11/163. Case study: acceleration/deceleration injury with angular kyphosis.OBJECTIVE: To discuss the case of a patient who received upper cervical chiropractic care after trauma-induced arcual kyphosis in the cervical spine. A practical application of conservative management for posttrauma cervical spine injury in the private office setting is described. Clinical Features: A 17-year-old female patient suffered an unstable C3/C4 motor segment after a lateral-impact motor vehicle collision. Additional symptoms on presentation included vertigo, tinnitus, neck and shoulder pain, and confusion. Intervention and Outcome: Conservative management consisted exclusively of upper cervical-specific adjustments guided by radiographic analysis and paraspinal bilateral skin temperature differential analysis of the cervical spine. During 10 weeks of care and 22 office visits, all symptoms subsided and the instability of C3/C4 motor segment appeared to be completely resolved. CONCLUSION: This study provides support for the use of upper cervical chiropractic management in cervical spine trauma cases. The clinical work-up consisted of physical examination, radiographic analysis, computer-administered and scored cognitive function testing, and audiometric examination. After conservative care, these examinations were repeated and demonstrated that the objective findings concurred with the subjective improvements reported by the patient.- - - - - - - - - - ranking = 1keywords = pain, upper (Clic here for more details about this article) |
12/163. Results of a longer than 10-year follow-Up of patients with rheumatoid arthritis treated by occipitocervical fusion.STUDY DESIGN: Evaluation of results a longer than 10-year follow-up of patients with upper cervical lesions due to rheumatoid arthritis who underwent occipitocervical fusion. OBJECTIVE: To determine the final outcome of patients with upper cervical lesions due to rheumatoid arthritis treated by occipitocervical fusion. SUMMARY OF BACKGROUND DATA: There are few studies reporting the final outcome of patients with rheumatoid arthritis treated by occipitocervical fusion and observed for longer than 10 years. methods: The subjects were 16 patients with rheumatoid arthritis with myelopathy who underwent occipitocervical fusion with a rectangular rod more than 10 years ago. All 16 patients had irreducible atlantoaxial dislocation, and 11 also had vertical dislocation of the axis. All patients had preoperative nuchal pain, and were classified into Class II (two patients), Class IIIA (nine patients), and class IIIB (five patients) according to Ranawat's preoperative neurologic classification. RESULTS: The atlas-dens interval remained the same as immediately after surgery. Vertical dislocation returned to the preoperative condition, despite successful surgical correction. Preoperative occipital pain disappeared or was reduced in all cases. Myelopathy improved in 12 of the 16 patients (75%) by more than one class in the Ranawat preoperative neurologic classification. survival rate at 10 years after surgery was 38%; mean age at death was 70.7 years. The postoperative periods during which patients could walk by themselves ranged from 6 months to 13 years (mean, 7.5 years). CONCLUSIONS: Occipitocervical fusion for patients with rheumatoid arthritis is useful for decreasing nuchal pain, reducing myelopathy, and improving prognosis.- - - - - - - - - - ranking = 2.5127962076906keywords = pain, upper (Clic here for more details about this article) |
13/163. Semiconstrained total shoulder arthroplasty for glenohumeral arthritis and massive rotator cuff tearing.Each of 6 patients (7 shoulders) underwent semiconstrained total shoulder arthroplasty for glenohumeral arthritis, subluxation, and extensive rotator cuff tearing to obtain a more balanced joint and achieve consistent pain relief. A hooded glenoid component (Neer 600%) was used to contain the humeral head within the joint. patients were followed for an average of 69 months (range, 26-125 months) or to revision surgery and were assessed clinically and radiographically. All patients experienced improvement with respect to pain; on average, active elevation and external rotation decreased to 44 degrees and 43 degrees. On radiographic evaluation, 3 of the glenoid components were seen to have complete radiolucent lines and 1 case showed a shift in component position. Five shoulders had anterior-superior joint subluxation. According to the shoulder score rating system of Neer, all but 1 of the shoulders were rated as unsatisfactory or unsuccessful at final follow-up. Two patients have undergone revision surgery for subluxation or glenoid loosening. We cannot recommend this method of treatment.- - - - - - - - - - ranking = 1.5823967494491keywords = pain (Clic here for more details about this article) |
14/163. Treatment of down syndrome-associated craniovertebral junction abnormalities.OBJECT: Operative intervention for craniovertebral junction (CVJ) instability in patients with down syndrome has become controversial, with reports of a low incidence of associated neurological dysfunction and high surgical morbidity rates. The authors analyzed their experience in light of these poor results and attempted to evaluate differences in management. methods: Medical and radiographic records of 36 consecutive patients with down syndrome and CVJ abnormalities were reviewed. The most common clinical complaints included neck pain (15 patients) and torticollis (12 patients). Cervicomedullary compression was associated with ataxia and progressive weakness. Hyperreflexia was documented in a majority of patients (24 cases), and 13 patients suffered from varying degrees of quadriparesis. Upper respiratory tract infection precipitated the presentation in five patients. Four patients suffered acute neurological insults after a minor fall and two after receiving a general anesthetic agent. Atlantoaxial instability was the most common radiographically observed abnormality (23 patients), with a rotary component present in 14 patients. Occipitoatlantal instability was also frequently observed (16 patients) and was coexistent with atlantoaxial dislocation in 15 patients. Twenty individuals had bone anomalies, the most frequent of which was os odontoideum (12 patients) followed by atlantal arch hypoplasia and bifid anterior or posterior arches (eight patients). Twenty-seven patients underwent surgical procedures without subsequent neurological deterioration, and a 96% fusion rate was observed. In five of 11 patients basilar invagination was irreducible and required transoral decompression. overall, 24 patients enjoyed good or excellent outcomes. CONCLUSIONS: The results of this series highlight the clinicopathological characteristics of CVJ instability in patients with down syndrome and suggest that satisfactory outcomes can be achieved with low surgical morbidity rates.- - - - - - - - - - ranking = 0.79119837472453keywords = pain (Clic here for more details about this article) |
15/163. arthroscopy after dysfunctional total knee arthroplasty: two cases with peg fracture of the polyethylene insert.arthroscopy may be indicated in patients with painful dysfunction of the knee joint following total joint replacement. Arthrofibrosis, impacted soft tissue, patellar malalignment, synovialitis, and intra-articular foreign bodies can be treated with the promise of a good outcome. Two cases of peg fracture of the polyethylene insert of a semiconstrained knee prosthesis are presented. In relation to fracture position, instability and locking-up of the joint were clinically manifest. When arthroscopy is used judiciously, its merits are found in ensuring the proper diagnosis and in the reliable planning of treatment. When the patient reports locking-up of the joint, the rare complication of a polyethylene peg fracture must be considered.- - - - - - - - - - ranking = 0.79119837472453keywords = pain (Clic here for more details about this article) |
16/163. Knee position feedback: its effect on management of pelvic instability in a stroke patient.PURPOSE: This is a case study of improvement in pelvic instability due to a stroke, with treatment. The patient had narrow knee-to-knee distance due to weakness in the pelvic muscles resulting in a narrow base of support. METHOD: Treatment was focused on pre-gait activities to improve upright posture control followed by gait training involving extrinsic auditory feedback about knee-to-knee distance. RESULTS: After two weeks of therapy with feedback technique incorporated in a functional context of gait therapy, the patient was able to advance his left lower extremity with proper foot placement. Laboratory measurements showed that step width and stride length gotten better after treatment as well. CONCLUSION: An inclusion of feedback information about knee-to-knee distance could benefit gait training of patients with pelvic instability.- - - - - - - - - - ranking = 0.37291552654686keywords = back (Clic here for more details about this article) |
17/163. Atlanto axial instability due to neurofibromatosis: case report.Neurofibromatosis is an autosomal dominant genetic disease, characterized by cafe au lait spots, neurofibromas and several bony anomalies. Deformities of the spine are the most frequent alterations. Involvement of the cervical spine has been studied less frequently. The case of a 16-year-old male patient affected by neurofibromatosis, with cervical pain without neurological symptoms is presented. x-rays, CT-scan and MRI demonstrated the presence of cervical kyphosis, occipitoaxial instability and atlantoaxial instability with subluxation. Posterior occipito-C2 fusion was performed with prior placement of a halo-vest. The outcome at four years was good with solid occipito axial fusion, moderate loss of cervical spine flexion and moderate-to-severe limitation of cervical spine rotation. The incidence and variety of alterations of the cervical spine in patients affected with neurofibromatosis is discussed, as well as the results obtained by the treatment.- - - - - - - - - - ranking = 0.79119837472453keywords = pain (Clic here for more details about this article) |
18/163. Potential complication of bioabsorbable screw fixation for osteochondritis dissecans of the knee.The 3 cases presented describe loosening or failure of bioabsorbable screws in the treatment of osteochondritis dissecans (OCD). In case 1, a 17-year-old boy with OCD of the medial femoral condyle was treated with bioabsorbable screw fixation. Six months after surgery, the patient had an acute episode of pain with effusion. Arthroscopic examination revealed 2 of the 4 screws backed out, causing cartilage damage to the corresponding tibial plateau. The shafts of the remaining 2 screws had completely absorbed, leaving the unabsorbed screw heads as intra-articular loose bodies in the knee. Unpredictable and inconsistent degradation of the screws is believed to be the mechanism for screw back-out and cartilage damage.- - - - - - - - - - ranking = 0.89774566802364keywords = pain, back (Clic here for more details about this article) |
19/163. No neurological involvement for more than 40 years in klippel-feil syndrome with severe hypermobility of the upper cervical spine.We report the case of a 42-year-old woman with klippel-feil syndrome, who showed severe hypermobility of the upper cervical spine without neurological involvement for more than 40 years. Radiographs revealed the presence of the odontoid bone and fusion of the atlas, odontoid bone, and occiput. Congenital fusion was present from the axis to C5 as a block vertebra. Lateral flexion-extension radiographs revealed severe hypermobility at the junction between the odontoid bone and the axis. Prophylactic surgical stabilization has been recommended in patients with severe hypermobility, but adjacent disc problems may possibly occur at the unfused levels in the future. We believe that early prophylactic stabilization should not be indicated for klippel-feil syndrome without neurological involvement only because of hypermobility.- - - - - - - - - - ranking = 0.34800270879245keywords = upper (Clic here for more details about this article) |
20/163. Stress fracture of the talus following resection of a talocalcaneal coalition: a case report.We report the case of a 15-year-old male with bilateral talocalcaneal coalition. Following resection of the symptomatic coalition, the patient developed a painful ankle. MR imaging revealed a stress fracture of the talar body. In this report we discuss presentation and treatment of a symptomatic talocalcaneal coalition complicated by a later stress fracture as well as a review of the literature.- - - - - - - - - - ranking = 0.79119837472453keywords = pain (Clic here for more details about this article) |
| <- Previous || Next -> |