Upper extremity bursitis.

Upper extremity bursae are injured through a number of processes, including overuse, hemorrhage, crystal deposition, autoimmune diseases and infection. These injuries may be disabling and can pose significant diagnostic and therapeutic challenges for the clinician. Treatment of the most common forms is directed at pain management and functional rehabilitation through a structured exercise program. Early recognition of infectious bursitis, followed by appropriate surgical and antibiotic treatment, is critical to prevent severe sequelae in these cases. This article reviews the pathophysiology, evaluation and treatment of the three most commonly involved upper extremity bursae: the subacromial, the olecranon and the subscapular bursae.

Efficacy of strength training in prepubescent to early postpubescent males and females: effects of gender and maturity.

There has been considerable debate concerning the benefits of children participating in weight training programs. With the potential benefits of such training in specific rehabilitation regimens, the safety/efficacy of weight training is a topic in need of scientific study. Fifty-two experimental and 39 control subjects participated in this study. A 2 x 2 x 2 (gender by treatment by Tanner stage) ANOVA was used to examine pre- to post-test differences in six strength measures, eight anthropometric measures, five motor performance measures, and one flexibility measure associated with participation in a 12-week progressive resistance programme. In addition, safety of the weight training programme was examined. For strength differences, there were two significant main effects favouring strength gains in males and four favouring the experimental group. For anthropometric changes, 3-way interactions occurred that were not easily explained. However, the predominant main effect was treatment; the experimental group generally experienced gains in body segment girths with decreases in skinfold thickness. For motor performance, the experimental group had greater improvements in three of five parameters. The experimental group also had significantly greater gains in flexibility. The weight training programme was associated with only one injury. These findings support the general observation that physical benefits can be gained safely by children who participate in a weight training programme.

Patient profile, referral sources, and consultant utilization in a primary care sports medicine clinic.

BACKGROUND: Sports medicine has matured as a focused discipline within primary care with the number of primary care sports medicine physicians growing annually. The practices of these physicians range from "part-time" sports medicine as a part of a broader practice in their primary specialty, to functioning as a full-time team physician for a university or college. Managed care organizations are increasingly incorporating primary care sports medicine providers into their organizations. The optimal role of these providers in a managed care system has not been described. METHODS: A descriptive analysis was made of patient contacts in a referral-based, free-standing primary care sports medicine clinic associated with a large managed care system. This study describes patient information including demographic data, referral source, primary diagnosis, specialized diagnostic testing, and subsequent specialty consultation. RESULTS: A total of 1857 patient contacts were analyzed. New patients were referred from a full range of physicians both primary care (family practice, internal medicine, pediatrics, and emergency physicians) and other specialists, with family practice clinic providers (physicians, physician assistants, and nurse practitioners) accounting for the largest percentage of new referrals. The majority of patient visits were for orthopedic injuries (95.4%); the most frequently involved injury sites were: knee (26.5%), shoulder (18.2%), back (14.3%), and ankle (10%). The most common types of injury were: tendinitis (21.3%), chronic anterior knee pain (10.6%), and ligament sprains (9.9%). Specialized testing was requested for 8% of all patients. The majority of patients were treated at the Ft Belvoir Sports Medicine Clinic by primary care sports medicine physicians without further specialty referral. CONCLUSIONS: Primary care sports medicine physicians offer an intermediate level of care for patients while maintaining a practice in their primary care specialty. This dual practice is ideal in the managed care setting. This study demonstrates the complementary nature of primary care sports medicine and orthopedics, with the primary care sports medicine physician reducing the demand on orthopedists for nonsurgical treatment. This study also demonstrates the need for revision in the orthopedic curriculum for primary care physicians.

Evaluation of pediatric foot problems: Part II. The hindfoot and the ankle.

The bony development of the growing child can lead to a variety of hindfoot and ankle problems. Overuse injuries are common, often occurring in conjunction with symptomatic pes planus and plantar fasciitis. Predisposing structural differences such as Haglund's disease, os trigonum, rigid and flexible pes planus, and Sever's disease merit special attention, but treatment may require only patient education and conservative management. Sprains and fractures of growing joints, however, may have poor outcomes if ignored or missed.

Evaluation of pediatric foot problems: Part I. The forefoot and the midfoot.

Foot problems in children can be the result of infection, trauma or overuse. Ingrown toenails, bunions, sesamoid disease, congenital overriding of the fifth toe, and fractures may occur in both adults and children. Some disorders, such as Freiberg's infarction and Kohler's disease, however, are unique to the pediatric population. The potential for adverse sequelae is greater in children than in adults. A thorough understanding of the anatomy of the pediatric foot and a systematic examination will facilitate the diagnosis of pediatric foot problems. A conservative approach to management will improve both compliance and outcome.

Lower extremity bursitis.

Bursitis is a common cause of lower extremity pain in patients presenting to primary care physicians. Several bursae in the lower extremity account for most of these injuries, including the ischiogluteal, greater trochanteric, pes anserine, medial collateral, prepatellar, popliteal and retrocalcaneal. Often the symptoms are mild, with the patient successfully self-treating through activity modification and other conservative measures. A systematic approach to the evaluation and treatment of patients with bursitis, including prevention, relative rest, ice, compression, elevation, anti-inflammatory medication and treatment modalities such as ultrasound and electrical stimulation, combined with a structured rehabilitation program, will greatly facilitate the healing process.

Common upper-extremity injuries.

In the daily practice of family medicine, injuries to the upper extremity are frequently encountered. Most of these injuries can by easily treated by the primary care physician who has an understanding of the joint anatomy and treatment principles. Some injuries, however, may appear relatively minor, yet require prompt referral for surgical care. We reviewed the pathoanatomy, historical and physical examination findings, and treatment of the more common injuries to the hand, wrist, elbow, and shoulder.

Special considerations for the pediatric running population.

Ever greater numbers of children are participating in running sports at earlier ages. These children will encounter many of the same problems seen in adults, but will also have many unique concerns. This article was written to provide information to primary health care providers on the differences in risks, injuries, treatments, and general health concerns of the pediatric running population.

Injuries and illnesses incurred by an army ranger unit during Operation Just Cause.

Detailed knowledge of anticipated casualties is essential for the medical officer preparing to support a mission. To accurately describe the injuries inflicted upon the 2/75th Ranger Battalion involved in Operation Just Cause, 471 (75.5%) Rangers were personally interviewed. The average Ranger was 23 years old, an E-4 with 3 years of active duty service, and in a good to excellent fitness category. The majority went into battle with little sleep or food. Injuries forced 9.5% out of combat, and limited another 9.9%. The overall unit casualty rate was 35%, with 217 Rangers suffering 281 injuries. Most of the injuries were musculoskeletal (sprains) and non-surgical, with 90% occurring during the insertion. The lower extremity, particularly the ankle, was the most frequently injured area. It is hoped that this study will assist those who are planning to support future, similar nighttime parachute operations.

Exercise-induced heat injury: diagnosis and management.

Exertional heat illness represents a spectrum of conditions ranging from the benign to the life-threatening. Prompt assessment and treatment can prevent fatalities in those who present as a heat casualty. More importantly, however, these injuries can be prevented from occurring altogether. This article reviews the physiology of thermoregulation and the pathophysiology of heat injuries associated with exercise. Current approaches toward the diagnosis, treatment, and prevention of exercise-induced heat injuries will also be discussed.

Appropriate strength training.

Strength training stimulates predictable cardiovascular and neuromuscular responses. The cardiovascular responses result in nonpathologic concentric left ventricular hypertrophy with preservation of ejection fraction and no diastolic dysfunction. Resting heart rates and blood pressures in strength-trained individuals remain unchanged or decrease slightly. Strength gains occur from enhanced neuromuscular activation over the initial 8 weeks and from increased muscle fiber density and hypertrophy during subsequent weeks. Significant strength gains are possible in all populations, including children, women, and the elderly, when exposed to an adequate strength-training program. Strength training can also be a valuable adjunct in cardiac rehabilitation with the possible exception of patients with baseline abnormal left ventricular function.

Stress fracture of the first rib from serratus anterior tension: an unusual mechanism of injury.

Fracture of the first rib usually results from high-impact, direct trauma. Stress fractures are less common and are associated with minimal morbidity. The case of a patient with a stress fracture resulting from the use of an exercise machine is reported. Previous reports have attributed stress and fatigue fractures of the first rib to the forces exerted by the scalene muscles. A new pathophysiologic mechanism involving the serratus anterior muscle is introduced and is supported by T2 relaxation times from magnetic resonance imaging. Stress and fatigue fractures of the first rib have minimal complications. An aggressive diagnostic evaluation of first rib fractures occurring by this mechanism is not warranted.