ConclusionsThere is a higher than average incidence of SLAP lesions in military patients compared to civilian patients. They tend to present with a history of trauma, as well as symptoms of pain and instability. Given the high incidence in military personnel, this diagnosis should be considered in military patients presenting with shoulder symptoms, and there should be a low threshold for shoulder arthroscopy. IntroductionShoulder complaints are prevalent, with shoulder pain being one of the most common types of musculoskeletal pain seen by general practitioners. By virtue of its anatomy and biomechanics, the shoulder is the most unstable and frequently dislocated joint in the body. Stability is maintained by several factors, including the labrum, a fibrocartilaginous structure on the glenoid rim. Pathology of the superior labrum, where the long head of biceps takes origin, was first described by Andrews et al (1) in a group of throwing athletes who had anterosuperior labrum tears, anterior to the biceps anchor, that were thought to have arisen as a result of repetitive traction from the biceps tendon on the labrum. In 1990, Snyder et al used the term "superior labrum anterior and posterior" (SLAP) lesion to describe a more extensive superior labral tear that begins posteriorly and extends anteriorly to include the anchor of the long head of biceps tendon (2). Snyder classified these lesions into four types (Figures 1-5) (2). Type 2 SLAP lesions are the most common (3).The exact incidence of SLAP lesions is uncertain, although literature to date suggests an incidence ranging from ~4-26%, with 6% being the most commonly quoted incidence in patients undergoing a shoulder arthroscopy (2,4-7).Military personnel are physically active and commonly injured. Although, lower limbs are
INTRODUCTION ‘Have I got a fracture or a break doctor?’ remains a commonly posed question in fracture clinics, suggesting that patients frequently feel a ‘fracture’ and a ‘break’ are two separate entities. This apparent misconception amongst fracture clinic patients may result in confusion and occasionally anger that doctors appear to have inconsistent views on the severity of their injury. Compliance and outcome of patient care can also be affected by poor communication. PATIENTS AND METHODS Our questionnaire-based study was conducted in two stages. The initial objective was to establish whether this misconception surrounding the words ‘fracture’ and ‘break’ is commonly held amongst our out-patient trauma patients. The second stage of the audit was to determine whether a patient information leaflet on fractures/broken bones could help reduce this misconception. RESULTS The preliminary audit involving 50 new patients attending our fracture clinic showed that 84% thought there was a difference between a ‘fracture’ and a ‘break’, with 68% believing a ‘break’ to be worse than a ‘fracture’. Following the introduction of an information leaflet, a re-audit of 61 new patients took place. This time 67% felt there was a difference between a ‘fracture’ and a ‘break’, with 65% believing a ‘break’ to be worse than a ‘fracture’. Only 21% had read the supplied information leaflet, and 69% of those still believed there was a difference between a ‘fracture’ and a ‘break’. CONCLUSIONS The majority of patients believed that there was a difference between a ‘fracture’ and a ‘break’. Access to information leaflets did not appear to alter this misconception. Verbal communication and explanation may be more beneficial and practical than visual aids and leaflets in overcoming this problem.
We report a case of acute compartment syndrome of the posterior thigh secondary to rupture of the biceps femoris muscle that was successfully treated with a fasciotomy. To our knowledge, acute compartment syndrome secondary to rupture of the biceps femoris muscle has not been previously described. Case reportA 34-year-old previously healthy man attended the Accident and Emergency department several hours after attempting to back heel a ball during a football game. It was a non-contact injury. At the time of the incident he felt a ''snap'' and pain in the posterior aspect of his left thigh. This pain progressively increased over time and on presentation to us was unrelieved by even significant amounts of opiate analgesia. He also complained of swelling within his thigh, parasthesia and paralysis of his foot and ankle. Examination revealed a tensely swollen (thigh circumference discrepancy = 6 cm) and extremely tender posterior thigh with associated bruising. Motor function in his knee was difficult to assess because of pain, he was unable to flex his knee and had 4/5 (MRC grade) motor function of his quadriceps. Motor function in his ankle was absent--0/5 (MRC grade) on dorsiflexion, plantarflexion and eversion. His foot was cold, but pedal pulses were present. Sensation to his leg was reduced with decreased sensation in the L2-4 and absent sensation in the L5-S1 dermatomal distribution. The biceps femoris tendon was absent to palpation on the lateral aspect of the knee. Radiologically, there was no evidence of bony injury. Intracompartmental pressures measured were 60-70 mmHg in the posterior thigh compartment, 25 mmHg in the anterior compartment and 15 mmHg in the medial compartment.He was urgently taken to theatre where a fasciotomy was performed through a lateral approach with the incision extending along the length of the thigh, exposing a dusky, ruptured and barely viable biceps femoris and haematoma. There was no frankly necrotic tissue. After debriding the area, the wound was packed with gauze and left open. A further debridement took place 48 h later, with eventual wound closure and split skin grafting 4 days after his admission.The patient noticed recovery of active ankle movement (MRC grade 4/5) and return of sensation 1 day post-operatively. He received physiotherapy and was discharged 2 weeks post injury having made a full recovery and regained full sensation, Injury Extra (2005) 36, 228-229
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