Sics Editore Before starting conservative treatment of diverticulitis make sure - based on clinical picture and on additional investigations if necessary - that the patient does not have a bowel obstruction or perforation necessitating surgery. Do not diagnose prolonged or recurring lower abdominal symptoms as diverticulosis before examining the patient thoroughly (knowing that the patient has diverticula must not prevent from investigating the cause of abdominal symptoms)
Sics Editore Always remember to measure plasma/blood glucose in insulin-treated diabetic patients showing symptoms of any kind. Check for an acute disease needing treatment (infection) as the reason for plasma glucose increase. Ketoacidosis must always be treated in hospital. If the hyperglycaemic, non-ketotic patient is not admitted to hospital for observation, make sure that the patient is given insulin and the plasma glucose begins to decrease. the patient is able to take care of himself and gets immediate help if he feels any worse. The reason for ketoacidosis should always be investigated and the patient's awareness of, and ability to manage, his/her diabetes should be checked.
Sics Editore The aim of the anti-doping work is to prevent the use of substances and methods that are hazardous for health and/or improve performance, to ensure the right to fair and pure sports and to control the adherence to the ethical principles of sports and medicine. The national anti-doping committees are responsible for doping control of athletes who participate in organized sports. They continually update doping regulations that are based on the regulations of World Anti-Doping Agency (WADA , www.wada-ama.org). This article describes the general principles of anti-doping regulation and provides guidance and examples for some common situations. Whenever there is uncertainty, check the facts at the website of your national anti-doping organization or WADA.
Sics Editore Dislocation may occur almost spontaneously in some persons or in association with e.g. trauma, yawning, dental examination etc. The dislocation is usually unilateral but may be bilateral. After an acute dislocation the condition easily becomes recurrent. Reposition is usually easy if the mandible is intact. If the mandible is dislocated backwards the patient has a condylar fracture. In such case, consult an oral and maxillofacial surgeon directly.
Sics Editore Sarcomas are divided into soft tissue sarcomas and bone sarcomas. Both groups have different behaviour and thus the treatment principles also differ, both between and within the groups. In the early stages sarcomas cause very few symptoms. Bone sarcomas cause pain, swelling or locally increased skin temperature only at a late stage and when they are fairly large. Soft-tissue sarcomas are usually painless even in the late stage. Sarcomas spread mainly via the bloodstream, rarely to local lymph nodes. Sarcomas send metastases most typically to the lungs. Basic management consists of an appropriate combination of surgery, radiotherapy and chemotherapy.
Sics Editore Compartment syndrome should be suspected in leg injuries when the patient experiences atypical pain aggravated by passive tension of muscles in the affected compartment. The muscles may be rescued by prompt surgical treatment provided that the acute syndrome is suspected early enough.
Sics Editore The major goal of the treatment is to prevent thrombotic complications and haemorrhages. The amount of red blood cells is kept within the normal range (haematocrit < 0.45, haemoglobin < 145 g/l). This prevents cardiovascular deaths and thromboses . Allopurinol is the primary drug for preventing gout symptoms and hyperuricaemic kidney lesions if urate levels are at the upper end of the normal range. In thrombocytosis, a low dose of aspirin (100 mg/day) is given to reduce the risk of distal ischaemia and transcient ischaemic attacks. This dose is sufficient to reduce the risk of thrombosis in cerebral and coronary circulation .
Sics Editore The majority of kidney cancers are discovered incidentally during abdominal ultrasonography. The typical symptoms are haematuria , weight loss, fever and flank pain. Hypersedimentation, anaemia and microscopic haematuria are common findings. Surgical procedure is chosen so as to spare any functioning renal tissue. New drug therapies have also improved the prognosis of metastatic disease.
Sics Editore Chronic lymphocytic leukaemia is a slowly progressing (chronic) malignant blood disease where morphologically normal looking B lymphocytes accumulate in the bone marrow, blood and lymphoid tissue (lymph nodes, spleen), leading to leucocytosis, lymphocytosis and, in some cases, to enlarged lymph nodes and/or splenomegaly. The clonal lymphocyte population gradually displaces the normal healthy haematopoiesis in the bone marrow. The subsequent bone marrow failure will lead to anaemia, neutropenia and/or thrombocytopenia. The diseased cells exhibit characteristic chromosomal changes, which have formed as a result of acquired mutations. The disease is not hereditary. In chronic monoclonal B-cell lymphocytosis (MBL), blood lymphocytes frequently carry surface antigens typical to CLL, i.e. they have the immunophenotype of CLL, but the number of lymphocytes is only slightly increased (less than 5 x 109/l) and other cell counts are normal. MBL is not considered a malignant condition, but the patient should, however, be monitored (for example, annually) because in some cases MBL may progress to CLL.
Sics Editore Contact injuries are treated surgically. Injuries caused by an electric arc are treated conservatively provided that the patient's clothing has not caught fire; in such a case, the injury is classified as a flame injury. After the injury, the patient should be attached to a cardiac monitor (arrhythmias, infarction), if there was a heart arrest at the moment of the incident and/or arrhythmia at arrival to the emergency department. Rehydration should be considered in accordance with the extent of the burnt area. In electric burns, fluid requirement usually is greater than in ordinary burn injuries. Rhabdomyolysis-induced renal failure should be prevented with enhanced diuresis and alkalisation of urine. Prophylaxis: early preventive fasciotomy decreases the pressure in muscle compartments. Cardiac function should be observed in a monitor after the injury if cardiac arrest, arrhythmia or otherwise abnormal ECG was documented during transportation or at the emergency department.
Sics Editore The risk of adenomyosis is increased by childbirth, miscarriage, uterine curettage and menorrhagia. The symptoms resemble those of endometriosis. Hysterectomy is the best and final treatment for older women with severe symptoms.
Sics Editore Suspect rhabdomyolysis in patients with typical history (particularly those found unconscious), symptoms and clinical findings. When suspicion arises diagnosis is easy to verify (serum creatine kinase, CK). Intensified fluid therapy is the most essential treatment measure: start with infusing 1 000 ml of 0.9% saline solution during the first hour.
Sics Editore Reduced function of exocrine glands is usually first manifested as dryness of the eyes (keratoconjunctivitis sicca) and mouth (xerostomia). May occur as a primary disease or secondary to rheumatoid arthritis, or rarely to SLE or scleroderma. 10-15% of patients with rheumatoid arthritis suffer from sicca symptoms. Presence of autoantibodies is typical in SjOgren's syndrome. Their absence in patients suffering from dryness of the eyes and mouth speaks against the diagnosis.
Sics Editore In a hyperthyroid patient, serum TSH concentration is below reference range (often unmeasurable), and serum free T4 and/or free T3 concentrations are increased.As a general rule, patients with hyperthyroidism are referred to a specialist in internal medicine for assessment. Start a beta-blocker and also antithyroid medication already at referral to a specialist when the diagnosis of hyperthyroidism is clear. Remember to inform the patient concerning the risk of agranulocytosis associated with antithyroid medication. Patients with thyroid eye disease (in Basedow's [Grave's] disease only) or with pregnancy-induced hyperthyroidism are promptly referred to a specialist. Hyperthyroidism is always treated. In uncertain cases, begin with a beta-blocker only. Depletion of hormone storages that is associated with an inflammatory state is not treated with antithyroid drugs (e.g subacute thyroiditis ). The thyroid gland is palpated in order to estimate its size, whereasultrasonography has no place in the diagnostics of hyperthyroidism.
Sics Editore Measure serum potassium concentration in hypertensive patients as an initial investigation. Suspect primary aldosteronism if a hypertensive patient presents with spontaneous hypokalaemia in the absence of diuretic use or hypokalaemia during low-dose diuretic use (serum potassium < 3.5 mmol/l in the absence of diuretic use or < 3.0 mmol/l during low-dose diuretic use). treatment-resistant hypertension adrenal incidentaloma early onset hypertension (under 40 years of age) or stroke.
Sics Editore There are two main types of dialysis: peritoneal dialysis and haemodialysis. Primary health care workers are most likely to meet patients undergoing dialysis when infection becomes a problem. The first sign of peritonitis in a patient on peritoneal dialysis is usually abdominal pain or cloudy drainage fluid. If peritonitis is suspected refer the patient immediately to a nephrology unit.
Sics Editore The missing insulin production of the pancreas is replaced by individual administration of different insulin preparations into the subcutaneous fat through injections or an insulin pump.In a patient with insulin deficiency, the administration of basal insulin must not be discontinued in any circumstances even if it may be necessary to reduce the dose in certain situations.A regime based on multiple daily insulin injections is the primary treatment mode in a patient with type 1 diabetes. It mimics normal insulin secretion at night and between mealtimes (basal insulin) as well as during mealtimes (mealtime insulin).Even in good diabetes control the blood glucose concentrations vary (due to, e.g., variation in insulin absorption, food composition and gastric emptying as well as stress, sickness, exercise, menstrual cycle). Temporary high concentrations are corrected with additional doses of rapid-acting insulin (corrective insulin) administered at meals.The patient is taught to adjust the insulin dosage him-/herself according to the daily rhythms, eating patterns, exercise and self-monitoring of blood glucose (plasma glucose concentration). Good treatment results are based on sufficient guidance as well as continuity of carethe patient's acceptance of the disease as a part of one's own lifesufficient and reasonable self-monitoring of blood glucose and actions taken according to the measurement results the ability of the patient to master the daily care of his illness shared, neutral and empowering problem solving. The individual aims and modes of treatment should be decided with the patient, taking into account the current life situation, the patient's proneness to hypoglycaemia and the ability of the patient to carry out the treatment himself/herself.Hypoglycaemias and the fear of them may pose an essential obstacle to good control of diabetes. If good glycaemic control is not achieved (HbA1c exceeds the individually set target, episodes of severe hypoglycaemia or wide daily variations in blood glucose concentration occur) with an appropriate multiple injection regime consisting of rapid-acting and long-acting insulin derivatives, the patient is referred for glucose sensor monitoring and for consideration of an insulin pump. In type 1 diabetes, blood pressure and blood lipids must also be in good control.
Sics Editore Diagnose acute arterial occlusion, deep venous thrombosis and erysipelas immediately. Recognize critical ischaemia and refer the patient urgently. Recognize compartment syndrome and stress fracture (which are particularly common in military conscripts and athletes).
Sics Editore Arterial diagnostics is technically rather easy with a high degree of certainty in interpretation. The Doppler stethoscope is the first-line diagnostic tool to be used in primary care for the detection of ischaemia in the lower extremities.
Sics Editore Prolonged diarrhoea is rarely caused by an infection unless the patient is immunocompromised. Possible causative agents include giardia, Clostridium difficile and Entamoeba histolytica. Perform primary investigations for the diagnosis of the most common malabsorption disorders (coeliac disease, lactose intolerance) and refer the patients to colonoscopy to diagnose inflammatory bowel diseases (ulcerative colitis, Crohn's disease, microscopic colitis ). Keep the possibility of malignancy in mind if diarrhoea has not lasted a relatively long period of time. Colonoscopy is the first-line investigation if a malignancy is suspected. It is important to identify the irritable bowel syndrome (IBS ) because a proportion of these patients have (from time to time) diarrhoea. IBS symptoms may also appear after an infectious gastroenteritis. Faecal impaction may cause so-called overflow diarrhoea especially in elderly persons who are in institutional care. In these patients, the use of antidiarrhoeal medication may lead to confusion. Faecal impaction is verified by digital rectal examination and by plain abdominal x-ray. It is important to distinguish between diarrhoea and faecal incontinence (by assessing the resting tone and the contractile force of the anal sphincter, by identifying rectal prolapse on exertion). Identify and treat the complications of prolonged diarrhoea in elderly patients (dehydration, electrolyte disturbances, confusion, orthostatic hypotension, malnutrition).
Sics Editore Colonoscopies are performed in the primary care in growing numbers, also by general practitioners. In diagnosing adenomas and cancers, colonoscopy is preferable to sigmoidoscopy. Colonoscopy should be performed as the initial investigation when looking for possible colonic causes of iron deficiency anaemia or occult blood in the faeces. Thorough investigation of these patients and endoscopic follow-up of adenoma patients is the key to an early diagnosis and treatment as well as prevention of colon cancer. Readiness for polypectomy is desirable, at least if colonoscopy is performed because of positive screening test for faecal occult blood. Sigmoidoscopy is often sufficient in the investigation of bloody or prolonged diarrhoea or fresh blood from the anus if the cause of the bleeding becomes evident in the investigation. Microscopic colitis can almost always be diagnosed from the sigma. If an adenoma is detected in sigmoidoscopy, colonoscopy must always be performed. Fiberosigmoidoscopy should replace rectoscopy with a stiff instrument whenever sigmoidoscopy is available. Sigmoidoscopy must always be complemented by proctoscopy and touch per rectum in order to detect abnormalities of the anal canal.
Sics Editore Ulcerative colitis may be the cause of recurrent or prolonged (bloody) diarrhoea. Treatment decisions and medication choices are based on the severity of the symptoms and the extent of the disease (proctitis, left-sided colitis or extensive colitis). Patients with acute severe colitis require hospitalisation. Owing to the increased risk of developing carcinoma, regular endoscopic screening is indicated in ulcerative colitis.
Sics Editore Suspect nephrotic syndrome as a rare cause of oedema. The most important symptom is oedema in the lower extremities caused by accumulation of salt and fluid within the tissues. In addition to treatment directed at the primary disease, proteinuria, hypertension (target blood pressure = 130/80 mmHg) and oedema are treated.
Sics Editore Suspicion of IgA nephropathy should arise if a person has asymptomatic microscopic haematuria and proteinuria, often associated with elevated blood pressure. ACE inhibitors and ATR blockers are the first-line drugs to treat hypertension, and they are used also in normotensive patients with proteinuria.
Sics Editore A routine urinalysis consists of chemical analysis (reagent strip or dipstick test) and particle counting (basic count or advanced differential count) performed either by microscopy (urine sediment or chamber counting) or using automated analysers.
Sics Editore Prostate cancer should be recognized by palpation (lumps) or prostate-specific antigen (PSA) determination in patients suffering from urinary symptoms.In addition to the plasma total PSA concentration, the ratio of free to total PSA and the PSA increase rate, also the age of the patient as well as the size and nodularity of the prostate gland are taken into account when assessing the probability of prostate cancer diagnosis and the need for further investigations. Metastatic prostate cancer should be identified.
Sics Editore Diagnose a severe infection as the cause of leucocytosis immediately and arrange treatment without delay. Absence of leucocytosis does not rule out severe infection or malignant haematological disease. If the cause of leucocytosis is not apparent, order further investigations considered necessary.
Sics Editore Erythrocytosis refers to an elevation of the total number of red cells in blood. In practical terms it can be defined by measuring either blood haemoglobin concentration, packed cell volume (haematocrit) or erythrocyte concentration. - In women: haemoglobin > 155 g/l, haematocrit > 0.46, or erythrocytes > 5.2 10 12/l - In men: haemoglobin > 167 g/l, haematocrit > 0.50, or erythrocytes > 5.7 10 12/l
Sics Editore The blood platelet or thrombocyte concentration varies between individuals but remains rather constant in each individual. The reference range is 150-360 x 109/l. Thrombocytosis (platelet count > 360 x 109/l) can be classified into two categories: primary thrombocytosis, i.e. thrombocytosis related to myeloproliferative diseases reactive or secondary thrombocytosis. In primary thrombocytosis the patient may have symptoms and complications due to the high thrombocyte concentration. In reactive thrombocytosis, not even a high thrombocyte count causes symptoms but the symptoms and complications are related to the primary disease.
Sics Editore The majority of cases of microcytic anaemia (MCV < 80 fl) are caused by iron deficiency. However, ca. 10% of these have secondary anaemia, and on the other hand, ca. 30% of cases of iron deficiency anaemia have MCV > 80 fl (depending on the patient population). About 20% of menstruating women have iron deficiency anaemia at same stage of their reproductive age. Iron deficiency in women after reproductive age and in men is always abnormal. The cause behind significant iron deficiency is in these cases usually gastrointestinal bleeding . If the patient has microcytic anaemia (MCV < 80 fl) and secondary anaemia appears to be excluded, iron deficiency anaemia is likely. Secondary anaemias are unlikely if there is no relevant chronic disease and past history, clinical status, erythrocyte sedimentation rate, CRP, serum creatinine concentration or leucocytosis do not indicate the presence of an underlying disease. If the cause of iron deficiency is certain or evident, the situation is sufficiently well characterised and iron therapy may be initiated. Among some ethnic groups and especially in known families thalassaemias may be the primary causes of microcytic anaemia.
Sics Editore In primary care, the principal aim should be to identify patients whose bleeding diathesis could be caused by leukaemia, meningococcal septicaemia or other acute systemic disease, severe haemorrhagic disease, medication-induced complication or an assault. The assessment of a patient with a bleeding diathesis differs from the management of a patient with an acute haemorrhage. In addition to clinical examination, the patient's age, sex, underlying diseases, medication, type of bleeding as well as family history, including distant relatives, will provide essential information that is required before additional investigations are ordered. A haemostatic disorder leading to a bleeding diathesis may be acquired or hereditary. In both cases, such a disorder may either be mediated via platelets or coagulation factors. Bleeding diathesis may also be caused by abnormal fibrinolysis or by structural abnormalities in the vessel walls or in connective tissue.
Sics Editore Before a screening programme is run as a public health policy there should be evidence from a randomized screening trial that the programme will reduce mortality and improve quality of life in the target population.Other prerequisites, more open to various interpretations, assume that the adverse effects of the programme will be acceptable compared to the benefitthe cost of the programme will be acceptable compared to the cost of health services in the target population.The ever smaller mortality benefits achieved with new screening programmes, when set in proportion to harms caused as regards quality of life and other aspects, bring ever closer the limit where harms become decisive for the applicability of a programme.Only a randomized health services research project set up in the initiation phase of a routine screening will provide certainty on the applicability.In addition, activities that have become routine in the health care system should be continuously assessed and monitored to ensure that the results are in line with the results obtained in the initiation phase.
Sics Editore The duration of palliative treatment for cancer ranges from months and years to a few days. Treatment of the cancer with antineoplastic drugs or radiotherapy may alleviate the symptoms of a patient in a better condition efficiently, while care and alleviation of pain are central in the treatment of a dying patient. At each stage of the disease the aim is to find therapies with beneficial effects outweighing the adverse effects. The treatment alternatives given in this article should be considered from this perspective. Also in curative treatment, it is important to effectively alleviate symptoms caused by the disease or treatment. These recommendations may be used when applicable. Discuss treatment alternatives with the patient. Explain the probable aetiology of the symptoms, engage family members in the treatment, and consult with specialists.
Sics Editore Bag-mask ventilation is the most important skill to possess when a patient's respiratory function becomes compromised. Supraglottic airway devices (laryngeal mask airway and tube) can be used to maintain a patent airway without needing to intubate the trachea. Supraglottic devices do not offer protection against aspiration and are therefore contraindicated in patients at risk of aspiration. According to current guidelines, tracheal intubation should only be attempted by those who are competent in this skill and have on-going experience with the technique. Sedating medication and muscle relaxants to assist intubation can only be used by doctors who have received training in anaesthesiology. If airway patency cannot be maintained with these methods, emergency tracheotomy, i.e. cricothyrotomy, should be considered.
Sics Editore Hypoxaemia is common, difficult to detect and deleterious. An experienced clinician can detect hypoxaemia on the basis of cyanosis only when blood oxygen saturation is 80% or less . Pulse oximetry is an easy-to-use and effective method for detecting hypoxaemia when the device recognizes a good pulse wave . Pulse oximetry should be used routinely for monitoring oxygen saturation; however, it tells nothing about ventilation .
Sics Editore A stress fracture should be suspected clinically when the patient gives a typical history of pain during exercise. Clinical examination is usually not reliable, and the diagnosis should be confirmed with imaging studies (x-ray, magnetic resonance imaging, bone scan). An early identification is especially important in those stress fractures where a dislocation would necessitate surgical management and thus prolong recovery period. Risk of dislocation is associated, in particular, with femoral neck and shaft fractures. A femoral stress fracture should be suspected in military conscripts and those involved in strenuous exercise who complain of groin, hip, thigh or knee pain, however mild. In order to avoid complications, the patient must be told not to engage in any activities associated with repetitive loading until a stress fracture has been excluded.
Sics Editore Indications: non-displaced fractures of the lower leg, rarely in knee fractures (mostly treated with surgery or a hinge orthosis). Equipment: tube gauze, padding, polyurethane foam bandage, 4-6 rolls of 15-20 cm wide plaster or 5 rolls of fibreglass/plastic cast (10 cm wide)
Sics Editore Not all wrist fractures are treated in the same way, and x-rays should be studied in order to diagnose the type of fracture (picture ). Two weeks after the application of a plaster cast, a decision should be made regarding the success of conservative treatment. The possible development of complex regional pain syndrome (CRPS) should be borne in mind and identified. The treating physician should be able to suspect especially the following (poor management may lead to osteoarthritis): Fracture of the scaphoid bone (it is not always apparent on x-rays taken on presentation) Ligament rupture between the scaphoid and lunate bone (scapholunate dissociation) Bennett's fracture at the base of the first metacarpal bone
Sics Editore Acupuncture is a therapeutic whole where the treatment event as such, with the interaction involved, improves the treatment result.Acupuncture is needling but all needling is not acupuncture.The treatment, when carried out carefully, is virtually harmless and economically advantageous and does not put significant physical strain on the patient.
Sics Editore A specialist orthopaedic centre must be consulted early whenever complications are suspected. Signs and symptoms of a postoperative infection must be recognised, the depth of the infection established and the causative organism identified. Attention must be paid to preoperative eradication of all possible foci of infection. Regular postoperative follow-up will ensure early recognition of complications. The emergence of symptoms in a previously asymptomatic joint must always be investigated.
Sics Editore Acute neck pain usually has a good prognosis and recovers spontaneously. Any factors which may aggravate the condition should be identified and alleviated. In the treatment of localized neck pain (e.g tension neck), continuation of normal activities and safe analgesic medication are the primary measures. In the treatment of chronic localized neck pain, active therapeutic exercise which improves muscular strength and endurance is beneficial.
Sics Editore Ganglion cysts that contain gelatinous fluid can occur in any joint or tendon with a tendon sheath, most often in the wrist or palm, but also in e.g. the shoulder and knee joints and in the distal tendon of the biceps muscle. A symptomatic ganglion can be treated by puncture or surgery.
Sics Editore Symptoms affecting the upper extremities, particularly nocturnal paraesthesias and numbness, should be identified as manifestations of carpal tunnel syndrome. Reduction of physical load factors together with conservative treatment options (night splint) are the primary management strategies in association with mild symptoms and findings. Nonspecific treatment (e.g. unnecessary physiotherapy) should be avoided. If the sensory disturbance is prolonged and ENMG reveals severe nerve entrapment, or if motor weakness develops, surgical management should be considered.
Sics Editore Entrapment of the lateral femoral cutaneous nerve in the inguinal area Seen especially in middle-aged overweight men. Symptoms include numbness, paraesthesias and burning pain in the anterior and lateral aspects of the thigh, which is aggravated by all movements of the hip region. The diagnosis is clinical; machine-assisted diagnostic investigations are needed in special cases only. High tendency of spontaneous recovery
Sics Editore Septic infections warranting immediate treatment should be identified. One should be able to clinically suspect a possible fracture of the femoral neck (including a stress fracture) even prior to x-ray to avoid additional damage due to weight bearing .
Sics Editore The aim in the prevention and treatment of osteoporosis is to prevent fractures.In prevention of osteoporosis on the population level it is essential to ensure sufficient intake of calcium and vitamin D and to advise proper exercise habits as well as cessation of smoking. Diagnosis of osteoporosis is the responsibility of primary care. Bone density measurements should be targeted at risk groups (see table ). General, non-targeted DXA-screening is not indicated . Bone density measurements targeted at persons with increased risk are cost-effective and should be a part of the public health care. The treatment yields most benefit for those patients who already have a history of a low energy fracture, usually after a fall on flat ground. Patients who have experienced such a fracture should be referred to bone density measurement or directly to treatment. They have a 2-4-fold risk of refracture. Causes of secondary osteoporosis should be identified and treated accordingly (e.g. hyperparathyroidism, hyperthyroidism, Cushing's syndrome, hypogonadism, uraemia, coeliac disease, myeloma, glucocorticoid therapy, rheumatoid arthritis). Bisphosphonates are the first line drugs in the treatment and prevention. Oestrogen therapy is suitable also in the prevention and treatment of osteoporosis in women who have postmenopausal symptoms that require treatment and who have no arterial disease. The success of pharmacological treatment is assessed by bone density measurements and, on the population level, by the decrease in complications.
Sics Editore Surgery is favoured in competing athletes and in cases where the rupture has become chronic. Conservative treatment is a good alternative for managing acute ruptures in normally active patients as well as in elderly and non-active patients.
Sics Editore Assess the biomechanical function and functional disturbance of the foot by clinical and radiological examinations. An observed functional disturbance is treated conservatively or surgically depending on the symptoms caused by the condition. The need and method of surgery is decided upon individually.
Sics Editore Septic arthritis should be diagnosed and treated as a medical emergency in the nearest hospital. Causes requiring specific treatment should be excluded within a time span of 2 weeks. All cases of suspected rheumatoid arthritis must be referred for specialist health care without delay. Gout can be diagnosed and the treatment started in primary health care. Osteoarthritis is principally treated in primary health care, and it should be differentiated from inflammatory joint conditions . Polyarthritis of recent onset should initially be considered as rheumatoid in origin. Laboratory tests, other than inflammatory parameters and rheumatoid factor (RF), should be requested with restraint. Imaging studies often confirm diagnosis. Local care pathways should be observed.