Bone densitometry has well-established usefulness in assessing fracture risk. Anyone with a condition that might reduce bone mass or accelerate bone loss should undergo testing, as should postmenopausal women and perimenopausal women who are undecided about starting estrogen replacement therapy. When stratifying a patient's risk of fracture, clinicians should consider not only BMD but also age, lifestyle, concurrent illness, and family history. Almost all patients with BMD in the osteoporotic range on densitometry should be considered for pharmacologic therapy, and so should many of those with values in the osteopenic range. Periodic retesting with bone densitometry is appropriate to monitor the progress of age-related bone loss and response to therapy. There are differences among skeletal sites used in BMD measurement, particularly regarding response to therapy. In addition, there are differences in calibration among densitometry machines, so whenever possible, serial studies should be done on the same machine and by the same technologist.
Trauma and compression along the course of the median, ulnar or radial nerve from the brachial plexus to the fingers may cause pain, weakness, numbness or tingling of the upper extremity. Diabetes, smoking, alcohol consumption, rheumatoid arthritis and hypothyroidism are risk factors for nerve entrapment, although these disorders typically produce bilateral symptoms. Carpal tunnel syndrome, the most common nerve entrapment condition, results from median nerve compression at the wrist. The diagnosis is suggested by decreased pain sensation and numbness in the thumb and index and middle fingers; symptoms are reproduced by wrist hyperflexion and median nerve percussion. Volar splinting and steroid injection often ameliorate symptoms. Decreased sensation of the little finger and the ulnar aspect of the ring finger, along with intrinsic muscle weakness, may be caused by cervical radiculopathy, thoracic outlet syndrome or compression of the ulnar nerve above the elbow (cubital tunnel syndrome) or at the wrist (ulnar tunnel syndrome). Electromyography and radiography may help differentiate these conditions. Radial tunnel syndrome occasionally accompanies inflammation of the common wrist extensors and lateral epicondylitis ("tennis elbow"). A radial nerve block can help exclude concomitant radial tunnel syndrome in patients with symptoms of lateral epicondylitis.
"A Skin-Deep Diagnosis." The Physician and Sportsmedicine, 22(12), pp. 79–82 Additional informationNotes on contributorsMark D. BrackerDr Bracker is an associate clinical professor in the Department of Family and Preventive Medicine at the University of California, San Diego (UCSD), School of Medicine. He is an editorial board member of THE PHYSICIAN AND SPORTSMEDICINE and a diplomate of the American Board of Family Practice. He holds a certificate of added qualifications in sports medicine.
The environment can have a profound impact on human performance. Over the past decade there has been considerable interest in the scientific study of the human ability of to protect oneself against heat and cold. This new knowledge has led to a better understanding of physiology and resulted in better prevention, recognition, and treatment of hyperthermia, hypothermia, and frostbite. This article reviews the pathophysiology of extreme environmental exposure and discusses current strategies for prevention and treatment.
A group of experts met to discuss a case from the University of California, San Diego, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.
A group of experts met to discuss a case from the University of California, San Diego, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.
A group of experts met to discuss a case from the University of California, San Diego, School of Medicine. This case conference is part of a series featuring a variety of sports medicine topics.
