How useful are genital exams during boys' sports physicals?

Examination may be useful to identify hernia but not testicular cancer. Insufficient evidence exists to recommend for or against screening genital exams for boys playing sports. Given the low risk of harm, screening for hernias as a part of a preparticipation physical evaluation (PPE) is recommended by several specialty organizations (strength of recommendation [SOR]: C, expert opinion)

What is the best way to treat Morton's neuroma?

No single treatment for Morton's neuroma has been identified in the literature.A protocol of stepped care that showed good results in an uncontrolled trial seems reasonable: patient education and footwear or insole changes, followed by corticosteroid injections and, finally, surgery (strength of recommendation [SOR]: C, case series). Injecting sclerosing alcohol depends on the provider's access to and comfort with ultrasound, but the evidence is insufficient to recommend it routinely (SOR: C, case series)

What's the best test for underlying osteomyelitis in patients with diabetic foot ulcers?

A: What's the best test for underlying osteomyelitis in patients with diabetic foot ulcers? A: Magnetic resonance imaging (MRI) has a higher sensitivity and specificity (90% and 79%) than plain radiography (54% and 68%) for diagnosing diabetic foot osteomyelitis. MRI performs somewhat better than any of several common tests--probe to bone (PTB), erythrocyte sedimentation rate (ESR) >70 mm/ hr, C-reactive protein (CRP) >14 mg/L, procalcitonin >0.3 ng/mL, and ulcer size >2 cm2--although PTB has the highest specificity of any test and is commonly used together with MRI. No studies have directly compared MRI with a combination of these tests, which may assist in diagnosis (strength of recommendation [SOR]: B, meta-analysis of cohort trials and individual cohort and case control trial). Experts recommend obtaining plain films when considering diabetic foot ulcers to evaluate for bony abnormalities, soft tissue gas, and foreign body; MRI should be considered in most situations when infection is suspected (SOR: B, evidence-based guidelines)

New Reduction Technique for Traumatic Posterior Glenohumeral Joint Dislocations

Traumatic posterior glenohumeral joint (GHJ) dislocation is a rare condition which can be missed if it is not suspected. Clinical presentation may be subtle, but limitation in range of motion in patient with acute trauma should warrant obtaining a thorough history, performing a comprehensive physical examination, and acquiring at least a 3-view plain radiography. Reduction can be achieved with a direct pressure to the posterior aspect of the humeral head

Septic Infrapatellar Bursitis in an Immunocompromised Female

Bursitis is a relatively common occurrence that may be caused by traumatic, inflammatory, or infectious processes. Septic bursitis most commonly affects the olecranon and prepatellar bursae. Staphylococcus aureus accounts for 80% of all septic bursitis, and most cases affect men and are associated with preceding trauma. We present a case of an 86-year-old female with an atypical septic bursitis involving the infrapatellar bursa. Not only are there very few reported cases of septic infrapatellar bursitis, but also this patient’s case is particularly unusual in that she is a female with no preceding trauma who had Pseudomonas aeruginosa on aspirate. The case also highlights the diagnostic workup of septic bursitis through imaging modalities and aspiration. This patient had full resolution of her septic bursitis with appropriate IV antibiotics

Morel-Lavallée Lesion of the Knee in a Recreational Frisbee Player

Traumatic swelling/effusion in the knee region is a relatively common presenting complaint among athletes and nonathletes. Due to its broad differential diagnosis, a comprehensive evaluation beginning with history and physical examination are recommended. Knee joint effusion can be differentiated from other types of swelling by careful physical examination. Imaging, including plain radiography, ultrasound, and magnetic resonance imaging (MRI), is preferred modality. Aspiration of a local fluctuating mass may help with the diagnosis and management of some of these conditions. We present a case of a 26-year-old gentleman with superomedial Morel-Lavallée lesion (MLL) of the knee with history of a fall during a Frisbee game. His MLL was successfully treated with therapeutic aspiration and compression wrap without further sequelae. MLL is a rare condition consisting of a closed degloving injury caused by pressure and shear stress between the subcutaneous tissue and the superficial fascia or bone. Most commonly, MLL is found over the greater trochanter and sacrum but in rare cases can occur in other regions of the body. In most cases, concurrent severe injury mechanisms and concomitant fractures are present. MLL due to sports injuries are very rare. Therapeutic strategies may vary from compression wraps and aspiration to surgical evacuation

A Surprising Finding of Remote Ischial Avulsion

A 25-year-old male presented to the ski clinic after colliding with a tree while snowboarding. He had immediate sharp pain at his “tailbone,” but denied numbness and weakness. Past medical history was initially reported as unremarkable. On exam, he demonstrated midline tenderness over the sacrum. Pelvic radiography was performed