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Orthopaedic Surgery Feb 2014Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed... (Review)
Review
Injury of the ulnar collateral ligament (UCL) of thumb can be incapacitating if untreated or not treated properly. This injury is notorious for frequently being missed by inexperienced health care personnel in emergency departments. It has frequently been described in skiers, but also occurs in other sports such as rugby, soccer, handball, basketball, volleyball and even after a handshake. The UCL of the thumb acts as a primary restraint to valgus stress and is injured if hyperabduction and hyperextension forces are applied to the first metacarpophalangeal joint. The diagnosis is best established clinically, though MRI is the imaging modality of choice. Many treatment options exist, surgical treatment being offered depending on various factors, including timing of presentation (acute or chronic), grade (severity of injury), displacement (Stener lesion), location of tear (mid-substance or peripheral), associated or concomitant surrounding tissue injury (bone, volar plate, etc.), and patient-related factors (occupational demands, etc.). This review aims to identify the optimal diagnostic techniques and management options for UCL injury available thus far.
Topics: Collateral Ligaments; Diagnostic Imaging; Humans; Metacarpophalangeal Joint; Physical Examination; Rupture; Thumb
PubMed: 24590986
DOI: 10.1111/os.12084 -
BMC Musculoskeletal Disorders Sep 2021The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given...
BACKGROUND
The physical examination is one of the cornerstones of the diagnostic process in patients with acute shoulder injuries. The discriminative properties of a given examination test depend both on its validity and reliability. The aim of the present study was to assess the interrater reliability of 13 physical examination manoeuvres for acute rotator cuff tears in patients with acute soft tissue shoulder injuries.
METHODS
In a large walk-in orthopaedic emergency department, 120 consecutive patients ≥40 years of age were included in a diagnostic study. Patients who had follow-up within three weeks of an acute shoulder injury without fracture on radiographs were eligible. Four emergency department physicians participated as examiners. In a subset of 48 patients, the physical examination tests were performed by two physicians, randomly chosen by their work rotation. The physicians were blinded to the findings of each other and the results of the ultrasound screening. The interrater reliability was assessed by Cohen's kappa, intraclass correlation coefficient (ICC), standard error of measurement (SEM) and Bland-Altman plots depending on whether the examination test result was registered as a binary, ordered categorical or continuous numerical variable.
RESULTS
The median age was 55.5 years, 46% were female. Twenty-seven percent had a rotator cuff full-thickness tear on ultrasound screening; all but one involved the supraspinatus tendon. Cohen's kappa for binary tests ranged from excellent to fair. Excellent agreement (kappa > 0.8) was found for the inability to abduct above 90° and abduction strength. External rotation strength expressed substantial agreement (kappa 0.7). The lowest scores were registered for Hawkins` test and the external rotation lag sign (kappa 0.25 and 0.40, respectively). The ICCs for active range of abduction and external rotation were 0.93 (0.88-0.96) and 0.84 (0.72-0.91), whereas the SEM was 15 and 9, respectively.
CONCLUSIONS
The results indicate that examination manoeuvres assessing abduction and external rotation range of motion and strength are more reliable than manoeuvres assessing pain in patients in the acute phase of traumatic shoulder injury. The poor agreement observed is likely to limit the validity in the present setting of two commonly used tests.
TRIAL REGISTRATION
The Norwegian Regional Ethics Committee South East ( 2015/195 ).
Topics: Female; Humans; Middle Aged; Physical Examination; Range of Motion, Articular; Reproducibility of Results; Rotator Cuff; Rotator Cuff Injuries; Shoulder Injuries
PubMed: 34503466
DOI: 10.1186/s12891-021-04659-x -
Primary Care Jun 1996The shoulder joint is a complex articulation requiring coordinated interaction of bone and soft-tissue structures for normal function of the upper extremity. Trauma or... (Review)
Review
The shoulder joint is a complex articulation requiring coordinated interaction of bone and soft-tissue structures for normal function of the upper extremity. Trauma or overuse of the shoulder may lead to dysfunction requiring medical evaluation. Most shoulder problems may be treated without surgery by the primary care physician. Appropriate conservative management depends on an accurate diagnosis of the underlying pathology.
Topics: Acromioclavicular Joint; Arthritis; Bursitis; Clavicle; Fractures, Bone; Humans; Joint Diseases; Joint Instability; Medical History Taking; Physical Examination; Range of Motion, Articular; Shoulder Impingement Syndrome; Shoulder Joint; Tendinopathy
PubMed: 8784937
DOI: 10.1016/s0095-4543(05)70283-9 -
American Family Physician May 1999Elder mistreatment is a widespread problem in our society that is often under-recognized by physicians. As a result of growing public outcry over the past 20 years, all... (Review)
Review
Elder mistreatment is a widespread problem in our society that is often under-recognized by physicians. As a result of growing public outcry over the past 20 years, all states now have abuse laws that are specific to older adults; most states have mandated reporting by all health care professionals. The term "mistreatment" includes physical abuse and neglect, psychologic abuse, financial exploitation and violation of rights. Poor health, physical or cognitive impairment, alcohol abuse and a history of domestic violence are some of the risk factors for elder mistreatment. Diagnosis of elder mistreatment depends on acquiring a detailed history from the patient and the caregiver. It also involves performing a comprehensive physical examination. Only through awareness, a healthy suspicion and the performing of certain procedures are physicians able to detect elder mistreatment. Once it is suspected, elder mistreatment should be reported to adult protective services.
Topics: Aged; Clinical Laboratory Techniques; Diagnosis, Differential; Elder Abuse; Humans; Medical History Taking; Physical Examination; Risk Factors; United States
PubMed: 10348072
DOI: No ID Found -
The Veterinary Clinics of North... Jul 2013Management of respiratory distress involves careful consideration of the history, physical examination, and diagnostic testing. Supplemental oxygen is useful. Urgent... (Review)
Review
Management of respiratory distress involves careful consideration of the history, physical examination, and diagnostic testing. Supplemental oxygen is useful. Urgent procedures, such as intubation, thoracococentesis, or tracheostomy, may be required. The prognosis is dependent on the underlying disease, but is often favorable. This article reviews the approach, differential diagnoses, and the approach to management for dogs and cats with respiratory distress.
Topics: Animals; Cat Diseases; Cats; Diagnosis, Differential; Dog Diseases; Dogs; Emergency Medical Services; Physical Examination; Respiratory Insufficiency; Respiratory Tract Diseases
PubMed: 23747261
DOI: 10.1016/j.cvsm.2013.03.005 -
Journal of the American Podiatric... 2008This literature review was undertaken to evaluate the reliability and validity of the orthopedic, neurologic, and vascular examination of the foot and ankle. (Review)
Review
BACKGROUND
This literature review was undertaken to evaluate the reliability and validity of the orthopedic, neurologic, and vascular examination of the foot and ankle.
METHODS
We searched PubMed-the US National Library of Medicine's database of biomedical citations-and abstracts for relevant publications from 1966 to 2006. We also searched the bibliographies of the retrieved articles. We identified 35 articles to review. For discussion purposes, we used reliability interpretation guidelines proposed by others. For the kappa statistic that calculates reliability for dichotomous (eg, yes or no) measures, reliability was defined as moderate (0.4-0.6), substantial (0.6-0.8), and outstanding (> 0.8). For the intraclass correlation coefficient that calculates reliability for continuous (eg, degrees of motion) measures, reliability was defined as good (> 0.75), moderate (0.5-0.75), and poor (< 0.5).
RESULTS
Intraclass correlations, based on the various examinations performed, varied widely. The range was from 0.08 to 0.98, depending on the examination performed. Concurrent and predictive validity ranged from poor to good.
CONCLUSIONS
Although hundreds of articles exist describing various methods of lower-extremity assessment, few rigorously assess the measurement properties. This information can be used both by the discerning clinician in the art of clinical examination and by the scientist in the measurement properties of reproducibility and validity.
Topics: Ankle; Foot; Humans; Neurologic Examination; Orthopedics; Physical Examination; Reproducibility of Results
PubMed: 18487593
DOI: 10.7547/0980197 -
American Family Physician May 1996Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees, for which no pathologic cause can be determined. The initial... (Review)
Review
Adolescent idiopathic scoliosis is defined as a lateral spinal curvature of greater than 10 degrees, for which no pathologic cause can be determined. The initial assessment of adolescents with scoliosis focuses on identification of any treatable underlying pathology. Adolescents with scoliosis typically are asymptomatic and have normal neurologic and physical examinations, with the exception of curvature of the spine. Treatment strategies are determined by the risk of progression. This risk depends on the extent of the curvature and anticipated future spinal growth. The extent of the curvature may be estimated by use of a scoliometer and verified by calculation of the Cobb angle on radiographic evaluation. Skeletal maturity may be estimated by several methods, including radiologic estimates of ossification by bone atlas or Risser sign. Treatment strategies include bracing and surgery.
Topics: Adolescent; Age Determination by Skeleton; Braces; Humans; Mass Screening; Medical History Taking; Physical Examination; Prognosis; Referral and Consultation; Risk Factors; Scoliosis
PubMed: 8638509
DOI: No ID Found -
BMC Medical Education Oct 2018Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students'...
BACKGROUND
Physical examination courses are an essential part of the education of medical students. The aim of this study was to ascertain the factors influencing students' motivation and willingness to participate in a physical examination course.
METHODS
Students were asked to complete a questionnaire subdivided into five domains: anthropometric data, religiousness, motivation to take part in physical examination courses, willingness to be physically examined at 11 different body regions by peers or a professional tutor and a field for free text.
RESULTS
The questionnaire was completed by 142 medical students. The importance of the examination course was rated 8.7 / 10 points, the score for students' motivation was 7.8 / 10 points. Willingness to be physically examined ranged from 6 to 100% depending on body part and examiner. Female students were significantly less willing to be examined at sensitive body parts (breast, upper body, groin and the hip joint; p = .003 to < .001), depending on group composition and / or examiner. Strictly religious students showed significantly less willingness to undergo examination of any part of the body except the hand (p = .02 to < .001). Considering BMI, willingness to be examined showed comparable rates for normal weight and under- / overweight students in general (80% vs. 77%). Concerning the composition of the group for physical examination skills courses, students preferred self-assembled over mixed gender and same gender groups.
CONCLUSIONS
Peer physical examination is a method to improve students' skills. While motivation to participate in and acceptance of the physical examination course appears to be high, willingness to be examined is low for certain parts of the body, e.g. breast and groin, depending on religiousness, gender and examiner. Examination by a professional medical tutor did not lead to higher acceptance. Most students would prefer to choose their team for physical examination courses themselves rather than be assigned to a group.
Topics: Adult; Attitude of Health Personnel; Body Weight; Curriculum; Education, Medical, Undergraduate; Female; Humans; Male; Middle Aged; Motivation; Peer Group; Physical Examination; Psychometrics; Religion; Sex Factors; Students, Medical; Work Engagement; Young Adult
PubMed: 30373579
DOI: 10.1186/s12909-018-1353-5 -
Cancer Jun 2010Young adult survivors of childhood brain tumors (BTs) may have late effects that compromise physical performance and everyday task participation. The objective of this...
BACKGROUND
Young adult survivors of childhood brain tumors (BTs) may have late effects that compromise physical performance and everyday task participation. The objective of this study was to evaluate muscle strength, fitness, physical performance, and task participation among adult survivors of childhood BTs.
METHODS
In-home evaluations and interviews were conducted for 156 participants (54% men). Results on measures of muscle strength, fitness, physical performance, and participation were compared between BT survivors and members of a population-based comparison group by using chi-square statistics and 2-sample t tests. Associations between late effects and physical performance and between physical performance and participation were evaluated in regression models.
RESULTS
: The median age of BT survivors was 22 years (range, 18-58 years) at the time of the current evaluation, and they had survived for a median of 14.7 years (range, 6.5-45.9 years) postdiagnosis. Survivors had lower estimates of grip strength (women, 24.7 + or - 9.2 kg vs 31.5 + or - 5.8 kg; men, 39.0 + or - 12.2 kg vs 53.0 + or - 10.1 kg), knee extension strength (women, 246.6 + or - 95.5 Newtons [N] vs 331.5 + or - 5.8 N; men, 304.7 + or - 116.4 N vs 466.6 + or - 92.1 N), and peak oxygen uptake (women, 25.1 + or - 8.8 mL/kg per minute vs 31.3 + or - 5.1 mL/kg per minute; men, 24.6 + or - 9.5 mL/kg per minute vs 33.2 + or - 3.4 mL/kg per minute) than members of the population-based comparison group. Physical performance was lower among survivors and was associated with not living independently (odds ratio [OR], 5.0; 95% confidence interval [CI], 2.0-12.2) and not attending college (OR, 2.3; 95% CI 1.2-4.4).
CONCLUSIONS
Muscle strength and fitness values among BT survivors were similar to those among individuals aged > or = 60 years and were associated with physical performance limitations. Physical performance limitations were associated with poor outcomes in home and school environments. The current data indicated an opportunity for interventions targeted at improving long-term physical function in this survivor population.
Topics: Activities of Daily Living; Adolescent; Adult; Age Factors; Body Mass Index; Brain Neoplasms; Child; Child, Preschool; Cranial Irradiation; Dependency, Psychological; Educational Status; Employment; Female; Humans; Male; Middle Aged; Motor Activity; Muscle Strength; Physical Fitness; Quality of Life; Risk Factors; Sensation Disorders; Survivors
PubMed: 20564409
DOI: 10.1002/cncr.25051 -
International Journal of Psychiatry in... 1974
Topics: Amnesia; Anxiety Disorders; Brain Damage, Chronic; Confusion; Conversion Disorder; Delirium; Denial, Psychological; Dependency, Psychological; Depression; Dissociative Disorders; Humans; Neurotic Disorders; Patient Compliance; Personality Disorders; Psychophysiologic Disorders; Psychotic Disorders; Suicide
PubMed: 4464285
DOI: 10.2190/7279-X24X-FPV9-E8WV