An algorithm for the evaluation and treatment of sacroiliac joint dysfunction.

Approximately 90 percent of adults experience an episode of low back pain in their lifetime. Sacroiliac joint (SIJ) dysfunction has been shown to cause approximately 13-30 percent of LBP in the adult population. SIJ fusion is becoming an increasingly popular treatment alternative for SIJ dysfunction. This paper presents a literature-based algorithm to assist the clinician in the evaluation and treatment of patients with suspected SIJ dysfunction.

NP vs. PA: what is the difference?

The recent passage of the Affordable Care Act (ACA) has highlighted the need for more primary care providers. One solution to increase the primary care provider base is the increased utilization of nurse practioners (NPs) and physician's assistants (PAs). Differences exist in the educational background, board examinations and licensing requirements of NPs and PAs. In addition, their practice patterns, recertification and types of supervision are different. Moreover, changes in the NP educational pathway leading to a doctoral degree will create new challenges regarding collaboration agreements currently required by South Dakota statute. This paper discusses the differences and similarities of NPs and PAs to gain a better understanding of these professions.

Evaluating hip pain in children.

Hip pathology in the pediatric patient can be very challenging to diagnose, as there are many diagnoses that must be considered by the clinician. Categorizing children by age can aid in the process of making an early diagnosis, which is especially important when it comes to serious pediatric hip conditions such as septic arthritis, Legg-Calvé-Perthes disease and slipped capital femoral epiphysis.

The effect of obesity on orthopaedic conditions.

Obesity is a worldwide health problem leading to a range of health consequences. This review summarizes the known effects of obesity on the musculoskeletal system. Specifically, the effects of obesity on the shoulders, spine, knees, feet and other areas related to sports medicine are examined.

Spinal health and smoking.

Spine care is a growing concern for health care in the United States. Although the etiology of spinal pain can be multifactorial, reducing preventable causes would have a significant impact on the morbidity and lost productivity that parallels spinal disease. Numerous studies have demonstrated significant direct relationships between smoking and back pain. Other studies identify smoking as a strong predictor for slow recovery or pseudoarthrosis, the failure of solid fusions, following spinal surgery. The mechanisms by which these occur may be multi-faceted, from decreased exercise among smokers to disruption of cellular metabolism in the vertebral bodies and discs.

Hip fracture management and outcomes at a regional South Dakota hospital.

The annual number of hip fractures is expected to increase dramatically in coming decades. It is, therefore, in the best interest of the health care community to maximize its efficiency in treatment of such fractures. This study examines the outcomes for elderly patients admitted to a Midwest regional hospital with the diagnosis of hip fracture in 2007. It found that the hospital tended to keep auxiliary cardiac testing at a minimum, treat as many patients as possible, get patients into surgery as quickly as possible and minimize both lengths of stays and mortality. However, our study found there was room for improvement in decreasing the wait time to surgery for the patient by improving physician communication and laboratory turnaround.

Idiopathic toe-walking.

Idiopathic toe-walking is a diagnosis of exclusion when a child presents with bilateral toe-to-toe gait. Although toe-walking is considered part of the normal gait spectrum in development, it is abnormal when persisting past the age of two. Toe-walking may be caused by cerebral palsy, congenital contracture of the Achilles tendon or paralytic muscular disorders such as Duchenne Muscular Dystrophy. Idiopathic toe-walking may be associated with developmental disorders such as autism or other myopathic or neuropathic disorders. The majority of disorders causing toe-walking can be ruled out through the history and physical examination, resulting in a diagnosis of idiopathic toe-walking. However, it may be difficult to differentiate mild forms of cerebral palsy, specifically mild spastic diplegia, and idiopathic toe-walking. The treatment options for idiopathic toe-walking include observation, conservative methods and surgical methods. Most children can be treated in the primary care setting with either observation or conservative treatment. Patients with severe contracture of the Achilles tendon, or persistent toe-walking, may need surgical intervention. The prognosis of idiopathic toe-walking is favorable with both conservative and surgical treatment allowing children to attain normal function and range of plantarflexion. The following article provides an overview of the background information, differential diagnosis and treatment options for idiopathic toe-walking.

Vertebral compression fractures: treatment and evaluation.

Vertebral compression fractures can occur secondary trauma, malignancies, or most commonly osteoporosis. Osteoporosis causes almost 1.5 million fractures throughout the United States every year and nearly 700,000 of these fractures are vertebral compression fractures. These fractures are frequently seen in elderly women; 40 percent of women older than 80 years old are affected by vertebral compression fractures. These injuries can be treated both conservatively and surgically. The conservative route includes bed rest, pain control, bracing, and strength training. The surgical method includes percutaneous vertebroplasty and kyphoplasty, both minimally invasive procedures. This article provides a general introduction to vertebral compression fractures and osteoporosis, the diagnostic methods used to identify vertebral compression fractures, and the known treatments.

Spinal stenosis.

Spinal stenosis can be generally described as the narrowing of the spinal canal causing compression of the spinal cord. This compression most often occurs in the lumbar portion of the spine and has a clinical presentation of pain and numbness in the low back, legs and buttocks after walking or extension of the lumbar spine. The symptoms associated with lumbar spinal stenosis are usually relieved with flexion of the lower back. In addition, compression at the cervical spine has occasionally been seen in combination with lumbar spinal stenosis, with thoracic spinal stenosis occurring only rarely. Therefore, because spinal stenosis is the most prevalent preoperative diagnosis for spine surgery and affects nearly 5 of every 1000 Americans older than 50 years old, it is imperative to understand the role of spinal stenosis in generating back and leg pain. In this article an overview of the etiology, treatment, and outcomes will be presented to give a better understanding of this condition.

Monteggia fractures: beware!

Monteggia fractures consist of an ulna fracture accompanied by radial dislocation. These fractures are easily overlooked because of the prominence of the ulnar fracture. Furthermore, the leading cause of malpractice cases brought against emergency departments involve missing high-risk orthopedic injuries, such as Monteggia fractures. The purpose of this article is to provide sufficient information to reduce the possibility of underestimating forearm injuries and, consequently, diagnose a Monteggia fracture correctly. This article outlines the classification of Monteggia fractures, the mechanism of injury, a specific case report, and a discussion of consequences when the extent of the injury is underestimated. Finally, specific ways are presented to easily avoid the misjudgment of a Monteggia fracture.