Office Orthopedics for Primary Care [Treatment] 3rd ed. - B. Anderson (Saunders, 2006) WW.pdf - Bio Med 19 - Aivree

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OFFICE ORTHOPEDICS FOR PRIMARY CARE:TREATMENT

ISBN 1-4160-2206-6

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Notice

Knowledge and best practice in this field are constantly changing.As new research and experience

broaden our knowledge, changes in practice, treatment, and drug therapy may become necessary or

appropriate. Readers are advised to check the most current information provided (i) on procedures

featured or (ii) by the manufacturer of each product to be administered to verify the recommended

dose or formula, the method and duration of administration, and contraindications. It is the

responsibility of the practitioners, relying on their own experience and knowledge of the patients, to

make diagnoses, to determine dosages and the best treatment for each individual patient, and to take

all appropriate safety precautions.To the fullest extent of the law, neither the Publisher nor the

Editors assumes any liability for any injury and/or damage to persons or property arising out of or

related to any use of the material contained in this book.

Library of Congress Cataloging-in-Publication Data

Anderson, Bruce Carl.

Office orthopedics for primary care: treatment / Bruce Carl Anderson.—3rd ed.

ISBN 1-4160-2206-6

1. Orthopedics. 2. Primary care (Medicine) I.Title.

RD732.A53 2006

616.7—dc22

2005046537

Acquisitions Editor: Rolla Couchman

Developmental Editor: Matthew Ray

Publishing Services Manager: Frank Polizzano

Project Manager: Lee Ann Draud

Design Direction: Karen O’Keefe Owens

Printed in the United States of America

Last digit is the print number: 9

Office Orthopedics for Primary Care: Treatment

(Third Edition)

Author(s): Bruce Carl Anderson, MD

ISBN: 978-1-4160-2206-0

Table of Contents

Page iv

Dedication

Page v

Preface

Pages vii-viii

Acknowledgments

Page ix

Section I: The 67 Most Common Outpatient Orthopedic Conditions

Chapter 1 - Neck

Pages 2-16

Chapter 2 - Shoulder Pages 17-49

Chapter 3 - Elbow

Pages 50-64

Chapter 4 - Wrist

Pages 65-85

Chapter 5 - Hand

Pages 86-103

Chapter 6 - Chest

Pages 104-110

Chapter 7 - Back

Pages 111-125

Chapter 8 - Hip

Pages 126-145

Chapter 9 - Knee

Pages 146-177

Chapter 10 - Ankle and Lower Leg

Pages 178-209

Chapter 11 - Foot

Pages 210-224

Section II: Fractures, Diagnostic Procedures, and Rehabilitative Care

Chapter 12 - Fractures Frequently Encountered in Primary Care

Pages 226-241

Pages 242-244

Chapter 13 - Radiology and Procedures

Chapter 14 - The Most Commonly Used Supports, Braces, and Casts Pages 245-264

Pages 265-293

Chapter 15 - Exercise Instruction Sheets

Pages 294-300

Appendix - Fractures, Medications, and Laboratory Values

References

Pages 301-313

Index

Pages 315-324

To the pioneering work of

P. Hume Kendall of the Department of Physical Medicine,

Guy’s Hospital, London, England

and

Joseph L. Hollander of the Arthritis Section,

Department of Medicine, Hospital of the University of Pennsylvania,

Philadelphia, Pennsylvania

PREFACE

Over the last 60 years, corticosteroids have been used

to treat acute and chronic inflammation of a wide variety

of diseases. Cortisone was originally identiﬁed and subse-

quently puriﬁed from animal adrenal glands in the 1930s.

Fifteen years later, cortisone and hydrocortisone were

synthesized from bile acids, setting the stage for the

clinical application of the glucocorticoid hormone in the

late 1940s. Injectable hydrocortisone was originally used

by the rheumatology group at the Mayo Clinic to treat

patients suffering from the acute and chronic inflamma-

tion of rheumatoid arthritis. Soon thereafter, having

documented hydrocortisone’s dramatic beneﬁt in this

select group of patients, the novel treatment was extended

to the treatment of other arthritic conditions and even-

tually to local orthopedic conditions. Over the next 30

years, hydrocortisone and its derivatives (triamcinolone,

methylprednisolone, dexamethasone, and betamethasone)

were used to treat the entire gamut of conditions charac-

terized by acute and chronic inflammation, from the

mildly inflammatory osteoarthritis and focal tendinitis

to the intensely inflammatory gout and systemic lupus

erythematosus. Percy Julian—a black educator born in

Alabama—is credited with the synthesis of cortisone from

soy beans in the 1950s.

The Mayo Clinic pioneered the use of cortisone as an

effective anti-inflammatory medication in the late 1940s

and early 1950s. Kendall, Henoch, and Slocumb ﬁrst

administered cortisone by daily injection to patients with

rheumatoid arthritis.Their results (Mayo Clin Proc 24:181,

1949), along with those of the studies later published

by Hollander, Brown, Frain, Udell, and Jessar (JAMA

147:1629-1635, 1951; J Bone Joint Surg Am 35A:983-990,

1953;Am J Med 15:656-665, 1953), were so signiﬁcant that

cortisone was originally proclaimed as a “cure for arthritis.”

Because of its early success with arthritic patients,

injectable cortisone was also pursued as a possible anti-

inflammatory treatment for a variety of local orthopedic

conditions. Kendall, Lapidus, and others published studies

in the late 1950s and early 1960s demonstrating cortisone’s

remarkable ability to arrest the persistent inflammation

of tendinitis, bursitis, and other local musculoskeletal

conditions (Industr Med Surg 26:234-244, 1957; BMJ

1:1500–1501, 1955; Ann Phys Med 6:287–294, 1962; BMJ

1:1277–1278, 1956).

These initial studies were summarized in publications

and editorials in the early 1960s. Hollander published his

10-year experience in 1961. His research group performed

100,000 intra-articular injections with a remarkable safety

proﬁle; only a 1 in 10,000 risk of postinjection infection

was noted (Bull Rheum Dis 11:239–240, 1961). Kendall

came to the same conclusion, having analyzed 6700 injec-

tions over a 3-year period between March 1954 and March

1957. “Because it exerts a powerful local action and does

not appear to give rise to any general hormonal effects,

hydrocortisone by local injection has proved of great

value in the treatment of isolated joint and soft-tissue

disease.” And “It is considered that the over-all incidence

and morbidity of the side-effects following the local use

of hydrocortisone are so low as not to constitute a

contraindication to this method of treatment.” (Ann Phys

Med 4:170–175, 1961).

Yet this early enthusiasm about the clinical application

of cortisone for arthritis and local musculoskeletal con-

ditions was short lived. Through the 1960s and 1970s a

series of publications appeared that emphasized the

serious side effects that occurred when large doses of

cortisone were given over prolonged periods of time.

In addition, a number of reports—nearly all single-case

reports or anecdotal series of ﬁve patients or fewer—

showed that local injection of tendons and other soft

tissue conditions were not without hazard. Local cortisone

injection was implicated in postinjection tendon rupture,

postinjection atrophy of tissue, and postinjection avascular

necrosis of the hip. The constant stream of negative

reports had the net effect of overshadowing the extensive

research published by Kendall and Hollander from the

1950s and cast a dark cloud over the use of cortisone,

especially local injection of cortisone, over the next 2

decades.

Thirty-ﬁve studies were published through the 1960s

and 1970s, all of which intimated a direct relationship

between the injection of cortisone and the reported

adverse clinical outcome. However, a closer analysis of

these case reports suggests that other factors may have

been equally important in affecting the outcome. For

example, a review of the 23 case reports on postinjection

tendon rupture, representing 50 combined patients (the

largest published series of 5 patients was published in

the Western Journal of Medicine ), shows that half of

these 50 patients were taking systemic steroids at the time

of injection. More than half of these patients had an

underlying connective tissue disease, mostly rheumatoid

arthritis and systemic lupus erythematosus. In addition,

details of the procedures and rehabilitation methods

were not disclosed in detail in these reports. None of

the studies provided information assessing the severity

of the condition. None provided radiographic studies to

determine whether degenerative changes or partial tears

were present. None of the studies supplied details of

the exact method of injection, whether peritendinous,

intratendinous, and so forth. Lastly, none of the 23

publications provided any detail of the management of the

patient following the injection, either to what degree the

joint was protected after the injection or the speciﬁc

rehabilitation exercises required for recovery.

Interestingly, only four tendons were described in these

reports, including the Achilles, patellar, biceps, and rotator

cuff tendons (the four largest tendons under the greatest

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