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Rupture of the Anterior Tibial and Peroneal Tendons

Rupture of the Anterior Tibial Tendon Anatomy The anatomy of the tendon makes it susceptible to degenerative rupture due to attrition under the extensor retinaculum. The healthy tendon passes under the medial compartment of the transverse and cruciate crural ligament, and inserts onto the medial cuneiform dorsally and medially, with an extension of the attachment to the more inferomedial aspect of the first tarsometatarsal joint and…

Midfoot Fractures and Dislocations

Introduction Injuries to the foot are common in the athletic population, accounting for approximately 16% of all sports injuries. Trauma to the tarsometatarsal (TMT) joints is the second most common injury pattern, second only to metatarsophalangeal (MTP) joint injuries. The Lisfranc joint complex is the most commonly involved in injuries to the midfoot due to the limited static and dynamic stability of this region. Stress fractures,…

Ankle and Midfoot Fractures and Dislocations

Introduction Fractures and dislocations of the foot are among the most common injuries in the musculoskeletal system. Sports-related lower limb fractures and dislocation are less frequent than those of the upper limb, but they are particularly problematic for athletes because they often result in significant periods of non-weight rehabilitation. The disability and time away from sports resulting from these injuries warrant close attention to diagnosis and…

Problematic Stress Fractures of the Foot and Ankle

Pearls 1. Subtle, unexplained pain in the foot or ankle in an athlete can be a stress fracture. 2. Stress fractures of the medial malleolus may be associated with pathologic varus coming from the knee, ankle, or hindfoot. If surgery is warranted, the underlying biomechanics leading to the stress fracture need to be addressed. 3. Navicular stress fractures can occur in both the competitive and recreational…

Stress Fractures: Their Causes and Principles of Treatment

Introduction Historical Perspective Stress fractures were first described in 1855 by Briethaupt, a Prussian military physician who observed foot pain and swelling in young military recruits unaccustomed to the rigors of training. He considered it to be an inflammatory reaction in the tendon sheaths resulting from trauma and called the condition Fussgeschwulst . It was not until the advent of radiographs that the signs and symptoms…

Impingement Syndromes of the Ankle

Introduction Impingement is derived from the Latin verb impingere, meaning “to force against,” where an anatomic structure becomes entrapped causing pain, bony and soft tissue injury, decreased range of motion, and dysfunction. When impingement occurs, one bone repetitively strikes another, which over time can stimulate the deep layer of the periosteum to form osteophytes that further exacerbate the impingement and alter the normal mechanics of the…

Fundamentals of Pediatric Radiology

Introduction Children have special needs and unique disease processes, and thus the diagnostic imaging approaches are also different. Pediatric imaging should be problem oriented. Communication between the referring physician and the pediatric radiologist is encouraged. The essential components of a pediatric imaging facility are listed in Box 25.1 . Box 25.1 Essential Components of Pediatric Imaging From Osborn LM, DeWitt TG, First LR, et al, eds. Pediatrics…

Otolaryngology

Acknowledgments The authors acknowledge and thank Children’s Hospital of Pittsburgh, Department of Radiology, and University of Pittsburgh School of Medicine, Department of Neuroradiology, for providing many of the radiographs and CT scans in this chapter. Supplemental videos are available at expertconsult.com . The importance of pediatricians and family physicians having understanding of and experience with otolaryngologic problems and being skilled in techniques of examination of the…

Pediatric Plastic Surgery

The word “plastic” is derived from the Greek word for “moldable.” Therefore, plastic surgery refers to surgery that focuses on form and function. Form is often related to appearance, which is why aesthetics usually plays an important role in plastic surgery. Although all surgeons repair function to some degree, plastic surgery emphasizes functions that improve quality of life, such as eating, speaking, self-confidence, and social interactions.…

Orthopedics

Children with musculoskeletal injuries and afflictions are brought for care because of pain, deformity, or loss of function. Because of their rapid physical growth and the special properties of their developing bones, children often pose special problems for the clinician. Musculoskeletal problems in children fall into several general categories. Trauma (discussed here and in Chapter 6 ) Congenital problems—problems resulting from genetic factors and from exposure…

Oral Disorders

Assessment Techniques Because oral and oropharyngeal problems and disorders are common and cause a wide variety of symptoms, routine and thorough oral examinations are an essential component of a complete physical examination; this enables the practitioner to make an appropriate diagnosis without undue delay. The American Academy of Pediatric Dentistry (AAPD) recommends that children are seen for a dental exam by no later than 1 year…

Ophthalmology

The pediatrician may be faced with a child who is systemically well or systemically unwell and has a common eye or visual problem, OR a child who is systemically well or unwell with an uncommon eye or visual problem. In the systemically unwell child, the eye findings may well help towards a unifying diagnosis. Assessing the child from an anatomical or structural attitude as well as…

Pediatric and Adolescent Gynecology

Acknowledgment The authors gratefully acknowledge Pamela Murray and Gina Succato for all of their work on previous versions of this chapter, as well as for contributing all the photographs not otherwise attributed. Supplemental videos are available at expertconsult.com . Normal Female Genitalia Newborn and Prepubertal In the newborn, the physical appearance of the genitalia reflects stimulation by maternal sex hormones ( Fig. 19.1 ). Separation of…

Surgery

Introduction General pediatric surgery encompasses a wide spectrum of disorders and malformations that overlap with other medical and surgical specialties. All pediatricians will undoubtedly be faced with conditions that warrant the involvement of a surgeon. The emphasis of this chapter is on the common conditions that may be seen in general pediatric primary care practices, including some unusual cases. Head and Neck Head and neck lesions…

Pulmonary Disorders

Introduction Respiratory diseases are among the most common reasons for pediatric patients to seek medical attention. Signs and symptoms can be subtle, and a careful history and physical examination are useful in assessing pediatric patients with respiratory complaints. Diseases of the chest can be divided into two major categories: acquired and congenital. Congenital chest diseases are often symptomatic rather than episodical. The spectrum of diseases involving…

Neurology

Acknowledgment The authors wish to thank Rajiv Varma and Shelley D. Williams for their work on this chapter in the previous edition. Neurologic Examination The primary objective of the neurologic examination is to assess the functional integrity of the central nervous system (CNS) and the peripheral nervous system (PNS) and to detect and localize any sites of neurologic dysfunction. Techniques and interpretation of the pediatric neurologic…

Urologic Disorders

Many congenital urologic malformations and acquired disorders, as well as the results of common urologic surgical procedures, produce visible or palpable findings on physical examination. Some clinical presentations are unique. In other cases, disorders of varying etiology may present similar signs, symptoms, and physical findings. Differential diagnosis is essential to an appreciation of pediatric urologic disorders. Physical Examination Prior to any physical exam, a thorough history…

Nephrology

The manifestations of kidney and genitourinary disorders range from readily apparent gross structural abnormalities to subtle abnormalities of the urinary sediment. This chapter will review key history and physical findings, characteristic urinary findings, and updated diagnostic and radiographical studies of renal disorders encountered in both ambulatory and hospital settings. Essentials Of Medical History and Physical Examination The medical history and physical examination often provide clues implicating…