1/29. Unusual case of septic arthritis of the hip: spread from adjacent adductor pyomyositis.Distinguishing intracapsular and extracapsular hip infections may be clinically difficult. Because of this difficulty in diagnosis, the spread of an extracapsular infection into the hip joint may be missed and lead to significant joint destruction. The case of a patient who suffered from the spread of adductor pyomyositis to the hip joint is reported. The delay in diagnosis of an intracapsular hip infection led to significant intra-articular destruction and ultimately necessitated a Girdlestone resection arthroplasty. The patient's hip function was salvaged with a total hip arthroplasty. The presence of an extracapsular hip infection should mandate serial physical examinations and aggressive evaluation to rule out intracapsular spread. A delay in diagnosis of an intracapsular hip infection can lead to catastrophic results.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
2/29. gout-induced arthropathy after total knee arthroplasty: a report of two cases.gout, although relatively rare in joint replacements, can present as an acute or chronic painful knee or hip arthroplasty. gout and acute infection of a joint replacement can be difficult to differentiate, with the physical examination and laboratory study results frequently being similar. Both conditions can present with a rapid onset of joint pain, swelling, erythema, and constitutional symptoms, including fevers and malaise. Laboratory findings in both conditions often include an elevated leukocyte count, erythrocyte sedimentation rate, and c-reactive protein level. Negatively birefringent, needle-shaped crystals in the synovial fluid confirm the diagnosis of gout. The mistaken diagnosis of septic arthritis in a joint replacement with crystal-induced synovitis can lead to inappropriate open debridement or component removal. The current study includes a review of the literature and presents two cases of gout after total knee arthroplasty. These cases suggest that in situations of suspected sepsis without synovial fluid crystals, operative intervention is indicated with a presumed diagnosis of septic arthritis. The identification of chalky white or yellow deposits in the synovium or bone is highly suggestive of gout. The definitive diagnosis is made by polarized light histologic evaluation of these tissues. If these deposits are present in the absence of a positive preoperative culture, positive Gram stain for bacteria, or component loosening, component retention is indicated.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
3/29. Gonarthritis in the course of lyme disease in a one-and-a-half-year-old child.A case of a one-and-a-half-year-old girl is reported in whom gonarthritis in the course of lyme disease was diagnosed. The girl was brought up in an urban environment. She never was in a forest and had no contact with animals (except for a healthy pet-dog, which was under veterinary supervision). She did not attend a nursery, and went for walks only within urban area under the careful guidance of her parents. In spite of the negative family history the level of antibodies against borrelia burgdorferi was estimated. A very high level of IgG antibodies and a low level of IgM borrelia burgdorferi antibodies, accompanied by physical symptoms allowed to diagnose the second stage of lyme disease. We considered the described case as worth presentation due to the child's very early age. Moreover, the infection was caused supposedly due to the contact with a dog (which may be unusual carrier of ticks), and not--as in most cases--in a forest.- - - - - - - - - - ranking = 0.080232617844381keywords = physical (Clic here for more details about this article) |
4/29. Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine.The authors developed an instrument called the "rehabilitation Problem-Solving Form" (RPS-Form), which allows health care professionals analyze patient problems, to focus on specific targets, and to relate the salient disabilities to relevant and modifiable variables. In particular, the RPS-Form was designed to address the patients' perspectives and enhance their participation in the decision-making process. Because the RPS-Form is based on the International classification of Functioning, Disability, and health (ICF) Model of Functioning and Disability, it could provide a common language for the description of human functioning and therefore facilitates multidisciplinary responsibility and coordination of interventions. The use of the RPS-Form in clinical practice is demonstrated by presenting an application case of a patient with a chronic pain syndrome.- - - - - - - - - - ranking = 0.32093047137752keywords = physical (Clic here for more details about this article) |
5/29. Pyogenic sacroiliitis in children: report of three cases.We report three children who were treated for pyogenic infection of the sacroiliac joint. The disease, usually present in late childhood or adolescence, is uncommon and difficult to assess so that the diagnosis is usually delayed. The three patients were two boys and one girl, aged 14, 15 and 12 years, respectively. A detailed history and physical examination are very important for establishment of the diagnosis. All the three cases presented with typical clinical triad of fever, limping gait and buttock pain. pelvis compression maneuver, which directly stresses the sacroiliac joint, may aggravate the joint pain and suggest this diagnosis. On physical examination, this test is positive in all our cases. Nuclear scintigraphy is useful for localization of early lesions. For detecting abscess formation, magnetic resonance imaging was performed in two cases and computed tomography in one. In one of the patients, computed tomography failed to demonstrate an iliopsoas abscess formation, which was proved by magnetic resonance imaging later. staphylococcus aureus was isolated from blood in all three patients. Prompt antibiotic therapy reduces complication and operation is rarely needed. With rapid and appropriate medical treatment, all our patients recovered without an sequelae.- - - - - - - - - - ranking = 2keywords = physical examination, physical (Clic here for more details about this article) |
6/29. A rare case of salmonella-mediated sacroiliitis, adjacent subperiosteal abscess, and myositis.We report the case of a 16-year-old female who was ultimately diagnosed with salmonella sacroiliitis, adjacent subperiosteal abscess, and myositis of the left iliopsoas, gluteus medius, and obturator internus muscles. Early and accurate recognition of this syndrome and other infectious musculoskeletal syndromes can prove difficult for the emergency physician, as these disease processes require special attention to pain of proportion to physical findings and a high index of suspicion.- - - - - - - - - - ranking = 0.080232617844381keywords = physical (Clic here for more details about this article) |
7/29. Computed tomography in diagnosis of septic sacroiliitis: report of three cases.Disorders of the sacroiliac joint are often overlooked during an initial physical examination because the patient is usually in a supine position and the posteriorly located joint is not accessible. Local pain and tenderness at the sacroiliac joint on lateral compression of the pelvis, together with Gaenslen and Fabere maneuvers, may direct the physician's attention to the joint. However, these symptoms are not specific or pathognomonic. Unusual presentation of septic sacroiliitis, which does not show radiologic changes during the early stages, may mimic gluteal, lumbar disc or intra-abdominal syndromes, leading to unnecessary abdominal exploration or lumbar discectomy. Computed tomography (CT), with its superb delineation of osseous, synovial and peri-articular structures, was applied to diagnose septic sacroiliitis in three patients. In Patient 1, septic arthritis and juxta-articular osteomyelitis with sequestrum formation were demonstrated by CT four weeks before abnormalities were shown on a roentgenogram. In patients 2 and 3, inflammatory processes affected the synovium and peri-articular muscles; thus, abnormalities were shown by CT but not by a roentgenogram. We consider CT to be helpful and superior to conventional radiography in the diagnosis of septic sacroiliitis.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
8/29. Pyogenic infection of the sacroiliac joint. case reports and review of the literature.Three cases of pyogenic sacroiliitis are described, and the English literature from 1878 to 1990 reviewed, for a total of 166 cases. In 1 patient the source of infection was identified at the site of an intravenous line; 1 patient had 2 risk factors for developing the disease (pregnancy and intravenous drug use); and a third patient had no source of infection and no associated risk factors. The diagnosis of pyogenic sacroiliitis was made in each patient by history, physical examination, and positive skeletal scintigraphy or computed tomography of the sacroiliac joint. The infectious agent causing septic arthritis was identified by fine-needle aspiration of the sacroiliac joint under fluoroscopic guidance. Two of the 3 patients also had an open biopsy of the sacroiliac joint--one to confirm the organism causing septic arthritis, and the other for surgical drainage of the infected sacroiliac joint. Cultures from all 3 patients grew organisms uncommon for this disease, and all were treated for 6 weeks with intravenous antibiotics. In all patients pain diminished after treatment. Pyogenic sacroiliitis is a relatively rare condition (1-2 cases reported/year) that may be clinically difficult to diagnose unless the clinician is familiar with the disease. A prompt diagnosis can prevent significant morbidity and reduce serious complication. Major predisposing factors include intravenous drug use, trauma, or an identifiable focus of infection elsewhere, but 44% of patients have no predisposing or associated factors identified. Most patients present with an acute febrile illness with pain in the buttocks and pain on movement that stresses the affected sacroiliac joint. There is no specific blood test which points to the diagnosis of pyogenic sacroiliitis, although the erythrocyte sedimentation rate may be greater than 100 mm/hr. The diagnostic procedure of choice is bone scan with attention to the early perfusion phase, which usually localizes the affected sacroiliac joint. Unilateral involvement is the rule. In patients whose blood cultures fail to reveal a causative organism, fluoroscopic guided fine-needle aspiration of the sacroiliac joint under general anesthesia may help to identify the organism. If all cultures are negative, open biopsy of the sacroiliac joint may be required. Open biopsy should also be done if sequestration or an abscess is formed, or if the patient fails to respond to antibiotic therapy.(ABSTRACT TRUNCATED AT 400 WORDS)- - - - - - - - - - ranking = 0.080232617844381keywords = physical (Clic here for more details about this article) |
9/29. Septic arthritis: common pitfalls.The diagnosis of suppurative arthritis is a challenging task complicated by many pitfalls. The physician must rely on the basic skills of a history, physical examination, and index of suspicion to properly decipher the differential diagnosis, and the perceptive analysis of laboratory studies is essential. Prompt institution of treatment with antibiotics and effective cleansing of the joint are the key factors in achieving a good result.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
10/29. Roentgen rounds #94. osteomyelitis of the left ilium--left iliacus muscle abscess.A left iliac osteomyelitis and left iliacus muscle abscess occurred in a patient who underwent bipolar hemiarthroplasty of the left hip six months prior for avascular necrosis of the left femoral head, secondary to sickle-cell disease. This illness followed an upper respiratory tract infection, and her physical examination was suggestive of a septic process involving the left hip. An aspirate of the hip was not confirmative for septic arthritis. The plain roentgenograms demonstrated that the prosthesis was in an acceptable position, but had limited value in the remainder of the differential diagnosis. In this case, the bone scan contributed significant information distinguishing osteomyelitis from osteonecrosis. The CT scan allowed rapid localization of an occult abscess and destructive changes in the left ilium secondary to osteomyelitis and guided surgical treatment.- - - - - - - - - - ranking = 1keywords = physical examination, physical (Clic here for more details about this article) |
| | Next -> |