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

12 male (mean age 28) and 11 female (mean age 32) patients treated with lunotriquetral (LT) arthrodesis were reviewed with a median follow-up of 28 months (range 18-40 months) for this retrospective study. At first presentation 12 patients were unable to work, and at follow-up only three men remained out of work. The relief of pain was significant (P < 0.001) and the median Culp (1993) wrist score obtained 74 (min. 45, max. 96); however, only one patient was totally free of pain and seven men had to change their occupations. Men lost 455 working days, women 191, a highly significant difference (P = 0.006). This loss correlated (P = 0.007) with the LT angle measured in the frontal plane: all patients but one with a LT angle of less than 31 degrees returned to work within 1 year, but only four with a greater angle (P = 0.007). This emphasizes the importance of correct positioning of the triquetrum, which seems hard to achieve with two AO lag screws. Furthermore, even two screws seem unable to ensure solid fusion as shown by the high rate of pseudarthrosis (57%). LT fusion cannot be considered as a routine procedure and results are not yet predictable. According to these results, we feel that a bone graft placed in a slot from lunate to triquetrum is the procedure of choice. In the presence of a chondromalacia in the ulnar midcarpal joint, a four bone fusion is primarily recommended.
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PMID:Lunotriquetral arthrodesis. A controversial procedure. 877 Jul 36

This article describes a study that evaluates a combined arthroscopy and high tibial osteotomy treatment protocol incorporating: a new curved and double-bladed barrel vault (dome) osteotomy guide; measurement of the mechanical axis of the limb during surgery as well as measurement of the femorotibial angle and mechanical axis before and after surgery; and prior arthroscopic evaluation and debridement. Forty-five high tibial osteotomies were performed in 42 patients. All 45 knees had varus angular deformity. Arthroscopy confirmed osteoarthritis in all 45 knees and grade 4 medial compartment chondromalacia in 44 of 45 knees. Patients were evaluated preoperatively and postoperatively using a grading scale modified from that of the Hospital for Special Surgery. Follow-up of patients ranged from 1 to 6 years (mean: 3.1 years). The average clinical score was 57.4 preoperatively and 89.8 postoperatively, an improvement of 56.4%. All patients achieved and maintained pain relief compared with their preoperative status. No patient needed total knee replacement. These results indicate that in patients with unicompartmental osteoarthritis with angular deformity, high tibial barrel vault (dome) osteotomy can improve the quality of life while preserving the knee joint. There was no relationship between clinical score and either patient age or severity of lateral compartment chondromalacia. Therefore, osteotomy may be appropriate for a larger population than generally thought.
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PMID:A new approach to dome high tibial osteotomy. 883 24

Six athletes who throw and one shot-putter who underwent elbow arthroscopy were found to have an area of chondromalacia involving the posterolateral aspect of the olecranon. Preoperative symptoms were pain and tenderness to palpation over the lateral edge of the olecranon. On physical examination, range of motion was full or only slightly decreased (< 5 degrees) in five patients; coexistent loose bodies were also noted in two patients having a 20 degrees loss of extension. None of the patients exhibited ligamentous laxity to valgus stress testing of the elbow. During arthroscopy, the involved area was distinct from the bare area of the olecranon. This area was found as an isolated lesion in only one of seven patients; localized synovitis was noted in five patients, olecranon osteophytes in three, and loose bodies in two. A reciprocal lesion on the articular surface of the humerus was not identified in any patient. During arthroscopy, the lesion was debrided to a stable margin, and all associated pathologic conditions were addressed. Six of the seven athletes were able to return to their sport at premorbidity levels with this approach. This area of trochlear chondromalacia has not been previously described and, in our study, occurred in individuals whose elbows were subjected to repetitive valgus stress with lateral compression.
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PMID:Chondromalacia of the trochlear notch in athletes who throw. 891 45

We studied a group of 602 patients who had anterior cruciate ligament reconstructions between 1987 and 1992. An autogenous patellar tendon graft was used, regardless of preexisting patellofemoral pain or chondromalacia. The surgeon and rehabilitation protocol were the same for all patients, with emphasis on obtaining full knee hyperextension postoperatively. All patients were evaluated by a questionnaire designed to determine the incidence and severity of anterior knee pain as it relates to sporting or daily living activities, prolonged sitting, stair climbing, and kneeling. Range of motion for the study group was recorded during physical examination. We compared the findings with those from a control group of 122 patients who had no previous knee injury. The study group reported a mean score of 89.5 +/- 12.5, compared with 90.2 +/- 12.3 in the control group. Both the operative and control groups reported little or no symptoms during sporting activities (94% and 92%, respectively). No differences were noted with respect to the other activities surveyed. These results demonstrate that anterior knee pain after anterior cruciate ligament reconstruction is not an inherent complication associated with patellar tendon harvesting. We suggest that the increased incidence of anterior knee pain with an autogenous patellar tendon graft can be prevented by obtaining full knee hyperextension postoperatively. This goal can be achieved through preoperative rehabilitation and a postoperative protocol emphasizing early restoration of full knee hyperextension.
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PMID:Preventing anterior knee pain after anterior cruciate ligament reconstruction. 900 90

Plicae are some of the normal synovial structures of the knee joint cavity. They are remnants of the mesenchymal tissue that occupies the space between the distal femoral and proximal tibial epiphyses in the 8-week-old embryo. The incomplete resorption leaves synovial pleats in most of the knee. The superior and the inferior plicae are the most common (50% to 65%) but have extremely little clinical relevance. Each may be of many various morphological types. The lateral plica is rare (1% to 3%). The medial plica is present at autopsies in one of every three or four knees. It also is of various types, wide and thick in one of every fifteen knees. Arthrography, ultrasonography, CT scan with arthrography, and MR imaging can demonstrate their presence and measure their size with good accuracy. Arthroscopy allows a very precise assessment of the plica, including dynamic examination. It looks for medial impingement against the patellofemoral articular surfaces and secondary (localized chondromalacia) as well as incidentally associated other knee pathologic conditions. Rarely, the medial plica becomes symptomatic, circumstances such as a history of blunt trauma, or more often, overuse of the knee can cause symptoms. Sometimes no special condition is necessary. The plica causes symptoms such as pain, crepitus, snapping or popping, or effusion related to patellofemoral joint motion. The clinical picture mimics a torn medial meniscus or a maltracking patella. Clinical examination is extremely helpful if the snapping plica is palpated at the medial edge of the patella, reproducing the patient's symptoms. If chronic, these symptoms may be treated with nonsteroidal anti-inflammatory drugs, physiotherapy, electrophoresis, or local injection. Surgical treatment is indicated if conservative therapy fails. Arthroscopic complete resection of the plica cures the symptoms in a few days, therefore confirming the correct diagnosis and the effectiveness of the treatment. Histologic examination often confirms the chronic conflict between the plica and the femoral condyle. No morphologic character allows the assessment of the pathologic aspect of the plica. A medial plica is or is not symptomatic. The incidence of this syndrome is probably one out of ten medial plicae and 3% of arthroscopies at most. Associated lesions are very common. They often make the evaluation of the plica's responsibility in symptoms difficult to analyze, leading to unsatisfactory results.
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PMID:Synovial plicae of the knee. Controversies and review. 901 63

A series of 8 patients each with an excessively long ulnar styloid that was impacting the triquetrum, causing chondromalacia, synovitis, and pain, is presented. Four patients developed symptoms as a result of an injury and 4 had no definable acute precipitating injury. The average age at the time of surgery was 34 years. There were 3 male and 5 female patients. The average follow-up period was 34 months. All patients were treated by open partial ulnar styloidectomy. Outcome was evaluated clinically and by means of patient questionnaire and radiographs. Pain decreased from a preoperative average score of 3.5 to a postoperative average score of 1.3, which equates to mild pain requiring no medication. All but 1 patient returned to their previous employment unrestricted. The average preoperative ulnar styloid length was 7.4 mm and the average ulnar styloid process index was 0.41, which is almost twice normal. There were no complications. It is likely that an excessively long ulnar styloid has important implications for the kinematics of the lunatotriquetral interval. Details of the diagnosis of this condition, including a new provocative test, and operative management are discussed.
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PMID:Ulnar styloid impaction syndrome. 926 Jun 29

During a two-year period, eighty-nine patients who were scheduled to have a total knee arthroplasty for the treatment of degenerative osteoarthrosis were randomly assigned to one of two groups: resurfacing of the patella or retention of the patella. All patients received the same posterior cruciate-sparing prosthesis, and all operations were performed by, or under the direct supervision of, one of us. Three patients died in the early postoperative period. The remaining eighty-six patients (118 knees; fifty-eight that had had resurfacing of the patella and sixty that had not) formed the study group. They were followed for a mean of thirty months (range, twenty-four to forty-four months). Evaluation was performed with use of the clinical scoring system of The Knee Society, a patient-satisfaction questionnaire, specific questions regarding patellofemoral symptoms and function, and radiographs. All clinical evaluations were performed by the same research nurse, without the involvement of a physician, in a blinded manner (neither the nurse nor the patient had knowledge of whether the patella had been resurfaced). Preoperatively, the mean Knee Society score, on a scale ranging from 0 to 200 points, was 89.7 points (range, 33 to 132 points); postoperatively, this score improved to a mean of 172.7 points (range, 98 to 200 points). With the numbers available for study, we could detect no significant difference between the knees that had had patellar resurfacing and those that had not with regard to the over-all score (p = 0.63), the subscore for pain (p = 0.56), or the subscore for function (p = 0.77). We also could detect no difference between the treatment groups, with the numbers available, with regard to patient satisfaction or the responses to questions involving the function of the patellofemoral joint, including the ability to exit from an automobile, to rise from a chair, and to climb stairs. Thirty-two patients had bilateral total knee replacement with resurfacing of the patella in one knee and retention of the patella in the other. These patients expressed no clear preference for either knee. Eight (13 per cent) of the sixty knees that had not had resurfacing were painful anteriorly compared with four (7 per cent) of the fifty-eight that had; this was not a significant difference (p = 0.38), with the numbers available. The anterior pain that was noted postoperatively was predominantly of new onset; it had not been observed preoperatively in three of the four knees that had had resurfacing or in four of the eight that had not. No additional treatment options were offered to the patients who had anterior pain in the knee after resurfacing. However, six (10 per cent) of the sixty knees that had not had resurfacing had it subsequently, because of anterior pain in the knee, after the twelfth postoperative month (range, fifteen to thirty-nine months). The pain decreased in four of these knees. Thus, total knee arthroplasty with retention of the patella yielded clinical results that were comparable with those after total knee arthroplasty with patellar resurfacing, but it was associated with a 10 per cent prevalence of the need for subsequent resurfacing. The prevalence of anterior pain after total knee arthroplasty was not influenced by whether or not the patella had been resurfaced. The postoperative clinical scores, the postoperative development of anterior pain, and the need for subsequent resurfacing were not predicted by the presence of preoperative anterior pain, obesity, or the grade of chondromalacia observed intraoperatively. Because of the short duration of follow-up, these results should be considered preliminary. Additional follow-up is planned.
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PMID:Resurfacing of the patella in total knee arthroplasty. A prospective, randomized, double-blind study. 965 14

The results of 320 arthroscopic procedures are reported here, in which laser surgery using the holmium: YAG laser is compared with conventional mechanical methods. The patients were followed-up during a 2-year period and the data analyzed in a prospective study. The following knee injuries were included: meniscal lesion, chondromalacia, combined meniscal/cartilage lesion, rheumatoid synovialitis and patellofemoral pain syndrome. Because strict inclusion criteria were used, the patient collective is homogenous. Gender, age, injured side, intrasurgical diagnosis, and the initial values of the Lysholm score (modified after Klein) are congruous. After 2 years, the results of the laser collective were significantly improved, whereas the results for the conventional collective, especially for chondromalacia and synovialitis, did not show the same improvement. Analysis of the effect of various instruments and the laser system itself show differing results for the various knee disorders. The hemostatic effect of the holmium: YAG laser was excellent during surgery of all knee disorders, including surface treatment. Operating time for laser surgery was not prolonged, in contrast to what is often claimed. This study shows that chondromalacia, combined meniscal-cartilage lesions, and chronic rheumatoid synovialitis are treated more effectively and with better results with the holmium: YAG laser than with conventional arthroscopic methods. Furthermore, laser treatment of lateral retinacular release can be considered to be better than mechanical techniques. No significant advantage can be found for using the laser during meniscectomy. Lasers are useful for treating smaller, hard-to-reach joints and lower the risk of iatrogenic cartilage damage. The holmium: YAG laser is a suitable instrument for arthroscopic surgery.
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PMID:Holmium: YAG-laser-assisted arthroscopy versus conventional methods for treatment of the knee. Two-year results of a prospective study. 933 29

Fourteen patients were evaluated who had an arthroscopic removal of the symptomatic mediopatellar plica of the knee in this retrospective study. The main complaint of the patients was the pain at the medial side of the knee. Before the operation only in 3 cases was the diagnosis the pathological plica. The arthroscopy was performed in a routine way. The plica was consider pathological, and removed, when it was thickened. There was grade I or II chondropathy in the knee on the medial femoral condyle and the patella respectively, caused by the plica. Good to excellent result were obtained in 93% of the knee with or without chondromalacia.
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PMID:The pathological plica in the knee. 940 97

A total of 42 cases of patellar pain in subjects aged an average of 17.2 years submitted to arthroscopy are analyzed. Femoropatellar balance, where indicated, led to resolution of disorders with full resumption of sports activity. In the remaining cases chondromalacia showed the features of an affection with a spontaneously favorable course, confirming the common orientation towards conservative treatment. Arthroscopy is effective for a correct classification of cartilaginous lesions, and it is a good instrument to use when attempting to achieve recovery of patellofemoral joint when disorders are caused by a lack of equilibrium.
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PMID:Chondromalacia of the patella. Natural progression. 961 78


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