Primary care
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Shoulder instability can result from acute injury or repetitive overhead activity. Once the injury is identified, the initial course of treatment is aggressive rehabilitation. ⋯ Should a thorough scapular stabilization and rotator cuff strengthening program fail, consultation with an orthopedic surgeon to consider further imaging or possible intervention is appropriate. As the physician's study of approaches to the first-time dislocator continues, they will be better informed of reasonable options to offer the athlete.
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Injuries to the Achilles tendon are common in primary care. Insertional tendonitis, retrocalcaneal bursitis, and paratenonitis are acute injuries usually treated conservatively with rest, ice, anti-inflammatory measures, and physical rehabilitation. Causative factors such as improper training or biomechanical abnormalities must be corrected to prevent reoccurrence. ⋯ Surgical treatment may occasionally be recommended. With rupture of the Achilles, there exists some controversy regarding the advantage of conservative versus surgical management. Treatment should be based on individual patient considerations and expectations.
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Rotator cuff problems are among the most commonly encountered disorders of the shoulder, and are commonly seen by primary care physicians. Their exact mechanism for susceptibility to injury remains unclear; however, with an understanding of the shoulder's anatomy and biomechanics, we are better able to treat the insults incurred on the cuff. Early recognition, proper treatment, and appropriate follow-up may expedite healing and prevent the occurrence of further injury or complications.
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Proximal biceps tendon rupture, biceps tendinitis, and medical biceps subluxation are injuries that occur alone and in association with other pathologic conditions of the shoulder. The literature describes various strategies for imaging and treating these biceps tendon complex injuries but offers no clear consensus on a gold-standard approach. The keys to successful treatment are an accurate diagnosis, identification of associated pathologic conditions, and assessment of functional limitations of the injury.