Articles related to Physical Medicine & Rehabilitation

This deep-dive into acromioclavicular joint injuries unpacks everything a physician needs to know about these prevalent injuries. Acromioclavicular joint (ACJ) injuries, mostly traumatic, can occur across all ages but are more frequent in males aged 20-40, often related to contact sports. Patients usually present with vague shoulder pain and swelling, but visible deformity is rare. Two mechanisms contribute to ACJ injuries: direct, resulting from a direct blow or fall onto the shoulder, and indirect, arising from a fall onto an outstretched hand or elbow. Imaging is crucial for diagnosis. The Rockwood system, among others, categorizes these injuries into six types. Plain radiographs, including an axillary view, generally suffice for accurate grading. However, in certain scenarios, CT or MRI might be necessary. In case of an injury suspicion with initial normal radiographs or contemplating surgical intervention on a type III injury, additional weight-bearing stress views can be beneficial. Indications of ACJ injury on a plain radiograph may include soft tissue swelling, acromioclavicular joint widening, increased coracoclavicular distance, and superior displacement of the distal clavicle. The treatment choice hinges largely on the patient’s age, lifestyle, and injury type. Conservative management typically applies to types I and II injuries, surgical treatment to types […]

A 37-year-old man presented with persistent swelling, limited range of motion, and loss of hand dexterity in both hands. He had a history of IV drug use, including opiates and methamphetamine. The examination showed diffuse swelling without joint inflammation. Lab tests were normal, and imaging revealed soft-tissue swelling. The diagnosis was puffy hand syndrome, a common complication of IV drug use. Treatment options are mainly symptomatic, including discontinuation of IV drug use and the use of low-stretch bandages and compression gloves. Puffy hand syndrome, often unrecognized by general practitioners, should be considered in patients with swelling and limited hand function who have a history of IV drug use. The syndrome involves progressive fibrosis of subcutaneous tissues due to repeated injection-induced vascular and dermal sclerosis. Diagnosis is based on clinical presentation, history, and evaluation ruling out other conditions. Treatment focuses on symptomatic relief and cessation of IV drug use.

Thirty-three studies comprised of 2,384 participants in various populations, including community dwellers, nursing home residents, and those with chronic disease, were identified. Hatha yoga was the foundation of most yoga styles, and Iyengar or chair-based methods were frequently used. Measures of gait speed, handgrip strength, balance, lower-extremity strength and endurance, and multicomponent physical performance were used as single-item frailty markers; no studies included a validated definition of frailty.

The patient’s blood pressure is 110/70 and his pulse is 52. Cardiac auscultation is normal. BMI is 22. The ECG shows sinus bradycardia and voltage criteria for LVH. The QT interval is 400 ms, and there is early repolarization. Review the details of the ECG and echo and determine your diagnosis.

A 12-month controlled trial randomized 189 individuals to spend 70–90 minutes performing 11 exercises or 20–30 minutes performing 5 exercises for 3 months. Outcomes were measured biweekly for the intervention period and again at 6 and 12 months. The two approaches were similar, except for one outcome. In the Knee Injury and Osteoarthritis Outcome Score for function in sports and recreation, high-dose therapy was superior.

Clinical trials of abaloparatide, a human parathyroid hormone related peptide analog, showed significantly increased bone mineral density at 12 months in the lumbar spine and femoral neck in men with osteoporosis.