Clay Shoveler's Fracture

faculty.washington.edu

Clay Shoveler's Fracture

Clay Shoveler's fracture is simply a fracture through a spinous process of a vertebra, like the picture shown above. These fractures are most common in C6 and C7, but can happen in any of the lower vertebra spinous processes. This type of fracture happens because of the excessive hyperflexion of the person's neck/back. Clay Shoveler's fracture was first described in Australian clay miners who attempted to throw a shovel full of clay from the mine floor, but the shovel stuck in the clay causing abrupt hyperflexion of the person. This fractures also occurs in laborers who perform activities including shoveling clay, soil, rubble, or snow (like the picture below) and then throw the contents of the full shovel over the head backwards. This motion allows the shear force of the muscles, the trapezius and rhomboid muscles, to pull on the spine at the base of the neck and tear off the bone on the spine. This type of fracture/injury can also be known as an avulsion injury from flexion injuries.

examiner.com

Symptom's of Clay Shoveler's fracture include a burning pain and "knife-like" pain at the site of fracture. This intense pain will continue as long as repeated activities that include strain on the neck muscles is involved. The pain from the fracture can last up to a few weeks with continuous activity of those muscles. The pain may subside sooner if proper rest is used. Clay Shoveler's fracture can be diagnosed by an x-ray of the spine, either through a diagnostic x-ray, CT or MRI imaging (like the picture demonstrated below). Most patients with this fracture do not need treatment, but pain meds and physcial therapy can help the healing process. There are times where the broken piece of the spinous process may need to be removed if the patient is experiencing long periods of chronic pain at the fracture site.

RiTradiology.com

References:

Definition of fracture, clay shoveler's. (1998). Medicinenet.com. Retrieved April 22, 2010 from http://www.medicinenet.com/script/main/forum.asp?articlekey=7988

Clay-shoveler fracture. (2009). Wikipedia.com. Retrieved April 22, 2010 from http://en.wikipedia.org/wiki/Clay-shoveler_fracture

Cervical spine fracture image. (2010). Google image. Retrieved April 22, 2010 from faculty.washington.edu

Snow shovelr image. (2010). Google image. Retrieved April 22, 2010 from examiner.com

Diagnostic x-ray image. (2010). Google image. Retrieved April 22, 2010 from RiTradiology.com

Dissection of Carotid Artery

nlm.nih.gov

ohiohealth.com

Dissection of Carotid Artery

Background

Carotid Artery Dissection (CAD) happens when there is a tear to one of the carotid arteries, and blood under arterial pressure is able to rush through the arterial wall and split the media or subadventitial layers of the artery wall. This blood in the walls of the artery can also cause narrowing or complete occlusion of the vessel. This dissection can lead to cause of an aneursymal dilatation or intramural hematoma. Dissection of a carotid artery can either be intracranially or extracranially

Carotid Artery Dissection can occur in many different ways: it can be spontaneous, hereditary, caused from underlying arteriopahy, blunt injury, or trauma. This dissection can most commonly lead to an ischemic stroke that can happen in patients of all ages, and is the most common cause of strokes in patients younger then the age of 50.

Symptoms

There are a variety of symptoms associated with a carotid artery dissection. The most common symptom is a headace that is described as being constant and severe.

Other symptoms include: neck and facial pain

orbital pain

transient episodic blindness

neck swelling

focal weakness

decreased taste sensation

Treatment options

The best form of treatment is to catch the dissection process as early as possible so that treatment can be easier/cheaper. If the patient first presents to the hospital with common dissection symptoms, a CT of the head should be performed, along with either a CTA of MRA to correctly diagnose the problem and find the dissection. Early onset dissection treatments could include observation, anticoagulants such as IV heparin, antithrombic therapy, or antiplatelet therapy. Further treatment options could include an angioplasty, stent placement, or carotid artery ligation.

(The above images show the location of a carotid artery as well as the difference between a normal artery and a dissected artery.)



References

Carotid Artery Dissection. (2010). Wikipedia.com. Retrieved April 14, 2010 from http://en.wikipedia.org/wiki/Carotid_artery_dissection

Dissection, Carotid Artery. (2009). Emedicine from web md. Medscape. Retrieved April 14, 2010 from http://emedicine.medscape.com/article/757906-overview

Google Image. (2010) Retrieved April 14, 2010 from ohiohealth.com

Google Image. (2010) Retrieved April 14, 2010 from nlm.nih.gov

Sjogren's Syndrome

This image depicts the most common symptoms of Sjogren's Syndrome

(pharmacy-and-drugs.com)

Sjogren's Syndrome

Sjogren's syndrome is a disorder of our immune system. The immune cells attack and destroy the exocrine glands. The mucous membranes and moisture-secreting glands of the eyes and mouth are affected first which causes decreased production of tears and saliva. Although the eyes and mouth are the most common area affected, the immune system can also damage other parts in the body such as the kidneys, thyroid, liver, or lungs.

Causes/Risk Factors

Scientists do not fully understand how this syndrome comes to affect people, or why it happens in some people and not others. It is believed that either a virus or bacterial infection may trigger the cause or that certain genes put people at high risk. Although anyone is capable of obtaining the syndrome, there are some known risk factors that increase chances of getting it. Usually people over the age of 40 and women obtain Sjogren's syndrome. This syndrome can also be hereditary and it is common that people who have Sjogren's will also have a rheumatic disease such as lupus or rheumatoid arthritis.

Symptoms/Complications

As listed above, Sjogren's usually affects the eyes and mouth, but the picture shown below shows a list of different ways Sjogren's could affect the body (wellsphere.com)

Treatment

At present time, there is actually no known cure for Sjogren's syndrome. Instead, there are only ways to treat the symptoms of Sjogren's. For the chronic dry eyes, eye drops and artificial tears are used to help keep the eyes moist. Restasis can also be prescribed that suppresses the inflammation that disrupts tear secretion. To help with the dry mouth, prescription drugs such as cevimeline (Evoxac) and pilocarpine can be taken to help stimulate salivary flow. In cases that are much more serious, corticosteroids or immunosuppressive drugs may be prescribed.

References:

Mayo clinic staff. (2009). Mayoclinic.com. Retrieved April 5, 2010 fromhttp://www.mayoclinic.com/health/sjogrens-syndrome/DS00147/DSECTION=lifestyle-and-home-remedies

Sjogren's syndrome. (2010). Wikipedia.com. Retrieved April 5, 2010 from http://en.wikipedia.org/wiki/Sj%C3%B6gren

Symptoms image. (2010). Google image. Retrieved April 5, 2010 from pharmacy-and-drugs.com

Symptoms image. (2010). Google image. Retrieved April 5, 2010 from wellsphere.com.

Moyamoya Disease

The above image shows the Circle of Willis and highlights the internal carotid arteries which is the most common place for blockages causing Moyamoya disease. (neurosurgery.ufl.edu)

The above image is an angiogram showing collateral vessels that have an appearance of a "puff of smoke" as coined by the Japanese. (depts.washington.edu)

Moyamoya Disease

This disease is said to be inherited and first appeared in the Japanese. Moyamoya disease is caused by some sort of blockage or clot in the arteries leading up into the brain. The internal carotid arteries are the most common arteries to become blocked, but this disease also affects the middle and anterior cerebral arteries. Unlike atherosclerosis, the artery wall actually overgrows inward to constrict the artery. It is because of this blockage, which can also develop clots, that the blood vessels start to develop new pathways to find ways to still get the blood to the brain. These pathways are called "collateral circulation." This collateral circulation appears like a "puff of smoke" on an MRI/MRA scan.

Symptoms of Moyamoya Disease

Although this disease originated in Japan, other parts of the world have become affected as well. In the United States, women in their 30's and 40's are most affected. Children and patients with down syndrome, neurofibromatosis, or sickle cell disease can acquire Moyamoya as well. In children, Moyamoya causes strokes or seizures, and in adults it can cause strokes, bleeding, numbness in the extremities, convulsions, and migraine-like headaches. Their are also times when no symptoms will appear and death could be right around the corner.

Treatment options

The natural history of this disorder is not well known. However, several treatment options have become available to prolong the life of patients with Moyamoya. As always, patients who are eligible can take anti-platelets to help prevent clots. Some of the more common surgery treatment options are more recommended though. Encephaloduroarteriosynangiosis (EDAS) is a procedure in which a scalp artery is dissected over a course of several inches and then a small opening in the skull is made directly below the artery. The artery is then sutured to the surface of the brain and the bone is replaced to the skull. Ensephalomyosynangiosis (EMS) and Superficial Temporal Artery (STA)- Middle Cerebral Artery (MCA) bypass are also similar surgery options in which the goal is to bypass the blockage and still be able to deliver blood to the brain by means of arteries.

References

Moyamoya disease. (2010). Wikipedia.com Retrieved March 29, 2010 from http://en.wikipedia.org/wiki/Moyamoya_disease

Circle of Willis. (2009). Google images. Retrieved March 29, 2010 from http://images.google.com/imgres?imgurl=http://www.neurosurgery.ufl.edu/patients/images/circle-of-willis.jpg&imgrefurl=http://www.neurosurgery.ufl.edu/patients/moyamoya-disease.shtml&usg=__MKpbJVa7wW5xLlqsmbI2X3taK5Q=&h=272&w=285&sz=16&hl=en&start=7&um=1&itbs=1&tbnid=zs7fR6hg07JrWM:&tbnh=110&tbnw=115&prev=/images%3Fq%3Dmoya%2Bmoya%2Bdisease%26um%3D1%26hl%3Den%26sa%3DN%26rlz%3D1T4ACAW_enUS314US314%26tbs%3Disch:1

Angiogram. (2009). Google images. Retrieved March 29, 2010 from http://images.google.com/imgres?imgurl=http://depts.washington.edu/neurosur/ptcare/images/sekhar/moya_images/lateral_moya.jpg&imgrefurl=http://depts.washington.edu/neurosur/ptcare/moyamoya.html&usg=__zMZ3mTYSnXIA-mOu-RkoJ-j_SlI=&h=341&w=341&sz=55&hl=en&start=1&um=1&itbs=1&tbnid=0zrV1hm_F10JDM:&tbnh=120&tbnw=120&prev=/images%3Fq%3Dmoya%2Bmoya%2Bdisease%26um%3D1%26hl%3Den%26sa%3DN%26rlz%3D1T4ACAW_enUS314US314%26tbs%3Disch:1

Empty Nose Syndrome

(http://www.metrohealth.org/)
The above image shows an "empty nose" with the turbinates (nasal conchae) missing

What is Empty Nose Syndrome (ENS)?

ENS, also known as wide nasal cavity syndrome is a rare syndrome of chronic nasal impairment of over resection of the superior, middle, and inferior turbinates in the nose following surgery. Turbinates as we know them from class are actually the nasal conchae. This over resection leaves the nose dry all the time. Turbinates play a big role in our nasal cavity. The superior, middle, and inferior turbinates, or conchae combined, aid in the following: warm and moisten the air and provide humidity; blocks particulate matter; harbor cells of the olfactory system; provide surface area/airway resistance.

What are symptoms of ENS?

Symptoms include: the feeling that the nose is always congested; a feeling of suffocating; pain; crusting in the nose; mucosal dryness; drainage; difficulty in blowing the nose and difficulty sleeping; paradoxical breathing obstruction.

What are the treatment options?

Moisturization of the nasal passages is the number 1 thing to achieve for treatment. ENS can be treated both surgically and non-surgically. Non-surgical treatment options are geared to help maintain the current condition and keep the nasal passages moist. This can be done by using a saline based mist spray or gel. It also will help to sleep with a cool mist humidifier at night.

Surgical treatment can be done by narrowing back the enlarged nasal cavity by the use of different kinds of turbinate implants. With the help of treatment options, this will help restore normal nasal aerodynamics, humidification, heat regulation, filtration, and airflow sensation capacities.

References

Empty Nose Syndrome. (2010). Wikipedia. Retrieved March 18, 2010 from

http://en.wikipedia.org/wiki/Empty_nose_syndrome

Google image. (2009). Empty Nose Syndrome. Retrieved March 18, 2010 from

http://www.metrohealth.org/body.cfm?id=2277&otopID=967

www.djo.harvard.edu

www.mdconsult.com

Orbital Cellulitis

Orbital Cellulitis is an infection in the tissues surrounding the eyes, including the eye lids, eyebrow, and cheek. Their are a handful of ways that Orbital Cellulitis can occur. The most common is through bacteria from a sinus infection. Other ways include: from bug bites, a stye on the eye, recent eyelid injury, and from a few different bacteria: Staphylococcus aureus, Streptococcus pneumoniae, and beta-hemolytic streptococci.

It seems that small children under the age of 8 are most susceptible to obtaining this bacteria, which in turn means they are highly likely to get Orbital Cellulitis. Orbital Cellulits can be diagnosed through several different tests, but probably the best to visualize this would be a CT orbital scan with contrast, like the image shown above.

Symptoms

Decreased vision

General malaise

Painful or difficult eye movements
Fever of 102 degrees F or higher
Painful swelling of upper and lower eyelids
Shiny, red or purple eyelid
Eye pain, especially with movement
Bulging eyes

Treatment/Prevention

If Orbital Cellulitis is your diagnosis, the best recommendation is to stay in the hospital and receive IV meds, such as antibiotics. This disease can become very severe if not taken care of properly. It is possible for Orbital Cellulitis to lead to: hearing loss, optic nerve damage, meningitis, and even vision loss.

The most common thing to do to prevent Orbital Cellulitis is getting the HiB vaccine as an infant. This is a routine vaccine given to prevent getting the haemophilus infection that can lead to Orbital cellulitis.

(The above orbital CT image with contrast is an axial view of an irregularly-shaped retrobulbar orbital mass filling the posterior orbit with near obliteration of the orbital fat.) http://www.mdconsult.com/

References:

Manju, S. M.D. (2007). Orbital cellulitis. Medline plus. Retrieved February 24, 2010

from http://www.nlm.nih.gov/medlineplus/ency/article/001012.htm

CT image. Google images. Retrieved February 24, 2010 from http://www.djo.harvard.edu/

Periorbital cellulitis. Google images. Retrieved Febraury 24, 2010 from

http://www.mdconsult.com/

baqofa.com

Hypopituitarism

As we have learned about the pituitary gland, this is a small bean-shaped gland at the base of our brain and located posterior to our nose and ears. This tiny little gland is responsible for secreting nearly every hormone that has an influence on our body. These hormones that are secreted by the pituitary help regulate important functions such as blood pressure, growth, and reproduction.

In Hypopituitarism, their is a short supply of some of the hormones that are secreted by the pituitary, or sometimes their is NO supply of one or more of the necessary hormones. This malfunction will produce disorders in what the hormones normally regulate such as the above mentioned of growth, BP, and reproduction. Hypopituitarism is a rare disorder and will need the treatment of medications throughout the duration of your life should you be affected.

So what triggers or causes Hypopituitarism??

Hypopituitarism is most commonly triggered by tumors of the pituitary gland. These tumors can grow in size and start to compress the tissues of the pituitary which in turn cuts off the secretion of hormones. Hypopituitarism can also be caused by malfunctions of the hypothalamus that is located just superior to the pituitary gland. The hypothalamus also produces hormones that have an effect on the pituitary gland.

Other common causes could include:

Head injuries

Brain tumors

Brain surgeries

Stroke

Tuberculosis

Genetic mutations resulting in imparied production of the hormones

So what does the person experience as far as symptoms??

Their can be many symptoms associated with Hypopituitarism that can occur spur of the moment or have a gradual onset. The severity of the symptom or reason for particular symptoms depends on the particular hormone that is deficient.

Symptoms include:

Nausea

Constipation

Fatigue

Headaches

Low tolerance of stress

Loss of underam or pubic hair

Loss of appetite

Muscle Weakness

Weight loss or gain

Low BP

Thirst and excess urination

Children may experience: stunted growth, short stature, and slowed sexual development.

How can Hypopituitarism be treated??

If the Hypopituitarism is caused by a tumor, than the tumor would be surgically removed. Another common treatment is hormone replacement medications. Common medications include: Corticosteroids

Levothyroxine

Desmopressin

Growth & sex hormones

References:

Chapman, I. (2007). Hypopituitarism. Retrieved February 20, 2010 from

http://www.merck.com/mmhe/sec13/ch162/ch162c.html

Google image. Retrieved February 20, 2010 from www.baqofa.com