Progressive Muscular Atrophy

A progressive neurological disease in which the lower motor nerve cells (motor neurons) deteriorate. PMA is not rapidly progressive.

What is PMA?

PMA affects only the lower motor neurons, causing atrophy and fasciculations.

PMA is noted by an absence of upper motor neuron difficulties such as spasticity, brisk reflexes, or the Babinski sign.

Patients with PMA survive longer than patients with ALS and in some cases symptoms can be restricted to the arms or legs for a long period of time before spreading elsewhere in the body.

Types of Progressive Muscular Atrophy?

There may be two subtypes, one with a patchy distribution and one with a leg distribution. In the first case, progression is unpredictable, whilst in the latter there is a prolonged latency period between the progression from legs to arms, and then again to the bulbar region.

Other PMA Related Resources:

• PMA Online Support Group - ideal for individuals wanting to learn more about PMA, or for individuals wanting to chat with others that have been affected by PMA.
• PMA description - This PMA support group discussion has more information about PMA. Join the group to add your questions or comments about PMA.

Legg-Calvé-Perthes Disease

Legg-Calvé-Perthes disease (or Perthes disease) is a temporary condition in children in which the ball-shaped head of the thigh bone, referred to as the femoral head, loses its blood supply. As a result, the femoral head collapses. The body will absorb the dead bone cells and replace them with new bone cells. The new bone cells will eventually reshape the femoral head of the thigh bone. Legg-Calvé-Perthes disease causes the hip joint to become painful and stiff for a period of time.

Legg-Calvé-Perthes disease goes through four phases of changes that affect the head of the femur. The phases include:

• Phase 1 - Blood supply is absent to the femoral head and the hip joint becomes inflamed, stiff, and painful. Portions of the bone turn into dead tissue. The ball of the thigh bone becomes less round in appearance on x-rays. This phase can last from several months up to one year.
• Phase 2 - The body cleans up the dead bone cells and replaces them with new, healthier bone cells. The femoral head begins to remodel into a round shape again. The joint is still irritated and painful. This phase can last from one to three years.
• Phase 3 - The femoral head continues to model itself back into a round shape with new bone. This phase lasts for one to three years.
• Phase 4 - Normal bone cells replace the new bone cells. This last phase can last a few years to complete the healing process.

What causes Legg-Calvé-Perthes disease?

The cause of Legg-Calvé-Perthes disease is unknown. It is five times more likely to occur in boys than girls.

Legg-Calvé-Perthes disease commonly affects first-born children and is typically seen in children 4 to 10 years of age. The majority of cases affect only one hip.

What are the symptoms of Legg-Calvé-Perthes disease?

The child typically complains of pain in his/her hip that is aggravated by activity. Sometimes, they will also experience pain in their thigh or knee area. The child usually walks with a limp and reports that rest will alleviate the pain.

The symptoms of Legg-Calvé-Perthes disease may resemble other conditions or medical problems of the hip. Always consult your child's physician for a diagnosis.

How is Legg-Calvé-Perthes disease diagnosed?

In addition to a complete medical history and physical examination, diagnostic procedures for Legg-Calvé-Perthes disease may include:

• x-rays - a diagnostic test which uses invisible electromagnetic energy beams to produce images of internal tissues, bones, and organs onto film.
• bone scans - a nuclear imaging method to evaluate any degenerative and/or arthritic changes in the joints; to detect bone diseases and tumors; to determine the cause of bone pain or inflammation.
• magnetic resonance imaging (MRI) - a diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
• arthrograms - a diagnostic imaging test to study the non-bony structures of joints.
• blood tests

Treatment for Legg-Calvé-Perthes disease:

Specific treatment for Legg-Calvé-Perthes disease will be determined by your child's physician based on:

• your child's age, overall health, and medical history
• the extent of the condition
• your child's tolerance for specific medications, procedures, or therapies
• expectations for the course of the condition
• your opinion or preference

The goal of treatment is to preserve the roundness of the femoral head and to prevent deformity while the condition runs its course. Treatment options are dependent upon the amount of hip pain, stiffness, and x-ray changes over time, as well as how much of the femoral head has collapsed.

Typically, the first step of treatment is to regain hip motion and eliminate pain that results from the tight muscles around the hip and the inflammation inside the joint. Treatment may include:

• rest
• activity restrictions
• medications such as ibuprofen
• bed rest and traction
• casting or bracing (to hold the femoral head in the hip socket, permit limited joint movement, and allow the femur to remold itself into a round shape again)
• surgery (to hold the femoral head in the hip socket)
• physical therapy (to keep the hip muscles strong and to promote hip movement)
• crutches or wheelchair (in some cases)

Long-term outlook for a child with Legg-Calvé-Perthes disease:

The ultimate goal in Legg-Calvé-Perthes disease is to diagnose the condition early in order to allow as much time as possible to let the femoral head remodel back into a round shape. Other treatment goals include controlling pain, maintaining hip motion, and preventing continued hip deformity.

The two most critical factors that determine the outcome are the child's age and how much of the femoral head is affected by this condition.

The more severe the case, the greater the likelihood that the child may experienc

DeQuervain's Disease

De Quervain’s disease is a painful inflammation of specific tendons that extend the thumb. The swollen tendons and their coverings cause friction within the narrow tunnel or sheath through which they pass. The result is pain that may extend from the forearm to the thumb base. De Quervain’s was named after the Swiss surgeon who first described the condition in 1895. It is one of the most common types of tendon lining inflammation (also called tenosynovitis).

What causes De Quervain’s Disease?

Overuse, a direct trauma or injuries to the thumb, repetitive grasping and certain inflammatory conditions, such as rheumatoid arthritis, can all trigger the disease. Gardening, racquet sports, and various workplace tasks are some activities that can aggravate the condition. It is also seen during the last trimester of pregnancy and in mothers of nursing children. Often, its cause is unknown. De Quervain’s affects women eight to 10 times more often than men. People who engage in activities that require sidewise motion of the wrist while gripping with the thumb (e.g., hammering, skiing) may be more likely to develop the condition.

Pain along the back of the thumb, directly over the two thumb tendons – the extensor pollicis longus brevis and the abductor – is typical of de Quervain’s. The condition can occur gradually or suddenly. In either case, the pain may travel into the thumb or forearm. Thumb motion may be difficult and painful, particularly when pinching or grasping objects. Some people also experience swelling and pain on the side of the wrist at the base of the thumb. The pain may increase with thumb and wrist motion. Some people also feel pain if direct pressure is applied to the area.

The test most frequently used to diagnose de Quervain’s disease is the Finkelstein test. Your doctor will ask you to make a fist with your thumb placed in your palm. When the wrist is suddenly bent to the little finger side (as in casting a fishing pole), the swollen tendons are pulled through the tight space. If this maneuver is very painful, it is likely that you have de Quervain’s disease. Arthritis and other forms of tendonitis may also cause symptoms in this area.

What are the benefits of treatment?

The main benefits of treatment are to alleviate the pain associated with the condition and improve mobility and function. Treatment usually involves wearing a splint 24 hours a day for four to six weeks to immobilize the affected area and refraining from any activities that may aggravate the condition. Ice may also be applied to reduce inflammation. If symptoms continue, your doctor may give you anti-inflammatory medication – which may be taken orally or injected – to reduce swelling. If de Quervain’s disease does not respond to conservative medical treatment, surgery may be recommended.

What are the risks and complications of surgery?

Risks include nerve injury, infection, bleeding, stiffness of thumb, recurrence, pain or numbness at the incision.

How do I prepare for surgery?

Always ask your surgeon for complete pre-operative preparation instructions.  Typically, these may include:

• Complete any pre-operative tests or lab work prescribed by your doctor.
• Arrange to have someone drive you home from the hospital.
• Refrain from taking aspirin and non-steroidal anti-inflammatory medications (NSAIDs) one week prior to surgery.
• Call the appropriate surgery center to verify your appointment time.  If your surgery is being done at Cleveland Clinic, call:
  • Main Campus: 216.444.0281
  • Beachwood: 216.839.3500
• Refrain from eating or drinking anything after midnight the night before surgery.

What is osteoarthritis?

Osteoarthritis is a condition that affects your joints. The surfaces within your joints become damaged so the joint doesn’t move as smoothly as it should (see Figures 1 and 2). The condition is sometimes called arthrosis or osteoarthrosis. Older terms are degenerative joint disease or wear and tear.

When a joint develops osteoarthritis, some of the cartilage covering the ends of the bones gradually roughens and becomes thin, and the bone underneath thickens. All the tissues within the joint become more active than normal – as if your body is trying to repair the damage:
The bone at the edge of your joint grows outwards, forming bony spurs called osteophytes.
The synovium (the inner layer of the joint capsule which produces synovial fluid) may thicken and make extra fluid. This causes your joint to swell.
The capsule and ligaments (tough bands that hold the joint together) slowly thicken and contract as if they were trying to make your joint more stable.




Sometimes your body’s repairs are quite good and the changes inside your joint won’t cause pain or problems. But in severe osteoarthritis, the cartilage can become so thin that it doesn’t cover the ends of your bones. Your bones rub against each other and start to wear away. The loss of cartilage, the wearing of bone and the bony spurs can change the shape of your joint, forcing your bones out of their normal position

Knee Cap Injuries

1) Dislocated Patella

What is it: Knee cap get pushed out of place. This is one of the least common knee injuries
Causes: Usually caused by major, high impact injury eg car crash.
Symptoms: Deformed leg - won’t be in a straight line. Very painful and swollen. Occasionally you lose feeling below the knee.
Treatment: Relocation of the bones, exercises, knee brace, may require surgery.

2) Patella Fracture

What is it: When the kneecap bone breaks into two or more pieces.
Causes: A great force through the front of the knee eg falling from a height or impact from a car crash.
Symptoms: Pain and swelling at the front of the knee. Difficulty moving the knee and walking
Treatment: May require surgery, exercises, knee brace and/or cast.

Knee Ligament Injuries

There are 4 ligaments in the knee, which work in the pairs. The anterior cruciate ligament and posterior cruciate ligament control the forwards and backwards movement of the knee and are really important for providing stability. The medial and lateral collateral ligaments provide sideways stability for the knee.

Ligaments are usually injured either by sudden twisting movements, or when a great deal of force goes through part of the knee eg from a sporting tackle.

1) ACL Injuries

What is it: Anterior Cruciate Ligament gets overstretched and tears/ruptures
Causes: Knee bending the wrong way, pushing back too far or twisting of the knee
Immediate Symptoms: Popping sound, swelling, pain, giving way
Long Term Consequences: Lack of stability with pivoting and twisting
Treatment: Exercise rehab and/or surgery. See ACL Injuries section for more info.

2) MCL tear


What is it: Damage to some or all of the fibres of the Medial Collateral Ligament.
Causes: Force through the outside of the knee eg tackle, sudden twisting of the knee eg skiing
Symptoms: Inner knee pain, swelling, instability, difficulty bending the knee
Treatment: PRICE, exercises, knee brace. See the MCL Tear section for more info.

3) Knee Sprain


What is it: Overstretching any of the knee ligaments which tears some of the fibres. This is one of the most common knee injuries
Causes: sudden force through the knee or sudden twisting
Symptoms: knee pain, swelling, instability, difficulty bending and straightening the knee
Treatment: PRICE, exercises, knee braces. See the knee sprain section for more info.

Knee İnjuries

Common knee injuries vary from minor falls which may settle down in a few days to major accidents which may take months to recover from. The knee ligaments and cartilage are the structures most commonly damaged.

Here you will find information on the most common knee injuries including how they occur, the knee injuries symptoms for each one and treatment information. You can find out more about each type of injury, including the best treatments to ensure a quick and full recovery by clicking on the links below for more info. They are grouped into four categories:

1) Ligament Injuries: damage to the ligaments that support the joint
2) Cartilage Injuries: damage to the cartilage lining the joint
3) Muscle Injuries: damaged to the muscle fibres
4) Kneecap Injuries: damage to the patella bone

(Search in our website for this injuries)