1/474. Pubic pain in athletes: a case due to an abscess in the obturator muscle.Pubic pain is a common symptom in soccer players. Its cause can be difficult to determine. We report a case in a 19-year-old soccer player who had an abscess in the obturator internus muscle. We are aware of only one similar report in the literature. Painful limitation of internal rotation of the hip and evidence of infection suggested the diagnosis, which was confirmed by magnetic resonance imaging. In a soccer player, a fever and groin pain do not always indicate osteitis pubis. Limitation of internal rotation of the hip should suggest a lesion in the obturator internus muscle.- - - - - - - - - - ranking = 1keywords = muscle (Clic here for more details about this article) |
2/474. Stereotactic pallidotomy in a child with Hallervorden-Spatz disease. Case report.The authors present a case of Hallervorden-Spatz disease (HSD) in a 10-year-old boy treated with stereotactic pallidotomy for control of severe dystonia. Hallervorden-Spatz disease is a rare type of neuraxonal dystrophy that can be familial or sporadic. This is the first case of HSD reported in the literature in which a pallidotomy was performed. The patient had progressively worsening dystonias and spasms that prevented useful function of his entire right side and eventually threatened his respiratory ability. Pre- and postoperative magnetic resonance images are presented along with electrophysiological recordings made in the globus pallidus at the time of surgery. Functional improvement in the use of the patient's limbs and relief from the painful dystonia were observed. Stereotactic pallidotomy should be considered as a potential treatment in the management of HSD.- - - - - - - - - - ranking = 0.067682301678841keywords = limb (Clic here for more details about this article) |
3/474. Muscle pain as a prominent feature of facioscapulohumeral muscular dystrophy (FSHD): four illustrative case reports.Clinical studies of facioscapulohumeral muscular dystrophy (FSHD) rarely report muscle pain as a significant feature of the condition. We report four adult patients with FSHD in whom muscle pain was a presenting complaint and remains their most disabling symptom. These four patients were investigated using a pain questionnaire and diary. Inflammatory and metabolic causes of muscle pain were sought by muscle biopsy and a range of biochemical investigations. All patients reported between three and seven different pains of varying site and nature. None of the group had more than one painfree day per month and all complained of disturbed sleep. While some pains could potentially be attributed to postural problems, others were clearly myalgic in nature, though most often not specifically exercise-related. These myalgic pains could be particularly difficult to control. Results of metabolic investigations and muscle biopsy revealed no clue to the pathogenesis of these pains and there was no evidence for any exceptional inflammatory response. We believe that pain in FSHD is an under-reported but significant symptom and that further work is necessary to determine its prevalence, understand its cause and provide effective treatment.- - - - - - - - - - ranking = 0.83333333333333keywords = muscle (Clic here for more details about this article) |
4/474. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 0.16666666666667keywords = muscle (Clic here for more details about this article) |
5/474. iliac artery pseudoaneurysm following renal transplantation presenting as lumbosacral plexopathy.A renal transplant patient developed chronic and progressive back and lower extremity pain followed by foot weakness. The correct diagnosis of lumbosacral plexopathy was made after electromyography and nerve conduction studies and the etiology of radiculopathy due to nerve root compression was excluded. This prompted further investigations that led to the discovery of a large internal iliac artery pseudoaneurysm. We emphasize the use of electrodiagnostic studies to investigate patients with back and limb pain for correctly localizing responsible pathology. In this case a potentially lethal situation was correctly identified in a transplant patient.- - - - - - - - - - ranking = 0.067682301678841keywords = limb (Clic here for more details about this article) |
6/474. An unusual manifestation of diabetes mellitus.MEDICAL history: Type 2 diabetes mellitus for five years; unexplained 35-lb weight loss three years ago; Bell's palsy on right side many years ago. MEDICATIONS: glipizide, 10 mg/day. family history: Father died of leukemia at age 65; mother has kidney stones; no diabetes or neuromuscular disease. SOCIAL history: insurance salesman; heterosexual, promiscuous, uses condoms; smokes (25 pack years); does not drink. physical examination: Well-nourished, well developed, not in acute distress; had difficulty rising from a sitting position because of right lower extremity weakness. blood pressure, 154/74; pulse, 88; temperature, 36.6 degrees C; respiratory rate, 16. head, eyes, ears, nose, and throat: normal. neck: normal. heart: S4. Lungs: clear. abdomen: mildly obese. extremities: no cyanosis, clubbing, or edema; atrophy and weakness of right thigh and both calves; wide-based gait; able to walk on toes but not heels. Neurologic responses: cranial nerves intact; deep tendon reflexes, 1 symmetrically; plantar reflexes, flexor bilaterally. skin: macular rash in sun-exposed areas. LABORATORY FINDINGS: Hemoglobin, 13.2 gm/dL; mean corpuscular volume, 80 micron 3; white blood cell count, 7,200/mm3 (normal differential); platelet count, 137,000/mm3. serum: electrolytes, normal; blood urea nitrogen, 18 mg/dL; creatinine, 0.8 mg/dL; glucose, 308 mg/dL; total protein, albumin, liver enzymes, and creatine kinase, normal. urine: 1 glucose. Venereal disease test: nonreactive; hiv test: negative. DIFFERENTIAL diagnosis: dermatomyositis; heavy-metal poisoning; diabetic amyotrophy. HOSPITAL COURSE: The patient was given 50 mg/day of oral amitriptyline to alleviate the painful paresthesias and was switched to 20 U/day of subcutaneously injected neutral protamine Hagedorn (NPH) insulin to normalize the blood glucose level. Histologic studies of skin and muscle showed sun damage and neuropathic changes, respectively. There was no evidence of vasculitis. Screening for heavy-metal toxins produced negative results.- - - - - - - - - - ranking = 0.16666666666667keywords = muscle (Clic here for more details about this article) |
7/474. Current therapy in the management of heterotopic ossification of the elbow: a review with case studies.Heterotopic ossification, or the appearance of ectopic bone in para-articular soft tissues after surgery, immobilization, or trauma, complicates the surgical and physiatric management of injured joints. The chief symptoms of heterotopic ossification are joint and muscle pain and a compromised range of motion. Current therapies for prevention or treatment of heterotopic ossification include surgery, physical therapy, radiation therapy, and medical management. Unlike heterotopic ossification of the hip, heterotopic ossification of the elbow has not been extensively investigated, leaving its optimal management ill-defined. To remedy this deficiency, we review risk factors, clinical anatomy, physical findings, proposed mechanisms, and current practice for treatment and prevention of heterotopic ossification. We then consider and draw conclusions from four cases of elbow injury treated at our institutions (three complicated by heterotopic ossification) in which treatment included surgery, radiation therapy, physical therapy, and medical therapy. We summarize our institutional practices and conclude with a call for a randomized clinical trial to better define optimal management of heterotopic ossification of the elbow.- - - - - - - - - - ranking = 0.16666666666667keywords = muscle (Clic here for more details about this article) |
8/474. pain and the guillain-barre syndrome in children under 6 years old.During a 15-year period, 29 children, under the age of 6 years, with acute guillain-barre syndrome were seen at our institution. A review of their charts revealed that pain was a symptom in all patients and was present on admission in 79% of cases. pain was often the most important symptom and led to misdiagnosis in 20 patients (69%). In 11 of these children, symptoms were present for more than a week before the correct diagnosis was made. The most common pain syndrome was back and lower limb pain, present in 83% of patients. Pediatricians should consider guillain-barre syndrome in their differential diagnosis when faced with a child who has lower limb pain and areflexia.- - - - - - - - - - ranking = 0.13536460335768keywords = limb (Clic here for more details about this article) |
9/474. Tumor-induced osteomalacia and symptomatic looser zones secondary to mesenchymal chondrosarcoma.Tumor-induced osteomalacia is a rare clinical entity that is associated with soft-tissue or skeletal tumors. We present a case report of a patient with a chest wall mesenchymal chondrosarcoma who presented with bone pain. The patient had skeletal changes in the femoral neck and fibula consistent with osteomalacia and laboratory values suggesting phosphate diabetes. The patient was treated with tumor resection and phosphate supplementation with reversal of the signs and symptoms of osteomalacia. Tumor-induced osteomalacia is vitamin-D-resistant and often reversed by complete removal of the tumor. Most commonly, the causative tumors are of vascular, mesenchymal, or fibrous origin. The osteomalacia is associated with bone pain, muscle weakness, and radiographic changes. Tumor-induced humoral factors have been implicated in causing the osteomalacia, but the definite etiology has yet to be determined. Current treatment includes complete tumor resection and electrolyte supplementation.- - - - - - - - - - ranking = 0.16666666666667keywords = muscle (Clic here for more details about this article) |
10/474. Painful supernumerary phantom arm following motor cortex stimulation for central poststroke pain. Case report.In this report, the authors describe a case in which the patient began to experience a supernumerary phantom arm after she received motor cortex stimulation for central pain. The patient had a history of right thalamocapsular stroke. It is speculated that the motor cortex activation triggered a response in the patient's parietal lobe, precipitating perception of the phantom limb. To the authors' knowledge this is the first reported case of its kind.- - - - - - - - - - ranking = 0.067682301678841keywords = limb (Clic here for more details about this article) |
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