The Orthopedic clinics of North America
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The diagnostic evaluation of chronic LBP is at best a complex and involved undertaking. The most important part of the process lies in the knowledge of the patient and a solid history and physical examination. From there, most of the serious and life-threatening causes of LBP can be elucidated and studies may be used for confirmation. ⋯ Furthermore, surgical correction of the mechanical portion of chronic LBP. even if correctly identified, then can be expected only to relieve a portion of a patient's symptoms as long as the confounding issues continue to be significant or have become life long adaptive mechanisms. In the end, the discogram and other diagnostic tests are tools that have clear limitations. In this field, clinical judgment begins and ends with an understanding of a patient's life and circumstances as much as with their specific spinal pathology.
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Orthop. Clin. North Am. · Apr 2003
ReviewIndications, techniques, and outcomes of posterior surgery for chronic low back pain.
This article summarizes a number of issues surrounding the diagnosis, indications, and techniques of posterior lumbar spine surgery for chronic low back pain. It would not be entirely unjustified for a spine surgeon to adhere to a totally avoidant approach to chronic low back pain, rationalized by a reasonably legitimate nihilism regarding the presently available means of diagnosing and surgically managing low back pain [64]. Judging by the number of lumbar fusions performed in North America and the tremendous intellectual and financial investment currently being made in technologies to enhance spinal fusion, such an approach is evidently not achieving wide-spread acceptance on this continent. ⋯ Every effort should be made to establish a pathoanatomic etiology of the back pain with a combination of diagnostic modalities. Surgical intervention should be approached cautiously and only after extensive dialog with the patient to establish realistic goals and expectations. Posteriorly performed interbody fusion procedures may provide a high fusion rate and satisfactory clinical outcomes for this challenging problem, although further research is necessary to determine more conclusively the role of surgery and the relative effectiveness of the various arthrodesis techniques.
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Athletic trauma to the hip and pelvis is rare; however, as football players hit harder and skiers ski faster, the incidence of high-energy hip and pelvis trauma can be expected to increase. As the energy of the injury increases, so do the associated risks. Therefore, a thorough understanding of on-field recognition and management is a necessary addition to the armamentarium of the sports medicine physician.
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Traumatic injuries to the elbow are not uncommon in the athlete. A fall onto the out-stretched arm may result in fracture of the radial head, dislocation of the elbow, or other injuries about the joint. ⋯ It is important for the sports medicine physician to become familiar with injury patterns about the elbow in athletes and treatment options. This article will be devoted to a summary of classification, diagnosis, and treatment considerations for selected traumatic athletic injuries of the elbow.
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Dislocations of the elbow are less common than shoulder dislocations. The primary treatment is conservative, with a conscious effort toward early mobilization. Recurrence is rare, and improvement in function and motion can be expected for up to 1 year. Operative treatment should be reserved for baseball pitchers and cases of complex instability.