Personal health records, designed to help patients keep all of their medical records in one place and make it easier for doctors to access patient files, may actually lead to inaccurate information and, as a result, improper treatment, some doctors fear.
This young woman sustained a hip fracture while running the Chicago Marathon. The case review suggests that training error was a critical factor. Be alert: Runners may experience stress fractures and ignore the pain.
Once a diagnosis of systemic lupus erythematosus (SLE) has been made, numerous neurological and psychiatric manifestations may be found to accompany the disease.
Heel pain (calcaneodynia) is most commonly due to plantar fasciitis, but has many other causes including nerve entrapment, stress fracture, and sciatica. This review describes an overall approach to diagnosis, discusses conservative treatments and highlights the most prevalent surgical procedures.
The features of systemic lupus erythematosus (SLE) are common in the lifetime course of rheumatoid arthritis (RA) and are significantly associated with an increased mortality risk, even after adjusting for well-described RA-specific predictors of mortality. For some SLE features, the increased risk may be as high as 6-fold.
Cervical spine injuries are common in athletes, particularly those engaged in contact sports.
Soft tissue musculoskeletal conditions are common causes of pelvic and lower extremity pain.
Hemochromatosis is a disorder of iron metabolism that may lead to abnormalities in multiple organ systems.
The main predictor of adherence to a multimodal treatment program for patients with fibromyalgia syndrome (FMS) is barriers, such as lack of time, too much effort, stressful events, and fatigue. Because barriers are important for adherence and adherence is related to outcomes, using a questionnaire about barriers is recommended as a basis for discussing them with patients.
ABSTRACT: High ankle sprains are not as common as low anklesprains, but they are a significant injury, and the diagnosis may bechallenging. The primary role of the syndesmosis is to maintain therelationship of the talus to the tibia under physiological loads.Toaccomplish this, the distal tibiofibular joint must maintain its stability.The syndesmosis is injured most often with external rotation at theankle joint while the foot is dorsiflexed and pronated. On physicalexamination, tenderness is located in the area of the anterior syndesmosis.There are several special tests for syndesmosis injuries.Radiographic assessment is helpful. The usefulness of classificationsystems is not well defined. The optimal rehabilitation programis unknown. Rehabilitation generally is divided into phases.(J Musculoskel Med. 2008;25:564-569)
The signs and symptoms can be controlled with early diagnosis and treatment.
Molecular imaging reveals fibromyalgia symptoms related to functional brain abnormalities.
Muscle strains are most common in the hamstring, gastrocnemius, soleus, and quadriceps strains, as well as the lumbar and thigh adductor. This image-rich review covers imaging, treatment, and prevention.
Knee pain is a common complaint in older patients, andosteoarthritis is the leading cause.We prospectively evaluated the diagnosticpatterns of nonorthopedic physicians in 100 consecutive patientsolder than 60 years who had knee pain. Our study shows thatthere is a lack of consensus about the use radiographic studies for diagnosisof knee pain in older patients.Weight-bearing radiographs areideal for evaluating knee pain. MRI frequently is overly sensitive in detectingpathology and often underestimates joint-space narrowingand arthrosis. MRI also represents a much larger cost and burden onthe health care system. MRI is indicated when the cause of knee painis not readily apparent after careful physical and radiographic evaluation.(J Musculoskel Med. 2008;25:500-504)
Vitamin C intake in men is inversely associated with serum uric acid (UA) concentrations. Therefore, vitamin C has a potential role in the prevention of hyperuricemia and gout.
ABSTRACT: Osteoarthritis (OA) is the leading cause of chronicdisability in older adults. A multitude of factors can contribute to thedisease process. Only a portion of patients who have radiographicevidence of OA have associated pain. Several conditions can mimicOA. Laboratory tests often contribute little to the diagnosis.Treatmentshould be tailored to individual patients. Exercises and joint protectiontechniques are the mainstays of treatment. Patient educationmay be beneficial. Acetaminophen and NSAIDs are effective in manypatients. Cyclooxygenase-2 inhibitors are associated with improvedGI tolerability. Glucosamine and chondroitin sulfate may produceimprovements in pain and function and may be associated with adecrease in the radiographic progression of OA. Corticosteroids canprovide symptomatic relief. Surgery is an option for advanceddisease. (J Musculoskel Med. 2008;25:476-480)
Differentiation between low and high ankle sprains iscritical to delivering appropriate care.The classic mechanism for a lowankle sprain is inversion and plantar flexion. A history of ankle ligamentinjury predisposes to recurring sprains. The ankle anterior drawertest may be used to evaluate ligamentous instability. Plain radiographsof the foot and ankle may be indicated in a patient who has an acuteankle injury. Clinicians often use the Ottawa ankle rules to determinethe need for radiographs. In the acute phase, the goals of treatment areto alleviate pain, reduce swelling, and protect the ankle from furtherinjury. NSAIDs and rehabilitation are important components of management.Primary prevention may be possible with strengthening andbalance programs. (J Musculoskel Med. 2008;25:438-443)
The "logical plan" for patient care includes sparing use of medications, providingpain relief, and quick resumption of work.
This detailed review desccribes the heterogeneous idiopathic inflammatory myopathies and their mimics, with criteria for classification, an overview of cardiac, pulmonary and malignant comorbidieis, and guidance for treatment.
Persons in the United States report musculoskeletal conditions-including arthritis, back pain, osteoporosis, and injuries-more than any other health condition, according to the US Bone and Joint Decade.
A 21-numbered circle visual analog scale (VAS) may be a desirable alternative to the traditional 10-cm horizontal line for pain and patient global estimate on a Multidimensional Health Assessment Questionnaire (MDHAQ).
A prediction rule for the development of rheumatoid arthritis (RA) in patients with undifferentiated arthritis (UA) has been validated. The rule accurately estimates the risk of RA in more than 75% of patients with recent-onset UA.
A study published in the Canadian Medical Association Journal reveals that PPIs for treating acid reflux elevate the risk of osteoporosis-related fractures.
ABSTRACT: If enough force is applied in a wrist ligament injury, aperilunate dislocation may occur. Physicians can readily make thediagnosis, but the injury may be missed in the initial evaluation. Withprompt recognition and intervention, the incidence of permanentdisability may be lessened. Acute carpal tunnel syndrome may accompanyperilunate injuries and frank dislocations. The scapholunateand lunotriquetral ligaments confer significant structural stabilityand help maintain the anatomical relationships of the carpal bones;when they are compromised, structural integrity is lost.Visual inspectionis critical to the physical examination. Neurovascular statusshould be determined and documented. Radiographic evaluationis recommended for all hand injuries. All perilunate dislocationsfirst need to be closed reduced, followed by surgical treatment.(J Musculoskel Med. 2008;25:390-395)
ABSTRACT: Osteopoikilosis is a rare, benign osteosclerotic dysplasiathat predominantly involves the appendicular skeleton. Radiographicfindings are diagnostic, and the disease often is discovered incidentallyon x-ray films. The importance of recognizing osteopoikilosis liesin differentiating it from osteoblastic metastases. The cause is unclear.Patients typically are asymptomatic. Diagnostic findings include theappearance of numerous small,well-defined, spheroid sclerotic foci.Because evidence suggests an association with skeletal and dermatologicalchanges, evaluation for coexisting pathological conditions maybe warranted. The differential diagnosis for a patient who has radiographiccharacteristics similar to those of osteopoikilosis includes osteoblasticmetastases, mastocytosis, tuberous sclerosis, melorheostosis,and osteopathia striata. (J Musculoskel Med. 2008;25:387-389)
ABSTRACT: Corticosteroid/anesthetic injections may be useful diagnosticand therapeutic tools for painful shoulder conditions. The currentdogma is to avoid performing more than 3 injections over a9- to 12-month period, but this rule may be broken. The volume of localanesthetic typically injected might be insufficient for assessing accuracy.Data demonstrating significant advantages of one corticosteroidover another are scarce. For patients with diabetes mellitus, considera somewhat insoluble phosphoric corticosteroid. There is no consensusabout appropriate dosages and techniques.We recommend using1.5-inch 25-gauge needles for most injections. Re-evaluating provocativemaneuvers after each injection is important. The patient's estimatedpain relief always should be documented.Two approaches toinjection may be used, an advanced/detailed method and abasic/quick method. (J Musculoskel Med. 2008;25:375-386)
I was very interested in the article "Chronic pain update: Addressing abuse and misuse of opioid analgesics" by Ross et al (The Journal of Musculoskeletal Medicine, June 2008, page 268) because pain management and addiction medicine is my specialty.The article was interesting, useful, and well written and referenced. However, it perpetuated one myth about opioid prescribing for chronic pain when the authors wrote, "Tolerance develops in most patients who receive long-term opioid therapy."
Meijer JM, Schonland SO, Palladini G, et al, University of Groningen, Groningen, theNetherlands, and other centers. Sjogren's syndrome and localized nodular cutaneousamyloidosis: coincidence or a distinct clinical entity? Arthritis Rheum. 2008;58:1992-1999.
ABSTRACT: Inflammation of the anserine bursa occurs frequently inathletes who have tight hamstrings, obese patients, patients who haveknee joint pathology, and those who experience direct trauma to thearea. Iliotibial band syndrome results from inflammation of the iliotibialtendon and the bursa. For both injections, the patient may beinjected while lying supine with the leg extended. During anserinebursa injection, the lidocaine and corticosteroid should flow withoutresistance, although some pressure is required. An inability to depressthe syringe plunger requires repositioning of the needle to avoid injectioninto the medial collateral ligament or pes anserinus tendons.(J Musculoskel Med. 2008;25:340-341)
ABSTRACT: Hip fractures in older patients are projected to increase infrequency as the US population continues to age.