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b2ap3_thumbnail_bony-hands_portrayal-89189_640.jpgBy Will Boggs MD
 
July 14, 2014
 
Information from Industry
NEW YORK (Reuters Health) - Ultrasonography diagnoses hand bony fractures in pediatric patients with greater than 90% accuracy, researchers from Italy report.
 
"Ultrasonography is a useful addition to physical examination for the diagnosis of hand fracture," Dr. Ingrid Rabach from IRCCS "Burio Garofoldo," Trieste, Italy told Reuters Health. "It allows a rapid evaluation, using x-ray only with positive ultrasonography examination."
 
Ultrasonography offers high-resolution evaluation of the bone cortex without exposure to ionizing radiation, and several studies have shown that emergency department physicians with adequate training can rapidly diagnose fractures in children using ultrasonography.
 
Dr. Rabach and colleagues evaluated the diagnostic accuracy of ultrasonography performed by an expert radiologist in comparison to x-ray for the diagnosis of bony hand fractures (metacarpals and phalanges) in a cross-sectional study of 204 pediatric patients admitted for hand trauma.
 
Standard radiography (an average of 2.6 x-rays per patient) revealed fracture in 79 (38.7%) patients, as reported online June 20th Archives of Disease in Childhood.
 
When radiologists reviewed the ultrasonography results, their interpretations were 91.7% sensitive and 97.6% specific for diagnosing fracture (compared with radiography), with 96.0% positive predictive value and 94.6% negative predictive value.
 
Results were very similar when emergency department physicians performed the ultrasonography: 91.5% sensitivity, 96.8% specificity, 94.7% positive predictive value, and 94.8% negative predictive value.
 
There was excellent agreement between ultrasonography carried out by the senior radiologist and by the emergency pediatrician
 
"In our experience, the ultrasonography examination was brief (about 3 min) and was safe and harmless without considerable strain or stress for the children," the investigators say. "The use of the water bath technique may allow for the maximum visualization of the underlying tissues with the water being somewhat of a relief for the pain and an interface that avoids the direct contact between the probe and the injured hand."
 
"For all cases in which the examination is not strongly suggestive of fracture and ultrasonography is negative, then x-ray could be avoided," Dr. Rabach said, "while in cases where the fracture is visible on ultrasound, x-ray must be done anyway as required by orthopedist to guide the right treatment."
 
"After a short training period, also an emergency department physician should be able to perform ultrasonography in the emergency department setting with no need to move the patient," Dr. Rabach said.
 
The researchers caution, "The study has some limitations: high quality ultrasonography machine and probes at high frequencies are needed, ultrasonography is a highly operator-dependent technique, manual skill and setting of the ultrasonography play a relevant role, the great majority of patients were older kids while age and cooperation of the patient may limit this approach, the number of patients is still limited so that these results need to be confirmed by further studies."
 
 
Information from Industry
Dr. Joni E. Rabiner from Albert Einstein College of Medicine, Bronx, NY has studied the accuracy of point-of-care ultrasonography for diagnosing fractures in children. She told Reuters Health, "Ultrasonography is especially useful to rule-in hand fracture as it has a higher specificity and lower sensitivity, and therefore simple mid-shaft phalanx or metacarpal fractures may be reduced and splinted with the use of ultrasound. In addition, ultrasonography for fracture may be especially useful in remote or resource-scarce locations without easy access to radiography."
 
"X-ray remains the standard of care for evaluation of hand fracture in children as several fractures were missed by ultrasonography in this study," Dr. Rabiner concluded. "However, ultrasound for hand fracture may be a helpful screening tool in overcrowded emergency departments or useful in locales without access to X-rays."
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b2ap3_thumbnail_Screen-shot-2014-08-15-at-8.09.20-AM.pngTendonitis in the front of the knee

Most people who have done any sort of sports, especially those that require a good amount of running, have experienced knee pain at some point.  One of the most common areas to experience pain is in the front of the knee around the kneecap (or patella). This is because the design of the knee uses the patella to increase leverage of the working muscles.  The downside is that repeated stress can accumulate around the patella and cause injury pain and swelling.

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What is Shoulder Bursitis by Scottsdale Sports MedicineA bursa is a fluid filled sac that lies between moving muscles/tendons and bony surfaces/other tendons and muscle. These sacs act as friction reducing pads that allow the moving parts to easily glide over each other.

When there is too much friction for the pads to take, they can break down and get inflamed. Inflammation is the body's natural response to tissue damage and when a bursa gets inflamed, it's called bursitis. If it happens to a tendon, it's called tendonitis.

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b2ap3_thumbnail_cycling-79618_150.jpgEndurance athletes have long known that training at specific intensities and durations yields the quickest results for their efforts. Instead of running or biking at a random pace that just "feels good", you should think about setting up training zones that target specific training goals.

For instance, aerobic exercise at a low intensity, commonly referred to as long, slow, distance (LSD), will burn mostly fat as a fuel source. This is fantastic if you're trying to lose fat or are training for a long distance event, however, the downside is that you're burning fewer calories per hour overall. This means that you need to make the "slow" workouts also "long" workouts so you burn an appreciable number of calories.

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Loren M Describes how she deals with POTS and wants to run a marathon!Meet SSMI patient, Loren M. She's a real inspiration and represents what it means to be determined. I'm so happy to have met her!

"My successes with SSMI have been happening a lot longer than just the one month Metabolic Program. In early 2010, I was diagnosed with POTS [postural orthostatic tachycardia syndrome]. Some people are bed ridden from POTS, and at my worst I was only able to stand for 20 minutes at a time before fainting or extreme dizziness. I did some research and found that cardiovascular exercise can be very helpful. I prayed specifically for a Doc that could really understand I was in a bad place, but was a dynamic enough thinker to believe I didn't have to stay in that bad place.

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SSMI Patient Story Scottsdale Sports Medicine Dr. CarafgnoJen is just the latest to join our Top Tens list -- check out her numbers! I'm so impressed with what she achieved. Here's what she had to say:

"I'm so happy that I took the first step and started Dr. Carfagno's weight loss and workout program. I'm very pleased with my results so far and will be keeping up with everything I've learned, that is keep active and watch what you put in your body. Thank you to Dr. C, and Dan for being very encouraging!

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b2ap3_thumbnail_dfa.jpgOriginally from the Midwest, Don graduated from the University of Michigan and attended Cleveland State University for his Masters degree in Exercise Science.  At Michigan, he was a Student Athletic Trainer and worked full competitive seasons with the football team (1993) and women's gymnastics (1994). Because of his dedication to his work with the football team, he received a scholarship to work training camp for the NFL Detroit Lions in 1994 after graduation, allowing him the privilege to work with NFL legends Barry Sanders and Chris Spielman. 

While attending graduate school, he was a Graduate Assistant at the Cleveland Clinic Foundation and eventually became a full staff Certified Athletic Trainer and Exercise Physiologist.  Don worked with athletes of all levels as the Coordinator for the Center for Athletic Performance at the Cleveland Clinic, designing sports-specific training programs and performing exercise testing for endurance athletes.  As a part of the Cleveland Clinic sports medicine staff, Don provided consultant work with the Cleveland Browns, the Cleveland Cavaliers, and the Cavalier's Dance Team.  In addition, he provided frontline sports medicine as an athletic trainer to local Cleveland high schools and the Cleveland-San Jose Ballet.  After moving to Arizona, he has worked for Center for Athletic Performance in Scottsdale as a Strength and Conditioning Coach providing speed and agility training for soccer players.  Most recently, he has worked as a Certified Athletic Trainer (AT)  at several high schools including Mountain Pointe.

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Posted by on in Patient Success Stories

Scottsdale Sports Medicine 30 Day Metabolic Program Success Story Andy DCongrats to Andy D!! He completed the 30 day Metabolic Program and totally crushed it, And he has awesome results! Here's what he has to say:

"Just wanted to thank Dr. Carfagno and Dan and the whole staff for their encouragement and professionalism. I would encourage anyone who is thinking about changing their health to do this program. It is so simple to follow and the results in 4 weeks are amazing! I dropped 25lbs, my LDL cholesterol went from 126 to 78, and my total cholesterol from 232 down to 162. My LDL started at 126 and went down to 78. My DXA body composition went from 37.5 to 30.5. And my lean mass went from at 55,737 g to 58,265 g. My blood pressure wetn from 126/70 to 106/63. This truly will be a simple lifestyle change!"

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Happy to have had the opportunity to present this information to the physicians at Banner Health last week. Compartment Syndrome is such a tricky diagnosis, and I've written about it here as well. Feel free to share or ask questions for more information.

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b2ap3_thumbnail_David-Dad-2014.jpgThis patient story hits very close to home for me, as it's by my father! I really appreciate him sharing his experience.

In mid-January of this year, my son, Dr. David Carfagno, gave me a thorough physical exam. In addition to routine requirements (blood profile, urine, etc.) he requested that I complete a CT Heart Score evaluation through an outside facility although it wasn't covered by my Medicare insurance. David advised me that there is no protocol for ordering a CT Heart Score test at my age. Medicine requires this evaluation below 60. But David had a feeling. Being the obedient patient an father that I am, I agreed.

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Posted by on in Health News

b2ap3_thumbnail_XLargeThumb_00149619-201401000-00000_CV.jpgOvertraining in the Athlete
By David G. Carfagno, DO, CAQSM and Joshua C. Hendrix, MS-III

Competitive athletes are pushed routinely to the limits of their physical abilities. When tempered with periods of rest and recovery, a highly demanding training schedule can have tremendous benefits. However when an athlete is pushed too far, overtraining syndrome (OTS) can develop and result in career-ending damage. Overreaching and overtraining are part of the same spectrum that can lead to OTS. The pressure to perform placed on elite athletes is a real danger. Athletes and coaches understand the importance of rest days, but the insidious onset of OTS slowly saps the efficacy of recovery times so the athlete is no longer able to reach previously attainable goals. Identifying markers that correlate with overreaching and overtraining can arrest progression of a potentially negative cycle. We will examine the c urgent literature and discuss possible screening tests and red flags that will assist in preventing OTS from occurring.

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b2ap3_thumbnail_azcycling.jpgI'm looking forward to presenting to the 2014 Jobing.com Women's Cycling Team this weekend -- even if they mispelled my name! 

It's a great opportunity to share and gain information with presentations on Stretching, Nutrition, Training, Injury Prevention, and bike maintenance. Led by local experts and PROS! An I'm one of them.

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b2ap3_thumbnail_running-78192_150.jpgWant to win a free Rock and Roll Marathon/Half Rock 'n' Roll Arizona Marathon & 1/2 Marathon Entry fee plus all VIP access? The first person to answer these 3 questions correctly win the prize!!

1. Name the three tendons of the hamstring.

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Posted by on in Patient Success Stories

b2ap3_thumbnail_Screen-shot-2014-01-02-at-4.32.43-PM.pngMeet LC. She's 88 years young and one of our patients here at SSMI. She's been suffering from osteoarthritis of the spine and hip. To treat it, she's done physical therapy, taken medications and had injections in her back. The biggest relief and what helped her start to walk again has been platelet rich plasma, or PRP Therapy.

PRP is blood plasma with concentrated platelets. The concentrated platelets found in PRP contain huge reservoirs of bioactive proteins initiate and accelerate tissue repair and regeneration. These bioactive proteins initiate connective tissue healing, bone regeneration and repair, promote development of new blood vessels, and stimulate the wound healing process.

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b2ap3_thumbnail_Botox1.jpgWe are happy to announce that our monthly Botox/Juvederm events over the year of 2013 were a huge success! We have had excellent results and extremely positive feedback. And for those of you who couldn't make it, we are offering upcoming events for the 2014 season!

We have always strived to provide the best and most comprehensive internal medicine and sports medicine to our patients. We are happy to now be integrating aesthetic injectables and skincare with the goal of keeping you healthy and feeling well, both on the inside and out.

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b2ap3_thumbnail_champagne-160867_150.pngAs we get closer and closer to the big holiday time, it's harder and harder to stay on track! Here are some more tips to help you feel good during this time of good cheer! The first tip appeared here as well as on Health2Fit.com, but I want to be sure you see them here, too.

Drink in moderation.

Limit your alcohol consumption to one or two alcoholic beverages during the party or holiday dinner. Anything extra will hinder your judgment and lead to a tendency to overeat, not to mention put your safety at risk. Don't drink and drive. Take a cab or have a friend or spouse drive if you have too. Also, the extra alcoholic beverages are extra calories that will lead to weight gain.

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b2ap3_thumbnail_vegetables-155715_150.jpgCortisol, a stress hormone, is raised by high sodium and processed foods like chips and crackers. To help reduce cortisol levels, munch on unsalted nuts and carrots, peppers or cucumbers with hummus. Magnesium, found in nuts, dark leafy greens and beans, can help keep cortisol levels low and prevent headaches and fatigue.

 

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Posted by on in Sports News

b2ap3_thumbnail_femaleskier-15877_150.jpgSkier's thumb (yes, it's really a thing) is a sprain of the ulnar collateral ligament (UCL) of the thumb. It occurs when the wrist straps on the ski poles get stuck in the snow, and the thumb gets caught up and bends back. It can also occur in football, judo, and skeet shooting as well.

On exam, I'll see pain over the proximal part of the thumb joint and mayb2ap3_thumbnail_hgdhg.png have laxity with stressing the UCL in abduction (moving the thumb away). On imaging, stress views of thumb can show an avulsion or fracture. If so, these are called a Stener's lesion and may need to be seen by an orthopedic hand specialist. Depending on the amount of laxity on exam, mild to moderate sprain can be treated nonsurgical with ice, immobilization for up to 4 weeks and then hand therapy. Complete tears or the avulsion Stener's lesion need to be surgical evaluated as above.

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b2ap3_thumbnail_san-diego-80389_150.jpgA recent study looked at the impact of sleep deprivation and fatigue in cyclists. In summary, one night of complete sleep deprivation resulted in decreased cycling time to task failure compared with a control condition. Self-reported measures, including RPE, were altered in sleep deprivation, confirming the importance of emotional processing in sleep deprivation-induced performance deficits.
 
Cognitive processes appear to be differentially sensitive to sleep deprivation, because only some cognitive functions were impaired. Furthermore, the compensatory effect of acute submaximal exercise on cognitive deficits induced by sleep loss was demonstrated. Neuromuscular function 3–4 min after cycling cessation was similar between CO and sleep deprivation, indicating that changes in the muscle and to the motor nervous system likely cannot explain any of the decrement in exercise performance with sleep deprivation.
 
Thus, the hypothesis that increased central fatigue after one night of complete sleep deprivation contributes to decreased exercise performance is unsupported.

 

 
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b2ap3_thumbnail_iStock_000019213140Small.jpgAging: you just can't away from it!

We all know that some parts get a bit softer and perhaps change shape as you age... but there are changes to your body you don't see.

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