Symptomatic os trigonum in national level javelin thrower: a case report.

INTRODUCTION: Os trigonum syndrome is a relatively uncommon condition, resulting from compression of a congenital bony anomaly (os trigonum) and adjacent soft tissues during repetitive hyper-plantarflexion. This condition is currently well-described in ballet, soccer, and running athletes, but few cases exist describing os trigonum syndrome in overhead athletes. CASE PRESENTATION: A 22-year-old national level male javelin athlete presented with a recalcitrant history of posterior ankle pain following a hyper-plantarflexion mechanism. Imaging demonstrated a symptomatic os trigonum and inflammation of surrounding soft tissues. Re-aggravation following a conservative trial of care led to orthopaedic referral. Surgical excision of the os trigonum was performed with an open posterolateral approach. The athlete returned to competition three months later with no recurrence of symptoms. SUMMARY: This case discusses the clinical presentation, imaging, and management of a symptomatic os trigonum and related pathologies in a javelin thrower.

INTRODUCTION: Le syndrome de l'os trigone est une pathologie relativement peu fréquente causée par la compression d'une anomalie osseuse congénitale (os trigone) et des tissus mous adjacents durant les mouvements répétitifs en hyperflexion plantaire. Cette pathologie touche souvent les danseuses de ballet, les joueurs de soccer et les coureurs. Peu de cas sont enregistrés chez les athlètes pratiquant des sports comportant des mouvements au-dessus de la tête. PRÉSENTATION DU CAS: Un lanceur de javelot de 22 ans se plaignait d'une douleur postérieure de la cheville déclenchée par des mouvements répétitifs en hyperflexion plantaire. Les examens par imagerie montraient un os trigone symptomatique et une inflammation des tissus périphériques. Une aggravation après une tentative de traitement conservateur a mené à une demande d'une consultation en orthopédie. L'excision chirurgicale de l'os trigone a été réalisée à ciel ouvert par voie d'abord ouverte postérolatérale. L'athlète e repris la compétition au bout de trois mois; ses symptômes ne sont pas réapparus. RÉSUMÉ: Cette étude de cas présente le tableau clinique, les examens par imagerie et la prise en charge d'un os trigone symptomatique et des pathologies apparentées observés chez un lanceur de javelot.

Symptomatic herniation pit of the femoral neck: a case report.

OBJECTIVE: To discuss herniation pits of the femoral neck as a possible source of hip pain in a young athletic population. CLINICAL FEATURES: A 25-year-old former varsity volleyball player sought treatment for recurrent episodes of sharp left hip pain after intense physical activity. Radiographs revealed a small, oval, lobulated radiolucency with a thin sclerotic border in the superolateral aspect of the left femoral neck. Passive internal rotation of the left hip reproduced the complaint. Iliopsoas tendinitis/bursitis tests did not reproduce the complaint. INTERVENTION AND OUTCOME: The patient reported no significant reduction of hip pain after a variety of conservative therapies including soft tissue therapy, stretching, interferential current, and long-axis distraction. CONCLUSION: There is evidence to suggest that herniation pits of the femoral neck are a result of mechanical stress from the overlying joint capsule and iliopsoas tendon. Herniation pits of the femoral neck should be considered a potential cause of hip pain, particularly if the patient is physically active.

Neck-tongue syndrome.

OBJECTIVE: To discuss a case of neck-tongue syndrome (NTS) affecting a dancer/figure skater, review literature summarizing the pathogenesis and treatment, and offer new categorization of neck-tongue syndrome. CLINICAL FEATURES: A 24-year-old female dancer/skater sought treatment for recurrent episodes of right-sided upper neck pain with associated ipsilateral numbness of her tongue following brisk active rotation. Radiographs revealed a narrowing of the left para-odontoid space. Physical examination revealed a mildly painful restriction in rotation at C1-2 with no apparent muscular hypertonicity. INTERVENTION AND OUTCOME: The patient had sought chiropractic treatment for this condition several times since she was 8 years old. Diversified chiropractic adjustments were applied to restrictions throughout the cervical spine as determined by the clinician. No other interventions were employed. The patient experienced significant improvement in frequency and intensity of the neck and tongue symptoms following spinal manipulative therapy applied to her cervical spine. CONCLUSIONS: There are 2 categories of NTS: complicated NTS due to the presence of an underlying disease process (inflammatory or degenerative) and uncomplicated NTS (idiopathic or trauma-related). This case report is of uncomplicated NTS that responded favorably to spinal manipulative therapy directed at the cervical spine. In the absence of upper cervical instability, spinal manipulative therapy appears to be beneficial and should be considered in all cases of uncomplicated NTS.

The female athlete triad: a case series and narrative overview.

OBJECTIVE: To illustrate the varying presentations of the female athlete triad and to inform the practitioner of the potential sequelae of this common condition. CLINICAL FEATURES: Four patients presented with a variety of signs and symptoms of the female athlete triad including low caloric intake, osteoporosis, amenorrhea and/or endothelial dysfunction. INTERVENTION AND OUTCOME: A conservative treatment approach was utilized in each case including education on the female athlete triad, education on increased caloric intake and a referral to the family physician. CONCLUSION: Health care practitioners should be aware of the different clinical presentations of the female athlete triad. A narrative review of the literature is provided to educate practitioners on the components of the female athlete triad, proper diagnosis and appropriate management.

OBJECTIF: illustrer les différentes manifestations de la triade de l'athlète féminine et d'informer le praticien des séquelles potentielles de cette affection courante. CARACTÉRISTIQUES CLINIQUES: quatre patients ont manifesté une variété de signes et de symptômes de la triade de l'athlète féminine, y compris un faible apport calorique, l'ostéoporose, l'aménorrhée ou une dysfonction endothéliale. INTERVENTION ET RÉSULTAT: une approche de traitement conservateur a été utilisée dans chaque cas, y compris une formation sur la triade de l'athlète féminine, une formation sur l'augmentation de l'apport calorique et un renvoi au médecin de famille. CONCLUSION: les professionnels de la santé devraient connaître les différentes manifestations cliniques de la triade de l'athlète féminine. Un examen narratif de la documentation est offert pour renseigner les praticiens sur les composantes de la triade de l'athlète féminine, le bon diagnostic et la prise en charge appropriée.

Curriculum reform in a public health course at a chiropractic college: are we making progress toward improving clinical relevance?

Improving education in health promotion and prevention has been identified as a priority for all accredited professional health care training programs, an issue recently addressed by a collaboration of stakeholders in chiropractic education who developed a model course outline for public health education. Using a course evaluation questionnaire, the authors surveyed students in the public health course at the Canadian Memorial Chiropractic College (CMCC) before and after the implementation of new course content based on the model course outline. Following the new course, there were significant improvements in perceived relevance to chiropractic practice and motivation to learn the material as a foundation for clinical practice. Changes made to the content and delivery of the course based on the model course outline were well received in the short term.