexibility. 4.Advance to stairs, pool running, captain’s chair, bird dog, and abdominal press 5.Avoid overhead lifting and compressive spine exercises 6.Treatment complicated by pulmonary embolism. 7.Tolerance of bending and lifting improved participation in household activities. 8.Goal: to return to weight lifting exercises and outdoor biking.

Intra-articular post-traumatic ankle joint mass imitating localized pigmented villonodular synovitis (LPVS), the aid of ankle arthroscopy for diagnosis and treatment—A case report

Intra-articular post-traumatic ankle joint mass is a rare entity that may mimic other pathologies, mainly localized form of pigmented villonodular synovitis (LPVS) regarding the clinical and imaging characteristics. We report the case of a 16-year-old female patient that presented an intra-articular ankle joint mass 8 months after an ankle joint sprain for which magnetic resonance imaging (MRI) suggested LPVS as possible diagnosis due to the presence of hemosiderin deposits. Diagnosis of a post-traumatic hematoma of her ankle joint was made via fine needle aspiration (FNA) biopsy and anterior ankle arthroscopy. At one-year-follow-up after the arthroscopic excision of the hematoma, the patient remained asymptomatic and pain free while MRI revealed no pathologic findings. This case demonstrates that LPVS is not always the diagnosis when hemosiderin deposits are depicted on the MRI of a solitary intra-articular mass. The FNA biopsy under direct arthroscopic view assists the diagnosis and guides the treatment plan in cases that no definite diagnosis has been reached preoperatively by MRI.Level of evidence IV, case report.