1/34. Musculoskeletal manifestations of osteomalacia: report of 26 cases and literature review.OBJECTIVE: This study was undertaken to describe the musculoskeletal manifestations in a selected population of 26 patients with biopsy-proven osteomalacia (OM) and provide a literature update. methods: The 26 patients with biopsy-proven OM were selected from a total number of 79 patients who underwent anterior iliac crest biopsy. The diagnosis of OM was confirmed by the presence of an osteoid volume greater than 10%, osteoid width greater than 15 microm, and delayed mineralization assessed by double-tetracycline labeling. RESULTS: OM was caused by intestinal malabsorption in 13 patients, whereas six other patients presented with hypophosphatemia of different causes. Five elderly patients presented with hypovitaminosis D, and in two patients the OM was part of renal osteodystrophy. Twenty-three patients presented with bone pain and diffuse demineralization, whereas three other patients had normal or increased bone density. Characteristic pseudofractures were seen in only seven patients. Six of the 23 patients with diffuse demineralization had an "osteoporotic-like pattern" without pseudofractures. Prominent articular manifestations were seen in seven patients, including a rheumatoid arthritis-like picture in three, osteogenic synovitis in three, and ankylosing spondylitis-like in one. Two other patients were referred to us with the diagnosis of possible metastatic bone disease attributable to polyostotic areas of increased radio nuclide uptake caused by pseudofractures. Six patients also had proximal myopathy, two elderly patients were diagnosed as having polymalgia rheumatica, and two young patients were diagnosed as having fibromyalgia. One of the patients who presented with increased bone density was misdiagnosed as possible fluorosis. CONCLUSION: OM is usually neglected when compared with other metabolic bone diseases and may present with a variety of clinical and radiographic manifestations mimicking other musculoskeletal disorders.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/34. Acute abstinence syndrome following abrupt cessation of long-term use of tramadol (Ultram): a case study.We report on a patient who had taken the centrally acting analgesic tramadol for over 1 year. The compound had proven to be sufficient to treat her painful episodes related to fibromyalgia. Due to lack of supply while being on a trip, intake of the drug was stopped abruptly, resulting in the development of classical abstinence-like symptoms within 1 week. Abstinence-like symptoms consisted of restlessness and insomnia for which the benzodiazepine lorazepam was given. Diarrhoea and abdominal cramps were treated with the peripherally active opioid loperamide, while bouts of cephalgia were treated with sumatriptan. Diffuse musculoskeletal-related pain and restless leg syndrome (RLS) were treated with dextromethorphan. All these different medications proved to be efficacious as they resulted in the cessation of symptoms. Within 1 week symptoms ceased and the patient regained her normal activities without any sequelae. Although tramadol is considered a non-habit- and non-dependence-forming analgesic, abstinence symptoms are likely to develop following abrupt cessation of intake, especially when the compound had been taken over 1 year. Therefore patients should be advised of such an effect whenever they decide to stop intake or their physician is planning to switch to another medication. To avoid abstinence-like symptoms doses should be slowly tapered down.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
3/34. The schnitzler syndrome. Four new cases and review of the literature.The schnitzler syndrome is characterized by a chronic urticarial eruption with a monoclonal IgM gammopathy. The other signs of the syndrome include intermittent elevated fever, joint and/or bone pain with radiologic evidence of osteosclerosis, palpable lymph nodes, enlarged liver and/or spleen, elevated erythrocyte sedimentation rate, and leukocytosis. The mean delay to diagnosis is more than 5 years, and this syndrome is of concern to internists and many medical specialists. patients with this syndrome are often initially considered to have lymphoma or adult-onset Still disease, which are the main differential diagnoses. However, hypocomplementic urticarial vasculitis, systemic lupus erythematosus, cryoglobulinemia, acquired C1 inhibitor deficiency, hyper IgD syndrome, chronic infantile neurologic cutaneous and articular (CINCA) syndrome, and Muckle-Wells syndrome should also be excluded, because diagnosis relies on a combination of clinical and biologic signs and there is no specific marker of the disease. The disease pursues a chronic course, and no remissions have yet been reported. Disabling skin rash, fever, and musculoskeletal involvement are the most frequent complications. Severe anemia of chronic disease is another serious complication. The most harmful complication, however, is evolution to an authentic lymphoplasmacytic malignancy, which occurs in at least 15% of patients. This hematologic transformation can occur more than 20 years after the first signs of the disease, thus patients deserve long-term follow-up. Treatment is symptomatic and unsatisfactory. The skin rash is unresponsive to treatment, and nonsteroidal antiinflammatory drugs, antihistamines, dapsone, colchicine, and psoralens and ultraviolet A (PUVA) therapy give inconstant results. fever, arthralgia, and bone pain often respond to nonsteroidal antiinflammatory drugs. In some patients, these symptoms and/or the presence of severe inflammatory anemia require steroids and/or immunosuppressive treatment, which ameliorate inflammatory symptoms but do not change the course of the skin rash.- - - - - - - - - - ranking = 2keywords = pain (Clic here for more details about this article) |
4/34. Muscular-skeletal cryptococcosis in a patient with idiopathic CD4 lymphopenia.A healthy 27-year-old woman presented, four months after childbirth, ingravescent pain and claudication of the left lower limb. magnetic resonance imaging of the lumbosacral and iliac regions showed widespread muscular-skeletal lesions. The patient underwent surgery; cryptococcus neoformans was isolated from surgical samples. Liposomal amphotericin b, fluconazole and itraconazole were administered. Laboratory findings showed lymphocytopenia, with reduction of CD4 lymphocytes (23 cells per cubic millimeter) in the absence of hiv infection and any other defined immunodeficiency. This is a rare case of muscular-skeletal cryptococcal infection isolated in a subject affected with idiopathic CD4 lymphocytopenia.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
5/34. Cervical headache.headache presents a diagnostic challenge for the physical therapist due to similarities of signs and symptoms among the many types of headache. Effective treatment depends upon accurate diagnosis and identifying the factors that may precipitate or perpetuate the symptoms. This commentary overviews some common forms of headache and specifically addresses cervical headache as a possible beneficiary of physical therapy intervention. Details of the history and physical examination, which is designed to diagnose cervical headache and rule out potential serious pathologies, are presented. Guidelines for treatment of articular and myofascial dysfunction are presented. A case report illustrating principles of examination, inherent ambiguities in diagnosis, and successful treatment is also presented.- - - - - - - - - - ranking = 0.52684309782023keywords = headache (Clic here for more details about this article) |
6/34. Towards successful physical stress reducing products: an evaluation of seven cases.lifting, carrying, pushing and pulling at work are assumed to be related to increased risks of musculoskeletal injury, mainly in the low back and shoulder region. The implementation of products to reduce the physical load in heavy work is a well-known strategy to attack this problem. The success of these products depends not only on the product itself, but also on the process of product development and implementation. In this paper, seven cases are described where products have been developed to reduce the physical load on scaffolders, bricklayers, bricklayer's assistants, roofworkers, aircraft loaders, glaziers and assembly line workers. These products are described with special reference to the physical load problem in the occupational task, the process of product development, the nature of the product, the potential effects on physical load and the opinion of workers. From these cases, a list of key factors in product development contributing to the success of a product is composed. These concern among others a direct participation of workers, a wide analysis of risks, an analysis of potential negative side effects, and a systematic stepwise approach.- - - - - - - - - - ranking = 0.010668324964249keywords = back (Clic here for more details about this article) |
7/34. Musculoskeletal causes of chest pain.BACKGROUND: chest pain is a common presenting problem to general practitioners and accident and emergency departments. Such a symptom generates anxiety in both patients and their medical attendants, for fear that this symptom represents a life threatening event. Numerous investigations often ensue, adding to the physical and financial burden on an already stressed health system. Musculoskeletal causes of chest pain are common but frequently overlooked. OBJECTIVE: This article aims to outline some of the more common musculoskeletal problems which may present as chest pain, and to present a practical approach to their diagnosis and management. DISCUSSION: It is estimated that somewhere in the vicinity of 20-25% of noncardiac chest pain has a musculoskeletal basis. Careful history taking to identify red flag conditions differentiates those who require further investigation. Historical features suggesting a musculoskeletal cause include pain on specific postures or physical activities. A musculoskeletal diagnosis can usually be confirmed by clinical examination alone, the key to which is reproducing the patient's pain by either a movement or more specifically palpation over the structure that is the source of the pain. Confirming the diagnosis, explanation and reassurance allay anxiety. Management strategies include manual therapy, the provision of analgesia and anti-inflammatory agents, either topically, orally or by injection. Focal injection of local anaesthetic alone may also be a useful diagnostic and therapeutic tool.- - - - - - - - - - ranking = 11.270606780635keywords = pain, chest (Clic here for more details about this article) |
8/34. buprenorphine treatment of patients with non-malignant musculoskeletal diseases.Adequate pain control is vital in the treatment of patients with musculoskeletal disease. These diseases are characterised by a number of pain-induced vicious circles, and satisfactory control of pain acts to disrupt these self-perpetuating processes. Consequently, early mobilisation can be achieved in patients with painful osteoporotic vertebral fractures, low back pain and sciatica, for example. In other cases analgesics may act simply to maintain the mobility of patients and in this way preserve their quality of life. When simple analgesics are not sufficient, the use of opioid-type analgesics is justified. buprenorphine transdermal therapeutic system (TDS) is a novel formulation of a well-tolerated and highly effective drug for satisfactory pain control that can also be used in patients with chronic non-malignant pain (CNMP) due to musculoskeletal diseases. Three case reports are presented to illustrate the effectiveness of buprenorphine TDS in such patients.- - - - - - - - - - ranking = 7.0106683249642keywords = pain, back (Clic here for more details about this article) |
9/34. Industrial medicine and acute musculoskeletal rehabilitation. 3. cumulative trauma disorders of the upper limb in computer users.This self-directed learning module highlights various cumulative trauma disorders of the upper limb that may be seen in computer users. The biomechanics and ergonomics of computer users are addressed in relationship to specific neurologic and musculoskeletal conditions within the neck and upper limbs. In addition to a general overview of these conditions, a case presentation is used to show the evaluation and treatment of a computer user who has carpal tunnel syndrome and concomitant de Quervain tenosynovitis. overall ARTICLE OBJECTIVES: (a) To review the important anatomic and ergonomic basis for upper limb cumulative trauma disorders in computer users and (b) to provide an example of evaluation and treatment.- - - - - - - - - - ranking = 0.032172608565736keywords = upper (Clic here for more details about this article) |
10/34. Stylohyoid syndrome: a case report.Elongation of the styloid process and/or ossification of the stylohyoid ligament can be associated with cervical pharyngeal pain, which may be detected both clinically and radiographically. Eagle's syndrome, stylohyoid syndrome, and pseudostylohyoid syndrome should be considered in the differential diagnosis.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
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