1/21. 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 = 1keywords = physical (Clic here for more details about this article) |
2/21. sjogren's syndrome presenting as remitting seronegative symmetric synovitis with pitting edema (RS3PE).Remitting seronegative symmetric synovitis with pitting edema (RS3PE) syndrome is characterized by symmetrical and acute synovitis, pitting edema, the absence of rheumatoid factor, increased acute phase reactants, lack of bony erosions on radiography, and benign and short clinical course. Half of all patients with sjogren's syndrome experience arthritis during the disease course. We here describe the first case of sjogren's syndrome presenting as RS3PE. She had swelling in knees, ankles, and wrists. After then the swelling spread to her lower legs, feet, face, and both hands. She was admitted to another hospital and was suspected of lupus or rheumatoid arthritis. Three months later, she had dry mouth and had lower lip biopsy. She was admitted to this hospital due to development of swelling in face and lower legs for 3 days. On physical examination, she had pitting edema in both hands and feet dorsum. Laboratory test showed elevated erythrocyte sedimentation rate, positivity of rheumatoid factor, anti-nuclear antibody, and anti-Ro antibody. There was no erosion in the hands radiography. Schirmer's test and lip biopsy was compatible with sjogren's syndrome. She was diagnosed RS3PE and sjogren's syndrome. She was begun with prednisolone and her symptoms improved gradually.- - - - - - - - - - ranking = 1.8005456011971keywords = physical examination, physical (Clic here for more details about this article) |
3/21. A case of hereditary angioedema with recurrent arthritis, erythema marginatum-like rash and chest pain.Hereditary angioedema (HAE) results from a congenital deficiency of C1 inhibitor and is characterized by submucosal and subcutaneous edema of skin, larynx and abdomen. Occasional reports have appeared linking HAE with autoimmune diseases. We report a case of HAE presenting recurrent nondeforming polyarthritis, erythema marginatum-like rash and chest pain. There were no significant radiographic joint changes. serologic tests for rheumatologic and autoimmune diseases were negative. After danazol treatment, physical examination and laboratory findings were normal over five years. We suggest that pediatricians should be aware of this rare disease and treat patients accordingly.- - - - - - - - - - ranking = 1.8005456011971keywords = physical examination, physical (Clic here for more details about this article) |
4/21. osteomyelitis and pyogenic sacroiliitis: A difficult diagnosis.Pyogenic sacroiliitis is an uncommon infection often diagnosed late because of poor localization of symptoms and inadequate physical examination. We describe a 12-year-old girl whose osteomyelitis and pyogenic sacroiliitis was initially misdiagnosed and discuss examination, investigation and management of the condition. This case highlights the importance of thorough physical examination and the consideration of septic arthritis in an unusual joint.- - - - - - - - - - ranking = 3.6010912023941keywords = physical examination, physical (Clic here for more details about this article) |
5/21. arthritis as a manifestation of self-mutilation in childhood.Traumatic arthritis resulting from self-aggression is rarely encountered in children. Differentiation from child abuse and common causes of childhood arthritis is difficult and rests upon a high level of suspicion. We describe a 10-year-old girl with hand deformities associated with joint pain and swelling managed as juvenile rheumatoid arthritis for 3 years. Reevaluation revealed both physical and radiographic evidence of recurrent trauma. Psychiatric assessment confirmed the diagnosis of autoaggression leading to self-mutilation and psychosocial rehabilitation was essential in successful management.- - - - - - - - - - ranking = 0.25keywords = physical (Clic here for more details about this article) |
6/21. Angiomatous malformation: a rare cause of recurrent swelling of the knee joint.Angiomatous malformation of the muscle around the knee joint is an extremely uncommon cause of recurrent swelling of the joint. We report a case of a 13-year-old boy who presented with recurrent episodes of knee joint swelling. Though the history and physical examination was typical, magnetic resonance imaging clinched the diagnosis.- - - - - - - - - - ranking = 1.8005456011971keywords = physical examination, physical (Clic here for more details about this article) |
7/21. Deep vein thrombosis in an athletic military cadet.STUDY DESIGN: Resident's case problem. BACKGROUND: A 21-year-old healthy athletic male military cadet with complaint of worsening diffuse left knee pain was evaluated 4 days after onset. The knee pain began 2 hours after completing a long car trip, worsened over the subsequent 3 days, and became almost unbearable during the return trip. The patient reported constant pain, limited knee motion, and difficulty ambulating. In addition, he was unable to perform physical military training or attend academic classes due to the severe left knee pain. Past medical history revealed a mild left lateral calf strain 21/2 weeks prior, which completely resolved within 24 hours of onset. diagnosis: Our physical examination led us to either monoarticular arthritis, pseudothrombophlebitis (ruptured Baker's cyst), or a lower leg deep vein thrombosis (DVT) as the cause of knee pain. diagnostic imaging of this patient revealed a left superficial femoral vein thrombosis and popliteal DVT, with bilateral pulmonary emboli (PE). DISCUSSION: A systematic differential diagnosis was undertaken to rule out a potentially fatal DVT diagnosis as the cause of knee pain, despite minimal DVT risk factors. The physical therapist in a direct-access setting must ensure timely evaluation and referral of a suspected DVT, even when patient demographics cause the practitioner to question the likelihood of this diagnosis. The physical examination findings, clinical suspicion, and established clinical prediction rules can accurately dictate the appropriate referral action necessary.- - - - - - - - - - ranking = 4.1010912023941keywords = physical examination, physical (Clic here for more details about this article) |
8/21. Open-label study of clarithromycin in patients with undifferentiated connective tissue disease.OBJECTIVE: The macrolide family of antibiotics (erythromycin, clarithromycin, and others), have both antimicrobial and immunomodulatory effects. This study explored the effect of clarithromycin on the clinical course of patients with undifferentiated connective tissue disease (UCTD) in a 12-week open-label study. methods: The diagnosis of UCTD was based on symptoms/signs of connective tissue disease, and the presence of 1 or more positive autoimmune disease tests, but with insufficient criteria to make a definitive diagnosis. Screening and monthly follow-up visits over 12 weeks included the following: history and physical examination; concurrent medications; the 68/66 tender/swollen joint count; visual analog scores 0 to 100 mm for patient and physician global assessment of disease activity, and patient pain; antinuclear antibody panel, rheumatoid factor, erythrocyte sedimentation rate, c-reactive protein, and blood chemistry. RESULTS: Seven patients with rheumatic disease were treated with clarithromycin; 6 of 7 had symptomatic relief. Two subjects treated empirically before the decision to perform an open-label study responded favorably. Four of 5 patients who completed the prospective open-label study had mean maximal improvements from baseline of 78, 75, and 79% in patient pain, patient global, and investigator global assessments, respectively. Pain relief occurred as early as 1 week. Drug withdrawal with rechallenge in 2 patients resulted in flare followed by recapture of symptomatic relief. CONCLUSIONS: clarithromycin, a macrolide antibiotic, led to clinical improvement in patients with UCTD. Efficacy and safety data support further investigation of macrolide antibiotic use as a primary or adjunctive treatment in various connective tissue diseases.- - - - - - - - - - ranking = 1.8005456011971keywords = physical examination, physical (Clic here for more details about this article) |
9/21. The triggering role of physical injury in the onset of peripheral arthritis in seronegative spondyloarthropathy.Three more cases of B27-positive patients who developed peripheral arthritis immediately after trauma are reported. The first had an exacerbation of arthritis in the right hip after falling from her motor-bike. The second had arthritis of the distal interphalangeal (DIP) joint of the right forefinger after shutting his finger in the door of his car. The third had arthritis of the right sternoclavicular joint after a road-accident while fastening her safety belt.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/21. Psoriatic arthritis precipitated by physical trauma.A case of skin psoriasis and psoriatic monoarthritis triggered by physical trauma is reported. Possible pathogenic mechanisms of this phenomenon are discussed.- - - - - - - - - - ranking = 1.25keywords = physical (Clic here for more details about this article) |
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