Right knee lateral meniscus tear

Ms JW, a 21 yrs old lady was walking on her high-heels when she suddenly twisted her ankle and knee yesterday. The knee swelled up slightly and she could hardly walk. She was brought in by her father yesterday evening and could not bear her weight on the right knee.

Clinically, she had moderate effusion and slight slight restriction of knee flexion. She had tenderness of the joint line (lateral aspect) and a positive McMurray's test. She also had mild tenderness of the proximal attachment of the Lateral Collateral Ligament (LCL). She was treated with RICE treatment and sent for further evaluation with plain X-rays and MRI of the Right knee (to evaluate extent of meniscus injury and injury to other structures e.g. ACL). She has been started on isometric exercises. However, she may require early surgical intervention if the meniscus tear restricts movement or can be repaired. Post-surgical rehabilitation would often require up to 12 weeks commitment before return to play.

FOr further reading:-
Meniscus injury
Lateral discoid meniscus

Right Axillary Follicular Abscess

Ramli is a 30 yrs old club soccer player who came with painful right armpit (axillary region) painful swelling of 3 days duration. He usually shaves his armpit hair for hygiene purpose but this is the first time he suffered this fate.

I examined him and found several peasized tender, firm swelling in his right axilla but there were no other enlarged lymph nodes. The skin in the groin and axilla is commonly colonised by Staphyloccus Aureus. Minute skin cuts or abrasion could have introduced the infection to the hair follicles. We treated him with a course of antibiotics and some topical antibiotic ointment for 5 days duration. His symptoms resolved quickly as the infection was still at early stage. If the swelling failed to subside, he would have required incision and drainage surgery.

For further reading:-
Folliculitis
Lympadenitis

Tinea Pedis (Athlete's Foot) and Onychomycosis

Tinea pedis (athlete's foot) is a common fungal condition occuring in the feet of athletes or workers who routinely wear their shoes without drying and cleaning them properly. Although it is more common to find the itchy, scaly (not always) and smelly skin lesion in between the toes, they can also infect the sole of the foot. Athletes who have the habit of wearing shoes belonging to their team mates may transmit the disease to others. This condition is easy to treat with foot hygiene, topical anti-fungal creams and occasionally require oral anti-fungal medication.

The nails may also be infected (see 2nd photo) causing Onychomycosis. This condition is more difficult to treat often requiring oral anti-fungal medication, topical anti-fungal lotion after filing the infected nail.

Links of interest:-
Athlete's Foot: MayoClinic.com
Nail Fungus

Wrist (Radiocarpal ) Impingement and mild arthritis

Mr White (not his real name) is a 120kg weightlifter in his 20s who suffered from right wrist pain since 2 weeks duration. Prior to his competition he came to see me as the pain was preventing him from lifting beyond maximal capacity during 'clean and jerk'. His earlier X-ray did not show any fracture or osteophytes.

I examined his wrist yesterday morning only to find tenderness and slight fullness (synovitis) over the lunate bone in his right wrist. Forceful wrist hyperextension ellicits the same pain he experiences doing 'cleans'. Resisted extension was unaffected (ruling out extensor digitorum communis tendon involvement) He would need to rule out a lunate stress fracture (Radioisotope Bone Scans would be useful). He did not have any scaphoid bone tenderness although it is more common amongst weightlifters.

While awaiting his Radioisotope Bone Scan to rule out a stress fracture or Kienbock's Disease he would need to avoid doing 'cleans' and reduce the load of lifts. An ultrasound scan would be able to determine the extent of joint and tendon involvement with a musculoskeletal radiologist. Meanwhile, he should not participate in competition as it could worsen his condition. He would benefit from daily low frequency ultrasound (Exogen) for another 2 - 4 weeks. If symptoms persists he would need to be reviewed. MRI Scan could be an option then.

Interesting links:-
Wrist arthritis
A possible complication: Kienbock Disease

Posterior Cruciate Ligament Rupture

Posterior Drawer Test