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Australian Journal of General Practice May 2020Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and...
BACKGROUND
Diabetic foot ulcers are associated with significant morbidity and mortality and can subsequently lead to hospitalisation and lower limb amputation if not recognised and treated in a timely manner.
OBJECTIVE
The aim of this article is to review the current evidence for preventing and managing diabetic foot ulcers, with the aim to increase clinicians' confidence in assessing and treating these complex medical presentations.
DISCUSSION
All patients with diabetes should have an annual foot review by a general practitioner or podiatrist. A three-monthly foot review is recommended for any patient with a history of a diabetic foot infection. Assessment involves identification of risk factors including peripheral neuropathy and peripheral vascular disease, and examination of ulceration if present. It is essential to identify patients with diabetes who are 'at risk' of ulceration, assess for any early signs of skin breakdown, initiate appropriate management to prevent progression and refer the patient if indicated.
Topics: Diabetic Foot; Humans; Physical Examination; Risk Factors
PubMed: 32416652
DOI: 10.31128/AJGP-11-19-5161 -
BMC Musculoskeletal Disorders Jan 2017Physical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Physical examination tests of the shoulder (PETS) are clinical examination maneuvers designed to aid the assessment of shoulder complaints. Despite more than 180 PETS described in the literature, evidence of their validity and usefulness in diagnosing the shoulder is questioned.
METHODS
This meta-analysis aims to use diagnostic odds ratio (DOR) to evaluate how much PETS shift overall probability and to rank the test performance of single PETS in order to aid the clinician's choice of which tests to use. This study adheres to the principles outlined in the Cochrane guidelines and the PRISMA statement. A fixed effect model was used to assess the overall diagnostic validity of PETS by pooling DOR for different PETS with similar biomechanical rationale when possible. Single PETS were assessed and ranked by DOR. Clinical performance was assessed by sensitivity, specificity, accuracy and likelihood ratio.
RESULTS
Six thousand nine-hundred abstracts and 202 full-text articles were assessed for eligibility; 20 articles were eligible and data from 11 articles could be included in the meta-analysis. All PETS for SLAP (superior labral anterior posterior) lesions pooled gave a DOR of 1.38 [1.13, 1.69]. The Supraspinatus test for any full thickness rotator cuff tear obtained the highest DOR of 9.24 (sensitivity was 0.74, specificity 0.77). Compression-Rotation test obtained the highest DOR (6.36) among single PETS for SLAP lesions (sensitivity 0.43, specificity 0.89) and Hawkins test obtained the highest DOR (2.86) for impingement syndrome (sensitivity 0.58, specificity 0.67). No single PETS showed superior clinical test performance.
CONCLUSIONS
The clinical performance of single PETS is limited. However, when the different PETS for SLAP lesions were pooled, we found a statistical significant change in post-test probability indicating an overall statistical validity. We suggest that clinicians choose their PETS among those with the highest pooled DOR and to assess validity to their own specific clinical settings, review the inclusion criteria of the included primary studies. We further propose that future studies on the validity of PETS use randomized research designs rather than the accuracy design relying less on well-established gold standard reference tests and efficient treatment options.
Topics: Humans; Physical Examination; Shoulder Impingement Syndrome; Shoulder Pain
PubMed: 28122541
DOI: 10.1186/s12891-017-1400-0 -
American Family Physician Jan 2020Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the... (Review)
Review
Adolescent idiopathic scoliosis affects 1% to 3% of U.S. adolescents. It is defined by a lateral curvature of the spine (Cobb angle) of at least 10 degrees in the absence of underlying congenital or neuromuscular abnormalities. Adolescent idiopathic scoliosis may be detected via the forward bend test and should be confirmed with scoliometer measurement. Mild scoliosis is usually asymptomatic; it may contribute to musculoskeletal back pain, but there is no evidence that it causes disability or functional impairment. Patients with severe scoliosis (Cobb angle of 40 degrees or more) may have physical pain, cosmetic deformity, psychosocial distress, or, rarely, pulmonary disorders. Several studies have shown modest benefit from bracing and scoliosis-specific physical therapy to limit progression in mild to moderate scoliosis, but there were no effects on quality of life. Because no high-quality studies have proven that surgery is superior to bracing or observation, it should be reserved for severe cases. There is little evidence that treatments improve patient-oriented outcomes. The U.S. Preventive Services Task Force and the American Academy of Family Physicians found insufficient evidence to assess the balance of benefits and harms of screening for adolescent idiopathic scoliosis in children and adolescents 10 to 18 years of age.
Topics: Adolescent; Child; Evidence-Based Medicine; Female; Humans; Male; Physical Examination; Practice Guidelines as Topic; Scoliosis
PubMed: 31894928
DOI: No ID Found -
Sports Health 2018Shoulder pain and dysfunction are common, with patients presenting complaints to both primary and orthopaedic physicians. History and physical examination remain... (Review)
Review
CONTEXT
Shoulder pain and dysfunction are common, with patients presenting complaints to both primary and orthopaedic physicians. History and physical examination remain essential to creating a differential diagnosis, even as noninvasive imaging has improved.
EVIDENCE ACQUISITION
Literature was obtained through keyword searches based on the pathology in question (eg, rotator cuff) and the keywords physical examination using PubMed from January 1, 1980, through September 20, 2017. Additional evidence was obtained through screening references from articles identified through the PubMed searches.
STUDY DESIGN
Clinical review.
LEVEL OF EVIDENCE
Level 3.
RESULTS
A total of 7817 articles were screened for relevance. Several physical examination maneuvers have been described for each specific pathology. The Neer sign has a 75% sensitivity for subacromial impingement (SAI), while the Hawkins-Kennedy test has an 80% sensitivity. The painful arc test has an 80% specificity for SAI. The apprehension test has a hazard ratio of 2.96 for anterior shoulder instability. The Jobe test has a sensitivity of 52.6% and a specificity of 82.4% for full-thickness supraspinatus tears, confirmed on arthroscopy. The lag sign is highly sensitive and specific for combined full-thickness supraspinatus and infraspinatus tears at 97% and 93%, respectively. The Speed test has a sensitivity of 54% and specificity of 81% for biceps pathology. The anterior slide test and O'Brien active compression test have been described for superior labrum anterior posterior tears with inconsistent reliability. The cross-body adduction test has a sensitivity of 77% and a specificity of 79% for acromioclavicular joint pathology.
CONCLUSION
Several physical examination maneuvers can isolate specific pathology of the shoulder, with widely ranging sensitivity and specificity.
Topics: Acromioclavicular Joint; Diagnosis, Differential; Humans; Joint Instability; Physical Examination; Rotator Cuff Injuries; Sensitivity and Specificity; Shoulder Impingement Syndrome; Shoulder Injuries; Shoulder Pain; Tendon Injuries
PubMed: 29443643
DOI: 10.1177/1941738118757197 -
Annals of Palliative Medicine Feb 2021The shoulder joint is a ball and socket joint which provides an extensive range of motion. Shoulder pain and weakness are common complaints among patients, which can... (Review)
Review
The shoulder joint is a ball and socket joint which provides an extensive range of motion. Shoulder pain and weakness are common complaints among patients, which can lead to disability and affect a person's ability to perform daily activities. Shoulder pain and weakness may be associated with shoulder conditions such as rotator cuff disorders adhesive capsulitis, superior labrum anterior to posterior lesions, lesions in the biceps, acromioclavicular joint disease, or instability. Often, a thorough understanding of the network of bony, ligamentous, muscular, and neurovascular anatomy is required to properly identify and diagnose shoulder pathology. Identifying a specific shoulder pathology may be challenging, considering the numerous structures involved in shoulder function. Appropriate physical examination of the shoulder is important for making an accurate diagnosis and distinguishing certain pathologies of the shoulder. Evaluation of shoulder problem may be reliant upon physical examination, which involves inspection, palpation, assessment of range of motion, strength, and neurovascular integrity. In addition, specific tests are used to reproduce symptoms and signs that would help physicians identify the pathology of the shoulder problem. The aim of this study was to review the shoulder anatomy and describe the specific tests used to evaluate common shoulder conditions to facilitate accurate diagnosis and guide proper treatment of these conditions.
Topics: Humans; Joint Instability; Physical Examination; Range of Motion, Articular; Shoulder; Shoulder Joint
PubMed: 33549026
DOI: 10.21037/apm-20-1808 -
American Family Physician Dec 2020Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if...
Peripheral neuropathy, a common neurologic problem encountered by family physicians, can be classified clinically by the anatomic pattern of presenting symptoms and, if indicated, by results of electrodiagnostic studies for axonal and demyelinating disease. The prevalence of peripheral neuropathy in the general population ranges from 1% to 7%, with higher rates among those older than 50 years. Common identifiable causes include diabetes mellitus, nerve compression or injury, alcohol use, toxin exposure, hereditary diseases, and nutritional deficiencies. Peripheral neuropathy is idiopathic in 25% to 46% of cases. Diagnosis requires a comprehensive history, physical examination, and judicious laboratory testing. Early peripheral neuropathy may present as sensory alterations that are often progressive, including sensory loss, numbness, pain, or burning sensations in a "stocking and glove" distribution of the extremities. Later stages may involve proximal numbness, distal weakness, or atrophy. Physical examination should include a comprehensive neurologic and musculoskeletal evaluation. If the peripheral nervous system is identified as the likely source of the patient's symptoms, evaluation for potential underlying etiologies should initially focus on treatable causes. Initial laboratory evaluation includes a complete blood count; a comprehensive metabolic profile; fasting blood glucose, vitamin B12, and thyroid-stimulating hormone levels; and serum protein electrophoresis with immunofixation. If the initial evaluation is inconclusive, referral to a neurologist for additional testing (e.g., electrodiagnostic studies, specific antibody assays, nerve biopsy) should be considered. Treatment of peripheral neuropathy focuses on managing the underlying etiology. Several classes of medications, including gabapentinoids and antidepressants, can help alleviate neuropathic pain.
Topics: Diabetic Neuropathies; Diagnosis, Differential; Family Practice; Humans; Medical History Taking; Peripheral Nervous System Diseases; Physical Examination
PubMed: 33320513
DOI: No ID Found -
The American Journal of Medicine Jan 2021The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine... (Review)
Review
The foot changes with age. Foot disorders in older adults are associated with falls, lower limb ulcers, and pain. Physical examination of the feet as part of the routine assessment of older adults is imperative to detect foot problems. Foot pain and pathologies are common in older adults. Regular foot care is important to prevent these issues. However, some older adults may find it difficult to complete foot care, including cutting toenails. Regular foot examination can detect common foot problems, functional decline, and is recommended for preventing falls. We describe a technique for performing a focused examination of the feet for older adults. This review addresses current podiatric issues in older patient populations and describes a method for foot examination to address the needs of older adults that can be incorporated into patient assessments in any clinical setting.
Topics: Accidental Falls; Aged; Aged, 80 and over; Aging; Female; Foot; Geriatrics; Humans; Male; Physical Examination; Podiatry
PubMed: 32805226
DOI: 10.1016/j.amjmed.2020.07.010 -
Sports Health Mar 2021The hip and pelvis have a complex anatomy and are a common source of pain and injury in the athletic population. The clinical examination of the hip requires a...
The hip and pelvis have a complex anatomy and are a common source of pain and injury in the athletic population. The clinical examination of the hip requires a systematic approach to differentially diagnose hip problems with overlapping pain referral patterns. Because of the complex anatomy of the hip, the physical examination is a comprehensive evaluation of the 4 main pain generators of the hip from deep to superficial: the osteochondral, capsulolabral, musculotendinous, and neurovascular elements of the hip. The hip examination begins with the standing examination and gait analysis followed by a seated, supine, lateral, and prone examination. A targeted physical examination used in conjunction with a layered understanding of the hip and pelvis can help guide diagnostic testing, distinguish hip-specific diagnoses from similar presenting pathologies, and inform treatment.
Topics: Arthralgia; Athletic Injuries; Femoracetabular Impingement; Gait Analysis; Hip Joint; Humans; Pelvis; Physical Examination; Prone Position; Range of Motion, Articular; Standing Position; Supine Position
PubMed: 33217250
DOI: 10.1177/1941738120953418 -
BMC Geriatrics Oct 2020Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based... (Review)
Review
BACKGROUND
Frailty is increasingly recognized as an important construct which has health implications for older adults. The Clinical Frailty Scale (CFS) is a judgement-based frailty tool that evaluates specific domains including comorbidity, function, and cognition to generate a frailty score ranging from 1 (very fit) to 9 (terminally ill). The aim of this scoping review is to identify and document the nature and extent of research evidence related to the CFS.
METHODS
We performed a comprehensive literature search to identify original studies that used the Clinical Frailty Scale. Medline OVID, Scopus, Web of Science, CINAHL, PsycINFO, Cochrane Library and Embase were searched from January 2005 to March 2017. Articles were screened by two independent reviewers. Data extracted included publication date, setting, demographics, purpose of CFS assessment, and outcomes associated with CFS score.
RESULTS
Our search yielded 1688 articles of which 183 studies were included. Overall, 62% of studies were conducted after 2015 and 63% of the studies measured the CFS in hospitalized patients. The association of the CFS with an outcome was examined 526 times; CFS was predictive in 74% of the cases. Mortality was the most common outcome examined with CFS being predictive 87% of the time. CFS was associated with comorbidity 73% of the time, complications 100%, length of stay 75%, falls 71%, cognition 94%, and function 91%. The CFS was associated with other frailty scores 94% of the time.
CONCLUSIONS
This scoping review revealed that the CFS has been widely used in multiple settings. The association of CFS score with clinical outcomes highlights its utility in the care of the aging population.
Topics: Aged; Comorbidity; Female; Frail Elderly; Frailty; Geriatric Assessment; Humans; Physical Examination; Surveys and Questionnaires
PubMed: 33028215
DOI: 10.1186/s12877-020-01801-7 -
American Family Physician May 2020Dyspnea is a symptom arising from a complex interplay of diseases and physiologic states and is commonly encountered in primary care. It is considered chronic if present... (Review)
Review
Dyspnea is a symptom arising from a complex interplay of diseases and physiologic states and is commonly encountered in primary care. It is considered chronic if present for more than one month. As a symptom, dyspnea is a predictor for all-cause mortality. The likeliest causes of dyspnea are disease states involving the cardiac or pulmonary systems such as asthma, chronic obstructive pulmonary disease, heart failure, pneumonia, and coronary artery disease. A detailed history and physical examination should begin the workup; results should drive testing. Approaching testing in stages beginning with first-line tests, including a complete blood count, basic chemistry panel, electrocardiography, chest radiography, spirometry, and pulse oximetry, is recommended. If no cause is identified, second-line noninvasive testing such as echocardiography, cardiac stress tests, pulmonary function tests, and computed tomography scan of the lungs is suggested. Final options include more invasive tests that should be done in collaboration with specialty help. There are three main treatment and management goals: correctly identify the underlying disease process and treat appropriately, optimize recovery, and improve the dyspnea symptoms. The six-minute walk test can be helpful in measuring the effect of ongoing intervention. Care of patients with chronic dyspnea typically requires a multidisciplinary approach, which makes the primary care physician ideal for management.
Topics: Diagnosis, Differential; Dyspnea; Echocardiography; Exercise Test; Humans; Medical History Taking; Physical Examination; Primary Health Care; Respiratory Function Tests
PubMed: 32352727
DOI: No ID Found