Taylor’s Musculoskeletal Problems and Injuries

Taylor’s Musculoskeletal

Problems and Injuries

Taylor’s Musculoskeletal Problems and Injuries

A Handbook

Robert B. Taylor, M.D. Editor

Professor Emeritus

Department of Family Medicine Oregon Health & Science University

School of Medicine Portland, Oregon

Associate Editors

Alan K. David, M.D. Scott A. Fields, M.D.

Professor and Chairman Professor and Vice Chairman Department of Family and Department of Family Medicine

Community Medicine Oregon Health & Science University Medical College of Wisconsin School of Medicine

Milwaukee, Wisconsin Portland, Oregon

D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H.

Professor and Chairman Clinical Professor Department of Family Medicine Department of Family and University of Mississippi Preventive Medicine

School of Medicine University of California, Jackson, Mississippi San Diego School of Medicine

San Diego, California

With 53 Illustrations

Robert B. Taylor, M.D.

Professor Emeritus

Department of Family Medicine Oregon Health & Science University

School of Medicine Portland, OR 97239-3098, USA

Associate Editors

Alan K. David, M.D. Scott A. Fields, M.D.

Professor and Chairman Professor and Vice Chairman Department of Family and Department of Family Medicine

Community Medicine Oregon Health & Science University Medical College of Wisconsin School of Medicine

Milwaukee, WI 53226-0509, USA Portland, OR 97201-3098, USA

D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H.

Professor and Chairman Clinical Professor

Department of Family Medicine Department of Family and Preventive Medicine University of Mississippi School University of California, San Diego

of Medicine School of Medicine

Jackson, MS 39216-4500, USA San Diego, California 92103-0801, USA

Library of Congress Control Number: 2005935915

ISBN-10: 0-387-29171-7 Printed on acid-free paper.

ISBN-13: 978-0387-29171-0

© 2006 Springer Science+Business Media, LLC

All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden.

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Preface

After more than a quarter century as a primary care educator, I am convinced that our graduates enter practice inadequately trained in the diagnosis and management of musculoskeletal problems and injuries. One reason for this perceived deficiency is the relatively short duration of primary care training—typically three years for family medicine, general internal medicine, and general pediatrics.

During this time, there are just not enough months to teach all a cli- nician needs to know about diseases and trauma involving the mus- culoskeletal system. This inadequacy is compounded by the sometimes quirky nature of the problems: that is, for example, the increased risk of nonunion in a fracture of the carpal navicular (scaphoid) bone or the maneuver that can magically reduce a child’s radial head subluxation.

The chapters in this book are from the edited reference book Family Medicine: Principles and Practice, 6th edition, which is widely used by family physicians in the United States and abroad. The publisher and I believe that, in addition to family physicians, the chapters in this book will also be useful to other clinicians providing broad-based care: general internists, general pediatricians, emergency physicians, nurse practitioners, and physician assistants. When compared to the large, comprehensive book, this volume will be preferred by some readers because of the physically smaller size and perhaps by the lower cost.

In selecting chapters to include in the book, I have included

problems involving all areas of the skeleton and related musculature,

in both children and adults. Athletic injuries are included because,

after all, primary care clinicians manage most sports injuries. I have

included a chapter on acute lacerations, which often accompany other

types of injuries. In addition to sprains, strains, and fractures, there are

chapters covering illnesses affecting the musculoskeletal system:

various types of arthritis, fibromyalgia, and the complex regional pain syndrome.

I hope you find this book useful in daily practice; comments are welcome.

Robert B. Taylor, M.D.

Portland, Oregon, USA

vi Preface

Clinical Practice Notice

Everyone involved with the preparation of this book has worked very hard to assure that information presented here is accurate and that it represents accepted clinical practices. These efforts include confirm- ing that drug recommendations and dosages discussed in this text are in accordance with current practice at the time of publication.

Nevertheless, therapeutic recommendations and dosage schedules change with reports of ongoing research, changes in government rec- ommendations, reports of adverse drug reactions, and other new information.

A few recommendations and drug uses described herein have Food and Drug Administration (FDA) clearance for limited use in restricted settings. It is the responsibility of the clinician to determine the FDA status of any drug selection, drug dosage, or device recommended to patients.

The reader should check the package insert for each drug to deter- mine any change in indications or dosage as well as for any precau- tions or warnings. This admonition is especially true when the drug considered is new or infrequently used by the clinician.

The use of the information in this book in a specific clinical setting or

situation is the professional responsibility of the clinician. The authors,

editors, or publisher are not responsible for errors, omissions, adverse

effects, or any consequences arising from the use of information in this

book, and make no warranty, expressed or implied, with respect to the

completeness, timeliness, or accuracy of the book’s contents.

Contents

Preface . . . v

Clinical Practice Notice . . . vii

Contents. . . ix

Contributors . . . xi

1 Disorders of the Back and Neck . . . 1

Walter L. Calmbach 2 Disorders of the Upper Extremity . . . 35

Ted C. Schaffer 3 Disorders of the Lower Extremity . . . 59

Kenneth M. Bielak and Bradley E. Kocian 4 Osteoarthritis. . . 89

Alicia D. Monroe and John B. Murphy 5 Rheumatoid Arthritis and Related Disorders . . . 97

Joseph W. Gravel Jr., Patricia A. Sereno, and Katherine E. Miller 6 Selected Disorders of the Musculoskeletal System . . . 127

Jeffrey G. Jones and Doug Poplin 7 Musculoskeletal Problems of Children . . . 147

Mark D. Bracker, Suraj A. Achar, Todd J. May, Juan Carlos Buller, and Wilma J. Wooten 8 Osteoporosis . . . 181

Paula Cifuentes Henderson and Richard P. Usatine

9 Gout . . . 197 James F. Calvert, Jr.

10 Athletic Injuries . . . 205 Michael L. Tuggy and Cora Collette Breuner

11 Care of Acute Lacerations . . . 233 Bryan J. Campbell and Douglas J. Campbell

12 Selected Injuries . . . 261 Allan V. Abbott

Index. . . 281

x Contents

Contributors

Allan V. Abbott, M.D., Professor of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California Selected Injuries

Suraj A. Achar, M.D., Clinical Instructor of Family Medicine, University of California-San Diego School of Medicine, LaJolla, California

Musculoskeletal Problems of Children

Kenneth M. Bielak, M.D., Associate Professor of Family Medicine, University of Tennessee – Knoxville School of Medicine, Knoxville, Tennessee

Disorders of the Lower Extremity

Mark D. Bracker, M.D., Clinical Professor of Family and Preventive Medicine, University of California-San Diego School of Medicine, La Jolla, California

Musculoskeletal Problems of Children

Cora Collette Breuner, M.D., M.P.H., Department of Pediatrics, University of Washington Medical Center, Seattle, Washington Athletic Injuries

Juan Carlos Buller, M.D., Staff Physician, San Diego Sports Medicine and Family Practice, San Diego, California

Musculoskeletal Problems of Children

Walter L. Calmbach, M.D., Associate Professor of Family and Community Medicine, Director of Sports Medicine Fellowship and South Texas Ambulatory Research Network (STARNET), University of Texas Health Science Center, San Antonio, Texas

Disorders of the Back and Neck

James F. Calvert Jr, M.D., Associate Professor of Family Medicine, Oregon Health & Science University School of Medicine, Portland;

Cascades East Family Practice Residency Program, Klamath Falls, Oregon

Gout

Bryan J. Campbell, M.D., Assistant Professor of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah

Care of Acute Lacerations

Douglas J. Campbell, M.D., Community Attending Physician, Good Samaritan Regional Family Practice Center, Yavapai Regional Medical Center, Prescott, Arizona

Care of Acute Lacerations

Joseph W. Gravel, Jr, M.D., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Director, Tufts University Family Practice Residency Program, Malden, Massachusetts

Rheumatoid Arthritis and Related Disorders

Paula Cifuentes Henderson, M.D., Clinical Instructor of Family Medicine, University of California – Los Angeles School of Medicine, Los Angeles, California

Osteoporosis

Jeffrey G. Jones, M.D., M.P.H., Medical Director, St. Francis Traveler’s Health Center, Indianapolis, Indiana

Selected Disorders of the Musculoskeletal System

Bradley E. Kocian, M.D., Sports Medicine Fellow, University of Tennessee -Knoxville Medical Center, Knoxville, Tennessee

Disorders of the Lower Extremity

xii Contributors

Todd J. May, D.O., Lieutenant Commander, Medical Corps, United States Naval Hospital, Camp Pendleton, California

Musculoskeletal Problems of Children

Katherine E. Miller, M.D., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Faculty, Tufts University Family Practice Residency Program, Malden, Massachusetts

Rheumatoid Arthritis and Related Disorders

Alicia D. Monroe, M.D., Associate Professor of Family Medicine, Brown Medical School, Providence; Memorial Hospital of Rhode Island, Pawtucket, Rhode Island

Osteoarthritis

John B. Murphy, M.D., Professor of Family Medicine, Brown Medical School, Providence, Rhode Island

Osteoarthritis

Doug Poplin, M.D., M.P.H., Medical Director, Saint Francis Occupational Health Center, Indianapolis, Indiana

Selected Disorders of the Musculoskeletal System

Ted C. Schaffer, M.D., Clinical Assistant Professor, Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine; Director, UPMC – St. Margaret Hospital Family Practice Residency Program, Pittsburgh, Pennsylvania

Disorders of the Upper Extremity

Patricia A. Sereno, M.D., M.P.H., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Hallmark Family Health Center, Malden, Massachusetts

Rheumatoid Arthritis and Related Disorders

Michael L. Tuggy, M.D., Clinical Assistant Professor of Family Medicine, University of Washington School of Medicine; Director, Swedish Family Medicine Residency Program, Seattle, Washington Athletic Injuries

Contributors xiii

Richard P. Usatine, M.D., Professor of Clinical Family Medicine and Assistant Dean of Student Affairs, University of California – Los Angeles School of Medicine, Los Angeles, California

Osteoporosis

Wilma J. Wooten, M.D., M.P.H., Associate Clinical Professor of Family and Preventive Medicine, University of California-San Diego School of Medicine, La Jolla, California

Musculoskeletal Problems of Children

xiv Contributors