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PURPOSE OF REVIEW: Acute knee injuries are commonly encountered in both the clinical and sideline setting and may be treated operatively or non-operatively. This article describes an evidence-based approach to non-operative acute knee injury. This includes history, physical exam, imaging, and initial management. In addition, the non-operative management of three such injuries-ligament injury, meniscus injury, and patellar dislocation injury-will be discussed via a case-based practical approach. RECENT FINDINGS: Aside from grade III ACL tears, most acute knee ligament injuries, especially in the absence of other concurrent injuries, can be treated non-operatively. There is new evidence that acute traumatic meniscus tears in those younger than 40 can be successfully treated non-operatively and can do equally, as well as those that undergo surgery, at 1 year out from injury. Based on the current literature, a short period of knee bracing in extension with progression to weightbearing to tolerance is recommended after initial patellar dislocation. Many of the most common acute knee injuries, including MCL tears, meniscus tears, and patellar dislocations, can be managed non-operatively. A detailed systemic approach to initial evaluation, including pertinent history, physical exam, and appropriate imaging, is essential and complementary to the subsequent non-operative treatment algorithm.
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This paper focuses on hyperglycemic hyperosmolar syndrome (HHS), a unique hyperglycemic state requiring divergent diagnosis and treatment approaches from diabetic ketoacidosis (DKA) despite some shared characteristics. We introduce the mnemonic DI-FF-ER-EN-CE-S to encapsulate unique HHS management and complications. 'DI' emphasizes the need to delay and decrease initial insulin therapy until serum glucose decline is managed by fluid resuscitation alone. 'FF' stresses the importance of double fluid replacement compared to DKA due to severe dehydration and 'ER' electrolyte replacement due to profound losses and imbalances. 'EN' denotes the potential for encephalopathy and the requirement for a controlled serum osmolality reduction. 'CE' indicates cerebral edema, a rare complication in HHS. 'S' signifies systemic multiorgan failure. We categorize the associated risks into three mnemonic groups: the 3Rs (renal failure, respiratory distress, rhabdomyolysis), the 3Hs (heart failure, hypercoagulation, hyperthermia), and AP (arrhythmias, pancreatitis) to facilitate awareness and screening of HHS.
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This review article discusses the anatomy and histopathology of the patellar tendon, as well as the risk factors and common interventions for patellar tendinopathy (PT) with a view to guide clinicians in treating athletes with patellar tendon pain. PT, or jumper's knee, refers to a chronic injury to the patellar tendon that affects athletes who engage in jumping and explosive movements. The condition is characterized by degeneration and disorganization of the collagen fibers in the tendon, an increase in mucoid ground substance, and fibroblast proliferation. Risk factors for patellar tendinopathy include participation in jumping sports, a greater counter-movement jump height, and training on hard surfaces. Nonoperative treatments for patellar tendinopathy include relative rest, stretching and strengthening exercises, and correction of biomechanical abnormalities. Surgery and other procedures, such as extracorporeal shockwave therapy (ESWT) and injection therapies, may be considered for patients who do not respond to conservative measures.
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Sports hernias are a complex cause of chronic groin pain in athletes, posing diagnostic and treatment challenges for clinicians. This review article synthesizes current knowledge on sports hernias, exploring pathogenesis, diagnostic approaches, and management strategies. Despite the growing body of research, sports hernias continue to present a significant challenge, necessitating a multidisciplinary approach and further research to improve clinical outcomes. This comprehensive review aims to equip clinicians with an updated understanding of sports hernias, ensuring optimal patient care and informing future research.
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[This corrects the article DOI: 10.7759/cureus.10829.].
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Osteoarthritis is a prominent cause of disability in older adults, especially with an increasingly obese and aging population. Clinical management of pain secondary to osteoarthritis should focus on education and self-management with exercise and weight management as a priority. Surgical intervention should only be considered once conservative measures have failed. This review provides a clinical update on the pathogenesis, diagnosis, and management of osteoarthritis.
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Giant cell tumors are rare benign lesions that typically occur at the epiphyses of long bones in the extremities and present with pain or swelling. These lesions very seldom occur in the skull, where they preferentially affect the sphenoid and temporal bones that develop by endochondral ossification. We report a rare case of a giant cell tumor of the frontal bone and review the literature on these lesions. A 21-year-old woman presented with localized swelling and tenderness over the left frontal bone. Imaging revealed a lytic lesion involving the left frontal bone, which was managed via left frontal craniectomy with resection of the bone and epidural mass. Histopathology revealed a giant cell tumor of bone (GCTB). Most data on giant cell tumors in the skull consist of case reports, with many large series of giant cell tumors having no examples in the skull. This report contributes to the scarce literature on these tumors in the skull.
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Glioblastoma is the deadliest and most common of the malignant primary brain tumors that can occur in adults. In contrast, brainstem gliomas are extremely uncommon in adults; however, their precise incidence is not known, due to the difficult nature of obtaining tissue from the brainstem provoking low biopsy and resection rates. In this case report, we have examined a 34-year-old female who was diagnosed with pontomedullary small cell glioblastoma following a successful biopsy of the brainstem lesion. A closed stereotactic needle biopsy with a contralateral approach was utilized using stealth computed tomography (CT) neuronavigation for tissue diagnosis without causing additional neurological deficits. Our goal is to share this novel approach of obtaining tissue from the brainstem in order to aid others in definitively diagnosing brainstem gliomas and subsequently providing appropriate treatment early in the disease process.