1/10. Malleolar bursitis in figure skaters. Indications for operative and nonoperative treatment.Figure skaters are unique athletes who must train for extended periods of time performing motions and routines that create excessive compressive and shear forces between their malleoli and boots. As a result, they are susceptible to the development of a painful adventitious malleolar bursitis. Most often these patients will relate a recent increase in their training schedule or the purchase of a new pair of skating boots. This condition usually responds favorably to nonoperative measures including stretching of the boot over the affected area and protective padding placed around the inflamed bursa. If the swelling is marked, then an aspiration, subsequent injection with cortisone, and a compressive wrap may be indicated. This treatment regimen will enable the majority of figure skaters to continue skating. If the symptoms continue or increase despite nonoperative measures, then cessation of skating for a brief period must be considered. If this is not a viable option for the skater, surgical excision of the bursa may be warranted. If septic bursitis occurs, immediate surgical debridement and intravenous antibiotics are indicated. A Staphyloccocus aureus organism is most often responsible and should be treated with appropriate antibiotics. These patients may return to skating when there is no sign of further infection, the soft tissues have fully healed, and there is no sign of residual inflammatory bursa, usually at 4 to 6 weeks after surgery.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/10. End-range mobilization techniques in adhesive capsulitis of the shoulder joint: A multiple-subject case report.BACKGROUND AND PURPOSE: The purpose of this case report is to describe the use of end-range mobilization techniques in the management of patients with adhesive capsulitis. CASE DESCRIPTION: Four men and 3 women (mean age=50.2 years, SD=6.0, range=41-65) with adhesive capsulitis of the glenohumeral joint (mean disease duration=8.4 months, SD=3.3, range=3-12) were treated with end-range mobilization techniques, twice a week for 3 months. indexes of pain, joint mobility, and function were measured by the same observer before treatment, after 3 months of treatment, and at the time of a 9-month follow-up. In addition, arthrographic assessment of joint capacity (ie, the amount of fluid the joint can contain) and measurement of range of motion of glenohumeral abduction on a plain radiograph were conducted initially and after 3 months of treatment. OUTCOMES: After 3 months of treatment, there were increases in active range of motion. Mean abduction increased from 91 degrees (SD=16, range=70-120) to 151 degrees (SD=22, range=110-170), mean flexion in the sagittal plane increased from 113 degrees (SD=17, range=90-145) to 147 degrees (SD=18, range=115-175), and mean lateral rotation increased from 13 degrees (SD=13, range=0-40) to 31 degrees (SD=11, range=15-50). There were also increases in passive range of motion: Mean abduction increased from 96 degrees (SD=18, range=70-125) to 159 degrees (SD=24, range 110-180), mean flexion in the sagittal plane increased from 120 degrees (SD=16, range=95-145) to 154 degrees (SD=19, range=120-180), and mean lateral rotation increased from 21 degrees (SD=11, range=10-45) to 41 degrees (SD=8, range=35-55). The mean capacity of the glenohumeral joint capsule (its ability to contain fluid) increased from 10 cc (SD=3, range=6-15) to 15 cc (SD=3, range=10-20). Four patients rated their improvement in shoulder function as excellent, 2 patients rated it as good, and 1 patient rated it as moderate. All patients maintained their gain in joint mobility at the 9-month follow-up. DISCUSSION: There seems to be a role for intensive mobilization techniques in the treatment of adhesive capsulitis. Controlled studies regarding the effectiveness of end-range mobilization techniques in the treatment of adhesive capsulitis are warranted.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
3/10. Adhesive capsulitis of shoulder and treatment with protease inhibitors in patients with human immunodeficiency virus infection: report of 8 cases.OBJECTIVE: To describe our experience with human immunodeficiency virus (HIV) infected patients receiving protease inhibitor therapy who presented with adhesive capsulitis of the shoulder. methods: Between July 1996 and December 1999, 8 HIV-infected patients (7 male) treated with protease inhibitors who presented with adhesive capsulitis of the shoulder were retrospectively identified. diagnosis of adhesive capsulitis relied on clinical features including shoulder pain and both active and passive restricted range of motion (ROM). All available clinical and radiographic data were reviewed. RESULTS: Onset of symptoms was insidious, and at presentation, patients complained of shoulder pain, which was bilateral in 4 of the 8 cases. physical examination showed global restriction of active and passive ROM of the glenohumeral joint. The mean delay between initiation of hiv protease inhibitors and onset of shoulder pain was 14 months (range 2 to 36). The protease inhibitor therapy always included indinavir. No underlying condition associated with secondary adhesive capsulitis of the shoulder, including shoulder trauma, diabetes mellitus, thyroid disease, pulmonary or cardiac diseases could be identified. In all 8 patients, despite continuation of therapy with indinavir, both shoulder pain and restricted ROM completely resolved, after a mean disease course of 7.4 months. CONCLUSION: Adhesive capsulitis of shoulder seems to be a new adverse event of HIV protease inhibitor therapy. In all reported cases, patients were treated with indinavir. Further observations will be necessary to confirm adhesive capsulitis as a side effect.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
4/10. Free anterolateral thigh fasciocutaneous flap with a fat/fascia extension for reconstruction of tendon gliding surface in severe bursitis of the dorsal hand.A 72-year-old man had severe bursitis in his left dorsal hand after resection of a ganglion twisted around the extensor tendons. After resection of the bursa, a free anterolateral thigh fascial flap with a skin island was used to fill the dead space and to reconstruct a two-layer gliding surface of the extensor tendons. The extensor tendons were wrapped in the fascial flap with the fat layer inside. The flap took completely and the patient was free of bursitis without loss of range of finger motion.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
5/10. Arthroscopic management of painful and stiff scapulothoracic articulation.We present the case of a patient who had chronic refractory scapulothoracic pain accompanied by the loss of scapulothoracic motion. Despite intensive physical therapy, the insidious onset of scapulothoracic pain and stiffness progressed. A wide range of diagnostic tests did not show a systemic, anatomic, or neurologic cause for the disorder. Finally, the patient elected to undergo an arthroscopic release and decompression of the scapulothoracic articulation. The patient had a dramatic response to surgery; the pain was gone immediately, and by 4 months after surgery, her scapulothoracic motion was evaluated as symmetric. One year after the surgery, she maintained an active lifestyle and was extremely satisfied with the result. Progressive and painful loss of shoulder motion in the case reported was due to a rare adhesive inflammation of the scapulothoracic bursa, which was successfully treated using arthroscopic resection. arthroscopy of the scapulothoracic articulation is an option to treat scapulothoracic abnormalities, especially bursitis, but long-term clinical studies are needed to strongly recommend this emerging treatment option.- - - - - - - - - - ranking = 3keywords = motion (Clic here for more details about this article) |
6/10. 'Bald trochanter' spontaneous rupture of the conjoined tendons of the gluteus medius and minimus presenting as a trochanteric bursitis.A 66-yr-old white woman presented with progressive complaints of right lateral hip and thigh pain associated with a disabling limp without an antecedent history of trauma. physical examination revealed localized pain over the right greater trochanter to palpation. A full pain-free range of motion of the right hip was associated with weakness in the hip abductors. The patient ambulated with a compensated right Trendelenburg gait. Subsequent magnetic resonance imaging demonstrated a trochanteric bursitis and an effusion of the hip and a full-thickness tear of the gluteus medius muscle, with both a disruption and retraction of the tendon of an atretic gluteus minimus muscle. Conjoined tendon pathology of both the gluteus medius and minimus as, revealed by magnetic resonance examination, is probably more frequent than heretofore commonly recognized. In patients presenting with "intractable" complaints of a trochanteric bursitis and an ambulatory limp due to weakness in the hip abductors, imaging studies calling attention to a possible tendon rupture may be diagnostic.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
7/10. The use of occupation-based treatment with a person who has shoulder adhesive capsulitis: a case report.This article describes a case report of the occupational therapy management of a 53-year-old woman diagnosed with primary shoulder adhesive capsulitis. The occupation-based interventions are described through the framework of occupation-as-means. Compensatory occupation, preparatory methods, and purposeful activities are demonstrated as being critical to minimizing connective tissue deformation associated with this condition. This case report indicates that occupation-based intervention should be initiated as soon as a diagnosis is identified to prevent the downward spiral of forced disuse associated with the affected upper extremity. As illustrated by the case report, occupation-based treatment that was provided in a timely manner immediately decreased pain, improved range and quality of motion, and enhanced occupational performance.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
8/10. Adhesive capsulitis of the wrist. diagnosis and treatment.Adhesive capsulitis occurs as a pathologic entity in the shoulder, hip, and ankle joints. Thickening and contracture of the wrist joint capsule were demonstrated on arthrograms performed on ten patients ranging in age from 20 to 82 years. The patients had pain and limited range of motion in the wrist. The findings included: (1) resistance to the injection of smaller than normal volumes of contrast material, (2) obliteration of recesses, and (3) extravasation of the contrast agent along the needle tract. Closed manipulation under general anesthesia of the wrist on four patients resulted in some improvement in range of motion. A distal ulna fracture in one older patient occurred as a complication of manipulation. Careful technique and judicious patient selection are of paramount importance.- - - - - - - - - - ranking = 2keywords = motion (Clic here for more details about this article) |
9/10. Calcifying supracoracoid bursitis as a cause of chronic shoulder pain.A case of chronic shoulder pain is reported with marked limitation of both active and passive elevations and a normal range of motion of the glenohumeral joint. X-ray examination demonstrated cloudy calcification in the coracoclavicular region, presumably indicating calcifying supracoracoid bursitis.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
10/10. Conservative treatment of calcific trochanteric bursitis.OBJECTIVE: To present a case of conservatively managed calcific trochanteric bursitis and discuss differential diagnosis and treatment alternatives. CLINICAL FEATURES: A 53-yr-old obese female presented with acute severe lateral hip and posterolateral thigh pain. Examination findings were consistent with trochanteric bursitis and radiographs demonstrated calcific infiltration of the trochanteric bursa. INTERVENTION AND OUTCOME: An intensive 2-wk course of pulsed ultrasound, ice massage, interferential current and chiropractic lumbopelvic manipulation resulted in symptomatic relief, abolishment of palpatory tenderness and return of pain-free passive and resisted range of motion of the hip. CONCLUSIONS: Trochanteric bursitis is a common cause of hip pain. A trial of conservative measures is warranted for this condition, even when calcinosis is present, before more invasive therapies are considered.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
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