Multidimensional evaluation of tracheobronchial disease in adults.

The large airways can be affected by a wide spectrum of acquired benign and malignant diseases. These lesions may present as focal or diffuse processes and with narrowing or widening of the airway. Some of these may be asymptomatic for quite some time and may be incidentally detected on imaging, while others may be symptomatic, causing airway compromise. There may be a characteristic radiograph and computed tomography (CT) appearance, suggesting a narrow differential. When the imaging findings are not definitive, tissue may be obtained for pathological analysis. It behooves the radiologist to be familiar with the pathologic findings that correlate with the radiographic or CT appearance of the most frequently seen large airway lesions. In this way, we may improve our diagnostic accuracy. This paper will present the imaging findings of the most prevalent tracheobronchial lesions along with any associated pathology. Teaching Points • The large airways can be affected by many acquired benign and malignant diseases.• Large airway lesions may present as focal or diffuse processes, with narrowing or widening.• There may or may not be characteristic imaging appearance of large airway disease.• If imaging findings are not definitive, tissue may be obtained for pathological analysis.

Hand Sensibility, Strength, and Laxity of High-Level Musicians Compared to Nonmusicians.

PURPOSE: To determine whether musicians have more sensitive, stronger, and flexible hands than nonmusicians. METHODS: A total of 100 musicians and 100 control subjects were assessed for 2-point discrimination, Semmes-Weinstein monofilament light touch, grip and pinch strength, and laxity. Musicians were included if enrolled as instrumental performance majors at a 4-year accredited conservatory of music. Nonmusician controls were university students who never or rarely engaged in playing an instrument. All subjects were between the ages of 18 and 28. The exclusion criterion was history of any hand condition, trauma, surgery, or diabetes. Statistical analyses were carried out using the t test, analysis of variance, and correlation coefficients as appropriate. RESULTS: High-level musicians in our cohort showed the same handedness (dominance) as the general population. The musicians were weaker than the nonmusicians. Male musicians were significantly weaker in pinch and grip bilaterally than nonmusicians, whereas female musicians were significantly weaker only in grip on the right/dominant side. Two-point discrimination was significantly less in musicians for the left/nondominant index, ring, and small fingers, and the right/dominant small and dominant index finger. Semmes-Weinstein testing was significantly better for the right/dominant digits, including the thumb, but not the left digits with the exception of the ring and nondominant middle and ring. There was no difference in laxity between the 2 groups. CONCLUSIONS: High-level musicians have, in general, more sensitive but weaker hands than nonmusicians, but the differences seem small and may not be clinically important.

Non-surgical treatment of lateral epicondylitis: a systematic review of randomized controlled trials.

BACKGROUND: Non-surgical approaches to treatment of lateral epicondylitis are numerous. The aim of this systematic review is to examine randomized, controlled trials of these treatments. METHODS: Numerous databases were systematically searched from earliest records to February 2013. Search terms included "lateral epicondylitis," "lateral elbow pain," "tennis elbow," "lateral epicondylalgia," and "elbow tendinopathy" combined with "randomized controlled trial." Two reviewers examined the literature for eligibility via article abstract and full text. RESULTS: Fifty-eight articles met eligibility criteria: (1) a target population of patients with symptoms of lateral epicondylitis; (2) evaluation of treatment of lateral epicondylitis with the following non-surgical techniques: corticosteroid injection, injection technique, iontophoresis, botulinum toxin A injection, prolotherapy, platelet-rich plasma or autologous blood injection, bracing, physical therapy, shockwave therapy, or laser therapy; and (3) a randomized controlled trial design. Lateral epicondylitis is a condition that is usually self-limited. There may be a short-term pain relief advantage found with the application of corticosteroids, but no demonstrable long-term pain relief. Injection of botulinum toxin A and prolotherapy are superior to placebo but not to corticosteroids, and botulinum toxin A is likely to produce concomitant extensor weakness. Platelet-rich plasma or autologous blood injections have been found to be both more and less effective than corticosteroid injections. Non-invasive treatment methods such as bracing, physical therapy, and extracorporeal shockwave therapy do not appear to provide definitive benefit regarding pain relief. Some studies of low-level laser therapy show superiority to placebo whereas others do not. CONCLUSIONS: There are multiple randomized controlled trials for non-surgical management of lateral epicondylitis, but the existing literature does not provide conclusive evidence that there is one preferred method of non-surgical treatment for this condition. Lateral epicondylitis is a condition that is usually self-limited, resolving over a 12- to 18-month period without treatment. LEVEL OF EVIDENCE: Therapeutic Level II. See Instructions to Authors for a complete description of level of evidence.