Australian Family Physician June 2007 - Musculoskeletal medicine
Vol 36, (6) 385–480
The theme for the June issue of AFP
is musculoskeletal medicine. This month's articles include Chronic
musculoskeletal
problems managed in general practice, Back, chest and abdominal
pain - is it spinal referred pain? and Gait and posture
- assessment in general practice.
Facing the challenge of musculoskeletal pain
Michael Yelland
Musculoskeletal pain and disability are among
the most common problems managed by general
practitioners, and present some of the greatest
challenges to general practice.
Letters to the editor
The opinions expressed by correspondents in this column are in no way endorsed by either the Editors or The Royal Australian College of General Practitioners
Chronic musculoskeletal problems managed in general practice
Janice Charles, Helena Britt, Salma Fahridin
The BEACH program, a continuous national study of general practice
activity in Australia, gives us an overview of
encounters at which chronic musculoskeletal problems were managed. This synopsis provides a backdrop against which articles in this issue of the Australian Family Physician
can be further considered.
Sports medicine meets musculoskeletal medicine
Victor Wilk, Daniel Abrams
Sports medicine is a popular topic pervading the media and has a clear core focus of treating athletes and promoting
exercise. While there is considerable overlap with musculoskeletal medicine, the latter is less well known and less well
defined, focusing more on spinal pain problems.
Gait and posture Assessment in general practice
Kent Sweeting, Michael Mock
A basic analysis of a patient's gait and posture provides information about the body and the capability of the
musculoskeletal system to adjust to physical stressors. An understanding of normal gait and posture is essential for
identifying and treating musculoskeletal pain.
Hip pain A focus on the sporting population
Peter Braun, Steve Jensen
Patients complaining of 'hip' or 'groin' pain can present a diagnostic and therapeutic challenge for practitioners not only
in primary care, but also those in specialist practice.
Shoulder pain
Scott Masters, Simon Burley
Shoulder pain is common in general practice and is a condition that frequently becomes chronic. Presentation
includes either pain, weakness and stiffness, or a combination of these symptoms.
Back, chest and abdominal pain. Is it spinal referred pain?
Geoff Harding, Micheal Yelland
In patients with pain in the back, chest or abdomen, it may be difficult to differentiate nonmusculoskeletal causes from
musculoskeletal causes.
Musculoskeletal ultrasound. Used to best advantage
NA Broadhurst, N Simmons
Effective management of both acute and chronic musculoskeletal pain revolves around a good history and physical
examination, as well as a more detailed knowledge of anatomy than is required in other related medical disciplines.
Musculoskeletal conditions What's new from Cochrane and how might this affect your practice?
Tania Winzenberg, Rachelle Buchbinder, Kelly Shaw, Graeme Jones
Australian Family Physician is pleased to introduce a series of
articles facilitated by the Cochrane Musculoskeletal
Group (CMSG). This series aims to place the findings of recent
Cochrane musculoskeletal reviews in a context immediately relevant to general practitioners.
Managing bleeding complications in skin surgey
Anthony Dixon
Mr AB, aged 78 years, developed a lentigo maligna (LM) on his left cheek just below the orbital
margin. Dermoscopy was typical for LM, with thickened variable peri-follicular
pigmentation, some granular pigmentation, and an area of regressive depigmentation.
Acceptance onto dialysis - CARI guidelines
Melissa Stanley, John Kelly, David Harris
The Caring for Australasians with Renal Impairment (CARI) guidelines initiative is an Australia/New Zealand evidence
based project that aims to provide high quality, evidence based clinical practice guidelines for the management of all
stages of kidney disease. This article summarises CARI guidelines on Acceptance onto dialysis and forms part of a series
on aspects of assessment and management of patients with chronic kidney disease.
Better primary health care for refugees - catch up immunisation
Christine b Phillips, Jill Benson
Many newly arrived refugees come from countries with fragile primary health infrastructure. As a result they may have had patchy primary immunisation against vaccine preventable diseases.
Acupuncture in musculoskelatal disorders - is there a point?
Marie Pirotta
Several surveys have identified that Australian general
practitioners have largely accepted acupuncture as
part of their armamentarium. About a quarter of GPs
have been trained in acupuncture and the majority of
those surveyed agreed that acupuncture was effective
and that they had referred patients for the therapy.
Levator ani syndrome - a case study and literature review
Ching Luen Ng
Although anorectal symptoms are a common problem seen in general practice, general practitioners may sometimes
encounter patients presenting with anorectal pain without a detectable cause.
Clinical Challenge
Questions for this month's clinical challenge are based on articles in this issue. The style and scope of questions is in keeping with the MCQ of the College Fellowship exam. The quiz is endorsed by the RACGP Quality Assurance and Continuing Professional Development Program and has been allocated 4 CPD points per issue.
Failure to diagnose: epidural abscess
Sara Bird
Early diagnosis of spinal epidural abscess is often elusive. Late diagnosis may leave the patient with permanent and severe
neurological disability. The aim of this article is to raise general practitioners' awareness of this uncommon condition.
How to survive as a basic term registrar
Emily Walsh
After trying a couple of other disciplines in medicine
I have finally found the career that suits me. If you,
like me, are interested in most things, enjoy meeting
people and can't stand the smell of the average
hospital ward, then general practice may really
appeal.
Seeking open minded doctors. How women who identify as bisexual, queer or lesbian seek quality health care
Ea Mulligan, Mary Heath
Bisexual, queer and lesbian women experience higher rates of discrimination, trauma and abuse and are at higher
risk for adverse health outcomes than heterosexual women in the same populations. This research investigated the
strategies these women use to maximise the quality of health care they receive.
Acute shoulder pain in primary care - an observational study
Scott Masters, Lorna O'Doherty, Geoffrey K Mitchell, Michael Yelland
Shoulder pain is a common presentation in general practice. Data on prognosis, treatment and compliance for acute
shoulder pain are lacking but would be valuable for guiding decision making. This study collected data on acute shoulder
pain and its outcome over 6 months.
The use of oral antidiabetic agents in primary care
Andrew Weekes, Merlin C Thomas
Guidelines and regulatory documents reflect the potential for chronic kidney disease to impact the efficacy and
safety profiles of antidiabetic regimens. We describe the influence of impaired kidney function and its perception by
practitioners on the pattern of antidiabetic use in Australian primary care.