Orthopedics

Does Intra-Articular Lidocaine Work for Shoulder Reduction?

Orthopedics, Pain/Sedation/Procedure, Sports Medicine

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Intra-articular lidocaine (IAL) is a safe alternative for the reduction of anterior shoulder dislocations and may have similar efficacy to intravenous (IV) sedation, with fewer adverse events and shorter ED length of stay.

Source
Intra-articular lidocaine versus intravenous sedation for closed reduction of acute anterior shoulder dislocation in the emergency department: a systematic review and meta-analysis. CJEM. 2022 Dec;24(8):809-819. doi: 10.1007/s43678-022-00368-z. Epub 2022 Oct 1.

Does Prepatellar Bursitis Need Aspiration?

Infectious Disease, Orthopedics

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Empiric antibiotic therapy – without aspiration – is a reasonable approach for the management of suspected prepatellar septic bursitis in non-toxic patients with close outpatient follow up.

Source
Efficacy of empiric antibiotic therapy without aspiration for septic prepatellar bursitis in emergency department patients. Acad Emerg Med. 2022 Aug;29(8):1027-1032. doi: 10.1111/acem.14499. Epub 2022 Apr 25.

A Real Pain in the Neck – C-Collar Adherence in Children After PED Discharge

Orthopedics, Pediatrics

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Many children discharged from the emergency department with minor traumatic cervical spine injury do not adhere to recommendations for cervical immobilization or outpatient follow-up, with no significant clinical consequences observed.

Source
The Fate of the Cervical Collar: An Observational Pilot Study Investigating Follow-up Care After Emergency Department Discharge in Children With Mild Traumatic Neck Injuries. Pediatr Emerg Care. 2022 May 25. doi: 10.1097/PEC.0000000000002755. Online ahead of print.

How to Manage Spinal Stenosis | Spoon-Feed Version

Medicine/Geriatrics, Orthopedics

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Lumbar spinal stenosis affects more than 1 in 10 U.S. citizens and over 100 million patients worldwide. This painful condition is diagnosed clinically with confirmatory imaging. Firstline treatment is activity modification, analgesia, and physical therapy, and careful selection of surgical candidates should be done only if conservative management fails.

Source
Diagnosis and Management of Lumbar Spinal Stenosis: A Review. JAMA. 2022 May 3;327(17):1688-1699. doi: 10.1001/jama.2022.5921.

The Achilles’ Heals…Without Surgery? Non-op vs Operative Management RCT

Orthopedics

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Patients with Achilles’ tendon rupture undergoing surgical repair, either open or minimally-invasive, did not have better outcomes at 12 months compared to non-operative treatment. However, those managed nonoperatively had a higher rate of tendon rerupture.

Source
Nonoperative or Surgical Treatment of Acute Achilles’ Tendon Rupture. N Engl J Med. 2022 Apr 14;386(15):1409-1420. doi: 10.1056/NEJMoa2108447.

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