An Evidence-Based Approach to Orthobiologics for Tendon Disorders.

Tendinopathy is a chronic injury that affects both the athletic and general population. Recalcitrant tendinopathy is both frustrating for patients and providers once typical conservative treatments have been exhausted. Current research in orthobiologics shows that they are safe and could improve pain and function in recalcitrant cases. Unfortunately, many studies show inconsistency in the content of the orthobiologic injectate and approach in treatment protocols. There are robust data to support the use of platelet-rich plasma for the treatment of recalcitrant common extensor tendinopathy and plantar fasciopathy, but high-quality random control trials are needed before drawing definitive conclusions for other tendinopathies.

Telehealth examination of the lumbar spine.

BACKGROUND: Telehealth evaluations of musculoskeletal conditions have increased due to the stay-at-home policies enacted during the COVID-19 pandemic. Back pain is one of the most common complaints in primary care. While telehealth may never supplant in-person evaluation of back pain, it is imperative in a changing world to learn to perform this evaluation via telephone or video. Virtual visits rely on history-taking and patient self-reported descriptions of pain elicited from self-palpation or specific movements while on the telephone with the clinician. Video examinations provide a unique way of evaluating the lower back compared to telephone because of the ability to visualize the actions of the patient. OBJECTIVE: To create an evaluation pathway for examination of the lumbar spine via telehealth. METHODS: Our group has created a step-by-step evaluation pathway to help physicians direct their patients through typical lumbar examination elements, including inspection, palpation, range of motion, and strength, special, and functional testing. RESULTS: We have developed a table of questions and instructions and a glossary of images of each maneuver to facilitate lumbar spine examination via telemedicine. CONCLUSIONS: This paper provides a guide for extracting clinically relevant information while performing telemedicine examinations of the lumbar spine.

Considerations in the Care of Athletes With Type 1 Diabetes Mellitus.

Type 1 diabetes mellitus is an autoimmune disease caused by affected individuals' autoimmune response to their own pancreatic beta-cell. It affects millions of people worldwide. Exercise has numerous health and social benefits for patients with type 1 diabetes mellitus; however, careful management of blood glucose is crucial to minimize the risk of hypoglycemia and hyperglycemia. Anaerobic and aerobic exercises cause different glycemic responses during and after exercise, each of which will affect athletes' ability to reach their target blood glucose ranges. The optimization of the patient's macronutrient consumption, especially carbohydrates, the dosage of basal and short-acting insulin, and the frequent monitoring of blood glucose, will enable athletes to perform at peak levels while reducing their risk of dysglycemia. Despite best efforts, hypoglycemia can occur. Recognition of symptoms and rapid treatment with either fast-acting carbohydrates or glucagon is important. Continuous glucose monitoring devices have become more widely used in preventing hypoglycemia.

Rare case of symptomatic calcific tendinopathy of the origin of rectus femoris tendon.

Although calcific tendinopathy of the shoulder is a relatively common clinical diagnosis, calcific tendinopathy of the rectus femoris tendon near its origin at the anterior inferior iliac spine is rare. We present a case of a 53-year-old female avid runner with left hip pain. Clinical evaluation and X-ray imaging led to a diagnosis of calcific tendinopathy of the rectus femoris tendon. The patient was treated conservatively with non-steroidal anti-inflammatory drugs, physical therapy and rest. Calcific tendinopathy of the rectus femoris tendon can occur rarely in active patients and may be a cause of hip pain, responsive to conservative management, but with other treatment options possible if recalcitrant.

Delayed Presentation of Basal Cell Carcinoma: A Case Report.

Basal cell carcinoma (BCC) is the most common skin cancer in the United States. Although BCC has a low metastatic potential, it can be locally invasive and destructive, especially when there is a delay in diagnosis or treatment. This can affect not only the surrounding skin, but deeper tissues including muscle, cartilage, and even bone. Primary care physicians often serve as the first line of defense in the recognition, diagnosis, and even treatment of skin lesions suspicious for BCC. Most low-risk BCC can be treated in the primary care office with electro-desiccation and curettage or surgical excision. We present a case of locally invasive BCC with significant soft tissue destruction of the neck, which was incidentally identified during an emergency department presentation for a myocardial infarction. It is the responsibility of primary care physicians to recognize the appearance of skin lesions suspicious for BCC and initiate or arrange for subsequent definitive diagnosis and treatment. Our intent in presenting this case is to illustrate a missed opportunity for earlier recognition and treatment because of lack of access to primary care, as well as to demonstrate the destructive nature of BCC when neglected over time. Comprehensive approaches to diagnosis and treatment are described elsewhere.

Subphysiological compressive loading reduces apoptosis following acute impact injury in a porcine cartilage model.

BACKGROUND: Acute cartilage injuries induce cell death and are associated with an increased incidence of osteoarthritis development later in life. The objective of this study was to investigate the effect of posttraumatic cyclic compressive loading on chondrocyte viability and apoptosis in porcine articular cartilage plugs. HYPOTHESIS: Compressive loading of acutely injured cartilage can maintain chondrocyte viability by reducing apoptosis after a traumatic impact injury. STUDY DESIGN: In vitro controlled laboratory study. LEVEL OF EVIDENCE: Level 5. METHODS: Each experiment compared 4 test groups: control, impact, impact with compressive loading (either 0.5 or 0.8 MPa), and no impact but compressive loading (n = 15 per group). Flat, full-thickness articular cartilage plugs were harvested from the trochlear region of porcine knees. A drop tower was utilized to introduce an impact injury. The articular plugs were subjected to two 30-minute cycles of either 0.5 or 0.8 MPa of dynamic loading. Cell viability, apoptosis, and gene expression of samples were evaluated 24 hours postimpaction. RESULTS: Cell viability staining showed that 0.5 MPa of dynamic compressive loading increased cell viability compared with the impact group. Apoptotic analysis revealed a decrease in apoptotic expression in the group with 0.5 MPa of dynamic compressive loading compared with the impact group. Significantly higher caspase 3 and lower collagen II expressions were observed in impacted samples without compressive loading, compared with those with. Compressive loading of nonimpacted samples significantly increased collagen II and decreased caspase 3 expressions. CONCLUSION: In this porcine in vitro model, dynamic compressive loading at subphysiological levels immediately following impact injury decreases apoptotic expression, thereby maintaining chondrocyte viability. CLINICAL RELEVANCE: Therapeutic exercises could be designed to deliver subphysiological loading to the injured cartilage, thereby minimizing injury.