Case 56
Vincent J Palusci, Dena Nazer, Patricia O Brennan in Diagnosis of Non-accidental Injury, 2015
An 18-month-old child was brought to the emergency department by his mother with extensive bruising of genitalia and inability to urinate. His mother stated that he fell from the jungle gym and had a straddling injury (Images 56a-e). Is the explanation plausible?What is the key element in the photos to prove or disprove the explanation?What is the aetiology of this patient’s presentation?A straddling injury is not a consistent explanation for this injury, as it would not remove epithelium from the glans penis. These injuries are due to oral sexual assault. ii. There are subtle injuries to the epithelium of both thighs, with slight bruising.While friction and abrasion injuries have been described in physical torture,1 the aetiology of the thigh injuries in this case is rubbing from the whiskers of the assailant, also known as ‘whisker burn’. A careful examination is essential in the presence of dramatic injuries to ensure important subtle injuries, i.e. the thighs, are not overlooked.
Falls Risk and Prevention in the Diabetic Patient
Medha N. Munshi, Lewis A. Lipsitz in Geriatric Diabetes, 2007
Finally, a “Get up and go test” should be performed to assess muscle strength, balance, and gait. This involves asking the patient to stand up from an armchair without using his or her own arms to push off. They should cross their arms in front of them and try to stand. Inability to do so suggests they have weak extensor muscles of the thighs (gluteus maximu) and knees (quadriceps), which may be remediable with strengthening exercises. Next, the patient is asked to stand still for a Romberg test with eyes open and then closed. An increase in sway with eyes closed indicates reliance on visual input to maintain balance. This can be remedied with treatment of cataracts or improved environmental lighting. A wide-based, unsteady stance with eyes open may indicate cerebellar deficits. Next, the patient is asked to walk 20 ft, turn in a circle, and return while the examiner observes their gait and balance. In Table 4, the different abnormalities in gait that can be detected and the specific treatments for each are listed. The “Get up and go test” can be timed to quantify the extent of a patient’s mobility impairment and assess the response to treatment (33).
Bones and joints
David Heylings, Stephen Carmichael, Samuel Leinster, Janak Saada, Bari M. Logan, Ralph T. Hutchings in McMinn’s Concise Human Anatomy, 2017
Femur - bone of the thigh, with the ballshaped head at the proximal end for the hip joint; it is joined to the shaft by the neck at an angle of about 125°. The greater trochanter is the large prominence located laterally at the junction of the shaft and neck; the lesser trochanter is the smaller cone-shaped projection at the distal part of the neck and adjacent shaft, facing medially and posteriorly. The expanded distal end has curved medial and lateral condyles for the knee joint and on either side palpable prominences known as the medial and lateral epicondyles. The epiphysis at the distal end usually begins to ossify in the ninth foetal month, a fact of possible medicolegal significance as an indication of maturity.
Research on dynamic comfort maintenance by measuring lower limb edema and seat pressure during simulated seated sleep in flight
Published in International Journal of Occupational Safety and Ergonomics, 2023
According to the descriptive statistics on the contact pressure of region B (figure 10), the pressure values in group P4–P5–P6 are higher than those in group P1–P2–P3. This indicates that crossing legs increases the pressure in the middle of the thigh. Additionally, the fluctuation between P4, P5 and P6 was also larger than that between P1, P2 and P3. The pressure value of region B in P5 is higher than that in P4 and P6, while group P1–P2–P3 have little fluctuation in pressure values. This indicates that sitting postures with legs parallel do not bring great changes to the pressure of the middle part (region B), mainly involving the transfer of pressure between regions A and C. In P5 and P6, the legs are crossed, the thighs fall to the side and region B begins to take more pressure. Whether region B bears pressure plays an important role in coordinating pressures in region A and region C. The pressure value of regions A and C variance tends to be steady in P4, P5 and P6, which is caused by crossing legs and participation of region B to bear pressure. It seems that region B’s participation in pressure bearing is a compromise strategy for comfort maintenance. It allows for a more even distribution of pressure to the thighs and hips, which explains why P5 has the longest duration of all postures (6.25 min). Therefore, for passengers, keeping P5 can maintain relative comfort in different regions.
Lower limb injuries in an english professional football club: injury analysis and recommendations for prevention
Published in The Physician and Sportsmedicine, 2023
Mohamad Y. Fares, Katy Stewart, Michael McBride, John Maclean
In addition, continuously researching and applying additional evidence-based interventions that can help reduce injury risk and improve performance is pivotal for developing effective strategies. For example, a recent study explored the effect of the hardness of cleat outsoles on lower limb kinematics and kinetics [38]. The study found that adopting softer material in the heel region of the shoe, and material of medium hardness in the medial forefoot, can help prevent injury and improve performance [38]. Adopting training regimens that focus on healing, stretching and strengthening vulnerable areas of the lower limb is essential to help acclimate and condition the muscles for longer periods of stress [39,40]. According to our findings, these would be exercises that help prevent injuries in the muscle groups of the thigh, as it is the most common site for injury in the sport. Research regarding eccentric training exercises have shown promise for hamstring injury prevention, with injury reduction rates reaching 65–70% [41,42]. One specific regimen that specializes in eccentric hamstring exercises is the Nordic hamstring (NH) exercise program [43]. While the NH program has proved to prominently help reduce hamstring injuries in football, only few clubs incorporated it into its training regimen [43,44].
Cutis marmorata telangiectatica congenita successfully treated with intense pulsed light and pulse dyed laser therapy: a case report
Published in Journal of Cosmetic and Laser Therapy, 2020
Elisabeth H. Tracey, Anna Eversman, Daniel Knabel, Mahwish Irfan
A four-year-old female with CMTC of the right lower extremity presented with painful ulcerations that persisted despite meticulous wound care. She was otherwise healthy with normal development, however the painful, chronic wounds had a profoundly negative impact on her quality of life. Examination revealed extensive violaceous reticulated plaques of the right leg and thigh with prominent atrophy and two overlying ulcers (Figures 1a & 2a). More subtle, violaceous, reticulated plaques were also noted on her back and neck with no associated surface change. A mild thigh circumference discrepancy was noted (30 cm on the left and 28.5 cm on the right). An MRI of the right lower extremity demonstrated no deeper vascular anomalies or persistence of embryologic vasculature.
Related Knowledge Centers
- Acetabulum
- Bone
- Femur
- Hinge Joint
- Femoral Head
- Pelvis
- Outline of Human Anatomy
- Hip
- Knee
- Ball-and-Socket Joint