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Friday, May 16, 2014

Disc Herniation and Other Disc Injuries

By: Robert Shepherd MS, Certified Medical Illustrator, President & CEO, MediVisuals Inc.

The term “degenerated disc” is generally used to describe a disc in the early degenerative process. It is the beginning of a progressive break down of the disc. This condition can be initiated or accelerated by a traumatic event.

A disc bulge is a more advanced collapse of the disc to the point that the disc expands beyond its normal contour. It may or may not impinge on the neural structures within the spinal canal or neural foramina. Similarly, a disc bulge can be the immediate or delayed result of a traumatic event, or a traumatic event may exacerbate a preexisting, stable disc bulge.

A subligamentous herniation is one in which nucleus pulposus has extended through the annulus fibrosus, but has not gone through the posterior longitudinal ligament.

The term “herniation” is generally used when the nucleus has completely extruded through the annulus fibrosus and posterior longitudinal ligament

However, it does not matter what the disc pathology is labeled, if it impinges upon, or irritates the neural components, it is a significant injury that will likely require some type of invasive procedure to correct. 

The disc can either be injured by an immediate tear of the annulus fibrosus and extrusion of the nucleus pulposus during a traumatic event, or they can be the result of a much more gradual process. In order to understand the gradual breakdown of the disc, one must first understand a little of the physiology of a disc. The inner disc relies on exchange of fluid, nutrients and oxygen through the end plate of the adjacent vertebral bodies.

During a traumatic event, the endplate may become injured resulting in interference with that exchange.
As a result of the inability of the disc to obtain the fluid, nutrients, and oxygen it needs, the disc gradually begins to break down - becoming a degenerated disc, followed by a bulging disc, and eventually to a herniated disc. The amount of time involved with the process of the disc breakdown is related to the severity of the initial disc injury.

Therefore, if a disc injury is not evident until weeks or months after a traumatic event, it does not mean the injury was not a direct result of the traumatic event.

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Wednesday, May 14, 2014

Breaking Down Traumatic Arthritis

 By: Robert Shepherd MS, Certified Medical Illustrator, President & CEO, MediVisuals Inc.

Fractures can result in several long term or permanent complications that can necessitate additional surgical procedures. One of the most common long term debilitating complications is traumatic arthritis.Traumatic arthritis can affect almost any moveable joint in the body. To explain traumatic arthritis more in depth, we will be focusing on the tibiotalar (ankle) joint, as shown in the illustration below.

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As like most moveable joints, the tibiotalar joint consists of smooth articular bone covered by thick, shock-absorbing articular cartilage. 

During trauma, the joint surfaces can be driven together resulting in injuries to the cartilage and microfractures of the articular surface (even without obvious intrarticular fracture). 

The bone and cartilage then undergo changes that result in the progressive breakdown of the joint. As the process advances, the joint becomes painful. In most cases, the only treatment options are joint replacement or fusion.

The acromioclavicular (AC) joint also frequently falls victim to traumatic arthritis. As the AC joint enlarges (hypertrophy) it impinges on the rotator cuff, which is referred to as subacromial impingement. This can cause irritation or tearing of the rotator cuff and is most often treated by AC joint resection and subacromial decompression.