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Images in Clinical Medicine
Hypertrophic Pulmonary Osteoarthropathy and Tripe Palms
Figure 1.
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Perspective
Medical Devices — Balancing Regulation and Innovation
Many Americans benefit from the implantation of medical devices, such as artificial joints and lifesaving defibrillators. Tragically, many also suffer or even die from complications related to medical devices that were never studied in clinical trials before being implanted in patients. As devices…
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Editorial
Nerve Growth Factor and Pain
Osteoarthritis, a common, painful condition, occurs at a rate of 1% per year and affects the majority of people who are over 55 years of age. In a proof-of-concept, phase 2 study in this issue of the Journal, Lane and colleagues report that blocking the activity of nerve growth factor with a…
Original Article
Tanezumab for the Treatment of Pain from Osteoarthritis of the Knee
Nerve growth factor is a neurotrophin that regulates the structure and function of responsive sensory neurons, including small-diameter nociceptive afferents. There has been increasing recognition of the potential role of nerve growth factor in pain modulation through nociceptor sensitization.–…
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Original Article
A Randomized Trial of Treatment for Acute Anterior Cruciate Ligament Tears
Rupture of the anterior cruciate ligament (ACL) is a serious knee injury that affects mainly physically active young people. The injury is characterized by joint instability that leads to decreased activity, unsatisfactory knee function, and poor knee-related quality of life in the short term,, and…
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In this randomized, controlled trial of young, active adults with an acute anterior cruciate ligament (ACL) injury, rehabilitation plus early ACL reconstruction was not superior to rehabilitation plus optional delayed ACL reconstruction with respect to pain, symptoms, knee function, and knee-related quality of life, and it resulted in significantly more knee reconstructions.
Editorial
Is Early Reconstruction Necessary for All Anterior Cruciate Ligament Tears?
The anterior cruciate ligament (ACL) is necessary to prevent knee instability (giving way) during sports activities, in particular those that require planting and pivoting-type maneuvers. Episodes of giving way typically occur during athletic activity but can also occur with activities of daily…
Correspondence
Minimally Invasive Total Knee Arthroplasty
To the Editor: In the Clinical Therapeutics article on minimally invasive total knee arthroplasty for osteoarthritis, Leopold (April 23 issue) does not offer advice regarding weight reduction to ideal levels as part of his recommendations for a female patient with a body-mass index (BMI, the weight…
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Clinical Therapeutics
Minimally Invasive Total Knee Arthroplasty for Osteoarthritis
Foreword. This Journal feature begins with a case vignette that includes a therapeutic recommendation. A discussion of the clinical problem and the mechanism of benefit of this form of therapy follows. Major clinical studies, the clinical use of this therapy, and potential adverse effects are…
A 65-year-old woman with osteoarthritis of the right knee seeks advice regarding minimally invasive total knee arthroplasty. Joint-replacement surgery is appropriate for patients with moderate-to-severe symptoms and functional limitation despite conservative therapy. The minimally invasive technique reduces postoperative pain and accelerates recovery but requires a surgeon with specific expertise and experience.
Original Article
Incidental Meniscal Findings on Knee MRI in Middle-Aged and Elderly Persons
The menisci are two semilunar, fibrocartilaginous disks located between the medial and lateral articular surfaces of the femur and tibia in each knee. Their key functions are the transfer of weight and absorption of shock during dynamic movements of the knee, thus protecting the cartilage in the…
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In this cross-sectional study involving magnetic resonance imaging (MRI) of the right knee in middle-aged and older men and women, more than a third of the participants had a meniscal tear or meniscal destruction or resection; many of these persons reported having had no knee pain or stiffness in the previous month. Meniscal damage was particularly common in persons with radiographic evidence of osteoarthritis. Clinicians should take into consideration the high prevalence of incidental meniscal findings when ordering or interpreting this test in older patients with knee pain.
Original Article
A Randomized Trial of Arthroscopic Surgery for Osteoarthritis of the Knee
Osteoarthritis of the knee is a degenerative disease that causes joint pain, stiffness, and decreased function.– Treatment is multidisciplinary and involves physical therapy, medication, and surgery. Arthroscopic surgery, in which an arthroscope is inserted into the knee joint, allows for lavage,…
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Editorial
Arthroscopic Surgery for Osteoarthritis of the Knee?
Orthopedic surgeons perform arthroscopic surgery in many joints of the extremities, most commonly the knee. Two or three incisions are routinely made, each measuring approximately 7 mm. The knee is inflated with fluid under pressure, with the assistance of a pump, to facilitate visualization.…
Correspondence
Osteoarthritis of the Hip
To the Editor: Among Lane's recommendations for the case described in the Clinical Practice article on osteoarthritis of the hip (Oct. 4 issue) is a referral to a physical therapist. Although evidenced-based recommendations for exercise in patients with osteoarthritis of the hip currently exist,…
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Clinical Practice
Osteoarthritis of the Hip
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 70-year-old…
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A 70-year-old man reports a gradual onset of hip pain that has limited his activities for about a year. The pain initially occurred only with walking and was limited to the anterior hip area but now has spread to the side of the hip and is present at rest. He has no history of hip, back, or lower back injury and has no pain or morning stiffness in any other joints. He has been taking ibuprofen at a dose of 200 mg once or twice daily, without improvement. How should the patient be evaluated and treated?
Review Article
Medical Education: Educational Strategies to Promote Clinical Diagnostic Reasoning
Clinical teachers differ from clinicians in a fundamental way. They must simultaneously foster high-quality patient care and assess the clinical skills and reasoning of learners in order to promote their progress toward independence in the clinical setting. Clinical teachers must diagnose both the…
Case Records of the Massachusetts General Hospital
Case 22-2006 — A 77-Year-Old Man with a Rapidly Progressive Gait Disorder
Presentation of Case. Dr. Robert H. Ackerman: A 77-year-old man was admitted to this hospital because of recent episodes of falling. He had been well until 18 months earlier, when an abscess of the right foot caused by Staphylococcus aureus developed. This was treated with surgical débridement,…
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A 77-year-old man had difficulty walking that progressed rapidly during four months. For approximately 14 months, he had had a series of medical problems that prevented him from carrying out his usually brisk physical activities. On examination, motor strength and sensation were normal, and a neurologist noted mild hyperreflexia and bilateral Babinski signs. Despite physical therapy, his symptoms worsened and additional physical signs developed. A diagnostic procedure was performed.
Editorial
Nutritional Supplements for Knee Osteoarthritis — Still No Resolution
Osteoarthritis is the most common form of arthritis, and when it affects the knee, as opposed to other joints, it is more apt to cause symptoms, including pain and stiffness, and functional limitation. Treatment of symptomatic osteoarthritis of the knee is focused on controlling the pain,…
Clinical Practice
Osteoarthritis of the Knee
Foreword. This Journal feature begins with a case vignette highlighting a common clinical problem. Evidence supporting various strategies is then presented, followed by a review of formal guidelines, when they exist. The article ends with the author's clinical recommendations. Stage. A 66-year-old…
A 66-year-old woman who is overweight reports bilateral knee pain of gradual onset during the past several months that increasingly has limited her activities. Last week, when walking down the stairs, she nearly fell when her knee gave way. She does not recall having injured her knee, and she has no morning stiffness and no pain in other joints. She has tried taking up to eight extra-strength (500 mg each) acetaminophen tablets daily without success and has never had ulcers or stomach bleeding. How should the patient be evaluated and treated?
Original Article
Glucosamine, Chondroitin Sulfate, and the Two in Combination for Painful Knee Osteoarthritis
Osteoarthritis is the most common of the arthritides, affecting at least 20 million Americans, a number that is expected to double over the next two decades. Currently available medical therapies primarily address the treatment of joint pain in patients with osteoarthritis. Analgesics as well as…
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In this 24-week trial, glucosamine and chondroitin sulfate were not more effective, alone or in combination, than placebo in controlling pain in patients with osteoarthritis of the knee. In secondary analyses, however, in the subgroup of patients with moderate-to-severe osteoarthritis, those given both glucosamine and chondroitin sulfate were more likely than those given placebo to have a decrease in pain (79 percent vs. 54 percent).
