1/29. Endoscopic supraorbital nerve neurolysis.Endoscopic surgery, performed through small incisions, yields therapeutic results equivalent or superior to those obtained using the conventional approach. The technique has been established in laparoscopic cholecystectomic surgery. In plastic surgery, endoscopic techniques were first developed in aesthetic procedures and have been reported to be useful in face-lift operations, breast reconstruction, muscle flap harvesting and subcutaneous surgery. Endobrow lift has become a more and more popular aesthetic procedure. The endoscope provides an excellent magnification and, through a high power light source, a very good illumination of the operative field. It explains why the endoscope is more and more used in reconstructive procedures. We report the case of a patient suffering from a posttraumatic entrapment of the right supraorbital nerve which was released by an endoscopic approach.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/29. Gluteal neuralgia - unusual presentation in an adult with intrasacral meningocele: a case report and review of literature.A nineteen year old man with intrasacral meningocele is reported, who presented with long standing episodic gluteal pain and progressive muscle wasting. magnetic resonance imaging established the diagnosis. Surgical excision relieved the pain but muscle wasting persisted. Pertinent literature is reviewed.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
3/29. Successful use of methadone in the treatment of chronic neuropathic pain arising from burn injuries: a case-study.methadone is used increasingly as a second-line opioid in the management of cancer pain refractory to conventional opioids. Recent case studies suggest that its use as an analgesic could be extended to non-cancer pain, especially neuropathic pain. The present case study reports, for the first time, the efficacy of methadone in a burn patient experiencing neuropathic pain in his healed wounds. The patient sustained extensive (55% total body surface area) chemical burns and developed chronic burning sensations, particularly in the lower limbs where skin grafting had been performed. Conventional pharmacotherapies against neuropathic pain were attempted to control pain for over 5 years. The agents used included long- and short-acting opioids, amitriptyline, clonazepam, and gabapentin, but they all failed to relieve the pain. When methadone (5 mg every 12 h) was introduced, it significantly alleviated the patient's pain within a few days of administration. The patient has now been taking methadone (15 mg every 12 h) for 10 months and reports that the opioid caused 70% pain relief and a 55% amelioration in his quality of life. Although these results are based on a case report, they suggest that a switch to methadone might be useful in some burn patients who have developed chronic neuropathic pain unrelieved by conventional pharmacotherapies. methadone, however, needs to be titrated with vigilance and thus should be administered by a physician experienced with its use in the treatment of chronic pain.- - - - - - - - - - ranking = 0.85329879979499keywords = limb (Clic here for more details about this article) |
4/29. Examination of the variations of lateral femoral cutaneous nerves: report of two cases.The origins, courses and relations of lateral femoral cutaneous nerves (LFCNs) were examined bilaterally in 28 cadavers, and the variations were observed in two. On the right side of one cadaver, the ventral rami of the first and second lumbar spinal nerves were united and then this nerve was divided into four branches. From medial to lateral, these branches were the obturator nerve, the femoral nerve, the medially located LFCN and the laterally located LFCN. On the left side of another cadaver, there were three LFCNs. All of these nerves pierced the psoas major muscle anterolaterally. Two of these nerves, which pierced the psoas major muscle more proximally than the third, united with each other by a communicating branch anterior to the iliacus muscle. These types of variations are very important, especially in the presence of paresthesias or pain in the anterior thigh, lateral thigh and gluteal region. In these cases, surgeons must always remember the possible variations of the LFCN during surgical procedures in order to prevent injury and the occurrence of meralgia paresthetica.- - - - - - - - - - ranking = 3keywords = muscle (Clic here for more details about this article) |
5/29. Neuropathic uterine pain after hysterectomy. A case report.BACKGROUND: Neuropathic pain arises when there is damage to or dysfunction of the nervous system. Diabetic neuropathy, postherpetic neuralgia and phantom limb pain are common types of neuropathic pain. It is not commonly recognized in gynecologic practice. CASE: A patient underwent a hysterectomy for a tuboovarian abscess and underlying endometriosis. Despite maximal dosing with conventional pain medications, she continued to have significant pain that had not been present following prior surgeries. Use of low-dose amitriptyline successfully treated the pain, with no sequelae. CONCLUSION: Persistent pain following gynecologic surgery that does not respond to conventional therapy may have a neuropathic origin. attention to appropriate history and physical examination may lead to an increase in the diagnosis of neuropathic pain in gynecology patients. This may have implications for persistent pain in other gynecologic diseases.- - - - - - - - - - ranking = 0.85329879979499keywords = limb (Clic here for more details about this article) |
6/29. The therapeutic potential of botulinum toxin.BACKGROUND: Botulinum toxin type A (BTX-A; commercial preparation BOTOX) is most well known for its effect on muscle contraction because of the BTX binding to the presynaptic nerve terminal, inhibiting the release of acetylcholine (ACH). The therapeutic benefit of BTX-A, however, can also be isolated to pain relief alone, suggesting that BTX-A also works through additional modes of action. OBJECTIVE: This article provides insight by an experienced physician into four different case reports. Each case demonstrates the therapeutic potential of BTX-A and the possibility of a different mechanism of action for BTX other than the inhibition of ACH release. RESULTS: Four patients, each with different symptoms such as relapsing-remitting multiple sclerosis, postherpetic neuralgia, peripheral neuropathy, and severe tingling caused by herniation of cervical vertebrae at the level of C8, were treated with BOTOX, and their symptoms were alleviated. CONCLUSIONS: The BTX-A mechanism providing pain relief is hypothesized to be something other than muscle relaxation by inhibiting the release of ACH at the neuromuscular juncture, such as inhibition of the release of substance p or the blocking of autonomic pathways, etc. This article is intended to continue to keep physicians using this substance for dermatologic indications aware of the potential unsuspected effects.- - - - - - - - - - ranking = 2keywords = muscle (Clic here for more details about this article) |
7/29. The management of malignant psoas syndrome: case reports and literature review.Malignant psoas syndrome (MPS) was first described in 1990, and is characterized by proximal lumbosacral plexopathy, painful fixed flexion of the ipsilateral hip, and radiological or pathological evidence of ipsilateral psoas major muscle malignant involvement. There have been 23 case reports of MPS in medical journals. Despite being associated with a severe and difficult pain, there is no definitive approach to management presented in the palliative care literature. We review the relevant clinical features and the subsequent multidisciplinary pain management in relation to four new cases of malignant involvement of the psoas muscle, and the 23 case reports in the literature. We propose that MPS comprises a continuum of symptoms and signs related to the degree of anatomical destruction with associated inflammatory reaction and muscle spasm, and also the degree of lumbosacral plexopathy causing neuropathic pain. A protocol is presented for the management of the complex pain issues of MPS directed at likely mechanisms. The treatment options include opioids, agents for neuropathic pain, muscle relaxants to manage psoas muscle spasm, and anti-inflammatory agents to reduce peritumoral edema. Direct anti-tumor measures also need to be considered. Further prospective study is needed to validate the proposed methods of assessment and treatment.- - - - - - - - - - ranking = 5keywords = muscle (Clic here for more details about this article) |
8/29. Perineal-onset Fournier's gangrene in a patient undergoing hemodialysis--importance of perineal-onset manifestation.We present a rare case of perineal-onset Fournier's gangrene in a patient undergoing hemodialysis. A 51-year-old Japanese man manifested an acute-onset perineal pain with perirectal abscess; subsequently, the pain extended to the abdomen, chest, and loin despite quick treatment. His consciousness deteriorated to delirium and he died of septic shock on the third day of admission. Computed tomography (CT) revealed soft-tissue air along the right rectal wall, moreover, the infection extended to the anterior wall of the bladder and the right peripsoas muscle. On the basis of the clinical course and CT findings, the patient was diagnosed as having the complications of Fournier's gangrene, however, no scrotal lesions were detected. Fournier's gangrene is considered to be easily diagnosed on the basis of skin lesions, such as scrotal erythema and swelling. However, in the early stage, the diagnosis of Fournier's gangrene is difficult in a patient with perineal pain before the detection of skin lesions. In conclusion, definitely the key to improving the prognosis of this fulminant infection is the prompt recognition of the pathological process. Therefore, Fournier's gangrene should always be considered when patients undergoing hemodialysis manifest perirectal disorders, even when no scrotal lesions are detected, because there is the possibility of intra-abdominal and intra-retroperitoneal infections resulting in septic shock.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
9/29. Acute painful neuropathy in thallium poisoning.Dysesthesia, allodynia, distal muscle weakness, and sensory impairment were noted in two patients with acute thallium intoxication. Two months later, nerve conduction studies showed an axonal degeneration. sural nerve biopsy disclosed a decreased fiber density in the large myelinated fibers. Quantitative sensory testing also revealed an impairment of pinprick, temperature, and touch sensations. Cutaneous nerve biopsy confirmed a loss of epidermal nerves indicating an involvement of the small sensory nerves.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
10/29. Saphenous nerve injury following medial knee joint injection: a case report.knee joint injection is a procedure commonly performed for pain management of osteoarthritis. Although several techniques have been described, it is usually performed by either medial or lateral approach with the lower limb extended on the examination table. We present the case of a patient who developed saphenous neuropathy following knee joint injection via medial approach. The clinical picture suggests that the needle pierced the nerve during the procedure. The patient was moderately obese. This is the first case report in the literature of saphenous nerve injury following medial knee joint injection. Practitioners should be aware of this complication in choosing an approach to the knee joint injection, especially when the patient is obese and the anatomic landmarks are obscured.- - - - - - - - - - ranking = 0.85329879979499keywords = limb (Clic here for more details about this article) |
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