The Journal of Musculoskeletal Medicine Vol 25 No 5

Evaluating elbow instability injuries

May 01, 2008

ABSTRACT: Instability may result in overuse injuries in the medialor lateral aspect of the elbow with overhead throwing in athletes.Understanding the functional anatomy helps physicians in the diagnosisand management of injuries. The ulnohumeral articulationprovides a significant amount of inherent stability. An abductionstress test may be used to evaluate medial collateral ligament (MCL)integrity. Patients who have lateral instability usually present withsymptoms after an elbow dislocation. The most sensitive test may bea lateral pivot shift apprehension test. Initial management of an MCLinjury consists of rest, use of anti-inflammatory agents, and physicaltherapy; surgical treatment may be required. Many lateral collateralligament complex injuries that occur with simple dislocations do notrequire surgical treatment. (J Musculoskel Med. 2008;25:248-252)

Injectable corticosteroids for the painful shoulder: Patient evaluation

April 30, 2008

ABSTRACT: Management with corticosteroid injections should beconsidered for a variety of painful shoulder conditions, such ascervical, acromioclavicular, subacromial, glenohumeral, and bicepstendon pathology. Several aspects of the physical examination areused to isolate the anatomical source of a patient's shoulder pain.Knowing how to perform provocative maneuvers and evaluate theresults is critical for making the diagnosis and identifying potentialcorticosteroid/anesthetic injection sites. In our comprehensive16-step shoulder examination, radiographs are not viewed initiallyto avoid bias that can lead to inaccurate diagnosis. When commonprovocative maneuvers for shoulder conditions are used in isolation,their sensitivity and specificity typically are lower than whenthey are used in combination. Obtaining high-quality radiographs isessential. (J Musculoskel Med. 2008;25:236-245)

Pediatric fractures in sports: Epidemiology and strategies for prevention

April 29, 2008

ABSTRACT: Sports activities are becoming increasingly popularamong children in the United States. The number of pediatric injuriescontinues to grow with the number of participants; up to25% of the injuries are fractures. The authors used a broad searchof databases and analyzed the current literature to help define theepidemiology and identify possible prevention strategies. Commonfracture locations include the distal radius, hand, elbow, and clavicle;90% of fractures involve the upper limb. Males sustain fracturestwice as often as females. The highest numbers of injuries occur inbicycle riding, basketball, football, and roller sports. Prospectivestudies of preventive strategies for pediatric sport fractures areurgently needed. (J Musculoskel Med. 2008;25:230-234, 254)

Documenting the burden of pediatric arthritis

April 27, 2008

An estimated 294,000 US children younger than 18 years (or 1 in 250 children) have received a diagnosis of pediatric arthritis or another rheumatologic condition, according to a CDC study designed to gauge the prevalence and annual number of ambulatory health care visits for these disorders. Children with one of the diagnoses account for about 827,000 physician visits each year, including an average of 83,000 emergency department (ED) visits, the study showed. The authors concluded that arthritis-related health care visits impose a substantial burden on the pediatric health care system and that a surveillance paradigm will help monitor and predict young patients' health care needs.

Low sex hormone levels increase fracture risk in older men

April 26, 2008

Meier C, Nguyen TV, Handelsman DJ, et al, University Hospital Basel, Switzerland, andother centers. Endogenous sex hormones and incident fracture risk in older men: theDubbo Osteoporosis Epidemiology Study. Arch Intern Med. 2008;168:47-54.

Easy, accurate RA diagnosis for general physicians

April 25, 2008

Yamane T, Hashiramoto A, Tanaka Y, et al, Kobe University GraduateSchool of Medicine, Japan, and other centers. Easy and accuratediagnosis of rheumatoid arthritis using anti-cyclic citrullinatedpeptide 2 antibody, swollen joint count, and C-reactiveprotein/rheumatoid factor. J Rheumatol. 2008;35:414-420.