1/38. Anteroposterior atlantoaxial subluxation in cervical spine osteoarthritis: case reports and review of the literature.Nontraumatic anteroposterior atlantoaxial subluxation (AAS) has been described in several rheumatic or inherited disorders, especially rheumatoid arthritis and to a lesser extent the inflammatory spondyloarthropathies. We describe AAS secondary to osteoarthritis (OA) of the cervical spine in a 76-year-old man and a 73-year-old woman with severe cervical OA, symptomatic C1-C2 facet joints, and signs of generalized OA. Only 6 similar cases exist in the literature. OA should be added to the causes of AAS, and conversely AAS should be assessed in cases with severe OA of the upper cervical spine.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
2/38. diclofenac-associated hepatitis.This patient, who had a history of osteoarthritis, had severe hepatitis 5 weeks after being started on diclofenac for increasing pain in the joints. A week before the onset of hepatitis, the patient complained of upper gastrointestinal symptoms and was treated for gastritis. Seven days later, she had full-blown, severe hepatitis. diclofenac was immediately stopped, leading to a complete restoration of liver functions over the course of the next few months. We highlight the importance of having a high index of suspicion for hepatic side effects of diclofenac and emphasize the need for increased awareness of this rare but potentially serious problem. We also review relevant literature regarding incidence and management.- - - - - - - - - - ranking = 1keywords = upper (Clic here for more details about this article) |
3/38. 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 = 96.227739513265keywords = back pain, back (Clic here for more details about this article) |
4/38. Synovial chondromatosis of the shoulder associated with osteoarthritis: conservative treatment in two cases and review of the literature.Periarticular synovial chondromatosis associated with osteoarthrosis is a rare condition that is more frequently seen in the lower extremity than in the upper extremity. In patients who have synovial chondromatosis of the joints of the lower extremity and are symptomatic, the traditional method of treatment has included open or arthroscopic synovectomy and removal of loose bodies. In cases involving the upper extremity, especially in the shoulder, patients have variable disability and may be treated successfully without surgery. Two patients who presented to our practice with shoulder symptoms due to synovial chondromatosis were treated successfully without surgery. In both patients nonoperative treatment consisting of activity modification, nonsteroidal anti-inflammatory medication, and cryotherapy as needed led to a good result without surgical intervention.- - - - - - - - - - ranking = 2keywords = upper (Clic here for more details about this article) |
5/38. Use of a classification system to guide nonsurgical management of a patient with chronic low back pain.BACKGROUND AND PURPOSE: This case report describes the use of a classification system in the evaluation of a patient with chronic low back pain (LBP) and illustrates how this system was used to develop a management program in which the patient was instructed in symptom-reducing strategies for positioning and functional movement. CASE DESCRIPTION: The patient was a 55-year-old woman with a medical diagnosis of lumbar degenerative disk and degenerative joint disease from L2 to S1. rotation with extension of the lumbar spine was found to be consistently associated with an increase in symptoms during the examination. Instruction was provided to restrict lumbar rotation and extension during performance of daily activities. OUTCOMES: The patient completed 8 physical therapy sessions over a 3-month period. Pretreatment, posttreatment, and 3-month follow-up modified Oswestry Disability Questionnaire scores were 43%, 16%, and 12%, respectively. DISCUSSION: Daily repetition of similar movements and postures may result in preferential movement of the lumbar spine in a specific direction, which then may contribute to the development, persistence, or recurrence of LBP. research is needed to determine whether patients with LBP would benefit from training in activity modifications that are specific to the symptom-provoking movements and postures of each individual as identified through examination.- - - - - - - - - - ranking = 240.56934878316keywords = back pain, back (Clic here for more details about this article) |
6/38. Dynamic magnetic resonance imaging technique for the study of the temporomandibular joint.AIMS: Echo planar imaging (EPI) is an ultrafast magnetic resonance imaging (MRI) technique that can scan a single frame in less than a second. The aim of this study was to use the EPI technique to develop a new dynamic MRI protocol for the temporomandibular joint (TMJ). methods: Basic fast-field echo and EPI pulse sequences were used for dynamic studies of the TMJ. The subjects were instructed to perform spontaneous, continuous, slow opening/closing movements without visual or audio feedback. Different scanning parameter settings were explored to optimize the results. RESULTS: With an opening/closing movement of approximately 6 to 7 seconds per cycle, the proposed protocol yielded a good insight into the relative motion between condyle and disc. It was also possible to see the deformation of the disc during movement. CONCLUSION: The EPI technique is a non-invasive technique that can be used for dynamic imaging study of a slow but continuous, uninterrupted jaw movement.- - - - - - - - - - ranking = 3.2385644661231keywords = back (Clic here for more details about this article) |
7/38. A case of anterior open bite developing during adolescence.Imaging studies have reported on the relationship between temporomandibular joint (TMJ) degeneration and facial deformity. These studies have suggested that mandibular growth is affected by TMJ degeneration, resulting in altered skeletal structure as mandibular retrusion. However, there are very few longitudinal case reports on TMJ osteoarthrosis (OA). Progressive open bite occurred in an adolescent patient with TMJ OA. Cephalometric analysis showed a downward and backward rotated mandible, and a labial inclination of the upper incisor. magnetic resonance imaging showed internal derangement without reduction and erosion in the right and the left condyles. Although the cause of open bite is unclear in this case, tongue thrusting, and internal derangements in the temporomandibular joint were suspected as causes of the open bite.- - - - - - - - - - ranking = 4.2385644661231keywords = back, upper (Clic here for more details about this article) |
8/38. Fat embolism syndrome and elective knee arthroplasty.PURPOSE: To report a case of fat embolism syndrome (FES) following elective left knee arthroplasty and review the diagnosis, investigation, prevention and perioperative management of this condition. CLINICAL FEATURES: A 76-yr-old lady presented for left total knee arthroplasty under general anesthesia. After an uneventful anesthetic and initial recovery, she developed respiratory and neurological complications six hours postoperatively necessitating supportive care in the intensive care unit. Following extensive investigation, a clinical diagnosis of FES was made 48 hr postoperatively supported by the development of diffuse encephalopathy, thrombocytopenia, hypoxemia, chest petechiae and chest x-ray changes. A magnetic resonance imaging scan five days postoperatively confirmed this diagnosis. Her postoperative course showed gradual improvement consistent with a slowly resolving encephalopathy. Previous published cases of FES associated with knee arthroplasty present either with intraoperative cardiorespiratory collapse or, as with this patient, in the postoperative period with respiratory, cardiovascular and/or cerebral dysfunction. CONCLUSIONS: The clinical diagnosis of FES is essentially one of exclusion, supported by laboratory and radiological investigations. Preoperative identification of at-risk patients, use of appropriate invasive perioperative monitoring and modified surgical techniques may minimize the development of the syndrome. Treatment is supportive.- - - - - - - - - - ranking = 0.54171284749938keywords = chest (Clic here for more details about this article) |
9/38. Pseudogout attack of the lumbar facet joint: a case report.STUDY DESIGN: A case of acute low back pain caused by pseudogout attack of the lumbar facet joint is reported. OBJECTIVE: To report a new cause of acute low back pain previously unreported in the literature. SUMMARY OF BACKGROUND DATA: There have been some reports of lumbar spinal stenosis caused by calcium pyrophosphate dihydrate crystal deposition. However, there are no known reports of pseudogout attack of the lumbar facet joint. methods: An axial magnetic resonance imaging scan demonstrated joint effusion at the level of the bilateral L4-L5 facet joint. Aspiration of the left L4-L5 facet joint yielded 1.5 mL of pus-like synovial effusion. Multiple cultures of synovial fluid tested negative for bacteria and fungi, whereas compensated polarized light microscopy revealed monoclinic or triclinic crystals with a positive birefringence. RESULTS: The symptoms of acute low back pain lasted for 3 days. Local and systemic inflammatory signs, as well as symptoms, gradually improved after joint aspiration. A follow-up evaluation 8 months after lumbar facet joint aspiration showed complete resolution of pain and no neurologic deficit. CONCLUSIONS: Pseudogout attack of the lumbar facet joint is rare, but this clinical entity should be added to the differential diagnosis of acute low back pain.- - - - - - - - - - ranking = 192.45547902653keywords = back pain, back (Clic here for more details about this article) |
10/38. Celecoxib-induced upper gastrointestinal hemorrhage and ulceration.COX-2 inhibitors are a new class of nonsteroidal anti-inflammatory drugs with a reported benefit of less gastric and duodenal ulceration and hemorrhage. We describe a 67-year-old man taking a higher than usual dose of celecoxib (Celebrex) for osteoarthritis with resultant gastric erosions, ulceration, and a significant gastrointestinal (GI) hemorrhage.- - - - - - - - - - ranking = 4keywords = upper (Clic here for more details about this article) |
| Next -> |