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    Bone scan and MRI may help confirm the diagnosis and may be posi- tive as little as 2 days after stress fracture generic 100mg diclofenac with amex. Treatment: Nondisplaced fractures (except in the case of a Jones fracture discount diclofenac 50 mg online, navicular bone buy diclofenac 100 mg otc, or other high-risk location fracture) may gen- erally be treated with rest, ice, orthotics, and a walking cast. Displaced fractures (or fractures in a high-risk location) generally require surgery. Index A AC joint, see Acromioclavicular physical exam, 6, 7, 9, 11, joint 12, 14, 15 Achilles reflex, 78, 79, 114 treatment plans, 15–17 Achilles tendon, ATFL, see Anterior talofibular palpation, 112–114 ligament tendonitis, 119 B ACL tear, see Anterior cruciate ligament tear Babinski reflex, 78, 79 Acromioclavicular (AC) joint, Ballotable patella, 97 arthritis, 36 Biceps reflex, 12, 13, 34 palpation, 20 Bicipital tendonitis, 36 Adhesive capsulitis, 37 Bouchard’s nodes, 55 Anatomic snuffbox, palpation, 53 Brachioradialis reflex, 12, 13, 34 Ankle pain, Bunion, see Hallux valgus differential diagnosis, 109 C history, 109–111 Calcaneofibular ligament physical exam, 111–114, (CFL), evaluation, 116, 117 116, 117 treatment plans, 118–120 Carpal tunnel syndrome, Anterior cruciate ligament anatomy, 56, 57 (ACL) tear, 99, 100, 105 physical exam, 57, 58 Anterior drawer test, 99, 116 treatment, 60, 61 Anterior interosseus nerve Cervical discogenic pain, 16 syndrome, 63 CFL, see Calcaneofibular Anterior talofibular ligament ligament (ATFL), injury, 114, 116 Compression test, 57 Apley compression test, 101–103 Cozen test, 44 Apley distraction test, 101, 103 Cubital tunnel syndrome, 43, 49 Apley Scratch test, 20–23 Apprehension test, 32, 33 D Arm pain, shooting, De Quervain’s tenosynovitis, dermatomes, 3, 4, 11, 12 physical exam, 53 history, 3–6 treatment, 61, 62 muscles and innervation, Dermatomes, 9, 11 lower extremity, 67, 78–80 127 128 Index upper extremity, 3, 4, 11, 12 G Distraction test, 14 Ganglion cyst, 63 Drop-arm test, 32 Gerber lift-off test, 32, 33 Dural tension test, 72 Gillet’s test, 71 E Glenohumeral joint, arthritis, 36 Elbow pain, differential diagnosis, 39 H history, 39, 40 Hallux valgus, 124 muscles and innervation, Hand pain, see Wrist and 46, 47 hand pain physical exam, 40–44, 46 Heberden’s nodes, 55 treatment plans, 47 Hip, Ely’s test, 84, 87 dislocation, 90 Empty can test, 31, 32 fracture, 90 Epicondylitis, osteoarthritis, 89, 90 lateral, 44, 47 pain, see Low back pain medial, 44, 47 Hoffman’s sign, 14, 15 F Hoover test, 79 Faber test, 83 J Finkelstein’s test, 53, 54 Flexor digitorum profundus, Jones fracture, 125, 126 55, 56 K Flexor digitorum superficialis, 55, 56 Knee pain, Flexor hallucis longis tenos- differential diagnosis, 91 ynovitis, 125 history, 91–93 Foot pain, muscles and innervation, 97 differential diagnosis, 121 physical exam, 93–95, 97, history, 121, 122 99–105 physical exam, 122, 123 treatment plans, 105–107 treatment plans, 123–126 L Fracture, ankle, 120 Lachman test, 99 cervical, 17 Lateral collateral ligament, foot, 125, 126 injury, 48, 97, 105, 106 hip, 90 palpation, 42 wrist and hand, 63, 64 Leg pain, shooting, 130 Index Posterior drawer test, 100 history, 19, 20 Posterior talofibular ligament muscles and innervation, 27 (PTFL), injury, 117 physical exam, 20, 23–28, Prepatellar bursitis, 107 30–34 PTFL, see Posterior talofibular treatment plans, 34–37 ligament SLAP lesion, see Superior labral anterior posterior lesion Q Speed’s test, 28–30 Q-angle, 93, 94 Spondondylolysis, 89 Sprain, ankle, 118, 119 R Spurling’s test, 12, 14 Radial styloid process, Stork standing test, 72, 73 palpation, 53 Subacromial bursa, Radicular pain, bursitis, 36 definition, 1 palpation, 20 neck, 2 Superior labral anterior pos- Radiculopathy, terior (SLAP) lesion, 37 cervical, 17 T characteristics, 3 definition, 1 Tarsal tunnel syndrome, 111, lumbosacral, 86 112, 119 pathophysiology, 3 Thomas test, 82, 83 Referred pain, Thompson test, 114 characteristics, 3 Tibialis posterior tendonitis, 111 pathophysiology, 2, 3 Tibial tubercle, palpation, 93, 94 Relocation test, 33, 34 Tinel’s sign, 42, 43, 111 Retrocalcaneal bursitis, 125 Tinel’s test, 57 Rheumatoid arthritis, Trendelenberg test, 69 hand, 55, 62, 63 Triceps reflex, 12, 14, 34 shoulder, 48 Trigger finger, 63 Rotator cuff, Trigger point, palpation, 70 impingement syndrome, Trochanteric bursitis, 70, 89 34–36 Tunnel of Guyon, palpation, tear, 36 54, 55 S U Scapular winging, 25, 26 Ulnar nerve, palpation, 42, 43 Shoulder pain, Ulnar styloid process, differential diagnosis, 19 palpation, 54 Index 131 V physical exam, 52–60 treatment plans, 60–64 Vertebral bodies, palpation, 70 Y W Yergason test, 30 Wartenberg sign, 43 Yocum test, 28, 29 Wilson’s sign, 104 Wrist and hand pain, Z differential diagnosis, 51 Z-joint disease, 15, 16 history, 51, 52 muscles and innervation, 61 . Andrew’s Centre for Plastic Surgery and Burns, Broomfield Hospital, Essex, United Kingdom David N. Galveston Shriners Hospital, Texas University of Texas Medical Branch, Houston, Texas MARCEL DEKKER NEW YORK Although great care has been taken to provide accurate and current information, neither the author(s) nor the publisher, nor anyone else associated with this publication, shall be liable for any loss, damage, or liability directly or indirectly caused or alleged to be caused by this book. The material contained herein is not intended to provide specific advice or recommendations for any specific situation. Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used only for identification and explanation without intent to infringe. Library of Congress Cataloging-in-Publication Data A catalog record for this book is available from the Library of Congress. For more information, write to Special Sales/Professional Marketing at the headquarters address above. Neither this book nor any part may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, microfilming, and recording, or by any information storage and retrieval system, without permission in writing from the publisher. Current printing (last digit): 10987654321 PRINTED IN THE UNITED STATES OF AMERICA To my wife Esther, who is everything; to my daughter Julia, who is even more; and to my parents, Juan Pedro (1933–2004) and Adelaida, who made me who I am. Barret Preface With an overall incidence of more than 800 cases per 1 million persons per year, only motor vehicle accidents cause more accidental deaths than burns. Advances in trauma and burn management over the past three decades have resulted in improved survival and reduced morbidity from major burns. Twenty-five years ago, the mortality rate of a 50% body surface area burn in a young adult was about 50%, despite treatment. Ten years ago, an 80 to 90% body surface area burn yielded 10% survival. Nevertheless, although burn injuries are frequent in our society, many phy- sicians feel uncomfortable managing patients with thermal injuries. Excellent textbooks about the pathophysiology of thermal injury and inhalation injury have recently been published. All new data produced by active research in the field of burn and trauma can be found in these books. Yet, the state-of-the-art tech- niques in the day-to-day care of burn patients—either as outpatients, in the operat- ing room, or in the burn intensive care unit—have yet to be outlined in a single volume. The current project includes all current techniques available today for the care of burn patients. Improved results in survival are due to advancements in resuscitation, operative techniques, infection control, and nutritional/metabolic support. All these improvements are included in the book, along with all the available techniques for burn shock treatment, hypermetabolic response support, new hemostatic and skin substitutes, and pain and psychology support and rehabil- itation. General surgeons, plastic surgeons, medical and surgical residents, emer- gency room physicians, senior students, and any kind of physician or burn team v vi Preface member involved in burn treatment in either community hospitals or burn centers would benefit from the present book, which not only outlines the basics of burn syndrome but also provides an overview of options for burn treatment. The book has been organized in a stepwise manner, with clear information as if the reader would be involved in weekly grand round, day-to-day work with the burn surgeon, anesthetist, or any other burn team member. We sincerely hope that it will serve its purpose of establishing the main principles of surgical treatment of burn injuries. Burn Wound Care and Support of the Metabolic Response to Burn Injury and Surgical Supportive Therapy.............................................

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    The Centers for Disease Control and Prevention (CDC) developed the case definition employed in the trial purchase diclofenac 100 mg overnight delivery, called ‘chronic multisymptom illness’ cheap 100 mg diclofenac free shipping, using statistical and clinical methods cheap diclofenac 100mg on-line. In a two-by-two factoral research design, veterans were randomized to one of four treatment arms that delivered 12 weeks of either physical activation, group cognitive behavioral therapy, or both versus usual postwar symptomatic care. Results were similar to those found in our pilot studies, revealing modest improvements in symptoms of fatigue and cognitive impairment and in mental health functioning with both graded activity and with cognitive-behavioral ther- apy. While the approach is not curative, it offered some symptom relief and improved quality of life for many veterans with chronic postwar pain, fatigue, and disability. The combined strategy of postwar registries, intensive postwar rehabilitative programs, and a center of postwar healthcare delivery and research expertise emerged from the health concerns of 1991 Gulf War veterans and represents advances in postwar military healthcare. Primary Care Practice Guidelines on Postdeployment Healthcare Delivery In evaluating the adequacy of the VA and DoD diagnostic programs for Gulf War veterans, healthcare scientists representing the Institute of Medicine concluded that a systematic quality improvement program was needed for these postwar healthcare programs. The panel recommended clinical practice guide- lines as one important early step in achieving that objective. Consequently, beginning in 1999, a collaboration with nearly fifty clinicians, scientists, and health policy experts from the federal sector and academic medicine developed a clinical practice guideline for assessing, evaluating, and treating returning ser- vice members with deployment-related health concerns. This guideline, called the Department of Defense and Veterans Health Administration Clinical Practice Guideline for Post-Deployment Evaluation and Management (PDH-CPG; see http://www. Complementary practice guidelines were developed for use among those patients identified in postwar assessments with chronic idiopathic pain and fatigue or with major depressive disorder (see http://www. All of these practice guidelines employed a process of evidence-based guideline development and implementation organized with the assistance of RAND Corporation investigators. The main goal of PDH-CPG is to facilitate, support, and improve the care provided for recently deployed veterans with postwar or postdeployment health Can We Prevent a Second ‘Gulf War Syndrome’? Features of PDH-CPG include an emphasis on primary care, primary care screening for deployment or war-related health concerns, and centralized web-based risk communication and clinician implementation support (see PDHealth. PDH- CPG offers clinical evaluation and follow-up guidance, a clinical framework for communicating effectively about military-related health risks, and other support- ing clinical and patient education tools. Several indicators (‘metrics’) are used to help track guideline implementation. Screening for health concerns is facilitated using a ‘military-unique vital sign’. Evidence suggests that this vital sign effectively identifies patients with idiopathic physical symptoms, depression, general psychosocial distress, and low satisfaction with care. PDH-CPG prescribes that all DoD beneficia- ries visiting primary care clinics get routinely asked, ‘Is your visit today for a deployment-related health concern? To facilitate development of population-based registries of individuals with deployment- related health concerns, visits that the patient reports are due to a deployment- related health concern are coded using an ICD-9-CM V-code (v70. Patients with health concerns are prescribed extra or extended visits to accommodate discussions of these concerns. Guidance to clinicians on how to facilitate communication around these concerns is offered for four types of patients: those without deployment health concerns, those with concerns who are otherwise asymptomatic, those with concerns and a diagnosable disease, and those with concerns and idiopathic symptoms (i. Guideline Implementation following the September 11 Pentagon Attack Programmatic efforts to provide health services for individuals affected by the September 11 Pentagon attack help illustrate how recent postwar healthcare initiatives may also lead to advances in healthcare system response following an event with homeland security implications. The Army Medical Department initiated ‘Operation Solace’ in the greater Washington, D. Piloting of PDH-CPG was nearly complete, and efforts to implement it were undertaken in area primary care portals. Primary care patients were asked a modified version of the military-unique vital sign to ascertain if a visit was due to deployment, bioterrorism, or attack-related health concerns. The care manager’s task was to help clinics to integrate guideline practices into their process of care.

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    The title page should also include a running title 50mg diclofenac mastercard, which is the title abbreviated to the number of letter spaces requested by the journal generic diclofenac 100 mg with visa, usually 30–40 including white spaces buy cheap diclofenac 100 mg on line. This title will appear in the header or footer of the journal pages other than on the title page. Finally, select 3–10 key words or short phrases to add to the bottom of the title or abstract page. Standard terms should be selected from the Medical Subject Headings (MeSH), which can be found at the MEDLINE® website (www2) or in the printed Index Medicus held by medical libraries. This will help to ensure that your paper is indexed correctly in the electronic databases and can be found easily by other researchers. Journals may have slight variations in the information that they require on the title page, so always check in the Instructions to Authors. References and citations After all, the ultimate goal of all research is not objectivity, but truth. In finding the references that you need, you can use the web to search MEDLINE® via PubMed® (www3) or you can use other websites to find links to further references and to netprints (www4–8). If you are quoting a method, a sentence, an idea, or some results published by another researcher, then you must cite the original source. Using other researchers’ ideas or any parts of their writing as your own is a serious offence known as plagiarism. When you are writing a journal article, you need to cite only the most valid, most important, and most recent literature. Ideally, you conducted a full literature search when the study was planned and you have updated it as the study progressed. This will allow you to format a bibliography in a fraction of the time that it takes to do it manually. In addition, your paper copies will be filed in alphabetical order or in an indexed or linked file so that they are readily retrieved. Even better, you will have read all of the original journal articles that you plan to cite. Before you submit your paper with a reference list created using a computer package, check with your editor that the format is acceptable. There is a much greater need to be selective rather than to be inclusive with the references that you quote in your introduction and discussion, which are essentially narrative reviews. It is best to only include references that are published in peer-reviewed journals and to exclude any references to unpublished work or abstracts. It is also best to cite only the data from studies that have been rigorous and provide high quality evidence. By selecting the most rigorous literature, you will raise the standard of your paper. The golden rule for an original article is to cite 20–35 references maximum although some journals set specific limits that may be larger or smaller than this. In your paper, you will need to cite your references in the style requested by the journal. The citation of references is usually in numerical order throughout your paper with the references listed at the end using Vancouver format (Box 4. The citation of books and book chapters is usually specific and should be checked with the Instructions to Authors (www10). Although most journals have moved to Vancouver format, some still retain their own format and most electronic database systems have various style options to allow for this. The vexed question of authorship: view of researchers in a British medical faculty. Broad-spectrum antibiotics for preterm, prelabour rupture of fetal membranes: the ORACLE I randomised trial.

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