1/7. Defective running shoes as a contributing factor in plantar fasciitis in a triathlete.STUDY DESIGN: Case study of a patient who developed plantar fasciitis after completing a triathlon. OBJECTIVES: To describe the factors contributing to the injury, describe the rehabilitation process, including the analysis of defective athletic shoe construction, and report the clinical outcome. BACKGROUND: Plantar fasciitis has been found to be a common overuse injury in runners. Studies that describe causative factors of this syndrome have not documented the possible influence of faulty athletic shoe construction on the symptoms of plantar fasciitis. methods AND MEASURES: The patient was a 40-year-old male triathlete who was followed up for an initial evaluation and at weekly intervals up to discharge 4 weeks after injury and at 1 month following discharge. Perceived heel pain, ankle strength, and range of motion were the primary outcome measures. Shoe construction was evaluated to assess the integrity of shoe manufacture and wear of materials by visual inspection of how shoe parts were glued together, if shoe parts were assembled with proper relationship to each other, if the shoe sole was level when resting on a level surface, and if the sole allowed unstable motion. RESULTS: The patient appeared to have a classic case of plantar fasciitis with a primary symptom of heel pain at the calcaneal origin of the plantar fascia. On initial evaluation, right heel pain was a 9 of 10, plantar flexion strength was a 3 /5, and ankle dorsiflexion motion was 10 degrees. One month after discharge, perceived heel pain was 0, plantar flexion strength was 5/5, and dorsiflexion motion was 15 degrees and equal to the uninvolved extremity. The right running shoe construction deficit was a heel counter that was glued into the shoe at an inward leaning angle, resulting in a greater medial tilt of the heel counter compared with the left shoe. The patient was taught how to examine the integrity of shoe manufacture and purchased a new pair of sound running shoes. CONCLUSIONS: A running shoe manufacturing defect was found that possibly contributed to the development of plantar fasciitis. Assessing athletic shoe construction may prevent lower extremity overuse injuries.- - - - - - - - - - ranking = 1keywords = motion (Clic here for more details about this article) |
2/7. Stacking of a dermal regeneration template for reconstruction of a soft-tissue defect after tumor excision from the palm of the hand: a case report.Excision of tumors from the hand often leaves tissue defects with exposed tendons or neurovascular structures that require coverage. Various types of free and pedicled grafts have been described for use in these situations. We present a patient who had a tumor excision in the hand followed by wound coverage with a stacked dermal regeneration template. A 50-year-old man presented with a mass over the palm of the hand. He had an incisional biopsy procedure, the results of which suggested malignancy. He then had wide excision with planned temporary skin coverage with a dermal regeneration template. The dermal template incorporated nicely. With adequate skin coverage the palmar defect still was substantial in terms of depth. This was raised with layering or stacking of the template followed by a split-thickness skin graft. Excellent wound healing and coverage of the defect ultimately were achieved. Additionally the patient went on to obtain full range of motion. Stacking of a dermal regeneration template coupled with split-thickness skin grafting was used to fill a soft-tissue defect over the median and nerve and flexor tendons after wide tumor excision.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
3/7. tryptophan-induced eosinophilia-myalgia syndrome.Eight patients who became ill while taking tryptophan had myalgia, fatigue, rash, fever, edema, alopecia, arthralgias, diminished joint motion, skin tightening, muscle cramping, and distal paresthesias. Three had shortness of breath, and one had pulmonary hypertension. Laboratory abnormalities included peripheral eosinophilia, leukocytosis, thrombocytosis, raised erythrocyte sedimentation rate, and elevated serum levels of aldolase, lactate dehydrogenase, and liver enzymes. Of 4 chest radiographs, 3 were abnormal. Of 5 skin and muscle biopsies, 4 showed sclerosis or mixed inflammatory cell infiltration of the dermis, subcutis, and fascia. eosinophils were often present, but vasculitis was absent. Muscle inflammation was minimal. We conclude that the "eosinophilia-myalgia syndrome" is related to the ingestion of tryptophan and that abnormalities in the secretion of lymphokines may be important in its pathogenesis.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
4/7. 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 = 0.25keywords = motion (Clic here for more details about this article) |
5/7. rehabilitation of eosinophilic fasciitis. A case report.Eosinophilic fasciitis (EF), first described in 1974, is characterized by the sudden onset of painful swelling with induration of the soft tissues and peripheral eosinophilia, often after an episode of intense physical exertion. It rapidly progresses to joint contractures because of inflammation and fibrosis of the fascia. Of the 200 cases reported in the medical literature, most have responded positively to a prolonged course of oral prednisone. Although complete recovery is possible, more frequently signs and symptoms of EF persist. There were no detailed descriptions found in the literature of any rehabilitative interventions in this disease. This case study describes the methods used in a successful, comprehensive rehabilitation treatment of a 21-yr-old man admitted to the Palo Alto VA Medical Center rehabilitation program 8 mo after the onset of symptoms. Previous medication therapy included prednisone and methotrexate. The patient underwent 2 mo of inpatient rehabilitation, which consisted of upper and lower extremity nerve blocks, serial splinting, application of physical modalities, massage, stretching and strengthening exercises and interdisciplinary pain management. Significant improvement was made in the range of motion in all extremities, strength, hand function, level of pain, gait and endurance. Aggressive therapy did not increase eosinophilia. In fact the eosinophil count returned to normal by the time of discharge. A detailed review of the patient's rehabilitation program is presented.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
6/7. Surgical management of eosinophilic fasciitis of the upper extremity.Eosinophilic fasciitis is a rare inflammatory disease associated with peripheral eosinophilia, hyper-gammaglobulinaemia and contractures of any joint in the upper extremity. Although conservative treatments are generally advocated, this study reports the results of surgical intervention. Four patients aged from 20 to 48 years underwent fasciectomy followed by oral administration of prednisolone. All presented with contractures of digits, wrist, or elbow due to eosinophilic fasciitis in the upper extremities. Despite one case that required a second operation for recurrence, all patients regained the range of motion of the affected joints a few weeks after surgery. The recovery was much sooner than in previously reported cases treated conservatively, suggesting that surgical management of eosinophilic fasciitis is effective in alleviating symptoms quickly and allows patients to resume activities of daily living sooner.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |
7/7. Atypical decubital fibroplasia in a young patient with melorheostosis.A case of atypical decubital fibroplasia of the right forearm arising in a 25-year-old male with melorheostosis is presented. The diagnosis of melorheostosis involving the right-sided bones was made by radiographical studies, and the patient has been obliged to use crutches due to the contracture and limited range of motion of the right leg. Two painless masses occurred in the subcutis of the posterior aspect of the right forearm over the excrescences of the underlying ulna due to melorheostotic deformity. Grossly, ill-defined firm masses, which measured 3 x 6 x 1.5 cm and 4 x 5 x 1 cm, respectively, were white and intermingled with yellow fatty tissue. Histologically, the lesions consisted of a proliferation of plump fibroblastic cells with abundant collagenous stroma. Vascular proliferation and occasional eosinophilic degeneration of the collagen fibers were also seen. The gross and histological features were those of atypical decubital fibroplasia (ischemic fasciitis). Immunohistochemically, the plump fibroblastic cells were positive for vimentin, but negative for desmin, muscle specific actin, and alpha-smooth muscle actin. Chondroid metaplasia was focally noted and round-shaped cells within this area were positive for S-100 protein. This lesion seemed to be a fibroblastic response against the long-standing, intermittent ischemia of the subcutaneous tissue between the bony excrescences due to melorheostosis and the weight-bearing forces of the crutch.- - - - - - - - - - ranking = 0.25keywords = motion (Clic here for more details about this article) |