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Context: Lyme disease is the most common tick-borne illness in North America and Europe, and Lyme arthritis is a frequent late-stage manifestation in the United States. However, Lyme arthritis has rarely been reported as a postoperative complication., Evidence Acquisition: The PubMed database was queried through June 2018, and restricted to the English language, in search of relevant articles., Study Design: Clinical review., Level of Evidence: Level 3., Results: A total of 5 cases of Lyme arthritis as a postoperative complication have been reported in the literature., Conclusion: These cases highlight the importance for providers practicing in Lyme-endemic regions to keep such an infection in mind when evaluating postoperative joint pain and swelling. We propose herein an algorithm for the workup of potential postoperative Lyme arthritis., Strength of Recommendation Taxonomy (sort): C.

Myositis ossificans is a benign, solitary, frequently self-limiting, ossifying soft-tissue mass encountered often in the active sporting population. Typically occurring within skeletal muscle - most often the brachialis, quadriceps and adductor muscle groups - lesions may arise with or without a traumatic history. The exact pathophysiology of these ossifying lesions is still poorly understood. Patients present with localized pain and swelling with loss of range of motion. Plain radiographs may not be able to detect early lesions, which allows for an expanded role of ultrasonography as an early screening modality, despite magnetic resonance imaging remaining the gold standard for imaging of soft tissue masses. Conservative treatment is implemented for most patients with excellent outcomes, with surgical excision being an option for persistent symptoms or progressive disease. Typically, athletes are able to progress to light activity at 2 to 3 months, full activity by 6 months, and back to their preinjury level by 1 year.

Lumbar spinal stenosis (LSS) is a frequent cause of chronic low back and lower extremity pain in older patients. Symptomatic LSS typically is described as neurogenic claudication consisting of pain, weakness, numbness, and/or fatigue arising in the back and radiating into the buttock, thigh, or lower leg. The diagnosis is complicated by lack of reliable clinical or x-ray criteria. North American Spine Society guidelines recommend magnetic resonance imaging study without contrast to confirm anatomic narrowing of the spinal canal or nerve root impingement. Conservative management options include exercise and drug therapy. Epidural injections can be considered for temporary symptom management. No studies show greater effectiveness of surgical intervention over conservative management in patients with mild to moderate symptoms. Progressive symptoms, emergence of frank neurologic deficit, or findings consistent with cauda equina syndrome are indications to pursue surgical evaluation. Decompression surgery without fusion typically is recommended in the absence of spondylolisthesis or other spinal instability. Active rehabilitation is likely more effective than usual care for improvement in functional status within 12 months postoperatively without adverse events. Approximately one-third to one-half of patients with mild to moderate LSS symptoms may have a favorable prognosis., (Written permission from the American Academy of Family Physicians is required for reproduction of this material in whole or in part in any form or medium.)