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A multidisciplinary approach to back pain care is beneficial to address its physical, psychological and social aspects, especially when pain is chronic, avoiding medication if possible.

For primary and recurrent treatment of disk disease, minimally invasive percutaneous endoscopic spine surgery, which uses an endoscope to remove fragments of disk (interlaminar or transforaminal approaches) under local anesthesia, has promise.


Electrodiagnosis can provide information on focal median mononeuropathy at the wrist and can classify carpal tunnel syndrome from mild to severe.


There is an increase in atypical femoral fractures with bisphosphonate use (relative risk 1.7), especially patients of an Asian race in North America, patients with femoral bowing, and patients who had used glucocorticoids.

The most specific study findings to identify hip osteoarthritis include squat causing posterior pain, groin pain on passive abduction or adduction, abductor weakness, and decreased passive hip, or less passive internal rotation compared with the contralateral leg. The presence of normal passive hip adduction was most useful for suggesting the absence of osteoarthritis.

There has not been clear clinical benefit of minimally invasive hip replacement surgery compared to standard invasive surgery, except for less total blood loss, shorter duration of surgery, and a shorter length of stay.


A randomized control trial showed that 2 years of intraarticular triamcinolone every 3 months, compared with intraarticular saline, resulted in significantly greater quantitative cartilage volume loss by MRI and no significant difference in knee pain. This finding suggests that regular use of corticosteroid injections for long-term treatment of knee osteoarthritis should be avoided.

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