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

A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier return to sport, though many individuals were improved symptomatically. Local steroids were not found to have a deleterious effect on outcome. Steroids were used most frequently in the chronic cases that presented late and had been treated previously: this group had most recurrences and surgical intervention. One case of Achilles rupture (3%) occurred in the group treated with steroids. Early presentation for treatment led to an earlier return to sport and avoidance of recurrences. Recurrences were most frequent in athletes with bilateral Achilles tendinopathy. The tendo Achillis lesion may range from peritendinitis through a mixed lesion of the tendon and paratenon, to complete rupture. The management depends upon accurate diagnosis, its chronicity and the age and aspirations of the patient. Steroids are safe to use and further prospective trials should note presentation time and disease staging accurately.
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PMID:Tendo Achillis pain: steroids and outcome. 160 Apr 48

Tendinitis and tenosynovitis of the wrist are often encountered in daily medical practice. This frequency is due to the long course of the tendons over the wrist, to the role played by these tendons in the mobilization and stabilization of that joint and to overuse of the hand in daily life as well as in professional and sporting activities. In their common form tendinitis and tenosynovitis are benign and episodic diseases which may present under two aspects: straightforward tenosynovitis with exsudation, crepitus, stenosis or adhesion, and tendinitis at the sites of attachment. In certain cases the condition is specific and of infectious or inflammatory origin. The diagnosis is based on questioning and on the demonstration, during examination, of a symptomatic triad characterized by resurgence of pain at palpation, inducement of passive tension of the tendon, and resisted muscular contraction. Treatment is based on local injections of corticosteroids and rest. Surgery is seldom indicated.
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PMID:[Tendinitis and tenosynovitis of the wrist]. 180 84

Images obtained from normal volunteers demonstrate highly detailed anatomy of the soft tissue and bony structures near the calcaneus and subtalar joint. Cortical bone, marrow, articular cartilage, ligaments, tendons, muscles, fibrous tissue, vascular bundles, and nerves can be identified. However, images obtained of acute calcaneal fractures were found to offer unsatisfactory depiction of bony anatomy. The presence of small fragments was obscured by a change in normal marrow signal by contusion, hemorrhage, and edema, and by the inability of magnetic resonance (MR) to image small pieces of cortical bone. Only in rare instances might MR be helpful in the acute setting when the location or displacement of tendons cannot be clearly ascertained with computed tomography (CT). MR may prove more useful in the long-term follow-up of healed fractures with persistent pain. In this setting it might be used in the diagnosis of complications such as residual or recurrent tendon displacement, tenosynovitis, heel fat integrity, and tarsal tunnel evaluation. However, this paper did not directly compare the efficacy of MR with that of CT in the long term. Therefore, the degree to which MR may eventually supplement or supplant CT is unclear and further study is required before the use of MR can be recommended in the routine clinical follow-up of calcaneal fractures.
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PMID:Magnetic resonance imaging of the calcaneus: normal anatomy and application in calcaneal fractures. 190 59

We developed a protocol to maximize medical therapy for "trigger finger." Fifty-eight patients with 77 episodes of flexor tenosynovitis of the hand that was resistant to rest, therapy with nonsteroidal anti-inflammatory drugs, and/or splinting were treated with single or multiple injections of depo-methylprednisolone acetate or triamcinolone acetonide. Patients were prospectively followed up for an average of 4.6 years. Results showed that symptoms and signs resolved in 61% after a single injection. Recurrent episodes, after prolonged pain-free intervals, occurred in 27% and were effectively re-treated with injection. In 12% of cases, either injection failed or early recurrence required surgical release. Local adverse reactions to injection, including pain at the injection site, stiffness, ecchymosis, or atrophy of subcutaneous fat, were self-limited. No episodes of postinjection infection or tendon rupture occurred. The medical management of flexor tenosynovitis with local corticosteroid injection(s) is effective in nearly 90% of cases and is free from serious adverse reactions.
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PMID:Treatment of flexor tenosynovitis of the hand ('trigger finger') with corticosteroids. A prospective study of the response to local injection. 198 90

To investigate the cause of valgus deformity of the hindfoot in patients who have rheumatoid arthritis and to characterize the effects of the deformity on gait, two groups of patients were evaluated clinically, radiographically, and with gait analysis in the laboratory. Group 1 consisted of seven patients who had seropositive rheumatoid arthritis and normal alignment of the feet and Group 2, of ten patients who had rheumatoid arthritis and valgus deformity of the hindfoot. In Group 2, the disease was of longer duration and the feet were more painful than in Group 1. There was no evidence of muscular imbalance, equinus contracture, valgus deformity of the tibiotalar joint, or isolated deficiency of the tibialis posterior (such as weakness, tenosynovitis, or rupture of the tendon) that could have contributed to the development of the valgus deformity. In the patients who had valgus deformity, quantitated electromyography demonstrated that the intensity and duration of activity of the tibialis posterior was significantly increased, apparently in an effort to support the collapsing longitudinal arch of the foot. Gait studies revealed decreases in velocity, stride length, and single-limb-support time, as well as delayed heel-rise in both groups, but the decreases were more marked in the patients who had valgus deformity. The results of this study suggest that valgus deformity of the hindfoot in rheumatoid patients results from exaggerated pronation forces on the weakened and inflamed subtalar joint. These forces are caused by alterations in gait secondary to symmetrical muscular weakness and the effort of the patient to minimize pain in the feet. Radiographs also suggested an association between the valgus deformity of the feet and valgus deformity of the knees in patients who have rheumatoid arthritis.
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PMID:Valgus deformities of the feet and characteristics of gait in patients who have rheumatoid arthritis. 199 19

A well-known complication after irradiation of tissue is development of postradiation sarcomas, and the shoulder girdle is in this connexion a frequent location, because it relatively often is exposured to x-rays. During the period 1956 to 1989 121 patients with sarcomas located to the shoulder girdle were referred to the Sarcoma centre in Arhus. Of these, six were postradiation sarcomas. The indication for the initial irradiation was in two cases cancer of the breast, in one malignant lymfogranulomatosis, in one a metastasis from malignant melanoma and finally two cases of peritendinitis humeroscapularis. In average 15 years (7-26 years) elapsed from irradiation to the diagnosis of the sarcomas. There were four bone sarcomas, two located in the clavicles and 2 in the humeri. Of these, three were osteogenic sarcomas and one a malignant fibrous histiocytoma. There were two soft tissue sarcomas, both located subcutaneously with involvement of deep fascia and muscle. Both tumors were extraskeletal osteogenic sarcomas. Three patients died of tumor on an average after 11 months. Two died without tumor from other causes, and one patient is alive without tumor 11 years after the treatment. If a patients presents with pain at the side of prior radiation, the diagnosis postradiation sarcoma must be considered and the patient referred to the Sarcoma centre. Radiation therapy should not be used in patients with benign lesions.
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PMID:[Radiation induced sarcoma of the shoulder girdle]. 205 30

Posterior heel pain can be caused by inflammation or pathology of the achilles tendon, the tendon sheath, the retrocalcaneal and subcutaneous tendoachilles bursa, can be caused by osteophytes or stress fracture of the os calcis and by rheumatoid or metabolic diseases. The majority of patients can be treated successful nonoperatively; however, there is a small group of patients who are refractory to nonoperative managements. In the years 1984 to 422 patients with posterior heel pain were treated conservatively, 26 of these patients were refractory to that management. There were 9 cases of achilles tendinitis and/or tenosynovitis, 7 cases of bursitis, 3 cases of osteophyte of the os calcis. In 7 cases there was seen a combination of these three diseases. The following operative procedures were performed: discision of the tendon sheath, excision of thickened parts by inflammation, excision of degenerative and necrotic pain-producing areas in the achilles tendon, excision of bursa and ostectomy of osteophyte at the posterior-superior angle of the os calcis. The mean follow-up was 2.7 years (range, 1/2 to 5 years). Overall there were 79% good results. In our opinion cases of posterior heel pain refractory to non-operative treatment are an indication of sports surgery, especially in patients who like to continue sports without pain.
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PMID:[Therapy-resistant heel pain--an indication for surgery in sports traumatology]. 223 38

Prolonged pain and disability are common complications of calcaneal fractures. A prospective study was conducted on the value of computed tomography (CT) in 63 patients with 73 calcaneal fractures sustained more than 6 months before. The fractures were classified from the initial plain radiographs, and the patients' current clinical condition assessed in terms of a "disability score". The mean disability scores (MDS) associated with the different types of fracture were correlated with the CT findings. The highest MDS was found in the intra-articular fracture group which comprised 71% of the series. In this group the MDS was increased in the presence of post-traumatic osteoarthrosis of the subtalar joint (61% of cases), involvement of the calcaneocuboid joint (39% of cases) and subluxation/dislocation of the peroneal tendons (47% of cases). Structural abnormalities of the peroneal tendons were associated with a higher MDS including chronic tenosynovitis (eight cases), chronic partial tendon rupture (eight cases), complete peroneus brevis tendon rupture (two cases) and scarring indicating stenosing tenosynovitis (14 cases). A similar spectrum of appearances affecting the medial tendons of the hindfoot was identified in eight cases. Direct CT measurements of the degree of comminution did not correlate well with the patients' MDS. In the patient with persistent symptoms, CT is of value in the later assessment of long-term complications by revealing abnormalities of the subtalar joints and adjacent tendons.
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PMID:Computed tomographic assessment of old calcaneal fractures. 226 61

The authors present three cases of peritendinitis calcarea in the extensor tendons of the wrist and the flexor tendons of the fingers. The symptoms were gout-like pain attacks and local inflammation. In the X-rays calcification was seen within the tendon sheath. The symptoms and the calcification disappeared spontaneously in a few months. In these rare cases there is no indication for surgery.
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PMID:[Peritendinitis calcarea of the hand, a case report]. 233 8

De Quervain disease (1895), tenosynovitis of Abductor Pollicis Longus and Extensor Pollicis Brevis, passing through their tunnel above the Radial Styloid Process, is not always cured by medical treatment but often requires surgical treatment. So, it is necessary to use a surgical one. The classical procedure, simple section of the radio-styloid pulley, is often complicated by the shifting of the two tendons on the radial styloid process caused by the wrist movements. Recently, an Italian author, G. Codega proposed an enlarging-reconstructing technique. The one described in this article consists of enlargement of the pulley by means of a diagonal incision, followed by suture after shifting of the diagonals. This technique ensures a real enlargement and solid reconstruction which allows early rehabilitation. The pain disappears at the same time as post-operative pain. Because of the small number of patients operated to data, it is not yet possible to perform statistical analysis, but the results have always been good or excellent.
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PMID:[Enlargement plasty of the radio-styloid tunnel in the treatment of De Quervain tenosynovitis]. 234 50


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