Degenerate meniscal tears and osteoarthritis (OA) are extremely common in the general population. Early degenerative changes in the meniscus can be found in many subjects under the age of 30. By 50 to 60 years of age, full degenerative meniscal tears are commonly found in 33-50% of subjects. Unless associated with the presence of osteoarthritis (OA), these degenerative meniscal tears are most often asymptomatic. Magnetic resonance imaging (MRI) is not recommended for degenerative meniscal tears unless there are mechanical symptoms (e.g., locking) or lack of improvement with conservative treatment (exercise/therapy, weight loss, bracing, topical or oral analgesia, intra-articular injections). MRI is not recommended for the diagnosis or management of OA. Weight-bearing X-rays should be ordered instead.
Arthritis Alliance of Canada. The Impact of Arthritis in Canada: Today and Over the Next 30 Years [Internet]. 2011 [cited 2017 May 5].
Buchbinder R, et al. Management of degenerative meniscal tears and the role of surgery. BMJ. 2015;350:h2212. PMID: 26044448.
Englund M. The role of the meniscus in osteoarthritis genesis. Rheum Dis Clin North Am. 2008;34:573-9. PMID: 18687273.
Englund M. Meniscal tear — a common finding with often troublesome consequences. J Rheumatol. 2009;36:1362-4. PMID: 19567632.
Englund M, et al. Incidental meniscal findings on knee MRI in middle-aged and elderly persons. N Engl J Med. 2008;359:1108-15. PMID: 18784100.
Strobel MJ. Manual of Arthroscopic Surgery. Springer: Verlag Berlin Heidelberg; 2002;1:99-200.
US Department of Veteran Affairs. VA/DoD Clinical Practice Guidelines: The Non-Surgical Management of Hip & Knee Osteoarthritis (OA) [Internet]. 2014 [cited 2017 May 5].Share on Facebook Share on Twitter
Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Although acute inflammatory tendinopathies (i.e., tendinitis) exist, most patients seen in primary care will have chronic symptoms (tendinosis). Multimodality options (e.g., relative rest, activity modifications, physical or athletic therapy, etc.) should be considered as the first line treatment of tendinopathies. Opiates should not be used in the initial phase of treatment.
Andres BM, et al. Treatment of tendinopathy: what works, what does not, and what is on the horizon. Clin Orthop Relat Res. 2008;466:1539-54. PMID: 18446422.
Fanelli G, et al. Opioids for chronic non-cancer pain: a critical view from the other side of the pond. Minerva Anestesiol. 2016;82:97-102. PMID: 26173558.
Khan KM, et al. Histopathology of common tendinopathies. Update and implications for clinical management. Sports Med. 1999;27:393-408. PMID: 10418074.
Wilson JJ, et al. Common overuse tendon problems: A review and recommendations for treatment. Am Fam Physician. 2005;72:811-8. PMID: 16156339.
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Pes planus is common in children. Although it rarely leads to disability, it is still a major concern for parents and is a common cause of clinic visits for pediatric foot problems. Most pediatric pes planus cases are characterized by a normal arch during non-weight bearing, and a flattening of the arch on standing. They are often painless, non-problematic, and resolve by adolescence. The current evidence suggests that it is safe and appropriate to simply observe an asymptomatic child with flexible pes planus.
Carr JB 2nd, et al. Pediatric Pes Planus: A State-of-the-Art Review. Pediatrics. 2016 Mar;137(3):e20151230. PMID: 26908688.
Halabchi F, et al. Pediatric flexible flatfoot; clinical aspects and algorithmic approach. Iran J Pediatr. 2013;23:247-60. PMID: 23795246.Share on Facebook Share on Twitter
Initial management of rotator cuff tendinopathy includes relative rest, modification of painful activities, and an exercise program guided by a physical therapist or athletic therapist to regain motion and strength. The addition of subacromial cortisone/local anesthetic injections may be helpful. Should conservative management fail to relieve pain and restore function of the shoulder, consider plain radiographs to rule out bony or joint pathology, and ultrasound to assess for rotator cuff and bursal pathology. MRI or MRA (MR arthrogram) should be considered if symptoms don’t resolve with conservative therapy and there is a concern of labral pathology.
Anderson MW, et al. Imaging evaluation of the rotator cuff. Clin Sports Med. 2012;31:605-31. PMID: 23040549.
Harrison AK, et al. Subacromial impingement syndrome. J Am Acad Orthop Surg. 2011;19:701-8. PMID: 22052646.
Lewis J, et al. Rotator Cuff Tendinopathy: Navigating the Diagnosis-Management Conundrum. J Orthop Sports Phys Ther. 2015;45:923-37. PMID: 26390274.
Roy JS, et al. Diagnostic accuracy of ultrasonography, MRI and MR arthrography in the characterisation of rotator cuff disorders: a systematic review and meta-analysis. Br J Sports Med. 2015;49:1316-28. PMID: 25677796.
Thomopoulos S, et al. Mechanisms of tendon injury and repair. J Orthop Res. 2015;33:832-9. PMID: 25641114.
Yablon CM, et al. Rotator cuff and subacromial pathology. Semin Musculoskelet Radiol. 2015;19:231-42. PMID: 26021584.Share on Facebook Share on Twitter
Ankle sprains are among the most common injuries seen in the ER or physician clinics. Ankle sprains cause a high incidence of absenteeism in professional and physical activities with important economic consequences. There is good evidence to show that functional bracing of the ankle instead of rigid immobilization is associated with improved and earlier functional improvement and an overall shorter recovery period. For ankle inversion sprains with no associated bony or syndesmotic injury, early mobilization using a functional ankle brace and physiotherapy/athletic therapy should be considered instead of rigid immobilization.
Cooke MW, et al. Treatment of severe ankle sprain: a pragmatic randomised controlled trial comparing the clinical effectiveness and cost-effectiveness of three types of mechanical ankle support with tubular bandage. The CAST trial. Health Technol Assess. 2009;13(13):1-65. PMID: 19232157.
Mizel MS, et al. Evaluation and treatment of chronic ankle pain. Instr Course Lect. 2004; 53:311-21. PMID: 15116624.
Prado MP, et al. A comparative, prospective, and randomized study of two conservative treatment protocols for first-episode lateral ankle ligament injuries. Foot Ankle Int. 2014;35:201-6. PMID: 24419825.Share on Facebook Share on Twitter