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Carpal tunnel syndrome costs the United States billions of dollars each year. The majority of patients are industrial workers, females, and the elderly who first present to their primary care physicians. Therefore, it is essential that the primary care physician understand this syndrome in order to diagnose and direct treatment. Here we present a review of the anatomy, pathophysiology, diagnosis, and current treatment of carpal tunnel syndrome that is relevant for the treating primary care physician. In addition, we discuss the role of the primary care physician in the diagnosis, management, and treatment of carpal tunnel syndrome. The aim of this review is to improve the integrated care of those patients suffering from carpal tunnel syndrome., Competing Interests: None of the authors identify any conflicts of interest., (©Copyright 2019 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

The standard practice of preoperative templating may be less important for direct anterior approach (DAA) total hip arthroplasty (THA) with intraoperative fluoroscopy (IF). However, this has yet to be tested. The purpose of this retrospective review was to report the hip offset (HO) and leg length (LL) equalization accuracy following 304 consecutively performed DAA THA with IF and no preoperative templating. A supplemental fluoroscopic gridding tool was used to assess hip symmetry. Operative and fluoroscopic times were also documented to assess for surgical efficiency. The mean HO and LL difference was 3.5 ± 2.6 mm (range: 0.0-9.3) and 2.9 ± 2.2 mm (range: 0.0-9.9), respectively. Hip offset and LL equalization within 10 mm was achieved in all patients. The mean operative time for unilateral THA was 72.2 ± 12.0 minutes, and the mean fluoroscopy time per hip was 10.5 ± 4.5 seconds. These results suggest that for surgeons with adequate experience performing DAA THA with IF, preoperative templating may not be necessary to reliably and efficiently achieve clinically acceptable HO and LL., Competing Interests: None of the authors identify any conflicts of interest., (©Copyright 2019 by University Health Partners of Hawai‘i (UHP Hawai‘i).)

Atrophy and protracted recovery of normal function of the ipsilateral quadriceps femoris muscle following anterior cruciate ligament reconstruction surgery is well documented. The Accelerated Recovery Performance trainer is a type of electrical stimulation device that delivers a high-pulse frequency via a direct current, making it unique from many other devices on the market. The purpose of the present study was to investigate the effects of the direct current (via the Accelerated Recovery Performance trainer protocol) on gains in thigh circumference following anterior cruciate ligament reconstruction. Twenty-five patients were enrolled following isolated anterior cruciate ligament reconstruction and randomly assigned to either an isometric rehabilitation protocol augmented with the Accelerated Recovery Performance trainer protocol (experimental group) or the isometric rehabilitation protocol alone (control group). The two groups participated in sixteen sessions of directed rehabilitation over a two-month time period. Patients were followed with serial thigh circumference measurements at 5, 10, 15, and 20 centimeters above the superior patellar pole. Comparison of the overall mean circumferential gains in thigh circumference of the involved leg demonstrated approximately 3:1 gains in the ARP group over the control group, demonstrating it to be superior to isometric rehabilitation alone with regards to gains in thigh girth. The Accelerated Recovery Performance trainer protocol should be considered for post-anterior cruciate ligament reconstruction rehabilitation in order to reverse disuse atrophy of the ipsilateral quadriceps femoris., Competing Interests: None of the authors identify any conflicts of interest., (©Copyright 2019 by University Health Partners of Hawai‘i (UHP Hawai‘i).)