Key Practice Recommendations

These key learning points summarize the consensus- and evidence-based recommendations included in this edition. The sources listed here for each statement recommend that physicians perform or implement these actions directly in a clinical setting. A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patientoriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

1. When clinical suspicion for fracture persists despite negative imaging, immobilize the affected extremity with protected weight-bearing; reassess with repeat radiography in 10 to 14 days or with advanced imaging with computed tomography or magnetic resonance imaging without intravenous contrast based on location and risk.
Evidence rating: SORT C
Source: Section One, reference 14

2. Recommend surgical management for patients younger than 65 years with distal radius fractures demonstrating radial shortening greater than 3 mm, dorsal tilt greater than 10 degrees, or intra-articular displacement or step-off greater than 2 mm.
Evidence rating: SORT B
Source: Section One, reference 18

3. Offer corticosteroid injections for de Quervain tenosynovitis and adhesive capsulitis.
Evidence rating: SORT A
Source: Section Two, reference 28 and 30

4. Recommend manual therapies such as osteopathic manipulative treatment for acute or chronic low back pain and massage therapy for acute or chronic low back pain or neck pain to improve pain and function.
Evidence rating: SORT C
Source: Section Three, references 7, 22, 23, and 28

5. Screen patients with chronic pain for comorbid mental health conditions.
Evidence rating: SORT A
Source: Section Four, reference 8

6. Offer cognitive behavior therapy for patients with chronic low back pain.
Evidence rating: SORT A
Source: Section Four, references 11 and 12