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The art of the musculoskeletal physical exam
This book is an invaluable resource for all those seeking to enhance their proficiency in physical examination. Emphasizing its importance for thorough assessments and accurate diagnoses, it equips practitioners with comprehensive theoretical and practical knowledge. With seven sections devoted to different orthopedic structures, the book meticulously examines their underlying anatomy, pathological conditions, and diagnostic methodologies. Each author presents joint-specific tests, and detailed anatomical insights, enabling accurate assessments and identification of underlying conditions. Written and edited by members of ISAKOS, this collaboration draws upon the expertise of leading international experts. Appealing to a broad readership, it is an invaluable tool for orthopedists, sports medicine physicians, physical therapists, athletic trainers and students.
BOOK
Musculoskeletal Examination of the Spine
The physical examination of the spine can be a complex topic for professionals with all levels of clinical experience. How can advanced concepts be taught in a user-friendly, clear format, while still providing necessary information for effective diagnosis and treatment of the spine?
Musculoskeletal Examination of the Spine: Making the Complex Simple by Drs. Jeffrey A. Rihn and Eric B. Harris answers these questions. Written by experts, this easy-to-carry book provides a thorough review of the most common pathologic spine conditions, techniques for diagnosis, as well as the appropriate treatment for each condition.
Musculoskeletal Examination of the Spine: Making the Complex Simple contains clear photographic demonstrations, tables, and charts throughout its pages, allowing a thorough and concise examination of the spine.
A glance at some of what is covered inside:
Physical Examination
Basics and specific tests of the physical examination of the cervical and thoracolumbar spine
General Imaging
Basics of general imaging of the degenerative and traumatic injuries of the spine
Common Conditions
Cervical spondylosis, lumbar disk herniation, diskitis and vertebral osteomyelitis of the spine, and more
Musculoskeletal Examination of the Spine: Making the Complex Simple contains essential information to successfully take a complex subject, and bring it to a level that will be welcomed by all orthopedic residents, attendings, physical therapists, athletic trainers, medical students in training, and other health care providers.
eBook
Waldman's Comprehensive Atlas of Diagnostic Ultrasound of Painful Conditions
With a focus on real-time clinical decision making, Dr. Waldman's practical text helps increase your diagnostic accuracy in dynamic scanning of suspected pathology at the time the patient is being examined. This unique resource helps guide your targeted point-of-care ultrasound examination. Nearly 2,000 classic ultrasound images and anatomic drawings depict commonly encountered conditions, and Dr. Waldman's expert advice guides you clearly toward the correct clinical diagnosis.
eBook
The effect of manual therapy to the thoracic spine on pain-free grip and sympathetic activity in patients with lateral epicondylalgia humeri. A randomized, sample sized planned, placebo-controlled, patient-blinded monocentric trial
Background
The treatment of first choice for lateral epicondylalgia humeri is conservative therapy. Recent findings indicate that spinal manual therapy is effective in the treatment of lateral epicondylalgia. We hypothesized that thoracic spinal mobilization in patients with epicondylalgia would have a positive short–term effect on pain and sympathetic activity.
Methods
Thirty patients (all analyzed) with clinically diagnosed (physical examination) lateral epicondylalgia were enrolled in this randomized, sample size planned, placebo-controlled, patient-blinded, monocentric trial. Pain-free grip, skin conductance and peripheral skin temperature were measured before and after the intervention. The treatment group (15 patients) received a one-time 2-min T5 costovertebral mobilization (2 Hz), and the placebo group (15 patients) received a 2-min one-time sham ultrasound therapy.
Results
Mobilization at the thoracic spine resulted in significantly increased strength of pain-free grip + 4.6 kg ± 6.10 (
p
= 0.008) and skin conductance + 0.76 μS ± 0.73 (
p
= 0.000004) as well as a decrease in peripheral skin temperature by − 0.80 °C ± 0.35 (
p
< 0.0000001) within the treatment group.
Conclusion
A thoracic costovertebral T5 mobilization at a frequency of 2 Hz shows an immediate positive effect on pain-free grip and sympathetic activity in patients with lateral epicondylalgia.
Clinical trial registration
German clinical trial register
DRKS00013964
, retrospectively registered on 2.2.2018.
Journal Article
Ultrashort-T.sub.2 mapping at 7 tesla using an optimized pointwise encoding time reduction with radial acquisition sequence at standard and extended echo times
Zero echo time (ZTE) sequences capture signal from tissues with extremely short T.sub.2 * and are useful for qualitative and quantitative imaging of musculoskeletal tissues' ultrashort-T.sub.2 * components. One such sequence is Pointwise Encoding Time Reduction with Radial Acquisition (PETRA). While this sequence has shown promising results, it has undergone only limited testing at 7 tesla (T). The purpose of this work was to evaluate PETRA at 7T in its standard, commercially available form and with sequence code modifications to allow extended echo times for the purpose of performing ultrashort-T.sub.2 * mapping. We acquired PETRA images of MnCl.sub.2 and collagen phantoms and of the knee in eight participants (5 for optimization and 3 for ultrashort-T.sub.2 * mapping assessment; 5 male/3 female, 39 ± 11 years old). Images were acquired using a 1-transmit/28-receive-channel knee coil. Artifacts, signal, signal-to-noise ratio (SNR), ultrashort-T.sub.2 *, the corresponding curve fit quality, and repeatability were assessed. In knee tissues, SNR was higher at TE = 0.07 msec than in a conventional-TE sequence (Dual-Echo Steady State with TE = 2.55 msec), with values of 68-337 for PETRA versus 16-30 for the same regions in the conventional-TE series. Acquisition of series for ultrashort-T.sub.2 * maps was feasible at 1.50 mm isotropic acquisition resolution and TE [less than or equal to] 0.58 msec. Strong linear correlations were observed between relaxation rates (R.sub.2 *) and MnCl.sub.2 concentration, and between signal and collagen concentration. Ultrashort-T.sub.2 * signal decay curve fit R.sup.2 and repeatability were high for phantom and knee ultrashort-T.sub.2 * <1 msec. PETRA imaging with minimal artifacts, high SNR, and scan time < 11 minutes was achieved at 7T at high (0.34 mm isotropic) resolution at TE = 0.07 msec and lower resolution (1.52 mm isotropic) at echo times [less than or equal to] 0.58 msec. Ultrashort-T.sub.2 * mapping provided acceptable curve-fitting results for substances with sub-millisecond T.sub.2 *.
Journal Article
Ultrashort-T.sub.2 mapping at 7 tesla using an optimized pointwise encoding time reduction with radial acquisition
Zero echo time (ZTE) sequences capture signal from tissues with extremely short T.sub.2 * and are useful for qualitative and quantitative imaging of musculoskeletal tissues' ultrashort-T.sub.2 * components. One such sequence is Pointwise Encoding Time Reduction with Radial Acquisition (PETRA). While this sequence has shown promising results, it has undergone only limited testing at 7 tesla (T). The purpose of this work was to evaluate PETRA at 7T in its standard, commercially available form and with sequence code modifications to allow extended echo times for the purpose of performing ultrashort-T.sub.2 * mapping. We acquired PETRA images of MnCl.sub.2 and collagen phantoms and of the knee in eight participants (5 for optimization and 3 for ultrashort-T.sub.2 * mapping assessment; 5 male/3 female, 39 ± 11 years old). Images were acquired using a 1-transmit/28-receive-channel knee coil. Artifacts, signal, signal-to-noise ratio (SNR), ultrashort-T.sub.2 *, the corresponding curve fit quality, and repeatability were assessed. In knee tissues, SNR was higher at TE = 0.07 msec than in a conventional-TE sequence (Dual-Echo Steady State with TE = 2.55 msec), with values of 68-337 for PETRA versus 16-30 for the same regions in the conventional-TE series. Acquisition of series for ultrashort-T.sub.2 * maps was feasible at 1.50 mm isotropic acquisition resolution and TE [less than or equal to] 0.58 msec. Strong linear correlations were observed between relaxation rates (R.sub.2 *) and MnCl.sub.2 concentration, and between signal and collagen concentration. Ultrashort-T.sub.2 * signal decay curve fit R.sup.2 and repeatability were high for phantom and knee ultrashort-T.sub.2 * <1 msec. PETRA imaging with minimal artifacts, high SNR, and scan time < 11 minutes was achieved at 7T at high (0.34 mm isotropic) resolution at TE = 0.07 msec and lower resolution (1.52 mm isotropic) at echo times [less than or equal to] 0.58 msec. Ultrashort-T.sub.2 * mapping provided acceptable curve-fitting results for substances with sub-millisecond T.sub.2 *.
Journal Article
The Telemedicine Musculoskeletal Examination
Telemedicine uses modern telecommunication technology to exchange medical information and provide clinical care to individuals at a distance. Initially intended to improve health care for patients in remote settings, telemedicine now has a broad clinical scope with the general purpose of providing convenient, safe, and time- and cost-efficient care. The coronavirus disease 2019 pandemic has created marked nationwide changes in health care access and delivery. Elective appointments and procedures have been canceled or delayed, and multiple states still have some degree of shelter-in-place orders. Many institutions are now relying more heavily on telehealth services to continue to provide medical care to individuals while also preserving the safety of health care professionals and patients. Telemedicine can also help reduce the surge in health care needs and visits as restrictions are lifted. In recent weeks, there has been a significant amount of information and advice on how to best approach telemedicine visits. Given the frequent presentation of individuals with musculoskeletal complaints to the medical practitioner, it is important to have a framework for the virtual musculoskeletal physical examination. This will be of importance as telemedicine continues to evolve, even after coronavirus disease 2019 restrictions are lifted. This article will provide the medical practitioner performing a virtual musculoskeletal examination with a specific set of guidelines, both written and visual, to enhance the information obtained when evaluating the shoulder, hip, knee, ankle, and cervical and lumbar spine. In addition to photographs, accompanying videos are included to facilitate and demonstrate specific physical examination techniques that the patient can self-perform.
Journal Article