U.S. Army combat operational stress control throughout the deployment cycle: a case study.

As military conflicts around the world persist, a comprehensive approach in managing behavioral health issues will continue to be a key component of military healthcare. Deployed military personnel frequently exposed to trauma are well-known to be at high risk for developing behavioral health disorders, including combat stress reactions and posttraumatic stress disorder. In the U.S. Army, members of combat operational stress control (COSC) units have unique skills to assist soldiers and their families not only throughout all phases of a deployment, but also throughout a soldier's entire career. The purposes of this article are twofold, first to describe the role of COSC operations with an emphasis on interventions in a deployed environment. The second purpose is to present a case study from Operation Iraqi Freedom highlighting the efficacy of the COSC approach to meet a Soldier's behavioral health needs in a deployed environment.

Analysis of clinical motor testing for adult patients with diagnosed ulnar neuropathy at the elbow.

OBJECTIVE: To compare the dichotomous results for 7 ulnar nerve clinical motor tests (Froment's sign, Wartenberg's sign, finger flexion sign, Jeanne's sign, crossed finger test, Egawa's sign, presence of clinical fasciculations) with motor nerve conduction velocity findings. DESIGN: A static group comparison design assessed for differences among dichotomous test outcomes with respect to motor nerve conduction velocity. SETTING: Five medical facilities throughout the United States provided data for this study. PARTICIPANTS: Records from participants (N=26) with diagnosed ulnar neuropathy at the elbow were included for data analysis. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Demographic data included age, sex, handedness, duration of symptoms, and the number of days between the clinical and electrodiagnostic exam. Other dependent variables included motor conduction velocity of the ulnar nerve, compound muscle action potential amplitude, and the dichotomous clinical motor test outcomes. RESULTS: Two motor signs, the presence of clinical fasciculations and a positive finger flexion sign, were identified more frequently (each present in 11 patients) than the other motor signs. An analysis of covariance revealed significant differences in motor nerve conduction velocity between positive and negative results for all the clinical motor tests except for the finger flexion sign. Significant chi-square analyses were found for the following comparisons: the presence of clinical fasciculations and Froment's sign, the finger flexion sign and the crossed finger test, Egawa's sign and Froment's sign, Warteberg's sign and Froment's sign, the crossed finger test and Froment's sign, and Egawa's sign and Wartenberg's sign. CONCLUSIONS: Some clinical motor tests are better than others at identifying early motor involvement, providing the rehabilitation professional some insight regarding the relative decrement of motor nerve conduction velocity when a selected test is positive.

Clinical relevance of neuromuscular findings and abnormal movement patterns: a comparison between focal hand dystonia and upper extremity entrapment neuropathies.

NARRATIVE REVIEW: Patients with focal hand dystonia and upper extremity entrapment neuropathies may present with similar symptoms and risk factors making it difficult to distinguish between the two diagnoses. Evaluating for the presence of neuromuscular findings and abnormal movement patterns can help assist the hand therapist in identifying the presence of focal hand dystonia or peripheral motor axon involvement in the absence of pronounced muscle atrophy. The purposes of this review article are twofold. First, to describe selected neuromuscular signs and symptoms characteristic of patients presenting with repetitive overuse syndromes of the upper limb leading to either a nerve entrapment syndrome or a focal hand dystonia. The selected topics will be limited to an overview of ectopic neuronal activity with an emphasis on fasciculations, muscle spasms/cramps, and sensation (including pain). Second, the article will conclude with a brief synopsis of focal hand dystonia and compression neuropathies, highlighting general assessment and treatment principles.

A review of clinical tests and signs for the assessment of ulnar neuropathy.

UNLABELLED: NARRATIVE REVIEW: As part of a comprehensive assessment for suspected ulnar neuropathy, clinical testing plays an important role in the initial identification of a lesion and determining subsequent changes from baseline. The purpose of this article was to review ulnar nerve provocative testing and the substantial collection of diagnostic signs and tests. Administration procedures for each maneuver are described as well as the resulting positive and negative outcomes. The clinical tests described constitute only one aspect of the examination and should not substitute for other key components, such as taking a thorough medical and occupational history. Empirical research studies are indicated to further quantify the relationship between the testing outcomes and the severity of a lesion as well as to determine the most robust motor signs seen in the early stages of the disease. LEVEL OF EVIDENCE: 5.

James traction splinting for PIP fractures.

Comminuted phalanx fractures about the PIP joint are a common injury seen in sports and recreational activities. Corrective treatment frequently requires some form of open reduction with internal fixation. These types of invasive treatments are insulting of soft tissue and often create significant secondary problems. These authors have designed a splint that attempts to optimize outcomes following fracture and surgical treatment.