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This Paper Will Change Your Practice: Upper Extremity

David Ring MD, PhD

Lessons

n  Deformity doesn’t correlate with impairment

n  Impairment doesn’t correlate with symptoms and limitations

n  Surgery adds injury and potential problems

Lessons

n  Expertise sensitive n  Preference sensitive n  Adaptation and resiliency are good for you

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Lessons

n  Not all fractures can be fixed and moved n  It’s OK to immobilize a joint n  The bone on the other end of the joint can

help you with alignment and fixation

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Lessons

n  Myths: n  “It’s too distal for a brace” n  “The elbow will get stiff”

This fracture doesn’t benefit from surgery

Lessons

n  Recovery is counterintuitive n  Pain trips the alarm n  Treatment

n  Empathy n  Expertise n  Resume normal life roles

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Lessons

n  Surgeons have different opinions and preferences for treatment

n  We are at risk of an error in diagnosis of patient preferences