The Journal of Musculoskeletal Medicine Vol 25 No 4

Managing hand and finger injuries in ball sports

March 30, 2008

Many hand and finger injuries in ball sports are misdiagnosedor mismanaged, possibly leading to disability. Primary carephysicians who obtain a detailed history, conduct a focused examination,and know the indications for referral can manage themeffectively. The chief complaint is pain. In mallet finger, a finger is"jammed" during sports participation; nonoperative treatment oftenis indicated. The ring finger is involved in most reported cases of jerseyfinger; surgical intervention is the treatment of choice. Managementof boutonnière deformity helps patients regain full strengthand range of motion. Collateral ligament injuries may occur at anyinterphalangeal joint. Finger fractures are the fractures most oftenseen in the primary care setting. Malrotation with phalangeal fracturesis unacceptable. (J Musculoskel Med. 2008;25:198-204)

Pregnancy Dilemmas in Rheumatologic Disease

March 29, 2008

Pregnant women with rheumatologic disease face dilemmascreated by their pregnancy and are at increased risk for complications. Some dilemmas are created by the medications that areused to control inflammation; others are created by disease activityor laboratory values. Dilemmas include fetal risk from receivingleflunomide and exposure to tumor necrosis factor α in pregnancy;timing and management of lupus nephritis in pregnancy; andasymptomatic elevated antiphospholipid antibodies. (J MusculoskelMed. 2008;25:190-195)

Injection of the wrist and ulnar styloid

March 28, 2008

The wrist, a complex joint, often is involved in inflammatoryarthritis, such as rheumatoid arthritis or psoriatic arthritis. Wristsynovitis causes pain, swelling, and loss of extension. Extension of thesynovial lining may lead to synovitis of the ulnar styloid. During injectionof the ulnocarpal joint, the lidocaine and corticosteroid mixtureshould flow without resistance. Injecting air after corticosteroidinjection of the ulnar styloid creates a seal that prevents the corticosteroidfrom leaking up the needle tract into the dermal layer and creatingunsightly depigmentation. (J Musculoskel Med. 2008;25:188-189)

Fighting fibromyalgia: Five key issues

March 27, 2008

ABSTRACT: Physicians treating patients with fibromyalgia syndrome(FMS) should rule out coexisting disorders and establish possible inducingfactors. They can work with patients to address their symptomsby providing patient education, instilling a sense of self-worth,advising avoidance of disability and narcotic medications, offeringinstruction in sleep hygiene, establishing anxiety reduction measures,and recommending an exercise program. Patients who havespecial needs and refractory cases may benefit from referral to amusculoskeletal specialist. Physicians can best improve patients'prognosis and quality of life by addressing several issues: whetherthe FMS is primary or secondary, whether there are underlying psychosocialstressors, whether pain is regional or widespread, how toapproach exercise for therapy, and determining which medicationsto use. (J Musculoskel Med. 2008;25:172-184)

Pregnancy dilemmas in rheumatologic disease

March 26, 2008

Pregnant women with rheumatologic disease face dilemmascreated by their pregnancy and are at increased risk for complications.Some dilemmas are created by the medications that areused to control inflammation; others are created by disease activityor laboratory values. Dilemmas include fetal risk from receivingleflunomide and exposure to tumor necrosis factor α in pregnancy;timing and management of lupus nephritis in pregnancy; andasymptomatic elevated antiphospholipid antibodies. (J MusculoskelMed. 2008;25:190-195)

The 10-minute examination for low back pain

March 26, 2008

Low back pain (LBP) is a major public health problem and a common reason for patient visits to a primary care physician. A pathoanatomically precise diagnosis cannot be made in most patients, and the primary care physician typically has only limited time to conduct a complete examination. A brief visit that is highly structured for efficiency can provide direction about the underlying pathology of acute LBP, leading to appropriate pharmacotherapy and adjunctive measures. Asking targeted questions during the history taking is the key to a successful diagnosis. Patient education helps ensure a successful outcome. Use of analgesics and skeletal muscle relaxants can help relieve symptoms in many patients. (J Musculoskel Med. 2008;25:162-168).

Overcoming obstacles in musculoskeletal medicine

March 25, 2008

Demand for total joint replacement (TJR) surgeries will far outstrip supply in the coming years, significantly diminishing the quality of patient care, and methicillin-resistant Staphylococcus aureus (MRSA) infection threatens to become a "21st-century plague,"according to speakers at the recent American Academy of Orthopaedic Surgeons (AAOS) annual meeting held in San Francisco.The breakthrough potential of stem cells, tissue engineering, and gene therapy in musculoskeletal medicine was another key area of discussion.