11/478. Management of acute lumbar disk herniation initially presenting as mechanical low back pain.OBJECTIVE: To describe the clinical management with spinal manipulation of a male patient with risk factors for lumbar disk herniation initially suffering from what appeared to be mechanical low back pain that evolved into radiculopathy; also to review issues pertinent to chiropractic/manipulative management of disk herniation. CLINICAL FEATURES: The patient initially suffered from unilateral low back pain and nonradicular/nonlancinating referral to the ipsilateral lower extremity. INTERVENTION AND OUTCOME: Disk herniation-in-evolution was included in the differential diagnosis, which was discussed with the patient, who then gave verbal informed consent for manipulative management. A day or so after the initial manipulation the presentation evolved to include S1 radiculopathy. Computed tomography, just after onset of radiculopathy, confirmed the clinical diagnosis of lumbosacral disk herniation. The patient continued with manipulative management and repeat computed tomography examination after clinical resolution about 2 months later revealed reduction in size of the apparently clinically significant herniation. CONCLUSION: risk factors for the development of disk herniation should be considered when assessing patients suffering from what appears to be mechanical low back pain. The role played by manipulation in the development of disk herniation in this case was believed to be circumstantial rather than causal. Manipulation was used in the treatment of this patient over a period of approximately 2 months; after this time, clinical and partial computed tomography imaging resolution was evident. Ongoing clinical (neurologic) evaluation of patients with manifest or suspected disk herniation is an important aspect of management. Good-quality trials of manipulation for patients with disk herniation are imperative for the chiropractic profession.- - - - - - - - - - ranking = 1keywords = back pain, back, pain (Clic here for more details about this article) |
12/478. An unusual extraspinal cause of bilateral leg pain.low back pain with pain radiating to the lower extremities is common in patients referred to a spine center. Lumbar spine pathology is commonly the etiology of such symptoms, but extraspinal causes of back and leg pain can manifest as a radicular disorder. Extraspinal etiologies must be considered in the workup of back and leg pain. This report describes an unusual case of spontaneously occurring bilateral femoral neck stress fractures presenting as low back pain with seemingly bilateral L4 radicular symptoms.- - - - - - - - - - ranking = 0.32403560310173keywords = back pain, back, pain (Clic here for more details about this article) |
13/478. Iatrogenic Mycobacterium infection after an epidural injection.STUDY DESIGN: Case report. OBJECTIVES: Successful excision of the mass and identification of the causative agent by histologic and microbiologic studies. SUMMARY OF BACKGROUND DATA: Spinal pain, caused by an infective mass, developed in a 39-year-old man 3 months after an epidural injection for low back pain. methods: Exploratory surgery was performed to remove the mass, and histologic and microbiologic studies were conducted. RESULTS: The inflammatory mass was excised successfully, and several specimens were examined for bacteriologic presence. Histologic examination of the excised specimen showed chronic granulomatous inflammation, and subsequent microbiologic studies cultured an acid- and alcohol-fast bacillus that was later identified as mycobacterium fortuitum. CONCLUSION: A review of the literature shows that this is a particularly uncommon micro-organism.- - - - - - - - - - ranking = 0.14610742382116keywords = back pain, back, pain (Clic here for more details about this article) |
14/478. Medical check of competitive canoeists.We gave a sports injury questionnaire survey to 821 active canoeists, members of the japan Canoe association (JCA), and performed a medical check of 63 top competitive JCA canoeists, including physical and laboratory tests and radiographic examinations of the chest, spine, shoulder, elbow, and wrist joints. Completed questionnaires were returned by 417 canoeists, whose reported racing styles were: kayak, 324; Canadian canoe, 71; slalom, 13; and not specified, 9. Of the 417 respondents, 94 canoeists (22. 5%) reported that they experienced lumbago; 20.9% experienced shoulder pain; 3.8%, elbow pain; and 10.8%, wrist pain. On medical examinations, lumbago was found to be mainly of myofascial origin or due to spondylolysis. Impingement syndrome was also observed in 4 canoeists with shoulder problems. The competitive canoeists had low blood pressure, and some had bradycardia. On laboratory examinations, serum hemoglobulin, hematocrit, high-density lipoprotein cholesterol (HDL-CHO), creatine phosphokinase (CK), and creatine (CRTN) in the top competitive canoeists showed high values in comparison with those of an age-matched control group. However, low serum total cholesterol (TP) values were observed in the top competitive canoeists.- - - - - - - - - - ranking = 0.0097508428920389keywords = pain (Clic here for more details about this article) |
15/478. Primary iliac muscle abscess due to staphylococcus aureus.A 55-year-old man presented with a 3-day history of lower back pain and right thigh pain. A diagnosis of discogenic pain had been made at two other hospitals. He had been admitted to a medical center for acute hepatitis 5 months prior to this admission. Large doses of parenteral hydrocortisone were used for 13 days to treat acute hepatitis. At the present admission, he was unable to stand and refused to move his right leg. There was mild tenderness in the right lower abdomen on deep palpation. Passive flexion and rotation of the right hip produced mild pain, while passive extension of the right hip produced severe pain and resistance. The Patrick test was positive and the psoas sign was present on the right side. The erythrocyte sedimentation rate (ESR) was 66/hr. The c-reactive protein (CRP) level was 0.161 g/L. Abdominal sonography showed a lobulated mass in the right iliac fossa. magnetic resonance imaging showed severe swelling of the right iliac muscle with a central heterogeneous mass. debridement, drainage of the abscess, and application of a septopal chain were performed via an anterior retroperitoneal approach, and parenteral cephazolin and gentamicin were administered. A culture of the abscess grew staphylococcus aureus. The ESR and CRP concentrations decreased to within the normal ranges 3 weeks later. awareness of this disease entity, careful physical examination, and appropriate imaging studies such as ultrasonography and magnetic resonance imaging are key to making a correct diagnosis.- - - - - - - - - - ranking = 0.15585826671319keywords = back pain, back, pain (Clic here for more details about this article) |
16/478. Lumbar spine pain originating from vertebral osteophytes.BACKGROUND AND OBJECTIVES: Axial spine pain originates from a number of structures. Putative pain generators include facet joints, intervertebral disks, sacroiliac joints, and myofascial structures. Osteophytes originating from lumbar vertebral bodies in the area of the intervertebral disks may be a source of nociceptive low back pain which may respond to local injection. methods: Five patients with axial low back pain unresponsive to traditional treatment modalities were treated with fluoroscopic guided injection of local anesthetic and corticosteroid near large intervertebral osteophytes. RESULTS: All 5 patients experienced relief. CONCLUSION: Vertebral osteophytes may be a source of axial spine pain. Injection of painful osteophytes with a local anesthetic and corticosteroid solution may produce pain relief.- - - - - - - - - - ranking = 0.3149668143904keywords = back pain, back, pain (Clic here for more details about this article) |
17/478. magnetic resonance imaging in the diagnosis of sacral stress fracture.Low back and buttock pain in athletes can be a source of frustration for the athlete and a diagnostic dilemma for the doctor. Sacral stress fractures have been increasingly recognised as a potential cause of these symptoms. As plain radiographs are often normal and the radiation load of an isotope bone scan is substantial, the alternative use of magnetic resonance imaging in the diagnosis of a sacral stress fracture is highlighted in this case report.- - - - - - - - - - ranking = 0.011034956283692keywords = back, pain (Clic here for more details about this article) |
18/478. A migrated lumbar disc herniation simulating a dumbbell tumor.We report a case of a migrated lumbar disc hemiation, which on magnetic resonance imaging (MRI) simulated a dumbbell tumor in a 44-year-old woman who had severe pain in her right buttock and leg. A large epidural mass mimicking a dumbbell tumor was detected at the L5 vertebral level by MRI and computed tomography over myelography. Surgical fenestration of the L4/L5 interlaminar space revealed a dorsolateral epidural mass connected to the L5/S1 intervertebral disc extending laterally through the right L5/S1 intervertebral foramen. Histologically, it was degenerative disc material without active inflammation. Reevaluation of the MRI suggested some clues that might be useful in differentiating such a herniated disc from an epidural tumor.- - - - - - - - - - ranking = 0.003250280964013keywords = pain (Clic here for more details about this article) |
19/478. Metastatic epidural spinal cord compression.OBJECTIVES: To provide an overview on the presentation, diagnosis, and treatment of metastatic epidural spinal cord compression (MESCC). DATA SOURCES: Published articles, book chapters, and research reports. CONCLUSIONS: MESCC is a common oncologic emergency that requires prompt recognition and emergency treatment to relieve pain and preserve neurologic function. The signs and symptoms of MESCC are easily detected and can be integral assessment components of the nursing care of any patient with a solid tumor. IMPLICATIONS FOR NURSING PRACTICE: nurses can have a dramatic impact on preventing neurologic complications caused by this oncologic metastatic problem. When neurologic compromise is not prevented or reversed, nurses also can provide expert care to patients and families in the rehabilitation phase of MESCC.- - - - - - - - - - ranking = 0.003250280964013keywords = pain (Clic here for more details about this article) |
20/478. chiropractic treatment of coccygodynia via instrumental adjusting procedures using activator methods chiropractic technique.OBJECTIVE: To discuss a case of coccygodynia that responded favorably to conservative chiropractic adjusting procedures with the Activator methods chiropractic Technique (AMCT) and the Activator II Adjusting Instrument (AAI II). CLINICAL FEATURES: A 29-year-old woman had unremitting coccygeal pain of 3 weeks' duration. The problem began after she had moved heavy boxes while at work. The pain was characterized by a continual dull ache in the coccygeal region, accompanied by intermittent sharp pain, particularly upon sitting or rising from a seated position. She had been taking self-prescribed over-the-counter analgesics (aspirin and ibuprofen) for 3 weeks without obtaining relief. INTERVENTION AND OUTCOME: Treatment consisted of mechanical force, manually assisted, short-lever (MFMA) chiropractic adjusting procedures to the coccygeal area, primarily the sacrococcygeal ligament. The AAI II was used to deliver the adjustment according to diagnostic and treatment protocol specified for AMCT. The patient experienced first treatment. CONCLUSION: chiropractic coccygeal manipulation may be effectively delivered via instrumental adjustment in certain cases of coccygodynia. The use of an AAI II in administering the coccygeal adjustment has the benefit of being a gentle, noninvasive procedure, as well as being comfortably tolerated by the patient. This method of coccygeal adjustment may bear consideration in certain cases of coccygodynia.- - - - - - - - - - ranking = 0.0097508428920389keywords = pain (Clic here for more details about this article) |
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