Taylor’s Musculoskeletal Problems and Injuries

无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Taylor’s Musculoskeletal Problems and Injuries 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Taylor’s Musculoskeletal Problems and Injuries A Handbook Robert B. Taylor, M.D. Editor Professor Emeritus Department of Family Medicine Oregon Health & Science University School of Medicine Portland, Oregon Associate Editors Alan K. David, M.D. Scott A. Fields, M.D. Professor and Chairman Professor and Vice Chairman Department of Family and Department of Family Medicine Community Medicine Oregon Health & Science University Medical College of Wisconsin School of Medicine Milwaukee, Wisconsin Portland, Oregon D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H. Professor and Chairman Clinical Professor Department of Family Medicine Department of Family and University of Mississippi Preventive Medicine School of Medicine University of California, Jackson, Mississippi San Diego School of Medicine San Diego, California With 53 Illustrations 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Robert B. Taylor, M.D. Professor Emeritus Department of Family Medicine Oregon Health & Science University School of Medicine Portland, OR 97239-3098, USA Associate Editors Alan K. David, M.D. Scott A. Fields, M.D. Professor and Chairman Professor and Vice Chairman Department of Family and Department of Family Medicine Community Medicine Oregon Health & Science University Medical College of Wisconsin School of Medicine Milwaukee, WI 53226-0509, USA Portland, OR 97201-3098, USA D. Melessa Phillips, M.D. Joseph E. Scherger, M.D., M.P.H. Professor and Chairman Clinical Professor Department of Family Medicine Department of Family and Preventive Medicine University of Mississippi School University of California, San Diego of Medicine School of Medicine Jackson, MS 39216-4500, USA San Diego, California 92103-0801, USA Library of Congress Control Number: 2005935915 ISBN-10: 0-387-29171-7 Printed on acid-free paper. ISBN-13: 978-0387-29171-0 © 2006 Springer Science+Business Media, LLC All rights reserved. This work may not be translated or copied in whole or in part without the written permission of the publisher (Springer Science+Business Media, LLC, 233 Spring Street, New York, NY 10013, USA), except for brief excerpts in connection with reviews or scholarly analysis. Use in connection with any form of information storage and retrieval, electronic adaptation, computer software, or by similar or dissimilar methodology now known or hereafter developed is forbidden. The use in this publication of trade names, trademarks, service marks and similar terms, even if they are not identified as such, is not to be taken as an expression of opinion as to whether or not they are subject to proprietary rights. While the advice and information in this book are believed to be true and accurate at the date of going to press, neither the authors nor the editors nor the publisher can accept any legal responsibility for any errors or omissions that may be made. The publisher makes no warranty, express or implied, with respect to the material contained herein. Printed in the United States of America. (SPI/EB) 9 8 7 6 5 4 3 2 1 springer.com 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Preface After more than a quarter century as a primary care educator, I am convinced that our graduates enter practice inadequately trained in the diagnosis and management of musculoskeletal problems and injuries. One reason for this perceived deficiency is the relatively short duration of primary care training—typically three years for family medicine, general internal medicine, and general pediatrics. During this time, there are just not enough months to teach all a cli- nician needs to know about diseases and trauma involving the mus- culoskeletal system. This inadequacy is compounded by the sometimes quirky nature of the problems: that is, for example, the increased risk of nonunion in a fracture of the carpal navicular (scaphoid) bone or the maneuver that can magically reduce a child’s radial head subluxation. The chapters in this book are from the edited reference book Family Medicine: Principles and Practice, 6th edition, which is widely used by family physicians in the United States and abroad. The publisher and I believe that, in addition to family physicians, the chapters in this book will also be useful to other clinicians providing broad-based care: general internists, general pediatricians, emergency physicians, nurse practitioners, and physician assistants. When compared to the large, comprehensive book, this volume will be preferred by some readers because of the physically smaller size and perhaps by the lower cost. In selecting chapters to include in the book, I have included problems involving all areas of the skeleton and related musculature, in both children and adults. Athletic injuries are included because, after all, primary care clinicians manage most sports injuries. I have included a chapter on acute lacerations, which often accompany other types of injuries. In addition to sprains, strains, and fractures, there are chapters covering illnesses affecting the musculoskeletal system: 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com various types of arthritis, fibromyalgia, and the complex regional pain syndrome. I hope you find this book useful in daily practice; comments are welcome. Robert B. Taylor, M.D. Portland, Oregon, USA vi Preface 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Clinical Practice Notice Everyone involved with the preparation of this book has worked very hard to assure that information presented here is accurate and that it represents accepted clinical practices. These efforts include confirm- ing that drug recommendations and dosages discussed in this text are in accordance with current practice at the time of publication. Nevertheless, therapeutic recommendations and dosage schedules change with reports of ongoing research, changes in government rec- ommendations, reports of adverse drug reactions, and other new information. A few recommendations and drug uses described herein have Food and Drug Administration (FDA) clearance for limited use in restricted settings. It is the responsibility of the clinician to determine the FDA status of any drug selection, drug dosage, or device recommended to patients. The reader should check the package insert for each drug to deter- mine any change in indications or dosage as well as for any precau- tions or warnings. This admonition is especially true when the drug considered is new or infrequently used by the clinician. The use of the information in this book in a specific clinical setting or situation is the professional responsibility of the clinician. The authors, editors, or publisher are not responsible for errors, omissions, adverse effects, or any consequences arising from the use of information in this book, and make no warranty, expressed or implied, with respect to the completeness, timeliness, or accuracy of the book’s contents. 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Contents Preface . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v Clinical Practice Notice . . . . . . . . . . . . . . . . . . . . . . . . . . . vii Contents. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ix Contributors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi 1 Disorders of the Back and Neck . . . . . . . . . . . . . . . . . . . . . . 1 Walter L. Calmbach 2 Disorders of the Upper Extremity . . . . . . . . . . . . . . . . . . . . 35 Ted C. Schaffer 3 Disorders of the Lower Extremity . . . . . . . . . . . . . . . . . . . . 59 Kenneth M. Bielak and Bradley E. Kocian 4 Osteoarthritis. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89 Alicia D. Monroe and John B. Murphy 5 Rheumatoid Arthritis and Related Disorders . . . . . . . . . . . . 97 Joseph W. Gravel Jr., Patricia A. Sereno, and Katherine E. Miller 6 Selected Disorders of the Musculoskeletal System . . . . . . 127 Jeffrey G. Jones and Doug Poplin 7 Musculoskeletal Problems of Children . . . . . . . . . . . . . . . 147 Mark D. Bracker, Suraj A. Achar, Todd J. May, Juan Carlos Buller, and Wilma J. Wooten 8 Osteoporosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181 Paula Cifuentes Henderson and Richard P. Usatine 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 9 Gout . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197 James F. Calvert, Jr. 10 Athletic Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205 Michael L. Tuggy and Cora Collette Breuner 11 Care of Acute Lacerations . . . . . . . . . . . . . . . . . . . . . . . . . 233 Bryan J. Campbell and Douglas J. Campbell 12 Selected Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261 Allan V. Abbott Index. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281 x Contents 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Contributors Allan V. Abbott, M.D., Professor of Family Medicine, Keck School of Medicine, University of Southern California, Los Angeles, California Selected Injuries Suraj A. Achar, M.D., Clinical Instructor of Family Medicine, University of California-San Diego School of Medicine, LaJolla, California Musculoskeletal Problems of Children Kenneth M. Bielak, M.D., Associate Professor of Family Medicine, University of Tennessee – Knoxville School of Medicine, Knoxville, Tennessee Disorders of the Lower Extremity Mark D. Bracker, M.D., Clinical Professor of Family and Preventive Medicine, University of California-San Diego School of Medicine, La Jolla, California Musculoskeletal Problems of Children Cora Collette Breuner, M.D., M.P.H., Department of Pediatrics, University of Washington Medical Center, Seattle, Washington Athletic Injuries Juan Carlos Buller, M.D., Staff Physician, San Diego Sports Medicine and Family Practice, San Diego, California Musculoskeletal Problems of Children 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Walter L. Calmbach, M.D., Associate Professor of Family and Community Medicine, Director of Sports Medicine Fellowship and South Texas Ambulatory Research Network (STARNET), University of Texas Health Science Center, San Antonio, Texas Disorders of the Back and Neck James F. Calvert Jr, M.D., Associate Professor of Family Medicine, Oregon Health & Science University School of Medicine, Portland; Cascades East Family Practice Residency Program, Klamath Falls, Oregon Gout Bryan J. Campbell, M.D., Assistant Professor of Family and Preventive Medicine, University of Utah School of Medicine, Salt Lake City, Utah Care of Acute Lacerations Douglas J. Campbell, M.D., Community Attending Physician, Good Samaritan Regional Family Practice Center, Yavapai Regional Medical Center, Prescott, Arizona Care of Acute Lacerations Joseph W. Gravel, Jr, M.D., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Director, Tufts University Family Practice Residency Program, Malden, Massachusetts Rheumatoid Arthritis and Related Disorders Paula Cifuentes Henderson, M.D., Clinical Instructor of Family Medicine, University of California – Los Angeles School of Medicine, Los Angeles, California Osteoporosis Jeffrey G. Jones, M.D., M.P.H., Medical Director, St. Francis Traveler’s Health Center, Indianapolis, Indiana Selected Disorders of the Musculoskeletal System Bradley E. Kocian, M.D., Sports Medicine Fellow, University of Tennessee -Knoxville Medical Center, Knoxville, Tennessee Disorders of the Lower Extremity xii Contributors 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Todd J. May, D.O., Lieutenant Commander, Medical Corps, United States Naval Hospital, Camp Pendleton, California Musculoskeletal Problems of Children Katherine E. Miller, M.D., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Faculty, Tufts University Family Practice Residency Program, Malden, Massachusetts Rheumatoid Arthritis and Related Disorders Alicia D. Monroe, M.D., Associate Professor of Family Medicine, Brown Medical School, Providence; Memorial Hospital of Rhode Island, Pawtucket, Rhode Island Osteoarthritis John B. Murphy, M.D., Professor of Family Medicine, Brown Medical School, Providence, Rhode Island Osteoarthritis Doug Poplin, M.D., M.P.H., Medical Director, Saint Francis Occupational Health Center, Indianapolis, Indiana Selected Disorders of the Musculoskeletal System Ted C. Schaffer, M.D., Clinical Assistant Professor, Department of Family Medicine and Clinical Epidemiology, University of Pittsburgh School of Medicine; Director, UPMC – St. Margaret Hospital Family Practice Residency Program, Pittsburgh, Pennsylvania Disorders of the Upper Extremity Patricia A. Sereno, M.D., M.P.H., Assistant Clinical Professor of Family Medicine and Community Health, Tufts University School of Medicine, Boston; Hallmark Family Health Center, Malden, Massachusetts Rheumatoid Arthritis and Related Disorders Michael L. Tuggy, M.D., Clinical Assistant Professor of Family Medicine, University of Washington School of Medicine; Director, Swedish Family Medicine Residency Program, Seattle, Washington Athletic Injuries Contributors xiii 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Richard P. Usatine, M.D., Professor of Clinical Family Medicine and Assistant Dean of Student Affairs, University of California – Los Angeles School of Medicine, Los Angeles, California Osteoporosis Wilma J. Wooten, M.D., M.P.H., Associate Clinical Professor of Family and Preventive Medicine, University of California-San Diego School of Medicine, La Jolla, California Musculoskeletal Problems of Children xiv Contributors 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 1 Disorders of the Back and Neck Walter L. Calmbach Disorders of the Back Low back pain is a common and costly medical problem. The lifetime prevalence of low back pain is estimated to be 70% to 85%, and the point prevalence is approximately 30%.1 Each year, 2% of all American workers have a compensable back injury, and 14% lose at least one workday due to low back pain.2 Among chronic conditions, back problems are the most frequent cause for limitation of activity (work, housekeeping, school) among patients under 45 years of age.3 Acute low back pain is the fifth most common reason for a visit to the physi- cian, accounting for 2.8% of all physician visits.4 And nonsurgical low back pain is the fourth most common admission diagnosis for patients over 65.5 Although difficult to estimate, the direct medical costs due to back pain totaled $33.6 billion in 1994. Indirect costs (i.e., lost produc- tivity and compensation) are estimated to be as high as $43 billion.6 In most cases, low back pain is treated successfully with a conservative regimen, supplemented by selective use of neuroradiological imaging, and appropriate surgical intervention for a small minority of patients.7 Background Epidemiology Low back pain affects men and women equally, with the onset of symptoms between the ages of 30 and 50 years. It is the most common cause of work-related disability in people under 45 years of age, and 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com 2 Walter L. Calmbach is the most expensive cause of work-related disability.8 Risk factors for the development of low back pain include heavy lifting and twist- ing, bodily vibration, obesity, and poor conditioning; however, low back pain is common even among patients without these risk factors.1 In cases of more severe back pain, occupational exposures are much more significant, including repetitive heavy lifting, pulling, or pushing, and exposures to industrial and vehicular vibrations. If even temporary work loss occurs, additional important risk factors include job dissatisfaction, supervisor ratings, and job environment (i.e., bor- ing, repetitive tasks).1 Factors associated with recurrence of low back pain include traumatic origin of first attack, sciatic pain, radi- ographic changes, alcohol abuse, specific job situations, and psy- chosocial stigmata. Of patients with acute low back pain, only 1.5% develop sciatica (i.e., painful paresthesias and/or motor weakness in the distribution of a nerve root). However, the lifetime prevalence of sciatica is 40%, and sciatica afflicts 11% of patients with low back pain that lasts for more than two weeks.9,10 Sciatica is associated with long-distance driving, truck driving, cigarette smoking, and repeated lifting in a twisted pos- ture. It is most common in the fourth and fifth decades of life, and peaks in the fourth decade. Most patients with sciatica, even those with significant neurological abnormalities, recover without surgery.11 Only 5% to 10% of patients with persistent sciatica require surgery.5,12 Despite the incidence and prevalence of low back pain and sciatica, the major factor responsible for its societal impact is disability.12 The National Center for Health Statistics estimates that 5.2 million Americans are disabled with low back pain, of whom 2.6 million are permanently disabled.13 Between 70% and 90% of the total costs due to low back pain are incurred by the 4% to 5% of patients with tem- porary or permanent disability.12 Risk factors for disability due to low back pain include poor health habits, job dissatisfaction, less appeal- ing work environments, poor ratings by supervisors, psychological disturbances, compensable injuries, and history of prior disability.12 These same factors are associated with high failure rates for treat- ments of all types. Natural History Recovery from nonspecific low back pain is usually rapid. Approximately one third of patients are improved at one week, and two thirds at seven weeks. However, recurrences are common, affecting 40% of patients within six months. Thus, “acute low back pain” is increasingly perceived as a chronic medical problem with intermittent exacerbations.14 无水印完整版本下载：www.n-ebook.com Doc uCo m P DF Tria l ww w.pd fwiz ard. com Low back pain may originate from many structures, including par- avertebral musculature, ligaments, the annulus fibrosus, the spinal nerve roots, the facet joints, the vertebral periosteum, fascia, or blood vessels. The most common causes of back pain include musculoliga- mentous injuries, degenerative changes in the intervertebral discs and facet joints, spinal stenosis, and lumbar disc herniation.14 The natural history of herniated lumbar disc is usually quite favor- able. Only about 10% of patients who present with sciatica have suf- ficient pain at six weeks that surgery is considered. Sequential magnetic resonance imaging (MRI) shows gradual regression of the herniated disc material over time, with partial or complete resolution in two thirds of patients by six months.14 Acute disc herniation has changed little from its description in the classic article of Mixter and Barr: the annulus fibrosus begins to deteriorate by age 30, which leads to partial or complete herniation of the nucleus pulposus, causing irri- tation and compression of adjacent nerve roots.5,15,16 Usually this her- niation is in the posterolateral position, producing unilat