DocTalk

Sometimes there are too many rules in the world. This week, the American Heart Association tried to get rid of some of them when it came to bystander CPR.

Wonder how that related to the NFL and childrens' stories? More on the web.

www.MDdirect.org/blog

 

The NFL on television has started to develop a medical drama sub-theme. Slow motion replay of an injury is followed by the locker room report, preliminary x-rays are discussed and during the Giant-Cowboy game the announcers mentioned that they had contacted their orthopedic source to get insight into the Romo's clavicle fracture. Add the Brett Favre ankle MRI watch adn I might well be watching House.

Television is perpetuating the myth that more testing and technology is always better and patients are buying into the idea that a test result is always needed to confirm a diagnosis. Aside from the cost of technology, there are significant downsides that can occur because of false postiive or false negative tests.

More on the web. This week is philosophy; statistics come later.

Thanks for reading.

Ben

 

Doc, I had a NFL trainer tell me a long time ago that when muscles are ripped from the bone, something is not right with that player. Normal muscles just do not rip from bone in normal NFL play. When I say not right, I mean not allowed. wink wink

What are your thoughts on this?

 

Muscles work by spanning a joint and contracting allowing the joint to move. The muscle has to be tethered into bone on each side of the joint either by directly inserting into the bone or by morphing into a tendon. It is not uncommon for the insertion to tear away from bone. Sometimes the bone is weaker than the muscle insertion point and some bone can tear away as well.

Your trainer's inuendo is false. I commonly see patients, many are elderly, who tear their hamstring insertion at the pelvis. The proximal bicep insertion is also another common injury site though surgery may be recommended for this injury.Similarly, small avulsion sprains are seen at the ankle at the lateral maleolus, where the anterior talo-fibular and calcaneo-fibular ligamnet insert. The bone tears instead of the ligament but the RICE treatment remains the same.

 

The only muscles you want to rip from the bone are those of the turkey on the Thanksgiving table.

 

Thank you very much for the response.

This would be a bicep or a tricep on a 20 to 30-year old.

The trainer stated that the muscles can grow faster (too fast) than the attaching material, and thus the strength of the muscle can tear it away from the bone.

This was back in the 1990s, though.

 

Hey Doc: My girlfriend has muscle spasms in her back and her doc, who tends to be kind of conservative, gave her something called Methocarbamol and it doesn't really work well for her. My doc, on the other hand, gave me something called Skelaxin a few years ago when I had a pinched nerve in my lower back and that seemed to work well for me from what I remember. Could that be a more effective medication for spasms than what she's taking or do you have a suggestion of something else she could ask for that might be better?

 

Methocarbamol is teh generic name for Robaxin. It, Skelaxin and Flexeril are all prescribed as muscle relaxants though there is no evidence that they do much good. There is alot to be said for strecthign, ice and anti-inflammatories but if muscle relaxation is required and one of the three doesn't work, another may be tried.

It's important to find the cause of the muscle spasm. Is it due to posture issues, muscle imbalance, injury or a systemic problem, for example abnormalities of sodium calcium or magnesium. Sometimes the answer and teh treatment cannot be found in a pill.

Best of luck to your friend.

 

Thanks. I told her about some of the stretches my chiropractor gave me that really helped.

 

The American Academy of Neurology has released its latest position paper on concussions. Unfortunately, I think their recommendations are more than a day late and a dollar short. Practicality is not their middle name.

More on this week’s web article. It’s Tuesday, you know. Thanks for reading.

www.MDdirect.org/blog

 

My diatribe about smoking continues this week but it has little to do with people who decide to start, even after reading the warning labels on each package. Instead, the frustration has to do with spending countless millions on cancer screening and diagnosis while choosing not to fund stop smoking strategies.
Thanks for reading

 

Daniel Levinson, the inspector general of the Department of Healthand Human Services (the guys that run Medicare) reported that 1 in 7 patients admitted to the hospital experienced serious harm. This is an alarming and sad commentary of how overwhelmed our hospitals have become to provide for the needs of our aging population. The answer will not be found in the wisdom of high tech but instead in the caring of high touch at the bedside. But that takes more than money, it takes people who care.

www.MDdirect.org/blog