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

Three cases of chronic hip pain with radiographic periarticular osteopenia and normal joint spaces are reported. The articular nature of symptomatology, periarticular demineralization, and radionuclide localization suggested intraarticular disease. Computed tomography did not disclose the cause of hip pain when utilized in two instances. Positive contrast hip arthrography was the only diagnostic modality which demonstrated the chondromatosis or adhesive capsulitis responsible for pain. Differential diagnosis and pathophysiologic mechanisms are briefly reviewed.
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PMID:Arthrography in the diagnosis of unexplained chronic hip pain with regional osteopenia. 40 64

A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.
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PMID:The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis. 128 Oct 62

Twenty-two patients (23 shoulders) with arthrographically verified adhesive capsulitis of the glenohumeral joint were treated by a combination of distention-arthrography, local anesthetics and steroids intraarticularly, and manipulation. The mean duration of the disease at the time of treatment was 14 months, and all patients suffered from disabling pain and stiffness. A rapid improvement was seen after treatment and at four to six weeks: 91% (21/23) of the patients had no or slight pain and 83% (19/23) of the patients had normal, or almost normal, range of motion. The treatment was well tolerated and no complications were recorded. The combination treatment for adhesive capsulitis of the shoulder is safe, yields immediate results, and is cost effective.
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PMID:Combination treatment for adhesive capsulitis of the shoulder. 151

A double-blind, prospective study of 45 patients with adhesive capsulitis of the shoulder compared the therapeutic efficacy of distensive and nondistensive arthrography in combination with the intra-articular injection of corticosteroids. After 1 and 3 months there was no significant difference between the two treatments in the degree of pain or of limitation of movement experienced by the patients. More than 80% of the patients who experienced pain at rest and nocturnal pain improved under both treatment regimens. Scapulohumeral mobility increased significantly but only partially within the first month of treatment. Articular capacity and the duration of symptoms before treatment were of no prognostic value.
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PMID:[Adhesive capsulitis of the shoulder: a comparative study of arthrography with intra-articular corticotherapy and with or without capsular distension]. 156 88

Painful shoulder conditions are common primary care problems. Providers should learn the topographical landmarks about the shoulder and understand shoulder mechanics. A careful clinical evaluation will usually provide a likely diagnosis. In unclear cases with marked pain, weakness, and reduced mobility, or with a suspected rotator cuff tear or rupture, arthrography or MRI will usually establish a diagnosis. Therapy of bursitis/tendinitis consists of a steroid injection into the inflamed subacromial area or a 14-day trial of an NSAID. Therapy of bicipital tendinitis, largely empiric because definitive studies are unavailable for any specific treatment, includes judicious peritendinous steroid injections and avoiding aggravating activities. In the management of patients with suspected tendon tears or rupture, primary care practitioners can confirm the diagnosis by ordering MRI or arthrography before referring these patients to an orthopedist for definitive surgical therapy. Optimal management of adhesive capsulitis remains unclear, but an intraarticular steroid injection appears beneficial at least in temporarily diminishing pain. Pendular motion exercising is also an integral part of therapy. Deleterious effects of peribursal or intraarticular steroid infiltration appear minimal; but injections into the tendon or frequent, repetitive injections are contraindicated. Each shoulder condition has a variable course, depending on the structure(s) and extent of involvement.
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PMID:Painful shoulder syndromes: diagnosis and management. 844 Oct 74

Arthrography of the wrist and hand is easy to perform, but accurate diagnosis requires meticulous technique and thorough knowledge of anatomy, pathology, and imaging principles. Wrist arthrography is usually performed to assess pain or instability after trauma; a complete examination usually requires injection of the RC, midcarpal, and distal radioulnar joints. Abnormalities that can be detected include interosseous ligament tears, capsular tears, triangular fibrocartilage perforations and separations, cartilaginous defects, loose bodies, and synovial abnormalities including adhesive capsulitis. Arthrography can also be useful in the evaluation of masses and scaphoid nonunion. Finger arthrography can demonstrate capsular injury, ligament tears, tendon derangement, volar plate disruption, cartilage abnormalities, fibrous ankylosis, synovial abnormalities, and ganglia. Tenography is seldom performed; this technique can delineate synovial abnormalities and can be used to evaluate tendon subluxation.
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PMID:Arthrography of the hand and wrist. 203 35

Seventeen patients who had recalcitrant chronic adhesive capsulitis were operated on between 1979 and 1986 and were followed for an average of 6.8 years. At operation, the major cause of the restricted glenohumeral movement was found to be contracture of the coracohumeral ligament and rotator interval. Release of the contracted structures relieved pain and restored motion of the shoulder in all patients. Histological study showed fibrosis, hyalinization, and fibrinoid degeneration in the contracted connective tissues, as well as fibrosis of the subsynovial tissue and an absence of the synovial cell layer on the joint side of the rotator interval. The contracture of the coracohumeral ligament and rotator interval appears to be the main lesion in chronic adhesive capsulitis. Resection of these structures, combined with appropriate exercise, will relieve pain and restore motion to the shoulder.
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PMID:Recalcitrant chronic adhesive capsulitis of the shoulder. Role of contracture of the coracohumeral ligament and rotator interval in pathogenesis and treatment. 239 99

Manipulation and lavage of the temporomandibular joint has been shown to add an important therapeutic dimension to arthrography. These therapeutic modalities were prescribed by the primary treating practitioner in conjunction with diagnostic arthrography in a group of patients. The therapeutic modalities consisted of joint mobilization (Farrar manipulation or distraction) augmented by (1) increased hydraulic pressure in the superior compartment, or (2) with small amounts of contrast in both compartments, and/or (3) with lavage of the superior joint compartment. The therapeutic modalities were prescribed in association with the arthrography as a logical extension of the arthrographic technique. The result of the mobilization and lavage was an increase in the mandibular range of motion (ROM) and a decrease in pain in cases with adhesions as well as those with anteriorly displaced disks without reduction. Patients with anteriorly displaced disks with reduction, redundant tissue in the fossa, osteochondritis, and adhesive capsulitis also showed benefit, although patient populations treated with these conditions were small. There were no adverse sequelae. Manipulation and lavage should now be viewed as one more tool in the treatment of intracapsular pathology.
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PMID:The intracapsular therapeutic modalities in conjunction with arthrography: case reports. 260 93

Adhesive capsulitis of the shoulder is an idiopathic condition characterized clinically by pain and limitation of movement. The characteristic arthrographic features are those of limited capacity of the joint, pain during injection, and retracted recesses. Progressive distension of the capsule with 1% lidocaine and 40 mg of triamcinolone acetonide (Kenalog) is a recommended form of treatment for this condition. Twenty-five patients treated by this method were reviewed retrospectively. Eleven (44%) were completely relieved of their symptoms, 6 (24%) had a 50% improvement, and 8 (32%) had no relief. Patients with idiopathic adhesive capsulitis responded more favorably to the treatment than those with a traumatic etiology. The duration of symptoms had no correlation with the results of therapy. There were no complications from the treatment.
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PMID:[Distention arthrography in the treatment of adhesive capsulitis of the shoulder]. 270 6

Primary adhesive capsulitis of the shoulder is a common cause of a painful shoulder in clinical practice. The pathogenesis remains unclear. Many patients continue to have significant long-term restrictions in their range of motion although few are functionally restricted. Prevention is the ideal treatment. Patients respond to treatment plans directed at pain relief and improving the range of motion, however, ongoing controlled therapeutic trials are necessary to better refine the selection of treatment for individual patients.
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PMID:Adhesive capsulitis of the shoulder: current concepts and treatment. 328 Nov 52


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