JAAOS, Volume 5, No. 2

Plantar Fasciitis: Diagnosis and Conservative Management.

Plantar fasciitis is a common cause of heel pain, which frustrates patients and practitioners alike because of its resistance to treatment. It has been associated with obesity, middle age, and biomechanical abnormalities in the foot, such as tight Achilles tendon, pes cavus, and pes planus. It is considered to be most often the result of a degenerative process at the origin of the plantar fascia at the calcaneus. However, neurogenic and other causes of subcalcaneal pain are frequently cited. A combination of causative factors may be present, or the true cause may remain obscure. Although normally managed with conservative treatment, plantar fasciitis is frequently resistant to the wide variety of treatments commonly used, such as nonsteroidal anti-inflammatory drugs, rest, pads, cups, splints, orthotics, corticosteroid injections, casts, physical therapy, ice, and heat. Although there is no consensus on the efficacy of any particular conservative treatment regimen, there is agreement that nonsurgical treatment is ultimately effective in approximately 90% of patients. Since the natural history of plantar fasciitis has not been established, it is unclear how much of symptom resolution is in fact due to the wide variety of commonly used treatments.

      • Subspecialty:
      • Foot and Ankle

    Extensor Tendon Injuries in the Hand.

    Until recently, extensor tendon injuries were often discounted as an important hand problem. However, studies have shown that not all extensor lacerations fare well and that loss of flexion can be problematic. Newer postoperative protocols emphasizing tendon gliding have improved results, and better repair techniques and postoperative rehabilitation regimens are under investigation. This article reviews the evaluation of acute open and closed extensor tendon injuries, their conservative and surgical treatment, and postoperative rehabilitation options.

        • Subspecialty:
        • Basic Science

        • Hand and Wrist

      Back Pain in Children and Adolescents: Evaluation and Differential Diagnosis.

      Back pain in children and adolescents usually has a recognizable organic origin. The most common entities seen are spondylolysis, spondylolisthesis, Scheuermann's kyphosis, disk herniations, infections, and tumors. Early recognition and treatment can provide patients the best chance at relief of symptoms and eradication of the underlying disease process. The goals of this review are to (1) familiarize the clinician with the various diagnoses associated with back pain in the skeletally immature patient and (2) to assist the clinician in making the appropriate diagnosis by providing a rational method of selecting diagnostic tests that maximize specificity and minimize costs.

          • Subspecialty:
          • Musculoskeletal Oncology

          • Pain Management

          • Pediatric Orthopaedics

          • Spine

        Metastatic Disease of the Hip: Evaluation and Treatment.

        Lesions in the area of the hip secondary to metastatic disease present challenging problems for the orthopaedic surgeon. With the advent of improved medical therapies for many types of cancer have come not only an increase in life expectancy but also an increased likelihood that symptomatic metastatic bone lesions will appear. Advances in internal fixation have enabled the orthopaedic surgeon to provide an increased level of comfort and mobility to many patients with metastatic disease.

            • Subspecialty:
            • Musculoskeletal Oncology

          The Female Athlete: Evaluation and Treatment of Sports-Related Problems.

          Although many of the problems faced by the female athlete affect the male athlete as well, some occur exclusively or more commonly in women. These include spondylolisthesis, stress fractures in the pelvis and hip, and pelvic floor dysfunction. Female athletes are also more likely to have patellofemoral problems, noncontact anterior cruciate ligament tears, and bunions. For many of these conditions, the relative influences of osseous anatomy, ligamentous laxity, and the effect of sex hormones have not yet been established. There are also problems related specifically to the menstrual cycle and pregnancy. Amenorrhea is present in up to 20% of vigorously exercising women. The term "female athlete triad" has been coined to describe the complex interplay of menstrual irregularity, disordered eating, and premature osteoporosis seen in the female athlete. Many of the concerns related to exercise during pregnancy focus on the safety of the fetus rather than the athlete herself. Musculoskeletal problems in the physically active pregnant woman are related to weight gain, ligamentous relaxation, lordosis, and change in the center of gravity.

              • Subspecialty:
              • Sports Medicine

            Painful Shoulder After Surgery for Rotator Cuff Disease.

            Persistent shoulder pain after surgery for rotator cuff disease may be caused by conditions that are either extrinsic or intrinsic to the shoulder. Extrinsic causes of persistent shoulder pain include cervical radiculopathy, suprascapular neuropathy, abnormalities of scapular rotation (due to long-thoracic or spinal-accessory neuropathy), and adjacent or metastatic neoplasms. Causes of persistent pain that are intrinsic to the shoulder include both intra-articular conditions (e.g., glenohumeral osteoarthritis, adhesive capsulitis, recurrent anterior subluxation, and labral and bicipital tendon abnormalities) and extra-articular conditions (e.g., persistent subacromial impingement, persistent or recurrent rotator cuff defects, acromioclavicular arthropathy, and deltoid muscle deficiency). Successful management requires an accurate diagnosis, maximal rehabilitation, judicious use of surgical intervention, and a well-motivated patient. The results of revision surgery in patients with persistent subacromial impingement, with or without an intact cuff, are inferior to reported results after primary acromioplasty or rotator cuff repair.

                • Subspecialty:
                • Shoulder and Elbow