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

Observations during the past 35 years on operative and conservative treatment of adult and young patients with isthmic spondylolisthesis, demonstrate the main indications of fusion are pain and risk of further progression of the slip. At one time, posterior fusion was recommended. Posterolateral fusion in situ was adopted in 1975, and during the past ten years anterior fusion combined with reduction and transpedicular fixation has been performed in severe slips. Surgery was mainly indicated to alleviate pain or to prevent further progression of the slip. It seems possible to alter the natural course of the disease by operation, but it is difficult to prove the connection between the radiographic findings and the pain. The epidemiologic study shows that the prevalence of spondylolisthesis in Finland is 6%, but there are no significant differences between these subjects and controls without spondylolisthesis. Symptomatic patients may have pain, however, even after a long observation time. Prevention of the slip is difficult because, statistically, 90% of the slip has already occurred when the patient is first seen. Posterolateral fusion in situ is the method of choice, especially for most young patients. Anterior fusion is indicated if the slip is greater than 40%-50%. Reduction of the slip is indicated in exceptional cases only.
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PMID:Isthmic spondylolisthesis in symptomatic and asymptomatic subjects, epidemiology, and natural history with special reference to disk abnormality and mode of treatment. 824 53

Anterior cruciate ligament reconstruction by free patellar tendon graft was performed using 2 different surgical approaches to the intercondylar notch in 67 consecutive patients with chronic anterior cruciate ligament insufficiency. In the first 30 patients (Group A), the traditional medial parapatellar arthrotomy with lateral luxation of the patella was done, whereas in the last 37 patients (Group B) a transpatellar tendon approach was used. Postoperative pain was managed by analgesics and, in patients who had epidural anesthesia, by administration of bupivacaine in indwelling catheters. Generally, the analgesics and bupivacaine were given immediately on request to establish comfort at rest and to permit range of motion exercises without severe pain. Compared with those in Group A, the patients of Group B had a significantly longer period from the first dose of analgesic or bupivacaine to the second, and the total number of doses of analgesic or bupivacaine was significantly lower. In the subgroup of patients with epidural anesthesia (21 in Group A and 32 in Group B), the Group B patients required significantly less analgesics, as doses equivalent to 10 mg of morphine, compared with that of Group A.
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PMID:Postoperative pain after anterior cruciate ligament reconstruction using a transligamentous approach. 836 9

Amyloidosis involving the musculoskeletal system is an uncommon occurrence. The primary form is rare and only six cases involving the spine have been reported in the literature. The following case is believed to be the first reported in Taiwan. A 65-year-old male was admitted due to chronic nonspecific pain in the lower back with progressive paralysis of the lower limbs. Amyloidoma involving both thoracic and lumbar spine, never reported in the literature, was proved by histologic and histochemical studies. Serial radiographic examinations were also presented. Anterior decompression of the thoracic spine with iliac crest strut bone graft and Kaneda device fixation achieved good functional results. The symptoms and signs of spinal amyloidoma are nonspecific and difficult to diagnose; hence a correct diagnosis requires the surgeon to be extremely suspicious. A special histochemical stain is essential for this purpose. Because of the rarity, we report this case with review of the literature.
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PMID:[Primary amyloidoma of the spine]. 838 62

Seventy-one athletes with 74 stress injuries to the femur were studied using a case-controlled design. Forty-three were females (26.6 yrs) and 28 were males (31.2 yrs). Each patient had exercise-induced pain in the hip, groin or thigh and a Tec-99m-MDP bone scan showing focal uptake of radionuclide in the femur. Running was the most common activity at the time of injury (89.2%) followed by triathlon (4.6%) and aerobic dance (4.6%). Thirty per cent of the runners had increased their training duration immediately prior to their first symptom. Anterior thigh pain was the most frequent site of exercise-induced pain (45.9%) followed by hip pain (27%) and groin pain (8.1%). During the clinical examination, when asked to hop on the affected limb, 70.3% of the patients had pain reproduced in the hip, groin or anterior thigh. There were 39 cases (53%) involving focal uptake of radionuclide in the femoral shaft, 15 (20%) in the lesser trochanter, 11 (15%) in the intertrochanteric region between the femoral neck and the greater trochanter, 8 (11%) in the femoral neck and 1 (1%) in the greater trochanter. Two patients suffered displaced fractures, one at the femoral neck and the other in the shaft of the femur. Neither patient had previously sought medical attention for their leg pain. Of 46 plain radiographs taken, only 11 (24%) were abnormal. The mean time to diagnosis and recovery were 6.6 and 10.4 weeks respectively. Substitution of cycling and water exercise for running were the most common therapeutic interventions.
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PMID:Exercise-induced stress injuries to the femur. 840 67

We report demographic, clinical, and imaging data on 92 patients with osteochondral lesions of the talus collected in one center between 1981 and 1992. All patients reported pain as their primary symptom. Ninety-four percent of the patients reported pain with activity. Physical examination was unhelpful. Using newer imaging techniques (bone scan and computed tomography) and with increased awareness, we have observed a sevenfold increase in the diagnostic frequency of osteochondral lesions of the talus between the years 1981 to 1986 and 1987 to 1992. Bone scan is an excellent screening tool for patients with chronic ankle pain and has 99% sensitivity in depicting osteochondral lesions. Computed tomography demonstrated a previously unclassified lesion, the radiolucent defect, which accounts for 77% of the lesions in this series. We have therefore modified the Berndt and Harty classification system, basing it on radiographic appearance (principally computed tomography) and adding the radiolucent lesion. Fifty-eight patients were treated surgically. Anterior and midtalar lesions are now approached arthroscopically. Surgical treatment of the radiolucent lesion, consisting of curettage and drilling, gives 42% excellent and 32% good results. Pain relief often occurs within months of surgery, but healing of the lesion requires years, and some may persist indefinitely.
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PMID:Osteochondral lesions of the talus. 842 54

We assessed short-term treatment results of younger patients with varus malalignment and chronic anterior cruciate ligament deficiency. Forty-one patients (mean, 32 years; range, 16 to 47) underwent a high tibial osteotomy. Because of giving way symptoms, 14 also had a lateral iliotibial band extraarticular procedure at the time of the osteotomy and 16 had an intraarticular anterior cruciate ligament allograft reconstruction after the osteotomy. All returned for followup (mean, 58 months; range, 23 to 86), which included KT-1000 arthrometer testing and evaluation by our knee rating system. Statistically significant (P < 0.05) improvements were found in the mean overall rating scores for pain, swelling, and giving way. Preoperatively, 30 (73%) had pain with activities of daily living or with any sports activity; 11 (27%) could perform only light sports activities without pain. At followup, 32 patients (78%) had no pain with activities of daily living or light sports. Ten of 15 patients with advanced medial tibiofemoral arthrosis (subchondral bone exposure) had significant improvements in symptoms. Patient satisfaction was high: 88% stated they would undergo the procedure again and 78% felt their knee condition was improved. Patients who had the allograft reconstruction had significantly lower (P < 0.05) anterior-posterior displacements at followup than those who had the extraarticular procedure. We concluded that osteotomy should be performed early in the disease process for younger athletes who experience symptoms with activity. It may be unrealistic, however, to expect continuation of sports beyond light recreational, given the joint arthrosis that is usually present and the high in vivo joint loadings with athletes. Anterior cruciate ligament reconstruction should be considered when giving way previously occurred and the patient plans to resume athletics. However, patients with advanced arthrosis can avoid anterior cruciate ligament surgery by reducing athletic activities.
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PMID:High tibial osteotomy and ligament reconstruction in varus angulated, anterior cruciate ligament-deficient knees. A two- to seven-year follow-up study. 842 63

Anterior compartment pressure was measured in 10 competitive runners and in 10 competitive cyclists who were asymptomatic for compartment syndrome. Pressures were measured at rest, after exercise at 80% VO2max, after maximal exercise, and 15 minutes after both exercise bouts. No difference in compartment pressure was found after exercise at 80% VO2max in runners and cyclists. Total creatinine phosphokinase enzyme levels measured before and after exercise at 80% VO2max showed a 10-fold increase in runners as compared to cyclists. Anterior compartment pressure measured after maximal exercise was significantly greater in runners as compared to cyclists. Compartment pressure showed no increase from resting values during cycling at 80% VO2max or maximal exercise. These findings suggest that patients with chronic anterior compartment syndrome may be able to cycle without elevation of compartment pressure and concomitant pain as an alternative exercise to maintain a continued degree of fitness and training. Compartment pressures should be measured during cycling in patients with chronic compartment syndrome to determine its efficacy as a method for maintenance of cardiorespiratory fitness.
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PMID:A comparison of anterior compartment pressures in competitive runners and cyclists. 842 66

Anterior cruciate ligament (ACL) reconstruction is often a painful operation. Fifty-eight patients who underwent ACL reconstruction using patellar tendon autograft received either a lumbar plexus block (LPB) or patient-controlled analgesia (PCA) for pain relief during the first 24 h after surgery. The average total dose of narcotic used was dramatically less for the LPB group (10.1 mg) than for the PCA group (91.9 mg). The common narcotic analgesic side effects of nausea, pruritus, sedation, and urinary retention were significantly less in the LPB group. The LPB is a safe and effective alternative analgesia after ACL reconstruction.
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PMID:A comparison of patient-controlled analgesia and continuous lumbar plexus block after anterior cruciate ligament reconstruction. 844 37

CT scans were performed 40 times in 28 postcystectomy patients to identify the type and location of tumor recurrence. Sixteen patients showed tumor recurrence. Patients without recurrence showed a complete symmetric pelvis and a thin string that looked like an operation scar. Cutaneous ureterostomy showed small tube-like structures, and ileal conduit looked like herniation of the ileum. Cases with recurrent tumors were divided into 3 patterns, 1) pelvic abscess recurrence, 2) anterior abdominal wall thickening, 3) pelvic lateral wall thickening, and combinations of these types. The abscess-recurrence type often showed air within the mass or a fuzzy contour that could not be differentiated from true inflammatory abscess. Anterior abdominal wall thickening was usually accompanied with abscess-type recurrence and appeared as thickening of the operation scar. Lateral wall thickening was usually seen at the site of the obturator internus muscle or obturator node. Patients without recurrence had no complaints except for two who had ileus. All patients with recurrence except one had complaints of pain, abnormal secretion, or a palpable mass. Because all patients with recurrence already had a relatively large tumor at the time of CT, routine follow-up CT is recommended even if the patient has no complaints.
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PMID:[CT evaluation of the pelvic cavity after total cystectomy]. 847 58

Seven patients (average age, 26.3 years) with traumatic knee dislocations were retrospectively evaluated more than 2 years (average, 51 months) after having fresh-frozen allograft anterior and posterior cruciate ligament reconstructions. All patients were treated consecutively at an average of 9.6 days after injury. Two patients had arterial injuries and three patients had or developed common peroneal nerve palsy. Five patients had 20 additional injuries. All patients were enlisted in an early, aggressive physical therapy regimen with early protected weightbearing. Four patients required a manipulation under anesthesia for arthrofibrosis at an average of 16.8 weeks postoperatively (range, 6 to 33 weeks). At followup, only one patient had significant pain, three patients had rare or occasional giving way, and all seven were able to return to school or to the workplace. The functional grading was excellent in three patients, good in three patients, and fair in one patient. No patient had a significant flexion contracture; the average flexion arc was 118 degrees (range, 105 degrees to 135 degrees). Knee dislocation is a very traumatic injury, often resulting in a painful, dysfunctional knee. Anterior and posterior cruciate ligament reconstructions in young, active patients can minimize pain and optimize functional outcome. Arthrofibrosis is a common occurrence in these patients, and manipulation under anesthesia is frequently required.
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PMID:Allograft reconstruction of the anterior and posterior cruciate ligaments after traumatic knee dislocation. 852 74


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