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FROM TENNIS ELBOW TO PREACHER'S KNEE: THE NAME'S THE THING
CHICAGO -- Some injuries are so closely associated with the activities that give rise to them -- from "tennis elbow" to "preacher's knee" and "snowboarder's ankle" -- that their scientific names have been eclipsed by their more common descriptive names, even among medical professionals. Some interesting and unusual eponyms for occupational and sports-related injuries -- and how they are diagnosed -- were presented here today during the 83rd Scientific Assembly and Annual Meeting of the Radiological Society of North America (RSNA).
"Some occupations and activities are so frequently associated with specific musculoskeletal conditions that the injuries are referred to by eponyms rather than by formal clinical or scientific terminology," said Kevin R. Math, M.D., department of radiology, Beth Israel Medical Center, New York. Among the injuries described by Dr. Math:
ï Housemaid's knee is caused by inflammation or infection in the bursae -- small fluid-filled sacs -- around the knee joint. It's brought on by repetitive work done on the hands and knees, such as scrubbing floors. It also affects other people who spend a good deal of time on their knees such as tile and carpet layers, Dr. Math said. The injury usually can be diagnosed without imaging, by the presence of tender, reddened and inflamed tissue on the front of the knee. The condition shows up on x-rays as an area of swelling; magnetic resonance (MR) imaging can provide a more definitive diagnosis.
ï Preacher's knee is similar to housemaid's knee, but it involves a different area of the knee. "The mechanism of injury is identical, but for preacher's knee the pressure is focused below the kneecap," Dr. Math said. "Plumbers get it, too, but the introduction of padded kneelers in churches and kneepads for workers has decreased its prevalence."
ï Jumper's knee is the bane of athletes such as basketball and volleyball players. It's caused by tiny tears in the tendon in the lower part of the kneecap and often doesn't show up on conventional x-rays. It is best diagnosed with ultrasound or MR imaging. "Usually the diagnosis can be made based on clinical symptoms and imaging usually is reserved for high-performance athletes who don't respond to conservative therapy," Dr. Math said. "MR can visualize the tendon and define the extent of the injury. More extensive tears may require surgery; milder tears can be treated conservatively."
ï Snowboarder's ankle is a fracture that occurs when the snowboarder lands from a jump or aerial maneuver with the soles of the feet turned inward. Computed tomography (CT) is the best way to diagnose the injury. "Knowledge of this type of injury is important because if it's misdiagnosed as a simple ankle sprain, it may not heal properly and may lead to arthritis in the ankle joint," Dr. Math said.
ï Lover's fracture (also called Don Juan's fracture), an injury to the heel, occurs when someone falls or jumps from a height. "It's named for the kind of injury that might be sustained by a suitor trying to escape from a window," Dr. Math said. "It can be diagnosed with x-rays, but CT is needed to decide whether surgery is required. In about 20 percent of patients, there also will be compression fractures of the spine."
ï Little League elbow is an injury to the growth plate of the arm bone that is usually seen in pre-adolescent baseball players. "Before the skeleton reaches maturity, the growth plates -- areas of cartilage -- at the end of bones are the weakest parts of the joints, and are most susceptible to injury," Dr. Math said. "When a young baseball pitcher is winding up to throw the ball, tension is created on the lateral side of the elbow -- the side opposite the thumb." Symptoms are swelling and pain, and difficulty extending the arm. Conventional x-rays are often normal and MR imaging may be needed to diagnose the condition. In severe cases, surgery may be needed to treat the injury.
ï Tennis elbow is an overuse injury that occurs on the medial side of the elbow joint -- the same side of the arm as the thumb. It also can be caused by the prolonged use of a screwdriver, Dr. Math said. "This injury involves the tendons that extend the wrist. Usually imaging is not required and the diagnosis can be made by clinical symptoms."
ï Gymnast's wrist is a stress or overuse injury caused by chronic, repetitive weight-bearing applied to the extended wrist of young athletes whose bones are still growing. "In extreme cases, it can lead to a premature fusion of the growth plate in the radius -- a bone in the forearm -- hindering future growth of the bone," Dr. Math said.
X-rays can diagnose severe cases but MR is needed to see early signs of the condition.
ï Gamekeeper's thumb is a name coined in 1955 to describe an injury in the ligaments of the thumb sustained by gamekeepers when they kill wounded rabbits by grasping and twisting the animal's neck with the base of the thumb and index finger. It's also called Skier's Thumb. In most cases it heals itself, but sometimes surgery is needed. MR imaging enables a definitive diagnosis.
Co-authors of a paper on the topic presented by Dr. Math during the RSNA meeting are M. Weinstein, M.D.; D. DeCorato, M.D.; F. Cushner, M.D.; and B. Ghelman, M.D.
The RSNA is an association of 30,000 radiologists and physicists in medicine dedicated to education and research in the science of radiology. The Society's headquarters are located at 2021 Spring Road, Suite 600, Oak Brook, Illinois 60523-1860.
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Copies of 1997 RSNA news releases are available online at http://www.pcipr.com/rsna beginning Monday, Dec. 1.
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