Bringing Physical Exam Skills Back from the Dead.

Physical examination education begins early for medical learners. A hindrance to physical exam competency is lack of exposure to pathology in standardized patient settings. This research focuses on improving medical education through the utilization of cadavers that have undergone a soft-embalming technique: the Thiel method. Three scenarios were created in four Thiel cadavers: anterior cruciate ligament (ACL) tear, posterior cruciate ligament (PCL) tear, and sham incision. Students were asked to diagnose ACL tears using the Lachman exam. A total of 54 learners participated in the study. Post-surveys indicated most learners: (1) prefer to use standardized patients (SPs) and soft-embalmed cadavers in their physical examination courses, (2) increased their confidence in performing the Lachman exam on real patients, and (3) enhanced their Lachman technique. SPs ultimately cannot volitionally reproduce the physical exam findings of ACL deficiency. Consequently, learners cannot accurately identify positive versus negative examination findings. Thiel-embalmed cadavers are a valuable resource for physical examination education. (Journal of Surgical Orthopaedic Advances 30(2):112-115, 2021).

Metacarpophalangeal Joint Denervation in the Treatment of Dieterich Disease: A Case Report.

Avascular necrosis of the metacarpal head, known as Dieterich disease, is rare. The underlying pathogenesis of the disease is not clearly understood, and there are few cases reported in the literature. Nonoperative treatment with rest and nonsteroidal anti-inflammatory drugs is often successful, but surgical management is sometimes indicated. The case outlined here describes a novel application of the known technique of metacarpophalangeal joint denervation to relieve pain while maintaining joint mechanics and grip strength.

Phalangeal Osteoid Osteoma of Thumb.

Osteoid osteomas are typically benign osteoblastic bone tumors. Patients often present in their twenties with progressively increasing pain that is worse at night and relieved with nonsteroidal anti-inflammatory drugs. These lesions rarely occur in the hand or wrist; however, when those are involved, the proximal phalanx is the most common location and the index finger is the most commonly affected digit. Lesions affecting the distal phalanges are least likely to occur and the thumb is least likely to be affected. Osteoid osteomas of the distal phalanges can cause great diagnostic challenges. They often present with atypical radiographic and physical examination findings. Although rare, osteoid osteomas of the distal phalanx can be a major cause of digit enlargement and pain. In a patient with a painful and/or swollen digit, the diagnosis should be considered.