Clinical evaluation vs magnetic resonance imaging of the skier's thumb: A prospective cohort of 30 patients.

INTRODUCTION: A skiers thumb, or a partial or complete rupture of the ulnar collateral ligament (UCL) is a clinical diagnosis. Swelling, pain, natural left-right difference and inexperience of a young physician can cause difficulty to correctly diagnose this injury. However, our theory is that any physician, given the correct instructions, should be able to diagnose this injury solely on clinical findings, without the necessity of additional imaging. MATERIAL AND METHODS: In a large Dutch teaching hospital, physicians (residents with working experience of 6months-3years) working at the ER received instructions for physical examination. Patients >18 years, with an injury <1 week old, suspected of a true skier's thumb had an MRI reported by two independent radiologists to confirm the diagnosis. RESULTS: Thirty patients were included. Seven patients had no fixed endpoint (23%), all had a complete ligamentous rupture of the UCL on MRI, of which three patients had a Stener lesion. Fifteen patients (50%) met with the criteria >35° laxity in extension of MCP/ >20° laxity in 30° flexion of the MCP. Of these, thirteen patients (81%) had a complete rupture (nine Stener lesions (56%)). One patient had a partial injury and one patient had no UCL-injury. Eight patients (27%) had inconclusive results during physical examination. Of these, two had a complete rupture (40%, 1 Stener). Three patients had a partial rupture and three patients had an intact UCL. CONCLUSION: A skier's thumb can be diagnosed by any resident when correctly instructed. Additional imaging when diagnosing a skier's thumb should be reserved in cases when physical examination remains inconclusive.

Screening of white middle-class US infants with the Wolanski Gross Motor Evaluation.

The purpose of this study was to evaluate the appropriateness of the Wolanski Gross Motor Evaluation (WGME) to screen Triangle Area (North Carolina, US) infants for developmental delay. Eighty full-term, white infants were tested once each and five infants were followed longitudinally using the WGME. The results of the study revealed that the Triangle Area infants scored significantly higher than did the Polish infants with whom the study was normed at three and six months of age, but not at nine and twelve months of age. At three and twelve months scores differed between males and females, with females scoring higher than males. No significant differences according to gender occurred at six or nine months. Longitudinal subjects did not remain in any single channel of development on either the existing WGME grids or on grids fabricated from the cross-sectional data from this study. The WGME grids would not be appropriate for use with American infants as they now stand. Further research is needed to develop appropriate scoring methods, as well as provide validity and reliability information.

[Causality of action and circular thinking--systems therapy versus psychoanalysis]. / Handlungskausalität und zirkuläres Denken--Systemtherapie versus Psychoanalyse.

The authors point out that systems therapy offers no substantial critique of psychoanalysis. The arbitrary and reductionist recourse of systems therapy to systems theory prevents an adequate dialogue with psychoanalysis.