Clinical Considerations in Returning Pediatric and Young Adults With Cancer to Physical Activity.

ABSTRACT: There is a gap in the literature on the best treatment of clinical sequelae within adolescent and young adult pediatric cancer populations. Children, adolescents, and young adults are at risk for a multitude of immediate and late effects of their disease and treatment that warrant a comprehensive, multidisciplinary team approach to optimize care. Sports medicine providers are well-equipped with their background to join the oncology rehabilitation team in diagnosing and managing cancer-related impairments to help these populations live a healthier and more active lifestyle. In this manuscript, four essential clinical components to consider when returning children, adolescents, and young adults with cancer history to physical activity are discussed: chemotherapy-induced peripheral neuropathy, cardiotoxicity, nutritional deficiencies, and deconditioning.

Elbow Evaluation Via Telephone and Video Visit.

Background Elbow conditions and pathology are commonly seen in the outpatient clinic. Telephone and video visits can allow for expeditious assessment of elbow complaints, without the added challenges of commuting for a clinic-based evaluation. In the setting of a pandemic, the benefits of telemedicine are apparent, but the time and effort saved from being able to remotely evaluate musculoskeletal conditions are also useful in a non-pandemic situation. In this modern era of telemedicine, protocols need to be developed to provide guidance for a remote elbow evaluation. As with all musculoskeletal conditions, the history about the elbow complaint allows the clinician to develop a differential diagnosis, which is either supported or refuted based on physical examination and diagnostic studies. Appropriate questions asked over a telephone call can provide answers that lead the clinician to a specific diagnosis and treatment plan. Furthermore, responses to these same questions can be further supported by a video assessment of the affected elbow, which may provide additional evidence to support a diagnosis and plan of care. Aims To outline possible questions, responses, and video examination techniques to aid the clinician in elbow examinations conducted via telemedicine. Methods We have created a pathway for step-by-step evaluation to help physicians direct their patients through the typical elements of a thorough elbow examination via telehealth. Results We have created tables of questions, answers, and instructions to help guide the physician through different aspects of a telehealth elbow examination. We have also included a glossary of descriptive images that demonstrate each maneuver.  Conclusion This article provides a structured guide to efficiently extracting clinically relevant information during telemedicine examinations of the elbow.

Evaluation of the Hand and Wrist via Telephone and Video Visit.

BACKGROUND:  The COVID-19 pandemic has highlighted the utility of telemedicine, with rapid incorporation throughout 2020. Telemedicine is a timely, safe, and effective means of evaluating, triaging, and treating patient conditions, including those of the musculoskeletal system. Hand and wrist complaints are frequently encountered in the primary care setting, and some can have serious consequences if not promptly diagnosed. Prior to the pandemic, over a quarter of the nation's allopathic degree-granting medical schools had initiated telemedicine training as part of the preclinical phase of their curriculum, and about half had implemented it into clerkships prior to the pandemic. Despite rapid acceptance, increased ease of access, and prior attempts to incorporate telemedicine into the educational curriculum, telemedicine evaluation continues to pose challenges to both the patient and provider. This is likely due to a lack of established protocols outlining clinical data collection through a virtual interface. Although telemedicine requires the patient to perform a physical examination, it allows the physician to collect clinically important information while observing the patient in their home environment. AIMS:  The aim of this paper is to provide a step-by-step method to evaluate and triage hand and wrist complaints. METHODS:  Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical hand and wrist examination elements, including inspection, palpation, range of motion (ROM), strength, special, and functional testing. RESULTS:  We have developed a table of evaluation questions and instructions and a glossary of images of each maneuver to facilitate hand and wrist examination via telemedicine. CONCLUSION:  This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the hand.

Head Pain in the Competitive Aquatic Athlete-An Approach to a Differential Diagnosis and Management.

ABSTRACT: Aquatic athletes not only face common headache etiologies similar to the general population and land-based athletes but also experience their own unique pathology. Posture, aquatic pressure, equipment, and even marine animals pose as unique causes to head pain in the aquatic athlete. Common head pain pathologies seen in the aquatic athlete include tension-type headaches, migraines, cluster headaches, and compressive headaches, including supraorbital neuralgia. Creating a thorough but focused differential diagnosis for head pain in the aquatic athlete can be a difficult and overwhelming task for some. We review both the common and not-so-common etiologies of head pain in the aquatic athlete and suggest a simple framework for assessment and treatment to diagnose and treat head pain in this specific population.

Tibial Post Fracture After Total Knee Arthroplasty: Ultrasound as a Viable Diagnostic Tool: A Case Report.

CASE: A 60-year-old woman presented with knee instability and pain that started approximately 13 years after a posterior stabilized total knee arthroplasty. Physical examination revealed significant posterior laxity. Bedside ultrasound (US) documented a free-floating, hyperechoic linear artifact within the posterior knee joint capsule. Revision with liner of increased thickness alleviated presenting symptoms. CONCLUSION: Tibial postfractures often present with instability and pain. Diagnosis of a tibial postfracture can be based on clinical examination; other diagnostics commonly used include arthroscopy or computed tomography/magnetic resonance imaging. US by a qualified sonographer is a potential diagnostic route that should be explored more rigorously.

Changing Perception: Outcomes from a Physical Medicine and Rehabilitation Medical Student Interest Fair.

Exposure to the field of Physical Medicine and Rehabilitation (PM&R) is limited in the curricula of many medical schools. As a result, many students lack awareness of the field and may therefore ultimately choose different careers. A medical student PM&R career fair was held on October 13th, 2015 at the University of Pittsburgh, and several local medical schools were invited to participate. Seven stations were deployed to highlight various aspects of PM&R careers. A total of 57 medical students attended, representing five different campuses across three states, with 29 of the reported medical students still within their first or second year of medical education. Self-reported interest and understanding of PM&R significantly increased in those attending the fair compared to baseline, with nearly half requesting further opportunities for faculty mentorship. These results indicate that PM&R interest fairs may be a means to further student understanding and awareness of PM&R while providing an opportunity to become more involved in the field.