Medical Notes - Faughnan

Sensational Strategies for Teaching Beginning Readers

The costs of professional tutoring in Orton-Gillingham (used in leading centers across the country) range from $30.00 to $55.00 for a 50 minute hour. Normally, children are seen multiple times each week. As you can see, the cost of 'Sensational Strategies for Teaching Beginning Readers' is quite small in comparison.

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Despite its roots in teaching rather well off children this approach is gaining favor in special education circles and among clinical neuropsychologists.

Orthopedics

For acute severe low back pain (torn muscle, etc):

1. Tru-Fit "one size back/shoulder polar-preene wrap": It's a neoprene belt with a mesh poush. You put a gel pack in the pouch. Roughly $16 with a gel pack.

2. Gott Blue Block "ice" for cooler. Flat, about 6"x3"x1". Contains antifreeze, so is colder than ice. Risk of cold injury if poor circulation. I liked the hard brick pressure. An Ace reusable cold compress is safer and softer.

3. Canes. Lightweight cane is a fantastic aid to early ambulation.

4. Motrin, optional additional vicodin for day 1-2.

5. encourage ambulation.

Management of Carpal Tunnel Syndrome - July 15, 2003 - American Family Physician

Summary

• hypalgesia and weak thumb abduction predict abnormal nerve conduction
  studies.


• splint the wrist in a neutral position and ultrasound therapy.


• local corticosteroid injections can help


• nonsteroidal anti-inflammatory drugs, pyridoxine, and diuretics don't
  work


• treat conservatively (splint) in pregnant women, resolves after delivery


• Nonspecific flexor tenosynovitis is the most common cause

History

• flick sign: "flick" wrist as if shaking down a thermometer for relief

Nerve Conduction Studies

NCS findings have only a loose association with symptoms. In one popn study
(below) having symptoms tripled the probability of a positive study, but the
half of studies in symptomatic patients are negative. Would be very good to know
what happened over time to the asymptomatic group with a positive NCS.

• 15%: pain, numbness, or tingling median nerve distn.
  
  
  
  • half had neuropathy by NCS
  
  
  • clinical certainty did not predict NCS findings
  
  
  
  


• a subgroup of pts. with no symptoms hand NCS done:
  
  
  • 18% had median nerve neuropathy by NCS
  
  
  
  

Treatment

• this paper includes an instrument for predicting the outcome of
  conservative treatment. If probability of success is low, consider early
  surgery?
  
  
  
  • risk factors for failure: > 10 months, constant parathesias, trigger
    digits, age > 50, phalen +ve<30 sec
  
  
  
  


• outcomes
  
  
  • Only 1/6 pts have long term relief with conservative mgt (80% initial
    response, but only 1/5 of those do not recur by 1 year)
  
  
  • 2/3 patients very satisfied 6/18/30 mo post surgery
  
  
  
  


• injection: 10 of lidocaine (Xylocaine) without epinephrine and 40 mg of
  methylprednisolone acetate (Depo-Medrol)