Papers by Michael Mulligan
Journal of Wrist Surgery, 2018
Background Ulnar styloid impaction syndrome (USIS) is produced by the tip of an oversized ulnar s... more Background Ulnar styloid impaction syndrome (USIS) is produced by the tip of an oversized ulnar styloid inappropriately contacting the triquetrum. This condition results in chondromalacia, synovitis, and ulnar-sided wrist pain. Case Description We report a rare case of bilateral USIS that presented with a prolonged course. The patient's symptoms resolved in both wrists following two separate ulnar styloidectomy procedures. Literature Review Our case differs from previous reports in that it involves a patient whose own history of USIS led to a timelier diagnosis of the same disease in the contralateral wrist. To the best of our knowledge, there are no prior reports of bilateral USIS. Clinical Relevance USIS remains an uncommon cause of ulnar-sided wrist pain and a particularly difficult diagnosis to confirm. Here, we illustrate that this syndrome can be confidently approached using a combination of careful attention to patient history, physical examination, and various imaging me...
Nerves and Nerve Injuries, 2015
The instrumental musician is vulnerable to high-performance musculoskeletal injuries. Nerve entra... more The instrumental musician is vulnerable to high-performance musculoskeletal injuries. Nerve entrapment syndromes are some of the most common and are attributed to the repetitive motions, awkward postures, and long practice hours of the instrumental musician. Although carpal tunnel syndrome and cubital tunnel syndrome are the most common, radial nerve entrapment, digital nerve entrapment, and thoracic outlet syndrome are not uncommon. The clinician must also remember that multiple sites of compression can exist concurrently. History and physical examination are usually enough to make a proper diagnosis, particularly when the musician-patient is evaluated with instrument in hand. When a diagnosis remains unclear, electrodiagnostic and imaging studies can be employed to aide in the workup. Conservative modalities are the mainstay of treatment. Operative intervention is reserved for the most severe refractory cases of entrapment neuropathy.
Orthopedics, 2013
Radiocarpal fracture-dislocations are uncommon injuries, comprising a spectrum of trauma to the c... more Radiocarpal fracture-dislocations are uncommon injuries, comprising a spectrum of trauma to the capsuloligamentous complex and osseous structures of the radiocarpal joint along with the adjacent structures. Management guidelines are derived from limited case series and expert opinions. An understanding of the relevant anatomy suggests that restoration of an anatomically reduced joint in conjunction with repair or reconstruction of the osseous and soft tissue structures optimizes outcome. Special consideration should be given to repair of the radial styloid, intercarpal ligaments, and radiocarpal capsuloligamentous complex. The authors report 2 patients with radiocarpal fracture-dislocations in which reduction and stabilization of the carpus was achieved using suture anchor fixation of the volar extrinsic radiocarpal ligaments.
The Journal of bone and joint surgery. American volume, Jan 6, 2016
The Institute of Medicine considers limited health literacy a "silent epidemic," as app... more The Institute of Medicine considers limited health literacy a "silent epidemic," as approximately half of Americans lack the competencies necessary for making informed decisions regarding their health. Limited health literacy substantially impedes the effective dissemination and comprehension of relevant health information, and also complicates communication, compromises care, and leads to worse patient outcomes. Poor health, early death, and worse control of chronic conditions have also been associated with limited health literacy. Unfortunately, physicians often struggle to identify those with limited health literacy, which can have adverse effects on the physician-patient relationship. In this article, we discuss the meaning of health literacy,the risk factors for and consequences of limited health literacy, orthopaedic-specific implications and investigations, and the strategies orthopaedic surgeons can utilize to improve health literacy and communication.
Orthopedics, 2015
The goal of this study was to evaluate the role of portable primary trauma survey radiographs in ... more The goal of this study was to evaluate the role of portable primary trauma survey radiographs in the evaluation and management of anteroposterior (AP) compression pelvic injuries. A retrospective analysis was conducted at a level I academic trauma center. Twenty-seven adults with AP compressive class pelvic ring injuries who received both portable pelvic radiographs and pelvic computed tomography (CT) imaging in an unbound pelvic state were included. Three orthopedic surgeons performed independent measurements of diastasis on portable pelvic radiographs and coronal pelvic CT reconstructions. Measurement techniques were standardized among observers and were repeated after 8 weeks to assess intraobserver reliability. Nonoperative vs operative treatments were correlated with the initial magnitude of pelvic injury on CT and portable radiographic images. Independent measurements of diastasis on both radiographs and CT scans showed excellent intraobserver reliability (average correlation coefficient, 0.986) and interobserver reliability (average correlation coefficient, 0.979). Compared with diastasis measurements on CT scans, portable pelvic radiographs overestimated diastasis by an average of 49%, or 12.6 mm (P<.0001; 95% confidence interval, 9.6-15.6). Portable pelvic films were less precise than standard pelvic radiographs in measuring the size of femoral head controls (R 2 =0.919 vs 0.759; P=.004). In 12 of the 27 patients evaluated, radiographic indications for operative pelvic fixation were met by portable radiographs but not CT scans, and 11 of these patients ultimately underwent operative fixation. Portable AP pelvic radiographs may distort and exaggerate pelvic bony injuries, especially those involving anterior pelvic structures. Surgeons should use caution when making management decisions based on preliminary portable pelvic radiographs. [Orthopedics. 2015; 38(3):e229-e233.]
HAND, 2016
Background: Approximately 33% of Americans have inadequate health literacy, which is associated w... more Background: Approximately 33% of Americans have inadequate health literacy, which is associated with infrequent use of preventative services, increased hospitalization and use of emergency care, and worse control of chronic diseases. In this study, the Literacy in Musculoskeletal Problems (LiMP) questionnaire was used to evaluate the prevalence of limited musculoskeletal literacy in patients undergoing carpal tunnel release (CTR), as these individuals may be at increased risk of inferior outcomes. Methods: This cross-sectional study included individuals older than or equal to 18 years of age who were scheduled for elective CTR. Participants completed a demographic survey and the LiMP questionnaire during their preoperative office visit. The prevalence of limited health literacy was determined, with chi-square analysis used to determine the influence of demographic parameters. Results: The mean LiMP score was 6 ± 1.40. Limited musculoskeletal literacy was seen in 34% of participants ...
Current Orthopaedic Practice, 2013
Health literacy is considered the single best predictor of an individual's health status. However... more Health literacy is considered the single best predictor of an individual's health status. However, it often is difficult to assess. As such, our group developed the Literacy in Musculoskeletal Problems (LiMP) questionnaire, a musculoskeletal-specific literacy assessment tool. We hypothesized that the degree of inadequate musculoskeletal health literacy would be higher than the rate of inadequate general healthy literacy, as assessed through the Newest Vital Sign (NVS).
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Papers by Michael Mulligan