1/5. Fibro-fatty nodules and low back pain. The back mouse masquerade.BACKGROUND: Few useful interventions exist for patients with persistent low back pain. We suggest that a fibro-fatty nodule ("back mouse") may be an identifiable and treatable cause of this and other types of pain. methods: We describe 2 patients with painful nodules in the lower back and lateral iliac crest areas. In both cases, the signs and symptoms were unusual and presented at locations distant from the nodule. One patient complained of severe acute lower abdominal pain, and the other had been treated for chronic recurrent trochanteric bursitis for several years. RESULTS: In both patients, symptoms appeared to be relieved by multiple injection of the nodule. DISCUSSION: There is agreement that back mice exist. Referred pain from the nodules might explain the distant symptoms and signs in these cases. Multiple puncture may be an effective treatment because it lessens the tension of a fibro-fatty nodule. CONCLUSIONS: Randomized trials on this subject are needed. In the meantime, physicians should keep back mice in mind when presented with atypical and unaccountable symptoms in the lower abdomen, inguinal region, or legs.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/5. Unresolving hip tendonitis leads to discovery of malignant tumor.OBJECTIVE: To discuss a case of malignant bone tumor in the left hip of a patient who sought treatment following a tennis injury. CLINICAL FEATURES: A 27-year-old male patient visited a chiropractic clinic 6 months after a twisting injury to his left hip which occurred while playing tennis. His pain had remained moderate in intensity and intermittent to frequent in frequency since it originated but became more intense the week prior to his visit. INTERVENTION AND OUTCOME: The patient was diagnosed with a tendonitis/bursitis and received 3 weeks of treatment. Care consisted of various forms of passive modalities to reduce pain and inflammation, as well as hip mobilization and tissue stretching. Plain film examination was then performed, due to lack of progress, and revealed a possible chondroblastoma of the femoral head. The patient was referred to his primary care physician (PCP) for follow-up imaging. Surgical resection of the lesion occurred approximately 2 months later. biopsy of the resected cells confirmed a new diagnosis of clear cell chondrosarcoma. A computed tomography (CT) scan of the chest was performed to rule out metastasis to the lungs. Regular follow-up care and imaging continued and revealed, 9 months following, that the femoral head lesion had returned and hip replacement surgery would be needed. CONCLUSION: Tendonitis, bursitis, and sprains commonly occur following sports-related trauma to the appendicular skeleton. A conservative trial of care should be performed on suspected soft tissue injuries. However, when lack of improvement occurs within the first month, further examination, special studies, or referral are warranted to ensure a proper diagnosis and to rule out a pathological condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/5. Nonligamentous problems of the athlete's knee.Acute and chronic nonligamentous problems of the athlete's knee are outlined, emphasizing diagnosis and treatment. Most such problems can be managed by the family physician or general practitioner, and recommendations are made for the referral of more complex problems.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/5. rupture of the triceps tendon with olecranon bursitis. A case report with a new method of repair.rupture of the triceps tendon is rare, and no previous report of its association with olecranon bursitis was found in the literature. A previously healthy 72-year-old man fell from a stationary bicycle and was examined by his family physician. Calcification over the olecranon area with an intact triceps tendon was revealed. Two months later the patient presented with triceps rupture and weakness of elbow extension with olecranon bursitis. Grossly, the pathologic lesion consisted of synovial frond proliferation and invasion of the cut end of a tendon. A "collar stud-shaped" bursa was found in front of and behind the triceps tendon and across a 3-cm gap in the tendon. The advancement was completed by splitting the tendon in partial thickness proximal to the cut end. The flap was turned down and anchored to the olecranon through drill holes. The end result was good return of function. patients with chronic olecranon bursa problems should be carefully examined for triceps function. The gap in the tendon can be treated by mobilizing the tendon in the manner described.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/5. Septic olecranon bursitis: recognition and treatment.BACKGROUND: The superficial location of the olecranon bursa places it at high risk for injury, possibly leading to the entry of bacteria into the bursal sac. Early differentiation between septic and nonseptic olecranon bursitis is paramount to direct therapy, to hasten recovery, and to prevent chronic inflammation. methods: A literature review was performed using medline files from 1967 to the present. Additional references from the bibliographies of these were also utilized. RESULTS AND CONCLUSIONS: Olecranon bursitis is a common condition that requires the treating physician to be aware of the predisposing factors, clinical signs and symptoms, and laboratory findings of both septic and nonseptic olecranon bursitis. With early recognition, prompt therapy, and preventive measures, the morbidity of septic olecranon bursitis can be considerably reduced, but surgical incision and drainage or excision could be required if conservative therapy fails.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |