Elbow Pain and Problems

Lateral Epicondylitis (Tennis Elbow)

Elbow Pain and Problems | Johns Hopkins Medicine

Linkedin Pinterest What You Need to Know

  • Tennis elbow can be caused by trauma to the elbow or more often by repeated stress on the elbow tendons such as from sports or use of certain tools.
  • Symptoms of tennis elbow can include pain or weakness when grasping and aches or pain in the elbow area.
  • Treatment of tennis elbow includes: activity modification, ice, medicine, stretching, braces and injections. Surgery is rarely used to treat tennis elbow.

Lateral epicondylitis, commonly known as tennis elbow, is swelling of the tendons that bend your wrist backward away from your palm.

A tendon is a tough cord of tissue that connects muscles to bones. The tendon most ly involved in tennis elbow is called the extensor carpi radialis brevis. Tennis elbow is usually diagnosed in both men and women between the ages of 30 and 50 years.

What causes tennis elbow?

Tennis elbow, as the name implies, is often caused by the force of the tennis racket hitting balls in the backhand position. Your forearm muscles, which attach to the outside of your elbow, may become sore from excessive strain. When making a backhand stroke in tennis, the tendons that roll over the end of our elbow can become damaged. Tennis elbow may be caused by:

  • Improper backhand stroke
  • Weak shoulder and wrist muscles
  • Using a tennis racket that is too tightly strung or too short
  • Other racquet sports, racquetball or squash
  • Hitting the ball off center on the racket, or hitting heavy, wet balls

However, many people who suffer from tennis elbow do not play tennis. The problem can be caused by any repetitive movement. Other causes of tennis elbow include:

  • Painting with a brush or roller
  • Operating a chain saw
  • Frequent use of other hand tools on a regular basis
  • Using repeated hand motions in various professions, such as meat cutters, musicians, dentists, and carpenters

What are the symptoms of tennis elbow?

The following are the most common symptoms of tennis elbow. However, you may experience symptoms differently.

At first, you may have pain, burning, or an ache along the outside of your forearm and elbow. With time, the pain gets worse. If you continue the activity that caused your condition, the pain may spread down to your wrist, even at rest.

Pain may also persist when you place your arm and hand palm-down on a table, and then try to raise your hand against resistance. You may also feel pain when you try to lift and grip small objects, such as a coffee cup.

A weak grip is another symptom of tennis elbow.

The symptoms of tennis elbow may resemble other medical problems or conditions. Always see your healthcare provider for a diagnosis.

How is tennis elbow diagnosed?

Your healthcare provider can usually diagnosis your tennis elbow by a physical exam. In some cases, you may certain tests, such as:

  • An X-ray to look at the bones of your elbow to see if you have arthritis in your elbow.
  • Magnetic resonance imaging (MRI) can show your tendons and how severe the damage is. An MRI of your neck can show if arthritis in your neck, or disk problems in your spine are causing your arm pain.
  •  Electromyography (EMG) of your elbow may show if you have any nerve problems that may be causing your pain.

How is tennis elbow treated?

It’s important to avoid the movement that caused your injury in the first place. Treatment may include:

  • Rest and stopping the activity that produces the symptoms
  • Ice packs (to reduce inflammation)
  • Strengthening and stretching exercises
  • Anti-inflammatory medicines (such as ibuprofen or naproxen)

If these treatments do not work, your healthcare provider may talk to you about:

  • Bracing the area to keep it still for a few weeks or use of a special brace with activities
  • Steroid injections to help reduce swelling and pain
  • A special type of ultrasound that can help break up scar tissue, increase blood flow, and promote healing
  • Surgery (rarely necessary)

What can I do to prevent tennis elbow?

  • Keep your arms flexible and strong
  • Avoid repetitive movements
  • Warm up before exercising or using your arms for sports or other repetitive movements
  • If you play a racquet sport, make sure your equipment is right for you

When should I call my healthcare provider?

  • If  pain or trouble moving affects your regular daily activities
  • If your pain doesn’t get better, or it gets worse with treatment
  • You see a bulge or lump on your arm

Key points about lateral epicondylitis

  • Lateral epicondylitis, or tennis elbow, is swelling or tearing of the tendons that bend your wrist backward away from your palm.
  • It’s caused by repetitive motion of the forearm muscles, which attach to the outside of your elbow. The muscles and tendons become sore from excessive strain.
  • Symptoms include pain, burning, or an ache along the outside of the forearm and elbow. It gets worse and may spread down to the wrist if the person continues the activity that causes the condition. The grip may become weak.
  • Lateral epicondylitis is diagnosed by an exam of the elbow joint. The healthcare provider may need an X-ray or MRI to see what’s causing the problem. An EMG may be done to look for nerve problems.
  • Lateral epicondylitis can be treated with rest and medicines to help with the inflammation. Exercises often help too. Rarely, surgery may be done to repair the tendon.
  • You can help prevent lateral epicondylitis by doing things warming up before exercise or sports, increasing activity slowly, using the right equipment for activities, and strengthening your arm muscles.
  • Follow your healthcare provider’s recommendations to get rest and manage pain and swelling. Let your healthcare provider know if these strategies don’t help reduce pain, swelling, and loss of function.

Source: https://www.hopkinsmedicine.org/health/conditions-and-diseases/lateral-epicondylitis-tennis-elbow

Johns Hopkins Hospital performs double arm transplant on Army soldier

Elbow Pain and Problems | Johns Hopkins Medicine

A former soldier who became a quadruple amputee after an explosion in Iraq three years ago has undergone a rare double arm transplant at Johns Hopkins Hospital in Baltimore, the hospital said Monday.

Brendan Marrocco, 26, of Staten Island, who underwent the marathon surgery last month, was the first service member from the wars in Iraq and Afghanistan to survive the loss of four limbs, officials have said.

He lost both legs above the knee, his left arm below the elbow and his right arm above the elbow when a military vehicle he was driving was struck by a powerful makeshift bomb on Easter in 2009.

A determined, soft-spoken young man who has endured numerous surgeries, return trips to the hospital and setbacks, he had been waiting for the transplants for years.

He got his wish Dec. 18 in a complex, multi-hour operation in which bundles of his muscle, bone, blood vessels, skin and nerves were joined — at times under a microscope — with those of a deceased donor.

View Graphic In a double transplant, four teams of surgeons operate simultaneously — two teams preparing the patient’s arms and the other two preparing the donor limbs. This is the basic procedure:

“He’s doing well,” Marrocco’s father, Alex, said Monday. “Doing well. It’s been a little over a month now.”

Marrocco is the first service member to receive a double arm transplant, and the hospital said he is one of only seven people in the United States who have undergone successful double arm transplants.

Later, in a new anti-rejection procedure, he received an infusion of bone marrow derived from vertebrae taken from the donor’s lower spine.

The infusion allows doctors to reduce the number of powerful anti-rejection drugs they use from three to one. That is beneficial because the anti-rejection drugs can have harmful side effects, possibly leading to infection, organ damage or cancer.

The surgery was done by a special team of transplant experts headed by W.P. Andrew Lee, professor and chairman of the Department of Plastic and Reconstructive Surgery at the hospital.

It was the first limb transplant by his newly established group at Hopkins, the hospital says.

Lee said results in such cases have been good, although transplanted arms are never going to have 100 percent of the function of the limbs they replace. But he said patients have learned to tie shoes, use chopsticks and put their hair in ponytails.

The hospital said it would provide details of the operation at a news briefing Tuesday.

In an interview, Lee said there have been about 80 arms transplanted in about 60 patients so far around the world.

His team, which until two years ago was based at the University of Pittsburgh, has transplanted 10 arms in six patients, which is about half the U.S. cases, he said.

There are hundreds of military amputees around the country — including four others who have lost four limbs and others who have lost three or two.

Many, Marrocco, have been treated at the old Walter Reed Army Medical Center in Washington, now the Walter Reed National Military Medical Center in Bethesda.

Marrocco was at the old Walter Reed for several years, and two other quadruple amputees are recovering at the new site.

Most such patients have been fitted with — and mastered — sophisticated mechanical prostheses. But Lee said in a recent interview that research has suggested younger amputees don’t always use them.

“The nonacceptance rate of prosthetics is highest among young people in their 20s and 30s,” he said.

So the possibility of limb transplantation, despite its enormous medical, psychological and logistical complexity, holds great promise, he said.

Aside from the physical outcome, “I think it also has additional advantage for the patient to be restored whole,” the doctor said. “Once they’re transplanted, they regard the arm as theirs. And I think they’re more comfortable going out on social occasions, as opposed to wearing a prosthetic.”

Marrocco, a fair-skinned young man with a shock of light-colored hair, has not spoken widely about the operation.

After recovering at Walter Reed, he returned to Staten Island, where a special home was reportedly constructed for him by charitable organizations.

On Dec. 16, a posting, which appeared to be his, announced: “Holy mother of god I was just told I might be having my transplant tomorrow!”

A later tweet said: “Wow what a day. I’ll be going to Baltimore tomorrow morning for pre-op and having my transplant tuesday!!!”

Lee, speaking generally and not about the specifics of Marrocco’s case, said the operation requires four surgical teams — two to prepare the donor’s arms and two for the recipient’s arms. Each team has three surgeons.

Little thus far is publicly known about Marrocco’s donor, but Lee said the donor arms often are brought from another hospital, another city or even another state.

Donor and recipient do not necessarily have to be of the same gender — about two years ago, at a California hospital, a female recipient successfully received a transplanted hand from a male donor, Lee said. But the limbs should match in size, skin color, tissue and blood type.

In a double transplant, all four arms must be carefully readied, with the skin peeled back and the bone ends often cut at angle, as a good carpenter might, to promote a solid connection, according to a textbook on transplantation Lee and his colleagues have prepared.

Inside the arms, individual muscle-tendon units, nerves and blood vessels are identified. They are then with pieces of light blue sterile bandage that are sewn in place and labeled in permanent black marker to ensure proper connection.

The connecting sequence begins with the bones, which are joined with metal plates. “It’s not as easy as fixing a fracture,” Lee said, “because the two ends of the bone belong to different people. ”

Next, he said, “we typically connect the muscles and tendons.”

After that, “we put together the blood vessels,” he said. “That’s the critical part, where we need to restore circulation to the transplanted limb by connecting the arteries and the veins. And they’re typically done under a microscope.”

Finally, the skin is sewn together.

Lee said war injuries often result in amputations high up the arm.

That is more problematic for transplants, in part because nerves in the donor arm are dead and must be replaced by the recipient’s nerves, which regenerate down the arm at the rate of about an inch a month.

Rejection and especially the drugs used to combat it pose other problems.

Un with organ transplants, “we’re not saving somebody’s life,” Lee said. “We’re improving the quality of life.” So the impact of the anti-rejection drugs is a serious consideration.

He said experts must use care in approaching donors’ families about arm transplants, even if they have agreed to organ transplants.

“We typically relay through [the organ-procurement organization] the story of the recipient,” he said. “What led to the loss of their hand. How much a new hand or hands can mean for that patient.

“For that reason, I think, we were very rarely turned down by the grieving family,” he said.

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Source: https://www.washingtonpost.com/local/johns-hopkins-hospital-performs-double-arm-transplant-on-army-soldier/2013/01/28/d4b8e082-673c-11e2-93e1-475791032daf_story.html

Malpractice Lawsuit Against Johns Hopkins Phlebotomist

Elbow Pain and Problems | Johns Hopkins Medicine

Complications from phlebotomy mistakes include loss of arm mobility, grip strength, and long-term pain.  This page discusses phlebotomy malpractice cases through the lens of a lawsuit that was filed against a John Hopkins phlebotomist.  

Taub v. Johns Hopkins Hospital

This is a phlebotomist malpractice case against Johns Hopkins. The victim was allegedly injured donating blood in anticipation of a bone marrow donation.

  • An IV infiltration malpractice claim, also filed in Baltimore

Summary of Plaintiff's Allegations

A Stafford, Virginia woman goes to the phlebotomy lab at Johns Hopkins Hospital in Baltimore, Maryland. She is scheduled to give an autologous blood donation in preparation for a bone marrow donation.

When the phlebotomist places the needle in her right arm to initiate the donation, she immediately feels pain and numbness causing her to yell.

A resident physician tells her that the needle ly struck a nerve, and advises her to call back in a few days if the symptoms persist.

After experiencing several days of pain, numbness, burning, and tingling, the woman contacts Johns Hopkins and is referred for evaluation and treatment.

After evaluation, it is determined that the woman suffered an injury to the lateral antebrachial cutaneous nerve in her right arm. This nerve is the sensory continuation of the musculocutaneous nerve which supplies the flexor muscles of the elbow.

Notwithstanding medical treatment, medication, and the passing of time, the woman continues to experience neurological symptoms in her right upper extremity, including pain and numbness. She is still undergoing regular medical care and treatment.

The woman files a medical negligence lawsuit against Johns Hopkins Hospital in Baltimore City, alleging that it violated the standard of care by failing to take reasonable care not to strike a nerve in the woman's arm when inserting the needle to draw blood. She, along with her husband, also file a loss of consortium claim.

The woman continues to experience significant pain, numbness, disability, loss of enjoyment of life, emotional distress and loss of wages and wage-earning capacity as a result of her injury, which is ly to be permanent in nature.

JurisdictionDefendants

  • Johns Hopkins Hospital
  • Johns Hopkins Health System Corporation

Negligence

  • Failed to take reasonable care in inserting a needle into the woman's arm

Specific Counts Pled

  1. Negligence- Johns Hopkins Hospital
  2. Negligence- Johns Hopkins Health System Corporation
  3. Loss of Consortium

Additional Comments

  • When you give blood (a larger needle is used donating blood than in regular venipuncture) there is a risk of nerve injury even when the phlebotomist follows the standard of care. It is a blind poke into the arm or hand and the phlebotomist cannot see every possible structure that the needle could hit. In other words, many of these phlebotomy nerve injuries occur in the absence of negligence. The harsh reality is that most of these cases end in defense verdicts.  Making matters worse, it is sometimes difficult to prove even meritorious claims.  This is frustrating for victims who have suffered.  
  • That said, there are a number of things a phlebotomist can do that is a breach of the standard of care and these can be very viable cases. Many phlebotomy lawsuits follow when the phlebotomist stray without a good reason from the median cubital vein. Draws to the median cubital veins are greatly preferred because they are closer to the surface of the skin, more stationary, and involve a less painful needle insertion. Accordingly, draws to the median cubital vein are less ly to injure nerves even if needle placement is not optimal. The basilic vein is tempting because it is easier, but it should be a last resort because of the risk of injury to structures in proximity to the basilic vein, i.e. the brachial artery and the underlying nerves.
  • Similarly, drawing blood from the hand is considered an advanced phlebotomy procedure. Hand draws are recognized to have an increased risk of injury to the nerves of the hand. This procedure should be avoided whenever a vein in the arm can be accessed.
  • The angle of the draw also matters. The standard of care says that an insertion angle of 15-30 degrees is optimal. A low angle goes a long way toward minimizing risk.
  • We summarize a lot of lawsuits on this website. This page gets a lot of visitors.  A lot of people get injured during the blood collection process.  If you are reading this and looking to bring a lawsuit against phlebotomist, you do need to understand that most injuries during blood collection do not result in a viable malpractice case. 
  • Looking at Maryland Case Judiciary Search in November 2019, we do not think this case was ever filed in Circuit Court which may mean that the plaintiff could not find an expert. 

Getting a Lawyer for Your Malpractice Claim

If you have been a victim of a doctor's mistake, our Maryland medical malpractice negligence attorneys can help. We handle serious injury and wrongful death cases. Call us today at 800-553-8082 or get a free, no-obligation online case review.

More Malpractice Claim Information

  • What is the value of a medical negligence claim in Maryland?
  • Sample lawsuit against Hopkins
  • Another sample lawsuit against Hopkins
  • Here is one more, a failure to diagnose deep vein thrombosis (honestly, if you want to see all of the lawsuits filed against Hopkins, check out the Hopkins link above — we list most of the recent lawsuits against this hospital)
  • This is a sample complaint in a lawsuit Miller & Zois filed against Hopkins
  • CALL our lawyers today at 800-553-8082 or get a free online medical malpractice injury and wrongful death claims. We handle claims throughout Maryland and Washington D.C. We can help you find out whether you have a viable claim that may bring you compensation for the harm that has been done.

Source: https://www.millerandzois.com/blood-draw-nerve-lawsuit.html

Polyarteritis Nodosa

Elbow Pain and Problems | Johns Hopkins Medicine

The first description of this disease dates back to 1866 when Kussmaul and Maier identified a condition that consisted of “focal, inflammatory, arterial nodules”. They termed this disorder “periarteritis nodosa” because of the inflammation they observed around the blood vessel wall.

The name was changed to polyarteritis nodosa (PAN) to underscore the fact that inflammation throughout the entire arterial wall – not just around the wall – is a major disease feature.

Polyarteritis nodosa is sometimes termed “systemic necrotizing vasculitis”, but this term is non-specific as other forms of vasculitis also have systemic and necrotizing features.

Who gets Polyarteritis Nodosa (the “typical” patient)?

Most cases of PAN occur in the 4th or 5th decade, although it can occur at any age. Men are twice as ly to be affected than women. A minority of patients with PAN have an active hepatitis B infection. In the rest of the cases, the cause(s) is presently unknown, and the disease is said to be “idiopathic” in nature.

Classic symptoms and signs of Polyarteritis Nodosa

PAN is a multisystem disease that may present with fever, sweats, weight loss, and severe muscle and joint aches/pains. PAN may develop in a subacute fashion, over several weeks or months.

Patients may have nonspecific complaints such as fever, malaise, weight loss, anorexia, and abdominal pain. The disease can affect nearly any site in the body, but it has a predisposition for organs such as the skin, kidney, nerves, and gastrointestinal tract.

Many patients with PAN have high blood pressure and elevated erythrocyte sedimentation rates (ESR).

The presentation of PAN may also include skin abnormalities (rash, ulcers) and peripheral neuropathy (pain, the sensations of burning, tingling, or numbness, or weakness in a hand or foot). However, the disease has a predilection for certain organs and tissues; these are described below.

  • Nerve
  • Skin
  • Kidney
  • Gastrointestinal tract
  • Heart
  • Eye
  • Genitals

Nerve

  • Peripheral neuropathies are very common (50 to 70%). This includes tingling, numbness and/or pain in the hands, arms, feet, and legs.
  • Central nervous system (CNS) lesions may occur 2 to 3 years after the onset of PAN and may lead to cognitive dysfunction, decreased alertness, seizures and neurologic deficits.

Skin

  • Skin abnormalities are very common in PAN and may include purpura, livedo reticularis, ulcers, nodules or gangrene.
  • Skin involvement occurs most often on the legs and is very painful.

Kidney

  • Renal artery vasculitis may lead to protein in the urine, impaired kidney function, and hypertension.
  • Small percentage of patients go on to require dialysis.

Gastrointestinal Tract

  • Abdominal pain, gastrointestinal bleeding (occasionally is mistaken for inflammatory bowel disease)
  • Hemorrhage, bowel infarction, and perforation are rare, but very serious

Heart

  • Clinical involvement of the heart does not usually cause symptoms.
  • However, some patients develop myocardial infarctions (heart attacks) or congestive heart failure.

Eye

  • Scleritis or inflammation in the sclera (white part of the eye)

What causes Polyarteritis Nodosa?

Hepatitis B causes a minority of cases of PAN. With the availability of hepatitis B vaccine now, cases of PAN caused by hepatitis B are now rare in the developed world. It is possible that other infections contribute to other cases of PAN, but links between other infections and this disease remain conjectural at the present time.

How is Polyarteritis Nodosa Diagnosed?

Routine laboratory tests may provide important clues to PAN, but there is no single blood test that is diagnostic of this disease. Most patients with PAN have elevated ESRs. Proteinuria (protein in the urine) is common among those with kidney involvement.

If there is skin or muscle/nerve involvement, a skin or muscle/nerve biopsy can be extremely helpful in coming to a definite diagnosis of PAN. Nerve conduction studies are a non-invasive way of identifying nerves that are involved by the inflammation. (These nerves can then be biopsied to confirm the diagnosis).

The diagnosis is confirmed by a biopsy showing pathologic changes in medium-sized arteries. The biopsy site may vary. Most biopsies are taken from skin, symptomatic nerve, or muscle. An angiogram of the abdominal blood vessels may also be very helpful in diagnosing PAN.

Aneurysms most often affect the arteries leading to the kidneys, liver or gastrointestinal tract.

The American College of Rheumatology (ACR) has established criteria that should be fulfilled if a patient is to be included in a research study of PAN. The criteria are designed to differentiate PAN from other forms of vasculitis. Not all patients have all criterion.

Some, in fact, may have only 2 or 3 criteria, yet their physicians are still comfortable classifying their disease as PAN. A committee of ACR physicians selected 10 disease features (criteria) as being those that best distinguish PAN from other vasculitides.

In order to be classified as a PAN patient – for the purpose of research studies – a patient should have at least 3 of the 10 ACR criteria.

The American College of Rheumatology 1990 criteria for the classification of Polyarteritis Nodosa

  1. Weight loss of > 4 kg since beginning of illness
  2. Livedo reticularis
  3. Testicular pain or tenderness
  4. Myalgias, weakness, or leg tenderness
  5. Mononeuropathy or polyneuropathy
  6. Development of hypertension
  7. Elevated BUN or creatinine unrelated to dehydration or obstruction
  8. Presence of hepatitis B surface antigen or antibody in serum
  9. Arteriogram demonstrating aneurysms or occlusions of the visceral arteries
  10. Biopsy of small or medium-sized artery containing granulocytes

Treatment and Course of Polyarteritis Nodosa

Treatment of PAN has improved dramatically in the past couple of decades. Before the availability of effective therapy, untreated PAN was usually fatal within weeks to months. Most deaths occurred as a result of kidney failure, heart or gastrointestinal complications.

However, effective treatment is now available for PAN. After diagnosis, patients are treated with high doses of corticosteroids. Other immunosuppressive drugs are also added for patients who are especially ill.

In most cases of PAN now, if diagnosed early enough the disease can be controlled, and often cured.

In medical terms, by David Hellmann, M.D

A discussion of Polyarteritis Nodosa written in medical terms by David Hellmann, M.D. (F.A.C.P.

), for the Rheumatology Section of the Medical Knowledge Self–Assessment Program published and copyrighted by the American College of Physicians (Edition 11, 1998).

The American College of Physicians has given us permission to make this information available to patients contacting our Website.

Polyarteritis nodosa is a small– and medium–sized arteritis affecting multiple organs, especially the skin, peripheral nerve, gut, kidney, and heart. The age of onset ranges from childhood to late adulthood but averages 40 years. Polyarteritis nodosa has been associated with active hepatitis B, hepatitis C, or both; therefore, the disease is more common in injection drug users.

Polyarteritis nodosa is probably mediated by deposition of immune complexes.

Evidence includes the observation that patients with polyarteritis nodosa associated with hepatitis B or hepatitis C have immune complexes consisting of immunoglobulin and viral antigens circulating in the blood and deposited in inflamed vessels. Moreover, antiviral therapy can remit the vasculitis in some of these patients.

The onset is gradual over weeks to months, and the initial symptoms are often nonspecific.

The earliest clues that the patient has vasculitis come usually from the skin (where vasculitis may appear as palpable purpura, livedo reticularis, digital gangrene, or tender nodules), or the peripheral nervous system (where infarction of one mixed motor and sensory nerve after another results in mononeuritis multiplex, one of the most specific clues that a patient has vasculitis). Renal involvement eventually develops in most and is accompanied by hypertension in half of patients, whereas Granulomatosis with Polyangiitis
rarely elevates the blood pressure. Polyarteritis nodosa also commonly involves the gut (abdominal angina, hemorrhage, perforation), heart (myocarditis, myocardial infarction), or eye (scleritis). Rupture of renal or mesenteric micoaneurysms can simulate an acute abdomen.

Confirming the diagnosis requires either biopsy specimen showing small– or medium–sized arteries, or mesenteric arteriography showing microaneurysms or alternating areas of stenosis and dilation.

Biopsy of a symptomatic nerve or a symptomatic muscle is 65% sensitive, whereas biopsy of an asymptomatic site is less than 30% sensitive. Because mesenteric angiography is 60% sensitive, it should be done when there is not a symptomatic site to biopsy.

Renal biopsy should be avoided unless angiography rules out microaneurysms susceptible to rupture.

Without treatment, almost all affected patients die within 2 to 5 years.

Treatment with prednisone (starting at 1 mg/kg daily) and cyclophosphamide (2 mg/kg daily) appeared to revolutionize the outcome of polyarteritis nodosa by achieving 70% 10–year survivals and established this combination of agents as the standard therapy.

However, newer studies suggest that prednisone alone may achieve the same high survival as prednisone and cyclophosphamide, although flares were less frequent in patients taking cyclophosphamide.

Other studies indicate that the traditional therapy with prednisone and cyclophosphamide should be abandoned in patients with polyarteritis nodosa associated with hepatitis B.

Patients treated with the traditional combination respond, but almost all survivors become chronic carriers of hepatitis B and may die later of cirrhosis or variceal bleeding. The newly propsed regimen consists of 2 weeks of prednisone to control the vasculitis, followed by plasmapheresis to remove immune complexes, and accompanied by antiviral therapy with lamivudine to rid the patient of the hepatitis B infection. The long–term value of anti–viral therapy for polyarteritis nodosa associated with hepatitis C is not established.

Source: https://www.hopkinsvasculitis.org/types-vasculitis/polyarteritis-nodosa/

10 tips for preventing sports injuries in kids and teens (via Johns Hopkins Medicine)

Elbow Pain and Problems | Johns Hopkins Medicine

Young athletes today are bigger and stronger, and they push themselves harder than ever before.

With sports camps and more structured activities, kids today are increasingly ly to play their chosen sport year-round. But more time on the field brings a greater risk of experiencing sports-related injuries, including ACL and meniscus injuries in the knee, or injuries to the labrum or UCL in the shoulder and elbow.

Pediatric sports medicine expert R. Jay Lee provides these 10 injury prevention tips to help keep your young athlete on the field rather than on the sidelines:

1. Talk with your young athlete.
Make sure your young athlete understands that he or she should talk with you and seek help if experiencing a pain or something that just doesn’t feel right.

“In my practice, I always promote participating in pain-free sports and activities,” says Dr. Lee.

“But some kids are tough and just push through pain, which can lead to a more serious condition that could have been prevented with early intervention.”

2. Get a preseason physical.
A preseason or back-to-school physical is a great way to determine if your young athlete is fit to play. “Sports physicals help assess any areas of concern for athletes before they start an activity, and in turn keeps them from further injuring themselves during play if a condition is present and needs to be treated,” says Dr. Lee.

3. Encourage cross-training and a variety of sports.
“I see kids today who play on two baseball or lacrosse teams on the same day or throughout the week and year.

But it’s important for athletes to change the sports or activities they are doing so they are not continuously putting stress on the same muscles and joints,” warns Dr. Lee.

Parents should consider limiting the number of teams their athlete is on at any given time and changing up the routine regularly so that the same muscles are not continuously overused.

4. Stress the importance of warming up.
Stretching is an important prevention technique that should become habit for all athletes before starting an activity or sport. Dr.

Lee suggests a mix of both static and dynamic stretching during warmups to help loosen the muscles and prepare them for play.

Toe touches and stretches, where you hold the position for a certain amount of time, are considered static, while jumping jacks and stretches, where the body continues to move during stretching, are considered dynamic.

5. Make sure they rest.
Athletes of all ages need to rest between practices, games and events. A lack of sleep and muscle fatigue predispose an athlete to injury, says Lee.

In fact, the most common injuries seen in young athletes are overuse injuries — too many sports and not enough rest.

Along these same lines, parents should also plan an offseason for their athlete, giving him or her adequate time to recuperate before the next season.

6. Provide a healthy, well-balanced diet.
It’s important for athletes to eat a well-balanced diet full of fruits, vegetables and lean proteins, and to maintain a regular eating schedule.

For instance, have breakfast, lunch and dinner around the same time each day.

“In sports wrestling, where extra importance is put on an athlete’s weight, parents also need to make sure their athletes are following safe eating habits,” says Dr. Lee.

7. Emphasize hydration.
Heat-related illness is a real concern for athletes, especially during hot and humid days. Parents should make sure their children have adequate water before, during and after play, and watch for any signs of a heat-related illness, including fatigue, nausea, vomiting, confusion or fainting.

8. Get the proper equipment.
Protective equipment, helmets, pads and shoes, are very important for injury prevention. Parents should talk with coaches before the season starts so that they have adequate time to properly outfit their child before practices begin.

9. Emphasize proper technique and guidelines.
In every sport, there is a correct way and a wrong way of doing things.

For example, football players should be taught the proper way to tackle an opponent to avoid a concussion, and baseball players should be taught the proper way to throw and follow the guidelines on how many throws to make in a day.

“I often hear from parents that they’ve followed the guidelines,” says Dr. Lee, “except for that one time.” Unfortunately, that one time is all your athlete needs for a shoulder injury to happen.

10. Recognize injury and get help early.
“I’ve seen a number of young athletes who have serious injuries and didn’t do anything about them, and now the damage has progressed,” Dr. Lee warns. “We need to get these kids in to see a doctor earlier to keep this from happening.”

If parents notice that there is a change in their athlete’s technique, such as a limp when running, throwing differently or rubbing a leg during activity, they should pull the athlete play. If the problems persists, parents should seek an assessment for their child prior to returning to the activity.

Dr. Lee warns: “Athletes will alter the way they do things because of pain, but then they can end up with a more serious injury because of it.”

When to see a doctor for your sports-related injury:

1. Consistently have pain during or after sports2. Persistent or new swelling around a joint3. Recurrent instability – joints “give way”4. Painful pops (nonpainful pops are OK)

5. Pain that does not respond to a period of rest

Source: https://www.masnsports.com/orioles-buzz/2017/08/10-tips-for-preventing-sports-injuries-in-kids-and-teens-via-johns-hopkins-medicine.html