News Category: General

The Internet isn’t used by orthopedic doctors to teach patients as much as it could be. That’s the conclusion made by researchers at the University of Pennsylvania. They carried out a study on Internet use among doctors.

The purpose of this study was to look at websites and compare information posted by private practice versus academic sources. The specific topic was orthopedic patient education.

Information was gathered on 154 websites related to orthopedic surgery. All academic sites were sponsored by orthopedic departments. These departments were approved by the Accreditation Council for Graduate Medical Education (ACGME). Researchers rated the sites on the following criteria:

In this study, ultrasound (US) was used and compared in two different ways to treat one-sided neck pain in 72 patients. US is a form of heat energy generated in the muscles and soft tissues. It’s applied through the skin with a special machine.

All patients in the study had shoulder and neck trigger points and pain on one side. Trigger points are irritable spots in the muscle that cause pain and spasm.

The control group had standard US over the area of pain. The applicator was moved in small circles over the area. Each treatment lasted five minutes. In the study group, high-power pain threshold (HPPT) US was used. In this method the US was turned up to the point patients could feel pain. Then it was turned down to half the intensity. This cycle was repeated three times. The probe was held motionless over the trigger point.

The authors report the results of these two methods using pain and neck range of motion as measures. Patients were followed for one month. US done with HPPT reduced pain much faster than standard US. Range of motion was equal in both groups after treatment.

The researchers suggest that HPPT may save money since fewer treatments are needed. This method is painful, but the pain intensity can be controlled by the physical therapist applying the US.

Tai chi chun (TCC) exercise can help slow bone loss in postmenopausal women. This is the conclusion of a study from the Hong Kong Center for Osteoporosis Care. And it’s good news, since bone loss is a major risk factor for fractures in women after menopause.

TCC is a low-impact exercise popular with many older adults. It’s made up of slow, gentle movements of the entire body. It’s performed in the standing position, making it a weight-bearing exercise. It’s also been shown to improve many aspects of health, such as balance, strength, and motor control.

In this study, 132 women were divided into two groups. Group one followed a program of regular exercise. TCC (Yang style) was done five days each week (45 minutes each day) for one year. The control group did not do any type of exercise.

Bone mineral density in the weight-bearing bones was measured in each woman before the study started. It was measured again 12 months later. The number of bone fractures was also recorded.

The authors report that a general bone loss occurred in both groups. This bone loss was greater in the control group. Bone loss occurred at a slower rate in the TCC group.

The authors conclude that TCC is a good exercise for older people to help prevent osteoporosis. It slows bone loss and decreases the risk of falls and fractures. Overall quality of life is improved, too. These changes come about because TCC increases range of motion, endurance, and strength. Less pain and better posture are added benefits.

Female athletes are at greater risk for leg injuries than males. Scientists think weakness of the core muscles is to blame. Core strength refers to the muscles around the pelvis and low back area, including the abdominal, hip, and trunk muscles. Researchers at the University of Delaware have something to say about this theory.

Physical therapists measured the difference in core strength between males and females. They also looked for any links between core stability in injured and uninjured athletes. All the athletes were involved in basketball or track. Everyone was tested two weeks before practice started. They were followed until the end of the season. The report explains each test done and the position used to test core muscles. The number of injuries and days lost due to injury were recorded for each athlete.

The authors reported on the core stability measurements between men and women. They also compared results of injured and uninjured athletes. The results show that 35 percent of women were injured, compared to 22 percent of men. Some athletes had more than one injury. The average time to return to play was about one week.

Findings also included:

Impairments and limitations. These are words used in the medical world to describe what’s wrong and how it affects us. In this study, physical therapists report on the link between impairments and limitations in patients with a condition called type I complex regional pain syndrome (CRPS).

CRPS was formerly known as reflex sympathetic dystrophy. It’s a poorly understood problem. It occurs after trauma or surgery and affects the arms or legs. Patients have mild to severe pain, dry or flaking skin, hair loss or hair growth, and hot or cold skin temperature.

Patients with CRPS vary in how severe the problem (impairment) is as measured by range of motion and grip strength. But does this impairment always lead to limitations in what patients can actually do in normal daily life? That’s what these researchers tried to find out.

They used a special tool called the upper-limb activity monitor (ULAM) to measure arm activity. This device gives data on what patients can actually do, not just what they say they can do. Thirty patients wore the ULAM for 24 hours. The results showed activity patterns (whether or not the arms were active) and what activities were performed.

The authors report that everyone had a loss of motion (impairment). The involved limb was less active than the “normal” arm. This was especially true when the patient was sitting. However, this impairment didn’t appear to limit the patients’ general mobility. The ULAM did show that the patients with CRPS of the dominant arm had more activity limitations than patients with CRPS of the nondominant side.

Does impairment lead to activity limitation? According to this study, yes. The more impairment, the more limits there were on activity.

Previous studies have shown that Tai Chi is good for balance and joint sense. Tai Chi is an ancient Chinese exercise that involves slow, deliberate movements. It is easy on the joints and not physically demanding. This makes it a good exercise for older people. Joint sense and balance get worse with age, leading to falls, so an exercise that improves these qualities is important.

Golf is another sport that older people can enjoy. This study, done in Hong Kong, tested whether golf could improve joint sense, too. The authors studied balance and joint sense in the knee in four groups: men over age 60 who had practiced Tai Chi for at least three years; men over 60 who had golfed for at least three years; a control group of healthy men over 60 who did not do a regular activity; and university-age men.

As expected, the group of young university students had better joint sense and balance than any of the other groups. The control group had the worst joint sense and balance. The Tai Chi group had scores that were closer to the young people. And the golfers had scores nearly as good as the Tai Chi group.

The results are clear. Golf and Tai Chi are both excellent ways for older people to maintain good balance and joint sense.

True or false: Stretching before sports or recreational activities prevents injuries. True or false: Stretching before competitive sports improves performance.

There isn’t enough proof to answer either of these questions. It’s not clear if routine stretching before or after exercise prevents injuries among athletes at any level. In fact, stretching and increased flexibility might even increase the rate of muscle injury.

Researchers found 361 articles on stretching published between 1966 and 2002. Six of these reports compared stretching with other methods to prevent injury. Results of these six reports are the focus of this study. The authors give information on the following four topics:

In a perfect world, your entire medical history would be accurately described in your medical records. But how reliable are doctors’ medical records? You may not care if your records are 100 percent complete. But much medical research relies on doctors’ records. That means those records are used to understand important medical issues. This makes accuracy very important.

These authors wanted to see how accurate surgeon’s records are. They looked at the records for 166 patients who had cervical spine surgery. The authors wanted to see if post-surgery problems with talking and swallowing were reported equally by surgeons and patients. Records were studied from appointments six weeks, three months, and six months after surgery. The records were then compared to a survey given to patients.

Surgeons’ records reported far fewer problems than the patients did. The records showed that only 11 percent of patients had problems swallowing, and only five percent of patients had problems talking. The patient surveys showed that 57 percent of patients had problems swallowing, and 30 percent had problems talking. The results didn’t match well for any surgeon. Mild and moderate problems were most often missing in the medical records. But even severe problems went unreported.

This is not very good news for medical researchers. It is impossible to tell if these results are also true for other types of surgery. And this study had some limitations. But it certainly makes a case that surgeons’ records may not be the best way to get a true picture of complications after surgery.

The authors suggest the lack of accuracy may be why different outcome studies can get such different results. They recommend that patient reports should be included in any study of outcomes after surgery.

In this report, doctors at Baylor College of Medicine look at a condition called coccygodynia. Coccygodynia is defined as pain in the coccyx (the tailbone). The pain is often sharp. It’s usually made worse by sitting.

Women are affected five times more often than men. Women often have past trauma such as a difficult vaginal birth. Obesity and trauma are the most common risk factors. There are other causes such as tumors, spastic muscles, and arthritis.

The authors describe the normal anatomy in the coccyx. They discuss causes of coccygodynia in detail. Patient symptoms, findings on exam, and the results of imaging studies are also presented. Dynamic X-rays offer the best understanding of the problem and what’s causing it. These images are taken while sitting and standing.

Nonsurgical treatments may include anti-inflammatory medicine, hot packs, ultrasound, and instructions to sit on a pillow or cushion. Patients may also benefit with hands-on treatments, such as massage, joint mobilization, or manipulation. If symptoms continue despite these measures, steroid injections into the problem area may be recommended.

If patients still have pain and problems, surgery may then be recommended. The main procedure described in this review is called coccygectomy, which is the surgical removal of the coccyx. Possible problems after surgery include wound infection and delayed healing. In some cases pain is not relieved, and the bones of the sacrum (just above the coccyx) may stick out. Treatment is most successful when there’s normal motion of the coccygeal spinal segments.

Many adults have a work-related injury. Most return to work quickly. What happens to the workers who don’t get better and end up with a long-term (chronic) musculoskeletal problem? How are they different from the workers who go back to work with little lost time?

That’s the subject of this study from the Productive Rehabilitation Institute of Dallas for Ergonomics (PRIDE). A large number of patients (over 1,000) were put into two groups: those who finished rehab without further health care visits, and those who didn’t. The second group visited at least one new health care provider after rehab was over.

The results of this study are important because chronic cases of disability account for a large amount of the money spent on health care for musculoskeletal problems. Some patients see many doctors for the same problem. Studies show there are many reasons why patients go “doctor shopping.” All of them lead to one thing: increased health-care costs.

The authors found that 90 percent of the group who didn’t visit a new health care provider (group zero) returned to work. They were still working a year later. On the other hand, 78 percent of the group who did seek more health care (group one) went back to work. Only 68 percent were still at work a year later.

Group zero settled all legal and financial issues linked to the injury. Only 77 percent of group one was able to do the same. The researchers noticed lower socioeconomic groups tend to use the health care system more. Group one had a much higher number of patients who had another operation at the site of injury. Overall, 25 percent of the patients in group one lost the most work, used the health care system the most, and had more legal problems than group zero.

The authors say these findings will help us understand workers’ compensation costs. Patients who stop working also look for other sources of money, such as continued workers’ compensation, Social Security disability, and welfare. The patients may use the ongoing health care visits as a way to prove they are disabled. In this way they try to qualify for more benefits.

The authors also say there is a need for more research. If we can tell who will develop chronic problems, it may be possible to prevent them early on. Finding risk factors for treatment failure can help doctors screen patients ahead of time and prevent disability.

You may not have heard of it, but wakeboarding is a popular new water sport. Wakeboarders are pulled behind motor boats just like water skiers. But wakeboarders ride on boards that are more like snowboards. Tight boot-like bindings keep their feet on the boards. Wakeboarders jump the wake of the boat. They can also do tricks like flipping, spinning, and jumping off ramps. Jumps can go up to 20 feet above the water.

Doing these tricks at high rates of speed, with feet tightly attached to the board, sounds dangerous. And as this doctor reports, it sure can be. This survey of wakeboarders and orthopedic surgeons turned up some serious wakeboarding injuries. Of the wakeboarders who returned the survey, 77 percent reported being injured while wakeboarding. Most of the wakeboarders reported tears of the anterior cruciate ligament (ACL) in the knee and ankle sprains. Most of the injuries happen from hitting the water during a trick that went wrong. It is unusual for injuries to happen from hitting a ramp, dock, or other structure.

About half of the surgeons reported seeing wakeboard injuries. Most were ACL tears. ACL tears accounted for 31 percent of the injuries. Shoulder dislocations made up 15 percent of the injuries. Twenty-one percent were fractures, including breaks in the spine, leg bones, feet, and ribs. These fractures were often very serious. Skull fractures have also been reported. Injuries seemed to happen in all levels of wakeboarders, from novices to professionals.

This study has many limitations. Finding a way to contact doctors and wakeboarders is difficult because it is a recreational sport that isn’t organized by official leagues. Very few wakeboarders returned the survey. The study can’t show what percentage of wakeboarders actually get injured.

Still, the author feels the research clearly shows that wakeboarding can cause serious injuries. He recommends that safety features be studied, including better bindings, helmets, and strength training.

Injuries on the slopes are less common than most people think. These authors report that, on average, downhill skiers and snowboarders only get injured once every 300 days of hitting the slopes. Still, there are a lot of ski injuries. And most of these injuries happen to beginning skiers.

The authors looked at injury patterns at three ski areas in Scotland. Injuries were divided up between skiers, snowboarders, and skiboarders. Skiboarding (often called snowblading) is a new sport. Snowbladers use short skis with bindings that can’t detach. The short skis are easy to maneuver, but the bindings make injuries more likely.

The authors collected information on injured skiers and a control group who did not get injured. As expected, the authors found that first-day skiers, snowboarders, and snowbladers were much more likely to be injured than the more experienced people on the slopes. The authors found some interesting facts about the injuries:

About half of all pregnant women will have low back and pelvic pain during pregnancy. For most women, the pain may go away a couple months after the baby is born. For some women, it doesn’t go away at all. They may be unable to complete daily tasks. They may not be able to go back to work. Serious disability can occur.

Researchers are looking for a way to treat this problem with exercise. Physical therapists from the University of Oslo in Norway report on the success of one exercise program for postpartum pelvic pain. They used a series of exercises called stabilizing exercises. Women did the exercises for 20 weeks. Pain levels, function, and quality of life were measured before and after the exercise program.

Eight-one women with pelvic pain were put in one of two groups. Both groups had an exercise program. Group one did the specific stabilizing exercises (SSEG). Group two (the control group) had physical therapy but not the special exercises. Each woman in group two had treatment just for her specific problem. Treatments may have included heat, electrotherapy, posture and body mechanics, or joint mobilization.

The authors report a difference in the results between the two groups. Group one (SSEG) had much less pain, better function, and a higher quality of life compared to the control group. Disability in the SSEG group went down by 50 percent. These good results lasted even after 12 months. No changes occurred in the control group.

The authors conclude that the specific exercises given to postpartum women with pelvic pain improved motor control and stability in the pelvic area. These changes helped transfer some of the load away from the pelvis. The program was low in cost. Very little equipment was needed, and all exercises could be done at home.

What’s best when lifting a heavy object? Should you hold your breath and bear down as you lift? Is it better to let your breath out slowly while lifting? Studies of breath control during lifting are few and far between.

This study looks at the effect of breath control on intra-abdominal pressure (IAP) during lifting tasks. Four types of breathing were used:

Any time a muscle is immobilized, it wastes away (atrophies). Serious illness, injuries, and fractures all involve some type of immobilization. So may surgeries such as total knee and hip replacements. One of the most important tasks of recovery in all these cases is to rebuild muscle.

The problem is, scientists don’t understand all the mechanisms of how muscles regrow. This article details the chemical and cellular changes that happen when muscles atrophy and regrow. Much of the research has been done in lab rats. One of the interesting findings is that muscle cells in older lab rats often have a great deal of trouble regrowing. Sometimes the cells don’t seem to be able to regrow at all. There are also differences in the ways that regrowth happens in the different types of muscle fibers.

This type of research can be the foundation for finding better ways to regrow atrophied muscles. Some day, this research may help doctors and physical therapists design even better rehab programs for their patients.

Sprains, strains, and fractures are the most common musculoskeletal injuries. They make up one of the biggest reasons patients go to the doctor. Degenerative joint disease that comes with aging is also a common condition. Most patients with these problems see their primary care doctor or an orthopedic doctor.

Sometimes patients with musculoskeletal problems are sent to a physical therapist (PT). In many states the patient can go the therapist without seeing a doctor first. This is called direct access. In every state, a doctor can refer patients to PT.

In this study, therapists try to find out which doctors send patients to PT. They looked for ways to tell which doctors are more likely to make a PT referral. The goal is to understand the doctor’s role in the use of physical therapy for musculoskeletal conditions. Do orthopedic doctors refer more often than primary care doctors? Why or why not?

The authors of this study found out:

Osteoporosis is a disease of low bone mineral density (BMD). People with osteoarthritis (OA) tend to have high BMD. That means people with OA don’t usually have osteoporosis–or so doctors have thought.

These authors looked at BMD, vitamin D and calcium levels, and health habits of 68 women. All the women were past menopause. All were getting hip replacement surgery because of severe OA. This means none of the women should have had osteoporosis, right? Wrong. Results showed that 25 percent of the women had both OA of the hip and osteoporosis. Apparently, the old theory is a myth.

The results also showed that 22 percent of all the women (both with and without osteoporosis) had too little vitamin D. The body produces vitamin D when exposed to sunlight. Vitamin D can also be found in some foods, including eggs. Vitamin D deficiencies did not seem to be related to osteoporosis, however.

The main message of this research is that doctors need to be aware that OA doesn’t protect women against osteoporosis. It is possible to for patients to have both conditions at the same time.

There’s a big difference between what should be done for the prevention and treatment of osteoporosis and what’s actually being done. This is the first report of a gap between guidelines and current practice in this area.

National guidelines for osteoporosis treatment and prevention are out. They come from the National Osteoporosis Foundation, the American College of Rheumatology, and the American Association of Clinical Endocrinologists. Many clinics make their own standards based on the national listings.

Doctors at the Oregon Kaiser Permanente Center for Health Research in Portland studied a group of 3,812 women in their health maintenance organization. All women were over 50 years of age. All had a fracture within the last six months. They found that less than half the women with fractures were treated by the clinic guidelines for osteoporosis. The guidelines advise measurement of bone mineral density (BMD) and treatment with drugs. Both steps should be done within six months of the fracture.

About 45 percent received drugs for osteoporosis, but most of them were already taking these before their fracture. Only five percent of the women had a BMD study in the 12 months before or six months after the fracture. Three-fourths of the women who did get the drug took it regularly. Younger women were more likely to follow the treatment on a regular basis.

The authors of this study report no change in the way doctors treated osteoporosis at their health care center from 1998 to 2001. They think something needs to be done about the gap between guidelines and practice for osteoporosis. Closing the gap is important as more and more people live longer. Just giving doctors guidelines probably isn’t enough. Suggestions include:

No one argues that frequent exercise has many benefits. Sports and exercise strengthen the heart, lungs, bones, and muscles. Exercise helps keep people slim. But very active people face a higher risk of injuries to the joints. This is especially true of athletic children and teens. Childhood sports injuries can create problems later in life. To make matters worse, doctors are seeing more and more sports injuries to the joints.

These authors feel that studies should be done on athletes over the long term. They say there is not enough data to show what happens when injured athletes return to sports. What is their situation 10, 20, and 30 years down the road? Are they still able to do normal tasks without pain? Did they need further surgery for the same problem? Have they developed osteoarthritis (OA)?

Existing research is not reassuring. The authors cite studies showing that:

How can doctors tell if arm pain in patients with fibromyalgia syndrome (FMS) is from the fibromyalgia or something else? FMS describes a condition of painful tender points in the muscles. To be diagnosed with FMS, the patient must have 11 positive tender points out of 18 possible points. The tender points must be present in all four arms and legs as well as the trunk. Other symptoms such as fatigue, headache, and sleep problems must also be present. Injury or damage to the nerves (neuropathy) in the arms and legs can also cause painful symptoms.

A careful exam is needed to sort these problems out when the patient who has FMS also develops symptoms of neuropathy. This is the conclusion of hand surgeons at Johns Hopkins University. They say the tests for nerve damage are still valid in patients with FMS. The tender points of FMS and the painful points with neuropathy are close together, but not the same.

The pain is also described differently. Pain with FMS is widespread and usually on both sides. Patients say it’s “deep” and “aching.” Pressure on the nerves to the arm usually causes numbness, tingling, or weakness more than pain. When it’s present, nerve pain is described as “hot,” “sharp or stabbing,” or “burning.”

The authors conclude that using standard tests for positive nerve damage is still useful in patients with FMS and arm pain.