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The initial examination of an infant was notable for passive hyperextension at right knee but otherwise full range of motion.
May 15, 2018 Issue
Hyperpronation Method for Reduction of Nursemaid's Elbow [Medicine by the Numbers]
Although data are limited, the results have consistently shown a higher rate of success with first attempt reduction of nursemaids' elbow when the hyperpronation method was used. For other outcomes, including pain and adverse effects such as bruising, no conclusions could be drawn because the quality of evidence was poor.
The latest installment of the top 20 research studies for primary care physicians includes studies on cardiovascular disease and hypertension, infections, diabetes mellitus, musculoskeletal problems, and cancer screening, among other topics. The five highest-rated practice guidelines are also summarized.
Lumbar fusion for degenerative spinal disease appears to be most beneficial for patients undergoing the procedure for spondylolisthesis, but it is of little clear benefit for patients with other indications, such as spinal stenosis or chronic back pain.
Most running injuries are due to overuse and typically respond to conservative treatment. Learn which tests can help diagnose patellar tendinopathy, patellofemoral pain syndrome, iliotibial band syndrome, Achilles tendinopathy, plantar fasciopathy, and tibial and hamstring injuries, and the recommended treatments for each condition.
Calcium channel blockers or B vitamins may lead to short-term improvement in nocturnal leg cramps. Stretching has mixed results. Quinine is effective but is no longer recommended, and it is not approved for treatment of leg cramps because of potential toxicity.
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.