1/133. Incomplete nondisplaced tibial osteotomy for treatment of osteoarthritic knee pain.Intraosseous venous hypertension is considered a significant factor in the production of knee pain secondary to degenerative arthrosis, thus vascular decompression by means of tibial osteotomy is a rational option for treatment of selected patients. A preliminary report is presented of six patients with symptoms of primary or secondary degenerative arthrosis who were treated by incomplete nondisplaced proximal tibial osteotomy with good or excellent results. These patients were refractory to nonoperative treatment and were not deemed suitable candidates for angulated osteotomy, arthroscopic surgery alone, or total knee arthroplasty. patients ranged in age from 36 to 61 years (mean age: 47 years). Follow-up ranged from .8 to 6.7 years (mean: 3.1 years). The subjects were studied postoperatively by interview, physical examination, radiographs, and bone scans. Results were assessed using the knee rating system of The Hospital for Special Surgery.- - - - - - - - - - ranking = 1keywords = pain (Clic here for more details about this article) |
2/133. Low power laser therapy and analgesic action.OBJECTIVE: The semiconductor or laser diode (GaAs, 904 nm) is the most appropriate choice in pain reduction therapy. SUMMARY BACKGROUND DATA: Low-power density laser acts on the prostaglandin (PG) synthesis, increasing the change of PGG2 and PGH2 into PG12 (also called prostacyclin, or epoprostenol). The last is the main product of the arachidonic acid into the endothelial cells and into the smooth muscular cells of vessel walls, that have a vasodilating and anti-inflammatory action. methods: Treatment was performed on 372 patients (206 women and 166 men) during the period between May 1987 and January 1997. The patients, whose ages ranged from 25 to 70 years, with a mean age of 45 years, suffered from rheumatic, degenerative, and traumatic pathologies as well as cutaneous ulcers. The majority of patients had been seen by orthopedists and rheumatologists and had undergone x-ray examination. All patients had received drug-based treatment and/or physiotherapy with poor results; 5 patients had also been irradiated with He:Ne and CO2 lasers. Two-thirds were experiencing acute symptomatic pain, while the others suffered long-term pathology with recurrent crises. We used a pulsed diode laser, GaAs 904 nm wavelength once per day for 5 consecutive days, followed by a 2-day interval. The average number of applications was 12. We irradiated the trigger points, access points to the joint, and striated muscles adjacent to relevant nerve roots. RESULTS: We achieved very good results, especially in cases of symptomatic osteoarthritis of the cervical vertebrae, sport-related injuries, epicondylitis, and cutaneous ulcers, and with cases of osteoarthritis of the coxa. CONCLUSIONS: Treatment with 904-nm diode laser has substantially reduced the symptoms as well as improved the quality of life of these patient, ultimately postponing the need for surgery.- - - - - - - - - - ranking = 0.4keywords = pain (Clic here for more details about this article) |
3/133. 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 = 0.2keywords = pain (Clic here for more details about this article) |
4/133. 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 = 2.5011075548931keywords = pain, back pain, back (Clic here for more details about this article) |
5/133. Transtrochanteric curved varus femoral osteotomy for spondyloepiphyseal dysplasia tarda. A case report.A female with spondyloepiphyseal dysplasia (SED) tarda suffered bilateral hip pain since about the age of ten. Her radiographs revealed subluxation and irregularity of the hip joints with acetabular dysplasia. Transtrochanteric varus osteotomy was performed on her left femur at 13 years of age and on her right femur at 14 years of age. The congruities of both hips improved after surgery. At follow-up, she had no pain in either hip even after walking for an extended period. Improved activity in daily life was noted.- - - - - - - - - - ranking = 0.4keywords = pain (Clic here for more details about this article) |
6/133. Early experience with total knee replacement.This paper presents a review of two years' experience with the geometric total knee replacement. The results of 23 arthroplasties in 22 patients are discussed. Relief of pain was consistent and dramatic, movement was increased postoperatively in only three patients, but imporvement in overall function occurred in 20 of the 22 patients. There was one failure requiring arthrodesis. In this patient, six months after surgery the medial tibial condyle collapsed and the polyethylene tibial component fractured. This complication has not been reported before. Early results are encouraging. Total knee joint replacement is a useful procedure in advanced arthritis when arthrodesis is the only alternative.- - - - - - - - - - ranking = 0.2keywords = pain (Clic here for more details about this article) |
7/133. Induction of an acute attack of calcium pyrophosphate dihydrate arthritis by intra-articular injection of hylan G-F 20 (Synvisc).Little is known about the induction of acute calcium pyrophosphate dihydrate arthritis after the intra-articular injection of hylan G-F 20 (Synvisc). Two reports have documented this adverse effect after the intra-articular injection of hyaluronan. Our patient, a 60-year-old man with osteoarthritis in both knees, presented with a history of an arthroscopy with meniscus shaving 7 years previously. He was given an injection of hylan G-F 20 in the right knee joint. Two days after the second injection, pain and swelling of the knee occurred. There was a severe loss of physical function. Systemic inflammatory reactions such as fever were not observed. A microscopic investigation of the synovial fluid showed evidence of calcium pyrophosphate dihydrate crystals. Bacterial contamination was not detected. There was no indication for calcium pyrophosphate dihydrate in the history of the patient. Some days after receiving nonsteroidal anti-inflammatory drugs and an intra-articular injection of steroids, the symptoms disappeared.- - - - - - - - - - ranking = 0.2keywords = pain (Clic here for more details about this article) |
8/133. The interdisciplinary approach to oral, facial and head pain.BACKGROUND: Chronic oral, facial and head pain is a common clinical problem, and appropriate diagnosis and management are a challenge for health care professionals. patients often will first seek the care of dentists because of the pain's localization in the oral cavity and surrounding structures. This article emphasizes the importance of establishing accurate diagnoses and conducting appropriate triage of the patient with complex orofacial pain. CASE DESCRIPTIONS: The authors present two case reports illustrating the complex nature of oral, facial and head pain, and the potential and actual pitfalls in management of this condition. These representative cases demonstrate how orofacial pain--which appears to be localized in the peripheral dental and oral structures--can have extremely complex etiologies involving other anatomical structures, the central nervous system and psychological factors. The reports point to the need for the expertise of a number of specialists in such cases. CLINICAL IMPLICATIONS: If the symptoms and clinical findings do not appear to be consistent with typical oral disease, or if standard treatments do not alleviate the pain, the dental clinician must consider other, more complex orofacial pain diagnoses. The dental professional should not hesitate to make referrals to key specialists or to members of an interdisciplinary team at a pain treatment center who have the expertise to appropriately diagnose and manage chronic oral, facial and head pain.- - - - - - - - - - ranking = 2.6keywords = pain (Clic here for more details about this article) |
9/133. 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 = 0.4keywords = pain (Clic here for more details about this article) |
10/133. Silastic interposition arthroplasty for osteoarthrosis of the carpometacarpal joint of the thumb.We performed Ashworth's (1977) silastic interposition arthroplasty for painful osteoarthrosis of the carpometacarpal (CM) joint of the thumb. Recently, however, some unsuccessful cases treated by this method have been reported. We therefore reviewed the results of patients treated by Ashworth's method. We reviewed 16 patients operated on according to the original Ashworth method for osteoarthrosis of the first CM joint. The cases consisted of 8 males and 8 females, ranging in age from 32 to 76 years (average, 59.6 years). The patients were grouped according to Eaton's classification as follows: 1 patient was stage II, 6 were stage III, and 9 were stage IV. All patients were followed postoperatively for 1 to 12.5 years (average, 4.5 years). Twelve patients did not complain of any pain but 3 patients felt slight pain when moving their thumb. However, the degree of pain was much less than that experienced preoperatively. Only one patient complained of severe pain 2 years after the first operation. Her implant ruptured and required additional surgery. All except one showed either an increase or no change in grip strength. The range of motion (ROM) was full in all patients. Implants showed sinking in 3 patients, a partial rupture of the implant edge in 5 patients and a whole body failure in only 1 implant, roentogenographically. In spite of these troubles, only 3 patients complained of an unpleasant feeling and 2 reported slight pain. Implant trouble did not always cause the symptoms. The clinical results of this method were mostly satisfactory.- - - - - - - - - - ranking = 1.2keywords = pain (Clic here for more details about this article) |
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