Severe Hematoma on Buttocks After a Fall

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RP is an elderly physician who I met in the most unlikely of circumstances. He was performing a life insurance physical on me and I noticed he had a cane. We struck up a conversation about his severe buttock pain after a fall.

The next thing you know I had him on my exam table and our roles reversed — the patient was examining the doctor. His story might be helpful to other patients with buttock pain after falling, as his case was one of a bright, shiny object which looked like the cause of his pain and a more subtle problem which turned out to be the cause.

RP’s Story

RP is an ex-military doctor who now makes a living in retirement performing life insurance physicals. He looks nothing like an ex-military guy, instead he has an earring and wears wild Hawaiian shirts. Perhaps he’s making up for all of those years in fatigues.

He fell a few months before I first met him and as a result he had severe pain in his right buttocks. After a stay in the ER where x-rays showed no fractures, his family doctor followed the religion of “take NSAID drugs and stay off it.”

However, after several visits to his family doctor produced no results other than a refusal to perform an MRI, he was frustrated. In addition, during this time he went from an active elderly man to becoming dependent on a cane to hobble around.

Learn about Regenexx procedures for hip conditions.

Diagnosing the Severe Buttocks Pain

When I first examined him, I immediately noticed a large lump in the gluteal muscles of his buttocks. A quick in office ultrasound revealed a hematoma the size of a small egg from the fall. This seemed to be tender so I attempted to remove the blood under ultrasound guidance. That usually doesn’t work because the blood has long since turned to sludge that won’t budge and it didn’t work here either.

Treating a Hematoma in the Buttocks

However, while this was the “low hanging fruit,” he also had evidence on exam of sciatica (pinched S1 nerve in his back). A low back MRI revealed a large herniated disc (his back hurt some, but most of his attention was on the butt pain). He underwent the Regenexx-PL disc procedure for his irritated low back nerve and I saw him today, without his cane! He now no longer limps and is grateful.

What’s interesting about RP is it illustrates what happens to a lot of patients with buttocks pain after a fall. They see their family doctors who prescribe anti-inflammatory drugs and maybe some PT, but when the pain doesn’t get better, there’s often a reluctance to really dig deeper. Some of these patients have injured muscles, tendons, nerves, or ligaments-but all too often they get blown off. To figure out the cause and treat the problem often takes just someone who is willing to look for the problem.

The upshot? RP’s “pain in the butt” was quite real. While he had a massive collection of blood from his fall that nobody found until an ultrasound revealed the issue, that turned out to be “window dressing”. The real cause of his severe butt pain and inability to walk was a pinched nerve in his low back. A quick injection of the growth factors from his own blood platelets quickly helped him recover!

Join us for a free Regenexx Spine Webinar Chris Centeno, MD is a specialist in regenerative medicine and the new field of Interventional Orthopedics. Centeno pioneered orthopedic stem cell procedures in 2005 and is responsible for a large amount of the published research on stem cell use for orthopedic applications. View Profile

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NOTE: This blog post provides general information to help the reader better understand regenerative medicine, musculoskeletal health, and related subjects. All content provided in this blog, website, or any linked materials, including text, graphics, images, patient profiles, outcomes, and information, are not intended and should not be considered or used as a substitute for medical advice, diagnosis, or treatment. Please always consult with a professional and certified healthcare provider to discuss if a treatment is right for you.

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Common Slip and Fall Injury Symptoms

Common Slip and Fall Injury Symptoms Date: Mar 29, 2019

Slip and fall accidents are among the most common accidents in the United States. Yet people often don’t report them if they think the accident was their fault because they were clumsy or not paying attention or they didn’t really hurt themselves.
However, another party is often liable for the conditions that cause a slip and fall accident. If you slip and fall and don’t report it, the hazard that caused the accident remains, and other people may fall victim to it. Also, never assume you didn’t really hurt yourself in a slip and fall. Minor accidents can have lingering consequences. Often the injuries sustained in a slip and fall accident don’t manifest themselves for hours or days after the fall. It’s important to seek medical attention as soon as possible after you slip and fall.

Slip and Fall Injury Statistics

The statistics can be quite alarming. The Mayo Clinic reports that over 10 million people a year are injured in slip and fall accidents. The National Center for Injury Prevention and Control, which works under the Center for Disease Control (CDC), reports that slips and falls are the leading cause of nonfatal injuries for all age groups except 10 to 24, and for that group is the second leading cause of nonfatal injuries.

Meanwhile, the CDC also reports that one in four adults over the age of 65 will suffer a fall, but only half of them will be reported. Every year, more than 3 million senior citizens are treated for falls in emergency rooms across the United States. Additionally, 95 percent of hip fractures are caused by slips and falls.
The National Safety Council says these accidents are the number one danger for senior citizens, while the National Floor Safety Institute (NFSI) reports that they are one of the top causes of injury-related fatalities for those over the age of 65 and are the leading cause for those over 85. They are also a leading cause of unintentional injuries.
Here are a few more statistics from the NSFI about slip and fall accidents:

• More women will experience slip and fall accidents than men, but more men will die from slip and fall accidents than women.
• Fractures are the most common kind of injury in a slip and fall accident. About 5 percent of all people who slip and fall break a bone or suffer a fracture.
• Slip and fall accidents are the most reported kind of workers’ compensation claim, especially for those aged 55 years or older. They are also responsible for the most missed days on the job.
• Slip and fall accidents are responsible for almost 90 percent of fractures suffered by people over the age of 65 and are one of the leading causes of spinal cord injuries and brain traumas.
• Slip and fall accidents are responsible for 40 percent of all admissions to nursing homes.

As you can see, slip and fall accidents need to be taken seriously, especially by older Americans.

Types of Injuries and Symptoms Suffered in Slip and Falls

If you slip and fall, you can injure any one of several parts of your body. And some of these injuries will not be detectable immediately. What seems like a minor sprain or a sore leg can be a torn ligament or even a fracture. After you suffer a slip and fall, it’s critical you seek medical attention immediately.
Some of the more common kinds of injuries suffered in slips and falls include:

1. Bruises and Cuts

The bruises and cuts you suffered when you slip and fall can appear severe but may be less serious than other injuries listed below. It’s not unusual to suffer bruises on your arms, legs, head or hips. However, these bruises aren’t always minor. Frequently, bruising and cuts hide more serious injuries below the skin. It’s always worth getting them checked out. It’s also a good idea to take pictures of your injuries. This documentation will help enormously if you decide to sue.

2. Stretched Tendons, Torn Ligaments Or Pulled Muscles

Often when we slip and fall, our muscles tense to protect us. We may twist our bodies or stretch out our hands to catch ourselves. Unfortunately, our attempts to protect ourselves may actually end up causing some damages. Twisting may lead to pulled muscles, torn ligaments or stretched tendons. The same is true when we reach out our hands to catch ourselves.

While these injuries can seem minor and perhaps not painful at first, they can ultimately be quite debilitating. A badly pulled muscle may require weeks of rest to recover. Stretched tendons and torn ligaments also have long recovery periods because they don’t tend to receive a lot of blood flow and thus heal slowly. Don’t assume that just because you have one of these injuries, you’ll be fine.

3. Sprained or Broken Wrists or Ankles

As mentioned above, when we fall, our impulse is to throw out our hands to try to protect ourselves or prevent ourselves from falling too hard. Or we try to catch ourselves from falling. This often puts far too much pressure on our wrists or ankles. In these cases, a sprained wrist or ankle is a common result, but it’s also not unusual for a wrist or ankle to break.

4. Broken Arms or Legs

When you break an arm or a leg, it’s also possible for the tissue surrounding the break to be damaged. This may result in the need for long-term therapy to deal with chronic pain and dysfunctions with the neuromuscular system.

Sometimes people think that if they can move their arm or joint, there is no break. However, you always need an x-ray to determine whether you’ve broken a bone. If you had a bad slip and fall, and you feel intense pain in a joint or in a bone, go to an emergency room immediately.

5. Fractured Collarbones

If you fall forward and your shoulder strikes the ground first, you could break your collarbone. While collarbones heal relatively quickly, it can be an incredibly painful and inconvenient injury.

6. Dislocated Shoulder

When you fall and hit the shoulder first, even if you don’t fracture your clavicle, you may dislocate your shoulder. While a dislocated shoulder is easier to treat than a broken collarbone, it still can be excruciating and result in weeks of rest and rehabilitation.

7. Damaged Knees

When you fall forward, your knees often strike the ground first. Depending upon how hard you fall and the type of surface on which you fall, you may injure one of the ligaments in your knee or, even worse, dislocate or fracture your patella. Knee damage can also result in the need for reconstructive surgery.

8. Bruised or Fractured Tailbone

If you have ever fallen backward onto your buttocks, you know how painful it can be. If the force of the fall is great enough, however, you can bruise or even fracture your tailbone. While this may seem like an almost humorous injury, it is far from funny for the person who suffers a bruised or a broken tailbone. It is difficult to sit, stand, use the bathroom, even sleep. In many cases, it is necessary to carry a soft pillow with you everywhere you go, whether to a restaurant or to your workplace to sit, comfortably. A bruised or fractured tailbone is no laughing matter.

9. Hip Fractures

This is the most common form of injury for those aged 65 years and older. The CDC reports that nearly all hip fractures are the result of slips and falls. Almost all these injuries will result in hospitalization or the need for seniors to live in a nursing home because of the need for constant care. Hip fractures can also be the most deadly form of injury for those aged 65 and older.

10. Injured Spinal Cords

An injured spinal cord is one of the most severe injuries you can suffer during a slip and fall. If you fall onto your back, the impact of this force is usually borne by your spine. The result can be a chipped vertebra, a slipped disc, nerve damage or even permanent damage to your spinal cord which can result in total or partial paralysis. If you land hard on your back when you slip and fall, even if it does not seem serious, it’s always a good idea to seek medical attention.

Spinal cord injuries require expensive treatment, frequently resulting in bills of over $1 million or more in the first year. In most cases, the higher up your spinal cord injury, the more damage will result.

11. Head Injuries

Many times when people slip and fall and hit their heads, they may only feel a mild headache at first. But traumatic brain injury (TBI) may not appear for hours or sometimes even a day or two. Critical symptoms to look for include:

• Loss of balance
• Dizziness
• Nausea after falling
• Intense or sudden headaches that grow worse
• Listlessness

12. Soft Tissue Damage

This can often be the most difficult kind of damage to diagnose successfully. They can also be among the most painful injuries. These injuries are not usually visible, but your body is sore after a fall. They may not manifest themselves until days or weeks after you suffer an injury. Untreated, these injuries can lead to chronic pain and often are a leading cause of other injuries as you compensate for the pain by overusing then damaging another part of your body.

Any of these slip and fall injuries can result in expensive medical bills, loss of income and long-term recovery. If you experience a slip and fall injury, contact an experienced personal injury attorney as soon as possible.

Common Causes of Slip and Fall Injuries

Slip and fall injuries can be caused by several different hazards:

1. Lighting

This is particularly a concern if you live in an apartment with poor lighting and dim hallways and stairwells. If you have repeatedly told your landlord or property manager that the hallways and stairwells are dark and dangerous, and they do not fix them before you or someone else slips and falls and hurts themselves, they can be sued for their negligence.

2. Weather

The Maine Department of Labor reported that the average claim for snow or ice-related falls was $33,000. A workers’ comp claim for the same injury resulted in a $48,000 claim. Most states don’t require property owners to remove snow or ice that builds up outside their properties. If conditions on the property, however, lead to an unnatural accumulation of snow or ice, the property owner may be held responsible. Also, if they decide to remove snow and ice, they need to do so responsibly.

3. Design Standards

The design of the building may lead to slips or falls, especially if there are sudden changes in flooring levels which can be made worse by poor lighting or narrow stairs.

4. Debris

This can be a particular problem at a construction or a worksite. Loose debris in a neighbor’s yard or in their homes can also be a hazard.

5. Torn Carpeting

Torn carpeting can be a problem in a neighbor’s home, in one’s workplace, at a store or at a worksite. Again, torn carpeting slip and fall accidents are more likely to happen in poorly lit locations such as hallways or stairwells or in darker areas of a home or a business.

6. Wet or Slippery Floors</strong

It’s not unusual to hear of slip and fall accidents in grocery stores or in the lobbies of business offices. Most property owners do what they can to notify people if floors are wet but not always. If someone has notified the property owner that their floor is slippery and potentially dangerous, and they don’t do anything to fix the situation, their negligence could lead to a lawsuit.

7. Cracked or Broken Public Sidewalks

Municipalities are responsible for public sidewalks and maintaining them in reasonable condition. If you suffer a slip or fall accident because you trip on a crack in a public sidewalk, you need to act quickly. Local, state and federal government entities are often protected by the law and are granted immunity in some cases. There is also a much shorter window for filing a claim against any form of government entity if you are injured in a slip and fall accident on government property. If this happens, contact a knowledgeable personal injury lawyer as soon as possible so you do not miss your chance to file a claim if necessary.

If You Had a Slip and Fall Accident, Contact the Law Offices of Argionis and Associates

If you or a member of your family were injured because of a slip and fall accident on someone else’s property, you may be entitled to compensation for these injuries. Slip and fall injuries can sometimes be difficult to prove, but working with an experienced lawyer can help you win your case.

The team of Chicago personal injury attorneys at Argionis and Associates have experience and knowledge in dealing with slip and fall injuries, and we can help you recover the damages to which you are entitled. As one of the leading law practices in the Chicago area, we have recovered millions of dollars in damages and awards for our clients.

If you have suffered a slip and fall injury and would like to talk to a Chicago slip and fall accident lawyer, you can call us at 312-626-6294 or visit our contact us page to schedule a free consultation. You can leave us your contact details and some information or questions about your accident. A member of our team will get back to you as soon as possible.

Falling On Your Bum Can Be A Pain In The Neck. Literally.

A patient of mine–let’s call him “Doug”–was walking his dog a while ago when an appetizing squirrel suddenly ran in front of them and his dog decided it was dinner time. The dog pulled hard on the leash, causing Doug to lose balance on a patch of ice and fall quite harshly on his bum.

He was very sore and couldn’t sit easily for a while, but Doug didn’t think much of it. One morning weeks after the fall though, he woke up and couldn’t move is neck. This brought him to the clinic.

Now for a moment, let’s think of Doug as a play-dough man: if he hit the ground, yes: the point of impact would be flattened, but the WHOLE, entire rest of the dough body would also be affected and completely change shape. The shock wave would create a change in the structure, even in parts far from the point of impact, along a force vector.

This is similar to how impacts work in the human body. The only difference is that the vector doesn’t follow the anatomy and can create what seems to be a random series of restrictions of mobility all through the body that only the expert hands of an Osteopathic Manual Therapist can look for.

The other difference with our play-dough man is that as we live, as we fall when we go skiing, as we slip on the ice, we accumulate these injuries all over our body that change the way traumas affect us in little ways.

One other interesting element is that after a trauma, symptoms can occur immediately or later in time, and even in body parts other than the originally painful ones. In the case of Doug, his neck “decompensated” long after his bum, but falling on your bum will create a little bit of an ascending whiplash phenomenon.

We pursued the treatment working on all the bones, muscles, ligaments, connective tissues, viscera, and nerves affected by the shockwave that made it all the way to Doug’s skull. The treatment helped him to be pain-free again, though he maintains that his dog is still a pain in the neck!

If you fall or suffer a trauma of some kind, it’s a good idea to see your Osteopathic Manual Therapist soon afterward. We even keep emergency appointment slots available for our patients, for when you would really benefit from being treated ASAP after something like this! You can click here to book an appointment with us.

Back Pain from a Slip-and-Fall Accident

A sudden slip-and-fall could instantly cause you severe back pain. A fall can prevent you from performing your daily responsibilities like working, driving, or caring for your family.

There are two categories of slip-and-falls, depending on what triggered the slip and the direction of the fall. A slip-and-fall results from a slippery surface and the victim generally falls backward. When someone trips on uneven pavement or an item in the path, they usually fall forward.

The type of fall you experience affects the way you hurt your back. If you have suffered either type of fall, and are suffering from back pain as a result, contact our office at (855) 77-SPINE immediately for an examination and diagnosis.

Slip-and-Fall Accidents

Many times, people injured in slip-and falls do not realize they are hurt until a day or more after the incident. Pain may arise from the fall itself, or the impact may have aggravated a pre-existing condition. Back pain that results from a slip-and-fall accident may be serious and should not be ignored. Some common slip-and-fall or trip and fall injuries include:

Cervical spine injuries

These injuries involve the neck. A bone may dislocate, potentially damaging the spinal cord. This unstable situation generally requires surgical correction.

Fracture

A broken bone in the spine causes intense pain. In backward falls, the tailbone is often involved. Fractures range in severity, from simple fractures to those where the bone has burst.

Herniated discs

Discs herniate when their soft centers, the nucleus pulposus, push through their harder shells, irritating neighboring nerves. Pain occurs in the affected area, which in falls may include the neck, upper or lower back, legs or buttocks. When the herniation compresses the nerves, tingling, weakness and numbness result. Herniated discs are also known as slipped discs.

Soft tissue injuries

Falls often cause strained muscles and/or tendons or sprained ligaments. Besides pain, symptoms include swelling and loss of flexibility. The most serious type of sprain after a fall involves the neck. These injuries benefit from non-surgical treatments, including physical therapy.

Whiplash

Although whiplash occurs primarily in motor vehicle accidents, a bad fall can cause the same strong rocking back and forth of the head. Unlike whiplash from a car accident, whiplash from a fall usually results in pain in the lower back or legs.

For minor back injuries, bed rest and anti-inflammatory medication will likely take care of the problem. For more serious injuries, treatment runs from physiotherapy to surgery. Some injuries from slip-and-fall accidents heal easily, while others may leave a patient permanently disabled.

Contact a Surgeon for Slip-and-Fall Accidents

An accurate diagnosis is the first step toward treatment and healing. After hearing a detailed account of what happened during the accident, the doctor can begin identifying the pain source. Risk factors, such as osteoporosis, are discussed. Typically, the doctor will perform diagnostic imaging to definitively identify the source of patient injuries and grade the injury level.

After diagnosis, they will devise a treatment and therapy plan, as well as offer pain management. If the accident results in litigation, they provide full documentation for legal and insurance purposes.

If you or a loved one suffers back pain because of a slip-and-fall injury, contact our office at (855) 77-SPINE for an examination and a full explanation of treatment options.

Buttock Pain – Causes, Injuries, Treatment and Rehabilitation

Often buttock pain is related to or as a result of an injury elsewhere such as the lower back. Pain usually develops gradually over time, but can also occur suddenly in the case of muscle strains or sciatic nerve-related injuries.

Sacroiliac joint pain

The Sacroiliac joint is located at the bottom and just to the side of the back.

• The joint can become inflamed and painful.
• Pain may be a sudden sharp pain.
• Or maybe more of an ache in the lower back which radiates into the buttocks.

Sacroiliac joint pain may have a number of causes including traumatic impact, poor biomechanics, inflammatory disease, or pregnancy.

More on Sacroiliac joint pain

Piriformis syndrome

Piriformis syndrome causes pain in the buttock which may radiate down the leg. It is due to the sciatic nerve being impinged by a tight piriformis muscle, deep in the buttocks.

• Symptoms include pain in the buttocks.
• Pain may radiate down into the back of the thigh and even into the calf muscles.

More on Piriformis syndrome

Hamstring tendonitis

Hamstring tendinitis is inflammation or degeneration of one of the hamstring tendons at the point it attaches to the pelvis.

• It may follow a tear of the hamstring tendon which hasn’t properly healed or simply develop through overuse.
• Pain may come on gradually, especially after activity.
• Stretching the hamstrings is likely to be painful. In particularly chronic cases the sciatic nerve becomes irritated causing sciatic pain.

More on Hamstring origin tendinopathy

Ischiogluteal bursitis

Ischiogluteal bursitis is inflammation of the bursa that lies between the ischial tuberosity and the tendon of a hamstring muscle. A bursa helps movement between the tendon and the bone.

• The bursa can become painful and inflamed with symptoms almost identical to Hamstring tendonitis.
• Pain is located at the top of the back of your thigh, just below the crease of the buttock.
• Stretching the hamstring muscles may be painful.
• It can occur with a hamstring strain or tendon injury.

More on Ischiogluteal bursitis

Prolapsed disc (slipped disc)

A herniated disc is sometimes also known as a slipped disc or prolapsed disc. It can occur anywhere in the spine although is most common in the lower back. Symptoms include:

• Back pain.
• Leg pain.
• Neural (nerve) related symptoms.
• Bowel and bladder problems.

Treatment may involve rest and exercises or surgery may be required in some cases.

More on Prolapsed disc

Hamstring/Pelvic avulsion fracture

A pelvic avulsion fracture is where the tendon comes away from the bone, often taking a piece of bone with it. This most commonly occurs at the ischial tuberosity where the hamstrings attach.

Symptoms include:

• Sudden pain, usually during a powerful, explosive movement.
• Pain at the back of the pelvis in the crease of your buttock.
• You will feel weakness and pain when doing certain movements such as sprinting, squatting, or jumping.
• Bruising and swelling are likely.

More on Pelvic avulsion fracture

Myofascial pain

Myofascial pain or trigger points in the Gluteus medius and/or Piriformis muscles can cause pain in the buttock area.

• A trigger point is a tiny localized knot in the muscle.
• It will cause pain in the buttock or lower back which may spread to other areas.
• Movement around the hip will be difficult, but this can be helped by stretching and massage.

More on Myofascial pain

Referred buttock pain (from the Lower back)

Pain in the buttocks may be referred from problems in the lower back, even if there is no obvious low back pain present. Many problems could cause this to happen including:

• Prolapsed or ‘Slipped’ discs
• Nerve impingement from the joints in the spine.
• Symptoms include a diffuse or deep aching in the buttock which can vary from mild to severe.
• The slump test is used to identify if the sciatic nerve causing buttock pain.

More on Sciatica

More on Prolapsed disc

Contusions/bruising

A contusion of the buttocks is bleeding in the muscles caused by a direct impact or trauma. This can be from a fall, or being hit in the area by a hard blunt object such as a ball or even an opponent. Symptoms include:

• Pain in the buttock at the time of impact.
• Obvious tenderness when pressing into the muscles or sitting down.
• Bruising may appear and pain and stiffness may be felt when stretching and contracting the buttock muscles during exercise.

Treatment involves rest and applying the PRICE principles.

• Apply ice or cold therapy products regularly for 15 minutes to ease the pain, bleeding, and swelling.
• Once comfortable to do so, start gently stretching the glute muscles.
• Sports massage can help to relax the muscles and disperse waste products, but should not be performed within 72 hours of injury due to possibly increasing blood flow.

Compartment syndrome

Chronic compartment syndrome occurs when a muscle swells up too big for the sheath that surrounds it.

• Symptoms consist of pain in the muscle, especially during exercise when the muscles expand due to blood flow.
• This is very rare but may happen in muscles at the back of the thigh and buttock, particularly following a muscle strain or previous injury.

Stress fracture of the sacrum

Stress fractures of the sacrum are rare and most likely to affect female long-distance runners. Symptoms include:

• Vague low back or buttock pain on one side, which is made worse with weight-bearing activities such as running.
• A specific tender point may be felt on the bone itself.

Treatment involves rest or non-weight bearing exercise until paid goes, usually a couple of weeks. Then a gradual return to training is important rather than going straight back into full training.

Be aware of:

There are a number of conditions which although rare may be overlooked when diagnosing buttock pain. These include:

• Spondyloarthropathies.
• Tumors.
• Infections of bone and joint.

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case report of a rare “near miss” event

Patient Saf Surg. 2008; 2: 27.

,¹,²,³,¹,¹ and ¹

Qi Zhang

¹Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

Huaijun Liu

²Department of Radiology, 2ed Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

Wade R Smith

³Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA

Jinshe Pan

¹Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

Wei Chen

¹Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

Yingze Zhang

¹Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

¹Department of Orthopaedics, 3rd Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

²Department of Radiology, 2ed Hospital, Hebei Medical University, Shijiazhuang, Hebei 050051, PR China

³Department of Orthopaedics, Denver Health Medical Center, University of Colorado School of Medicine, Denver, CO 80204, USA

Corresponding author.

Received 2008 Oct 6; Accepted 2008 Oct 29.

Copyright © 2008 Zhang et al; licensee BioMed Central Ltd.

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

This article has been cited by other articles in PMC.

Abstract

Traumatic injuries of the inferior gluteal artery are rare, the majority of which are aneurysms due to sharp or blunt trauma. We report the rare case of a “near miss” event of a patient with an acute hemorrhagic mass in the right buttock caused by blunt trauma to the inferior gluteal artery without “hard” clinical signs of vascular injury. Despite the unusual presentation, diffuse injury of the inferior gluteal artery branches was diagnosed by ultrasonography and angiography. This article highlights the importance of considering an arterial injury following blunt trauma to the buttock with subsequent pain and swelling. Appreciation of this rare injury pattern is necessary in order to facilitate rapid diagnosis and appropriate treatment.

Background

Gluteal artery injury is uncommon and the injury of the inferior branch (IGA) is more rare than that of the superior branch (SGA)[1]. In the past 30 years, 21 cases of traumatic IGA injury have been reported in the world literature [1-12]. There were 16 cases due to sharp injury, 5 cases due to blunt injury including 4 cases falling onto the buttock. All patients survived the injuries including one case suffering massive blood loss due to delayed diagnosis and treatment[11]. To our knowledge, diffuse breakage of the IGA branches due to falling onto the buttock has not been reported previously. The present case report illustrates the need to consider the diagnosis of arterial injury, and the definitive role of timely angiography in diagnosis and treatment.

Case presentation

A 63-year-old man presented to the emergency department with a painful swelling in the right buttock. Three hours prior, the man was walking along the road, tripped and fell down with his right buttock directly impacting the edge of the road. The patient felt moderate pain in the right buttock after the injury. He continued walking. Thirty minutes later he began to suffer increasing pain and pressure in the right gluteal area, with increased swelling, firmness and warmth. Upon presentation in our Emergency department 3 hours after the initial injury, the patient developed pain and a large mass in the right buttock with tingling radiating down his right leg. The symptoms aggravated with straightening of the right leg. The patient denied fever, chills, dizziness, nausea, vomiting or shortness of breath. The patient had been undergoing antiplatelet therapy with traditional Chinese medicine for 1 year due to a previous cerebral infarction.

On clinical examination, vital signs were normal except blood pressure of 150/110 mm Hg and complaint of 10/10 pain. There was a firm swelling 15 cm × 8 cm in the right gluteal region, from the superior medial gluteal region to the inferior lateral gluteal region (Figure ). The swelling was tender and warm on palpation but not pulsatile. No bruit was appreciated on auscultation. Bilateral symmetrical pedal pulses were present. Neurological examination revealed the stolidity of the sciatic nerve.

The patient lies prone, the right gluteal region is obviously more swollen than the left. The swelling measures about 15 cm × 8 cm from the superior medial to the inferior lateral gluteal region.

The provisional diagnosis was injury of the SGA with hematoma and pressure on the sciatic nerve. X-ray showed no fracture in the right hip or pelvis. An ultrasonographic examination of the mass demonstrated lobulated low densities in the gluteus maximus muscle implying multiple fluid collections in the muscular layers (Figure , panel A). A color-flow doppler ultrasonography was performed without abnormal color signal and evidence of a bleeding stream within the hemorrhagic mass (Figure , panel B). The patient then urgently underwent an arterial catheterization and pelvic angiogram in the interventional radiology suite. Selective angiography was performed. The right common iliac artery, right internal iliac artery and its branches were checked separately. The arteriography showed normal flow of the SGA and diffuse leak of contrast medium in the branches of the right IGA (Figure , panels A, B). The diagnosis was revised to diffuse breakage of the IGA branches. Gelatin sponge was infused into the right IGA and no leak of contrast medium was found in the follow-up angiogram (Figure , panel C). The patient’s postoperative course was uneventful and he was discharged three days after the procedure. He went on to an uneventful recovery with resumption of normal work and activity levels.

An ultrasonographic examination of the mass demonstrated lobulated low level densities in the gluteus maximus muscle (panel A). A color-flow Doppler ultrasonography was performed without abnormal color signal within the hemorrhagic mass (panel B).

The arteriogram reveals a diffuse leakage of contrast medium. Arrows represent ruptured branches of inferior gluteal artery (panels A, B). Arteriography after interventional embolization show no leakage of contrast medium (panel C).

Discussion

The main arteries to the gluteal region are the IGA and SGA. It was once reported that the SGA supplied blood to the superior half of the gluteus maximus and the IGA supplied blood to the inferior half of the muscle[13]. However, Song et al. demonstrated that the dominant IGA pattern showed higher frequency than the dominant SGA pattern among the four gluteal artery patterns and the branches of IGA distributed blood to a larger area than did those of the SGA[14]. The course of the muscular branches of the SGA and the IGA are in the lateral or inferolateral direction. The SGA perforators were found adjacent to the medial two-thirds of a line drawn from posterior inferior iliac spine to greater trochanter of the femur and the IGA perforators were concentrated along a line in the middle third of the gluteal region above the gluteal crease[15]. The course of IGA perforating vessels is more oblique through the substance of gluteus maximus muscle than the course of SGA perforators[14]. When falling down onto the ground, the IGA and its branches are anatomically more at risk than the SGA.

Why minor falls may cause major arterial injury to the IGA is unknown. Likely there are specific patient predilections such as low compliance of arteries or anticoagulation. The patient in this case had suffered from cerebral thrombosis one year previously which maybe imply intrinsic arterial disease. He was also taking an antiplatelet traditional Chinese medicine. These treatments may affect the normal vascular coagulation function. Kuzuya et al. reported a similar case of a patient suffering an IGA bleed without history of trauma whose only risk factor was antiplatelet therapy[16].

The direction and position of the hemorrhagic mass on clinical examinination is not pathognomonic for the specific arterial injury. Diagnostic techniques for arterial lesions include ultrasonography, color-flow doppler ultrasonography, aspiration, computed tomography, magnetic resonance imaging and angiography[4]. In this case, the injury of the IGA could not be distinguished clinically from that of SGA. Ultrasonography was chosen as primary test which demonstrated lobulated low-density signals. These findings led to the more definitive test for arterial bleeding and intervention: angiography. Angiography is the major method to diagnose arterial injury with several benefits including the ability to identify the distal and proximal tributaries of the affected artery and the ability to combine diagnosis and treatment during a single examination[3]. Helical CT or CT-angiogram can also be applied to determine vascular hemorrhage[6]. If considered as high flow hemorrhage, vascular injuries must be treated urgently.

Arterial lesions may be repaired using either surgical or less invasive techniques, such as embolization during angiography. However, in this case, surgery would likely have caused more injury to the IGA branches and have required an extensive open wound. Keeling et al. reported a patient with a traumatic IGA pseudoanuerysm who suffered life-threatening blood loss due to delayed diagnosis and treatment[11]. The patient was intially treated by surgical exploration. Three days later, there was a large, acute bleed from the previous surgical wound site. Despite repeat packing, the blood loss failed to cease following 10 units of packed red blood cells. However, selective angiographic embolization of such cases is an effective and reliable method to stop arterial bleeding, especially in the pelvic region, with minimal invasion and improved outcomes[17]. The advantages of angiography with embolization include a decreased risk of infection, the avoidance of opening the retroperitoneal space and decreased risk of iatrogenic nerve and arterial injuries[1]. In the present case report, embolization was performed urgently to decrease bleeding and avoid permanent damage to the sciatic nerve from the expanding hematoma.

Conclusion

The differential diagnosis of any acutely expanding gluteal mass following blunt trauma should include an arterial injury. Immediate angiography should be considered as a diagnostic and therapeutic tool.

Competing interests

The authors declare that they have no competing interests.

Authors’ contributions

All authors contributed equally to this case report. All authors read and approved the final version of the manuscript.

Consent

Written informed consent was obtained from the patient for publication of this case report.

References

• Agarwal M, Giannoudis PV, Syed AA, et al. Pseudoaneurysm of the inferior gluteal artery following polytrauma: diverse presentation of a dangerous complication: a report of two cases. J Orthop Trauma. 2003;17:70–4. doi: 10.1097/00005131-200301000-00013. [PubMed] [CrossRef] [Google Scholar]
• Rinaldi I, Fitzer PM, Whitley DF, et al. Aneurysm of the inferior gluteal artery causing sciatic pain. J Neurosurg. 1976;44:100–4. [PubMed] [Google Scholar]
• Gilroy D, Saadia R, Hide G, et al. Penetrating injury to the gluteal region. J Trauma. 1992;32:294–7. [PubMed] [Google Scholar]
• Bennett JD, Brown TC, Coates CF, et al. Pseudoaneurysm of the inferior gluteal artery. Can Assoc Radiol J. 1992;43:296–8. [PubMed] [Google Scholar]
• Kaplan JL, Challenor Y. Posttraumatic osseous tunnel formation causing sciatic nerve entrapment. Arch Phys Med Rehabil. 1993;74:552–4. doi: 10.1016/0003-9993(93)90124-S. [PubMed] [CrossRef] [Google Scholar]
• Romano L, Pinto A, De Lutio Di Castelguidone E, et al. Spiral computed tomography in the assessment of vascular lesions of the pelvis due to blunt trauma. Radiol Med. 2000;100:29–32. [PubMed] [Google Scholar]
• Chang J, Zhang Z, Pang J. The breakage of inferior gluteal artery: a case report. Chin J Gen Pract. 2004;13:104. [Google Scholar]
• Aksoy M, Taviloglu K, Yanar H, et al. Percutaneous transcatheter embolization in arterial injuries of the lower limbs. Acta Radiol. 2005;46:471–5. doi: 10.1080/02841850510021670. [PubMed] [CrossRef] [Google Scholar]
• Aydin A, Lee CC, Schultz E, et al. Traumatic inferior gluteal artery pseudoaneurysm: case report and review of literature. Am J Emerg Med. 2007;25:481–3. doi: 10.1016/j.ajem.2006.11.015. [PubMed] [CrossRef] [Google Scholar]
• Unno N, Yamamoto N, Nishiyama M, et al. Inferior gluteal artery aneurysm with arteriovenous fistula. J Vasc Surg. 2007;45:1262. doi: 10.1016/j.jvs.2006.08.088. [PubMed] [CrossRef] [Google Scholar]
• Keeling AN, Naughton PA, Leahy AL, Lee MJ. Traumatic inferior gluteal artery pseudoaneurysm and arteriovenous fistula managed with emergency transcatheter embolization. Cardiovasc Intervent Radiol. 2008;31:S135–9. [PubMed] [Google Scholar]
• Mavili E, Donmez H, Ozcan N, et al. Endovascular treatment of lower limb penetrating arterial traumas. Cardiovasc Intervent Radiol. 2007;30:1124–9. doi: 10.1007/s00270-007-9142-2. [PubMed] [CrossRef] [Google Scholar]
• Cormack CG, Labmerty SG. The arterial anatomy of skin flaps. 2. Churchill Livingstone, Edinburgh; 1994. pp. 218–25. [Google Scholar]
• Song WC, Bae SM, Han SH, et al. Anatomical and radiological study of the superior and inferior gluteal arteries in the gluteus maximus muscle for musculocutaneous flap in Koreans. J Plast Reconstr Aesthet Surg. 2006;59:935–41. doi: 10.1016/j.bjps.2005.11.028. [PubMed] [CrossRef] [Google Scholar]
• Ahmadzadeh R, Bergeron L, Tang M, et al. The superior and inferior gluteal artery perforator flaps. Plast Reconstr Surg. 2007;120:1551–6. [PubMed] [Google Scholar]
• Kuzuya A, Fujimoto K, Iyomasa S, et al. Transluminal coil embolization of an inferior gluteal artery aneurysm by ultrasound-guided direct puncture of the target vessel. Eur J Vasc Endovasc Surg. 2005;30:130–2. doi: 10.1016/j.ejvs.2005.03.006. [PubMed] [CrossRef] [Google Scholar]
• Vauthey JN, Maddern GJ, Balsiger D, et al. Superselective embolization of superior gluteal artery pseudoaneurysms following intramuscular injection: case report. J Trauma. 1991;31:1174–5. [PubMed] [Google Scholar]

Butt Pain | Understanding Pain in the Buttocks & 8 Causes

Bruised buttocks

A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the buttocks are common, given the location on the body.

Rarity: Rare

Top Symptoms: constant butt pain, butt pain, butt pain from an injury, recent buttocks injury, butt bruise

Symptoms that always occur with bruised buttocks: butt pain from an injury, recent buttocks injury, constant butt pain

Urgency: Self-treatment

Coccydynia

The tailbone, called the coccyx, is the most bottom portion of the spine. Coccydynia is pain around the area of the tailbone, which is triggered by pressure on the tailbone such as during sitting on a hard chair. Symptoms get better with standing or walking. Doctors are not completely sure what causes this pain.

Rarity: Uncommon

Top Symptoms: back pain, lower back pain, painful sex, back pain that shoots to the butt, constant butt pain

Symptoms that always occur with coccydynia: constant butt pain

Symptoms that never occur with coccydynia: warm and red tailbone swelling

Urgency: Self-treatment

Tailbone bruise

A bruise is the damage of the blood vessels that return blood to the heart (the capillaries and veins), which causes pooling of the blood. This explains the blue/purple color of most bruises. Bruises of the tailbone are common, given the location on the body.

Rarity: Rare

Top Symptoms: constant butt pain, tailbone pain, tailbone pain from an injury, tailbone injury, butt bruise

Symptoms that always occur with tailbone bruise: tailbone pain from an injury, tailbone injury, constant butt pain

Urgency: Self-treatment

Anal fissure

An anal fissure is a break, or tear, in the mucous membrane lining of the anus. The anus is the opening at the end of the digestive tract where stool leaves the body. A fissure is caused primarily by constipation, which leads to straining to pass large hard stools; trauma caused by insertion of objec..

Piriformis syndrome

The two piriformis muscles, left and right, each run from the base of the pelvis to the top of the thighbone. The two sciatic nerves, left and right, are each attached to the spine and run down between the pelvic bone and the piriformis muscle to the back of each leg.

If the piriformis muscle is damaged through sudden trauma, or through overuse as in sports, the resulting inflammation or spasm of the muscle can trap the sciatic nerve between the pelvic bone and the muscle.

Piriformis syndrome is most often found in women over 30.

Symptoms include pain over one or both sides of the low back, and shooting pain (sciatica) down one or both legs.

Diagnosis is made through physical examination and sometimes imaging such as CT scan or MRI.

Treatment involves rest; over-the-counter, nonsteroidal anti-inflammatory drugs; physical therapy; therapeutic injections; and, rarely, surgery.

The best prevention is a good regimen of stretching before exercise, to help prevent damage to the piriformis.

Rarity: Common

Top Symptoms: pelvis pain, butt pain, pain when passing stools, leg numbness, hip pain

Symptoms that never occur with piriformis syndrome: involuntary defecation, leaking urine

Urgency: Primary care doctor

Sciatica

Sciatica is a general term describing any shooting pain that begins at the spine and travels down the leg.

The most common cause is a herniated or “slipped” disc in the lower spine. This means some of the cushioning material inside the disc has been forced outward, pressing on a nerve root. Bony irregularities..

Anal cancer

Most anal cancers are linked to the human papilloma virus, or HPV. However, many people carry HPV and have no symptoms or illness of any kind.

Most susceptible are men who have sexual contact with men; women who have had cervical cancer; and anyone who has engaged in anal intercourse, had anal warts, or is HIV positive. Smoking and lowered immunity are also factors.

Symptoms include minor anal bleeding and itching, which may be attributed to hemorrhoids; pain or fullness in the anal region; and abnormal anal discharge.

It is important to see a medical provider about these symptoms so that if needed, treatment can begin as soon as possible.

Diagnosis is made through patient history; physical examination; anal swab; and biopsy. CT scan, ultrasound, or endoscopy of the anus may also be done.

Treatment involves some combination of surgery, radiation therapy, and chemotherapy depending on the needs of each individual patient.

Rarity: Rare

Top Symptoms: abdominal pain (stomach ache), stool changes, constipation, diarrhea, pain when passing stools

Urgency: Primary care doctor

The buttocks are very sore after falling on a snowboard – Question to the orthopedist-traumatologist

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“Slippery topic” or how to avoid injuries on ice

“Slippery topic” or how to avoid injury on ice

Winter is amazing
time of the year. A crowd of children, with a cheerful shout flying from a slide, beautiful snowy
caps sparkling in the trees, and snowflakes slowly falling on
covered with a “white blanket” land. All this creates an aura of magic and a feeling
a real fairy tale.

But there is also the opposite
side of the coin. Winter is also ice, which means any wrong movement
on a slippery surface can end in a lot of troubles, ranging from
bruises and concussions, and ending with serious fractures. In this case
winter fairy tale will instantly change to harsh reality and give a lot
unpleasant minutes. Can this be avoided? Undoubtedly. Helpful hints,
provided in this article will help you prepare for a walk down the street in
ice, stand on slippery surfaces and group correctly if
the fall did occur.

Pay attention to the weather

Winter weather like
never changeable. It was snowing recently, now it is covering the road
a blizzard, and literally in a couple of hours the sun comes to replace the bad weather and
creaking frost. But for us pedestrians, the days are especially dangerous when after
a slight thaw, the frost grows stronger and fine snow will sprinkle the earth. In such
ice to appear on the street is extremely dangerous, especially if you do not have
suitable shoes.This is especially true for elderly people who
are no longer so mobile, and for them the fall can turn into disastrous
consequences. It is better for them to postpone their appearance on the street until
the ice will melt or the utility workers will sand the roads.

Find the right footwear

Ice strength
friction between the foot and the ground is minimal, which means you need
think about how to increase the traction of shoes on slippery surfaces.For such cases, shoes with soft rubber soles with
deep tread. In this regard, women are especially at risk who
wear boots with high heels or even stiletto heels. Move in
such shoes are extremely dangerous. You should not be fashionable, risking your own health,
it is better to choose more stable shoes for these days. If the other
there is no alternative, then at least visit a shoe shop, where an experienced master
will put a non-slip prophylaxis (rubberized) sole and put
special heels.

But what if
Do you need to rush to work, but the road is frozen overnight? V
in this case, you can apply some tricks to help maximize
reduce slipping of shoes. The easiest way is to stick to the sole
adhesive plaster. Alternatively, you can rub the sole with sandpaper or
sand. All this will help to at least slightly increase the grip. As for
elderly people, they are advised to purchase special anti-icing
overlays.Such devices do not look very aesthetically pleasing, but they do
moving on an icy road is as safe as possible.

Learning to walk on ice

First of all,
when driving on a slippery road, watch your step. You are sure to
see areas with a ribbed surface or snowy areas on
which can be stepped on without fear of falling. Plus it’s better
move the path where you will be able to hold on to
handrails or tree branches.That is why the safest sites
in the ice are the edges of the sidewalk, where there is less rolled snow. Elderly
people should arm themselves with a cane with an anti-ice tip, which
will bite into ice and not slide on its surface.

Pay
attention to your gait, which should not be imposing on ice
or sweeping. Your stride should be small and frequent. By speeding up the step, you
increase the likelihood of falling. Try to barely lift your legs
from the surface of the earth, moving in sliding movements, as if on
small skis.In this case, the legs should not be tense.

And more. Neither in
Never keep your hands in your pockets when walking on ice. When
falling, you simply do not have time to take them out, which means that you will not be able to keep
balance and protect your head from injury. If you have to climb
or going down stairs, move only holding onto the handrails.
Moreover, pay attention, do not take a step to the next step until
both feet will not stand on the previous one.

Going outside
on ice, be sure to put on a hat, and the denser the better. V
In the event of an unexpected fall, a thick headgear can soften the impact of
ice surface, which means to save your health.

Learning to fall correctly

Now
let’s talk about how to fall properly. Surely when you
slipped, and remain literally a split second before contact with
ground, it’s too late to think about the safest way to lie flat on the ground.Topics
however, some tips can help you minimize getting
injury. First of all, remember, if your feet began to slide on the ice,
and you feel that you will fall, try to sit down. This will displace
center of gravity and, quite possibly, stay on your feet.

Many people
slipping on the ice, throw their hands forward, trying to protect themselves
from hitting the ground. It is clear that such actions, by and large,
instinctive, but if you can control the fall, try not
put outstretched arms in front of you so as not to dislocate the wrists and
tear the tendons.Better to tuck your arm under you and fall, fall on
the side with your forearms forward to help absorb the impact.
Likewise, do not stick out your elbows, leaning back, so as not to get
elbow fracture. Just press your chin to your chest and spread your arms in
sides. This will save your head from injury.

If you fall
from the stairs, do not try to slow down the fall by throwing your hands into
sides. This will hurt you even more. You better group up and
cover your head with your face with your hands.In this way, you will minimize
the risk of traumatic brain injury.

One of the most
severe fractures that elderly people receive after falling
ice is a fracture of the femoral neck. The result of such an injury is
fall on the buttocks in a swing on the naked ice. To avoid this, during
while falling, try to sit down, tuck your legs under you and fall over
on the side.

Features of the fall of men and
women

You will be surprised
but men and women fall in completely different ways.Representatives
the fair sex, as a rule, pulls to fall to the “fifth point” that
threatens to rupture the connection between the coccyx and the sacrum, and
damage to the upper lumbar and lower thoracic vertebrae. And desire
women put out their hand in order to protect themselves during the fall, turns around
fracture of the radius.

Unlike
women, men on the ice often fall backwards, hitting the back of their heads on the ground.
The result of such a fall, as a rule, is a concussion, bruise.
brain, traumatic brain injury or subluxation of the cervical vertebrae.

If fall
still happened

If
you fall, first aid measures should be taken. Consider
major fall injuries.

Contusion

Most often, a person is bruised when falling. You can define it by
characteristic signs, namely painful sensations, the presence of a bruise
and swelling at the site of impact. To reduce soreness, simply
wrap the compacted snow with a piece of cloth and attach it to the impact site.Avoid direct skin and snow contact to avoid provoking
frostbite. If you hurt your stomach, chest or head badly, do
when the ambulance arrives, try to be completely calm.

Fracture

Do not
sudden movements before the arrival of doctors are necessary because the injury
may not be a bruise at all, but a real fracture. These
injuries are common symptoms, and therefore, hitting the ice, you may not understand
that the bone is broken or cracked.That is why doctors
it is necessary to wait for sure. If you are in the city, you can
wait for doctors without resorting to any action. But if the doctors
far away, you, or the victim you find, will need the first
help. It must be carried out extremely carefully so as not to harm yet
more.

Remember, neither in
in no case should you set your leg or arm if it is in
unnatural situation. In the event of a fracture, a splint must be applied to
ensure rest of the injured limb.Not at all necessary
to use the stick found nearby, it is quite simple
tie an arm to the chest or a sore leg to a healthy one,
an ordinary scarf. This must be done carefully so as not to cause
pain.

And more. It is forbidden,
so that the injured person remains lying until the ambulance arrives
on the snow. It must be moved to a warm room, and when
if there is none, spread something underneath that minimizes contact
with cold ground (if possible).To get rid of pain to the victim
you can give one of the pain relievers to drink.

Sprain of ligaments

Another common injury that can occur on slippery surfaces
ice, is a sprain, and possibly even rupture. To earn
it’s as easy as shelling pears, all you need to do is twist your leg, and you are right there
feel a crunch in the joint and a piercing pain. Very quickly in place
stretching, swelling and swelling appear, and the joint itself becomes
practically motionless.To minimize the consequences, 15–20
minutes, apply a cold compress to the affected joint, and then,
bandage. All other manipulations will be done by the doctors of the emergency room where you are
must be sure to contact after such an incident.

Concussion

Dangerous
the consequence of falling into ice is a blow to the head on a hard
surface followed by concussion. Injured
the person feels at the same time severe pain in the head area, dizziness,
darkening of the eyes, nausea and lightheadedness, he has pallor
skin.In severe cases, it can be pulled out or completely lost.
consciousness. To help such a victim, you should immediately call
“Ambulance”, and before the arrival of doctors to provide the victim with peace, laying
on a flat surface and placing something under your head. When
if the victim starts to vomit, turn him over on his side so that he does not
choked on vomit. All further actions for resuscitation
the patient is in the competence of doctors.

Fright

Finally, let us say that, having slipped on the ice, a person can resist
legs, but from surprise to be very frightened.And if a healthy person is
in this case it will cost a little excitement, then for persons suffering from
heart disease, such a fright can result in a heart attack. V
this moment is extremely important that a frightened person has
there were pills that would help him cope with the
excitement. That is why, going outside on ice, be sure to
take with you Nitroglycerin, Papazol, valerian tablets or any
another drug prescribed by your doctor.

But even if you
twisted your leg or fell, hitting your head, but you do not feel heavy
symptoms, you should still see a doctor and take a picture because
untreated ligament rupture or improperly healed fracture, such as
and the consequences of a concussion can be a huge problem in
the future.

How to strengthen bones to avoid
fractures

Whatever
was, any fracture or crack in the bone, this is not only a consequence
unsuccessful fall, but also weakness of bone tissue.That’s why
constantly strengthen your bones by exercising regularly and
proper nutrition. Make sure that in your diet
there was food containing calcium, iodine and vitamin D. In this regard
the most useful will be dairy products, namely, cottage cheese,
kefir, sour cream and cheese. Moreover, it is advisable to use fat-free
products, since calcium is poorly absorbed with animal fats. From
other foods that contribute to the formation and strengthening of bone
system, we single out buckwheat, seafood, nuts and honey.

Be attentive and remember: your health is in your hands!

90,000 The occurrence of transient neurological symptoms after spinal anesthesia with lidocaine compared with other local anesthetics in adults undergoing surgery

Review question

We aimed to determine if transient neurologic symptoms (TNS) occur more frequently after recovery from spinal anesthesia with lidocaine than with other local anesthetics in adults.Symptoms include mild to severe pain in the buttocks and legs that can last for several days. We also looked at longer-term sensory or movement disorders caused by local anesthetic nerve damage, known as neurological complications.

Relevance

Mild pain in the lower back is a common complaint after spinal anesthesia (when a local anesthetic is injected into the spinal column, as opposed to general anesthesia for the whole body).People can also experience headaches and low blood pressure. TNS symptoms are different. They appear within hours to 24 hours after spinal anesthesia and can last up to two to five days.

Lidocaine (local anesthetic) continues to be used for spinal anesthesia due to its unique short duration of action, intense blockade, rapid recovery and suitability for daytime surgery, but alternatives are needed.

This review was originally published in 2005 and previously updated in 2009.

Research characteristics

We included all randomized and quasi-randomized trials that compared the incidence of TNC and neurological complications following spinal anesthesia with lidocaine versus other local anesthetics. Randomized trials compare two or more treatments that are randomly assigned to participants, which cannot be predetermined by the study organizers. Quasi-randomized studies are similar, but not truly randomized, and are more likely to be predetermined by the organizer of the treatment participants will receive (for example, based on date of birth or the order in which people were included in the studies).

Evidence is current to 25 November 2018.

Key findings

We included 24 trials with 2226 participants, of whom 239 developed TNC. There was no evidence that TNCs were associated with any specific neurological disease, and the symptoms resolved on their own by the fifth day after surgery. The risk of developing TNS with lidocaine for spinal anesthesia was increased compared with bupivacaine, prilocaine, or procaine; and similar compared to 2-chloroprocaine and mepivacaine.

Specifically, when alternative local anesthetics were compared directly to lidocaine, the risk of developing TNC was reduced 82-90% with bupivacaine, levobupivacaine, prilocaine, procaine and ropivacaine than with lidocaine. There were no clear differences in THC between lidocaine and 2-chloroprocaine or mepivacaine. In the case of 2-chloroprocaine, THCs emerged in only one study, and the results were very different in a small number of participants. Pain symptoms disappeared by the fifth day after surgery in all participants.Among pregnant women who underwent surgery, only 3 out of 310 women developed TNS; it was not possible to draw conclusions about whether symptoms were more likely with lidocaine use.

The authors also used a statistical network meta-analysis to compare different local anesthetics. This analysis also showed that the risk of developing THC was lower for bupivacaine, levobupivacaine, prilocaine, procaine and ropivacaine, while 2-chloroprocaine and mepivacaine did not differ in the risk of developing THC compared to lidocaine.

Quality of evidence

Due to the quality of the evidence (very low to moderate) among the currently available studies, further research efforts are needed in this area to evaluate alternatives to lidocaine that can provide high-quality anesthesia without the development of TNS.

Conclusions

Lidocaine was the drug of choice for the induction of spinal anesthesia in outpatient surgery (or day surgery) because of its rapid onset of action, intense nerve blockade and short duration of action.This review shows that lidocaine is more likely to induce TNS than bupivacaine, prilocaine, and procaine. However, these drugs have a longer lasting local anesthetic effect and are therefore undesirable for outpatients.

Our results indicate that 2-chloroprocaine may be a viable alternative to lidocaine for short duration day surgery and obstetric procedures, as this local anesthetic has a rapid onset of action, is rapidly metabolized and has low toxicity.However, this finding is based on only two studies and low-quality evidence.

to take a pill, sign up for a massage or call an ambulance?

Contusion or sprain

Most cases of back pain are associated with damage to ligaments or muscle fibers. You can “stretch your back” as a result of falling, lifting weights and even unsuccessful sudden movements. At the site of the injury, swelling usually occurs, and the skin becomes bluish.

If the pain is mild and does not particularly interfere with living, most likely, within a couple of days everything will go away by itself; all you have to do is limit physical activity as much as possible. However, if the third day has gone from the moment of the injury, and the pain still does not let go, it makes sense to visit a traumatologist. It also happens that from the very beginning the pain is so strong that it cannot be tolerated without analgesics; in this case, it is better to go to the emergency room without delay.

Osteoarthritis

This disease, which attacks the cartilage tissue of the joints, usually affects those over 45 years old.It all starts with mild aching pains and stiffness of movements; symptoms increase over time. Sometimes others are added to them: the joints begin to crackle during movements, the back swells in the region of the spine.

The first step is to visit a therapist or rheumatologist. To clarify the diagnosis, your doctor will order blood tests and x-rays. In the initial stages of the disease and during its mild

In these forms, diet, well-chosen physical exercises, warm baths and drug therapy will help.In severe cases and in advanced cases, joint replacement may be required.

Radiculitis

They bent down to lace up their boots and froze in an awkward position, clenching their teeth in pain; this is how sciatica manifests itself. For a long time, this disease spared the young and mostly chose those over 40. However, in recent decades, sciatica began to rapidly grow younger. At risk are both victims of sedentary work and professional sports workers.

The cause of the disease is inflammation or damage to the roots of the spinal nerves.The most common type of the disease is sciatica, characterized by severe pain in the lumbar region, which makes itself felt during bending or walking. Less common are chest sciatica (pain seems to encircle the chest), cervical and cervicobrachial sciatica (pains are concentrated in the neck, shoulders, arms, sometimes dizziness joins them).

If something similar happens to you, do not delay visiting a neurologist. An X-ray examination will help to make an accurate diagnosis.The treatment will be complex: anti-inflammatory and analgesic drugs, physiotherapy, massage and exercise therapy.

Acute pyelonephritis

Usually affects the fair sex; the reason for this is the structural features of the urethra in women. The first signal is severe back pain, in the lumbar region or slightly higher; can give to the sides. The temperature rises to 40 degrees, chills begin, headache; nausea up to vomiting is possible. Frequent urge to urinate; the urine leaves cloudy, with a sharp smell, sometimes with blood.

At the first symptoms, you need to call an ambulance as soon as possible; they are not joking with the kidneys, in this case the slightest delay can lead to their irreversible damage. Acute pyelonephritis is usually treated in a hospital – a course of injectable antibiotics is prescribed, if necessary, a catheter is inserted into the ureter to ensure a normal outflow of urine, and in complicated cases, which, fortunately, are infrequent, they resort to surgical intervention.

Herniated disc

Even young people are not insured against it.Signs that the structure of the discs separating the vertebrae is broken can be very different: from mild back pain and slight muscle numbness to dizziness attacks, high blood pressure, numbness of the limbs while walking and urinary incontinence. The more pronounced the symptoms, the sooner you need to see a doctor – an orthopedist or spinal surgeon. The most informative examination is an MRI of the spine: the results will show whether conservative treatment can be dispensed with, or whether surgery is necessary.

Vertebral fracture

Usually the result of a serious injury such as a fall or road accident. However, in people over 60 years old, suffering from osteoporosis, even a slight physical effort, such as a banal tilt, can lead to a vertebral fracture. Muscle spasm, sharp and severe back pain, pronounced hematoma – a reason to immediately seek help from a traumatologist. You will be prescribed CT or MRI, as well as a measurement of bone density – densitometry.In most cases, treatment includes wearing a special corset and taking local anesthetic, but for complicated fractures – in particular, if the spinal nerve is damaged – surgery is essential.

Ankylosing spondylitis

Other names – ankylosing spondylitis, ankylosing spondylitis. It all starts with the fact that there is strong stiffness in the movements (it is difficult, and sometimes even impossible to bend over), the back hurts in the lumbar region, and the joints ache.Pain is typically relieved with little physical activity or after a hot shower. Then constant weakness, weight loss and subfebrile (below 37.5 degrees) temperature can join. Typically, the disease affects young people under 30; men suffer from it nine times more often than women.

It is better not to delay the visit to the doctor. Otherwise, sooner or later, such unpleasant complications as constant aching back pain, severe curvature of the spine, and disruption of the work of an increasing number of joints will make themselves felt.Get ready for regular communication with doctors; for a correct diagnosis, you will need to be followed for at least three months. Treatment – corticosteroids, nonsteroidal anti-inflammatory drugs, physiotherapy.

Spine injury

Car crashes, falls and other accidents can cause serious injury with spinal cord injury. Symptoms: acute pain or, conversely, complete loss of sensitivity in the back and limbs; Breathing may be difficult, and fecal and urinary incontinence is common.The sooner you can call an ambulance, the better. But moving the victim on your own is a bad idea; so you can harm him even more.

Inflammation of the sciatic nerve

Other names – sciatica, sciatica. If the sciatic nerve is inflamed, the pain is localized in the lower back and in the buttocks, radiates to the legs and can intensify during coughing. Sometimes muscle weakness and numbness in the legs join the pain; swelling of the legs and excessive sweating of the feet are possible.With such symptoms, it is worth visiting a neurologist; the doctor will check your reflexes, prescribe ultrasound and MRI, recommend anti-inflammatory drugs, as well as massage, exercise therapy, physiotherapy and manual therapy.

Osteochondrosis

If the back hurts in the lumbar region and the pain radiates to the sacrum or legs, if the pain intensifies during physical exertion, if there is obvious discomfort when trying to bend or turn, there is a high probability that you are faced with manifestations of lumbar osteochondrosis.It is also characterized by a violation of the sensitivity of the legs. With osteochondrosis of the thoracic region, pain is localized between the shoulder blades and in the chest; aggravated during hypothermia, deep inhalation and exhalation, or an attempt to turn, felt more strongly at night than during the day. Those who have thoracic osteochondrosis often complain that the chest seems to be squeezed from all sides, and goosebumps now and then run through the skin. At the first alarm bells, you need to visit a neurologist; the doctor will prescribe an X-ray and MRI of the problematic spine.Treatment of osteochondrosis includes manual therapy, physiotherapy exercises, massage.

Editorial opinion

The services of chiropractors have gained immense popularity now. When looking for such a specialist, do not trust newspaper ads – the risk of running into a charlatan is too high. It is better to go to a certified clinic – then a certified doctor will deal with you.

90,000 Back pain in children and adolescents

GBU RO “KB im.ON. Semashko “

6 children’s neurological department

Neurologist, 1st category, Elena Aleksandrovna Lizorkina

Where do children have back problems? Why can a child’s back hurt? In fact, as in adults, children can have back pain due to various reasons – from simple fatigue due to vigorous exercise and daytime activities to the presence of very dangerous and serious diseases.

Causes of back pain.

There are more than a hundred reasons for back and spine pain.

One of the important causes of pain in the back and spine can be trauma, sprains in the area of ​​the muscles of the back, lower back. Often this happens with back bruises and falls on the back, with excessive or improperly aligned sports, exercises on the back muscles without their preliminary warm-up and preparation. This can be in adolescents, more often in boys. Moreover, it is worth remembering that complaints of pain may not arise immediately after training or injury, but after a few days or several hours, when active inflammation occurs in the focus of the affected muscle.If the child complains of back pain, ask him if he fell on his back, if he was hit by it, if he did not exercise too much.

During adolescence (at the age of 11-13 years), a number of serious changes and rearrangements take place in the child’s body, which lead to intensive growth of the whole body. And when the body begins to grow, bones also grow, and the spine is not always ready for this and therefore problems may arise. During the first year of intensive growth, the body can grow by 10-15 cm, and this is not the limit, weight increases, hormones are released, the child becomes a teenager.In the spine, subluxation of the vertebrae can occur, the spine bends and health problems arise, scoliosis is formed, followed by scoliosis – osteochondrosis, intervertebral hernias.

Extremely heavy loads also lead to back pain and stoop. Children are forced to wear heavy backpacks with books and school supplies, sit in a static position for a long time in lessons, and even pore over their lessons in the evenings. School loads today are such that doing homework with children is a matter of more than one hour.The global penetration into our lives of computers, tablets, TVs and other devices that make life easier also contributes to the development of back problems. If earlier children from the street could not be driven home, they rode bicycles, ice skates and sledges all day after school, today for many parents it is a problem to send their children for a walk. At home there are social networks, games on tablets and computers, films and cartoons on TV, etc. During prolonged sitting or standing, static loads on the spinal column lead to its compression, compression of the intervertebral discs and impaired posture.It is already necessary to cope with such problems with the help of a neurologist, orthopedist, exercise therapy doctor, to carry out physiotherapy exercises, to do massage and physiotherapy. When driving, the loads are evenly distributed and there is no such problem. In addition, parents need to take care of an ergonomic table and chair for the student so that the spine does not suffer.

Also, the cause of back pain can be the desire of parents for the comfort of the baby and the purchase of a soft mattress for him. It has been shown that constant sleep on feather beds or very soft mattresses can lead to back pain.During sleep, the back should be straight, supporting all physiological curves along the spine, which helps the muscles to fully relax. If the mattress is soft and pressed under the baby’s body, the muscles experience stress and tension instead of rest, which leads to their spasm and blood stasis, this causes pain and a feeling of tension in the back. Purchasing the right mattress can be a solution to this problem.

Another problem associated with back pain can be damage to internal organs.In particular, the genitourinary system of children. If a child regularly complains of lower back pain, while they are not associated with physical exertion and injury, and when tapping in the lumbar region, pain intensifies – this may be a sign of kidney damage. You must first contact a nephrologist who will prescribe an appropriate examination and treatment.

In adolescent girls, back pain in the sacrum and lumbar region can occur as harbingers of menstruation, or pain occurs in the first days of menstruation, and such pains can also be a sign of damage to the genital organs, especially the uterine appendages.With such complaints, an immediate visit to a gynecologist and a detailed examination is necessary.

It is worth remembering that the child’s skeleton consists of a strong bone base, vertebral bodies, which are strong and durable due to the sufficient content of calcium in them. If the child’s nutrition is inadequate, he receives little calcium with the diet, or calcium is intensively consumed, is blocked by taking any medications or toxic drugs (for example, anticonvulsants), a state of rickets occurs (if it is up to 1-2 years old), or a state of osteoporosis at an older age.Vitamins necessary for the absorption of calcium, especially vitamin D and vitamins of group B, will be no less important. Take care of the child’s proper nutrition and his intake of a sufficient amount of foods with calcium.

Even less often, children develop viral, microbial and tuberculous lesions of the spine, causing persistent symptoms that grow in strength and severity. The manifestations of these diseases are combined with the presence of other clinical symptoms – fever, changes in blood tests, inflammation of other localization.With the flu, aches and pains in all joints of the body, including the spine, and muscle pain can occur.

Back pain can be stressful, then the shoulders, neck and spine ache, as if “carrying a heavy load on the shoulders.” As the child recovers from the stress, the shoulders relax and the back pain goes away. This usually occurs as a protective psychological reaction reflected in the physical state. Back pain can be of a reflected nature, as a projection of the pain of the organs located inside the body. With pains of the heart, there may be pain between the shoulder blades, with pain in the region of the pancreas along the upper part of the lower back, under the ribs, with an illness of the intestine, the back hurts in the area from the zone of the lower ribs to the sacrum.

What to do if your back hurts?

First of all, check your back for injuries, abrasions, bruises and contusions. Children sometimes get injured in the excitement of a fight or a game, and do not remember them. If there are obvious areas of injury on the back, cold, absorbable ointment and rest are needed. If there are areas of redness, an increase in temperature, the muscles under the arms are dense when probing, it is necessary to consult an orthopedic traumatologist.

And also it is necessary to consult a neurologist and orthopedist in case of back pain, not related to diseases of internal organs.Pay attention to how your child sits, how he writes, walks, whether he complains of back pain or whether he has spinal curvatures. And if you notice any irregularities, first get examined. The doctor will ask you about the onset of pain and its nature, connection with any phenomena. And then he will carefully examine the back. If necessary, various tests will be prescribed and an examination carried out. This will give the doctor a picture of the structure of the spine and indicate many of the pathologies. Based on the results of the examination, the doctor will diagnose and develop a treatment system.

In order to avoid the consequences, it is necessary to diagnose violations in time.

Remember, the earlier you start treatment, the better results you can achieve.

Contusion of soft tissues of the buttocks: first aid, treatment, rehabilitation

Author Yulia Vladimirovna Dmitruk Read 5 min Views 3.5k. Published 12/20/2017
Updated 07/31/2018

Contusion of the buttocks is a fairly common injury from a fall.The gluteus muscle has a fairly dense layer of fat, and to get serious injury requires a lot of force in the area of ​​the hip joint. With severe bruising, the patient usually complains of pain in the gluteus muscle while sitting or walking, as well as when palpating the bruised area.

ICD trauma code 10

According to the International Classifier of Diseases 10 (ICD 10), an injury of the buttocks is referred to the ICD 10-S30 code.

Common buttock injuries are found under the following ICD 10 codes:

• S0 – contusion of the gluteal region;
• S20 – closed tailbone fractures;
• S21 – open fractures of the coccyx;
• S2 – Dislocations of the sacrococcygeal joints.

Reasons

The most common cause of gluteal muscle pain is a bruised buttock from a fall or bump. When soft tissues are damaged, the blood vessels and the lymphatic system of the buttock region give an instant reaction – the bruised area swells, and a hematoma forms on it, accompanied by a long-lasting pain in the buttocks.

The main causes of injury are:

• Injury from unsuccessful exercise during sports activities;
• falling as a result of slippery floor covering;
• household injury.

Symptoms

Symptoms of injury to the soft tissues of the buttocks as a result of an injury depend on the strength of the injury received. In this case, there are some changes in the tissues of the subcutaneous tissue.

In case of severe trauma to the buttock, internal hemorrhage may occur, resulting in a severe hematoma on the thigh. And although the pain from a blow as a result of a fall or mechanical damage to the gluteus muscle passes over time, such injuries can be harmful to health in their scale and depth of localization.For example, the victim will be accompanied for a long time by pain that occurs when walking.

Also, during an accident, nerve endings can be injured, which similarly causes pain, and in some cases even hyperthermia and swollen lymph nodes.

First aid

First aid for bruising the buttocks consists in the following actions: initially, cold should be applied to the site of the bruise. This action will help the vasoconstriction, which in turn will slow down the bleeding.After a couple of days, warm compresses and lotions can be applied to the hematoma to eliminate pain and reduce swelling.

Diagnostics and treatment

If the bruise of the gluteal region continues to hurt for a long time, you should consult a doctor. Since, in addition to bruising the buttocks during a fall, there may be a fracture of the hip joint or pelvis. Timely diagnosis and determination of the extent of damage is extremely important.

The doctor will assess the extent of the injury to the buttock and prescribe the best treatment methods.It will also identify and write a prescription for the most appropriate medication to relieve pain due to an accident.

Most often these include local anesthetics (Movaliz, Nise, Nimesil, Ibuprofen). Thanks to these drugs, swelling and inflammation are reduced.

How to cure a bruise

Treatment of a bruised buttock at home involves the use of all kinds of compresses, infusions prepared according to folk methods.

For the removal of inflammatory processes, such a folk remedy as apple cider vinegar is widely known.

Vinegar recipes:

• Pour 1 tsp into a glass of vinegar. salt and 10 – 15 drops of iodine. The affected area should be covered with a cotton pad soaked in the solution; to reduce the swelling from above, it is advisable to apply cold and wrap up the site of the injury.
• Chop the head of garlic and add to a glass of apple cider vinegar, insist the contents in a dark place for 24 hours, then rub it into the affected area of ​​the skin, followed by applying a compress.

Compress made from oak bark:

• Oak bark and daisy flowers are crushed to dust, in equal proportions, mix both ingredients and pour 1 tbsp. l. mixture of 250 ml of boiling water, insist half an hour. After cooling to room temperature, oak bark with daisy flowers is applied to the damaged area.

Garlic tincture for tumor removal:

• To prepare the tincture, you will need 2 chopped heads of garlic and apple cider vinegar, which are mixed in an opaque container with a volume of half a liter, the tincture is left for a week in a cool place.After preparation, the resulting mixture is rubbed every day into the hematoma 2 times for 10 minutes. The shelf life of the tincture is at least 8 months.

Bitter wormwood in treatment:

• The wormwood herb must be chopped in a blender or with a meat grinder. Further use depends on the degree of imagination – you can apply the raw material, having previously placed it in gauze, if the plant is freshly harvested, the juice of bitter wormwood applied to the site of the injury will also perfectly relieve swelling.

Rehabilitation

With a decrease in pronounced symptoms of contusion, such procedures are prescribed as:

• electrophoresis;
• UHF;
• magnetic therapy;

The use of just a few of these procedures leads to a rapid restoration of normal motor activity and elimination of pain.

Complications and consequences

In case of severe bruising of the soft tissues of the gluteal region, adverse consequences are not uncommon.If the injury is severe, infection or suppuration may occur.

In order to avoid possible complications, the victim needs to promptly help and begin treatment, which may include both traditional medicines and folk remedies.

Dear readers of the 1MedHelp website, if you have any questions on this topic, we will be happy to answer them. Leave your feedback, comments, share stories of how you survived a similar trauma and successfully coped with the consequences! Your life experience may be useful to other readers.

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