1/4. rheumatology: 14. diagnosis and management of anterior knee pain.A 32-year-old male runner visits his family physician in late spring complaining of pain in his knees over the past month. The pain is mostly anterior but is not well localized. It is aggravated by running, especially on hills, but subsides after the patient stops running. The patient has kept fit during the winter by swimming and occasional cross-country skiing. He has no history of obvious trauma or a noticeable injury.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/4. hepatitis c virus associated arthritis in absence of clinical, biochemical and histological evidence of liver disease--responding to interferon therapy.BACKGROUND: Extrahepatic manifestations associated with hepatitis c virus (HCV) such as arthritis, vasculitis, cryoglobulinemia, are well known. However, HCV related arthritis in the absence of clinical, biochemical and histological evidence of liver disease is not common. This article deals with such a case and its response to interferon therapy. CASE REPORT: We present a case of a 32 year old Filipino male who presented with bilateral symmetrical painful swelling of multiple joints including, hands, elbows, shoulders, and knees. serum rheumatoid factor, antinuclear antibodies and a comprehensive work-up for rheumatologic disorders were all negative. Both initially and subsequently, serological tests for hepatitis a, B, and autoimmune liver diseases, Wilson's disease, hemochromatosis, syphilis, human immunodeficiency virus (hiv) and cryoglobulinemia were negative, initially and subsequently. However, the hepatitis c antibody test was positive and hepatitis c viral rna was detected in high titers. The joint symptoms did not improve despite therapy with nonsteroidal anti-inflammatory drugs and a short course of prednisone prescribed earlier by his primary care physician. The patient then requested and was subsequently treated with interferon alpha 2b. RESULTS: The patient responded rapidly to the interferon therapy with significant and sustained improvement in joint symptoms and disappearance of hepatitis c viral rna from his serum. CONCLUSIONS: HCV arthritis should be considered in the differential diagnosis of seronegative arthritis of undetermined etiology even in the setting of normal liver chemistries.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/4. diagnosis of medial knee pain: atypical stress fracture about the knee joint.STUDY DESIGN: Resident's case problem. BACKGROUND: A 19-year-old female, currently enrolled in a military training program, sought medical care for a twisting injury to her right knee. The patient reported her symptoms as similar to an injury she incurred 1 year previously while enrolled in the same military program. The patient's past medical history included a nondepressed fracture of the medial tibial plateau and complete tear of the deep fibers of the medial collateral ligament. diagnosis: Physical exam revealed nonlocalized anterior and medial knee pain without evidence of internal derangement. Initial knee and tibia radiographs were unremarkable. Referral for orthopedic physician evaluation resulted in concurrence with the therapist's diagnosis and plan of care, and the patient was allowed to continue with limited physical training demands. Despite periods of rest, the patient's symptoms progressively worsened upon attempts to resume running. The examining therapist referred the patient for magnetic resonance imaging (MRI) due to the patient's worsening symptoms, normal radiographs, and concern for a proximal tibia stress fracture. MRI revealed a severe proximal tibial metaphysis stress fracture. DISCUSSION: Stress fractures are commonly encountered injuries in individuals subjected to increased physical training demands. Early evaluation may not yield well-localized findings and may mimic other conditions. Nonmusculoskeletal conditions should be considered in the management of patients with stress fractures. This resident's case problem illustrates the importance of serial physical examinations and collaboration with other healthcare practitioners in the comprehensive assessment and management of a patient with a severe stress fracture.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/4. Medical problems affecting musicians.The physical demands of performing on musical instruments can cause pain, sensory loss, and lack of coordination. Five cases illustrate common problems. knowledge of the interaction between the technique of playing the instrument and the particular musician can help physicians diagnose and resolve problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |