Dupuytren’s contracture is a condition that causes thickening of tissue in the palm of the hand, particularly over the bands that flex the middle, ring and pinky fingers. Initially the skin can become wrinkled, nodular and thick, but over time the bands to each of those fingers can contract or tighten which makes each affected finger difficult to fully extend. This can make the hand look clawed.

Prevalence and patterns

There is also an association between Dupuytren’s contracture and Peyronie’s disease, which is a curvature of the penis. So if you have one, your doctor may ask you if you have the other.

Management and treatment options

If the affected hand is able to be used normally, management is not necessary immediately. However, the tight bands in the palm can continue to contract, and if that leads to impairment, discomfort, or clawing, treatment is suggested. This can include:

• Hand therapy: Includes bracing, splinting, massage, and active exercises.
• Radiotherapy: Particularly effective early in the contracture.
• Collagenase injection: A minimally invasive procedure done in an office, where the collagenase is injected into the cord. The following day, the doctor manually extends and massages the tight bands, thereby releasing them.
• Surgical fasciotomy: Less common since the introduction of collagenase injection; however, there is a role if the injection is not available or the disease is severe. This is usually performed by a plastic or general surgeon.

Osteitis pubis is an inflammation in the joint at the front of your pelvis, just above your genitals. The pubic joint, its cartilage and the surrounding muscles can be affected, which causes a range of symptoms. It is caused by repetitive microtrauma to the area that puts pressure on the joint.

Osteitis pubis is most common in men 30-50 years of age, but can happen at any age and in both sexes.

The mainstay of treatment for osteitis pubis is avoiding the triggers, such as high impact exercise, and engaging with other exercises that reduce tension on the pelvis. This means avoiding exercise such as running or football and instead swimming or using the gym.

With the assistance of a physiotherapist, a plan can be made to strengthen the muscles of your core and lower back, which stabilises the pelvis. Stretching your adductors, which are the muscles on the inside of the thighs, can also help improve the symptoms of osteitis pubis.

Rarely, if osteitis pubis is chronic or very painful, your doctor may organise a cortisone injection into the pelvis. This can help with pain and discomfort, which can assist you with strengthening and rehabilitation, but doesn’t itself cure the condition any faster.

Most people improve from osteitis pubis within 3-6 months.

The meniscus is cartilage in the knee that helps with cushioning of the joint during impact, such as running and twisting. A meniscal tear can occur when the meniscus endures trauma from activities like walking, sitting, exercising, and generally moving. Each knee has two menisci – the medial and lateral – and each is attached to your thighbone (femur) and tibia (shin bone). The medial and lateral menisci are both C-shaped, which when connected make an O-shape covering the whole knee. Because the meniscus cops a lot of trauma from these activities, sometimes it can tear. This can lead to potential issues.

Surgery

The surgery for meniscal injuries is almost always done via arthroscopy, which involves tiny cuts and a small camera inserted into the joints. The meniscus is either shaved or trimmed so that there are no jagged edges and any loose parts are removed from the knee joint. Very rarely, the whole meniscus may be removed.

The surgery is a day procedure, so you usually only stay in hospital for one day. Walking and movement is encouraged immediately after the operation to improve recovery, however you will often need a knee brace and crutches.

Can you prevent meniscal injuries?

Strengthening your leg muscles, particularly the quadriceps, can protect you from meniscal injuries.

Generally speaking, the knee is strengthened and the meniscus is protected by doing multiple different sports because evidence shows that meniscal tears are more common in people who focus on only one sport.

Other factors that may help prevent a meniscal tear include warming up and stretching before exercise, learning proper techniques and using a knee brace.

Final thought

Meniscal injuries are common in all ages and can present in varying ways. If you have issues with your knee, see your doctor to discuss whether you require an MRI.

Pectus excavatum is a condition that causes your chest to sink in the middle over the sternum (also known as the breastbone). For this reason, it is also known as sunken, hollow, or funnel chest.

It is thought to be caused by an abnormal growth of the ribs that attach to the breastbone and it is thought to be a genetic, or inherited, condition. Approximately one-third of people with pectus excavatum have a family member with the condition. It occurs more commonly in men than women, at a rate of 4:1. It occurs in approximately 1 in 350 people.

It can be obvious and diagnosed when you are born or as an infant, but pectus excavatum becomes more pronounced in adolescence. It stays present your whole life and can get deeper over time unless it is corrected with an operation.

However, the most common issue is psychological because the cosmetic appearance can lead to shame, embarrassment, anxiety and depression. People with pectus excavatum may wear baggy shirts, avoid swimming or exposing their bare chest to others for this reason.

Seeking help

If you think you have pectus excavatum and it is affecting you physically or mentally, speak to your doctor about how you can pursue management.

Iliotibial band syndrome, also referred to simply as ITB, is a common condition that causes knee and leg pain. In some studies it can affect up to 50% of people, particularly in populations that do a lot of exercise. This article will explain what the iliotibial band is, how its dysfunction causes the ITB syndrome and what you can do about it.

How is ITB syndrome diagnosed?

ITB syndrome is usually diagnosed by your doctor or rehabilitation provider (such as physiotherapist, osteopath or myotherapist) through a physical examination. This is usually sufficient, but if there are any questions about the diagnosis you may also have an X-ray, ultrasound or MRI of your knee.

How is ITB syndrome treated?

• Conservative treatment: The treatment for ITB syndrome is usually conservative, which means we normally avoid invasive procedures.
• Enough rest: Commonly, you should avoid the trigger that caused the condition. This might be avoiding certain shoes, exercises or positions. Sometimes enough rest from the trigger can be enough to cure the condition, however occasionally if you resume the same trigger the symptoms can return.
• Anti-inflammatories: Anti-inflammatories can be used to settle the pain. These can be taken as tablets or as a gel to the affected area.
• Cold compresses/warm packs: Cold compresses can be used in the early stages of the condition, however when it has persisted for a long time warm packs can help to loosen up prior to exercise.
• Physical therapy: The mainstay of treatment is physical therapy. This includes stretches and strengthening. A ball or foam roller can be used on the outer part of your leg to help with this. A physical therapist can teach you techniques to warm up and cool down after exercise, to aid healing and prevent flare ups.
• Steroid injection: For severe, chronic cases, your doctor may recommend a steroid injection. This is usually administered via ultrasound and can work as an anti-inflammatory in the trigger areas.
• Surgery: Very rarely, surgery can be performed where a small part of the ITB is removed on the outer side of your knee. This can be done through a small cut on the side of your knee or with a camera. After an operation, physical therapy is still important for full recovery.

A final note

ITB syndrome is commonly treated by doctors and physical therapists. Most of the time it resolves on its own with small adjustments to your exercise regimen or lifestyle.

Resources and support

IT Band Stretches, Strength Exercises, and More – Healthline

Iliotibial Band Friction Syndrome – Medscape

Iliotibial Band Syndrome – Cedars-Sinai

Iliotibial Band Syndrome – Cleveland Clinic

The sciatic nerve is the longest nerve in the body, and extends from the lower back, through the hips and buttocks, down each leg. “Sciatica” refers to pain that radiates along the path of the sciatic nerve. Sciatica tends to primarily affect one side of the body, and is most often seen in adults between 30 and 50 years old. Sciatica is typically a continuous burning sensation or a shooting pain, starting in the lower back/ buttock and radiating down the front or back of the thigh and leg, and/or foot. You may notice is positional/postural, getting worse when you try to sit, stand, walk, bend, twist or while coughing.

Sciatica describes the presence of pain in the path of the sciatic nerve, but it is not a diagnosis in itself.

Patient resources

• Pain Australia: Offers comprehensive resources on managing chronic pain, including sciatica (Pain Australia Website).
• Health Direct Australia: Provides health information and services, including a directory to find physiotherapists and exercise physiologists (Health Direct Service Finder).

Method of Injury

The ACL is commonly injured in active people during sports such as basketball, tennis, skiing, football and soccer. It can be injured when there is a mix of jumping, pivoting, changing fast direction or speed. It can also be injured from direct trauma, such as in a car accident or a tackle.

Prognosis for ACL injuries

Whether you have surgery or not, physical therapy is necessary to strengthen the ligaments and muscles that support the knee. It is common to develop early arthritis in the knee that sustained the ACL tear, which makes exercise and strengthening even more important.

Further resources & patient information about ACL injuries

https://patient.info/bones-joints-muscles/sports-injuries/knee-ligament-injuries https://patient.info/doctor/knee-ligament-injuries-pro 

https://emedicine.medscape.com/article/89442-overview 

https://www.healthline.com/health/anterior-cruciate-ligament-acl-injury

Who gets low back pain?

• Low back pain is commonest in people between the ages of 45 and 59.
• It’s equally common in women as men.
• Low back pain related to employment is commoner in men than women.

How common is low back pain?

• Back pain is the commonest cause of sick-days for both manual and non-manual workers.
• Over 50% of people will suffer from low back pain at some point in their lives (1).
• Low back pain affects about 1 in 3 people each year (2).

Your bones are in a constant state of turnover throughout life- as some bone cells dissolve, others form. Amazingly, this means that every 10 years or so you completely replace most of your own skeleton! However, if for some reason, the loss of bone is greater than the growth of new bone, this can gradually lead to a condition called Osteoporosis, with thinning of the bones and a higher risk of fractures (broken bones). Osteoporosis is sometimes picked up when a person breaks a bone from a low impact injury, and can be confirmed by performing a bone density scan (dexa scan). Whilst Osteoporosis runs in families, there are a number of other risk factors.

Other hormone problems

In men, testosterone gets converted to oestrogen, which helps to maintain bone density. If testosterone is low, this can lead to Osteoporosis. Other hormones that regulate bone density include parathyroid hormone, growth hormone and thyroid hormone. The parathyroid glands are adjacent to the thyroid gland in your neck- if you produce too much parathyroid hormone (hyperparathyroidism), you can lose calcium in your urine. A lack of calcium leads to lower bone density.Low levels of growth hormone (which is made in the pituitary gland) and high levels of thyroid hormone (hyperthyroidism)may also lead to Osteoporosis.

Being Physically Inactive

If bones are not subjected to regular physical exercise and activity, they get weaker over time. This can simply be due to a sedentary lifestyle, or may be due to a health issue that causes a person to have reduced mobility.

Smoking and alcohol

Smokers tend to have lower bone density than non-smokers. It appears that smoking may have a toxic effect on the bone cells, as well as disrupting how the body uses Vitamin D, calcium and oestrogen. Excess alcohol can also affect bone growth and loss of calcium.

Certain medications can increase the risk of osteoporosis. Steroid medications are particularly likely to cause reduced bone density. Other culprits include medications used to treat Epilepsy.

Other Chronic Disease

Many chronic diseases can lead to Osteoporosis over time. These include Rheumatoid Arthritis, Chronic Kidney Disease, Chronic Liver Disease, Coeliac Disease, Inflammatory Bowel Disease (such as Crohn’s or Ulcerative Colitis), Multiple Myeloma and Lupus. Being either underweight or obese can also be a risk factor for Osteoporosis.

If you’ve had a broken bone (fracture) from a low impact injury, or you are simply concerned about your risk of Osteoporosis, you may require a Dexa scan (bone density scan) and other investigations. Speak to your doctor, who will be able to advise you further.

Further Patient Resources:

osteoporosis.org.au

Article Resources:

Ewald D. (2012). Osteoporosis: Prevention and Detection in General Practice

Ragucci KR, Shrader SP. (2011). Osteoporosis treatment: an Evidence Based Approach

People who run or who play sports that involve lots of running commonly present to physiotherapists and doctors with shin pain. There are several possible causes for pain in this part of the leg. Here are 3 underlying conditions that should be considered.