1/12. Painful pectoralis major myospasm as a result of sternal wound reconstruction: complete resolution with bilateral pectoral neurectomies.We report a patient with a highly unusual and previously unreported complication with the use of the pectoralis major muscle to treat the infected median sternotomy. The diagnosis of painful myospasm was made by a combination of physical findings and exclusion of other conditions such as recurrent infection. Treatment by pectoral denervation was relatively simple and highly successful. patients with chest-wall pain after sternal wound reconstruction should have myospasm entertained as a possible cause.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/12. Colonic spasm and pseudo-obstruction in an elongated colon secondary to physical exertion: diagnosis by stress barium enema.Anatomic and functional abnormalities of the colon are known to cause a variety of abdominal complaints, including constipation, diarrhea, and pain. We describe a patient with dolichocolon (elongated colon) with transient spasm (pseudo-obstruction) associated with exertion. The diagnosis in this case rested with a novel approach and less invasive evaluation of the colon.- - - - - - - - - - ranking = 4keywords = physical (Clic here for more details about this article) |
3/12. Tetraplegia: update on assessment.The overall assessment in the tetraplegic patient should be comprehensive and detailed. This paper discusses aspects of the medical and physical assessment that normally may go unrecognized but are extremely important in the outcome of the tetraplegic patient. A comprehensive classification also is provided as a new guideline for rehabilitation and surgery. Additionally, the power of [figure: see text] cultural, social, and personal dimensions of disability are illustrated and the importance of these dimensions as they relate to assessment is examined. Finally, the COPM is introduced as an outcome measure capable of crossing cultural [table: see text] boundaries and allowing for the comparison of interventions.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
4/12. Use of botulinum toxin type A on orthopedics: a case report.Botulinum toxin type A is effective in treating neurologic entities with increased muscle tone. Few reports show the benefits of this treatment for orthopedic conditions. We present the case of a 54-year-old man who manifested bilateral pectoralis major stiffness and bilateral shoulder pain; he had a score of 6 on a visual analog scale (VAS). Complex regional pain syndrome (type I) after cardiac surgery, which had already been resolved, was significant in the patient's clinical background. On examination, neither increases in muscle tone nor signs of tendinous or joint pathology was found. However, the patient experienced significant pain when both pectorals were stretched. The patient's Constant score, a validated scale of shoulder function, was 45/100 on the right shoulder and 41/100 on the left. The patient's shoulder stiffness and pain neither responded to rehabilitation (stretching exercises, passive mobilization, electrostimulation) nor to oral medication (alprazolam, gabapentin). Despite the lack of increased muscle tone, we decided to administer botulinum toxin type A to control pain. Subsequently, pain intensity was reduced to 4 on a VAS on both sides, and functionality improved (Constant scale score, 62 on the right side; 60 on the left). This improvement enabled the patient to resume his job as a building supervisor, which required active involvement in physical construction work.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
5/12. Self-inflicted orodental injury in a child with leigh disease.leigh disease is an inherited progressive mitochondrial neurodegenerative disease that affects the neurological, respiratory and cardiovascular systems and is associated with retardation of the intellectual and physical development. This report describes the case of a 4-year-old boy with leigh disease who presented with self-inflicted traumatic injury to the teeth, alveolar bone, lips and tongue during repeated episodes of intense orofacial spasms. Conservative management of the injury included repositioning the fractured alveolar bone, splinting the traumatized teeth and planning for a mouthguard. However, after a second incident of severe self-induced injury to the teeth and alveolar bone, extraction of the anterior teeth became inevitable to protect the child from further self-mutilation and to allow healing of the injured tissues.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
6/12. Splinting for adaptation of musical instruments.Classic instrument design does not always match the physical capacity of the musician, as instruments are often chosen because of the pleasing sound and not the ease of play. Devices that are commercially available to create a more ergonomic structure may not address the specific needs of a musician with a chronic condition. Through basic splinting of the musician with an injury, these physical stressors can be reduced, allowing the continuation of musical practice and performance. Appropriate design modification requires a solid understanding of upper extremity anatomy, splint design technique, and the biomechanic principles of playing the instrument. Through knowledge of music theory and appreciation, one may modify the instrument while protecting tonal flexibility, resonance, mechanical freedom, and sound quality. Two case studies present a range of splint design, from small to large, static to dynamic, and for congenital or chronic conditions.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |
7/12. Bilateral upper extremity ischemia after administration of dihydroergotamine-heparin for prophylaxis of deep venous thrombosis.Prolonged arterial spasm as a complication of ergot-containing medications has been reported since antiquity. This article describes our experience with a patient who had severe bilateral arterial spasm in the upper extremities 6 days after the initiation of a regimen of dihydroergotamine and heparin for prophylaxis against deep venous thrombosis. The spasm was refractory to oral calcium channel blocking agents and direct intraarterial infusion of tolazoline (Priscoline). However, intraarterial nitroglycerin produced a prompt and dramatic improvement in symptoms and in physical and arteriographic findings. This experience suggests that intraarterial nitroglycerin may be an appropriate first choice for ergot-induced arterial spasm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
8/12. Vasospastic exercise-associated unilateral leg ischemia: evaluation with thallium-201.thallium 201 (Tl-201) as a marker of regional tissue perfusion is described as a diagnostic aid in a case of exercise-induced vasospastic disease affecting the lower leg of a physically active young adult male who had no evidence of atherosclerotic disease. The success and failure of various therapeutic attempts made in behalf of this patient have been monitored by repeated Tl-201 administrations. exercise-associated ischemia in tissues other than the myocardium can be investigated with Tl-201.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
9/12. magnetic resonance imaging findings and correlations in spasmodic dysphonia patients.A sample of 19 spasmodic dysphonia (SD) patients was selected from a larger population of such patients to undergo magnetic resonance imaging (MRI), auditory brain stem response (ABR) testing, speech analysis, and extensive physical examination. Six patients had abnormal spin-echo MRI findings, ranging from infarcts within the basal ganglia to demyelinating lesions within the supralateral angles of the lateral ventricles. A weakly positive correlation was noted between the abnormal MRI findings and an abnormal ABR. The lack of a significant correlation between the MRI findings and other predictors of brain stem and midbrain disease, and the current spatial resolution limitations of MRI, suggest that we are visualizing the associated lesions rather than the actual foci of SD. The range of MRI findings is consistent with the concept that SD is a voice disorder in a heterogeneous patient population.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
10/12. Hamstring spasm in anterior cruciate ligament injuries.The accurate diagnosis of an anterior cruciate ligament (ACL) injury continues to be a challenge to clinicians, and often requires magnetic resonance imaging or arthroscopy for confirmation. We present a literature review of the currently known physical signs of ACL injury, followed by three case reports that describe a sign we believe may be helpful in the diagnosis of acute/semi-acute ACL injury: involuntary hamstring spasm.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
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