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The Journal of Musculoskeletal Medicine Vol 26 No 8

Diagnosis of isolated axillary neuropathy in athletes: Case studies

August 05, 2009

Isolated axillary neuropathy is a somewhat uncommon diagnosis, but it may not be as rare as might be expected. Given a thorough clinical history, physical examination, and timely studies, the diagnosis needs to be considered in the differential in the proper setting. Sports and other activities in which this injury might occur include overhead sports (eg, volleyball, javelin), racquet sports, gymnastics, rock climbing, workouts that involve shoulder traction (eg, pullups), and contact sports that involve tackling with an extended arm (eg, rugby, American football).

Established and Novel Treatments for Lupus

August 04, 2009

Although many medications are used for the management of systemic lupus erythematosus (SLE) and its complications, only aspirin, corticosteroids, and the antimalarial drug hydroxychloroquine (HCQ) are specifically approved by the FDA.1 Most other medications used for SLE treatment are commercially available off label (Table 1), usually borrowed from cancer or transplant regimens. In some cases, medications have been approved for a specific clinical manifestation seen in both idiopathic disease and SLE, such as bosentan for pulmonary hypertension.

Evaluating cardiovascular risk in rheumatoid arthritis

August 04, 2009

There have been significant advances in the management of rheumatologic disorders with the availability of newer disease-modifying drugs and biologic agents. However, cardiovascular disease (CVD) morbidity and mortality remain significantly increased in patients with rheumatologic disorders, especially rheumatoid arthritis (RA)1-4 and systemic lupus erythematosus (SLE).

Making bone health a top priority

August 02, 2009

An estimated 52 million Americans will have osteoporosis and low bone mass by next year, according to the National Osteoporosis Foundation (NOF), constituting what the Surgeon General 5 years ago termed "a major public health threat" with "epidemic" proportions. For 25 years, the NOF has been dedicated to preventing osteoporosis and related fractures, promoting lifelong bone health, improving the lives of those affected by the condition and-through programs of awareness, advocacy, public and health professional education, and research-finding a cure. This year, the NOF is marking its 25th anniversary by providing sets of 25 osteoporosis and bone health educational materials for patients and their physicians.

Delineating risk factors may prevent lower extremity injury

August 02, 2009

Athletes classified as having high generalized joint laxity demonstrate increased midfoot loading, according to researchers at the Sports Medicine Biodynamics Center at Cincinnati Children’s Hospital. Foss and associates1 noted that delineation of risk factors for medial collapse of the foot, including hypermobility in athletes, may help clinicians evaluate and prevent lower extremity injury.

Low back pain contributors: Defining a role for biomechanical deficiencies

August 02, 2009

Although low back pain (LBP) may be attributed to a variety of known vertebral disorders (eg, fractures, infections, tumors, and hernias), a definitive diagnosis often remains elusive.1 Biomechanical deficiencies of the lumbar spine may be a contributor, according to students at the University of Southern California's Musculoskeletal Biomechanics Research Laboratory (MBRL), and they are conducting research to determine what role the deficiencies may play in an effort to identify improved rehabilitation interventions.

Serum urate level is an unreliable indicator of acute gout

August 01, 2009

A normal serum urate (SU) level at presentation does not exclude an acute gouty attack. A normal level should be considered below 6.8 mg/dL rather than 8 mg/dL as is accepted and reported by several laboratories.

Combination therapy improves both pain and depression

August 01, 2009

For patients who have comorbid depression and musculoskeletal pain, optimized antidepressant therapy combined with pain self-management may result in substantial improvements in both conditions. However, additional interventions may be needed to achieve bigger improvements in pain and higher depression response and remission rates.

BMD-erosions correlation in RA: Potential for bone-directed treatments?

August 01, 2009

Hip bone mineral density (BMD) correlates with erosion scores in postmenopausal women who have rheumatoid arthritis (RA), although the relationship is not statistically significant after adjustment for clinical factors. BMD and erosions appear to be more strongly correlated in patients with early RA. Solomon and coworkers studied 163 postmenopausal women being treated for RA but not for osteoporosis.

Balloon kyphoplasty better for vertebral compression fracture

August 01, 2009

Balloon kyphoplasty results in more and faster improvements in quality of life and disability measures and reduction of back pain than nonsurgical treatment for patients with acute painful vertebral fracture. However, the differences in improvement diminish by 1 year after treatment for most outcome measures, probably because of natural fracture healing.

Clinical utility of the Fibromyalgia Impact Questionnaire is enhanced

August 01, 2009

Bennett RM, Bushmakin AG, Cappelleri JC, et al, Oregon Health and Science University, Portland, and other centers. Minimal clinically important difference in the fibromyalgia impact questionnaire. J Rheumatol. 2009;36:1304-1311.