Critique of the analysis of UpToDate.com on the treatment of painful vertebral compression fractures: time to update UpToDate.

The treatment of painful vertebral compression fractures has changed substantially since the introduction of vertebroplasty in the mid-1980s and balloon kyphoplasty in the late 1990s. Both procedures were widely accepted with the vertebral fractures treated reaching 150,000 per annum in 2009 prior to the publication of 2 randomized controlled trials comparing vertebroplasty with a sham treatment published in the New England Journal of Medicine in August 2009. Since then, there has been a flood of information on vertebral augmentation and balloon kyphoplasty. It is worth evaluating this information especially because it relates to current recommendations that are often followed blindly by medical and administrative groups unfamiliar with either the procedure or the high level of evidence surrounding vertebral augmentation. To streamline the evaluation of some current recommendations, we limited the analysis to the recommendations found on UpToDate.com. This Web site is an evidence-based, peer-reviewed source of information available for patients, doctors, health insurance companies, and population-based medical decision-making.

MR imaging of the adult elbow.

Magnetic resonance (MR) imaging can provide important diagnostic information in the evaluation of the adult elbow. Optimal imaging technique should include the use of proper positioning, surface coils, and appropriate sequences and imaging planes as indicated by the suspected abnormalities. A familiarity with the anatomy of the normal elbow is crucial to identifying pathologic entities correctly and avoiding diagnostic pitfalls. Disruption of the collateral ligaments can best be demonstrated with thin-section coronal gradient-echo MR images. Injuries to the flexor and extensor muscle groups, biceps muscles, and triceps muscles require T2-weighted or short-inversion-time inversion recovery (STIR) MR images in the long and short axes of the affected muscle. The evaluation of osteochondral lesions and intraarticular bodies is optimized with T1-weighted and STIR MR images. Synovial processes usually necessitate the intravenous administration of gadopentetate dimeglumine to distinguish joint fluid from pannus. The contents of the cubital tunnel are best visualized on axial T1-weighted and STIR MR images. Masses arising in or near the elbow should be imaged with multiple sequences in at least two planes, and involvement of adjacent vital structures should be carefully evaluated.