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

Chest pain is commonly caused by musculoskeletal chest wall disorders. Tietze's syndrome is a relatively rare cause of chest wall pain characterised by non-suppurative, painful swelling of the upper costal cartilages. The diagnosis should be based on these classic clinical features after excluding other potential causes of pain. A patient who was diagnosed with Tietze's syndrome but was found to have squamous cell carcinoma of the mediastinum with unknown primary site invading the sternum and anterior chest wall is presented for discussion.
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PMID:Malignant tumor with chest wall pain mimicking Tietze's syndrome. 1152 37

Chest pain in the athlete has a wide differential diagnosis. Pain may originate from structures within the thorax, such as the heart, lungs or oesophagus. However, musculoskeletal causes of chest pain must be considered. The aim of this review is to help the clinician to diagnose chest wall pain in athletes by identifying the possible causes, as reported in the literature. Musculoskeletal problems of the chest wall can occur in the ribs, sternum, articulations or myofascial structures. The cause is usually evident in the case of direct trauma. Additionally, athletes' bodies may be subjected to sudden large indirect forces or overuse, and stress fractures of the ribs caused by sporting activity have been extensively reported. These have been associated with golf, rowing and baseball pitching in particular. Stress fractures of the sternum reported in wrestlers cause pain and tenderness of the sternum, as expected. Diagnosis is by bone scan and limitation of activity usually allows healing to occur. The slipping rib syndrome causes intermittent costal margin pain related to posture or movement, and may be diagnosed by the 'hooking manoeuvre', which reproduces pain and sometimes a click. If reassurance and postural advice fail, good results are possible with resection of the mobile rib. The painful xiphoid syndrome is a rare condition that causes pain and tenderness of the xiphoid and is self-limiting. Costochondritis is a self-limiting condition of unknown aetiology that typically presents with pain around the second to fifth costochondral joints. It can be differentiated from Tietze's syndrome in which there is swelling and pain of the articulation. Both conditions eventually settle spontaneously although a corticosteroid injection may be useful in particularly troublesome cases. The intercostal muscles may be injured causing tenderness between the ribs. Other conditions that should be considered include epidemic myalgia, precordial catch syndrome and referred pain from the thoracic spine.
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PMID:Musculoskeletal problems of the chest wall in athletes. 1192 53

The effectivenss and acceptability of the Copper-7 (Cu-7) IUD was assessed over a total of 8064.5 woman-months calculated by the life-table method of Tietze-Lewit, were accidental pregnancy, 3.1; spontaneous expulsion, 3.2; removal for bleeding and/or pain, 3.7; removal for other medical reasons, .5; removal for planned pregnancy, 5.3; and removal for other personal reasons, 5.2. The overall termination rate was 21/100 women. Most of the side effects occurred within the first 6 months of use. There were no cases of pelvic infection. The incidence of side effects and the reversibility of the method did not appear to be affected by the addition of copper to the device. Serum progesterone, estrogen, copper, and iron levels remained within the normal range. No marked endometritis was observed. It is concluded that the CU-7 IUD is a safe and effective contraceptive device.
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PMID:Clinical studies on Cu-7; copper-IUD. 1215 49

Data is presented on the use of the Merchant's Copper Coil (MCC) IUD by 400 private patients between March 1981-June 1985. The MCC is a polyethylene IUD in the shape of an open ring largely enveloped in a copper thread .2 mm in diameter and with a surface area of 251 sq mm. Overlapping of the extremities of the MCC allows it to adapt to uterine activity and to all types of uterus. Danger of perforation during a vigorous uterine contraction is minimized by the absence of protruding extremities. Insertion is done using a tube of 3.6 mm in diameter, making the procedure easy and painless even in nulliparas. The MCC is available in different sizes. The size selected in the series was not significantly related to the age of the woman but was slightly related to parity. The average age of users was 26.5 years and the average parity was 1.4. All insertions were done in the office without anesthesia except in 1 nullipara who needed a local cervical anesthetic. 46.7% of users were 20-25 years old, 31.3% were 26-30, and 16% were 31-35. 10.7% were nulliparas, 50.3% had 1 child, 31.5% had 2 children, 5.5% had 3, and 2.0% had 4 or more. 83.5% had secondary educations or better. 80.5% had interval insertions and 19.5% had insertions 2-4 weeks after 1st trimester abortions. Insertions were without complications except for spotting or bleeding in 9 cases lasting from a few hours to 3 days. Between March 1981-June 1985, 118 women used the MCC for 2 years and the total number of woman months of use was 6864. In the 2nd year of use, the cumulative net rates using the Tietze method and numbers of events respectively were .3 and 1 for pregnancy, 4.1 and 14 for expulsion, .6 and 2 for removal because of bleeding, 0 and 0 for removal because of pain, 5.0 and 12 for removal because of other medical reasons or to change the IUD, 13.4 and 34 for desired pregnancy, and 2.3 and 6 for personal reasons. The continuation rate was 91.5% after 1 year and 74.3% after 2 years. There were no cases of perforation due to the IUD. The crude rates of termination per 100 users after 1 and 2 years respectively were 0 and .4 for pregnancy, 3.3 and 4.5 for expulsion, .6 and .6 for bleeding or pain, 1.1 and 5.8 for other medical reason, 3.7 and 15.4 to become pregnant, and 1.0 and 2.5 for other personal reason.
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PMID:[Further experience with MCC (Merchant's Copper Coil)]. 1228 Aug 64

Painful orthopedic symptoms in the sternal area, such as arthritis of the manubriosternal and sternoclavicular joint or Tietze's syndrome, were found in 14 of 132 cases of pustulosis palmaris et plantaris. The majority of the pustulosis palmaris et plantaris patients with orthopedic symptoms had skin eruptions not only on the palms and soles, but also on the backs of the hands and feet, the arms, the legs and the trunk. Such cases were usually accompanied by elevation of the erythrocyte sedimentation rate, leucocytosis, changes in serum globulin, and also pyrexia at the time of exacerbation. The skin and orthopedic symptoms often worsened after acute exacerbation of the focal infection, and occasionally responded to tonsillectomy or chemotherapy with antibiotics, which is suggestive of the probable cause of the bacterid.
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PMID:Orthopedic symptoms in pustular bacterid (pustulosis palmaris et plantaris): Tietze's syndrome and arthritis of manubriosternal joint due to focal infection. 1546 26

In two patients, men aged 39 and 66 years, a sternal mass in combination with pain developed. One patient was diagnosed with a non-Hodgkin lymphoma located in the sternum and the other one with a primary chondrosarcoma of the sternum. They both recovered after treatment. The differential diagnosis of disorders of the chest wall is troublesome and includes haematologic, rheumatologic and infectious processes. Tietze's syndrome is a rare cause of pain and non-suppurative swelling of the costosternal joints. However, tumours of the anterior chest wall can also cause these symptoms and these must therefore be excluded if the complaints persist or the swelling progresses. The most common malignant tumours of the chest wall are non-Hodgkin lymphoma, primary chondrosarcoma and metastases. Diagnostics should consist of blood tests and X-rays. CT and MRI scans are more helpful in establishing the diagnosis. A definitive diagnosis can only be determined by biopsy.
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PMID:[Sternal pain: not always harmless]. 1563 92

Objective: To present the unique case of a collegiate swimmer who experienced nearly 9 months of unresolved rib pain.Background: A 20-year-old collegiate swimmer was jumping up and down, warming up before a race, when she experienced pain in the area of her left lower rib cage. She completed the event and 2 additional events that day with moderate discomfort. The athlete was evaluated by a certified athletic trainer 3 days postinjury and followed up over the next 9 months with the team physician, a chiropractor, a nonsurgical sports medicine physician, and a thoracic surgeon.Differential Diagnosis: Intercostal strain, oblique strain, fractured rib, somatic dysfunction, hepatosplenic conditions, pleuritic chest pain, slipping rib syndrome.Treatment: The athlete underwent 4 months of conservative treatment (eg, activity modification, ice, ultrasound, hot packs, nonsteroidal anti-inflammatory drugs) after the injury, independently sought chiropractic intervention (12 treatments) 4 to 6 months postinjury, was referred to physical therapy (10 visits) by a nonsurgical sports medicine physician 6 to 8 months postinjury, and finally underwent surgical intervention 9 months after the onset of the initial symptoms.Uniqueness: Slipping rib syndrome was first described in 1919. However, many health care professionals who are involved with diagnosing and treating athletes and active individuals (eg, athletic trainers, physicians) are relatively unfamiliar with this musculoskeletal condition.Conclusions: It is important for clinicians and team physicians to familiarize themselves with and consider the diagnosis of slipping rib syndrome when assessing and managing individuals with persistent abdominal and/or thoracic pain.
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PMID:Slipping Rib Syndrome in a Collegiate Swimmer: A Case Report. 1597 Sep 59

Participation in the sport of rowing has been steadily increasing in recent decades, yet few studies address the specific injuries incurred. This article reviews the most common injuries described in the literature, including musculoskeletal problems in the lower back, ribs, shoulder, wrist and knee. A review of basic rowing physiology and equipment is included, along with a description of the mechanics of the rowing stroke. This information is necessary in order to make an accurate diagnosis and treatment protocol for these injuries, which are mainly chronic in nature. The most frequently injured region is the low back, mainly due to excessive hyperflexion and twisting, and can include specific injuries such as spondylolysis, sacroiliac joint dysfunction and disc herniation. Rib stress fractures account for the most time lost from on-water training and competition. Although theories abound for the mechanism of injury, the exact aetiology of rib stress fractures remains unknown. Other injuries discussed within, which are specific to ribs, include costochondritis, costovertebral joint subluxation and intercostal muscle strains. Shoulder pain is quite common in rowers and can be the result of overuse, poor technique, or tension in the upper body. Injuries concerning the forearm and wrist are also common, and can include exertional compartment syndrome, lateral epicondylitis, deQuervain's and intersection syndrome, and tenosynovitis of the wrist extensors. In the lower body, the major injuries reported include generalised patellofemoral pain due to abnormal patellar tracking, and iliotibial band friction syndrome. Lastly, dermatological issues, such as blisters and abrasions, and miscellaneous issues, such as environmental concerns and the female athlete triad, are also included in this article.Pathophysiology, mechanism of injury, assessment and management strategies are outlined in the text for each injury, with special attention given to ways to correct biomechanical or equipment problems specific to rowing. By gaining an understanding of basic rowing biomechanics and training habits, the physician and/or healthcare provider will be better equipped to treat and prevent injuries in the rowing population.
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PMID:Rowing injuries. 1597 36

We report a case of thoracic wall myositis ossificans (MO) located anterior to the ninth rib, causing right lower thoracic-upper abdominal pain. The diagnosis was based on the findings of ultrasonography (US) and computed tomography (CT). Numerous disorders can be included in the differential diagnosis of right lower thoracic-upper abdominal pain, so we must first establish if the pain is somatic or visceral in origin. Somatic pain in this region can be caused by traumatic muscle pain, overuse myalgia, costochondritis, or thoracic wall malignancies. Although rare, MO should also be considered in the differential diagnosis of pain and thoracic wall masses in this region. As the calcifications may not be seen on a plain chest X-ray in the early course of this condition, superficial tissue US or CT should be performed to establish the diagnosis.
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PMID:Myositis ossificans in the right inferior thoracic wall as an unusual cause of lower thoracic-upper abdominal pain: report of a case. 1882 Aug 77

Costochondritis, an inflammation of costochondral junctions of ribs or chondrosternal joints of the anterior chest wall, is a common condition seen in patients presenting to the physician's office and emergency department. Palpation of the affected chondrosternal joints of the chest wall elicits tenderness. Although costochondritis is usually self-limited and benign, it should be distinguished from other, more serious causes of chest pain. Coronary artery disease is present in 3 to 6 percent of adult patients with chest pain and chest wall tenderness to palpation. History and physical examination of the chest that document reproducible pain by palpation over the costal cartilages are usually all that is needed to make the diagnosis in children, adolescents, and young adults. Patients older than 35 years, those with a history or risk of coronary artery disease, and any patient with cardiopulmonary symptoms should have an electrocardiograph and possibly a chest radiograph. Consider further testing to rule out cardiac causes if clinically indicated by age or cardiac risk status. Clinical trials of treatment are lacking. Traditional practice is to treat with acetaminophen or anti-inflammatory medications where safe and appropriate, advise patients to avoid activities that produce chest muscle overuse, and provide reassurance.
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PMID:Costochondritis: diagnosis and treatment. 1981 27


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