Thursday, April 22, 2010

ACL Tear


The anterior cruciate ligament (ACL) is one of four major ligaments of the knee. It's major function is to provide support to the entire knee joint. The ACL is the most commonly injured ligament in the knee and most injuries happen when playing sports or doing something active.
The ACL is usually injured when a person is doing an activity that involves a pivoting motion or when landing from jumping. Although athletes are more prone to ACL tears, someone in a MVA, a fall, or just roughing around can also tear the ligament. Symptoms can be pain, swelling, the knee giving out, and popping in the knee. Most ACL tears are either diagnosed by a physical examination and/or a MRI of the knee. MRI's provide excellent detail of the fibrous tissue that make up the ACL.
Treatment of an ACL tear doesn't necessarily mean surgery. It the tear is just a partial tear it can be repair by basically sewing it back together. If the tear is full, then surgery will mostly likely be in order. Grafting tissue from one's own body or using tissue from an organ donor would be used to "make" a new ACL.

Wednesday, March 24, 2010

Rotator Cuff Tear


The rotator cuff is located in the shoulder and is made up of four muscles and their tendons. These muscles are the subscapularis, supraspinatus, infraspinatus, and teres minor. These muscles help give the shoulder joint stability and help hold the head of the humerus in the glenoid fossa. An injury to the shoulder can put strain on one or more of these muscles/tendons and cause a tear.
There are many activities and different ways to cause a rotator cuff tear. Repetitive over head arm activities, such as throwing a baseball or spiking a volleyball can put strain on the tendons. Also lifting or falling on the shoulder can cause injury. Prolonged tendinitis in the shoulder can lead to weakening of the muscle tendons and lead to a tear. The most common muscle/tendon to get injured is the supraspinatus because it's tending basically wraps over the head of the humerus, making it the most susceptible to injury.
Symptoms of a rotator cuff tear can either be subtle or extreme pain. There can be pain when trying to lift the shoulder above or behind one's back. Also the loss of range of motion as well as increased shoulder weakness.
There are several exams that can be performed to diagnose a rotator cuff tear: xrays, ultrasounds, and MRI's. An MRI is usually the exam most frequently ordered as it visualizes, in great detail, muscles and tendons.
Treatment of a rotator cuff tear and varied according to severity. A mild injury can actually heal itself with time and relaxation. More severe cases can be treated with physical therapy, which will help re-strengthen the shoulder through specific exercises. A physician may choose to inject the shoulder with steroids to help manage pain. If a patient has a very large tear, then surgery can be performed to repair the the tendon/muscle.

Sunday, February 28, 2010

Uterine Fibroids


Uterine Fibroids are non-cancerous tumors that form on the uterus. They are also know as leiomyomas or fibromyomas. Up to 75% of women can or will develop fibroids, but most will go undetected because more often than not, there are no symptoms.
For those women that do experience symptoms, the most common are heavy menstrual bleeding, back ache, pain in the pelvic area, frequent and/or trouble urinating.
Uterine fibroids acutally form in the smooth muscle layer of the uterus called they myometrium. A cell will reproduce rapidly until it forms a mass, which can be too small to detect with the human eye or very large. The major causes of fibroids are genetics, race, or from an unbalance of the two major hormones in the female body, estrogen and progesterone.
Most fibroids are discovered during routine pelvic examinations. To further investigate, a Md will order a pelvic ultrasound, where the radiologist can get a better look at the fibroid(s) and measure their size. A trasvaginal ultrasound can get a very good look at fibroids since the transducer is closer to the uterus. If an ultrasound doesn't get a good view, there are numerous exams that can be ordered such as MRI, CT, or a hystersalpingography. MRI is very useful as it is very detailed and the use of IV contrast can help enhance the fibroids.
There are many treatment options for uterine fibroids. If there are no symptoms, one could wait and watch the fibroids to see if they get any bigger and/or cause problems. If the patient is past child-bearing years and has problem causing symptoms, a hysterectomy could be performed, where the uterus (containing the fibroids) can be completely removed. Another surgical procedure can be performed called a myomectomy, where the fibroids are removed, but the uterus is left in place. This is a good option for women who still want to bear children, although fibroid can still redevelop. There are also many drugs to help further stop the growth of fibroids and may even shrink the fibroids.

Tuesday, February 9, 2010

Renal Artery Stenosis



Renal artery stenosis is a narrowing of the right, left, or both renal arteries, which branch off the abdominal aorta and supply blood to the kidneys. It is most common in those over the age of 65, but in rare cases can happen in younger people. The major causes of renal artery stenosis are atherosclerosis, high blood pressure, diabetes, and cigarette smoking.
Patients who have renal artery stenosis may present symptoms of chronic high blood pressure, decreased kidney function, and/or hormone imbalance. Blood tests and routine check-ups can determine if kidneys are properly functioning.
There are numerous tests that can be performed to determine an accurate diagnosis. As for the imaging tests, a patient could have an angiogram, MRI, CT, or doppler ultrasound. An angiogram is the most invasive exam as it is done in an interventional radiology department and entails a catheter being inserted in the patient's groin and contrast injected and watched via live xray as the contrast enters the renal arteries. Although this is more invasive, if there is stenosis, a stent can be placed at the time of the angiogram, thus reducing the need for another procedure. A CT or MR angiogram can also be performed and is much quicker and less invasive. For both exams, intravenous contrast is administered and images are taken in a timed manner to "catch" the contrast as it's entering the renal arteries from the abdominal. Post process procedures can later be done to produced well-defined cut-out images (MIP's) of just the abdominal aorta, renal arteries, and kidneys.
Treatment for renal artery stenosis varies depending on the cause. If high blood pressure is the culprit, the medicines are usually the answer. More invasive/surgical treatments are needed for more serious cases of stenosis. These include an angioplasty and/or placing a stent in the narrowed artery to let blood flow more freely.

Monday, January 25, 2010

Emphysema


Emphysema is a chronic lung disease where the lungs basically loose their elasticity and the smallest structures of the lungs, the alveoli, get damaged. As the disease progesses, the tissues in the lungs that are damaged begin to trap air, and over time the lungs enlarge, and breathing is impaired.
The major cause of emphysema is cigarette smoking. There are several thousands of toxis in tobacco that slowly break down the lung alveoli and elastic structures that make normal breathing possible. People who are diagnosed with emphysema often have shortness of breath and make a wheezing sound when they breathe. They are also very weak when trying to do any physical activity and can develop a bad cough that's similar to bronchitis.
There are numerous exams that are helpful in diagnosising emphysema. Simple pulmonary fuction tests help determine how much air your lungs can hold as well as how much air is coming/going from your lungs. Chest xrays can show emphysema to some degree, but are usually used with another exam to make an accurate diagnosis. A CT scan of the chest can also be performed on patients with emphysema. It will show up as holes in the small lung tissues that are caused by the disease.
Treatment is limited with emphysema, as the damage is not reversable. Patients who's disease is cause by smoking need to stop smoking right away. Often supplemental oxygen and inhaled steriods are the best choice to help make the patient comfortable and slow the disease from progression. A lung transplant is also an option, but only when all others have failed.