Conservative Management of Low Back Pain.

Description Low back pain (LBP) is frequently encountered in outpatient clinics and affects individual patients and society in general with decreased physical function, quality of life, disability, and/or economic burden. Although most acute LBP resolves on its own, recurrent and chronic LBP is a common reason for outpatient clinic visits. This review explores pragmatic approaches to LBP in the clinical setting, focusing on recognizing prognostic factors, initial approaches to evaluation, including selective imaging, and conservative management including patient education, therapeutic exercises and bracing.

Localization of Hand and Wrist Anatomic Structures Among Physical Medicine and Rehabilitation Residents: Implication of Ultrasonography in Palpation Skill Verification.

Objective: The objective of this cross-sectional study is to evaluate the accuracy of physical medicine and rehabilitation (PM&R) resident palpation skills of hand and wrist joint and soft tissue structures using ultrasonography (US) verification. Methods: PM&R residents palpated hand and wrist anatomic structures in an outpatient musculoskeletal (MSK) clinic. Once the presumed structures were localized, residents marked a one centimeter size circle on the overlying skin with an ink marker. The accuracy of the circle over the joint line and soft tissue structures was verified using US. Results: Overall palpation accuracy for 16 joint line and soft tissue structures was 40.6%. There was no significant difference in palpation accuracy with advanced educational level (37.5% in PGY-2, 33.8% in PGY-3, 50% in PGY-4, p = 0.12). The percentage of combined accurate palpation and less than one centimeter error in accurate palpation revealed a significant improvement along the advancement of PGY training (50%, 61.3%, 69.8% in PGY-2, 3, 4 respectively, p = 0.01). Conclusions: This study demonstrated an overall suboptimal accuracy of hand and wrist palpation skills by PM&R residents and a need to improve palpation skills among PM&R residents.

Acute mountain sickness in disability and adaptive sports: preliminary data.

Acute mountain sickness (AMS) is a frequent complication for military personnel, veterans, athletes, and travelers at high altitudes. Symptoms may occur in individuals with less cerebrospinal fluid volume and less ability to accommodate increased brain volume. No studies on AMS exist in individuals with neurological impairments. We studied 64 subjects, including active and sedentary controls and those with tetraplegia, paraplegia, multiple sclerosis, and traumatic brain injury at the 2007 National Veterans Winter Sports Clinic in Snowmass, Colorado. Subjects completed three Lake Louise Score surveys to quantify symptoms. We found a higher than expected occurrence of AMS overall (51.6%) but no differences among groups, and few participants sought treatment. Fatigue and weakness were common symptoms. High subject activity levels may explain these findings. More research is warranted on larger sample sizes and on preventative medications and treatments for AMS, especially since many military personnel with neurological impairments are returning to full active service.

The military upper extremity amputee.

Throughout the course of military history, soldiers have continued to sustain amputation injuries during war times and during peacetime and training missions. What has changed over time is the etiology of, indication for, and management of the amputations. Technology has advanced significantly, often with some military connection. More work still needs to be done, especially in the areas of greater prosthetic limb function and usage as well as phantom pain and sensation management. Collaborative efforts among physiatrists, surgeons, prosthetists, and therapists can only benefit the patient.