When X-Rays Lie
From July 2020, The Certainty of UncertaintyMedical tests can lie. X-rays are simply a test. The purpose of any test is to affect our pre-test probability - it is not to make a diagnosis. Any test result (positive or negative) must be placed in the clinical context it is being used. We should have an expectation of any test before we order …
11min 7Arun Sayal, MD and Neda Frayha, MD
TIDBSI: Knee Injections
From June 2020, Cause of Death?An elderly patient with knee pain limps into your clinic asking for a “cortisone shot”. Do you reach for the needle? Paul Simmons and Justin McCarthy dive in to the real evidence behind intra-articular knee injections in this TIDBSI segment. •
15min 43Paul Simmons, MD and Justin McCarthy, MD
Common Sprains
From February 2020, Don't Go Breaking My HeartManagement of sprains can be divided into the acute and functional phase. In the acute phase early range of motion exercises and techniques to manage pain and swelling are key aspects of treatment. In the functional phase the focus shifts more to emphasize strength, stability, and a return to …
18min 27Matt Baird, MD, Neda Frayha, MD, and Matthew DeLaney, MD, FACEP, FAAEM
Common Peds Fractures
From June 2019, Does My Liver Look Fat?Andi and Miz sit down with PEM doc Ilene Claudius to sort out high yield and “can’t miss” pediatric foot and ankle injuries. •
23min 45Matthew DeLaney, MD, FACEP, FAAEM, Ilene Claudius, MD, and Mike Weinstock, MD
Bursitis
From April 2019, A Maelstrom of Mail!In acute superficial bursitis, aspiration can be both therapeutic and diagnostic. In this segment, Brandon Grove takes us on a tour of olecranon and pre-patellar bursitis, and how to approach aspiration and treatment.
8min 18Brandon Grove, MD
Paper Chase #1 | Calcium and Vitamin D Supplements Don’t Always Help
From April 2018, Will You Be My Facebook Friend?In this meta-analysis of randomized clinical trials, the use of calcium, vitamin D, or both was not associated with a lower risk of fractures. We should stop prescribing or recommending them for this purpose.
5min 50Andrew Buelt, DO and Joe Weatherly, DO
Orthopedic Injuries in Non-Accidental Trauma (NAT)
From March 2018, What’s Your (Code) Status?Non-accidental trauma should be considered in cases where the nature of the fracture is inconsistent with the mechanism described by the provider, which can include severity of the injury, location, or mechanism is inconsistent with child’s development stage.
23min 6Solomon Behar, MD and Jason Woods, MD
Paper Chase 3 - Do Steroid Injections Make You Weak in the Knees?
From September 2017, You Can Do It!!This study found that triamcinolone knee injections were inferior to saline injections as measured by the WOMAC scale every three months over a two year period. Triamcinolone was also associated with a statistically significant decrease in amount of knee cartilage.
6min 12Andrew Buelt, DO and Joe Weatherly, DO
Paper Chase 4 - Joint Replacement and Patient Age
From May 2017, My Gut Biome Told Me SoThe vast majority of knee and hip replacements are still functional 20 yrs post implantation. Given this, perhaps joint replacement surgeries could be considered in younger patients than is typical. •
5min 29Andrew Buelt, DO and Joe Weatherly, DO
Vertebral Compression Fractures
From March 2017, The Benzos & Fungus Among UsVertebral compression fractures are the most common osteoporotic fractures. They can be caused by low force activities, such as coughing, straining at stool, or as in this case, trying to open a frozen front door. Plain films are the diagnostic modality of choice, although CT and MRI may also be …
23min 29Adrien Selim, MD and Joe Weatherly, DO
Osteoporosis, Part 1
From January 2017, Bones Lose Their AutonomyWho should care about osteoporosis? Everybody. It affects 1 in 3 women and 1 in 5 men. Dr. Heidi James and Dr. Sylvie Ouellette discuss the evaluation and treatment of patients at risk for, and who have, osteoporosis. •
17min 55Heidi James, MD and Sylvie Ouellette, MD
Osteoporosis, Part 2
From January 2017, Bones Lose Their AutonomyWho should care about osteoporosis? Everybody. It affects 1 in 3 women and 1 in 5 men. Dr. Heidi James and Dr. Sylvie Ouellette discuss the evaluation and treatment of patients at risk for, and who have, osteoporosis.
24min 4Heidi James, MD and Sylvie Ouellette, MD
Hip Pain
From November 2016, Aspirin Loses Its TenurePatients present with hip pain and how you approach a patient should be methodical. Matt and Sarah discuss a step by step approach to hip pain, including how to evaluate intra-articular and extra-axial causes of hip pain and how to evaluate for referred pain as well. •
15min 31Mizuho Morrison, DO
Things I Do But Should I: Sacral Dimples
From September 2016, Best Weight, Best Exercise!Review an approach to the neonate with a sacral dimple.
6min 44Vanessa Cardy, MD and Adrien Selim, MD
Paper Chase 4: Avoid Surgical Repair of Degenerative Meniscal Tears
From June 2016, C Diff Shows No Mercy!Resection of a torn meniscus has no added benefit over sham surgery to relieve knee catching or occasional locking •
5min 4Andrew Buelt, DO and Joe Weatherly, DO
Paper Chase 3: Vitamin D Supplement Yields No Benefit in Knee Osteoarthritis
From June 2016, C Diff Shows No Mercy!In patients with low serum vitamin D levels and knee pain, vitamin D supplementation did not result in significant differences in change in tibial cartilage volume or knee pain. •
6min 57Andrew Buelt, DO and Joe Weatherly, DO
Introduction: Dupytren's Disease
From May 2016, The Sexology of Radicular Back PainDupuytren's’ contracture can cause significant disability, but 10% will resolve spontaneously. •
11min 36Rob Orman, MD and Heidi James, MD
Paper Chase 1: Knee Osteoarthritis
From February 2016, The Allergy That Isn't and the B-12 That IsIn patients with knee osteoarthritis, unilateral total knee replacement followed by nonsurgical treatment resulted in greater pain relief and functional improvement after 12 months than did nonsurgical treatment alone. •
6min 4Andrew Buelt, DO and Joe Weatherly, DO
The Painful Pediatric Elbow
From April 2015, The Iron CranberryReview common presentations of the painful elbow in the pediatric population.
26min 3Mizuho Morrison, DO, Solomon Behar, MD, and Yu-Tsun (Yo) Cheng, MD