The lack of quality studies relating to the diagnosis of ankle sprains may be attributable to the fact that all ankle sprains are treated in a similar manner regardless of grade (1). They are separated primarily by the length of time spent in the different phases of recovery. Interestingly ankle sprains are also treated similarly in all of the healing arts with only minor differences. Even the value of surgical intervention for Grade 3 sprains rather than conservative treatment is controversial.   [full article]

Ankle injuries are responsible for 15% of all sports injuries and are commonly encountered in practice. The diagnostic difficulties surrounding grading of the injury and ruling out fracture are the greatest challenges to the physician. Many of the articles located are "how to" articles and the author's comments appear very strong in support of certain diagnostic procedures. However there is very little in the literature that demonstrates sensitivity and specificity of standard diagnostic procedures, particularly related to partial ligament tears and ruptures.   [full article]

Although lateral ankle sprain (LAS) is considered one, if not the most, common sports injury, a very conflicting body of evidence exists as to risk factors. Recurring themes of many studies are statements such as “our findings disagree with previous studies”. It seemed in preparation of this review unless a risk factor had been only reported in one study; there was a different assessment in another.   [full article]

Over the years, scientific evidence has been published that may improve the physician's ability to differentially diagnose various spinal pathologies but clinical diagnosis of mechanical back pain has not seen many new developments. Clinicians continue to rely on orthopedic tests and palpation skills as the primary tools to determine the origin of the pain. Based on the results of these tests, the clinician then decides if additional testing is needed and/or selects the treatments that are most appropriate for the patient's condition.   [full article]

Smoking is on the decline in the United States with about 20% of American adults reporting that they currently smoke and although it has declined in adults, it is increasing in certain groups including adolescents and females. Still, tobacco use in general remains the most preventable cause of death in the United States leading to over 400,000 deaths and billions of dollars in medical expenses. The Centers for Disease Control and Prevention (CDC) stated that it should be the goal of every health care provider to ascertain the use status of their patients and advise them to make a quit attempt.   [full article]

Although there are serious concerns relating to the use of antibiotic drugs in the treatment of otitis media (OM), very little research has taken place to develop alternative, conservative treatments. Antedotal evidence and observational studies abound but few RCT’s were located to demonstrate effectiveness of drugless interventions. The obvious first concern for the physician is to relieve pain and suffering of the patient as well as prevention of more serious pathological conditions. It is also important in OM to insure the patient does not experience hearing loss and suffer the associated sequelae of learning impairment and developmental delays in language and behavior.   [full article]

Otitis media presents in two primary forms, acute otitis media (AOM) and otitis media with effusion (OME). With the heightened concerns relating to the increasing number of antibiotic resistant microbes and inappropriate use of antibiotics, the first diagnostic concern is to distinguish between the two variants. AOM is characterized by the signs of infection (fever, otalgia, irritability, headache, rhinitis, pulling at ears) combined with a bulging, sometimes red tympanic membrane and often treated with antibiotics. OME does not have the signs of infection and is characterized by a neutral or retracted tympanic membrane. Recommended treatment is "watchful waiting" for 3 months.   [full article]

The American Academy of Pediatrics has expressed concern with the rising rates of antibacterial resistant pathogens and resultant use of more expensive and broader spectrum antibiotics for the treatment of otitis media (OM). As a result they have issued recommendations intended to reduce the amount of antibiotics prescribed. It appears these recommendations have had little effect on prescription patterns between 1995 and 2000. One answer to reducing antibiotic therapy would be to reduce the number of children who develop acute otitis media (AOM) through prevention strategies. Several risk factors have been identified in the literature. Although some of these prevention strategies do not have large clinical trials demonstrating effectiveness, the evidence available has been repeated in multiple studies and appears promising.   [full article]

The gleno-humeral joint is commonly accepted to be the most complex joint in the human body. Possibly due to the difficulty of arriving at an accurate diagnosis, the term "shoulder impingement syndrome" (SIS) has become a standard term in shoulder diagnosis. Any condition that narrows the space between the anterior/inferior aspect of the acromion and coracoacromial ligament can result in SIS. The most common causative factors are a thickened subacromial bursa and rotator cuff tendonopathy.   [full article]

The chiropractic profession relies largely upon specialized manual therapy procedures (adjustment/manipulation) as a means of patient care. The methods of delivering chiropractic adjustments are not homogeneous and often require complex motor skills. These manipulative procedures involve biomechanical variables such as velocity, amplitude and the line of drive of force. Consideration of these variables is important in order to render them therapeutically safe and functionally effective. Learning these techniques in private practice or in chiropractic colleges is a process that involves significant repetition. These teaching methods have potentially damaging effects. Doctors or students learning new manipulative procedures are initially at greater risk in the skill acquisition phase, when the neuromuscular system is adapting to the new skills associated with the manipulative procedure. Epidemiological studies demonstrate that work related musculoskeletal disorders are common among health providers. Chiropractors also risk injuries of various types related to their work. Some DC's are forced to leave practice due to injury sustained in practice. Thus, an emphasis needs to be placed upon safety to ensure practice longevity.   [full article]