Acute Shoulder Injuries in Adults.

Acute shoulder pain lasting less than six months is a common presentation to the primary care office. Shoulder injuries can involve any of the four shoulder joints, rotator cuff, neurovascular structures, clavicle or humerus fractures, and contiguous anatomy. Most acute shoulder injuries are the result of a fall or direct trauma in contact and collision sports. The most common shoulder pathologies seen in primary care are acromioclavicular and glenohumeral joint disease and rotator cuff injury. It is important to conduct a comprehensive history and physical examination to identify the mechanism of injury, localize the injury, and determine if surgical intervention is needed. Most patients with acute shoulder injuries can be treated conservatively using a sling for comfort and participating in a targeted musculoskeletal rehabilitation program. Surgery may be considered for treating middle third clavicle fractures and type III acromioclavicular sprains in active individuals, first-time glenohumeral dislocation in young athletes, and those with full-thickness rotator cuff tears. Surgery is indicated for types IV, V, and VI acromioclavicular joint injuries or displaced or unstable proximal humerus fractures. Urgent surgical referral is indicated for posterior sternoclavicular dislocations.

Global Lifestyle Medicine: For People Who Need It the Most but Have It the Least.

In many low- and middle-income countries, chronic or noncommunicable disease is rising exponentially leading to high rates of death and disability. Many low-resource countries also still have high rates of infectious disease, leading to a double burden. As demographics shift and people are able to afford higher calorie convenience foods there can be concomitant obesity and malnutrition. Lifestyle medicine can prevent and reverse these diseases, but the concepts of lifestyle medicine are not reaching the people who need them the most. Lifestyle medicine's unique contribution to the fight against noncommunicable disease is well trained providers who can reach people, really hear their stories, and provide tools for them on their journey, which can affect individuals, communities, and the planet. Providers all over the world are realizing this and joining together in the Lifestyle Medicine Global Alliance (LMGA) to build a network of providers; share best practices, educational resources, and research initiatives; and to advocate on the global stage. The contribution lifestyle medicine has to offer in synergy with public health efforts has been recognized by the World Health Organization, and the Lifestyle Medicine Global Alliance has been invited to partner with them to reduce noncommunicable disease by 30% by 2030.