1/11. A study of post-traumatic shingles as a work related injury.BACKGROUND: After chicken pox, the herpes varicella-zoster (HVZ) virus may remain dormant in the dorsal root ganglion until later reactivation causes shingles, characterized by painful dysesthesias and cutaneous vesicular eruptions along a unilateral dermatome. Shingles as a work-related injury has not been previously addressed in the medical literature. Case history We present a 50-year old female hospital employee who, while working, sustained an acute, traumatic hyperextension injury to her right wrist, hand, and fingers. Although she initially responded to treatment for flexor tendinitis, she suddenly developed shingles in the right C5-C6 dermatomes. She was treated with famcyclovir and her skin lesions resolved, but post-herpetic neuralgia persisted. CONCLUSIONS: It was felt that her shingles was causally related to her occupational injury since trauma (previously reported to precipitate shingles) was her only risk factor and the timing and location of the lesions corresponded closely to the occupational injury. In addition to appropriately diagnosing and treating their patients, workers' compensation physicians often must determine if a particular condition was caused by the original work-related incident. Clinicians who treat trauma patients and injured workers should be aware of post-traumatic shingles and understand the causal relationship of this uncommon but clinically important phenomenon.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/11. sports-specific concerns in the young athlete: basketball.basketball is played by millions of athletes throughout the world and is the most popular team sport in American high schools. basketball is the leading cause of sports-related injury in the united states. Acute basketball injuries most often involve the extremities, especially the hands, wrists, ankles, and knees. This article reviews the history, epidemiology, and common injury patterns that occur in this sport. We include several case reports to emphasize diagnostic dilemmas frequently encountered by emergency physicians.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/11. Orthopedic pitfalls in the ED: scaphoid fracture.wrist injuries are frequently encountered in the emergency department. When a patient presents with such an injury, the possibility of scaphoid fracture must be at the top of the differential for the emergency practitioner. Unfortunately, these injuries can be missed on first presentation, as they are frequently radiographically occult. When left unrecognized and untreated, these injuries lead to a high incidence of long-term functional disability and chronic pain. The emergency physician needs to be vigilant for scaphoid fracture and be aggressive in both its diagnosis and treatment to avoid this practice pitfall. This review examines the clinical presentation, diagnostic techniques, and management options applicable to the emergency physician.- - - - - - - - - - ranking = 2keywords = physician (Clic here for more details about this article) |
4/11. rehabilitation techniques for ligament injuries of the wrist.The goal of treatment after any wrist injury is a pain-free, stable joint with sufficient strength and mobility to carry out the daily recreational, and occupational tasks required by the individual. Treatment varies considerably depending on the age of the patient, the severity of the initial injury, the operative procedure performed, and the specific guidelines requested by the referring physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/11. Hamate hook fracture in a 17-year-old golfer: importance of matching symptoms to clinical evidence.OBJECTIVE: To describe the importance of correlating symptoms with objective clinical findings and appropriate diagnostic imaging in a patient with traumatic wrist pain. CLINICAL FEATURES: A 17-year-old golfer had persistent left wrist pain of 4 months' duration that began while playing golf. Approximately 1 week after injury, he was diagnosed with a scaphoid fracture and was splinted. He reported that his pain did not decrease with splinting or with subsequent physical therapy, and on dismissal from orthopedic care he could not use the wrist well enough to return to golf. INTERVENTION AND OUTCOME: The patient was found to have marked point tenderness at the hamate. Although plain-film radiography was negative, secondary computed tomography of the wrist showed a fracture to the hook of the hamate. A referral was made to an orthopedic surgeon and surgical excision of the hook of the hamate was recommended because of the failure of union at the fracture site. CONCLUSION: This case shows the significance of follow-up diagnostic imaging in a patient who does not respond as expected. In addition, it stresses the importance of the doctor of chiropractic in the diagnostic process, although the patient may have been treated and released by another physician.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/11. Manual demands and consequences of rock climbing.Types of rock climbing, hand-grip techniques, and training practices used by rock climbers are described. A survey was completed by 46 climbers. Three fourths of the climbers reported a climbing-related injury; of these injured climbers, almost one half reported a hand or wrist injury. More than half of the injured climbers had been treated by a physician for their injury. More than half of all climbers reported distal interphalangeal or proximal interphalangeal joint pain while climbing. case reports of three climbers with acute hand injuries are presented to illustrate the minimal effects of their residual deficits on their climbing abilities. A wider understanding of the manual aspects of rock climbing and an awareness of the patterns and incidence of injuries in this sport will facilitate prevention, treatment, and rehabilitation.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/11. Minimalistic approach to treating wrist torus fractures.Thirty-three patients with unilateral wrist torus fractures were reviewed retrospectively. patients were all treated with a removable plaster-of-paris volar forearm splint and a symptom-based splinting protocol. This protocol emphasized the parents and patients deciding when to wean from the splint as their symptoms improved. patients were followed about 4 weeks after fracture, and initial and follow-up radiographs were compared for any changes in fracture angulation. All of the fractures healed without significant clinical change in angulation or complications. The authors propose the following treatment protocol: radiographic diagnosis and application of the removable splint in the emergency department, and one orthopaedic office/clinic visit to confirm the diagnosis and provide splinting instructions. The elimination of the additional orthopaedic visit for repeat radiographs and cast removal reduces the family's time lost from school and work and the physician's time and costs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/11. Palmar radiocarpal dislocation resulting in ulnar radiocarpal translocation and multidirectional instability.Posttraumatic ulnar radiocarpal translation is a rare, often subtle, highly unstable, and potentially devastating manifestation of severe "proximal radiocarpal ligamentous instability. Radiocarpal dislocation should alert the treating physician to the risks of the spectrum of radiocarpal instabilities. Radiocarpal instability may initially be masked or unappreciated owing to presentation without radiocarpal dislocation, local pain and swelling, initially normal standard wrist radiographs, lack of recognition, or delay in the appearance of a static lesion. The specificity, sequence, and extent of extrinsic radiocarpal and ulnocarpal ligament traumatic disruptions are not fully understood, vary with injury severity, and may differ in instances of dorsal as opposed to palmar subluxation or dislocation. Multidirectional (global) wrist instability typically accompanies this ulnar radiocarpal instability in its most severe form and consequences may be dire. The carpus may be difficult to reduce or maintain owing to marked instability, compressive forces across the wrist, and soft tissue or bony fragment interposition. Additional local distal radioulnar joint or intercarpal injuries may further confound stability and require their own specific and simultaneous treatment. Radiocarpal reduction and repair of the radioscaphocapitate ligament and radiolunate ligaments may be sufficient treatment for acute isolated palmar radiocarpal instability. Temporary K-wire fixation may be added as a precaution to prevent palmar carpal subluxation during the time of ligament healing. Radiocarpal reduction, palmar and dorsal soft-tissue repair, and temporary K-wire fixation comprise one method of treatment for early recognized cases of post-traumatic ligamentous ulnar radiocarpal transposition. Halikis et al have recommended radiolunate arthrodesis. Rayhack et al have suggested that limited or complete wrist arthrodesis may be indicated for patients with delayed presentation or in acute cases with extreme instability. Wrist arthrodesis is one means of management for patients with severe radiocarpal instability confounded by distal radioulnar joint or intercarpal instability, as seen in our patient. Damaged ligaments may have a poor blood supply and often may not hold sutures or heal well. Bone anchor sutures or some type of ligament augmentation may help to restore joint stability in some patients. Loss of stability may occur later owing to ligamentous laxity or inadequate soft-tissue healing. Radiolunate, radiocarpal, or complete wrist arthrodesis may be necessary to relieve pain, restore wrist alignment and stability, and reestablish extremity function for patients with chronic radiocarpal instability. Wrist symptoms, age, general health, hand dominance, and occupation may be among the factors that influence the necessity for and timing of reconstruction. Rayhack et al have also postulated that negative ulnar variance may accommodate the occurrence of ulnar radiocarpal translocation and confound repair owing to lack of buttress at the ulnocarpal joint. They further speculated that a joint leveling procedure might improve the support for ligamentous repair or reconstruction in these cases. Permanent functional impairment must be anticipated in patients with ulnar radiocarpal instability. Impairment has typically been commensurate with the extent of the initial lesion, additional confounding local lesions, and length of follow-up.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/11. Team physician #5. Salter-Harris type I fracture of the distal radius due to weightlifting.A Salter-Harris Type I distal radius fracture was sustained by a skeletally immature adolescent while performing a supine bench press during weight training. Closed reduction was accomplished without difficulty. Fractures in adolescence due to weightlifting are rare but illustrate the need for proper instruction and supervision.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
10/11. Scapholunate dissociation: a practical approach for the emergency physician.Scapholunate dissociation is an injury caused by forced hyperextension of the wrist and results in characteristic radiographic features that may not be apparent on routine x-ray studies. In addition, significant ligamentous damage may be present even with normal radiographs. If misdiagnosed and improperly treated, this injury can lead to chronic wrist pain, instability, and degenerative changes. We present an illustrative case, review the pertinent literature, and present an algorithm for the evaluation and management of scapholunate dissociation.- - - - - - - - - - ranking = 4keywords = physician (Clic here for more details about this article) |
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