Extensor Carpi Ulnaris Tendinopathy in Athletes: A Review of the Conservative and Rehabilitative Options.

BACKGROUND: Extensor carpi ulnaris (ECU) tendinopathy is characterized by pain along the dorsal and ulnar aspect of the wrist and distal forearm. It is common in athletes who play stick and racquet sports due to repetitive motion and axial-loading through the wrist and forearm. Conservative therapeutic options include rest, the use of anti-inflammatory medications, and various injections. Rehabilitation via occupational or physical therapy includes therapeutic exercise, splinting, activity modification, manual therapy, and modalities. METHODS: A narrative review of the literature on ECU tendinopathy is presented, and a case study approach is used to highlight the clinical management of this condition in an elite athlete. RESULTS: An approach of medical management and rehabilitation allowed this patient to successfully return to play. CONCLUSIONS: A combination of conservative measures and rehabilitation can be used to treat ECU tendinopathy and permit patients to be symptom-free and return to their desired activities.

Telerehabilitation Use With Spinal Cord Injury: Occupational Therapists' Perspective.

IMPORTANCE: Telerehabilitation provides people with spinal cord injury (SCI) an alternative mode of accessing specialized health care. Further research on occupational therapy practitioners' perspectives of telerehabilitation may provide additional evidence for clinical practice implementation. OBJECTIVE: To explore urban occupational therapists' perspectives on the benefits of and barriers to telerehabilitation use with SCI. DESIGN: A qualitative study design using a demographic questionnaire and a single, individual semistructured interview. Thematic analyses included member checking, constant comparative analysis, triangulation, and self-description and self-reflexivity. SETTING: Residential and community settings. PARTICIPANTS: Six occupational therapists with a range of experience in SCI rehabilitation were recruited using purposeful sampling. RESULTS: Six participants were interviewed, and four primary themes emerged: (1) communication, (2) personal factors, (3) benefits, and (4) barriers. CONCLUSIONS AND RELEVANCE: Telerehabilitation offers numerous potential benefits for SCI intervention. This study provides an understanding of practitioner concerns and potential barriers to use. The results indicate that a hybrid model incorporating both in-person and distance-based treatment is likely optimal. What This Article Adds: Our results provide information that addresses practitioner concerns and recommendations for the use of telerehabilitation with people with SCI. As practitioner concerns are identified and addressed, telerehabilitation may increase in the U.S. health care system, potentially facilitating an alternative treatment delivery method for underserved populations.

Immediate Weight Bearing of Plated Both-Bone Forearm Fractures Using Eight Cortices Proximal and Distal to the Fracture in the Polytrauma Patient Is Safe.

INTRODUCTION: Rehabilitation of trauma patients is facilitated by surgical stabilization permitting weight bearing (WB) of the fractured extremity. Both-bone forearm fracture (BBFx) plate osteosynthesis is an accepted technique with high union and low complication rates; yet, postoperative WB protocols have not been adequately investigated. There exists concern for increased complications in plated BBFx fractures for patients prescribed immediate WB. We hypothesized that immediate WB of surgically treated BBFxs results in acceptable rates of complications. METHODS: Patients presenting to a Level-1 trauma center from 2007 to 2016 with a BBFx were identified retrospectively. Patients were skeletally mature, surgically treated with prescribed immediate WB protocol, and followed for 6 months or to fracture union. Collected data included demographics, fracture characteristics, associated injuries, and WB protocols for all extremities. Complications recorded included nonunion, hardware failure, and infection. Standard statistical comparisons were used to evaluate the risk of complication in polytrauma patients with modified lower extremity WB protocols (polytrauma group) and patients with no lower extremity WB restrictions (isolated group). RESULTS: Two hundred thirteen patients were included with 75 (35%) females and 138 (65%) males. Mean age was 40 years and mean follow-up was 46 weeks. There were 142 (67%) patients in the poly-trauma and 71 (33%) patients in the isolated groups. In the poly-trauma group 21 (10%) patients had bilateral lower extremity WB restrictions. There were 11 (6%) complications noted: 2 non-unions, 4 hardware failures, and 5 infections. Demographics did not vary between the two groups. There was no difference in complications in the isolated (5.7%) versus poly-trauma groups (5.0%) (P = 0.75). CONCLUSION: Immediate WB rehabilitation after BBFx plate osteosynthesis seems to be safe and associated with low nonunion and complication rates. Our results demonstrate that polytrauma patients using ambulatory aids for lower extremity injuries can immediately WB without increased risk compared with isolated BBFx patients.

An update on pharmacotherapy of autism spectrum disorder in children and adolescents.

To date, no medication is proven to be effective in treating core symptoms of autism spectrum disorder (ASD). Psychotropic medications are widely used to target emotional and behavioural symptoms in ASD. This article reviewed evidence for pharmacotherapy, novel therapeutic agents, and Complementary and Alternative Medicine (CAM) in children and adolescents with ASD. Currently, only risperidone and aripiprazole have been approved by the US Food and Drug Administration (FDA) for treatment of irritability associated with ASD in children and adolescents. However, associated metabolic side-effects are concerning. Evidence supports use of methylphenidate and atomoxetine for attention deficit hyperactivity disorder (ADHD) symptoms and clonidine and guanfacine ER appear to be helpful. SSRIs are poorly tolerated and lack evidence in reducing restricted repetitive behaviours (RRB), anxiety, and depression. Buspirone shows promise in the treatment of RRB. The evidence is inconsistent for the effectiveness of anti-epileptic medications. Recent studies of glutamatergic, Gamma-aminobutyric acid (GABA)ergic, and cholinergic agents and oxytocin show inconsistent results. Despite wide use of CAM agents, the evidence is inconclusive. Melatonin can be helpful in reducing sleep problems. Overall, the evidence is limited for pharmacotherapy in children with ASD, and side-effects with long-term use can be burdensome.

de Quervain's tenosynovitis: a review of the rehabilitative options.

de Quervain's tenosynovitis is an overuse disease that involves a thickening of the extensor retinaculum, which covers the first dorsal compartment. A case study approach was utilized in this article to demonstrate many of the available medical and occupational therapy modalities to treat this condition. A 34-year-old right hand-dominant female who works in a daycare facility presents with radial side wrist pain during lifting activity for the past 4-6 weeks. The patient was diagnosed with de Quervain's tenosynovitis and conservative care was initiated. Conservative care involved anti-inflammatory medication and corticosteroid injections as well as occupational therapy to include splinting, activity modification, modalities, manual treatment, and therapeutic exercise. Although conservative care assisted the patient with her symptoms initially, she returned with increased pain and discomfort after 2 months time. At that point, surgery was discussed and performed to release the first dorsal compartment as well as the sub-compartment. The patient was provided with a splint postoperatively and initiated occupational therapy for edema and scar management, therapeutic exercise, and desensitization. Ultimately, the patient was able to return to work pain free.

Endonasal ethmoidectomy and bifrontal craniotomy with craniofacial approach for resection of frontoethmoidal osteoma causing tension pneumocephalus.

Tension pneumocephalus is an unusual, potentially life-threatening complication of frontal fossa tumors. We present an uncommon case of a frontoethmoidal osteoma causing a tension pneumocephalus and neurological deterioration prompting a combined endonasal ethmoidectomy and bifrontal craniotomy with craniofacial approach for resection. A 68-year-old man presented with a 1-week history of worsening headache, slowness of speech, and increasing confusion. Standard computed tomography scan revealed a marked tension pneumocephalus with ventricular air and 1-cm midline shift to the right. Further studies showed a calcified left ethmoid mass and a left anterior cranial-base defect. A team composed of neurosurgery and otolaryngology performed a combined endonasal ethmoidectomy and bifrontal craniotomy with craniofacial approach to resect a large frontoethmoid bony tumor. No abscess or mucocele was identified. The skull base defect was repaired with the aid of a transnasal endoscopy, a titanium mesh, and a pedunculated pericranial flap. Postoperatively, the pneumocephalus and the patient's symptoms completely resolved. Pathology was consistent with a benign osteoma. This is an uncommon case of a frontoethmoidal osteoma associated with tension pneumocephalus. Recognition of this entity and timely diagnosis and treatment, consisting of an endonasal ethmoidectomy and a bifrontal craniotomy with craniofacial approach, may prevent potential life-threatening complications.