Trust the Physical Exam

​BY ALI OZCAN, MD; AYUSH GUPTA, MD; ISABEL NEACATO, MD; DAVID DONALDSON, DO; &SHANNA JONES, MDA 17-year-old boy presented to the pediatric emergency department complaining of a right shoulder injury and right clavicular pain for two hours. The pain started after he checked another player into the boards while playing hockey. He had no head injury, loss of consciousness, or other trauma. He took 600 mg of ibuprofen with no relief, so he came to the ED.He had no past medical or surgical problems, and reported his pain as 4/10 over the clavicle region. His review of system was otherwise negative. The patient's vitals were within normal limits. He had tenderness over the medial side of the right clavicle and no visible deformity or crepitus. He had intact distal neurovascularity over the right upper extremity and normal breath sounds bilaterally. All other systems were normal.An x-ray of the right clavicle was negative for acute fracture. (Image 1.) The right clavicle appeared inferiorly displaced relative to the left. The patient was reevaluated, and was still complaining of pain despite receiving morphine. We ordered a CT without intravenous contrast of the sternoclavicular joint (SCJ), which revealed the diagnosis. (Images 2 and 3.)Image 1. The chest x-ray showing an inferiorly displaced right clavicle relative to the left may be positional.Images 2 and 3. CT of the sternoclavicular joint without contrast: Acute comminuted fracture involving the medial most right clavicl...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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AbstractAplastic anemia (AA) has been reported to be associated with inflammatory bowel disease (IBD), but mostly with ulcerative colitis (UC). Little is known about the associations between AA and Crohn ’s disease (CD). We aim to determine the portraits of patients with AA-CD. Among a total of 657 patients with CD registered in Xijing Hospital of Digestive Diseases IBD center from January 2008 to October 2018, the patients diagnosed with concurrent AA were reviewed. Clinical presentation, medical history, endoscopic features, response to treatment, and prognosis in this set of patients were collected. Six male patie...
Source: Annals of Hematology - Category: Hematology Source Type: research
Conclusions: The proposed guidelines provide easy access to existing information in endodontics. The findings are common and possess clinical and medico-legal importance.
Source: Quintessence International - Category: Dentistry Source Type: research
Conclusions: Since One Shape and Revo-S are both based on the rotational approach and WaveOne on reciprocal approach, less incidence of postoperative pain intensity with One Shape and Revo-S in single-appointment nonsurgical endodontic retreatment could be associated with the motion type during root canal shaping.
Source: Quintessence International - Category: Dentistry Source Type: research
Sk ármeta, Nicolas Patri / Pesce, Maria Cecilia / Saldivia, Josefina / Espinoza-Mellado, Paula / Montini, Francisca / Sotomayor, ClaudioPage 662 - 669Objective: The understanding the etiology of painful temporomandibular disorders (TMD) has evolved over the last eight decades. Evidence-based systematic research had questioned historical concepts and abandoned preconceived dogmas based purely on mechanically based etiologies, transforming TMD into a complex musculoskeletal chronic pain model. Unfortunately, many of these old ideas persist in undergraduate education and the dental community. Revisiting the historical ...
Source: Quintessence International - Category: Dentistry Source Type: research
Publication date: Available online 18 August 2019Source: Journal of Oral Biology and Craniofacial ResearchAuthor(s): Sourav Sarkar, N.T. Prashanth, E.S. Shobha, Vinod Rangan, G. NikhilaAbstractObjectivesThe aim of this study is to compare the effectiveness of Platelet Rich Fibrin gel and Chitosan gel dressing in providing hemostasis in patients receiving Oral Antiplatelet Therapy and also to evaluate their surgical healing outcome following dental extractions.MethodologyA total of 60 patients under Oral Antiplatelet Therapy indicated for tooth extraction were included for treatment in the study without altering the oral an...
Source: Journal of Oral Biology and Craniofacial Research - Category: Dentistry Source Type: research
ConclusionsBevacizumab may arrest both tumor progression and hearing loss in select NF2 patients presenting with VS lesions. However, a considerable proportion of patients are anticipated to experience serious adverse events; correspondingly, judicious use of bevacizumab for symptomatic management of VS in NF2 is recommended.
Source: Journal of Neuro-Oncology - Category: Cancer & Oncology Source Type: research
Publication date: Available online 18 August 2019Source: Journal of Anxiety DisordersAuthor(s): Casey L. Straud, Jedidiah Siev, Stephen Messer, Alyson K. ZaltaAbstractThere is conflicting evidence as to whether military populations (i.e., veteran and active-duty military service members) demonstrate a poorer response to psychotherapy for posttraumatic stress disorder (PTSD) compared to civilians. Existing research may be complicated by the fact that treatment outcomes differences could be due to the type of trauma exposure (e.g., combat) or population differences (e.g., military culture). This meta-analysis evaluated PTSD ...
Source: Journal of Anxiety Disorders - Category: Psychiatry Source Type: research
Publication date: Available online 18 August 2019Source: Journal of Anxiety DisordersAuthor(s): Joshua D. Clapp, Denise M. Sloan, William Unger, Daniel J. Lee, Janie J. Jun, Scott D. Litwack, J. Gayle BeckAbstractDespite high levels of traffic-related mortality, injury, and impairment among former service members, measures validated to assess problematic driving in this population remain limited. The current study examined characteristics of the Driving Behavior Survey (DBS) in male veterans (76.3% White; age: M = 56.4, SD = 12.3) meeting criteria for PTSD. Confirmatory factor analyses indicated...
Source: Journal of Anxiety Disorders - Category: Psychiatry Source Type: research
A Saint Louis University pain researcher has received a $2.1 million grant from the National Institutes of Health to investigate a pain signaling pathway in order to help open up a new avenue for pain medication research, officials said. Dr. Daniela Salvemini has spent her career studying chronic neuropathic pain in order to help find new ways to treat it without opioids. Neuropathic pain affects between 15 and 20 million people in the U.S. This type of pain happens after injuries to the nervous…
Source: bizjournals.com Health Care:Biotechnology headlines - Category: Biotechnology Authors: Source Type: news
PURPOSE: Hydrocodone, codeine, oxycodone, and tramadol are frequently prescribed to adolescents for moderate pain related to minor trauma or dental, surgical, or medical procedures. Pharmacokinetic and pharmacodynamic differences between these opioids coul...
Source: SafetyLit - Category: International Medicine & Public Health Tags: Age: Adolescents Source Type: news
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