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The locomotor system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Low back pain The lumbar spine should be examined with the patient standing, supine and prone: With the patient standing, assess the curvature of the spine. Scoliosis may be due to muscle spasm in acute sciatica or may be postural in leg length inequality. Loss of the normal lordosis is a sign of inflammatory spinal disease, such as ankylosing spondylitis.Palpate the erector spinae muscles to assess spasm.Perform a modified Schober’s test (see Box 5.7 and Fig. 5.14).Ask the patient to lean over to each side in turn and run their hand down the side of the leg to the knee; this assesses lateral flexion.Then ask the patient to lean over backwards to assess extension. If extension is painful, facet joint disease (usually degenerative) may be present.
Orthopaedic operations
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Michael Whitehouse, David Warwick, Ashley Blom
The problem of leg length inequality often presents in childhood. Several questions need to be answered before a technique appropriate for the particular child is determined: What is the expected adult height of the child?What will the discrepancy be when the child is mature?When will the child reach skeletal maturity?Is there an angular, translational or rotational deformity associated with the leg length discrepancy?
Treatment of Myofascial Pain Syndromes
Published in Mark V. Boswell, B. Eliot Cole, Weiner's Pain Management, 2005
Robert D. Gerwin, Jan Dommerholt
When clinical determination by physical examination is uncertain, a radiographic study of the pelvis and lumbar spine using a plumb line can be helpful (Travell & Simons, 1992). A functional scoliosis can be corrected or reduced by a heel lift, even if it has been present for years. A fixed skeletal cause of scoliosis does not correct with a heel or butt lift. Functional scoliosis must be distinguished from those asymmetries that cannot be corrected before attempting to use a heel or butt lift. Relief of pain in the neck, shoulder, low back, and legs can result from the complete or partial correction of leg length inequality and scoliosis.
Estimating peak height velocity in individuals: a comparison of statistical methods
Published in Annals of Human Biology, 2020
Melanie E. Boeyer, Kevin M. Middleton, Dana L. Duren, Emily V. Leary
The adolescent growth spurt is characterised by one of the most rapid periods of post-natal growth, which is followed closely by epiphyseal fusion and the attainment of final adult height (Bogin 1988; Bogin et al. 2018; Eveleth and Tanner 1990). Over the last several decades, significant progress has been made in the development of statistical methodologies for assessing individual and population average growth in height leading up to and throughout adolescence (Cole 2012; Cole et al. 2010; Preece and Baines 1978). These methods have allowed human biologists and paediatric practitioners to estimate the chronological age at which peak height velocity (aPHV) is attained as well as the rate of growth occurring during peak height velocity (PHV) (e.g. Sanders et al. 2017). Estimates of adolescent ontogenetic parameters are of critical importance, particularly for paediatric practitioners treating children with skeletal growth and/or developmental disorders, including constitutional growth delay (Poyrazoğlu et al. 2005), adolescent idiopathic scoliosis (Busscher et al. 2012; Chazono et al. 2015; Little et al. 2000), or leg length inequality (Green and Anderson 1960; Moseley 1977, 1987). However, the most commonly employed methodologies for predicting aPHV and/or PHV result in large differences in estimates, even when using identical data (Preece and Baines 1978; Simpkin et al. 2017).
Current and future therapeutic approaches for osteosarcoma
Published in Expert Review of Anticancer Therapy, 2018
Douglas J. Harrison, David S. Geller, Jonathan D. Gill, Valerae O. Lewis, Richard Gorlick
Local control can be rendered either via limb-salvage surgery or ablative surgery. While limb-salvage surgery has become the most frequent local control preference for both patients and surgeons [44], amputations nevertheless remain an important surgical technique. Rotationplasty, often described as an intercalary amputation, remains a very rewarding and durable procedure. It is particularly applicable in instances where significant leg-length inequality is anticipated or in cases where the patient desires return to high-impact activities that jeopardize endoprosthetic reconstructions by way of early loosening, accelerated wear, or catastrophic mechanical failure.
Classification of cervicogenic dizziness
Published in Hearing, Balance and Communication, 2023
First, it is known that FHP has the potential to activate trigger points in the cervical region [46]. Trigger points is a hyperirritable spot associated with a taut band within a shortened or weak muscle and the hallmark clinical sign of myofascial pain syndrome (MPS) [47]. MPS is musculoskeletal disorder associated with regional pain originating from trigger points in skeletal muscle and fascia [48]. It is known that up to 85% of people experience MPS at least once in their lifetime, and the prevalence varies from 21% to 93% depending on a clinic [49,50]. MPS is happened by postural stress, muscle imbalance, repetitive overuse, psychological stress, or systemic pathology, and it can be perpetuated by three factors: ergonomic factors (hypermobility forward neck posture, forward shoulder posture, work related activities, prolonged static postures, telephone or computer use), structural factors (scoliosis, sacroiliac joint dysfunction, structural or functional leg-length inequality, pelvic torsion), and medical factors (hormone, nutrition, infectious disease) [48,51]. Patients with MPS complain symptoms such as autonomic dysfunction, hyperaesthesia, numbness, decreased work tolerance, muscle fatigue, weakness, pain, or dizziness [51]. Especially, cervical MPS is associated with symptoms, such as dizziness, blurred vision, and tinnitus [52]. MPS can play a role in the aetiology of cervicogenic dizziness [53]. Vural et al. [54] reported that 40.1% (n = 947) of patients with only neck pain without trauma, disease, surgery, or psychological causes (N = 2361) showed cervicogenic dizziness, and of these, patients with MPS was 59.7%. Many researchers also mentioned a correlation between cervicogenic dizziness and MPS and found that the frequency and severity of dizziness is reduced by treatments for MPS such as manipulation, exercise, dry needling, medication, modalities in their experiments [52,54,55].