Category: Diseases and Conditions

ACL Injuries

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What is an ACL injury?
ACL refers to the anterior cruciate ligament. It is 1 of 4 ligaments in your knee. The other knee ligaments are PCL (posterior cruciate ligament), MCL (medial collateral ligament), and LCL (lateral collateral ligament). The ACL is located behind the kneecap (patella). It stabilizes the knee when it rotates. The ACL and PCL connect your thigh bone (femur) to your shin bone (tibia).

A torn ACL is a common knee injury. On average, women are 2 to 8 times more at risk of ACL injuries than men. Teenagers also are getting ACL injuries at an increased rate. More kids are involved in organized sports. The increase in ACL injuries is also due to awareness and advanced testing.

Symptoms of an ACL injury
The primary sign of an ACL injury is a popping noise. This is often combined with pain and swelling. You could experience grinding feelings of your bones or kneecap. Another sign is not being able to put weight on your leg.

What causes an ACL injury?
ACL injuries often occur in sports or active environments. They usually occur without contact rather than with direct contact. Several things can cause the injury, such as:

If you are moving and quickly stop or change directions.
If you are still and make a sudden movement, like a jump or turn.
If you overstretch your knee joint.
If someone hits you in the knee, causing it to move away from the rest of your leg.
This can happen while doing things like skiing, playing soccer or football, and jumping on a trampoline.

When you injure your ACL, it can be a partial or full tear. Other injuries can occur at the same time. These include other torn knee ligaments (primarily the MCL, the ligament that gives your knee stability), a torn meniscus (knee cushion), or bone bruises.

How is an ACL injury diagnosed?
If you think you’ve injured your ACL, seek medical attention. Your doctor will perform a knee exam to check range of motion and extent of injury. An MRI (magnetic resonance imaging) could confirm the injury.

Can ACL injuries be prevented or avoided?
The leading way to prevent injuries such as an ACL tear is to follow a certain training routine. Prevent Injury, Enhance Performance (PEP) programs have become more common for this purpose. They combine stretching, strengthening, and agility exercises that focus on knee stabilization. Organizations like U.S. Soccer have seen positive results and fewer injuries with PEP. The Santa Monica Sports Medicine Foundation (SMSMF) created this program.

There is no clear evidence that use of a knee brace prevents ACL injuries. There also is no proof that a knee brace helps more in treatment or physical therapy.

ACL injury treatment
Your doctor will weigh several factors to decide on a treatment plan. These include severity of the injury, age, physical condition, medical history, and other injuries or illnesses.

People who are young, active, and healthy typically get surgery. Your primary care doctor will refer you to an orthopedic surgeon. In surgery, they will repair, or reconstruct, the ACL with tissue. This can come from your hamstring or a minor patellar (knee) tendon. They also can get it from a donor. Surgery should be performed shortly after the injury, within 5 months, for best results. After surgery, you will need intense physical therapy to rebuild strength in your knee and leg.

Another treatment option for people who are aren’t as active or healthy is therapy. This is less intense and invasive. Therapy programs can range anywhere from 10-32 weeks. The goal is to increase movement and strength, and allow the ligament to heal naturally.

Living with an ACL injury
Recovering from an ACL injury can be difficult. This is especially true if the injury happened during a daily or regular activity. Keep in mind, your doctor’s goal is to restore your ACL, so treatment is important.

There is some evidence that people who have ACL injuries will develop osteoarthritis or degenerative arthritis over time. This outcome is similar regardless of how the injury is treated.

Questions to ask your doctor
Why are women and girls more at risk of ACL injuries?
How long after surgery or therapy until I can play sports or be active again?
Can I re-injure my ACL? If so, how can I prevent re-injury?
Resources
American Academy of Orthopaedic Surgeons, Management of ACL Injuries: Clinical Practice Guideline

Santa Monica Sports Medicine Foundation, PEP Program

Abusive Head Trauma

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What is abusive head trauma?
Abusive head trauma is also called shaken baby syndrome. It’s a form of child abuse that can be deadly or leave a baby seriously injured for a lifetime. Most often, victims of this kind of abuse are less than 1 year old, but it can happen with children up to age 5.

Symptoms of abusive head trauma
A severe case of abusive head trauma in your baby or young child can cause unconsciousness, seizures, or shock.

Other initial symptoms of abusive head trauma can include the following:

vomiting
irritability
unusual drowsiness
trouble sucking or swallowing
no interest in eating
stiff appearance
changes in consciousness
no smiling, babbling, or talking
differently sized pupils
inability to lift his or her head
inability to focus eyes or track movement
In many cases, abusive head trauma also leaves a child with long-term problems that affect him or her physically and intellectually. A survivor of abusive head trauma may be dependent on medical, special education, and social services for the rest of his or her life.

What causes abusive head trauma?
Abusive head trauma happens when a baby is shaken violently, hit in the head, thrown, or dropped on purpose. It usually happens at the hands of an overwhelmed parent or caregiver who can’t cope with a baby’s long periods of crying and the demands of caring for a young child.

Violently shaking a young child or hitting him or her in the head causes the child’s brain to shake back and forth inside the skull. This is especially true in babies whose neck muscles aren’t fully developed. The movement causes your child’s brain to swell, bruise, and bleed from the tearing of blood vessels, nerves, and tissue.

How is abusive head trauma diagnosed?
You should go to the emergency room right away if you suspect your child is suffering from abusive head trauma. Because some symptoms of abusive head trauma (for example, vomiting or irritability) are also common in other illnesses, it is important for the doctor to know if your child may have been shaken or hit in the head. The doctor will ask questions about what happened. Unfortunately, the person responsible for the abuse may not be honest about his or her actions.

The doctor will use a number of visual clues and tests to make the diagnosis and find out how severe the damage is. Visual clues include checking the child’s eyes for bleeding; looking for marks on the skull, arms, or legs; and checking for bruises around the child’s neck or chest. Certain imaging tests (for example, an X-ray, CT scan, or MRI) can show evidence of swelling or bleeding in the brain. These tests also can show skull or rib fractures.

Can abusive head trauma be prevented or avoided?
Because this happens due to a caregiver’s actions, it is absolutely possible to prevent abusive head trauma. It is important for everyone who takes care of your baby or young child to learn how to handle stressful situations (for example, when your baby cries for a long time).

One way to handle stress is taking several deep breaths, finding a safe place for your child (for example, the crib), and walking to another room for 10 to 15 minutes to calm yourself. When you feel out of control, call a friend or family member to help with your child or help you regain control. Understanding the consequences of abusive head trauma can help you take an active role in preventing this with your child.

Soothing a crying baby is not easy. However, there are a number of things you can try to calm the baby, including the following:

sing
rock
swaddle
take him or her for a ride or a walk
offer a bottle or pacifier
breastfeed
lay the baby on his or her stomach across your lap and gently rub or pat the baby’s back
Combining these strategies with “white noise” or rhythmic sounds (for example, music, a hair dryer, or a clothes dryer) can help. You also can try putting your child down for a nap on his or her left side to help with digestion, or on his or her back. If all else fails, be sure to consider whether your child could be sick. Call your doctor for advice.

If you have a caregiver for your child, it’s important to teach your caregiver about the dangers of shaking a baby or young child. Be sure he or she knows what to do if he or she feels stressed while caring for your child. Choose a caregiver carefully and continue to monitor your child’s safety under his or her care.

Abusive head trauma treatment
For more mild cases of abusive head trauma, your child may need medicine, a hospital stay, and at-home observation. In the most severe cases, treatment may begin in the hospital emergency room or operating room with life-saving steps. These steps might include inserting a breathing tube down your child’s throat or doing surgery to stop bleeding or reduce swelling in your child’s brain.

Living with abusive head trauma
Depending on how severe the trauma is, your child may have to be monitored over time. Survivors of abusive head trauma may suffer long-term health problems, such as:

permanent hearing loss
visual impairment (including blindness)
seizures
developmental, speech, and academic delays
severe intellectual disability
memory and attention challenges
cerebral palsy
Questions to ask your doctor
How can I tell whether my baby’s symptoms are caused by abusive head trauma or a normal illness?
Can brain damage be reversed?
What are some local resources for helping parents cope?
Resources
The National Center on Shaken Baby Syndrome

Abdominal Aortic Aneurysm (AAA)

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What is an abdominal aortic aneurysm (AAA)?
The main blood vessel in your body is the aorta. It is a long blood vessel that reaches from your chest into your abdomen. It carries blood from your heart to the rest of your body. The part of the aorta in your abdomen is called the abdominal aorta. It supplies blood to your stomach, pelvis, and legs.

Sometimes an area of a blood vessel wall will get weak. It can start to swell like a balloon and become abnormally large. This is called an aneurysm. If an aneurysm forms in your abdominal aorta and grows too large, your aorta could tear or burst.

Symptoms of an AAA
As the aneurysm develops, there are usually no symptoms. This can go on slowly for years. Often, AAAs don’t cause symptoms unless they leak, tear, or rupture. If this happens, you may experience:

sudden pain in your abdomen, groin, back, legs, or buttocks
nausea and vomiting
abnormal stiffness in your abdominal muscles
problems with urination or bowel movements
clammy, sweaty skin.
If you have these symptoms, call your doctor. Internal bleeding from a ruptured AAA can put you into shock. Shock can be fatal if not treated right away.

What causes an AAA?
Doctors don’t know exactly what causes an AAA. Weaker aorta walls increase your chance of developing an aneurysm. There are many conditions that can weaken the walls of the aorta. These include aging, smoking, and high blood pressure. If any of the following factors apply to you, you are at higher risk of having an AAA.

Being male. Men are more likely than women to develop an AAA.
Age. AAAs are more common in people age 65 or older.
Personal history. If you have had aneurysms of any kind, you are at greater risk of an AAA.
Smoking. Smoking damages and weakens the aorta walls.
High blood pressure. Having high blood pressure weakens the walls of your aorta.
Family history. If any family members have had AAAs, you are at higher risk. You also could get an AAA before you are 65.
Talk to your doctor if you have a higher risk for an AAA, or if you have any of the symptoms.

How is an AAA diagnosed?
Doctors commonly find AAAs by chance during a routine exam. They also find them when doing tests for other issues, including unrelated pain in your abdomen. Doctors recommend an AAA screening for men age 65 to 75 who have ever smoked.

If your doctor finds or thinks you have an AAA, he or she may order tests. Common tests include:

Ultrasound or echocardiogram – These use sound waves to create pictures of the inside of your body.

Computed tomography (CT) scan – The doctor uses X-rays to take pictures of your organs. Dye is injected into your veins so he or she can see them clearly.

Magnetic resonance imaging (MRI) – This test uses magnets and radio waves to create pictures of your organs.

Angiography – This test uses dye and X-rays to look at the inside of your arteries. This can help your doctor see how much damage or blockage there is in your blood vessels.

If your doctor finds or thinks you might have an AAA, he or she might refer to you a specialist for treatment.

Can an AAA be prevented or avoided?
You can’t always prevent an AAA from forming. But there are steps you can take to lower your risk. These include:

Don’t smoke, or try to quit, if you are a smoker.
Eat a healthy diet.
Be physically active.
Manage conditions such as high blood pressure that can be controlled with medicine.
AAA treatment
Treatment for an AAA depends on its size. If your aneurysm is small, it might not need to be treated. Your doctor may just monitor it using routine testing. If your doctor is concerned about it, he or she may prescribe medicine. These can be used to lower blood pressure or relax blood vessels. This can help prevent the AAA from rupturing.

If your aneurysm is large or is growing quickly, you will most likely need surgery. There are 2 main kinds of surgery to remove or repair AAAs:

Open abdominal surgery – This is the most common form of surgery for an AAA. The surgeon will make an incision (cut) in your abdomen. He or she will remove the aneurysm. The removed section of the aorta is replaced with a graft made of man-made material.

Endovascular repair – In this procedure, the doctor inserts a graft into the aorta to strengthen it. He or she will insert a catheter (tube) into your artery through your leg. The graft will be threaded through the aneurysm and expanded. This will reinforce the weak section of the aorta and allow blood to flow normally. This helps keep the AAA from rupturing.

The type of surgery you have depends on many factors. Talk to your doctor about which kind is best for you.

Living with an AAA
If you have an AAA, it is important to get regular medical care. Listen to your doctor and follow your treatment plan. He or she may advise you to avoid lifting heavy objects. Try to avoid highly emotional situations or crises that could raise your blood pressure. Take care of yourself to prevent the aneurysm from bursting or tearing.

Questions to ask your doctor
If I’ve had one AAA, am I likely to experience another?
Are there any lifestyle changes I can make to avoid getting another AAA?
Is watchful waiting safe? Is there a chance the AAA could burst?
Are there any side effects from an AAA that I should be watching for?
What should I do if my pain gets worse?
Should I visit a specialist?
Are there any websites you recommend where I can learn more about AAAs?
Resources
National Heart, Lung, and Blood Institute, Aneurysm

U.S. National Library of Medicine, Aortic Aneurysm