The goal of the practitioner managing a patient with knee osteoarthritis (OA) is to minimize pain and optimize their function. Several noninterventional (noninjectable) therapies are available for these individuals, each having varying levels of efficacy. An individualized approach to the patient is most beneficial in individuals with knee OA and the treatment plan the practitioner chooses should be based on this principle. The focus of this article is to provide an up-to-date overview of the treatment strategies available, evidence to support them, and in whom these treatments would be most appropriate. These include exercise (aerobic and resistance), weight loss, bracing and orthotics, topical and oral analgesic medications, therapeutic modalities, and oral supplements.

We aimed to determine whether additional molecular and microbiological evaluations of methicillin-resistant Staphylococcus aureus (MRSA) isolated from patients newly identified as nasal carriers were useful for control strategies and whether longitudinal testing during the same or repeat hospitalization changed MRSA status. Nasal swabs from patients positive by Xpert MRSA PCR and not known to be colonized in the previous year were cultured for S. aureus. Isolates were tested for resistance to a variety of antibiotics, including high-level mupirocin resistance (HLMR) and low-level mupirocin resistance (LLMR) and the presence of genes mecA and mupA and those for Panton-Valentine leukocidin (PVL), USA300, and USA400. Repeat nasal screens during the 6-month study were tested for continued presence of MRSA. Among 130 patients, cultures revealed MRSA in 85 (65.4%), methicillin-susceptible S. aureus in 19 (14.6%), and no growth in 26 (20%). MRSA isolates were USA300 positive in 13/85 (15.3%) and LLMR in 8/85 (9.4%) patients. No isolates were HLMR or mupA positive. mecA dropout was detected in 9/130 (6.9%) patients. The rate of subsequent MRSA infections in USA300-positive versus -negative patients was not different. MRSA nasal status remained concordant in 69/70 (98.6%) patients who had follow-up testing. The findings do not support expanding MRSA surveillance to include routine detection of genes for USA300, PVL, or mupA, all of which were either of low frequency or not significantly associated with MRSA infection risk in our population of newly identified nasal carriers. Repeat nasal screening for MRSA during the same or subsequent hospitalizations over 6 months could also be deferred, reducing costs associated with screening.

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Background: Shoulder pain is one of the most common musculoskeletal concerns in manual wheelchair users including among athletes. However, there is a paucity of research characterizing both shoulder pain and shoulder pathology in this population. Objective: To characterize and compare the prevalence of current shoulder pain and ultrasound metrics of shoulder pathology between wheelchair athletes, nonathletic wheelchair users, and nonwheelchair users. Design: Cross-sectional. Setting: Chicago-area adaptive sport teams/programs and musculoskeletal clinics. Participants: Thirty-four wheelchair athletes, six nonathletic wheelchair users, and 12 nonwheelchair users. Methods: Self-reported shoulder pain was assessed by questionnaire and Wheelchair User Shoulder Pain Index (WUSPI). Shoulder physiology and pathology were assessed by physical and ultrasound evaluation of both shoulders by a sports medicine physician. Main Outcome Measures: Questionnaire outcomes: Prevalence of current shoulder pain, total WUSPI score. Physical examination outcomes: total Physical Examination of Shoulder Scale (PESS) score. Sonographic outcomes: Acromiohumeral distance (AHD) and presence of shoulder pathology. Results: The majority of wheelchair athletes (68%) and nonathletic wheelchair users (67%) experienced shoulder pain since using a manual wheelchair. Wheelchair basketball players had a mean WUPSI score of 17.2 (SD = 21.8), and athletes participating in handcycling, sled hockey, and quad rugby had mean scores of 4.91 (SD = 8.32), 7.76 (SD = 13.1), and 4.29 (SD = 7.75), respectively. Shoulder pathology was observed in 14 of 31 (45%) wheelchair athletes and 4 of 6 (67%) nonathletic wheelchair users (p = .41). Conclusions: Although wheelchair use is a risk factor for shoulder pain, participation in amateur wheelchair sports may not be associated with increased risk of shoulder pain. It is possible that overhead sports such as wheelchair basketball may define a unique high-risk group. Further study is needed to examine this relationship and to determine whether there are differences between specific wheelchair sports.