Showing 21-40 of 97 for: Essential Evidence Topics > Musculoskeletal 
- Dermatomyositis and polymyositis
Essential Evidence Topics, 9-May-2021
Overall Bottom Line: DM and PM are autoimmune inflammatory myopathies associated with symmetric proximal muscle weakness, and can be associated with cutaneous findings (specifically DM), elevated muscle enzymes, findings of myopathy on EMG, and inflammati
- Disability evaluation
Essential Evidence Topics, 13-Sep-2020
OVERALL BOTTOM LINE: Disability is an individual determination that is influenced as much by diagnosis and degree of impairment as by demographic, environmental, social, and economic factors. Document objective assessments of a person's impairments and th
- Discoid lupus erythematosus
Essential Evidence Topics, 26-Dec-2022
Overall Bottom Line: Discoid lupus erythematosus (DLE) is a clinical diagnosis based on characteristic erythematous papule or plaque with follicular plugging, adherent scale, and atrophy. Topical corticosteroid treatment and antimalarials are the mainst
- Dislocation (patella and knee)
Essential Evidence Topics, 8-Jul-2022
Overall Bottom Line: Diagnosis should be made clinically through history and the presence of Bassett's sign, (tenderness along medial retinaculum) and/or hemarthrosis. A positive apprehension test can help confirm the diagnosis but is less sensitive. Ev
- Dislocation (shoulder)
Essential Evidence Topics, 27-Feb-2022
Overall Bottom Line: Prereduction radiographs can be limited to individuals with first-time dislocation, age more than 40 years, and history of trauma. Bankart lesions do not heal conservatively and need to be surgically repaired to decrease the likelih
- Dupuytren's contracture
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: Dupuytren's contracture is a clinical diagnosis characterized by shortening and thickening of the palmar fascia aponeurosis typically resulting in flexion contracture of the 4th and 5th digits. Steroid injections into early Dupuytre
- Epidural abscess
Essential Evidence Topics, 13-Dec-2019
Overall Bottom Line: Consider epidural abscess and obtain imaging in patients with back pain and fever or neurologic deficit. Obtain ESR and CRP for patients with back pain and risk factors (diabetes mellitus, IV drug use, indwelling catheter, recent sp
- Ewing sarcoma
Essential Evidence Topics, 30-Dec-2021
Overall Bottom Line: Patients require complete evaluation of primary tumor and possible metastatic sites. Combination chemotherapy with a regimen that includes doxorubicin, ifosfamide, and etoposide improves outcomes. Local control strategies remain c
- Female athletic triad syndrome
Essential Evidence Topics, 30-Mar-2021
Overall Bottom Line: The history should focus on training regimen, menstrual history, previous fractures, family history of osteopenia, and signs of disordered eating. Explain the potential connection between poor nutrition and caloric intake coupled wi
- Fibromyalgia
Essential Evidence Topics, 19-Jul-2022
Overall Bottom Line: The diagnosis of fibromyalgia syndrome is made using the American College of Rheumatology (ACR) criteria. Effective medications include tricyclic antidepressants (TCAs), duloxetine or milnacipran, muscle relaxants, tramadol,
- Fracture (arm)
Essential Evidence Topics, 11-May-2021
Overall Bottom Line: Take note of history of direct blow to forearm, or a fall on an outstretched hand or directly on forearm. Get anteroposterior, lateral, and oblique x-rays for most suspected fractures. If neurovascular compromise is evident, refer
- Fracture (finger and hand trauma)
Essential Evidence Topics, 30-Jan-2022
Overall Bottom Line: All finger and hand trauma require radiographic evaluation with posteroanterior, lateral, and oblique views. Treatment for distal phalanx extensor mechanism disruption (mallet finger) requires continuous splinting in extension for a
- Fracture (foot and toes)
Essential Evidence Topics, 17-Mar-2020
Overall Bottom Line: Always include evaluation and documentation of distal neurovascular status in the physical examination. Use Ottawa Foot Rules, to determine the need for foot films. If x-ray is warranted, obtain three-view foot series and/or dedic
- Fracture (leg)
Essential Evidence Topics, 23-Apr-2022
Overall Bottom Line: Use Ottawa Knee Rules to decide whether radiographs are needed for knee injury. For all other parts of the leg consider radiographic imaging if there is significant bony tenderness, deformity on exam, and/or a concerning history for
- Fracture (rib)
Essential Evidence Topics, 20-Oct-2021
Overall Bottom Line: Order standard PA and lateral CXRs if rib fracture is suspected; order a skeletal survey for any child with rib fractures suspected to have been abused. Order a bone scan if radiographs are normal and the level of suspicion of rib f
- Fracture (vertebral compression)
Essential Evidence Topics, 20-Jul-2021
Overall Bottom Line: Plain X-rays are recommended for acute back pain in patients older than 50 years, those with pain for longer than 1 month, or those with a history of malignancy, corticosteroid use, unexplained weight loss, or previous vertebral compr
- Ganglion cyst
Essential Evidence Topics, 17-May-2021
Overall Bottom Line: Palmar wrist ganglions present as swellings on the palmar radial aspect of the wrist adjacent to the radial artery, and on the dorsal wrist. Examination reveals a firm, usually nontender cyst that feels like a small marble under the
- Giant cell arteritis
Essential Evidence Topics, 4-Jul-2022
Overall Bottom Line: Consider giant cell arteritis (GCA) in patients over age 50 years with jaw claudication, diplopia, or temporal artery physical findings. Do not delay treatment while waiting for results of temporal artery biopsy; start high dose cor
- Gout
Essential Evidence Topics, 31-Dec-2021
Overall Bottom Line: Disorders and health habits that increase the uric acid pool (eg, obesity, alcohol use) increase a patient's risk of gout. A validated clinical decision rule can help rule in or rule out the diagnosis for many patients. Algorithms
- Henoch-Schonlein purpura
Essential Evidence Topics, 14-Nov-2019
Overall Bottom Line: Suspect Henoch-Schonlein purpura (HSP) in children with palpable purpura and abdominal pain, joint pain, proteinuria, or hematuria. Routine testing should include vital signs, CBC, urinalysis, and stool for occult blood; consider ab
