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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Bone scintigraphy is of growing interest to the sports physicians in the evaluation of benign disorders of the musculoskeletal system. It is atraumatic and easily applied, and being very sensitive a normal scintigram excludes pathophysiological conditions or mechanical disorders of the bones and joints. The indication is mainly suspicion of stress fractures, where a graduation is possible allowing prognostic interpretation. The finding of stress fractures in female athletes with long-lasting amenorrhea may warrant further interest in the bone mineral content of the skeleton. In the diagnostic evaluation of particularly longer-lasting joint-related pain in younger subjects without obvious degenerative disease, bone scintigraphy is very sensitive to exclude joint affection, but not very specific to reveal an exact diagnosis. In athletes with back pain and radiographically demonstrated spondylolysis, tomography of bone scintigrams (SPECT) may discern between an actively healing process, probably eliciting the pain, and an inactive, healed process not responsible for the back pain. Bone tumors always show increased uptake in bone scintigraphy, but the method does not allow a reliable differentiation between benign and malign etiology.
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PMID:Bone scintigraphy in sports medicine: a review. 945 97

Degenerative changes of the spinal column have long been and continue to be confused with the presence of spinal distress and pain. All parts of the spine undergo degenerative changes as we age. The purpose of this chapter is to describe the degenerative process and its clinical consequences. The disc degenerative process will be discussed; its consequences on the facet joint and osteophyte formation are considered. The prevalence of disc degeneration, the role of physically demanding work and leisure and the interference of spinal deformity is clarified. A section particularly important for the clinician deals with the clinical consequences of the degenerative process in disc herniation, degenerative spondylolisthesis, spondylolysis and stenosis. This chapter tries to put the degenerative changes of the spine into the context of a normal ageing process.
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PMID:What are the age-related changes in the spine? 966 61

Despite advances in nuclear medicine, bone scintigraphy remains an important imaging technique. It is sensitive in detecting stress fractures and bone metastases and can assess suspected injury that is difficult to see on plain films (e.g., rib fracture). Scintigraphy is useful in evaluating new symptoms, response to therapy, and prognosis in patients with known malignant tumor. In patients with low back pain, the technique can determine the age of fractures to help identify osteoporosis and can uncover other causes of the pain (e.g., spondylolysis, arthritis). When Paget's disease is suggested by unexplained bone pain or an elevated serum alkaline phosphatase level, bone scintigraphy is a useful screening test. Combined with other appropriate nuclear medicine studies, it helps in early identification and localization of osteomyelitis. Scintigraphic scans can provide a general indicator of malignant versus benign disease (according to the amount of lesion activity seen) and may produce characteristic findings in certain primary tumors (e.g., osteoid osteoma) that are difficult to evaluate with other methods.
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PMID:When to use bone scintigraphy. It can reveal things other studies cannot. 982 85

The incidence and etiology of back pain during orthotic management of idiopathic scoliosis was determined for 303 patients treated from 1980 through 1990 for a minimum of 1 year. All patients denied back pain before orthotic prescription. Thirty-four (11%) patients reported back pain after institution of brace treatment. A family history of scoliosis (p = 0.014) and vigorous sports activities (p < 0.001) were correlated with pain. Seventeen of 34 patients with pain showed >10 degrees of curve progression during bracing, whereas 67 of 269 patients without pain progressed (p = 0.002). Four patients with pain and 11 without were eventually found to have an underlying pathology (spondylolysis/listhesis). No other underlying pathologies were found. Night pain or a left thoracic curve pattern were not correlated with a serious underlying etiology. Back pain occurring after institution of brace treatment for idiopathic scoliosis is often associated with curve progression and is poorly correlated with a serious underlying pathology.
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PMID:Back pain during orthotic treatment of idiopathic scoliosis. 1008 88

Currently recommended management for low back pain in adults is presented. The algorithm consists of two phases. In a patient presenting acute low back pain with no previous history thorough clinical evaluation (phase I) should aim at exclusion of cauda equina syndrome, fracture, neoplasm, infection, progressive neurological deficit, or chronic pain syndrome. If none of these condition is responsible for low back pain 4-6 weeks therapy depending on the severity of symptoms should be commenced. Then clinical reevaluation is indicated and if pain persists patient should be referred to a specialist (phase II). Previous diagnosis and treatment should be reviewed critically; if found appropriate the treatment might be repeated during phase II. Primary sources of low back pain as herniated nucleus pulposus, unremitting low back pain (segmental instability), spondylolysis, isthmic spondylolisthesis degenerative spondylolisthesis with spinal stenosis should be identified and appropriate treatment (surgical or conservative) undertaken. Patient education is an important component of phase II. In general, phase II of the algorithm aims at returning the patient to full psychophysical activity and at prevention of low back pain recurrence.
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PMID:[Algorithm in low back pain management in adults]. 1009 9

We analyzed the pain-relieving effect and the functional outcome during external pedicular fixation of the lumbar spine. Twenty patients were included, and the diagnoses were disc degeneration with or without facet joint arthrosis in eight patients, pain after decompression in six patients, spondylolysis/olisthesis in two patients, other types of lumbar anomalies in three patients, and pseudarthrosis after prior uninstrumented fusion in one patient. Before application of the external frame, the pain level on the Visual Analogue Scale was registered at rest, as a mean level for the preceding week, and at seven different functional tests. Maximum walking capacity and walking time needed for a standardized distance were also measured. The same test procedure was repeated 1 week postoperatively with the external frame applied in locked position. With stabilization, 11 patients reported pain relief at rest and 14 when approximating the mean pain level for the week. Both these measured levels correlated to the pain level at all of the seven functional tests. Thus, the patients selected for a subsequent fusion based on pain relief during extended functional provocation would not differ from the patients selected by using only the pain-relieving effect at rest. The patients reporting pain relief tended to increase their walking distance (p = 0.06, t test) but not the speed of walking.
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PMID:External pedicular fixation of the lumbar spine: outcome evaluation by functional tests. 1022 30

We investigated the origin of low back pain associated with lumbar spondylolysis and spondylolytic spondylolisthesis by removing fibrocartilage masses from the lytic sites in symptomatic patients and staining the masses by the Gairns gold chloride method to examine mechanoreceptors. The fibrocartilage masses were found to contain four types of mechanoreceptors: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. All of these mechanoreceptors were present at the periphery of the specimens, and Ruffini receptors and free nerve endings were abundant. Some mechanoreceptors had a slightly atypical structure, in addition to those with typical morphology. Comparison with mechanoreceptors in normal lumbar facet joint capsules showed that there were more mechanoreceptors in the fibrocartilage masses and a greater proportion of atypical structures at lytic sites. The presence of mechanoreceptors at lytic sites suggests that the fibrocartilage masses are not simply scar tissue filling the defect. Rather, these masses also appear to play a protective role by sensing instability via mechanoreceptors and transmitting this information as pain, while at the same time acting as ligament-like tissue that connects and stabilizes the separated vertebral arches.
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PMID:A study of mechanoreceptors in fibrocartilage masses in the defect of pars interarticularis. 1066 24

Spondylolysis is a relatively common incidental radiographic finding that, most frequently, is asymptomatic. Isthmic spondylolysis with a lesion in the pars interarticularis may be a significant cause of pain in a given individual, particularly in adolescent athletes involved in sports with repetitive spinal motions. The pars lesion likely represents a stress fracture of the bone caused by the cumulative effect of repetitive stress imposed by physical activity. The lesion frequently presents as focal LBP and can often be identified on plain radiography. Advanced imaging with SPECT, CT, and MR imaging may be needed to ascertain the acuity of the lesion, assist in identifying a particular pars lesion as potentially symptomatic, and to exclude other spinal pathology that may be present. Conservative treatment is usually successful in controlling symptoms and restoring function; only a small percentage of patients require surgical intervention for pain or progressive spondylolisthesis. Based on current evidence, treatment requires activity restriction (i.e., temporary discontinuation of the aggravating sport or activity) and may require bracing to achieve treatment goals, although healing, pain relief or both may occur without brace application. A full understanding of spinal biomechanics and pathophysiology, the role of diagnostic imaging, and treatment options is needed to care for these patients.
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PMID:Spondylolysis. 1109 19

Teenaged girls constitute the fastest growing segment of children and adolescents participating in organized athletics. Adolescent girls appear to have similar injury rates as boys in comparable activities but different injury patterns. To properly diagnose and manage athletic injuries in adolescent girls, pediatric health care providers must be aware of these differences, especially as the literature and their knowledge base may be skewed to the traditional predominance of males in sport. This review identifies athletic injuries that are unique to or especially common in adolescent girls, including apophyseal injuries; breast and pelvic injuries; scoliosis and spondylolysis; multidirectional shoulder instability and "gymnast's wrist"; anterior cruciate ligament injuries and patellofemoral pain syndrome; chronic exertional lower-leg compartment syndrome, ankle sprains, and reflex sympathetic dystrophy; and stress fractures. It also briefly discusses possible risk factors for these injuries, emphasizing the female athlete triad.
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PMID:Common athletic injuries in adolescent girls. 1171 55

Direct repair of the pars interarticularis defect was carried out in 16 spondylolysis patients. There were 8 male and 8 female patients. The site of pars defects involved L5 in 10 cases and L4 in 6 cases. Chronic low back pain was the main symptom, only one patient presented with acute severe back pain. Pars defects were confirmed by oblique views of the lumbosacral spine. The height of the spinous process of the involved vertebra was measured and compared to the above adjacent vertebra. Radiographic fusion of the defects was confirmed by bridging of bone across the pars on oblique views. All the patients except one were treated conservatively prior to surgery. Clinical outcomes were assessed by pre- and post-operative pain, union of the pars defects, functional status and patient verbal rating scales. The mean follow-up was 36 months, the longest was 7 years. At 2 years follow-up, the overall satisfaction and improvement were reported in most of the patients. There was no functional failure. Hypoplasia of the neural arch was found in 3 patients. There were two non unions, both of them had maldevelopment of neural arches. One symptomatic non union needed resurgery for stabilization.
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PMID:Surgical repair of pars defects in spondylolysis. 1180 Feb 94


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