Lateral femoral neck stress fractures:A case report

BACKGROUND Sport-induced injuries particularly affect young, healthy, and active individuals. Running, a popular and accessible sport, can cause a wide range of injuries, including stress fractures. Stress fractures can occur during high-intensity training or competitions, especially among well-trained amateurs and professional athletes. Adequate diagnosis can be complicated by the typically young age, unremarkable medical history, and vital condition of the patient. Stress fractures present insidiously, and this is specifically the case with stress fractures of the femoral neck. Timely intervention is crucial to prevent progressive displacement, as this can damage the blood supply to the femoral head. CASE SUMMARY A 30-year-old male runner presented to our outpatient clinic with persistent pain 3 weeks after running a marathon. X-ray showed a complete lateral fracture of the left femoral neck, which was treated surgically with a dynamic hip screw. CONCLUSION It is essential for healthcare providers to be vigilant for the subtle symptoms of stress fractures to ensure timely treatment. Early recognition prevents complication and leads to a better prognosis.</p

Opereren binnen zorguitgavenkaders

Door het wettelijk recht op zorg kan vooraf geen volledige zekerheid worden geboden dat zorguitgaven onder alle omstandigheden binnen de grenzen van het Budgettair Kader Zorg blijven. Wel zijn aanvullende maatregelen mogelijk om marktpartijen maximaal te prikkelen binnenskaders te blijven. Hierdoor worden de uitgaven voor medisch-specialistische zorg aanzienlijk beter beheersbaar dan nu het geval is

The PEX study – Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749]

BACKGROUND: Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome. Exercise therapy is also often prescribed although evidence on effectiveness is lacking. The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only). The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS). METHODS/DESIGN: 136 patients (adolescents and young adults) with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care. The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting. Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study. Secondary outcome measurements include an economic evaluation. A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs) and incorporates direct medical costs and productivity costs DISCUSSION: This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed. The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007. The first results will be available around December 2007

Dutch multidisciplinary guideline on anterior knee pain: Patellofemoral pain and patellar tendinopathy

PURPOSE: The purpose of this study was to develop a multidisciplinary guideline for patellofemoral pain (PFP) and patellar tendinopathy (PT) to facilitate clinical decision-making in primary and secondary care.METHODS: A multidisciplinary expert panel identified questions in clinical decision-making. Based on a systematic literature search, the strength of the scientific evidence was determined according to the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) method and the weight assigned to the considerations by the expert panel together determined the strength of the recommendations.RESULTS: After confirming PFP or PT as a clinical diagnosis, patients should start with exercise therapy. Additional conservative treatments are indicated only when exercise therapy does not result in clinically relevant changes after six (PFP) or 12 (PT) weeks. Pain medications should be reserved for cases of severe pain. The additional value of imaging assessments for PT is limited. Open surgery is reserved for very specific cases of nonresponders to exercise therapy and those requiring additional conservative treatments. Although the certainty of evidence regarding exercise therapy for PFP and PT had to be downgraded ('very low GRADE' and 'low GRADE'), the expert panel advocates its use as the primary treatment strategy. The panel further formulated weaker recommendations regarding additional conservative treatments, pain medications, imaging assessments and open surgery ('very low GRADE' to 'low GRADE' assessment or absence of scientific evidence).CONCLUSION: This guideline recommends starting with exercise therapy for PFP and PT. The recommendations facilitate clinical decision-making, and thereby optimizing treatment and preventing unnecessary burdens, risks and costs to patients and society.LEVEL OF EVIDENCE: Level V, clinical practice guideline.</p

Knee complaints seen in general practice: active sport participants versus non-sport participants

Background. Since knee complaints are common among athletes and are frequently presented in general practice, it is of interest to investigate the type of knee complaints represented in general practice of athletes in comparison with those of non-athletes. Therefore, the aim of this study is to investigate the differences in type of knee complaints between sport participants, in this study defined as athletes, and non-sport participants, defined as non-athletes, presenting in general practice. Further, differences in the initial policy of the GP, medical consumption, and outcome at one-year follow-up were also investigated. Methods. Patients consulting their GP for a new episode of knee complaints were invited to participate in this prospective cohort study. From the total HONEUR knee cohort population (n = 1068) we extracted patients who were athletes (n = 421) or non-athletes (n = 388). Results. The results showed that acute distortions of the knee were significantly more diagnosed in athletes than in non-athletes (p = 0.04). Further, more athletes were advised by their GP to 'go easy on the knee' than the non-athletes (p < 0.01), but no differences were found in number of referrals and medication prescribed by the GP. The medical consumption was significantly higher among athletes; however, no significant differences were found between the two groups for recovery at one-year follow-up. Conclusion. There are no major differences in the diagnosis and prognosis of knee complaints between athletes and non-athletes presented to the GP. This implies that there are no indications for different treatment strategies applied in both groups. However, athletes are more often advised to 'go easy on the knee' and to rest than non-athletes. Further, there is a trend towards increased medical consumption among athletes while functional disability and pain are lower than among the non-athletes

Developing Clinical and Research Priorities for Pain and Psychological Features in People With Patellofemoral Pain:An International Consensus Process With Health Care Professionals

OBJECTIVE: To decide clinical and research priorities on pain features and psychological factors in persons with patellofemoral pain. DESIGN: Consensus development process. METHODS: We undertook a 3-stage process consisting of (1) updating 2 systematic reviews on quantitative sensory testing of pain features and psychological factors in patellofemoral pain, (2) an online survey of health care professionals and persons with patellofemoral pain, and (3) a consensus meeting with expert health care professionals. Participants responded that they agreed, disagreed, or were unsure that a pain feature or psychological factor was important in clinical practice or as a research priority. Greater than 70% participant agreement was required for an item to be considered important in clinical practice or a research priority. RESULTS: Thirty-five health care professionals completed the survey, 20 of whom attended the consensus meeting. Thirty persons with patellofemoral pain also completed the survey. The review identified 5 pain features and 9 psychological factors—none reached 70% agreement in the patient survey, so all were considered at the meeting. Afte the meeting, pain catastrophizing, fear-avoidance beliefs, and pain self-efficacy were the only factors considered clinically important. All but the therma pain tests and 3 psychological factors were consid ered research priorities. CONCLUSION: Pain catastrophizing, pain self-efficacy, and fear-avoidance beliefs were factors considered important in treatment planning, clinical examination, and prognostication. Quantitative sensory tests for pain were not regarded as clinically important but were deemed to be research priorities, as were most psychological factors.</p

Patellofemoral Pain Syndrome and Exercise Therapy

Patellofemoral Pain Syndrome (PFPS) can be considered as a clinical entity evolving during adolescence and young adult age.Though the complaints may be self-limiting and follow a benign course there are claims that exercise therapy may be beneficial for patients with patellofemoral pain syndrome. The aim of this thesis is to study the clinical effects and costeffectiveness of exercise therapy for patellofemoral pain syndrome. In this thesis the results of a clinical trial on exercise therapy for PFPS as well as the results of a systematic literature review are presented. Furthermore the effectiveness of exercise therapy is studied in relation to other conservative strategies. Additional to these studies data are presented concerning the current strategies for PFPS and for other non-traumatic knee complaints in general practice