Articles related to BONE HEALTH

Navigate the complex world of diagnosing Chiari malformation in this insightful review of a clinical case. To understand Chiari malformation, let’s explore a clinical case. A mid-30s patient with a migraine history came to the ED with a sudden posterior headache. Accompanied by transient total body numbness, loss of coordination, and an inability to swallow with drooling, these symptoms started abruptly after violent sneezing. Although neurological symptoms faded after 20 seconds, the headache persisted. Regarding vital signs and physical examination, everything was normal. The patient had a head CT ordered. Interpreting the clinical picture and CT images with care is crucial in these cases. Even though a sudden onset headache could signify a ruptured berry aneurysm, no blood was detected on the CT cuts, minimizing that concern. Remember, an LP is seldom recommended if the CT is performed within 6 hours and hemoglobin exceeds 10 g/dL. However, the clinical presentation in this case, characterized by headache and drooling, didn’t match a typical migraine. Be mindful that many patients might loosely use the term “migraine” for any severe headache. The CT cut revealed a brainstem compressed by the cerebellum, indicative of a Chiari malformation type 1. Chiari malformation, characterized by an […]

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 […]

This woman presented to the emergency room stating she had been the victim of an assault. What in her findings support the explanation for her injury?

Internal medicine physicians play a crucial role in addressing osteoporosis challenges. Many at-risk patients are not screened or educated about fracture prevention, and a significant number of individuals with high fracture risk remain undiagnosed and untreated. Efforts should focus on recognizing fractures as diagnostic indicators, expanding screening, and implementing effective treatments. The recent clinical guideline emphasizes bisphosphonates as first-line therapy, denosumab as second-line, and injectable medications for high-risk cases. Primary care physicians should take an active role in screening, diagnosing, and treating osteoporosis to prevent future fractures, even without immediate subspecialist care. Risk assessment tools, healthy lifestyles, and consideration of benefits, harms, patient values, and costs in medication selection are important. Empowering primary care doctors is vital in bridging the treatment gap and preventing fractures.

Use of Carnett sign, greater trochanter palpation, and a simple extension to typical joint examination can reduce imaging and orthopedic referrals by primary care physicians and bring faster effective treatment to the patient.

This 70-study meta analysis concludes that the evidence is moderate to high that bisphosphonates and denosumab reduce the risk for hip, vertebral, and other fractures. The evidence is moderate to high that abaloparatide and teriparatide reduce clinical fractures and radiographic vertebral fractures, and low to moderate that SERMs reduce radiographic vertebral fractures, but not clinical fractures.