Docnotes

Schilling Tendon Procedure

 So now there's a Wikipedia entry for the Schilling Tendon Procedure.  We'll have to get that added to the medical textbooks real soon now.  The news reports are not so clear about this as I would like .. and I'm still not certain that the wikipedia entry is accurate .. so please edit it if you know more of the details.  It's my first contribution to the wikipedia.  Not too hard, but the editing takes some getting used to.

Imaging for back pain, PSA, etc

Another article looks at the question of whether imaging is helpful for the management of back pain.

Ever since my MRI in 1989, I've known I had an L5S1 disc herniation.  (I'm not alone, of course) The MRI didn't change my treatment - indeed, I think that in the first few years after my diagnosis .. I was less active because of it.

The pressure to do something and know what it is often is blamed on the patient, but I think physicians are guilty of such behavior just as much - if not more.  Patients learn from the physician .. and I can say with some confidence that patients and physicians can learn from each other to work toward healing without ordering unnecessary tests.

... and speaking of unnecessary tests, I ordered a PSA last week for a patient who had chosen (after lengthy discussions) not to have it done the previous two years. 

The result was not what we wanted .. and I thought instantly of the recent JAMA paper.  oy.

Next topic  ...

Lyme disease is quite prevalent in these parts.  I've seen a handful of very severe cases, and saw my first case of a true Erythema Migrans rash today.  Impressive.

A Simple, Accurate Method to Confirm Placement of Intra-articular Knee Injection

PubMed Entry: A Simple, Accurate Method to Confirm Placement of Intra-articular Knee Injection Glattes RC, Spindler KP, Blanchard GM, Rohmiller MT, McCarty EC, Block J. Department of Orthopaedics and Rehabilitation and the Department of Radiology, Vanderbilt Sports Medicine Center, Nashville, Tennessee. BACKGROUND: Intra-articular knee injections are routinely performed in clinical practice without documenting intra-articular placement. HYPOTHESIS: A small amount of air to an intra-articular knee injection produces an audible "squishing" sound with range of motion. STUDY DESIGN: Prospective nonrandomized clinical trial. METHODS: The study group (20 knees from 20 patients) received an intra-articular injection with a mixture of local anesthetic, corticosteroid, contrast dye, and 1 to 2 cc of air. The control group (10 knees from 5 patients) received extra-articular injections of a mixture of local anesthetic, contrast dye, and 2 cc of air. All knees were examined immediately after injection for a squishing sound with range of motion. Postinjection arthrographic radiographs were taken to verify the actual placement. RESULT: All study group knees and no control group knees had intra-articular contrast by radiograph. Clearly audible squishing sounds were heard in 17 of 20 study knees (sensitivity of 85%). Squishing sounds were audible in none of the control knees (specificity of 100%). CONCLUSION: Adding 1 to 2 cc of air to knee injections provides a no-cost, reliable, sensitive, and specific method of confirming accurate placement. Clinical Relevance: This simple method is easily reproduced, can confirm accurate placement, and can eliminate extra-articular injection as the reason for clinical response failure. PMID: 15150053 [PubMed - in process]