Site-specific techniques of joint injection. Useful additions to your treatment repertoire.

Joint and soft-tissue aspiration and injection procedures are relatively easy to master once the physician has acquired an understanding of the techniques and subtleties of performing these procedures at certain sites. These techniques can be used to diagnose and treat many painful joint and soft-tissue conditions and are useful additions to the primary care physician's treatment repertoire.

Basics of joint injection. General techniques and tips for safe, effective use.

Successful joint and soft-tissue aspiration and injection rely on the physician's understanding of the indications, contraindications, and general techniques involved in these procedures. The procedures are generally well tolerated and can be used to treat many painful musculoskeletal and soft-tissue conditions.

Spondylolysis in active adolescents: expediting return to play.

Spondylolysis is the most common identifiable cause of back pain in active adolescents, who often cope with the condition by hoping it will just go away. If the pain is prolonged or severe enough to bring them to a physician, an aggressive work-up for a specific diagnosis should be initiated. History and physical exam findings are suggestive but not diagnostic. Radiographs provide a first look, but other tests (eg, bone scans, CT, and MRI) are necessary to determine the metabolic activity and full extent of any lesions. Conservative therapy, including activity modification, physical therapy, and sometimes bracing, provides pain relief and focuses on return to full activity and prevention of recurrence.

Practical methods of preventing ankle injuries.

Each year ankle sprains account for a significant degree of disability and expense. Thus, it is important that family physicians become familiar with methods of preventing ankle sprains. Both internal and external methods prevent ankle injuries. Internal methods include improving flexibility, strength and proprioception; effective external methods of ankle protection include using athletic tape, lace-up stabilizers and semirigid orthoses.

Occipital neuralgia in a football player: a case report.

Occipital neuralgia, a painful condition thought to be caused by nerve entrapment, has been described in the general population. Athletes, particularly those who participate in collision sports, such as football, may be predisposed to this condition. An illustrative case is presented along with discussion of the differential diagnosis and treatment of this type of headache.

Disqualifying criteria in a preparticipation sports evaluation.

BACKGROUND: This study was undertaken to demonstrate the relative frequency of disqualifying criteria in a complete history and physical sports examination. METHODS: A review was conducted of 2574 preparticipation physical evaluations (PPEs) performed on 11- to 18-year-old student athletes to determine which factors are associated with denial of unrestricted sports participation. RESULTS: Eighty-five percent of the student athletes passed the screening. Of those who did not, the denial decision was based on the medical history alone in 58% of cases (P < .05). A logistic regression analysis identified seven items associated with denial: dizziness with exercise, history of asthma, body mass index, systolic blood pressure, visual acuity, heart murmur, and musculoskeletal examination. CONCLUSIONS: Although physicians often take a complete history and perform physical examinations, relatively few variables appear related to denial of eligibility for participation in organized sports. The history is one of the most important aspects of the PPE. A directed PPE may be more efficient, thereby allowing more time to address other important issues.

Management of thyroid nodules.

Clinically apparent thyroid nodules occur in about 5 percent of the population. Because most patients with thyroid nodules present initially to their primary care physician, family physicians should have a thorough understanding of the diagnosis and treatment of thyroid nodules. The history and physical examination may be helpful in detecting thyroid nodules but are not useful in predicting malignancy. Furthermore, laboratory studies, ultrasonography and nuclear medicine scans do not reliably differentiate between benign and malignant thyroid nodules. In most cases, fine-needle aspiration biopsy can accurately identify malignant thyroid nodules. Fine-needle aspiration biopsy is safe and can be performed in an office setting.

Calcitonin in the treatment of osteoporotic bone pain.

Calcitonin has been observed to have an analgesic effect on painful bone conditions. A case illustrating the antinociceptive effect of calcitonin on bone pain caused by osteoporotic vertebral compression fracture is presented. There is increasing clinical evidence supporting this phenomenon, though few rigorously controlled studies exist. Calcitonin may have an advantage over other analgesics in the treatment of bone pain resulting from an osteoporotic compression fracture, because, in addition to the observed analgesic effect, it is useful in treating the underlying disorder.