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Choosing Wisely Canada

Canadian Academy of Sport and Exercise Medicine

Tendinopathy is a broad term encompassing painful conditions occurring in and around tendons in response to overuse. Although acute inflammatory tendinopathies (i.e., tendinitis) exist, most patients seen in primary care will have chronic symptoms (tendinosis). Multimodality options (e.g., relative rest, activity modifications, physical or athletic therapy, etc.) should be considered as the first line treatment of tendinopathies. Opiates should not be used in the initial phase of treatment.

Choosing Wisely Canada

Canadian Academy of Sport and Exercise Medicine

Degenerate meniscal tears and osteoarthritis (OA) are extremely common in the general population. Early degenerative changes in the meniscus can be found in many subjects under the age of 30. By 50 to 60 years of age, full degenerative meniscal tears are commonly found in 33-50% of subjects. Unless associated with the presence of osteoarthritis (OA), these degenerative meniscal tears are most often asymptomatic. Magnetic resonance imaging (MRI) is not recommended for degenerative meniscal tears ...

Choosing Wisely Canada

The Canadian Pediatric Neurosurgery Study Group

Chiari I malformation, defined as cerebellar tonsillar herniation greater than or equal to 5mm below the foramen magnum on MRI brain, is a frequent incidental finding in children, with an estimated prevalence of 1 to 3%. The vast majority of children with incidentally discovered, asymptomatic Chiari I malformations have no clinically significant progression of tonsillar descent on routine follow-up, and symptom development is often unassociated with radiographic change. Radiographic follow-up ...

Choosing Wisely Canada

The Canadian Pediatric Neurosurgery Study Group

Positional flattening is very common, affecting up to 40% of infants since the Back to Sleep campaign began in 1992. There is now prospective, randomized control trial evidence that helmeting is no better at improving head shape in mild to severe positional flattening compared with physical therapy and providing general positioning recommendations such as maximizing tummy time while awake, and limiting time in swings and car seats. New guidelines from the Congress of Neurological Surgeons, ...

Choosing Wisely Canada

The Canadian Pediatric Neurosurgery Study Group

Children with hydrocephalus, on average, obtain two head imaging assessments annually until the age of 20. Their lifetime increase risk of fatal cancer is estimated to be 1 excess case of fatal cancer per 97 patients if standard head CT is used, or 1 excess case of fatal cancer per 230 patients if low-dose head CT is used. Head ultrasound (in infants with open fontanelles), and rapid sequence MRI (in all other children) do not require ionizing radiation and adequately assess for radiographic ...