11/17. Treatment of traumatic arthritis in children.Although alternatives do exist for the treatment of traumatic arthritis in children, all efforts should be directed to treat the initial condition to avoid its progression to arthritis. Once arthritis is established, then follow the axiom, "treat patients, not x-rays." If despite all attempts at conservative treatment, a surgical option is necessary, then attention must be given to potential future growth, joint stability, and alignment, pain relief, and anticipated postoperative range of motion. All cases must be individualized because, unfortunately, none of the alternatives available is capable of guaranteeing a "normal" end result.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
12/17. Gouty tenosynovitis in the hand.Gouty tenosynovitis can present as an infection, tendon rupture, nerve compression, or digital stiffness. In ten patients, extensive urate deposition was encountered in the extensor tendons at both the wrist and digital levels in addition to involvement of the flexor tendons in the carpal canal and digital theca. Direct nerve or muscle involvement was not observed in the hand. Medical therapy, which is now the cornerstone of treatment for most aspects of gout, may not be the best treatment for tophaceous deposits in the hand. Operative treatment may be required to debulk tophaceous deposits, improve tendon gliding, decompress nerves, allow increased range of motion of joints, and ameliorate pain.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
13/17. A new diabetic with complications: primary nursing care.Martha, an elderly patient, presented a real challenge to our nursing staff. As a new diabetic, she needed a great deal of education in addition to extensive nursing care for her multiple bleeding leg ulcers, dehydration and malnutrition due to uncontrolled diabetes, and reactive depression. Despite these problems, in approximately one month's time Martha was able to return to her home in control of her diabetes and her emotions and ambulating without pain. Her successful return to normal life was enhanced by holistic nursing management. The nursing staff found that the use of a problem list and a diabetes educational plan assisted them in individualizing their patient care.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
14/17. Palmar fasciitis and polyarthritis associated with ovarian carcinoma.Six postmenopausal women (ages 50 to 65 years) developed palmar fasciitis and polyarthritis associated with a malignant ovarian tumor. Rheumatic signs preceded the diagnosis of adenocarcinoma of the ovary by 5 to 25 months. All had bilateral pain and limitation of motion of the shoulders and hands as well as prominent palmar fasciitis and polyarthritis. arthritis of the elbows, wrists, knees, ankles, and feet was also common. Two patients had carpal tunnel syndrome. Nonresectable tumor with ascites and peritoneal metastatic seeding was found in all patients. Endometrioid carcinoma, poor tumor differentiation, and unusually severe stromal proliferation of fibrous tissue were seen. There was no consistent improvement of the musculoskeletal syndrome after corticosteroid treatment or chemotherapy. All patients died 2 to 17 months after diagnosis of the neoplasm.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
15/17. Cricoarytenoid arthritis and ankylosing spondylitis.A variety of systemic diseases may manifest with laryngeal symptoms. Cricoarytenoid arthritis with or without limitation of vocal fold motion is an example. It has been described in up to 25% of rheumatoid patients. Ankylosing spondylitis is classified among the seronegative spondylarthritides. Besides its systemic features, rare reports of cricoarytenoid involvement have been published. Six previous cases reported have been characterized by a long history of ankylosing spondylitis before the cricoarytenoid joint involvement occurred. We describe only the seventh case of cricoarytenoid arthritis secondary to ankylosing spondylitis and the first patient (to our knowledge) to present with bilateral vocal fold fixation as the initial presenting symptom.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
16/17. Corrective osteotomy for scaphoid malunion: technique and long-term follow-up evaluation.Five patients with dorsal intercalated segment instability underwent corrective osteotomy for symptomatic scaphoid malunion. Follow-up examination at an average of nearly 9 years after the procedure (range, 1.5-19 years) revealed that all had improvement in range of motion (ROM). Total active ROM improved from a mean of 127 degrees (range, 95 degrees-165 degrees) to a mean of 156 degrees (range, 95 degrees-214 degrees). Grip strength increased from a mean of 16 kg (range, 14-35 kg) to a mean of 32 kg (range, 24-48 kg). The wrist score improved from an average of 19 to 75. The preoperative intrascaphoid and carpal malalignments were reduced, as demonstrated by trispiral tomography. Symptomatically, all patients reported improvement. All osteotomies healed within 5.5 months of the procedure. No case of avascular necrosis was noted. Mild radioscaphoid arthrosis is apparent in four patients and a preexisting midcarpal arthrosis persists in one patient. Corrective osteotomy for scaphoid malunion may have a role in the prevention or slowing of the onset of premature arthritis in young patients with high functional demands. A technique is described.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
17/17. tuberculosis of the ankle in childhood: clinical, roentgenographic and computed tomography findings.We report on three Italian children who presented with unilateral ankle tuberculosis (TB) consecutively during a short time period and in the same geographical area. A 6-year-old-girl with a family history of TB had limited mobility of the right leg at age 9 months; Mantoux test and radiographs at that age yielded normal findings. When severe right tibiotarsal swelling, reddening, pain and restriction of motion became apparent at age 4.6 years, the typical lesions of TB were evident on radiographs and computed tomographic (CT) scans. Mantoux test and synovial biopsy confirmed TB. A three-drug regimen of treatment proved useless: articular cartilage destruction and diffuse osteosclerosis ensued. Only a four-drug prolonged regimen of treatment proved to be somewhat effective. A 5-year-old girl had a 6-month history of painless swelling and limited mobility of the ankle; radiographs and CT showed osteopenia with marginal erosion of cartilages. A 14-month-old boy presented with a 2-week history of painless swelling ankle. Radiographs showed decreased bone density of talocalcanear bones. Mantoux test and synovial biopsy confirmed TB in both patients; treatment with a three-drug regimen greatly reduced symptoms. A careful suspicion of the diagnosis of tuberculosis is paramount in children with chronic or subacute monoarticular arthritis, even in absence of a positive tuberculin test or abnormalities on chest radiograph. When negative early on, the tuberculin test should be repeated after 6 weeks of arthritis, and a needle biopsy of the synovium is required in those children with monoarticular arthritis and a positive tuberculin test. Careful therapy is necessary to avoid sequelae that may lead to severe osteoarticular damage.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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