Objectives-Ultrasound imaging is commonly used to teach basic anatomy to medical students. The purpose of this study was to determine whether learning musculoskeletal anatomy with ultrasound improved performance on medical students' musculoskeletal physical examination skills.Methods-Twenty-seven first-year medical students were randomly assigned to 1 of 2 instructional groups: either shoulder or knee. Both groups received a lecture followed by hands-on ultrasound scanning on live human models of the assigned joint. After instruction, students were assessed on their ability to accurately palpate 4 anatomic landmarks: the acromioclavicular joint, the proximal long-head biceps tendon, and the medial and lateral joint lines of the knee. Performance scores were based on both accuracy and time. A total physical examination performance score was derived for each joint. Scores for instructional groups were compared by a 2-way analysis of variance with 1 repeated measure. Significant findings were further analyzed with post hoc tests.Results-All students performed significantly better on the knee examination, irrespective of instructional group (F 5 14.9; df 5 1.25; P 5 .001). Moreover, the shoulder instruction group performed significantly better than the knee group on the overall assessment (t 5 -3.0; df 5 25; P < .01). Post hoc analyses revealed that differences in group performance were due to the shoulder group's higher scores on palpation of the biceps tendon (t 5 -2.8; df 5 25; P 5 .01), a soft tissue landmark. Both groups performed similarly on palpation of all other anatomic structures.Conclusions-The use of ultrasound appears to provide an educational advantage when learning musculoskeletal physical examination of soft tissue landmarks.
Objectives Our purpose was to determine whether ultrasound (US)‐aided instruction and practice on musculoskeletal anatomy would improve first‐year medical students’ ability to locate and identify specific soft tissue structures by unaided palpation in the upper and lower extremities of healthy human models. Methods This study was a randomized crossover design with 49 first‐year medical students randomly assigned to 1 of 2 groups. Each group was provided expert instruction and hands‐on practice using US to scan and study soft tissue structures. During session 1, group A learned the anatomy of the upper extremities, whereas group B learned the lower. Students were then tested on their proficiency in locating 4 soft tissue structures (2 upper and 2 lower extremities) through palpation of a human model. During session 2, group A learned lower extremities, and group B learned upper. At the end of session 2, students repeated the assessment. Results After the first instructional session, neither group performed significantly better on identifying and locating the soft tissue landmarks they learned aided by US. After the second instructional session, however, scores for both groups increased approximately 20 percentage points, indicating that both groups performed significantly better on palpating and identifying both the upper and lower extremity soft tissue landmarks (Cohen d = 0.89 and 0.82, respectively). Conclusions Time and practice viewing soft tissue structures with US assistance seems to have a “palpation‐with‐eyes” effect that improves students’ abilities to correctly locate, palpate, and identify limb‐specific soft tissue structures once the US assistance is removed.
Background: Stress fractures of the sacrum are an uncommon cause of low back and buttock pain in athletes. They have been described in a few case reports, with the injury occurring most often in female distance runners. Given the rarity of this condition, there is a general lack of awareness of this injury, which may lead to a missed or delayed diagnosis. Study Design: Case series. Level of Evidence: Level 5. Methods: The 5 cases were identified by performing a medical records search within the practices of the senior authors over a 3-year period from January 2016 to December 2018. Results: Three of 5 patients (1 male, 2 females) returned to regular activity after diagnosis and treatment. Two (1 male, 1 female) have yet to return to regular activity. Magnetic resonance imaging was the key modality in all diagnoses. All 3 female patients had components of the female athlete triad—menstrual irregularity, disordered eating, and decreased bone mineral density. Conclusion: A high index of suspicion is required to make the correct diagnosis and initiate treatment for this rare condition given its association with low body mass index, vitamin D insufficiency, disordered eating, and malabsorption disorders. Appropriate treatment includes rest from the causative activity, nutritional support, and biomechanical optimization. In severe, chronic, or recurrent cases, referral for nutritional counseling, hormonal replacement therapies, and mental health support may be necessary. Clinical Relevance: Sacral stress fractures, though uncommon, should be included prominently in the differential diagnosis for runners with low back pain, especially if the athlete has a history of prior stress fracture or the female athlete triad.
Data with respect to collegiate fencing injuries are very limited. We performed a prospective cohort study of a college fencing team to analyze the rates and types of injuries that occurred to this team over the course of a year. We noted that the injury rate was low, with 2.43 injuries per 1000 athlete exposures. We also noted that 75% of those injured had a time loss of less than 2 wk. A large percentage of our injuries (88%) were musculoskeletal in nature. There were equal numbers of acute and chronic injuries. Men and women had a similar rate of injury. In our study population, we noted that most of the injuries occurred in practice over competition (87.5% vs 12.5%, respectively). We compared the data from a small subset population with the current evidence published with respect to fencing injuries. We noted some similarities and also some differences when comparing certain populations.
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