The Journal of Musculoskeletal Medicine Vol 25 No 10

Taking a closer look at rotator cuff disorders

October 01, 2008

ABSTRACT: Symptomatic rotator cuff disease usually occurs whenbiological factors combine with dynamic events in the setting of staticstructural problems. At risk are persons with compromised blood supplyto the cuff tissues; a history of repetitive overhead or sudden,acute trauma to the rotator cuff; or abnormalities that disrupt thebalance of forces across the cuff. The key to management lies in understandingrotator cuff anatomy and biomechanics. Patients maypresent with pain and weakness, but tears also may be asymptomatic.A combination of physical examination, shoulder testing, and MRIusually will confirm the diagnosis. Evidence suggests that rotator cuffdisease can progress if the patient does not receive treatment. Rest,corticosteroids, and physical therapy are the basics of conservativecare. (J Musculoskel Med. 2008;25:481-488)

Osteoarthritis: 20 Clinical pearls

September 30, 2008

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)

Aspiration and injection of the knee

September 29, 2008

ABSTRACT: Acute pain in the knee and its surrounding structuresmay be related to fractures, septic and inflammatory arthritis,ligamentous and meniscal injuries, or tendinous strains. Chronicsymptoms often result from osteoarthritis and inflammatoryarthritides, bursitis, and tendinitis. Aspiration and analysis of kneesynovial fluid is a safe and reliable means of diagnosing many acuteand chronic conditions, and knee injection also remains an effectiveway to administer pain-relieving therapies. For aspiration of largeeffusions, the medial retropatellar and superolateral retropatellarapproaches are preferred because they permit access to the suprapatellarpouch. These two approaches may be used for aspiration orinjection or both. The anterior approach is convenient when onlyinjection is performed. (J Musculoskel Med. 2008;25:470-472)

Managing Musculoskeletal Issues in Lupus: The Patient’s Input Invited

September 27, 2008

ABSTRACT: About half of patients with systemic lupus erythematosusexperience musculoskeletal involvement: arthritis, arthralgia,myalgias,myositis, tenosynovitis, fibromyalgia, or osteonecrosis. Patientswith arthritis often have symmetrical large- and small-joint polyarthritisunassociated with radiographic evidence of erosive or deformingdisease.Treatment generally focuses on anti-inflammatoryagents, such as NSAIDs and corticosteroids. Antimalarials are commonlyused. When NSAIDs prove ineffective, limited use of corticosteroidsmay help, but patients need to be informed of the adverseeffects. Antimalarial agents usually are recommended for all personswith lupus arthritis. Shared decision making can allay concernsabout drug toxicity and adverse effects and encourage compliancewith treatment. (J Musculoskel Med. 2008;25:458-463)

Reducing gender bias in anterior cruciate ligament injury research

September 26, 2008

Much has been learned about characteristic sex differences in knee structure and function, but researchers still know little about the underlying causes of the differences or whether they reflect an increased injury risk for physically active women versus men, according to a new consensus statement on anterior cruciate ligament (ACL) injuries from the National Athletic Trainers' Association (NATA).