1/8. Cervical angina caused by atlantoaxial instability.Cervical angina is defined as a paroxysmal precordialgia that resembles true cardiac angina caused by cervical spondylosis. Cervical angina most commonly results from compression of the C7 ventral root. We present here a case of cervical angina caused by atlantoaxial instability. This case had marked atlantoaxial instability but no flexibility of the middle to lower levels of the cervical spine. Although there was mild C7 root compression on the radiologic findings, the chest pain was induced by neck motion, and the precordialgia disappeared after posterior atlantoaxial fusion without C7 root decompression. Therefore, we diagnosed this case as cervical angina caused by spinal cord compression at the C1-C2 level. It was speculated that a perturbation of the sympathetic nervous system or a hypofunction of the pain suppression pathway in the posterior horn of the spinal cord caused the pectoralgia. Although cervical angina is a rare disease, physicians should be aware of it; if there are no abnormal findings on cardiac examinations for angina pectoris, they should examine the cervical spine. Cervical angina due to atlantoaxial instability is one of the differential diagnoses of precordialgia.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/8. Primary chest wall tumor appearing as frozen shoulder. review and case presentations.The term frozen shoulder may apply to a primary, common, recognizable entity with a predictable course to a painful stiff condition with periarthritis secondary to trauma, rotator cuff or arthritic source. We studied 140 cases of frozen shoulder, referred to a surgical clinic for manipulation when conservative care was not effective. Investigations showed only 40 cases had "primary" frozen shoulder and among these were 3 patients with a local primary invasive neoplasm mimicking the exact features of the common condition. The attending physician and surgeon should be suspicious of tumor in younger patients with progressive pain among the other features of primary frozen shoulder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/8. Fingernail deformities secondary to ganglions of the distal interphalangeal joint (mucous cysts).Twenty-six nail deformities secondary to ganglions of the distal interphalangeal joint were retrospectively reviewed to assess the important aspects of their management. The patients' ages ranged from 41 to 79 years. The long and index fingers were most commonly involved. A depression or groove was present in 23 of 26 digits reviewed. Two had gross disruption of the nail. Fifty-eight percent of the cysts had spontaneously drained or had been drained by the patient or a physician preoperatively. Degenerative arthritic changes were seen in 87 percent of those with x-rays or a radiology report available. Most underwent surgical removal of the cyst and debridement of associated osteophytes of the distal interphalangeal joint. The cyst was located above the germinal matrix in all but two digits. Osteophytes were found in all 20 digits in which the joint was explored. No recurrences were seen in those available for postoperative follow-up (22 of 25). Normal nail growth was found in 14 of 22, although follow-up was short in one. All eight postoperative nail deformities were quite mild and of little concern to the patient. There was no correlation between preoperative cyst drainage and aesthetic postoperative nail growth. Nail removal at the time of surgery appeared to be unnecessary unless the nail was grossly disrupted.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/8. Infected total hip arthroplasty due to actinomyces israelii after dental extraction. A case report.Late infection of a total hip arthroplasty after dental extraction has been reported, but never with an organism that is found exclusively in mouth flora. actinomyces israelii is an organism responsible for dental caries. A 61-year-old woman developed an infected total hip arthroplasty after dental work. She denies ever being instructed to take prophylactic antibiotics by her orthopedic surgeon, by her internist, or by her dentist. Considering the extensive morbidity and potential mortality of an infected hip prosthesis, it is essential that all physicians are aware of the indications for antibiotic prophylaxis following joint arthroplasty. Recommendations for antibiotic prophylaxis for dental manipulation are a loading dose of 2.0 g of penicillin v orally or 1.2 million U of aqueous procaine penicillin g with 1.0 gram of streptomycin given intramuscularly 30 minutes before dental work, followed by four doses of 0.5 g of penicillin v orally every six hours.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/8. Lumbar spinal stenosis in a patient with diffuse idiopathic skeletal hypertrophy syndrome.Lumbar spinal stenosis is associated with a variety of conditions, including dysplastic narrowing of the spine, lumbar spondylosis, Paget's disease, and achondroplastic dwarfism. No case of lumbar stenosis associated with diffuse idiopathic skeletal hyperostosis (DISH) previously has been described. It would appear that this case could represent either another manifestation of DISH characterized by involvement of the ligamentum flavum or coincidental association with lumbar spondylosis. In either case, physicians treating spinal and skeletal diseases should be aware of potential neurologic complications requiring surgical decompression due to narrowing of the spinal canal in this unusual disorder.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/8. Acrometastases. Initial presentation as diffuse ankle pain.Acrometastases are rare and often misdiagnosed or overlooked. When it involves the feet, it generally attacks the larger bones containing the higher amounts of red marrow. The patient may or may not have a known history of cancer, which makes diagnosis much more difficult. The symptomatology is generally vague and can mimic other conditions, such as osteomyelitis, gouty rheumatoid arthritis, Reiter's syndrome, Paget's disease, osteochondral lesions, and ligamentous sprains. Therefore, the physician must consider metastatic disease in the differential diagnosis. Once the diagnosis is made, the prognosis is poor and treatment is limited to pain relief and maintaining function.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/8. Hip instability encountered in pediatric podiatry practice.Infants and children with pathologic conditions of the foot and leg frequently have predictable comorbidity. The treating physician has the responsibility for identifying these associated problems and promptly referring if the problem is outside of his or her area of expertise. Hip dysplasia and dislocation occur frequently enough in association with congenital foot and leg deformity that they must be actively sought out in all cases. This article presents an overview of the topic, a review of screening protocols and appropriate imaging techniques and case studies of children with hip instability encountered in pediatric podiatry practice.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/8. Differential diagnosis of the hip vs. lumbar spine: five case reports.With recent health care policy changes and the implementation of direct access in many states, physical therapists must be able to identify pathology that is beyond their scope of practice. The five case reports presented in this series required the differential diagnosis of hip vs. lumbar spine pathology. All of the cases required a referral from the physical therapist to either the patient's physician or a specialist because of abnormal screening test results. Each referral resulted in a new diagnosis of pathology that was beyond the scope of physical therapy. Cyriax's concepts of capsular and noncapsular patterns of joint restriction and the "Sign of the Buttock" proved useful in differentiating between hip and lumbar spine pathology in each patient. Our clinical experience indicates that utilizing the presence/absence of a capsular pattern and a "Sign of the Buttock" to screen out hip pathology in patients may be effective; however, further research is needed to support these claims.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |