A "needling" problem: shoulder injury related to vaccine administration.

A 22-year-old woman with no significant medical history developed acute left shoulder pain and severe restrictions in range of motion after a seasonal influenza vaccine injection. Imaging by MRI, approximately 8 weeks after the injection, and by ultrasound, approximately 9.5 weeks after the injection demonstrated contusions on the humerus, injury of the supraspinatus, and effusion in the subacromial bursa.

Spontaneous heterotopic pregnancy successfully treated via laproscopic surgery with subsequent viable intrauterine pregnancy: a case report.

Background: Heterotopic pregnancy (HP) refers to the presence of simultaneous pregnancies at two different sites of implantation, one intrauterine and the other extrauterine. The incidence of HP has increased in recent years secondary to a rise in the use of assisted reproductive technologies (ART).

Case: A 34-year-old woman, without risk factors for multiple pregnancies, presented with a spontaneous hypertopic pregnancy to a military facility.

An uncommon cause of chest pain in the deployed soldier.

Chest pain is a common complaint at medical treatment facilities during combat operations. The initial evaluation focuses on potentially life-threatening conditions (acute coronary syndrome, aortic dissection, pulmonary embolus), in addition to pericarditis and benign musculoskeletal conditions such as costochondritis. Pulmonary arteriovenous malformation is a rare condition, but an important diagnostic consideration in soldiers who present with chest pain and/or hypoxia and in whom other life-threatening conditions, such as cardiovascular disasters and pulmonary embolus, are excluded.

Does home sleep testing impair continuous positive airway pressure adherence in patients with obstructive sleep apnea?

Background: The increasing recognition of obstructive sleep apnea (OSA) and demand for polysomnography has created a need for home sleep testing (HST) using unattended diagnostic and titration studies. Although these studies increase access to care and reduce cost, the limited interaction with sleep laboratories may negatively affect positive airway pressure (PAP) adherence. We sought to determine the difference in PAP use between HST and traditional in-laboratory studies.

Variable application and misapplication of cricoid pressure.

Background: In 1961, Sellick described a three-finger technique of cricoid pressure used to prevent gastric regurgitation during induction of anesthesia. The "Sellick maneuver" is now used worldwide. The authors have observed great variability in the application of cricoid pressure by health care providers and have suspected that misapplication occurs.

Exertional collapse in the runner: evaluation and management in fieldside and office-based settings.

Exertional collapse is a commonly encountered phenomenon among runners, particularly in the setting of long distances and extreme environments. Although exertional collapse is generally a benign event occurring in an exhausted finisher at race completion, the multifactorial nature of this disorder creates a broad differential diagnosis. The ability of the sports provider to appropriately recognize and treat these various potential concerns is critical, because collapse may represent several life-threatening conditions.

Ischemic colitis related to sumatriptan overuse.

Background: Serotonin-1 5-hydroxytryptamine (5-HT 1) receptor agonists are first line agents for migraine headaches. Patients with refractory headaches may use supratherapeutic doses of these medications. Described is a case of ischemic colitis related to overuse of sumatriptan.

True knot of the umbilical cord: a report of 13 cases.

True knots of the umbilical cord are complications that can result in obstetric disasters, including fetal asphyxia and eventual fetal death. This study reports on 13 patients with a true knot of the umbilical cord in a delivery population of 967 deliveries during a 1-year period. In this group, there was one second-trimester fetal demise, four cases of fetal distress during labor necessitating cesarean delivery, and eight cases with a true knot found incidentally at delivery.

Evaluation of nausea and vomiting.

A comprehensive history and physical examination can often reveal the cause of nausea and vomiting, making further evaluation unnecessary. Acute symptoms generally are the result of infectious, inflammatory, or iatrogenic causes. Most infections are self-limiting and require minimal intervention; iatrogenic causes can be resolved by removing the offending agent.

Thromboendarterectomy as treatment in the antiphospholipid syndrome.

Antiphospholipid antibody syndrome (APS) may lead to pulmonary hypertension, a lethal complication of chronic pulmonary thromboembolism. There are few viable treatment options for pulmonary hypertension, but pulmonary thromboendarterectomy (PTE) has been used to successfully treat this condition in many patient populations. Following is a description of a patient with APS and systemic lupus erythematosus (SLE) who presented with severe pulmonary hypertension and underwent lifesaving surgery with pulmonary thromboendarterectomy.

Electrocardiographic findings in sports medicine: normal variants and the ones that should not be missed.

There are a few "red flag" findings in the history and physical examination of an athlete that may require obtaining an electrocardiogram (ECG) as part of a cardiac evaluation. In this article we discuss the normal variants seen in the ECG brought on by regular physical training and ECG abnormalities that are seen with a few of the structural and conduction abnormalities associated with an increased risk of sudden cardiac death. These conditions are all relatively uncommon and the ECG may reveal the first clue to the presence of a potentially significant underlying abnormality.

Sport-related concussion: factors associated with prolonged return to play.

Objective: To assess predictive value of concussion signs and symptoms based on return-to-play timelines.

Design: Physician practice study without diagnosis that includes presentation, initial and subsequent treatment, and management of concussion.

Setting: National multisite primary care sports medicine provider locations.

Primary ovarian pregnancy after postpartum bilateral tubal ligation: a case report.

Background: Primary ovarian pregnancy constitutes <1% of ectopic gestations. Likewise, bilateral tubal ligation failure is uncommon, occurring in approximately 1% of tubal sterilization procedures. Should pregnancy occur after bilateral tubal ligation, of every 3 such pregnancies, 1 will be an ectopic.

Knee pain and bicycling: fitting concepts for clinicians.

Anterior knee pain and patellofemoral pain syndrome are among the most common leg overuse injuries in cyclists. Bicycle fit, recent change in equipment, training distance and intensity, and individual anatomic factors are important evaluation considerations. Clinicians need a basic understanding of bicycle fitting and how anatomic factors and training errors contribute to repetitive stress injuries.