Showing posts with label Trauma. Show all posts
Showing posts with label Trauma. Show all posts

Elbow Pain in Adults - 2014 review from Am Fam Physician

The elbow is a complex joint designed to withstand a wide range of dynamic exertional forces. The location and quality of elbow pain can generally localize the injury to one of the four anatomic regions: anterior, medial, lateral, or posterior.

The history should include questions about the onset of pain, what the patient was doing when the pain started, and the type and frequency of athletic and occupational activities.

What are the common causes?

- Lateral and medial epicondylitis are two of the more common diagnoses and often occur as a result of occupational activities. Patients have pain and tenderness over the affected tendinous insertion that are accentuated with specific movements.

- If lateral and medial epicondylitis treatments are unsuccessful, ulnar neuropathy and radial tunnel syndrome should be considered.

- Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing.

- Biceps tendinopathy is a relatively common source of pain in the anterior elbow; history often includes repeated elbow flexion with forearm supination and pronation.

- Olecranon bursitis is a common cause of posterior elbow pain and swelling. It can be septic or aseptic, and is diagnosed based on history, physical examination, and bursal fluid analysis if necessary.

What are the recommended tests?

Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions. Magnetic resonance imaging is the preferred imaging modality for chronic elbow pain. Musculoskeletal ultrasonography allows for an inexpensive dynamic evaluation of commonly injured structures.


Evaluation of Elbow Pain in Adults. Kane SF, Lynch JH, Taylor JC. Am Fam Physician. 2014 Apr 15;89(8):649-657.

Image source: Normal radiograph; right picture of the straightened arm shows the carrying angle of the elbow. Wikipedia, Creative Commons Attribution-Share Alike 2.5 Generic license.

How to Avoid Dog Bites -- It's National Dog Bite Prevention Week

Dogs are the most diverse mammal species on the planet ( They can vary in weight from 6 lb (3kg) to 200 lb (90kg) when fully grown and have widely differing body shapes and hair types.

Not surprisingly, dog-bite injuries in children (head and neck) peak in warmer weather. The family pet is to blame in 27% of cases, and pit bulls are most commonly involved.

Dog bites are the third leading cause of emergency room visits for children, and the majority of those bites are from a dog known by the child. The ASPCA's Director of Anti-Cruelty Behavior Research Dr. Katherine Miller discusses How to Avoid Dog Bites in this WSJ video:

Pay attention to the dog's body language

Put a safe amount of space between yourself and a dog if you see the following signals, that the dog is uncomfortable and might feel the need to bite:

tensed body
stiff tail
pulled back head and/or ears
furrowed brow
eyes rolled so the whites are visible
flicking tongue
intense stare
backing away

What to do if you think a dog may attack

Resist the impulse to scream and run away.
Remain motionless, hands at your sides, and avoid eye contact with the dog.
Once the dog loses interest in you, slowly back away until he is out of sight.
If the dog does attack, "feed" him your jacket, purse, bicycle, or anything that you can put between yourself and the dog.
If you fall or are knocked to the ground, curl into a ball with your hands over your ears and remain motionless. Try not to scream or roll around.

Here is a brief 3-minute summary from CNN with some practical tips how to prevent dog bites:


How to Avoid a Dog Bite : The Humane Society of the United States
How to avoid dog bites | Cesar Millan
Dog-bite injuries in children peak in warm weather | Reuters

Punched Out: The Rise and Fall of NHL Enforcer Derek Boogaard (NYTimes video)

Derek Boogaard was one of the N.H.L.'s most feared fighters before overdosing in 2011. The New York Times examined the life and death of the professional hockey player Derek Boogaard, who rose to fame as one of the sport's most feared fighters before dying at age 28 on May 13. The 36-minute video is from 2014:

A native of Saskatchewan, he was known primarily as a fighter and enforcer throughout his career, from junior hockey to the pros. His fighting prowess made him a favorite with fans. In 2007 he was voted as the second most intimidating player in the NHL, behind Georges Laraque, who attributed his retirement in part to a desire to avoid the serious injury Boogaard could inflict, such as the cheekbone fracture Todd Fedoruk suffered that had to be repaired with metal plates.

He died at 28 from an accidental drug and alcohol overdose while recovering from a concussion. A posthumous examination of his brain found he had suffered from chronic traumatic encephalopathy more advanced than that seen in some former enforcers who had died in middle age. That disclosure came shortly after the deaths of two other hockey enforcers, both of whom were also under 40 and had similar health issues. The three deaths triggered a debate in the hockey community about the issues faced by enforcers and their place in the game. His parents have filed lawsuits against the NHL and its players' union over his death.

Read the NYTimes story here:


Punched Out: The Rise and Fall of Derek Boogaard [Full Version] | The New York Times - YouTube

Derek Boogaard - Wikipedia

Poison vs. venom: What's the difference?

Lesson by Rose Eveleth, animation by TED-Ed. "Would you rather be bitten by a venomous rattlesnake or touch a poisonous dart frog? While both of these animals are capable of doing some serious damage to the human body, they deliver their dangerous toxins in different ways. Rose Eveleth sheds light on the distinction between poison and venom (and why you shouldn't treat either one like you've seen in the movies)."

Snowboarding continues to evolve as a sport, and so do injuries (video)

Snowboarding exhibits high injury rates, at 2-3 times the rates of alpine skiing

The relatively young sport of snowboarding has gained immense popularity during the past 30 years and exhibits high injury rates, at 2-3 times the rates of alpine skiing. Upper extremity injuries are the most common type in snowboarders as a whole. Injury rates in snowboarders remain higher than in skiers. Wrist, shoulder, and ankle injuries are more common among snowboarders, while knee ligament injuries are more common in skiers.

Injuries are different in elite-level snowboarders vs. beginners

Elite-level snowboarders are often injured when performing difficult manoeuvres at high velocities and with amplified levels of force to the lower limbs. Consequently, elite-level snowboarders suffer from injuries that are of higher severity and have decidedly greater lower extremity injury rates. Conversely, injuries to the upper extremities are decreased in the elite snowboarders.

Snowboarding injury patients are 12 years younger than skiing injury patients

At one Rocky Mountains clinic, the mean overall age of injured patients was 32.9 years, 35.4 for skiers and 23.6 for snowboarders. The knee accounted for 43% of all skiing injuries, the shoulder 12%, and the thumb 8%. The wrist accounted for 18% of all snowboarding injuries, the shoulders 14%, and the ankle and knee each 13%.

Beginner snowboarders were more likely to present with wrist injuries compared with intermediate and advanced snowboarders.

At this mountainside clinic, the most frequent ski injuries are to the knee and shoulder, regardless of skill level. Beginning snowboarders most frequently injure their wrists whereas shoulder injuries remain frequent at all skill levels.

Snowboarding continues to evolve as a sport. This includes a steady progression in the degree of difficulty of the manoeuvres conducted by athletes and an increase in the number of snowboarders attempting such manoeuvres.

Olympic athletes break down their signature tricks (video)

Snowboarders and skiers have an extensive vocabulary of spins and flips. Here, Olympic athletes break down their signature tricks (from NYTimes):


Injuries in elite and recreational snowboarders. Br J Sports Med. 2014 Jan;48(1):11-7. doi: 10.1136/bjsports-2013-093019. Epub 2013 Nov 26.

Injury patterns in recreational alpine skiing and snowboarding at a mountainside clinic. Wilderness Environ Med. 2013 Dec;24(4):417-21. doi: 10.1016/j.wem.2013.07.002. Epub 2013 Oct 16.

Snowboarding injuries: trends over time and comparisons with alpine skiing injuries. Am J Sports Med. 2012 Apr;40(4):770-6. doi: 10.1177/0363546511433279. Epub 2012 Jan 20.


Sochi Olympics 2014 | Shaun White: Halfpipe Snowboarding | The New York Times - YouTube
Sochi Olympics 2014 | Mark McMorris, Slopestyle Dervish | The New York Times - YouTube

How to avoid getting a 'Text Neck' - Cleveland Clinic video

The popularity of texting on cellphones and using mobile devices has triggered an increase in neck pain. Dr. Bang, DC, of Cleveland Clinic gives tips on the right way to hold your mobile device.

How to prevent dog bites?

Not surprisingly, dog-bite injuries in children (head and neck) peak in warmer weather. The family pet is to blame in 27% of cases, and pit bulls are most commonly involved:

Here is a brief 3-minute summary from CNN with some practical tips how to prevent dog bites:

Most People Crammed Into A Car: 20 (Guinness World Records Video)

How is a Guinness World Records video relevant to a medical blog? Well, if you have a few minutes to spare and watch some of the videos from the official YouTube channel of Guinness World Records, you can't help but notice that a few of the record attempts definitely look hazardous to the health of the contestants:

For example:

Heaviest weight lifted with the eyelid
Car Drawn By Hook Through Mouth
Stretchiest Skin!
Truck Pulled By HAIR?!
Heaviest road vehicle pulled by teeth
Coconut Smashes To The Head?!
Most scorpions in the mouth
Climbing Stairs... WITH YOUR HEAD
Chainsaw Juggling... On A UNICYCLE
Most pig iron bars broken with the head in one minute
Most boiled eggs swallowed and regurgitated

In this video, 18 members of the Climb Fit Team (all Australia) squeezed into a standard Smart Car on the set of Australia Smashes Guinness World Records, at the Warringah Mall, Sydney, Australia, on 25 January 2010:

The record is now at a limb-bending 20 and was achieved by the Glendale Cheerleading Team (USA) on the set of 'Guinness World Records Gone Wild' at The Staples Center in Los Angeles, USA, on 28 September 2011.

Now, this is impressive: Most consecutive ninety degree push ups. In this video, Christian Bázan (Spain) executed 12 consecutive 90 degree push ups on the set of 'Guinness World Records', Madrid, Spain, on 16 January 2009. The Record now stands at 13 and was achieved by Jesus Villa (USA) in Las Vegas, Nevada, USA on 18 September 2010.

Industry breeds "superior" rodeo bulls. The result? A lot of cowboys with broken bones

Rodeo Bulls Kick Higher and Buck Harder. A great bucking bronco can be worth hundreds of thousands of dollars, and an entire industry has sprung up that's dedicated to breeding these superior bulls. The result? A lot of cowboys with broken bones. WSJ's Michael M. Phillips reports:

Concussions 101, a Primer for Kids and Parents (video)

Dr. Mike has put together a few resources on concussions at

Dr. Mike Evans is founder of the Health Design Lab at the Li Ka Shing Knowledge Institute, an Associate Professor of Family Medicine and Public Health at the University of Toronto, and a staff physician at St. Michael's Hospital.

Conceived, written, and presented by Dr. Mike Evans, Illustrated by Liisa Sorsa, Produced, directed, and filmed by Nick De Pencier, Picture and sound edit by David Schmidt, Gaffer, Martin Wojtunik, Whiteboard construction by James Vanderkleyn, Production assistant, Chris Niesing, ©2011 Michael Evans and Mercury Films Inc.

Mild traumatic brain injury (MTBI)

What is Mild traumatic brain injury (MTBI)?

Mild traumatic brain injury (MTBI) is commonly known as concussion. A universally accepted definition is lacking.

Mild traumatic brain injury and concussion are classified by:

- transient loss of consciousness
- amnesia
- altered mental status
- a Glasgow Coma Score of 13 to 15
- focal neurological deficits following an acute closed head injury

"Red flag' symptoms include: progression of physical, cognitive, and behavioral symptoms, seizure, progressive vomiting, and altered mental status.

What is the prognosis of mild traumatic brain injury (MTBI)?

Most patients recover quickly, within 1-2 weeks.

However, persistent symptoms may be noted in 5-20% of persons who have mild traumatic brain injury (MTBI):

- Physical symptoms include headaches, dizziness, and nausea, and changes in coordination, balance, appetite, sleep, vision, and hearing.

- Cognitive and behavioral symptoms include fatigue, anxiety, depression, and irritability, and problems with memory, concentration and decision making.

Who is at greatest risk after a mild traumatic brain injury (MTBI)?

Women, older adults, less educated persons, and those with a previous mental health diagnosis are more likely to have persistent symptoms.

Protecting the brain from concussion: $20-helmet is a good way to protect $100,000 education

Neuropsychologist Kim Gorgens makes the case for better protecting our brains against the risk of concussion -- with a compelling pitch for putting helmets on kids: A $20-helmet is a good way to protect $100,000 education. "Mind your (brain) matter."

Subacute to chronic mild traumatic brain injury. Mott TF, McConnon ML, Rieger BP. Am Fam Physician. 2012 Dec 1;86(11):1045-51.
Image source: Hippocampus, from Wikipedia, public domain.

More than 50% of injuries on Fourth of July are related to fireworks

The eyes are the most frequently injured body parts, followed by the fingers and hands. Here is a video from the Cleveland Clinic with some advice how to prevent these injuries:

This video discusses ways to prevent and identify heat-related illness in senior citizens:

Drowning Prevention Guidelines

Here is a video from the Cleveland Clinic:

Key risk factors for drowning are:

- male sex
- age of less than 14 years
- alcohol use
- low income
- poor education
- rural residency
- aquatic exposure
- risky behavior
- lack of supervision

For people with epilepsy, the risk of drowning is 15 to 19 times as high as the risk for those who do not have epilepsy.

For every person who dies from drowning, another four persons receive care in the emergency department for nonfatal drowning.

Drowning Doesn’t Look Like Drowning

- Except in rare circumstances, drowning people are physiologically unable to call out for help. The respiratory system was designed for breathing. Speech is the secondary or overlaid function. Breathing must be fulfilled, before speech occurs.

- Drowning people’s mouths alternately sink below and reappear above the surface of the water.

- The mouths of drowning people are not above the surface of the water long enough for them to exhale, inhale, and call out for help. When the drowning people’s mouths are above the surface, they exhale and inhale quickly as their mouths start to sink below the surface of the water.

- Drowning people cannot wave for help. Nature instinctively forces them to extend their arms laterally and press down on the water’s surface. Pressing down on the surface of the water, permits drowning people to leverage their bodies so they can lift their mouths out of the water to breathe.

- Throughout the Instinctive Drowning Response, drowning people cannot voluntarily control their arm movements. Physiologically, drowning people who are struggling on the surface of the water cannot stop drowning and perform voluntary movements such as waving for help, moving toward a rescuer, or reaching out for a piece of rescue equipment.

- From beginning to end of the Instinctive Drowning Response people’s bodies remain upright in the water, with no evidence of a supporting kick. Unless rescued by a trained lifeguard, these drowning people can only struggle on the surface of the water from 20 to 60 seconds before submersion occurs.


Drowning Doesn’t Look Like Drowning. Mario Vittone.On Scene Magazine: Fall 2006 (page 14)
Drowning - free NEJM review, 2012

Symptomatic knee osteoarthritis (OA) increased during the past 20 years but radiographic OA did not

A recent surge in knee replacements is assumed to be due to aging and increased obesity of the U.S. population.

This cross-sectional study used data from 6 NHANES (National Health and Nutrition Examination Survey) surveys between 1971 and 2004 and from 3 examination periods in the FOA (Framingham Osteoarthritis) Study between 1983 through 2005 of the U.S. population.

Prevalence of knee pain increased by 65% in NHANES from 1974 to 1994.

In the FOA Study, prevalence of knee pain and symptomatic knee osteoarthritis doubled in women and tripled in men over 20 years.

However, no such trend was observed in the prevalence of radiographic knee osteoarthritis.

Prevalence of knee pain has increased substantially over 20 years. Obesity accounted for only part of this increase.

Symptomatic knee osteoarthritis increased but radiographic knee osteoarthritis did not. Why the patients are more symptomatic now than 20 years ago?

Research Finds Exercise is Good for Arthritis (a Cleveland Clinic video):

What is Boomeritis?

In 2006, the NYTimes described the health problems of aging baby boomers who continue to exercise: osteoarthritis which needs "knee and hip replacements, surgery for cartilage and ligament damage, and treatment for tendinitis, arthritis, bursitis and stress fractures." Some doctors call this phenomenon "boomeritis" or "Generation Ouch."


Increasing Prevalence of Knee Pain and Symptomatic Knee Osteoarthritis: Survey and Cohort Data. ANN INTERN MED, December 6, 2011, vol. 155 no. 11 725-732.

What is Boomeritis?

Image source:, public domain.

Running Marathons and Staying Injury Free - Mayo Clinic Video

Mayo Clinic Florida sports medicine physician Daniel Montero, M.D., provides tips on avoiding injuries while running in a marathon. He also addresses tips on:

- safely keeping up when running in large crowds
- staying hydrated
- dressing for weather conditions
- running the way you were trained to do

First snowmobile front flip landed and winter sport trauma (video)

Heath Frisby lands the first snowmobile front flip in competition:

This is what happens when the things don't go as planned: Colten Moore flies 120 feet into the air and then hits the snow hard in Snowmobile Freestyle Finals... (video below). He not only survived but went on to win Winter X Games Gold later.

Not all extreme winter sport champions are so lucky though, and some of them have barely escaped death, with life-altering injuries: Kevin Pearce reflects on Sarah Burke's death (USA Today).

iPad app tests athletes for concussion - Cleveland Clinic video

An iPad app tests athletes for concussions (a Cleveland Clinic video). The players perform a series of balance, memory, vision, and reaction time experiments to obtain a baseline reading. If they receive a blow to the head during a game or practice, these tests can be redone to determine when it is safe for the athlete to return to action.


Concussion Center - Cleveland Clinic.
Cleveland Clinic Treats Concussions With iPad App. Fox News.
Chronic traumatic encephalopathy (CTE): Brain bank examines athletes' hard hits - CNN, 2012.

Comments from Twitter:

@DrVes: Why are some doctors and nurses giving back their iPads? - Easy: iPad works great for pt education, NOT for data entry. Only 10% of doctors currently use an iPad at work - I use iPad daily to discuss these diagrams:

iPad is a great teaching tool @CraigCCRNCEN was able to explain to Vietnamese family AFib and clots by showing them animation from YouTube.

Brian S. McGowan PhD @BrianSMcGowan: so is the best option for docs still a touch screen laptop? teach w/ touch screen, work w/ full keyboard? #hcsm

@DrVes: iPad works well for discussing DDx, Tx options with pts. Much more portable than laptop. Full-keyboard COWs best for typing.

Jeff Bray @jeffkbray: I have been scanning all my medical reference books and store them on my iPad for quick use and no weight - great tool and mobile

Acute altitude illnesses

This summary is based on a recent BMJ review:

Acute altitude illnesses include:

- high altitude headache
- acute mountain sickness
- high altitude cerebral edema
- high altitude pulmonary edema

Typical scenarios in which such illness occurs include:

- a family trek to Everest base camp in Nepal (5,360 m)
- a fund raising climb of Mount Kilimanjaro (5,895 m), shown in the map below
- a tourist visit to Machu Picchu (2,430 m)

View Larger Map

High altitude headache and acute mountain sickness often occur a few hours after arrival at altitudes over 3,000 meters.

Occurrence of acute mountain sickness is reduced by slow ascent. Severity can be modified by prophylactic acetazolamide.

Mild to moderate acute mountain sickness usually resolves with:

- rest
- hydration
- halting ascent
- analgesics

Occasionally people with acute mountain sickness develop high altitude cerebral oedema with confusion, ataxia, persistent headache, and vomiting.

Severe acute mountain sickness and high altitude cerebral edema require urgent treatment with:

- oxygen if available
- dexamethasone
- possibly acetazolamide
- rapid descent

High altitude pulmonary edema is a rare but potentially life threatening condition that occurs 1-4 days after arrival at altitudes above 2,500 meters. Treatment includes oxygen if available, nifedipine, and rapid descent to lower altitude.

What do extreme athletes who can summit the peaks of Mt. Everest have in common with people with heart failure? This Mayo Clinic video explains it:


Clinical Review: Acute altitude illnesses. BMJ 2011; 343:d4943 doi: 10.1136/bmj.d4943
High-Altitude Medicine

Restraint technique could be fatal: Forcing a detainee to bend over while seated can lead to death

Researchers found that the hold, forcing a detainee to bend over while seated, can massively cut lung capacity.

They placed 40 volunteers in chairs and then leaned them forward, bringing their face close to the lap. They used arm holds and applied a small amount of force to prevent the volunteer from attempting to return to a normal sitting position. In the worst cases, the lungs' capacity was almost halved.

"Imagine that from the perspective of the security staff. They feel you struggle and they will feel that you are getting angry. They will apply more force to manage your resistance. It becomes a vicious circle."


Restraint technique could be fatal, research suggests. BBC.
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