Anterior Cruciate Ligament (ACL) Injuries of the Knee

2 Comments / John T. Rowe, MD / September 25, 2014

Causes of ACL Injury

The anterior cruciate ligament (ACL) is one of the four major ligaments that stabilize the knee joint. The anterior and posterior cruciate ligaments are so named because they cross one another like an ‘X’ or a cross as they connect the femur (thigh bone) and the tibia (shin bone). Among other things, the ACL prevents the tibia from sliding forward relative to the femur. Injury to the ACL is one of the most common injuries related to sports and as the ligaments become weaker with age, ACL injuries can actually occur with just normal activities. ACL injuries include tears, sprains and rupture. They occur most commonly when the knee is bent backwards or twisted as may occur in sports like soccer, skiing, basketball and tennis which require jumping, pivoting or quick changes in direction or when the knee is hit with direct force as may occur in football.

Signs and Symptoms

The classic complaint after a severe ACL injury is hearing the sound or even having the ‘feeling’ of a loud popping at the time of the injury. There may be swelling and pain on the lateral (outside) and posterior (back) aspects of the knee. The swelling may develop over 6 to 24 hours. The knee joint may then be unstable and have limited movement. In addition to loss of full range of motion of the knee, there will be tenderness to palpation of the joint. With a minor injury, the patient may be able use the limb, but have the feeling that the knee is ‘giving way’ when bearing weight on it.

Treatment

While ACL injuries are among the most dreaded of sports injuries, there are now many treatment options as well as opportunities to prevent injury in the first place. Immediate treatment includes rest, ice, compression and elevation of the knee, known as the RICE protocol (which can be applied to other injuries as well). If not contraindicated, anti-inflammatory medications can help control pain and swelling. Definitive treatment ranges from physical therapy to surgery.

Prevention

It is important to be aware that girls are at greater risk of ACL injuries and all adolescents who suffer an ACL injury are at greater risk of developing degenerative knee osteoarthritis later in life. Young athletes can reduce their risk of sustaining a severe ACL injury by utilizing training programs that emphasize strengthening exercises and balance training. Your pediatrician, sports medicine physician, physical therapist or athletic trainer can provide you with more information about these helpful programs.

For More Information

For more information about Anterior Cruciate Ligament injuries and related topics, check out the excellent medical blog of sports medicine guru, Dr. David Geier.

Anterior Cruciate Ligament (ACL) Injuries of the Knee Read More »

Ebola Virus

John T. Rowe, MD / August 27, 2014

First Reported in West Africa

Named for the Ebola River in the Democratic Republic of Congo where some of the original cases were reported in 1976, Ebola Virus Disease (EVD) causes severe illness in humans with almost 90% of cases being fatal. The virus is acquired from wild animals and is then transmitted from human to human when secretions, including blood, semen or other bodily fluids, gain entrance to the body through mucous membranes or broken skin.

Signs and Symptoms

Symptoms begin to appear from a few days to three weeks after infection with the Ebola virus. Infectivity lasts as long as the virus remains in bodily secretions which can be up to two months from the time the illness begins. Signs and symptoms are characterized by sudden onset of fever, sore throat, headache, muscle pain and weakness, followed by vomiting, diarrhea and rash. Eventually, liver and kidney function become impaired. There may be bleeding, both internally and externally, due to a low platelet count, hence this disease’s former name, Ebola Hemorrhagic Fever. Ebola Virus Disease is confirmed by several laboratory tests, which must be conducted under strict protective conditions.

No Known Cure

There is currently no vaccine for Ebola Virus Disease and there is no known cure other than experimental drugs and supportive treatment in the hospital, including hydration, blood transfusions and oxygen. Despite the highly contagious nature of this infection, two patients with confirmed Ebola Virus Disease were recently transported from Africa to the United States for treatment. In spite of the fact that little is known about this often fatal disease, or perhaps because of it, it was entirely appropriate to repatriate these American citizens to a medical center where every effort could be made to save them.

A Learning Experience

Fortunately, our country continues to have the most advanced medical care available anywhere in the world and we are entirely capable of isolating highly contagious patients such as these. In what can only be described as a major milestone in treating this serious infection, both patients have now been released from Emory University Hospital in Atlanta, Georgia, free of Ebola Virus Infection. The experience gained from treating these individuals will be invaluable when doctors are faced with their next patient suffering from this devastating disease.

Ebola Virus Read More »

Testicular Cancer

1 Comment / John T. Rowe, MD / July 29, 2014

Testicular Cancer Targets Young Males

Although testicular cancer is rare, it is the most common cancer occurring in young men between the ages of 15 and 34. Because it targets a specific population in an anatomical location where it can be detected at an early stage, it can usually be treated successfully. Nonetheless, the American Cancer Society estimates that approximately 380 men will die of testicular cancer in 2014. Until recently, white males had the highest rate of testicular cancer in the United States, but data collected by the National Cancer Institute shows that the incidence of testicular cancer among Hispanic males rose by 58% from 1992 to 2010.

Signs and Symptoms of Testicular Cancer

The scrotum is the musculocutaneous sac that contains the testes or testicles. The scrotal sac is divided into two compartments, each containing a testis (testicle) with its attached epididymis and spermatic cord. In most men, one of the testicles will hang lower than the other. The testes are the male gonad, homologous to the ovaries in the female, and they have two main functions, to produce testosterone and to produce sperm. Testicular cancer usually occurs in only one testis or testicle. Signs and symptoms of testicular cancer include a lump or swelling in either testicle; sudden accumulation of fluid in a testicle; pain, discomfort or a feeling of heaviness in the testicle or scrotum; and sometimes enlargement of the breast tissue.

Risk Factors and Diagnosis

Several factors may increase a man’s chance of developing testicular cancer. These include an undescended testicle; congenital abnormalities of the testicles, penis or kidneys; history of previous testicular cancer; and having a father or brother with testicular cancer. In addition to abnormal findings on physical examination, testicular cancer is diagnosed by blood tests looking for certain tumor markers; ultrasound of the scrotum to confirm the presence and size of a mass and to distinguish it from other pathology in the scrotum, including a collection of fluid and infection; and, finally, a biopsy of the testicle. If the biopsy shows that cancer is present, then further tests are performed to determine if the cancer has spread. These may include a chest x-ray and abdominal and pelvic CT scans.

Treatment and Prevention

Once a diagnosis of testicular cancer has been made, further evaluation will determine the type and extent of the cancer. Depending on these findings, treatment may include surgery, radiation and chemotherapy. A regular physical examination by a health care provider should include examination of a man’s testicles. Although there is some disagreement on whether testicular self-examination is effective, I recommend that my patients perform a monthly testicular self-examination after puberty.

You Might Be Interested to Know

Medical terms relating to the testes often begin with a prefix derived from the Greek word for testis, which is ‘orchis’, thus orchidectomy is removal of the testicle. Interestingly, the orchid plant is so named because the shape of its root tubers resembles a testicle.

Testicular Cancer Read More »

Measles

1 Comment / John T. Rowe, MD / June 24, 2014

Measles Cases on the Rise

During the first quarter of 2014, 129 cases of measles were reported in the United States, 58 of which were from California. Almost all of the cases (95%) were either imported from foreign counties or acquired while traveling to a foreign country. This increase in the cases of measles highlights the importance of adhering to recommended immunization schedules. Children should receive their first dose of the MMR (measles, mumps, rubella) vaccine at 12 through 15 months and their second dose at 4 through 6 years of age. Measles is still endemic in some countries, such as the Philippines, where recently there have been 20,000 cases and 69 deaths. For this reason, children and infants traveling out of the country should be evaluated by their pediatrician to determine whether they should receive an accelerated dosing schedule of MMR vaccine.

Signs and Symptoms of Measles

Many physicians practicing in the United States, not to mention parents, have never seen a case of measles, thanks to the highly effective vaccination programs in our country. Because of the increase in international travel and the current uncontrolled influx of aliens into the United States it is important to be aware of the signs and symptoms of measles or rubeola. This highly contagious viral infection is characterized by high fever and a maculopapular rash that starts on the face and upper neck and spreads to the extremities. The rash changes from red to dark brown before disappearing after about 8 days. In addition, measles is characterized by ‘the three Cs’, cough, coryza (runny nose) and conjunctivitis (inflammation and redness of the white part of the eyes). The fever can be as high as 104 degrees and precedes the appearance of the rash by several days. Clinching the diagnosis of measles are the white spots on the inside of the cheek opposite the upper molars, known Koplik spots, which appear transiently before the rash. These are often missed even by experienced physicians.

Treatment and Complications

Treatment is supportive and most patients recover within two weeks. Minor complications such as diarrhea are common, but pneumonia and encephalitis can lead to serious sequelae and even death. Immunocompromised individuals are at particular risk. Patients suspected of having measles should be isolated immediately. For non-immune, at risk patients exposed to measles, immune globulin may reduce the risk of infection if administered within six days of exposure. Your personal physician or nurse practitioner can provide you with more information about measles and review your records to make sure you and your children are up to date on all your immunizations.

Measles Read More »

More About Washing Your Hands

John T. Rowe, MD / May 6, 2014

The Five ‘F’s and Water

Hand washing is considered to be one of the most important ways of preventing the spread of communicable diseases. Infectious diseases can be spread from person to person in a variety of ways and the following simple mnemonic (or memory aid) is a helpful way of learning one of the important principles of sanitation. I can still remember Dr. Leonard Laskowski, my microbiology professor in medical school, teaching us how the common infectious diseases, particularly those acquired through the respiratory and gastrointestinal routes are transmitted by the ‘five Fs and water’…fingers, food, feces, flies, fomites and water.

Fomites?

OK, we know what fingers, food, feces, flies and water are, but just what is a fomite? We saw in our last article that the one dollar bill can harbor many different bacteria which cause infections in humans. In this case, the dollar bill is an example of a fomite, which is defined as an inanimate object that serves to transmit an infectious agent from person to person. Every object (or fomite) that we touch can potentially harbor infectious agents, including the button on the drinking fountain, the hotel room TV remote control, that borrowed pen or pencil and even the soap dispenser in public restrooms. So, next time you touch a seemingly innocuous object, avoid putting your fingers near your mouth or nose until you’ve had a chance to wash your hands. Following this simple principle of sanitation will go a long way toward keeping you healthy.

More About Washing Your Hands Read More »

The Importance of Hand Washing

John T. Rowe, MD / April 23, 2014

Dirty Money

An article by Robert Lee Hotz, published in the Wall Street Journal on April 18, 2014 gives new meaning to the old expression, ‘filthy lucre’, which was originally meant to describe money obtained dishonestly. In this case the dirty money refers to the ubiquitous one dollar bill that each of us handles every day. By studying the DNA found on dollar bills, researchers at New York University discovered more than 3,000 types of bacteria on the surface of paper money. Some of the more common types of bacteria found on the bills were the same ones associated with acne, pneumonia, food poisoning, stomach ulcers and staph infections.

Wash Your Hands

The article went on to explain that the average life span of a one dollar bill is 21 months of circulation. During that time, skin residue and oils deposited on the paper currency by human hands actually serve as nutrients for microbes. When the dollar bill is placed in the warm environment of a wallet in someone’s rear pocket, you have a perfect incubator for the growth of microbes. Paper currency is just one example of an inanimate object or ‘fomite’ that can transmit infectious disease. So, take a lesson from doctors, nurses and other health professionals and make it a habit to wash your hands frequently throughout the day, keeping in mind that even inanimate objects can harbor infectious agents.

* The word lucrative, meaning producing a great deal of profit, is derived from the same Latin root word, lucrum, meaning money, gain or profit.

The Importance of Hand Washing Read More »