Cases reported "Pain"

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1/41. 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.
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ranking = 1
keywords = heel
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2/41. magnetic resonance imaging evaluation of heel pain.

    magnetic resonance imaging is superior to radiographic and scintigraphic examination for pathologic evaluation of the musculoskeletal system. magnetic resonance imaging demonstrates increased sensitivity and specificity compared with radiographic evaluation, and equal sensitivity and increased specificity compared with scintigraphic examination. Two case studies of magnetic resonance imaging evaluation of heel pain involving a calcaneal stress fracture and a capillary hemangioma are presented.
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ranking = 5
keywords = heel
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3/41. Atypical heel pain. hyperparathyroidism-induced stress fracture of the calcaneus.

    The authors present a case of atypical heel pain masquerading as plantar fasciitis. The patient was subsequently diagnosed with hyperparathyroidism-induced stress fracture of the calcaneus. The clinical entity of hyperparathyroidism and its manifestations in the skeletal system are presented, as well as a review of stress fractures and pertinent imaging studies.
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ranking = 152.63913278118
keywords = plantar fasciitis, fasciitis, heel
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4/41. Endoscopic release of plantar fasciitis--a benign procedure?

    This is a case report of a patient suffering from subcalcaneal pain syndrome due to plantar fasciitis that was resistant to non surgical treatment. After endoscopic partial release of the plantar fascia the patient was pain free for several weeks, before he became symptomatic again. This new pain was located more proximally. An MRI study showed a stress reaction of the calcaneus.
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ranking = 738.19566390588
keywords = plantar fasciitis, fasciitis
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5/41. Tibialis posterior myofascial tightness as a source of heel pain: diagnosis and treatment.

    STUDY DESIGN: We report 2 cases in which a novel tibialis posterior muscle stretch is used to treat heel pain and lower extremity impairment. OBJECTIVES: To explore dysfunction of the tibialis posterior as a source of heel pain. BACKGROUND: heel pain is a common symptom of orthopaedic dysfunction of the lower extremity. Tibialis posterior tendon dysfunction is well documented in the medical and surgical literature, but its identification in its early or precursive stages has received little attention. methods AND MEASURES: An examination and treatment outline, incorporating a novel assessment and stretching technique, is presented. RESULTS: We identified a stage of dysfunction of the tibialis posterior ("Pre-Stage 1") without clinically identifiable tendon pathology. We refer to this as tibialis posterior myofascial tightness (TPMT). CONCLUSION: Tibialis posterior myofascial tightness is a clinical entity that may be differentially diagnosed in cases of heel pain and specifically treated.
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ranking = 7
keywords = heel
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6/41. Unusual presentation of polyarteritis nodosa.

    We describe an unusual presentation of a localized form of polyarteritis nodosa (PAN) manifested by acute onset of severe calf pain. Biopsies of the gastrocnemius muscle and fascia revealed an acute necrotizing arteritis with fasciitis. The lumens of affected vessels were occluded by thrombi. PAN localized to calf muscles is extremely rare. To our knowledge this is the first report of evidence of fascial involvement believed to contribute to the severity of the clinical features of PAN. The occurrence of multiple intraluminal thrombi in conjunction with anticardiolipin antibodies suggested the possibility of a coexisting coagulopathy, and they were also likely contributors to the severity of the pain.
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ranking = 1.9806496054402
keywords = fasciitis
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7/41. Management of a heavily exuding, painful wound with necrotising subcutaneous infection.

    Wounds with necrotising fasciitis are often malodorous and produce copious exudate. Selecting appropriate dressings can alleviate these symptoms and improve the patient's quality of life within a short time period.
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ranking = 1.9806496054402
keywords = fasciitis
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8/41. Ankylosing spondylitis: a difficult diagnosis in patients on long-term renal replacement therapy.

    We report the case of a 48-year-old male, whose musculoskeletal manifestations, previously related to long-term renal replacement therapy (RRT), were diagnosed as ankylosing spondylitis when symptoms changed their pattern on daily hemodialysis (DHD). The patient started RRT in 1981; in 1985 he received a cadaver graft, which failed in 1987. Secondary hyperparathyroidism, amyloid geoids, bilateral carpal tunnel syndrome and high aluminium levels were present. musculoskeletal pain, reported since 1986, involved feet, heels, hips, shoulders, hands, spine. Symptoms impairing daily life did not improve after parathyroidectomy. He developed chronic hypotension and recurrent atrial fibrillation. In 1994 and 1998, because of thoracic pain, coronarography was performed (normal on both occasions). In June 2000, DHD was started. Equivalent renal clearance increased from 9-12 to 15-17 mL/min. Well-being remarkably improved. In September 2000, musculoskeletal pain worsened and bilateral Achilles tendinitis occurred. The worsening of musculoskeletal symptoms despite the improvements in well-being and other dialysis related symptoms prompted a re-evaluation of the case. The diagnosis of ankylosing spondylitis was based on: history of plantar fasciitis, bilateral Achilles tendinitis, inflammatory spinal pain with limitation of lumbar spine mobility (positive Schober test), radiological evidence of grade 2 bilateral sacroiliitis, presence of HLA-B27. This diagnosis cast light on the episodes of chest pain, explained by enthesopathy at the costosternal and manubriosternal joints and atrial fibrillation, due to HLA-B27 associated impairment in heart conduction. This case exemplifies the difficulty of differential diagnosis of multisystem illness in patients with long RRT follow-up.
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ranking = 148.63913278118
keywords = plantar fasciitis, fasciitis, heel
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9/41. Managing wound pain in patients with vacuum-assisted closure devices.

    The etiology and management of wound pain for patients with vacuum-assisted closure devices can be complex. patients, such as the patient with necrotizing fasciitis described in this case study, may experience all three types of pain described in the Chronic Wound Pain Experience Model--acute noncyclic, acute cyclic, and chronic. Strategies that include local wound management to reduce all three types of pain and holistic psychological care to reduce the ache and anguish that may accompany dressing change procedures may help provide comfort and reduce pain and suffering.
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ranking = 1.9806496054402
keywords = fasciitis
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10/41. Differential diagnosis and treatment of subcalcaneal heel pain: a case report.

    OBJECTIVE: To describe the examination and intervention strategy utilized in the differential diagnosis and treatment of a patient with subcalcaneal heel pain. BACKGROUND: The patient was a 44-year-old man with an 8-month history of left subcalcaneal heel pain. He presented with a chief complaint of limited standing and walking tolerance secondary to pain in the left heel. He had not responded to previous treatments of rest, anti-inflammatory medication, cortisone injections, and exercise prescription. MATERIALS AND methods: The patient's subcalcaneal heel pain was reproduced utilizing the straight leg raise (SLR) in combination with ankle dorsiflexion and eversion to sensitize the tibial nerve. These findings suggested a neurogenic component to the dysfunction. Because restricted ankle dorsiflexion, excessive pronation, and posterior tibialis weakness were also found, mechanical dysfunctions also likely contributed to the etiology of heel pain. The patient was treated for 10 visits over a period of 1 month. Treatment consisted of active and passive motions aimed at restoring pain-free soft-tissue motion along the course of the tibial nerve. In addition, low-dye taping and therapeutic exercises were utilized to control excessive pronation and reduce stress on the plantar structures of the foot. RESULTS: The patient's SLR increased from 42 degrees to 54 degrees and became pain-free. Dorsiflexion range of motion increased from 3 degrees to 8 degrees in the left ankle, and left posterior tibialis strength was normalized. Over a period of 1 month the patient's symptoms were resolved, and his standing and walking tolerance was fully restored. CONCLUSION: Assessment and potential contribution of neural dysfunction should be considered in patients with subcalcaneal heel pain.
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ranking = 10
keywords = heel
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