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Although childhood leg and foot problems are a common concern for parents, most are normal variants of growth that resolve without treatment. The musculoskeletal examination should include evaluation for hip dysplasia, leg length discrepancy, and joint laxity; assessment of passive range of motion and rotational positioning of the lower extremities (i.e., torsional profile); and a gait analysis. Learn when parental reassurance is sufficient and when to refer to an orthopedist for further evaluation and treatment.
Several treatments for calcaneal apophysitis may produce modest short-term improvements in pain scores. Heel inserts and prefabricated orthotics may initially improve pain scores and dysfunction, but patients have equal improvement by three months with or without therapy.
Superficial bursitis most often occurs in the olecranon and prepatellar bursae. Diagnosis is usually based on clinical presentation, with a particular focus on signs of septic bursitis.
Many common acute shoulder injuries can be managed without surgery by a knowledgeable family physician; however, it is important to know when to refer to an orthopedist. Learn about diagnostic clues, conservative management options, and indications for referral.
Jul 1, 2016 Issue
Topical NSAIDs for Acute Musculoskeletal Pain in Adults [Medicine by the Numbers]
Studies show that patients had improved pain control with diclofenac gel, ketoprofen gel, and ibuprofen gel with no increase in local or systemic adverse events. See why.
Vertebral compression fractures can lead to chronic pain, disfigurement, height loss, impaired activities of daily living, increased risk of pressure sores, pneumonia, and psychological distress. Find out which patients are most likely to benefit from conservative therapy, and when to consider surgery.
This study found no significant difference in the management of acute musculoskeletal extremity pain, including fractures, with oxycodone/acetaminophen vs. hydrocodone/acetaminophen. Adverse events, including nausea and dizziness, occurred significantly more often with oxycodone/acetaminophen.
It is hard to figure out what to do with these results. On the one hand, steroid injection did not provide a significant benefit compared with placebo injection in patients with radicular pain or spinal stenosis. However, part of the reason for this may be the significant and sustained improvement of pain scores seen with the placebo injection.
Quinine is moderately effective in decreasing the frequency and intensity of muscle cramps, but it is also associated with an increase in minor adverse effects. In addition, there is a risk of rare but serious adverse effects.
Find out which types of fractures can be treated conservatively and which ones require orthopedic referral, as well as typical healing times for the most common types of foot fractures seen in primary care: metatarsal shaft fractures, proximal fifth metatarsal fractures, and toe fractures.