The Journal of Musculoskeletal Medicine Vol 25 No 11

Clinical management of muscle strains and tears

November 02, 2008

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.

Managing and preventing hip pathology in trochanteric pain syndrome

November 01, 2008

Greater trochanteric pain syndrome shares painpatterns with other musculoskeletal conditions, complicatingthe diagnosis and treatment. Many advances in evaluating andmanaging hip pathology have resulted in improved outcomes.Conservative treatment includes the use of NSAIDs for reducing pain.Physical therapy is combined with stretching of the iliotibial band andhip external rotators. Successful relief of trochanteric compartmentpain has been achieved with local anesthetic and corticosteroidinjections. Surgical management often results in significant improvementin refractory pain. There are several ways to work towardpreserving the integrity of the joint, especially maintaining anappropriate biomechanical relationship between the acetabular fossaand the femoral head. A diversified strength-training program isrecommended. (J Musculoskel Med. 2008;25:521-523)

Advances in pediatric rheumatology paving the way to better care

October 30, 2008

Advances in pediatric rheumatologic disease have pavedthe way to better outcomes for children. Anchoring an improved standardof care is the patient care team, including the primary carephysician, pediatric rheumatologist and associated rheumatologyhealth care personnel, and patient and family. Improved medicationshave expanded the treatment arsenal to include disease-modifyingantirheumatic drugs and biologic agents. The medical regimen can bebolstered with a program of healthy diet and exercise that focuses onsuch low-impact activities as swimming, stretching, and bicycling. Thepatient and family can work together to ensure that the child complieswith the prescribed treatment and also takes care to get adequate,restful sleep; manage stress; and protect bone. (J MusculoskelMed. 2008;25:505-512)

MRI for Evaluating Knee Pain in Older Patients: How Useful Is It?

October 29, 2008

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)

Heart failure differs in patients with RA

October 26, 2008

The clinical presentation and outcome of heart failure differ significantly in patients who have rheumatoid arthritis (RA) and those who do not.The presentation of heart failure is more subtle in patients with RA, and mortality is significantly higher.