1/9. Fluoroquinolone-induced tendinopathy: what do we know?fluoroquinolones are relatively safe, effective antibiotics. As their use becomes more frequent, so will the adverse side effects. I highlight a rare but debilitating adverse reaction-fluoroquinolone-induced tendinopathy. case reports and letters from 1987 to 1998 were identified by using grateful med and pubmed internet accesses to the National Library of medicine. Articles were reviewed for clinical practicality. There are few articles on fluoroquinolone-induced tendinopathy in the US literature targeting primary care physicians. This entity has been described in many case reports, but little has been done to isolate the causative agents. incidence of this side effect is difficult to estimate, since no prospective studies are available for review or calculation of risk. Fluoroquinolone-induced tendinopathy appears more commonly in tendons under high stress. The cause is probably multifactorial. risk factors for the development of fluoroquinolone-induced tendinopathy are age, renal failure, corticosteroid use, and previous tendinopathy from fluoroquinolones.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
2/9. levofloxacin-induced bilateral Achilles tendonitis.OBJECTIVE: To report a case of possible levofloxacin-induced bilateral Achilles tendonitis. CASE SUMMARY: An 83-year-old white woman presented to her physician with five days of hemoptysis. She was diagnosed with right lower-lobe pneumonia based on chest X-ray, and levofloxacin 500 mg/d po for 10 days was prescribed. Three days into treatment she began having a variety of adverse effects, including severe nausea, constipation, stomach cramps, and dizziness. Signs of tendonitis began three days after treatment and peaked four days after completion of therapy. Two weeks later, she was treated by her podiatrist with an ankle immobilizer and rest. At her three-week follow-up, she had marked improvement in her pain and bruising; however, her symptoms had not completely resolved. DISCUSSION: Tendonitis and tendon rupture are rare adverse effects of fluoroquinolone antibiotics; there are no reports in the literature of levofloxacin-induced tendonitis. As newer fluoroquinolones become available, the postmarketing studies will become increasingly important to capture the data on rare but serious adverse effects not discovered in the premarketing trials. CONCLUSIONS: To our knowledge, this is the first reported case of tendonitis caused by levofloxacin reported in the literature. Reports have been made, however, to the manufacturer via postmarketing surveillance. As more people are treated with newer fluoroquinolones, the clinical incidence of tendon rupture with these agents may become clearer.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
3/9. Unresolving hip tendonitis leads to discovery of malignant tumor.OBJECTIVE: To discuss a case of malignant bone tumor in the left hip of a patient who sought treatment following a tennis injury. CLINICAL FEATURES: A 27-year-old male patient visited a chiropractic clinic 6 months after a twisting injury to his left hip which occurred while playing tennis. His pain had remained moderate in intensity and intermittent to frequent in frequency since it originated but became more intense the week prior to his visit. INTERVENTION AND OUTCOME: The patient was diagnosed with a tendonitis/bursitis and received 3 weeks of treatment. Care consisted of various forms of passive modalities to reduce pain and inflammation, as well as hip mobilization and tissue stretching. Plain film examination was then performed, due to lack of progress, and revealed a possible chondroblastoma of the femoral head. The patient was referred to his primary care physician (PCP) for follow-up imaging. Surgical resection of the lesion occurred approximately 2 months later. biopsy of the resected cells confirmed a new diagnosis of clear cell chondrosarcoma. A computed tomography (CT) scan of the chest was performed to rule out metastasis to the lungs. Regular follow-up care and imaging continued and revealed, 9 months following, that the femoral head lesion had returned and hip replacement surgery would be needed. CONCLUSION: Tendonitis, bursitis, and sprains commonly occur following sports-related trauma to the appendicular skeleton. A conservative trial of care should be performed on suspected soft tissue injuries. However, when lack of improvement occurs within the first month, further examination, special studies, or referral are warranted to ensure a proper diagnosis and to rule out a pathological condition.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
4/9. An underdiagnosed hip pathology: apropos of two cases with gluteus medius tendon tears.Until recently, gluteus medius tendon tears have been the sort of hip pathology that is relatively unknown in the realm of rheumatology. Their diagnosis can pose a serious challenge to physicians, despite diligence. In this report we summarize two relevant cases and put forward some hints for their evaluation. magnetic resonance imaging is quite beneficial in demonstrating the pathology and ruling out other likely pathologies after a prompt physical examination. physicians should exercise care and vigilance in order not to overlook these cases, in which prompt physical examination and radiological interventions remain a prerequisite in the diagnostic algorithm.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
5/9. Retropharyngeal calcific tendinitis: report of five cases and review of the literature.Retropharyngeal calcific tendinitis is an inflammation of the longus colli muscle tendon, which is located on the anterior surface of the vertebral column extending from the atlas to the third thoracic vertebra. Five cases of acute retropharyngeal calcific tendinitis seen in the emergency department (ED) over a 15-month period are reported. In addition, a retrospective review of four cases diagnosed as retropharyngeal abscess and admitted to the hospital revealed that two of these cases actually represented retropharyngeal calcific tendinitis. A review of the literature and potential differential diagnoses are presented. For those primary care physicians who must evaluate patients with acute cervical pain, sore throat, or odynophagia, an x-ray study of the neck revealing retropharyngeal calcium deposition should raise the question of the diagnosis of acute retropharyngeal tendinitis. Clinical characteristics of this entity include a painful condition which is treatable and is often mistaken for retropharyngeal abscess, pharyngitis, or peritonsillar abscess. In our opinion, this condition may be more prevalent than the literature suggests.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
6/9. adolescent runners.The inherent flexibility of young and adolescent runners does not protect them from injury. An understanding of the similarities to and differences from adult problems will help the physician to not only treat appropriately but also give meaningful advice to parents and coaches.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
7/9. Acute calcific retropharyngeal tendinitis. Clinical presentation and pathological characterization.Acute calcific retropharyngeal tendinitis is an underrecognized cause of pain and stiffness in the neck associated with odynophagia and retropharyngeal soft-tissue swelling. We report on five patients in whom an initial misdiagnosis of this entity as a retropharyngeal or nasopharyngeal abscess, a neoplasm, or a fracture-dislocation of the cervical spine led to interventions such as admission to the hospital and parenteral administration of antibiotics. An open biopsy was performed in one patient because of a suspected neoplasm. Evaluation of the tissue specimen with routine and polarized light microscopy, scanning electron microscopy, and energy-dispersive spectrometry demonstrated a foreign-body inflammatory response to deposited crystals of hydroxyapatite. In all five patients, the correct diagnosis was established only after retrospective review of the radiographic studies by a physician who was familiar with acute calcific retropharyngeal tendinitis. The computed tomographic findings of acute calcific retropharyngeal tendinitis are distinctive and consist of prevertebral calcification localized to the insertion of an edematous tendon of the longus colli muscle. Symptomatic relief was provided with anti-inflammatory and analgesic medications. The symptoms resolved, without sequelae, within one to two weeks for all of the patients. We hope that an increased awareness of hydroxyapatite deposition in the tendon of the longus colli muscle will result in improved early diagnosis of acute calcific retropharyngeal tendinitis.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
8/9. Myofascial release of carpal tunnel syndrome.Current treatment for carpal tunnel syndrome may be ineffective or associated with complications or recurrence. In the case reported here, a myofascial release by the physician combined with the patient's self-stretch reduced pain and numbness and improved electromyographic results. The manipulative approach releases the transverse carpal ligament,-and "opens" or dilates the canal. The patient stretches the wrist, digits, and thumb, including myofascial components. An aggressive, conservative approach lessens the need for surgery in mild to moderate cases. Studies with magnetic resonance imaging may be helpful to document canal size before and after treatment.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |
9/9. In-season management of shoulder pain in a collegiate swimmer: a team approach.shoulder pain is a common problem among competitive swimmers, often limiting their ability to train and compete. Although a number of rehabilitation programs for shoulder injuries have been reported in the literature, there is a lack of objective data regarding the effectiveness of these protocols in the competitive swimming population. This case report describes the evaluation and treatment of shoulder pain in an NCAA Division I swimmer during the competitive season. Once a physical therapy diagnosis was made, a plan of care was developed to address each component impairment. This required the input of the team trainers, the team physician, and an orthopaedic surgeon. A chief component of the athlete's rehabilitation involved allowing the athlete to compete, but not practice. Excellent results were achieved, as evidenced by symptom reduction and swimming performance. This case report highlights the interactive, team approach necessary for optimal management of the injured athlete.- - - - - - - - - - ranking = 1keywords = physician (Clic here for more details about this article) |