Clinical Pain Advisor

Evaluation and Management of Fractures of the Capitellum

The Problem Fractures of the capitellum represent a distinct subset of coronal plane partial articular injuries of the distal humerus, and account for less than 1% of all elbow fractures. These are coronal shear fractures that may involve the capitellum in isolation, extend medially to involve the trochlea, or occur with complex osseous or ligamentous…

Evaluation and Management of Scapular Winging due to long thoracic nerve palsy

The Problem Scapular winging is a rare condition that results in abnormal scapular motion, causing pain and decreased functionality of the upper extremity. The diagnosis can be missed, leading to unnecessary surgery, although a thorough physical examination and proper diagnostic studies can lead to the correct diagnosis as well as elucidating the underlying etiology. Causes…

My Approach to Superior Labral Pathology

The Problem Injury to the superior glenoid labrum and biceps anchor is an important cause of shoulder pain in overhead athletes and active individuals. Accurate diagnosis is often challenging, and management of these injuries remains controversial. “Superior labrum anterior-posterior” – or SLAP – tears represent a variety of injuries originally classified into four types (Figure…

Glenohumeral Degenerative Disease: Osteoarthritis

The Problem Degenerative osteoarthritis (OA) of the glenohumeral joint may be a primary, idiopathic process. However, it can also be secondary to a number of inciting factors including post-traumatic, previous capsulorrhaphy, chondrolysis from intra-articular pain pumps, hardware complication, persistent instability, and developmental problems that accelerate the degenerative process. Although both OA and inflammatory arthropathies such…

Fractures of the Olecranon and Proximal Ulna

The Problem Fractures of the olecranon are classically the result of fall on the elbow with eccentric triceps contraction. These range from small extra-articular fragments to intra-articular comminuted fractures that may be associated with elbow dislocations. Fractures of the proximal ulna are higher energy injuries and are associated with injuries to the proximal radio-ulnar joint;…

Sarcoidosis

What every physician needs to know: Sarcoidosis is a rare (incidence of 10-40/100,000) multi-organ, granulomatous disease of unknown etiology. While the lungs and hilar and mediastinal lymph nodes are usually involved, any organ system may be effected. The disease manifestations depend upon the duration of disease, site and extent of organ involvement and the activity…

Laryngomalacia

OVERVIEW: What every practitioner needs to know Are you sure your patient has laryngomalacia? What are the typical findings for this disease? Upper airway obstruction in the neonatal period is not uncommon but it is usually mild and self-limiting. Simple measures are usually sufficient in managing mild airway symptoms, but further evaluation and management become…

Molybdenum cofactor deficiency

OVERVIEW: What every practitioner needs to know Are you sure your patient has molybdenum cofactor deficiency? What are the typical findings for this disease? Molybdenum cofactor deficiency is a rare autosomal recessive disorder most often presenting with severe neonatal seizures. It should be suspected in any infant with progressive neurologic decline in which asphyxia is…

Glutaric aciduria type I

OVERVIEW: What every practitioner needs to know Are you sure your patient has glutaric aciduria type I? What are the typical findings for this disease? Glutaric aciduria type I (GA-I) should be considered in any patient who has a history of dystonia/dyskinesia with macrocephaly. Prior to these overt chronic neurologic symptoms, there is usually a…

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