Physician Sportsmed
-
Physician Sportsmed · Sep 2011
ReviewThe NSAID dilemma: managing osteoarthritis in high-risk patients.
For decades, evidence-based data and reported experience have warned that the common chronic oral nonsteroidal anti-inflammatory drug (NSAID) therapy for osteoarthritis (OA) in elderly patients is ultimately dangerous. Elderly patients with OA are at heightened risk for developing serious gastrointestional and cardiovascular adverse events, including gastrointestinal bleeding, myocardial infarction, and stroke. Prescribing NSAIDs, especially in an elderly population, continues to be discouraged because of these significant risks. ⋯ The goal of this clinical review was to evaluate the risks versus benefits of current options in the treatment of OA. This review found that topical NSAIDs seem to be the safest choice among all options to mitigate gastrointestinal and cardiovascular risks and should be considered prior to the initiation of oral nonselective or cyclooxygenase (COX)-2-selective NSAIDs for individuals presenting with a localized expression of OA. Further research is needed to evaluate and compare these therapies in treating both pain and inflammation effectively while mitigating safety risks in high-risk populations.
-
Physician Sportsmed · Sep 2011
ReviewUltrasound versus anatomic guidance for intra-articular and periarticular injection: a systematic review.
To investigate the clinical efficacy of ultrasound when compared with anatomic standard injection using palpation/anatomic landmarks. ⋯ This systematic review can confirm that accuracy is improved with the use of ultrasound-guided intra-articular injection. We can also confirm that short-term outcome improvements are present using ultrasound-guided injection techniques but can confirm no difference in long-term outcome measures using either technique.
-
Physician Sportsmed · Sep 2011
Randomized Controlled Trial Multicenter StudyAn open-label, long-term safety and tolerability trial of diclofenac sodium 1% gel in patients with knee osteoarthritis.
To evaluate the long-term safety and tolerability of topical diclofenac sodium 1% gel (DSG) in the treatment of knee osteoarthritis (OA) for up to 12 months. ⋯ The long-term safety profile of DSG was consistent with previous 12-week studies, and DSG remained effective for a 1-year period.
-
Physician Sportsmed · Sep 2011
ReviewClavicle fractures: a review of the literature and update on treatment.
Clavicle fractures are common, and it is important for primary care physicians to be familiar with basic principles of evaluation and management in order to initiate treatment as well as discuss these injuries with patients and consulting orthopedic surgeons. These injuries are almost always the result of trauma (often a direct blow to the shoulder) and occur most often in the young male population. Evaluation begins with a thorough history and physical examination and typically progresses to plain radiographs identifying the fracture site and pattern. ⋯ Open reduction and internal fixation has shown superior results compared with conservative management in recent trials of management of displaced fractures. Nonunion and malunion are rare, but may be symptomatic in a subset of patients. These complications may be addressed with open reduction and internal fixation, bone grafting, and osteotomy as needed.
-
Physician Sportsmed · Sep 2011
ReviewDimethyl sulfoxide: an effective penetration enhancer for topical administration of NSAIDs.
Dimethyl sulfoxide (DMSO) is a molecule with a long history in pharmaceutics and is now well established as a penetration enhancer in topical pharmaceutical formulations. It is currently used for this purpose in diclofenac sodium topical solution (approved in the United States to treat signs and symptoms of osteoarthritis) and idoxuridine topical solution (approved in Europe for the treatment of herpes zoster). ⋯ The clinical use of pharmaceutical-grade DMSO as a penetration enhancer is supported by the robust data that have accumulated over the past 3 decades demonstrating the favorable safety and tolerability profile. Dimethyl sulfoxide is a safe and effective mechanism for facilitating the transdermal delivery of both hydrophilic and lipophilic medications to provide localized drug delivery.