Lateral epicondylitis is a relatively common clinical prob lem, easily recognized on palpation of the lateral protu berance on the elbow. Despite the "itis" suffix, it is no an inflammatory process. Therapeu...Lateral epicondylitis is a relatively common clinical prob lem, easily recognized on palpation of the lateral protu berance on the elbow. Despite the "itis" suffix, it is no an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, cortico steroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other ap proaches have included provision of healing cytokine from blood products or stem cells, based on the recog nition that this repetitive effort-derived disorder repre sents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle(enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physi ologic approaches, including manipulation, therapeuti ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, ha also had limited success. This contrasts with the benefi of a simple mechanical intervention, reducing the stres on the attachment area. This is based on displacemen of the stress by use of a thin(3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required as thick bands(e.g., 2-3 inch wide) simply reduce mus cle strength, without significantly reducing stress. Thi approach appears to be associated with a failure rateless than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments.展开更多
Bursitis is quite responsive to therapeutic intervention, once the afflicted area is accurately identified. This is especially notable for some hip complaints. Patients' use of the term "hip" can relate ...Bursitis is quite responsive to therapeutic intervention, once the afflicted area is accurately identified. This is especially notable for some hip complaints. Patients' use of the term "hip" can relate to anything from the low back to groin to lateral thigh pain. Trochanteric area surface localization of "hip" pain may afford an opportunity for immediate cure. Effectiveness of therapeutic intervention is predicated upon injection of not one or two, but all four peri-trochanteric bursa with a depot(minimally water-soluble) corticosteroid. The term trochanteric bursitis suggests that the inflammation is more focal than what is clinically observed. While easier to express, perhaps it is time to refer to inflammation in this area, naming all four affected bursae.展开更多
Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to pati...Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to patients' electronic medical records do not seem to notify of new information.The unknown time from prescription to patient action and the variable time required for individual test performance seem to mandate that a physician attempting to be conscientious would have to examine all sections of every patient medical record in their practice, every day.That is quite inefficient and error-prone.Electronic medical record still contains what appear to be dangerous "bugs" which compromise our ability to provide the care we believe our patients deserve? I remain unsure that outpatient electronic medical records are "ready for prime time."展开更多
Expansion of diagnostic criteria for rheumatoid arthritis and deletion of exceptions increases sensitivity, but at the expense of specificity.Two decades later, modification of criteria included the caveat: "abse...Expansion of diagnostic criteria for rheumatoid arthritis and deletion of exceptions increases sensitivity, but at the expense of specificity.Two decades later, modification of criteria included the caveat: "absence of an alternative diagnosis that better explains the synovitis."That puts great faith in the diagnostic skills of the evaluating individual and their perspectives of disease.The major confounding factor appears to be spondyloarthropathy, which shares some characteristics with rheumatoid arthritis.Recognition of the latter on the basis of marginally distributed and symmetrical polyarticular erosions, in absence of axial(odontoid disease excepted) involvement requires modification to avoid failure to recognize a different disease, spondyloarthropathy.Skeletal distribution, pure expression of disease in natural animal models and biomechanical studies clearly rule out peripheral joint fusion(at least in the absence of corticosteroid therapy) as a manifestation of rheumatoid arthritis.Further, such studies identity predominant wrist and ankle involvement as characteristic of a different disease, spondyloarthropathy.It is important to separate the two diagnostic groups for epidemiologic study and for clinical diagnosis.They certainly differ in their pathophysiology.展开更多
文摘Lateral epicondylitis is a relatively common clinical prob lem, easily recognized on palpation of the lateral protu berance on the elbow. Despite the "itis" suffix, it is no an inflammatory process. Therapeutic approaches with topical non-steroidal anti-inflammatory drugs, cortico steroids and anesthetics have limited benefit, as would be expected if inflammation is not involved. Other ap proaches have included provision of healing cytokine from blood products or stem cells, based on the recog nition that this repetitive effort-derived disorder repre sents injury. Noting calcification/ossification of tendon attachments to the lateral epicondyle(enthesitis), dry needling, radiofrequency, shock wave treatments and surgical approaches have also been pursued. Physi ologic approaches, including manipulation, therapeuti ultrasound, phonophoresis, iontophoresis, acupuncture and exposure of the area to low level laser light, ha also had limited success. This contrasts with the benefi of a simple mechanical intervention, reducing the stres on the attachment area. This is based on displacemen of the stress by use of a thin(3/4-1 inch) band applied just distal to the epicondyle. Thin bands are required as thick bands(e.g., 2-3 inch wide) simply reduce mus cle strength, without significantly reducing stress. Thi approach appears to be associated with a failure rateless than 1%, assuming the afflicted individual modifies the activity that repeatedly stresses the epicondylar attachments.
文摘Bursitis is quite responsive to therapeutic intervention, once the afflicted area is accurately identified. This is especially notable for some hip complaints. Patients' use of the term "hip" can relate to anything from the low back to groin to lateral thigh pain. Trochanteric area surface localization of "hip" pain may afford an opportunity for immediate cure. Effectiveness of therapeutic intervention is predicated upon injection of not one or two, but all four peri-trochanteric bursa with a depot(minimally water-soluble) corticosteroid. The term trochanteric bursitis suggests that the inflammation is more focal than what is clinically observed. While easier to express, perhaps it is time to refer to inflammation in this area, naming all four affected bursae.
文摘Concern is expressed that electronic medical records may actually compromise care.Reports are electronically collated with patient charts, but when are they examined? Current electronic transmission of results to patients' electronic medical records do not seem to notify of new information.The unknown time from prescription to patient action and the variable time required for individual test performance seem to mandate that a physician attempting to be conscientious would have to examine all sections of every patient medical record in their practice, every day.That is quite inefficient and error-prone.Electronic medical record still contains what appear to be dangerous "bugs" which compromise our ability to provide the care we believe our patients deserve? I remain unsure that outpatient electronic medical records are "ready for prime time."
文摘Expansion of diagnostic criteria for rheumatoid arthritis and deletion of exceptions increases sensitivity, but at the expense of specificity.Two decades later, modification of criteria included the caveat: "absence of an alternative diagnosis that better explains the synovitis."That puts great faith in the diagnostic skills of the evaluating individual and their perspectives of disease.The major confounding factor appears to be spondyloarthropathy, which shares some characteristics with rheumatoid arthritis.Recognition of the latter on the basis of marginally distributed and symmetrical polyarticular erosions, in absence of axial(odontoid disease excepted) involvement requires modification to avoid failure to recognize a different disease, spondyloarthropathy.Skeletal distribution, pure expression of disease in natural animal models and biomechanical studies clearly rule out peripheral joint fusion(at least in the absence of corticosteroid therapy) as a manifestation of rheumatoid arthritis.Further, such studies identity predominant wrist and ankle involvement as characteristic of a different disease, spondyloarthropathy.It is important to separate the two diagnostic groups for epidemiologic study and for clinical diagnosis.They certainly differ in their pathophysiology.
