RESUMO
This case series presents four cases of scapholunate interosseous ligament (SLIL) injury. We discuss the process of early recognition and highlight difficulties encountered in current diagnostic and conservative management strategies. The cases profile interdisciplinary management of four scapholunate (SL) injuries that have different clinical presentations and injury mechanisms. Three sport-related SL injuries were managed conservatively by a sport specialist chiropractor and one sport-related case was self-managed. Management strategies included early wrist immobilization, soft tissue manual therapy, low-level laser therapy, proprioceptive and strengthening exercises, and early orthopedic referral. This case series highlights: (1) the spectrum of SL injuries (2) the importance of early specialty referral, (3) the paucity of literature with respect to conservative management of these injuries and (4) the role of manual therapy and rehabilitation professionals as part of the healthcare team in detecting and helping manage these wrist injuries.
Cette série de cas présente quatre cas de blessures du ligament interosseux scapho-lunaire (LISL). Nous discutons du processus de reconnaissance précoce et soulignons les difficultés rencontrées dans les stratégies actuelles de diagnostic et de gestion conservatrice. Ces cas illustrent la prise en charge interdisciplinaire de quatre lésions du ligament scapho-lunaire (SL) dont les tableaux cliniques et les mécanismes de blessure sont différents. Trois lésions scapho-lunaires liées au sport ont été prises en charge de manière conservatrice par un chiropraticien spécialiste du sport et un cas lié au sport a été auto-soigné. Les stratégies de prise en charge comprenaient une immobilisation précoce du poignet, une thérapie manuelle des tissus mous, une thérapie par laser à faible niveau, des exercices proprioceptifs et de renforcement, et une demande de consultation d'un orthopédiste le plus tôt possible. Cette série de cas met en évidence : (1) le spectre des lésions du ligament scapho-lunaire, (2) l'importance d'une orientation précoce vers un spécialiste, (3) la rareté des documents scientifiques concernant la gestion conservatrice de ces blessures et (4) le rôle des professionnels de la thérapie manuelle et de la réadaptation en tant que membres de l'équipe de soins de santé dans la détection et la gestion de ces blessures du poignet.
RESUMO
PURPOSE: Three cases of acetabular labral tear (ALT) diagnosed with sonography (US) are reported. We aim to show utility for US with the addition of manual hip traction as an adjunctive modality to the current diagnostic imaging of choice, magnetic resonance arthrography (MRA), for diagnosing ALT. METHODS: Three cases of young athletic patients with similar clinical presentations are reported. All received US examination of the hip with attention to the labrum that included a novel long-axis hip traction technique which assisted in diagnosing ALT. RESULTS: In the first and second cases, MRA and orthopedic consult were obtained for confirmation of the diagnosis. Arthroscopy was performed to correct the ALT. The third patient declined an MRA. Conservative management consisted of McKenzie method active care, resulting in return to sport in the third case. CONCLUSION: These three cases demonstrate the clinical and sonographic presentation of ALT. The dynamic long-axis hip traction protocol facilitated the use of US as an adjunctive modality for diagnosing ALT by increasing the visualization of the defect.
