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Evaluation and Diagnosis of Wrist Pain: A Case-Based Approach

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Patients with wrist pain commonly present with an acute injury or spontaneous onset of pain without a definite traumatic event. A fall onto an outstretched hand can lead to a scaphoid fracture, which is the most commonly fractured carpal bone. Conventional radiography alone can miss up to 30 percent of scaphoid fractures. Specialized views (e.g., posteroanterior in ulnar deviation, pronated oblique) and repeat radiography in 10 to 14 days can improve sensitivity for scaphoid fractures. If a suspected scaphoid fracture cannot be confirmed with plain radiography, a bone scan or magnetic resonance imaging can be used. Subacute or chronic wrist pain usually develops gradually with or without a prior traumatic event. In these cases, the differential diagnosis is wide and includes tendinopathy and nerve entrapment. Overuse of the muscles of the forearm and wrist may lead to tendinopathy. Radial pain involving mostly the first extensor compartment is commonly de Quervain tenosynovitis. The diagnosis is based on history and examination findings of a positive Finkelstein test and a negative grind test. Nerve entrapment at the wrist presents with pain and also with sensory and sometimes motor symptoms. In ulnar neuropathies of the wrist, the typical presentation is wrist discomfort with sensory changes in the fourth and fifth digits. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers), may increase the risk of ulnar neuropathy. Electrodiagnostic tests identify the area of nerve entrapment and the extent of the pathology.

Also Read: Orthopedic Doctor: Types Of Fractures

Musculoskeletal problems are responsible for up to 20 percent of all visits to primary care offices in the United States. 1  Family physicians are often the first to evaluate and treat wrist pain. Wrist pain is traditionally classified as acute pain caused by a specific injury or as subacute/chronic pain not caused by a traumatic event (Tables 1 and 2). Injuries that cause acute pain may result in contusions, fractures, ligament sprains or tears, and instability. Subacute or chronic pain may result from overuse, have neurologic or systemic causes, or be a sequela from an old injury. Patients with these injuries may have a history of repetitive wrist movement, either occupationally or recreationally. The addition of sensory disturbances, such as numbness or tingling, points to nerve involvement.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.xml.

History and physical examination lead to the correct diagnosis in most cases. The location, nature, timing, and quality of the pain are important clues for narrowing the differential diagnosis. In acute wrist injuries, plain radiography should be obtained with anteroposterior, lateral, and oblique views. When the diagnosis remains unclear, further imaging, such as bone scan, ultrasonography, computed tomography, or magnetic resonance imaging (MRI), may help identify the cause. Because nontraumatic wrist pain has a wide differential diagnosis, the patient history should include a review of systems with neurologic or constitutional symptoms, as well as a social history of vocational and recreational activities. The following case studies discuss the background and presentation of three causes of wrist pain, as well as diagnostic tests and strategies.

Case 1. Scaphoid Fracture

A 21-year-old man presents with dorsal left wrist pain after falling onto his outstretched hand while inline skating. He noted immediate swelling and painful wrist extension. Physical examination reveals soft tissue swelling with limited motion, mostly in extension, secondary to pain. There is bony tenderness along the distal radius as well as the anatomic snuff box. His sensory and vascular examination results are unremarkable.

BACKGROUND

The wrist comprises eight carpal bones (Figure 12), but only the lunate and scaphoid articulate with the radius and absorb significant impact during a fall onto an outstretched hand. The scaphoid is the most commonly fractured carpal bone. The primary vascular supply to the scaphoid originates distally from retrograde branches of the distal radial artery, making the proximal pole of the scaphoid relatively avascular and at higher risk of nonunion and avascular necrosis. Fractures of the proximal and distal portions of the scaphoid each account for 20 percent of scaphoid fractures, and the middle portion accounts for the remaining 60 percent.

 

Figure 1.

The bones of the wrist.

Reprinted with permission from Daniels JM II, Zook EG, Lynch JM. Hand and wrist injuries: part I. Nonemergent evaluation. Am Fam Physician. 2004;69(8):1941.

The peak incidence of scaphoid fractures occurs at about 15 years of age. Because of the weakness of the distal radius compared with the scaphoid, scaphoid fractures are not common in older persons. In young children, the supportive cartilage surrounding the ossific nucleus of the immature scaphoid creates protection, making physeal injuries of the radius more common.

Also Read: Orthopedic Doctors In Florida: Facts About A Proximal Humerus Fracture

PRESENTATION

The typical history of a patient with a scaphoid fracture is a fall onto an outstretched hand with the wrist dorsiflexed and radially deviated. Most patients with scaphoid fractures present shortly after a fall, but in some cases, the initial pain improves, causing a delayed presentation.

Physical examination may reveal a swollen wrist. Tenderness is usually located dorsally around the distal radius. Patients may have painful wrist extension and loss of grip strength if they present a few days after the injury.

There are no reliable clinical tests to rule out a scaphoid fracture. Swelling of the anatomic snuff box (Figure 2) increases the likelihood of a scaphoid facture. The combination of snuff box swelling, scaphoid tubercle tenderness, and pain with axial pressure on the first metacarpal bone has a sensitivity of approximately 100 percent. However, the specificity of each test is 9, 30, and 48 percent, respectively. Diminished grip strength compared with the contralateral side increases the positive predictive value for a scaphoid fracture. The differential diagnosis of a suspected scaphoid fracture is listed in Table 3.

Figure 2.

Anatomic snuffbox. The scaphoid is located below the snuffbox.

Reprinted with permission from Phillips TG, Reibach AM, Slomiany WP. Diagnosis and management of scaphoid fractures. Am Fam Physician. 2004;70(5):880.

DIAGNOSTIC TESTS

Conventional radiography (anteroposterior, lateral, and oblique views) alone can miss up to 30 percent of scaphoid fractures. Based on retrospective studies, sensitivity improves if additional views are added (i.e., posteroanterior in ulnar deviation, pronated oblique, and supinated oblique). In many cases, repeat radiography is needed in 10 to 14 days to observe sclerosis, which indicates a healing fracture.

If the diagnosis cannot be confirmed with plain radiography, a bone scan or MRI can be performed. Bone scan has a sensitivity near 100 percent but produces false-positive results up to 25 percent of the time. MRI within one day after trauma has a sensitivity of 80 percent, but late examination (more than 10 days after injury) has a sensitivity and specificity comparable to bone scan.

DIAGNOSTIC STRATEGY

If a scaphoid fracture is suspected based on history and physical examination, plain radiography should be performed, including specialized views such as a posteroanterior in ulnar deviation and a pronated oblique. If radiography is negative for fracture but clinical suspicion is high, the wrist should be protected in a thumb spica cast with the option of repeat plain radiography in 10 to 14 days or a bone scan one to two days after injury. If repeat plain radiography is negative but wrist pain persists, MRI should be performed to clarify the diagnosis.

Case 2. Ulnar Neuropathy

A 39-year-old right-handed woman presents with a four-week history of wrist pain and numbness and tingling in her right hand. There is no history of trauma or injury to the neck, elbow, or wrist. She works mostly at a desk job but has not had any changes in her work schedule. Physical examination of the wrist reveals no soft tissue swelling, muscle atrophy, or skin changes. She has painful wrist extension, as well as reproduction of the tingling in her fifth finger with tapping over the pisiform. Grip strength is normal and no other bony tenderness is appreciated.

BACKGROUND

The ulnar nerve originates from the C8 and T1 nerve roots (Figure 3), and extends from the medial cord of the brachial plexus through the axilla, innervating the muscles of the forearm and the hand. Proximal to the wrist, dorsal and palmar cutaneous branches split off, whereas the rest of the nerve courses through the Guyon canal (Figure 4) to the palmar surface of the hand. This triangular canal is bordered medially by the pisiform, laterally by the hamate, anteriorly by the tendon of the flexor carpi ulnaris, and posteriorly by the transverse carpal ligament. In the canal, the ulnar nerve splits to a superficial sensory branch, which supplies sensation to the hypothenar eminence, and to a deep motor branch that innervates the hypothenar muscles, adductor pollicis, and flexor pollicis brevis. The ulnar nerve may be compressed anywhere in the Guyon canal, causing motor, sensory, or mixed deficits. Compression is usually caused by ganglion cysts or repetitive trauma.

Ulnar nerve entrapment is the second most common neuropathy of the upper extremity, surpassed only by median nerve entrapment (i.e., carpal tunnel syndrome). Although the true incidence of ulnar neuropathy at the wrist is not well documented, it is accepted to be the second most common site after compression at the elbow. Ulnar neuropathies are slightly more common in men than in women. Peak incidence is in men older than 35 years.

PRESENTATION

The typical presentation in ulnar neuropathy is wrist discomfort with sensory changes in the fourth and fifth digits. Grip weakness may be present in chronic cases. History usually reveals no specific injury. Activities that involve repetitive or prolonged wrist extension, such as cycling, karate, and baseball (specifically catchers) may increase the risk of ulnar neuropathy.

Physical examination of a patient presenting with these neurologic symptoms should include cervical spine, shoulder, and elbow examinations to rule out a proximal lesion. Reproduction of pain on neck movement could indicate cervical disk disease; pain with shoulder motion could indicate a brachial plexus problem; and reproduction of symptoms with compression of the nerve at the ulnar groove could indicate compression at the elbow. Compression of the ulnar nerve at the Guyon canal should cause weakness of the hypothenar muscles innervated by the deep motor branch and sensory disturbances of the fifth digit innervated by the superficial sensory branch.

Clinical tests include a positive Tinel sign on percussion of the ulnar nerve over the Guyon canal, as well as a positive Phalen sign (maximum passive flexion of the wrist for more than one minute) with paresthesias in the fourth and fifth fingers. Unlike in carpal tunnel syndrome, sensitivity and specificity of these tests for ulnar neuropathy at the wrist are not known. The differential diagnosis of suspected ulnar neuropathy at the wrist is listed in Table 4.

DIAGNOSTIC TESTS

Plain radiography evaluates wrist anatomy well, and can identify fractures, dislocations, or soft tissue masses that may have led to nerve compression.

Ultrasonography of peripheral nerves is helpful in identifying compressive etiologies of nerve injury and in visualizing structural nerve changes. It is noninvasive, relatively inexpensive, and well tolerated by patients.

Electromyography and nerve conduction studies can be helpful in identifying the area of entrapment and documenting the extent of the pathology. Motor and sensory conduction velocities are more useful in acute entrapments, whereas electromyography is a better choice for chronic neuropathies because it shows axonal degeneration more clearly. The sensitivity and specificity of these electrodiagnostic tests in the primary care setting are unknown because existing studies are limited to a small number of patients with known neuropathy.

MRI can detect abnormalities of the ulnar nerve, flexor tendons, vascular structures, and the transverse carpal ligament around the Guyon canal. Neurogenic edema can be seen as early as 24 to 48 hours after denervation compared with electromyography, in which changes after denervation are not seen for one to three weeks. Imaging criteria for neuropathy on MRI are not well defined, and several studies have found MRI abnormalities in healthy, asymptomatic patients.

DIAGNOSTIC STRATEGY

If ulnar neuropathy is suspected, plain radiography should be ordered first. If no obvious mass or lesion is found, electrodiagnostic tests should be ordered to localize the lesion, measure its severity, and aid in the prognosis. In the setting of inconclusive or nonlocalizing electrodiagnostic test results, ultrasonography or MRI may be useful.

Case 3. De Quervain Tenosynovitis

A 31-year-old woman presents with several months of worsening radial left wrist pain that started insidiously. She denies any specific trauma. She has no numbness or tingling in the wrist, hand, or fingers. Her pain worsens with gripping and grasping, and with picking up her nine-month-old daughter. Physical examination reveals no discoloration and minimal soft tissue swelling along the radial styloid and anatomic snuff box. There is soft tissue tenderness about the anatomic snuff box and radial styloid. She has limited motion of the thumb, with pain mostly in extension and abduction. Her sensory and vascular examinations are unremarkable.

BACKGROUND

Two major dorsal tendons of the thumb are involved: the extensor pollicis brevis and the abductor pollicis longus (Figure 5). [ corrected] These tendons comprise the lateral border of the anatomic snuffbox, with the extensor pollicis longus medially and the scaphoid bone at the bottom. The two tendons have similar function in bringing the thumb into radial abduction. These tendons run in a synovial sheath in the first extensor compartment of the hand. Inflammatory changes in the sheath and tendons result in a tenosynovitis. Recurrent or persistent inflammation may result in stenosing tenosynovitis.

PRESENTATION

The typical presentation includes subacute radial wrist pain at the thumb base and into the distal radius. In retrospect, patients may identify a new or repetitive hand-based activity as the cause, but the etiology often is idiopathic. De Quervain tenosynovitis is more common in women, particularly those 30 to 50 years of age. New mothers are especially noted to have this problem from picking up a child.

Physical examination may reveal a minimally swollen wrist. Tenderness is usually located over the radial tubercle and sometimes around the soft tissues of the anatomic snuff box. Thumb motion is invariably painful. Neurovascular examination should be unremarkable. The Finkelstein test is confirmatory because it has good sensitivity and specificity. It is performed by making a fist over the thumb and then moving the hand into ulnar deviation, which passively stretches the thumb tendons over the radial styloid A grind test of the thumb, which is performed by axial compression and slight rotation of the metacarpophalangeal joint, should be negative in those with de Quervain tenosynovitis but positive in those with first carpometacarpal osteoarthritis. The differential diagnosis of suspected de Quervain tenosynovitis is listed in Table 5.

DIAGNOSTIC TESTS

The diagnosis is clinical based on history and examination. In cases where osteoarthritis of the carpometacarpal joint is considered, pain relief with diagnostic lidocaine (Xylocaine) injection of the first extensor compartment excludes arthritic cause. Radiography, electromyography/nerve conduction studies, blood tests, and MRI or ultrasonography may be used to evaluate for alternative diagnoses.

DIAGNOSTIC STRATEGY

If the history and examination are consistent, no further diagnostic testing is needed. For suspicion of fracture or arthritis, radiography is an appropriate first step. If suspected, radial nerve abnormalities may be ruled out with electromyography or nerve conduction studies. If there is concern for infectious tenosynovitis, a complete blood count and measurement of inflammatory markers, such as erythrocyte sedimentation rate and C-reactive protein levels, are appropriate. If the patient does not respond to treatment or if the diagnosis is in question, an MRI or musculoskeletal ultrasonography may be ordered to further evaluate the first extensor compartment.

Data Sources: A PubMed search was completed in Clinical Queries using the key terms scaphoid fracture, ulnar neuropathy, and de Quervain’s. The search included meta-analyses, randomized controlled trials, clinical trials, and reviews. Also searched were Essential Evidence Plus, the Cochrane database, the National Guideline Clearinghouse, and UpToDate. Search date: August 2011.

Also Read: Long Bone Fractures and Complications

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Things To Do In Cocoa Beach This Fall

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Cocoa Beach

Cocoa Beach is a Florida city south of Cape Canaveral Air Force Station. It’s a gateway to the Kennedy Space Center Visitor Complex, which has rockets and iconic artifacts.

The city is known for its beach and surf breaks. The Florida Surf Museum traces the sport’s local history, and nearby Cocoa Beach Pier has eateries and shops. The maritime forest at oceanfront Lori Wilson Park attracts assorted birdlife as well.

Want to know more about vacation packages in Cocoa Beach and fun things to do in Cocoa Beach? Here’s your list of the best Cocoa Beach attractions and activities for the whole family to enjoy.

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Park Yourself by the Shore


You’ll find one of the area’s loveliest escapes at Lori Wilson Park. Aside from its clean, wide beach, thick with golden-hued sand, the park boasts free parking. Remember to wander the nature trail while you’re there, as well. It winds into a maritime hammock, lush with live oak, palmetto and greenery. You’ll feel like civilization is a world away.

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Ride a Wave


Cocoa Beach is renowned for its calm, consistent waves. That, combined with the fact the water is shallow enough to simply wade out past the breakers, makes it an ideal place to learn to surf. You can take a lesson, rent a board, or bring your own. It’s one of the best places to surf in the state, making it one of the top things to do in Cocoa Beach.

Image result for Cocoa Beach Pier

 

 

Explore the Cocoa Beach Pier


The Cocoa Beach boardwalk stretches 800 feet over the Atlantic Ocean. Besides giving you a swell view of the beach, it’s brimming with shops, restaurants and boutiques. Don’t miss noshing on a juicy fish sandwich at the Atlantic Ocean Grille.

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Discover Ron Jon Surf Shop


This iconic Ron Jon Surf Shop is the world’s largest surf shop, encompassing 52,000 square feet. The store, which is one of the top Cocoa Beach attractions, is open 24 hours a day, and offers everything you could possibly need for the beach lifestyle, including bikinis, surf boards, clothing and sports gear. With its fish tanks, glass elevators and flowing waterfalls, it’s worth discovering even if you don’t feel like shopping.

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Eat Outside


Fat Kahuna’s Beach Side Grille boasts breezy outdoor seating and a gorgeous ocean view. Or escape indoors into a cool, air-conditioned paradise complete with soft background Hawaiian music, a wraparound bar and fullscreen television, featuring non-stop surf footage. Shark tacos, anyone?

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Paddle Peacefully


Enjoy a nature tour kayaking the Thousand Islands with Adventure Kayak or Fin Expeditions. You’ll see manatee, dolphin, and many species of birds while paddling through tropical mangroves.

Fun in the Sun


Take your pick from leisurely or extreme adventures at 321 Kiteboarding and Watersports. They offer stand-up paddle board and kayak rentals as well as kitesurfing and surfing lessons.

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Munch on Lunch


If you have time for a beach lunch, make it Coconuts on The Beach. The location, smack-dab on the Atlantic, is a ten. But the view isn’t all Coconuts offers. Sink your teeth into a Fish Reuben, fish tacos, or fish ‘n chips, and make sure to try the sweet potato fries. Wash it down with an icy beach drink or a pina-colada smoothie.

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Roll into Space


Space Coast Segway Tours invites you to experience the fun and adventure of riding a Segway through sunny Port Canaveral. You’ll snag an up-close-and-personal look around Ron Jon Cape Caribe resort and explore areas by the Ocean and the Port. You may catch a full view of the cruise ships or even a manatee in the locks.

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Conquer the Half Pipe


Cocoa Beach Skate Park is lovingly described by teens as ‘sick,’ and it’s one of their favorite things to do in Cocoa Beach. The park, a friendly, inexpensive haven for kids, boasts two deep bowls and a half pipe, in addition to a grassy area and bleachers where parents can relax.

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Compra La Casa de Tus Sueños en Orlando, FL Cerca a Disney World

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casas en orlando

¿Te imaginas tener una linda casa en Orlando, Florida muy cerca de Disney? Si tienes hijos, este sería todo un sueño. Poder disfrutar en cualquier momento del año uno de los parques más grandiosos del mundo y vivir en una de las mejores zonas de Estados Unidos con un clima espectacular, puede parecer un sueño difícil de cumplir, pero no es así. La compra de casas en Orlando cada día es más accesible. En este post te daré unos consejos para que puedas adquirir cualquiera de las hermosas casas en Orlando que estén disponibles en el mercado.

Also Read: Casas Vacacionales en Orlando, FL Cerca a Disney

¿Por Qué Comprar Casas En Orlando?

1. Ubicación Perfecta

Como lo dijimos, el clima, el lugar, la cultura y los servicios que ofrece Orlando lo convierten en una de las ciudades más paradisíacas y visitadas del mundo. Un excelente lugar tanto para la familia como para una pareja joven.

2. Precios

Aunque no lo creas, las casas en Orlando pueden ser mucho más accesibles que en otras partes de los Estados Unidos.

3. El Tamaño

Además de precios excepcionales y accesibles puedes, puedes conseguir casas en Orlando de gran tamaño y bien cuidadas.

4. Playas

En Florida podrás encontrar 600km o más de playas, siendo muchas de estas importantes y conocidas como South beach. ¿Imaginas una casa donde la playa te quede a una hora o menos?.

5. El clima

Esta es la zona soleada de los Estados Unidos y durante todo el año, las casas en Orlando disfrutan de una temperatura de 20 grados como media. Ni muy frío ni muy caliente, es perfecto.

6. Costo de vida más económico.

Al comprar una casa en Orlando disfrutas del mar, el clima, una casa grande, Disneyland y además el costo de vida es más barato estando por debajo de la media. ¿Qué más se puede pedir?

7. Ahorro De Servicios

Las Casas en Orlando tienen sistema de ahorro energético de electricidad, lo que significa que también ahorrarás en tus gastos mensuales.

8. Seguridad

Esta zona del país suele ser muy segura y se puede llevar una vida placentera y tranquila.

9. Actividades de Ocio

No solo existe DisneyLand, puedes disfrutar del golf, la pesca, una divertida vida nocturna entre otras cosas en esta magnífica ciudad.

Orlando es el sueño de todos los turistas, ¿por qué no vivir en la ciudad soñada? La compra de casas en Orlando hoy es más accesible que nunca. No te pierdas la oportunidad de adquirir tu vivienda.

Consejos Para la Compra de Casas En Orlando Florida.

  • Busca siempre un agente que tenga licencia, ellos te podrán asesorar en todo el proceso legal y bancario que necesites.
  • Compara precio, tamaños y zonas de las casas de Orlando antes de hacer la compra. Hay mucha variedad y puedes encontrar una más grande o más bonita mucho más económica.
  • Verifica que la casa cumpla tus necesidades de vida diaria: transporte, servicios públicos o privados, escuelas, etc.
  • ¡Visita!
  • Revisa los aspectos legales de la vivienda.
  • Ten todos tus documentos necesarios para la compra a mano.
  • Busca una entidad bancaria que te ofrezca un crédito accesible y seguro.

Con estos consejos estás listo para comenzar tu búsqueda, recuerda que un buen asesor te ayudará en el proceso de compra, y si aún no me crees, siempre puedes comenzar viendo la oferta en internet y descubre por ti mismo las oportunidades que puedes tomar.

Visit: Buying A Home First Time 

 

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Cinco lugares para visitar en Orlando, FL

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la ciudad de orlando fl

La ciudad de Orlando, FL es un gran destino turístico dentro de los Estados Unidos debido a la asombrosa cantidad de increíbles parques temáticos que posee, por lo que, si se va de visita a esta ciudad, sea que se hospeda la familia en un hotel o en una casa en Orlando, hay una serie de lugares que no pueden perderse de conocer, siendo evidentemente todos ellos, parques temáticos. A continuación, se presentarán 5 parques temáticos que no pueden dejar de visitarse al ir a vacacionar a la ciudad de Orlando, FL:

Walt Disney World

        El parque temático más grande del mundo y el ícono de los parques temáticos. Pensar en Orlando es pensar en Walt Disney World. En este lugar deben dejarse atrás las preocupaciones de la vida adulta y permitirse envolver en la magia que trae consigo Disney. Una experiencia inolvidable para toda la familia aguarda en este lugar, sobre todo si se va con la compañía de niños con un rango de edad entre 3 a 8 años ya que estos podrán sacarle provecho al máximo a esta magnífica e inolvidable experiencia.

Al tratarse del parque temático más grande y emblemático del mundo, es también el que mayor cantidad de público maneja, por lo que suelen haber largas colas para acceder a las atracciones, por lo que valdría la pena pagar un poco más por un fast past, el cual permite disfrutar de las atracciones sin hacer esas interminables colas.

Visit: Compra De Casas En Orlando

Universal Studios Orlando

           El segundo parque temático más emblemático del mundo. Este parque permite vivir la experiencia a todos aquellos amantes del cine de disfrutar de atracciones y actividades como en sus películas favoritas. Muchas de las instalaciones están ambientadas en escenarios característicos de diversas películas, por lo que, si se es amante de los parques temáticos y del cine, este es el lugar ideal para visitar. Se requieren de al menos dos días bien planificados para disfrutar completamente de la experiencia.

  • Epcot

        Epcot, por sus siglas en inglés de Experimental Prototype Community of Tomorrow o Prototipo de Comunidad Experimental del Mañana. Se trata del segundo parque temático más grande en el interior del Walt Disney World Resort. Está orientado en la cultura internacional y la innovación tecnológica, aunque inicialmente estaba pensado en ser un modelo de una ciudad del futuro.

      Posee una gastronomía muy variada y un excelente sitio de esparcimiento para jóvenes y adultos.

  • Sea World Orlando

        Ideal para los amantes de los parques acuáticos. Además de tratarse de un parque temático, también se trata de un zoológico marino. Posee gran cantidad de montañas rusas acuáticas y numerosas atracciones que exploran de forma maravillosa el mundo acuático.

  • El Mundo embrujado de Harry Potter

             Asombroso parque temático dedicado al extenso y fantástico mundo del mago de Hogwarts, Harry Potter. Un lugar asombroso donde la magia se hace realidad y diversos escenarios de la saga de películas se vuelven palpables, siendo el más emblemático el castillo de Hogwarts.

          Sin duda alguna, Orlando tiene muchos fantásticos sitios para visitar y disfrutar de un viaje en familia muy especial.

Also Read: Tres Motivos Para Comprar Una Casa Vacacional en Orlando, FL

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Lifestyle

Compra casas nuevas en Orlando, FL

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comprar una casa

Adquirir una casa es parte importante en la vida de las personas, y es una decisión que debe ser pensada con calma y analizada con todas sus ventajas y desventajas, estableciendo mentalmente que la vivienda que se está adquiriendo va a ser el sitio en el que se va a residir por al menos un período de tiempo de 2 a 5 años. Orlando, FL suele ser un destino turístico importante en los Estados Unidos y un sitio clave para invertir y adquirir una vivienda.

¿Casa nueva o Casa usada?

            Es bien sabido que en líneas generales cualquier artículo o propiedad usada suele ser más económica que una nueva. Varios factores influyen en esa decisión, principalmente el presupuesto de la persona que decide adquirir una vivienda. Los precios de la mayoría de las casas nuevas en Orlando, FL va desde $200.000 hasta $500.000, y este precio va aumentando según la ubicación de la misma, ya que a medida que éstas se encuentran más cerca de algún parque temático como el de Disney World, su precio va aumentando considerablemente.

             Una casa nueva, aunque sea más costosa que una casa previamente usada, tiene evidentemente una serie de ventajas importantes, entre ellas la garantía de propiedad la cual no suele haberla en aquellas casas que ya han sido usadas, además, otra ventaja muy importante es que las casas nuevas se construyen con alta eficacia eléctrica lo que permite abaratar los costos del servicio de electricidad mientras que aquellas casas usadas no. Aunque una casa nueva sea mucho más costosa es una mejor inversión que la que se puede hacer al comprar una casa vieja o usada.

Visit: Compra De Casas En Orlando

Otros factores que influyen en la compra de una casa

       Una vez se ha establecido un presupuesto con el que se cuenta para comprar una casa en Orlando lo siguiente es elegir en que parte de la ciudad se vivirá ya que eso suele afectar también el coste.

        El comprador debe averiguar cuáles son los sitios de interés cercanos, la seguridad de la zona, el tipo de vivienda que se desea adquirir tomando en cuenta la cantidad de personas que van a vivir en dicha casa, y si el inmueble por todas esas características le conviene o no según su estilo de vida ya establecido.

         Es muy importante siempre al comprar una vivienda no tener una única opción, si no varias, de forma que antes de realizar cualquier tipo de compra se puedan visitar varias casas, preferiblemente en un lapso de varios días si las opciones son muchas. A medida que se van descartando opciones es ideal que aquellas opciones que se han mantenido sea una cantidad no mayor a 3 casas, para que, al momento de decidir la compra definitiva de alguna de las propiedades, las mismas puedan visitarse una última vez en un mismo día.

        En definitiva, lo más recomendable antes de adquirir una vivienda es pedir la asesoría de un agente de bienes raíces que son expertos en este tema y sabrán orientar adecuadamente a los compradores.

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Lifestyle

Tres Motivos Para Comprar Una Casa Vacacional en Orlando, FL

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comprar una casa en orlando

Las casas vacacionales son una excelente opción a la hora de elegir un sitio en donde hospedarse durante un viaje, en especial si se trata de un viaje largo y si se está en compañía de esos seres queridos. La ciudad de Orlando en Florida posee una gran cantidad de parques temáticos llenos de horas y horas de entretenimiento y diversión por lo que puede que en una sola visita no sea suficiente para conocer todo, por tanto, si tú y tu familia son de los que regularmente viajan a Orlando, te presentamos tres motivos para comprar una casa en Orlando:

Vacaciones en familia

Tener un lugar a donde llegar siempre es fundamental, y hay mayor seguridad si dicho lugar es propio. Las casas vacacionales en Orlando son ideales para viajes familiares con una duración mayor a 1 semana donde se desee un ambiente similar al habitual en casa, pero con ese toque de algo diferente, por lo que, si eres de los que quiere disfrutar de unas buenas y merecidas vacaciones familiares, esta es una excelente idea.

Visit: Compra De Casas En Orlando

Cocina completamente equipada

Dentro de los diversos gastos que implica un viaje vacacional, uno de ellos es la comida, lo cual se convierte en un tema difícil sobretodo en viajes largos donde es poco rentable comer toda una familia en la calle por más de una semana. Disponer de una cocina totalmente equipada permite ahorrar una cantidad importante de dinero durante el viaje, bien sea en los almuerzos o durante la visita a los parques temáticos. Si se trata de un viaje largo es en definitiva la opción más rentable ya que siempre será más económico ir al supermercado y cocinar en la casa que comprar comida en la calle constantemente.

Disponibilidad los 365 días del año

Por último y no por ello menos importante, la mayor ventaja en definitiva de comprar una casa en Orlando es la de poder disponer de ella en cualquier momento. Éste tipo de propiedad es muy cotizada por la comodidad que representa por lo que las reservaciones de las mismas suelen hacerse incluso con un año de antelación cuando éstas se van a alquilar, pero si se compra la vivienda estará disponible en cualquier fecha del año, bien sea una temporada alta o baja, y por la cantidad de semanas que se desee.

De igual forma, una manera de sacarle provecho durante las fechas en las cuales no se está utilizando es alquilarla a otras familias que deseen también disfrutar de unas vacaciones en Orlando, de esta forma puede mantenerse la estructura en condiciones idóneas ya que estaría generando un ingreso que a la larga podría ayudar a recuperar parte de la inversión hecha.

En conclusión, si tú y tu familia son amantes de los parques temáticos de Orlando, FL y quieren disfrutar de sus vacaciones fuera, pero con las comodidades necesarias como si estuviesen en su hogar, comprar una casa en Orlando es realmente una excelente inversión a corto, mediano y largo plazo.

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Lifestyle

Types Of Hip Fractures, Treatment Options And Risks

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Hip Fractures

You, or a loved one, were recently admitted to the hospital with a hip fracture. Following the diagnosis it is normal to have questions and concerns. The following patient information was developed to help you better understand hip fractures: the different types, treatment options, risks, recovery and future fracture prevention.

Types Of Hip Fractures

Review of your recent x-ray or CAT scan confirmed that you have a fracture of your hip. There are three common broad categories of hip fractures based on the location of the fracture

  • Femoral neck fractures (sub capital, transcervical),
  • Intertrochanteric fractures, and
  • Subtrochanteric fractures.

Less common are the subtrochanteric fractures, greater trochanter fracture, and less trochanter fracture. Pictures of each of these fractures are illustrated in the figure to the right. The location of the fracture, and whether or not the fracture is displaced, or separated, can effect the recommended treatment.

Treatment Options And Risks

Surgery may be suggested as a treatment option. Surgical repair or replacement is sometimes suggested for femoral neck and intertrochateric fractures. While surgery has risks, there are also risks associated with laying immobilized for long periods including: blood clots, atelectasis (lung scarring), pneumonia, bed sores, urinary tract infections, and muscle wasting. While the surgical risks include those of immobilization, you are able to get up and start moving after surgery, thereby reducing some of the risk associated with prolonged bed rest.

We will attempt to reduce these risks before, during and following surgery. You will be given antibiotics to help reduce the risk of infection at the time of surgery. You will be wearing compression stockings to reduce the risk of blood clots in your legs. Following surgery we will also begin an injectable medication to reduce your risk of blood clots.

The type of procedure the doctor recommends for you is based upon your fracture type, age, activity level, prognosis for recovery, and other illness you have. These treatment options are summarized below.

Femoral Neck Fractures

  • Cannulated Screw Fixation: If the fracture leaves the bone well aligned, and the surgery can be performed in a timely manner, screws may be placed across the fracture site to hold the bone in place while it heals. This is done through a small incision where a guide wire is passed. Over this guide wire, screws are placed hence the term cannulated screw fixation.
  • Hemiarthroplasty: Literally, this means partial hip replacement. If the fracture is displaced (or separated) it will sever the blood supply to the head portion of your femur. In this case a partial hip replacement may be recommended. The head and neck of the femur are removed and replaced with a brand new ball placed into the middle of your thighbone.
  • Total Hip Replacement: If you are a candidate for a partial hip replacement, but in addition you have known arthritis of your hip, a complete hip replacement may be recommended. The cup, or socket, of your pelvis is replaced with new ball and socket replacement.

Intertrochanteric And Subtrochanteric Fractures

  • Open Reduction Internal Fixation: A compression screw is inserted up the femoral neck and into the femoral head. This is either cross linked through a large nail that extends down the inside of the femur or to a plate that runs down the side of the femur and is attached using screws.

Greater Or Lesser Trochanter Fractures

Surgical treatment is typically not necessary. If you have a fracture of the greater trochanter the doctor may ask you to be non-weight bearing for a period of time, followed by a progression of gradual weight bearing. With stress, these fractures can extend to become an intertrochanteric fracture.

Recovery

Hospital stay following a hip surgery is generally 3 days. Occasionally this will extend slightly longer. The nurse and therapist with review precautions that you may have. If your hip was partially or totally replaced you will be warned of hip precautions. These will extend 6 weeks postoperatively. During the first postoperative day, you will begin therapy and take a few steps to sit up in a chair next to your bed. You will be receiving antibiotics and IV pain medication as needed. We will begin your daily injections to prevent blood clots. On the second postoperative day, you will continue therapy and walk a bit further. You will likely switch to oral pain medication. We will continue your daily injections to prevent blood clots. On the third day you will continue therapy, typically walking a few steps prior to discharge. We will continue your daily injections to prevent blood clots.

Following discharge from the hospital it will be important that you have someone to help you until you are independent. We estimate a minimum of a 3-week period. Many patients prefer to go to rehab during this time. This is recommended for safety reasons and allows patients to have daily therapy in a gym type setting. If you plan to go home with a family member or friend, you need 24-hour care for this 3-week period. You will be required to give yourself an injection to prevent blood clots once daily for at least the first 5 days after discharge. Home care (therapy) can be arranged to come into the house approximately 2-3 times per week.

Prevention

You can take steps to prevent a future fracture by treating the underlying cause of your fracture.

  • Get Tested for Osteoporosis: If you have not been tested for osteoporosis with a DEXA test, within the past 24 months, please discuss this with your doctor. We can schedule this test to be performed in the next 6-8 weeks at our office. (Due to positioning, it is typically not recommended sooner following hip surgery.) Knowing what your bone density is can allow steps to be taken to reduce a future fracture.
  • Stop Smoking and do not drink excessively.
  • Fall Proof Your Home: Keep home well lit and free of hazards that may cause you trip/slip and fall.

Also Check Out:

Humeral Shaft Fracture

Flexor Sheath

Flexor Tendon Avulsion

Cruciate Flexor Repair

 

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Lifestyle

Best Injury Lawyers In Port Orange

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Best Injury Lawyers In Port Orange

When you undergo a serious injury, the results are often permanent in some way or form. Whether that means a lifelong limp, a persistent cough, or even just a phobia of the situation that landed you up injured. It’s this kind of permanence that worries most people, but there is another problem that’s almost as serious, and that’s the question of representation.

Personal injury representation can mean the difference between a by-the-numbers court case and (hopefully) payout, and a travesty, where you lose money on top of your injuries. You need representation, and representation you can trust.

Join us today, as we bring you three of the top personal injury lawyers currently in operation in the Port Orange area.

Best Injury Lawyers In Port Orange

Discover the best injury lawyers in Port Orange.

Ward T. Berg

Ward T. Berg, P.A. makes your personal significant injuries their business. Because the nature of these injuries is that they can occur without any outward signs, pain and suffering are often similarly unmeasurable. With their free consultation services, Ward T. Berg offers comprehensive physical injury services, investing their time and resources into each case. Utilizing their extensive industry experience with a focus on this, Ward T. Berg conducts work that earns them their reputation as the best personal injury lawyer in New Smyrna Beach.

Politis & Matovina

Established in 1993, Politis & Matovina has been representing the citizens of Central Florida for more than two decades. From auto accidents to compensation for lost wages and even wrongful death cases, personal injury representation at Politis & Matovina runs the gamut of legal offerings and does it very well indeed.

Brian R. Toung

When a person is seriously injured in an accident resulting from carelessness, they need representation to help them cope with the struggles they’ll experience as a result. Brian R. Toung is a skilled, compassionate personal injury attorney who has been representing Daytona Beach clients since 1983.

Top Personal Injury Lawyers In Port Orange

Personal injury is an unpleasant business. There’s the issue of the injury itself, as well as the fallout and lasting effects these injuries usually bring. But few things can measure up to the legal and financial responsibilities these issues bring with them.

With today’s article on the best injury lawyers in Port Orange, you’ll be prepared when the day comes that you need representation.

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Best Caregivers in Ormond Beach

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caregivers in Ormond Beach

Sometimes, in life, we have to make concessions.

“Sure, gas is cheaper at that gas station, but this one’s closer.”

“I know you wanted to see this movie, but there’s an earlier showing for this movie.”

And it’s alright because, really, they’re usually small, unimportant things that don’t matter in the grand scheme of things. But that doesn’t apply to family members. Or loved ones. The people who mean the most to us.

These are the people who deserve the best we can find for them. Especially when it comes to finding a caregiver. It’s with that in mind that we bring you our list of the five best caregivers in Ormond Beach, today!

Because, sometimes, it just won’t do to settle for anything less than the best.

Caregivers In Ormond Beach: Five Of The Best

Granny Nannies

When it comes to in-home care, few providers out there are even on the same level as Granny Nannies. With a dedicated team of professional, friendly Certified Nursing Assistants (CNAs, to those of you in the biz) and a team ready to help out in any situation, this is an agency that cares.

With their comprehensive services covering everything from companionship services to ambulation and in-home care, there’s no compromise when it comes to Granny Nannies.

Caregivers in Ormond Beach

Discover five of the top caregivers in Ormond Beach, with Web Stark Media

Home Instead

Home Instead offers very good senior care services, with offices from Port Orange to Cassadega. Expect professional administrative services and accommodative staffers. While their services list is a little more basic, their client reviews speak for themselves.

Plan Life Care

When it comes to affordable in-home care services, Plan Life Care is a strong option. Find caregivers to help your loved ones carry out their day to day tasks, for an affordable price. Just what you’re looking for to set your mind at ease.

Concierge Care

From 24-hour care to specific Alzheimer’s and transitional care support services, Concierge Care provides reliable, safe, dependable work for seniors. Friendly staffers help to make the initial transition easier, and Concierge Care will take charge from there.

caregivers in Ormond Beach

Discover the top caregivers in Ormond Beach, with today’s top five list from Web Stark Media

Sonas Home Health Care

Their site promises “24/7 Dependable Home Care” and that’s a perfect way to describe their services. Safe and reliable, Sonas might not be as well known as some of the others on this list, but what they offer is extremely good.

And there you have it – five of Ormond Beach’s best in-home care facilities. When it comes to taking care of your loved ones, you need to know you’re choosing a service that has something reliable behind its name. And with today’s selection, that’s exactly what you’ll be getting.

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In Home Care in Daytona Beach

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in home care in Daytona Beach

Finding in home care in Daytona Beach that matches your needs is a big move. Whether you’re looking for yourself or a loved one, the service has to be medically sound, personable, and uniquely tailored. This is, after all, a new home, and the aim is to feel taken care of.

Join us, today, as we look at professional in home care in Daytona Beach, and find one that works for you.

Granny Nannies

Granny Nannies stands out as one of the foremost caregiver services in the Daytona Beach and greater Volusia area.

For everything from senior home care to special needs and recovery care, this is a full-service agency that puts its customers first. Add to this the impeccable service, attention to detail, and focus on each individual’s specific needs, and Granny Nannies isn’t just good. It’s setting new standards within the industry.

in home care in Daytona

Find the best in home care in Daytona with Web Stark Media

Concierge Care

Concierge Care wears its focus on elderly care on its sleeve. Servicing Florida communities as far north as Jacksonville, Concierge Care offers services ranging from in-home care to senior living transitional services.

Home Instead

In-home care services are only as good as the people who provide them. With that said, Home Instead offers an invaluable service, with professional caregivers who not only provide expert services but also really care about their clients.

America’s Best Caregivers

Family owned and operated caregiver service, America’s Best Caregivers puts their benefits out in front. Professional CNA services covering a wide variety of unique needs, they help elderly people maintain their quality of life.

in home care in Daytona Beach

Onyx Home Care

The focus at Onyx Caregivers is straightforward: quality care and reassuring companionship for elderly clients. Though you might not find much on them, as of yet, there’s a lot of promise here, and we’re impressed with what we’ve seen so far.

In Home Care In Daytona Beach

In home care in Daytona Beach gives our relatives and loved ones a chance to age gracefully, with an understanding caregiver on hand to help with daily living. Hopefully today you’ve found a service that matches your unique needs.

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Lifestyle

Sacha Inchi Oil, Omega 3s, and the Brain

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Sacha Inchi oil

As we grow older, maintaining the health of our brain becomes increasingly important. This has a direct impact on our long and short-term memory, our ability to work, and our emotions. The human body is a machine. As it grows old, over time, certain parts begin to perform less often at their full capacity.

Omega 3 fatty acids are recommended for maintaining brain health and numerous other parts of your body. Studies have revealed links between Omega 3 imbalances and impaired brain performance.

Join us today, as we break down the crucial biological relationship between Omega 3s and the brain. And, for all your Omega 3 needs, make sure to check out Vitazon’s amazing line of Sacha Inchi oil products, one of the world’s most underrated sources of Omega 3 fatty acids.

Sacha Inchi Oil

Learn more about the numerous positive effects Sacha Inchi oil has on your brain.

Omega 3 Fatty Acids: Health Benefits For The Brain

There are more than 100,000,000,000 cells in the human body, and Omega 3 comprises the building blocks that make them up. Bound to the actual membranes of the cells, these oils increase the fluidity important to each brain cell’s function. The benefit of this is in changing and adapting the brain to new information.

Additionally, Omega 3 levels in cell membranes help with the function of neurotransmitter receptors. Neurotransmitters are brain chemicals that communicate information throughout the brain and body. They help to facilitate the ways the brain communicates data.

Early studies have also indicated Omega 3s may increase the growth hormone in the brain, BDNF. This, in turn, increases the production of brain messengers and decreases the rate at which they are destroyed.

A Note On Brain Disorders

New research has begun to suggest a connection between omega-3s and the treatment of cognitive disorders such as depression and bipolarism, schizophrenia and ADHD. While the results of these studies are not yet conclusive, several have linked Omega 3s in low levels within the body with treating these conditions like these.

Sacha Inchi Oil: Get Your Omega 3s Today

Discover the benefits of Omega 3 oils for your brain (and the rest of your body), today, with Sacha Inchi oil supplements from Vitazon.

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