A detailed history alone may lead to a specific diagnosis in approximately 70 percent of patients who have wrist pain. Patients who present with spontaneous onset of wrist pain, who have a vague or ...distant history of trauma, or whose activities consist of repetitive loading could be suffering from a carpal bone nonunion or from avascular necrosis. The hand and wrist can be palpated to localize tenderness to a specific anatomic structure. Special tests can help support specific diagnoses (e.g., Finkelstein's test, the grind test, the lunotriquetral shear test, McMurray's test, the supination lift test, Watson's test). When radiography is indicated, the posterior-anterior and lateral views are essential to evaluate the bony architecture and alignment, the width and symmetry of the joint spaces, and the soft tissues. When the diagnosis remains unclear, or when the clinical course does not improve with conservative measures, further imaging modalities are indicated, including ultrasonography, technetium bone scan, computed tomography, and magnetic resonance imaging. If all studies are negative and clinically significant wrist pain continues, the patient may need to be referred to a specialist for further evaluation, which may include cineroentgenography, diagnostic arthrography, or arthroscopy.
Evaluation of poststreptococcal illness Hahn, Ricardo G; Knox, Lynda M; Forman, Todd A
American family physician,
2005-May-15, Letnik:
71, Številka:
10
Journal Article
Recenzirano
Group A beta-hemolytic streptococcal pharyngitis, scarlet fever, and rarely asymptomatic carrier states are associated with a number of poststreptococcal suppurative and nonsuppurative complications. ...As in streptococcal pharyngitis, acute rheumatic fever, pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection, and poststreptococcal glomerulonephritis most often occur in children. The hallmarks of rheumatic fever include arthritis, carditis, cutaneous disease, chorea, and subsequent acquired valvular disease. Pediatric autoimmune neuropsychiatric disorders encompass a subgroup of illnesses involving the basal ganglia in children with obsessive-compulsive disorders, tic disorders, dystonia, chorea encephalitis, and dystonic choreoathetosis. Poststreptococcal glomerulonephritis is most frequently encountered in children between two and six years of age with a recent history of pharyngitis and a rash in the setting of poor personal hygiene during the winter months. The clinical examination of a patient with possible poststreptococcal complications should begin with an evaluation for signs of inflammation (i.e., complete blood count, erythrocyte sedimentation rate, C-reactive protein) and evidence of a preceding streptococcal infection. Antistreptolysin O titers should be obtained to confirm a recent invasive streptococcal infection. Other important antibody markers include antihyaluronidase, antideoxyribonuclease B, and antistreptokinase antibodies.
Part 2, "Upper Extremity," covers areas such as acromioplasty, anterior capsular reconstruction, rotator cuff repair, superior labral anteroposterior repair, total shoulder arthroplasty, extensor ...brevis release and lateral epicondylectomy, ulnar collateral ligament reconstruction with ulnar nerve transposition, primary flexor tendon repair in the digit, and carpal tunnel release. The final part, covering lowerextremity surgery, is the largest part in the book and contains chapters on total hip arthroplasty, open reduction and internal fixation of the hip, anterior cruciate ligament reconstruction, arthroscopic lateral retinaculum release, meniscectomy and meniscal repair, open reduction and internal fixation of the patella, total knee arthroplasty, lateral ligament repair, open reduction and internal fixation of the ankle, ankle arthroscopy, and Achilles tendon repair.
The author uses a mix of text, photographs, and line drawings to review techniques for measuring active and passive range of motion and performing special tests.
Background Community-dwelling older adults are at risk for declines in physical health, cognition, and psychosocial well-being. However, their enactment of active and health-promoting lifestyles can ...reduce such declines.
Purpose The purpose of this article is to describe the USC Well Elderly II study, a randomized clinical trial designed to test the effectiveness of a healthy lifestyle program for elders, and document how various methodological challenges were addressed during the course of the trial.
Methods In the study, 460 ethnically diverse elders recruited from a variety of sites in the urban Los Angeles area were enrolled in a randomized experiment involving a crossover design component. Within either the first or second 6-month phase of their study involvement, each elder received a lifestyle intervention designed to improve a variety of aging outcomes. At 4—5 time points over an 18—24 month interval, the research participants were assessed on measures of healthy activity, coping, social support, perceived control, stress-related biomarkers, perceived physical health, psychosocial well-being, and cognitive functioning to test the effectiveness of the intervention and document the process mechanisms responsible for its effects.
Results The study protocol was successfully implemented, including the enrollment of study sites, the recruitment of 460 older adults, administration of the intervention, adherence to the plan for assessment, and establishment of a large computerized data base.
Limitations: Methodological challenges were encountered in the areas of site recruitment, participant recruitment, testing, and intervention delivery.
Conclusions The completion of clinical trials involving elders from numerous local sites requires careful oversight and anticipation of threats to the study design that stem from: (a) social situations that are particular to specific study sites; and (b) physical, functional, and social challenges pertaining to the elder population. Clinical Trials 2009; 6: 90—101. http://ctj.sagepub.com
The purpose of this study was to determine whether anterior translation increased significantly after exercise in patients whose anterior cruciate ligament (ACL) was normal, deficient, or ...reconstructed and whether a difference existed among these groups in their knees' response to repetitive stress. The authors examined a total of 103 knees (40 normal, 33 ACL-deficient, and 30 ACL-reconstructed). In all groups, they found a statistically significant increase in anterior translation after exercise. The authors found the mean postexercise increase in anterior translation to be 0.75 + or - 1.21 mm for normal knees, 0.62 + or - 2.08 mm for ACL-deficient knees, and 0.25 + or - 0.88 mm for ACL-reconstructed knees. After using an ANOVA with repeated measures, they determined that there was a statistically significant difference among the groups and, based on post hoc testing with Tukey's procedure, that the post-exercise anterior translation increase in the group with ACL-reconstructed knees was significantly smaller than in either the control group (normal knees) or the group with ACL-deficient knees.
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