Pain during physical examination of a healing upper extremity fracture

The evidence that symptom intensity and magnitude of limitations correlate with thoughts and emotions means that subjective signs, such as pain with physical examination, reflect both physical and mental health. During a 1-month evaluation of a rapidly healing upper extremity fracture with no risk of nonunion, 117 people completed measures of adaptiveness to pain and pain during the physical examination. Greater pain during examination correlated with less adaptive responses to pain and older age. This finding raises questions about using tenderness to assess fracture union. Level of evidence: II

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Fracture location impacts opioid demand in upper extremity fracture surgery: Opioids in upper extremity fracture surgery

Injury ◽

10.1016/j.injury.2021.05.026 ◽

2021 ◽

Author(s):

Daniel Cunningham ◽

Micaela LaRose ◽

Oke Anakwenze ◽

Christopher S. Klifto ◽

Marc J. Richard ◽

...

Keyword(s):

Upper Extremity ◽

Fracture Location ◽

Extremity Fracture ◽

Upper Extremity Fracture ◽

Fracture Surgery

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Percutaneous upper extremity fracture fixation using a novel glass-based adhesive

Journal of Orthopaedics ◽

10.1016/j.jor.2018.01.033 ◽

2018 ◽

Vol 15 (1) ◽

pp. 67-69 ◽

Cited By ~ 2

Author(s):

Paul Zalzal ◽

Oleg Safir ◽

Adel Alhalawani ◽

Marcello Papini ◽

Mark Towler

Keyword(s):

Upper Extremity ◽

Fracture Fixation ◽

Extremity Fracture ◽

Upper Extremity Fracture

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An audit of admission clerking of patients in Heddfan, Adult Mental Health Unit in BCUHB - north Wales

BJPsych Open ◽

10.1192/bjo.2021.238 ◽

2021 ◽

Vol 7 (S1) ◽

pp. S75-S75

Author(s):

Asha Dhandapani ◽

Sathyan Soundararajan ◽

Manjula Simiyon ◽

Vinila Zachariah ◽

Rajvinder Sambhi

Keyword(s):

Mental Health ◽

Physical Examination ◽

Junior Doctors ◽

Physical And Mental Health ◽

Improvement Project ◽

North Wales ◽

History Of ◽

Mental Health Unit ◽

State Examination ◽

Source Of Information

AimsTo ensure admission clerking includes salient features needed for the management of both physical and mental health of the patient and also to aid in administrative purposes.MethodThe audit included a team of doctors reviewing the admission clerking notes for 50 patients in the General Adult Psychiatric unit in-patient ward.We created a standard questionnaire-based on Intended learning outcome of core training in psychiatry CT1-CT3 from Royal College of Psychiatry and standard textbooks.Our aim is to achieve 100 % compliance in clerkingResultIt was noted that only 30% wrote their GMC number, 4% added route of admission of the patient and a mere 8% filled the Consultants name. Though almost everyone had written the presenting complaints, the other aspects such as history of presenting illness, medical and family history, Allergy status and substance misuse history were missing in many clerking notes. None of them had filled in details of personal history and very few did a risk assessment.Further lacuna was noted with Mental state examination. Physical examination was also noted to be incomplete. While more than 50% had completed the Blood investigations and ECG, half of them had not documented it and that meant searching in the entire file. A mere 20% filled the nursing observation level whilst none had completed the formulation in the notes.ConclusionAdmission clerking is a vital source of information that would be needed for the formulation of patients diagnosis and future management.Apart from this, it also is needed for further continuity of care.Hence this vital source of information will need to be shared with the junior doctors who will be clerking the patient and seeing them in the first instance.We, therefore, intend to create a complete clerking proforma along with physical health proforma to aid us in this respect.We will audit initially in the first round and then plan to introduce a proforma for Clerking and physical examination based on the findings.We will re-audit to see if the standards are achieved after using the proforma and will consider a Quality improvement project based on this topic

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Extremity Injuries in Children: Predictive Value of Clinical Findings

PEDIATRICS ◽

10.1542/peds.78.5.803 ◽

1986 ◽

Vol 78 (5) ◽

pp. 803-807

Author(s):

Frederick P. Rivara ◽

Ruth Ann Parish ◽

Beth A. Mueller

Keyword(s):

Lower Extremity ◽

Physical Examination ◽

Clinical Findings ◽

Clinical Predictors ◽

Lower Extremity Fracture ◽

Extremity Fracture ◽

Extremity Injuries ◽

Physical Findings ◽

Upper Extremity Fracture ◽

Point Tenderness

This study sought to identify clinical predictors of extremity fracture in children with trauma. There were 189 children 1 to 15 years of age with 209 extremity injuries seen during a 9-month period. Gross deformity and point tenderness were the best predictors of upper extremity fracture; these two findings correctly identified 81% of children with fractures and 82% of these without fractures. Gross deformity and pain on motion best predicted lower extremity fracture, with 97% of children with fractures correctly identified. The study showed that physical examination is predictive of fractures in extremity injuries of children, regardless of age. In the absence of the specific physical findings identified by the study, the probability of diagnosing a fracture by roentgenographic findings is low.

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MODERATE INTENSITY PHYSICAL EXERCISE: PSYCHONEUROIMMUNOLOGICAL ASPECTS

Revista Brasileira de Medicina do Esporte ◽

10.1590/1517-869220182405185533 ◽

2018 ◽

Vol 24 (5) ◽

pp. 395-398

Author(s):

Eduardo Vignoto Fernandes ◽

Celio Estanislau ◽

Emerson José Venancio

Keyword(s):

Mental Health ◽

Nervous System ◽

Immune System ◽

Physical Exercise ◽

Chronic Stress ◽

Expert Opinion ◽

Moderate Intensity ◽

Anxiety And Depression ◽

Physical And Mental Health ◽

Level Of Evidence

ABSTRACT The literature presents several instances of interaction between the nervous system (NS) and the immune system (IS). These interactions are promoted by several molecules, such as cytokines and hormones, with modulating action for both the NS and IS. In this sense, the two systems may influence each other: changes in behavior may be accompanied by alterations in the IS (e.g., immunosuppression) and immunological disorders, such as infections, may modulate behavior (e.g., anxiety and depression). Considering that chronic stress, in addition to affecting behavior, also modulates the IS and that there is evidence that moderate intensity physical exercise (PE) protects physical and mental health, the objective of this review is to explore the influence of moderate-intensity PE on behavior and immunity. Level of Evidence V; Expert opinion.

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