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Knee Exam

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901. FES-Rowing Versus Zoledronic Acid to Improve Bone Health in Spinal Cord Injury (SCI)

were planned to receive CT scans of their knees at MGH at the beginning and end of the study. Up to 20 subjects were to have an additional CT scan (at MGH) six months into rowing. Research blood samples were planned to be collected at VABHS five times during duration of the study and stored at the VA for further study of molecular markers of bone turnover. All participants were expected to be screened for renal function and calcium and vitamin D levels at the beginning and end of the study (...) androgenic steroids estrogenic steroids glucocorticoids antiepileptics lithium. Any subject with a planned invasive dental procedure will be excluded. These criteria will be reviewed by telephone survey followed by a health exam where blood pressure will be assessed and a skin and neurological exam performed. Contacts and Locations Go to Information from the National Library of Medicine To learn more about this study, you or your doctor may contact the study research staff using the contact information

2011 Clinical Trials

902. Diagnostic Accuracy of Whole Body Magnetic Resonance Imaging in Inflammatory Myopathies

. Evaluation of reproducibility inter-observers and intra-observers of interpretations of RMI. Evaluation of reproducibility inter-observers and intra-observers of muscles biopsy interpretations according with the European neuro muscular classification ENMC. Study calendar : Including 130 patients during 24 months RMI interpretations are realised immediately after RMI exam without informing the investigator. Procedures of anonymisation of the double reading are done every 03 months. V1 = inclusion visit (...) using the contacts provided below. For general information, Layout table for eligibility information Ages Eligible for Study: 18 Years and older (Adult, Older Adult) Sexes Eligible for Study: All Accepts Healthy Volunteers: No Criteria Inclusion Criteria: Skin rash typical of dermatomyositis: "lilac" rash (+/- oedemata) of upper eyelids, periungual sign, erythematous-scaly eruption occurring over the MCP and IPP, elbow, knees (Gottron's signs ands papules), erythema of light-sensitive areas

2011 Clinical Trials

903. Does Vibration Therapy Induce Higher Than Normal Bone Strains and Strain Rates Than Those Experienced During Habitual Daily Activities

] Peak amplitude attenuation αm (in cm and percentage) and phase shift βm (in degrees) of the oscillating positional coordinates and accelerations (at different anatomical landmarks) measured by VICON MX motion analysis system during vibration therapy (using the vibration device as a reference) Posture during vibration therapy assessed in terms of the angulations of the ankle, knee and hip joints and of the trunk, derived from the positional coordinates [ Time Frame: At time of Vibration Therapy (...) Accepts Healthy Volunteers: Yes Criteria Inclusion Criteria: Male or female volunteers, ages 18 to 50 years Generally healthy, as determined by review of medical history and physical exam Ambulatory Willing and physically able to undergo all study procedures BMD (measured by DXA) at the lumbar spine and hip within ± 2 SD of the young normal range BMI < 30 Exclusion Criteria: Previous diagnosis of osteoporosis History of fracture of the spine, pelvis, leg or foot History of bone or joint disorders

2011 Clinical Trials

905. Optimal measurement of clinical rotational test for evaluating anterior cruciate ligament insufficiency. (PubMed)

Optimal measurement of clinical rotational test for evaluating anterior cruciate ligament insufficiency. Rotational instability in ACL insufficient knee addresses the symptom or the abnormal motion which can be reproduced and subjectively evaluated in the clinical exam. Clinically available quantitative measurement for this instability has not been established due to mixed testing maneuvers and complex kinematics. The purpose was to measure knee kinematics during three manually performed (...) was calculated. The differences of these parameters between ACL intact and deficient knees were tested.Knee rotation is not different between ACL intact and deficient during both pure rotational stress test and pivot shift test. The coupled anterior tibial translation during pivot shift test was significantly different between ACL intact, 13.5 ± 4.1 mm, and deficient knees, 23.1 ± 4.4 mm, (P < 0.01) as well as the acceleration of the tibial posterior translation (1.1 ± 0.4 m/sec(2) in intact knees, 3.2 ± 1.5

2012 Knee Surgery, Sports Traumatology, Arthroscopy

906. Development of a hospitalist-led-and-directed physical examination curriculum. (Full text)

and based on a learner-centered educational model. First, selected faculty fellows achieve expertise through mentorship with a master clinician. They then develop a bedside teaching curriculum in the selected domain and conclude by delivering the curriculum to peer faculty.We have developed curricula in examination of the heart, shoulder, knee, and skin. Currently, curricula are being developed in the examination of the lungs, critical care bedside rounds, and motivational interviewing. Curricula (...) are integrated with educational activities of the internal medicine residency and medical school whenever possible.A hospitalist-led physical examination curriculum is an innovative way to address deficits in physical exam skills at all levels of training, engenders enthusiasm for skills development from faculty and learners, offers scholarship opportunities to general medicine faculty, encourages collaboration within and between institutions, and augments the education of residents and medical

2012 Journal of Hospital Medicine

907. The Difficult Delivery: Umbilical Cord Prolapse

The Difficult Delivery: Umbilical Cord Prolapse The Difficult Delivery: Umbilical Cord Prolapse - First10EM Search The Difficult Delivery: Umbilical Cord Prolapse by | Published - Updated Case Once again, a 34 year old G5P4 woman at 39 weeks gestation is wheeled into your resus room in what appears to be . You perform a quick exam, but instead of encountering the presenting part, you feel a pulsatile cord. Oh no, you remember hearing about umbilical cord prolapse back in medical school… My (...) approach This is the simplest of our “difficult delivery” series: As soon as the examining hand reveals an umbilical cord, the hand is used to elevate the presenting part and reduce compression of the cord. This hand remains in the vagina until baby is delivered by emergency c-section. Call for help: Inform obstetrics and rapidly transport the patient to the OR for an emergency c-section. Position the mother to reduce cord compression: either knee to chest position or left lateral with head down

2015 First10EM

908. Antithrombotic Therapies in Spine Surgery

(62 PSF/3 ASF/ 2 hardware removal) Consecutive series (select one)? Yes Type(s) of surgery: ASF/PSF/Circumferential or hardware removal Duration of follow-up: 3-20 days for duplex with 2-year retrospective review of group Validated outcome measures used (list): Duplex Doppler and V/Q in 73/116; no clear functional outcome measure used Nonvalidated outcome measures used (list): Diagnosis of DVT/PE made by (check all that apply): Clinical exam Ultrasound Venography Other (please specify (...) one)? Yes Type(s) of surgery: Cervical corpectomy Duration of follow-up: 2 days post-op; 2.5 year one-level, 5.3 year multi-level Validated outcome measures used (list): None Nonvalidated outcome measures used (list): None Diagnosis of DVT/PE made by (check all that apply): Clinical exam Ultrasound Venography Other (please specify): CT angiogram of chest on patients with suspected PE Nonmasked patients No validated outcome measures used Small sample size <80% follow-up Lacked subgroup analysis

2009 North American Spine Society

909. Management of Pregnancy

- if negative, elevate care - Screening fundal height - Screening for hypertensive disorders - Assessing weight gain - Assessing for symptoms of preterm labor (week 28, 32) - Assessing fetal kick counts For specific interventions see Prenatal Care Interventions – Weeks 28-41. A-7. Postpartum Visit BACKGROUND The postpartum visit provides the opportunity for providers to interact with the new mother and her infant through interview, exam, and testing. The timing and the content of the postpartum visit have

2009 VA/DoD Clinical Practice Guidelines

910. Diagnosis and Treatment of Acute Achilles Tendon Rupture

that a detailed history and physical exam be performed. The physical examination should include two or more of the following tests to establish the diagnosis of acute Achilles tendon rupture: o Clinical Thompson test (Simmonds squeeze test) o Decreased ankle plantar flexion strength o Presence of a palpable gap (defect, loss of contour) o Increased passive ankle dorsiflexion with gentle manipulation Strength of Recommendation – Consensus* Description: The supporting evidence is lacking and requires the work

2009 American Academy of Orthopaedic Surgeons

911. Groin Pain In Athletes

that this is the source of your pain, a local anesthetic can be injected to numb the nerve. That can assist your doctor in determining whether or not the nerve is the source of your pain. In a group of over 300 athletes with groin pain. more than 60% had pain due to the Pubic Aponeurosis. The other causes were far less common causes of athletic groin pain. There is a lot of overlap in terms of physical exam findings and complaints that the athlete offers. Therefore, a meticulous exam is necessary in order (...) to determine the source of the groin pain. An MRI is useful when the results are put into context with the complaints of the athlete and the findings on exam. Despite the prevalence of abnormal hip signal on MRI, relatively few patients met the criteria for surgical intervention. Dr Andy Franklyn-Miller Perhaps most enlightening … . That means they may have been told that the pain was coming from their hip joint and that surgery was indicated. As I say often, we need to treat patients and not an MRI image

2015 Howard J. Luks, MD blog

912. What Is An MCL Tear? Terminology Tuesday

to have the knee cave in and feel loose. That athlete is usually carried off the playing field. How to diagnose an MCL tear Your doctor will diagnose an MCL injury on physical exam. An MRI is useful to determine if anything else was injured at the same time. We can determine if the MCL is injured based on where your pain is located. By stressing the knee during an examination, we can also determine the severity of the tear by examining your knee. How severe is my MCL injury? We grade the severity (...) of an MCL tear between a Grade I and a Grade III. Grade I tears are the least severe. Grade 1 injuries involve a stretch or a strain of the MCL. An exam should reveal a stable knee, but pain when touching the MCL. Grade II injuries involve a partial tear of the MCL ligament. A knee with a Grade II tear will feel a little loose, but should not feel unstable. Grade III MCL tears are complete tears. That means the ligament has completely torn into two separate pieces. Many people with grade III injuries

2015 Howard J. Luks, MD blog

913. Frozen shoulder? Let it go, Let it go….

of a frozen shoulder, like most things, is usually done mainly with the subjective history. Patients age, medical history, onset, nature, aggs and eases all give clues of a frozen shoulder. Clinical examination to confirm a frozen shoulder is relativity simple, it involves looking for 3-4 movements that have EQUAL loss of both active and passive range of movement with significant pain at end of range, as well as doing resisted shoulder tests that usually produce no significant pain or weakness. This exam (...) the worse affected. I have little to no internal rotation on my dominate arm (right) meaning I can even reach over and touch my left side (front) and back, well thats just not happening . Right arm started in Sept 2016 with the Dr doing an ultra sound and saying it was bicep tendonitis, I had one cortisone shot into bursa but that did nothing. My arm became so painful over the next month it was stupid and slight movement would drop me to my knees .. then i felt the left arm going so i quickly began

2015 The Sports Physio blog

914. How Medicare ruined the annual physical

proven to be of little value, but there were more and more screening and preventive services we simply needed to talk about. It was also a time to do a thorough review of systems, and to update the family history. When patients started talking about sore knees, allergies or frequent urination, I would try to gently steer the conversation by saying something like “those are things we can look into sometime, but today I’d like to focus on the big health issues that could kill you.” This approach (...) wellness visits on their Medicare patients, but not according to their own best efforts or their patients stated preference — one item missed or omitted out of deference to conflicting guidelines or common sense, like the kindergarten-style visual exam for new Medicare beneficiaries in their first six months of coverage, and no payment is collected. And similarly, check a few basic things like lung or heart sounds, the presence of leg edema or skin cancer, and the free insurance benefit is forfeited

2015 KevinMD blog

915. NIRS-Assisted Resuscitation: Following the N=1 Principle. (Part 1) #FOAMed #FOAMcc #NIRS

. In septic shock it is very common and often if you repeat the US exam, you will seen new onset of LV dysfunction once you start such drugs. Using a new modality, like LV strain, we will probably be able to pick that up earlier. The third point is that NIRS never lie. At the MHI we have used it for more than 6000 cases since 2002 and a low value is always abnormal. The problem is to find why but there is no doubt in the literature that low values (particularly those who become low or start higher (...) account. ( / ) You are commenting using your Facebook account. ( / ) Connecting to %s Notify me of new comments via email. Notify me of new posts via email. This site uses Akismet to reduce spam. . on on on John on on the best is yet to come. This site is the bee's knees where everything is up for debate . . . Brazilian Jiu Jitsu for Wrestlers Spheres of basic emergency medicine knowledge Critical discussions on critical care a blog for thinking docs: blending good evidence, physiology

2015 Thinking critical care blog

916. Why doctors overtreat patients. And how to fix it.

of pacemakers are inserted unnecessarily. And long-term follow-up of many commonly performed surgeries demonstrate minimal impact. An oft-cited example is low back pain. Thousands of Americans undergo disc removal or spinal fusion each year, despite limited evidence that either surgical procedure is more effective than non-operative therapy in providing long-term pain relief or improved function. And for patients with the typical wear-and-tear osteoarthritis of the knee, physical therapy proves (...) attack or stroke. But screening more frequently than national guidelines recommend is ineffective, a waste of time and resources. So why does this ineffective ritual of the annual physical exam continue? Psychological studies reveal that a powerful anecdote can be much more influential than data. Doctors and patients remember the one patient in a thousand for whom a routine examination found something unexpected. Meantime, they overlook the 999 for whom it made no difference and led to unnecessary

2015 KevinMD blog

917. Patient Modesty: Volume 73

skip the questions / part of an exam. So no mention of body language or anything the patient might display if they really don't want to answer / consent but feel obligated to, or just as a sign of general embarrassment / discomfort? Jason K. Jason, no whipping. And yes, the students are taught to be aware of unspoken but behavioral rejection and yes, if the patient rejects despite further explanation, that activity is not performed but the students are to explain the absence in their writelups (...) to have a point of view from the patient in some of these scenarios - they count too right? The fact that the patient isn't represented is very telling IMHO Kevin At , said... Dr. B, I would agree that trust in medical professionals has eroded. There are likely a number of causes, but those I see as important factors are: 1. Disclosure of past or current practices where the privacy of patients was violated without their knowledge or consent - i.e. the practice of trainees performing pelvic exams

2015 Bioethics Discussion Blog

918. Taking a page from medicine to improve the quality of baseball

to rely on to determine whether a particular practitioner was competent. So some decades later, American medicine created the boards, which were charged with weeding out unqualified practitioners. Over decades, these boards have developed objective and fair criteria for making these tough decisions, using such tools as standardized examinations. What I envision is a high-stakes, multiple-choice exam, administered by computer over perhaps several days, which every player would be required to pass (...) before being allowed to play in the big leagues. I am not talking about esoteric trivia. I am talking about the basics of the game. Consider this sample question: What defines the bottom of the strike zone? A. Mid thigh. B. Just above the knee. C. The hollow beneath the knee cap. D. Mid shin. To allow any player who does not know the answer to ascend to the big leagues would represent an abrogation of the game’s professional responsibility. Yet in the current unregulated system that constitutes

2015 KevinMD blog

919. How heartburn caused a patient to lose her left leg

. A noncontrast abdominal/pelvic CT is ordered, performed and the patient is taken back to an exam room in the ED. The nurse seeing the patient recognizes that the patient has heartburn and gets an order for TUMS. The patient’s symptoms quickly abate. The CT scan is read by the radiologist as negative for acute pathology—there is no cause for acute abdominal pain demonstrated. A 2.6 cm indeterminate mass is described in the central aspect of the right hepatic lobe for which a liver mass protocol CT (...) on her knee and is not able to move into all the necessary positions. Based on the imaging results and the history of heartburn, an upper endoscopy is performed — this test demonstrates a normal esophagus, stomach, and proximal duodenum. During the procedure, however, the patient has a massive aspiration event. The patient is admitted to the hospital, and a subsequent chest radiograph demonstrates a large focus of consolidation in the right middle and lower lobes consistent with history of aspiration

2015 KevinMD blog

920. 15 years of Explaining Pain – where have we been and where are we going?

15 years of Explaining Pain – where have we been and where are we going? 15 Years of Explaining Pain - Part 1 Research into the role of the brain and mind in chronic pain 15 years of Explaining Pain – where have we been and where are we going? June 12, 2015 by Neuroscience was clearly my favourite course at uni – I loved it so much I was learning for fun, not for exams. I don’t recall ever studying for a neuroscience exam – it all seemed to magically stick in there – as if there were tailored (...) ? and (2) how *can* you tell how serious the threat of tissue damage is? I’ve studied some health psychology at uni and in theory I accept the idea behind EP. I experience different types of chronic pain. For example, there’s a bit of lose bone in my knee that moves around, sometimes locking my knee, this leads to painful sensation and the pain seems to accurately mark the movement of the lump. A few years ago a PT said to me that I wasn’t doing any damage walking on my painful knee. I just didn’t

2015 Body in Mind blog

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