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

Forty-three cases (44 joints) with tuberculosis of sacroiliac joints were treated surgically through 3 approaches: (1) Anterior approach was indicated for the cases with abscess in iliac fossa or with fistula in buttock, in 21 cases (22 joints). (2) Posterior approach was used for the cases with or without abscess and/or fistula of buttock, in 20 cases. (3) Antero-posterior combined approach was adopted for the cases with large abscess and/or fistula both at iliac fossa and buttock, in 2 cases (2 joints). Follow-up, ranging between 6 months and 16 years, presented no recurrent case of tuberculosis. In the cases with bony fusion, the symptoms disappeared altogether postoperatively, while the local pain still remained in the cases without bone grafting. The authors' opinions are as following: In the treatment of tuberculosis of sacroiliac joint, surgical approach should be chosen according to the location and size of abscess and the direction of fistula. Bony fusion is significant for elimination of symptoms.
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PMID:[Comparison among the surgical approaches to tuberculosis of sacroiliac joint]. 803 86

A follow-up study was conducted on correlations of radiographic measurements of isthmic spondylolisthesis to indexes of low-back pain as well as functional and working capacity in 148 middle-aged patients treated for low-back pain an average of 17 years earlier. Posterior or posterolateral fusion in situ had been performed in 50% and decompression (Gill's procedure) in 23% of patients, whereas 27% of the patients had been treated conservatively. The mean degree of the slip was 34.4 +/- 19.7% (SD) at follow-up, and the mean progression of the slip during the observation time was 6.1% units. The level of progression of the slip, instability of the olisthetic segment, or radiological nonunion of spinal fusion did not correlate with either the pain index or the activities of daily living (ADL) index. No marked radiological differences were seen between those actively employed and those pensioned. The degree of slip correlated positively with the pain index (r = 0.31; p = 0.007) and the ADL index (r = 0.24; p = 0.026) in the joint group of nonsurgical and decompression-treated patients, whereas negative correlations (pain index, r = -0.22, p = 0.065; ADL index, r = -0.22; p = 0.066) occurred in the fusion group. We conclude that degree of slip and spinal fusion operation are slightly associated with the prognosis of isthmic spondylolisthesis, whereas the other radiological variables of our study showed no association.
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PMID:Radiographic correlations in adult symptomatic spondylolisthesis: a long-term follow-up study. 818 88

Fourty-three cases with metastatic spinal cord compression were reviewed post-operatively to clarify the usefulness of the procedures concerning restoration of neurological function, and pain relief. Only patients with pathological spinal instability and neurological sequelae were included. Posterior decompression and stabilization was performed in all but six patients. All but four patients (91%) reported decrease of pain symptoms. Amelioration of neurological function was achieved in 58%. Re-establishment of walking ability was obtained in 57%. Post-surgery life expectancy averaged 11 months. In patients with widespread metastatic disease and/or multi-level instability of the spine restriction to palliative dorsal procedures is sensible. Post-operative ancillary treatment is necessary.
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PMID:Metastatic spinal cord compression--options for surgical treatment. 823 91

Thirty-two total knee arthroplasties (TKAs) in patellectomized patients were evaluated with recent clinical and radiographic examinations. Eighteen patients had a primary TKA with a mean follow-up period of 49 months, and 14 patients had a revision TKA with a mean follow-up period of 36 months. A control group of 13 TKA patients with intact patellae were randomly generated but matched for age, sex, follow-up data, diagnosis, and prosthesis. Posterior cruciate ligament-retaining types of prostheses were used in the primary knees, while the revision knees underwent arthroplasties with the more constrained, posterior cruciate ligament-substituting prostheses. All knees were evaluated based on the Knee Society's clinical and radiographic scoring system. In addition, 18 patients (9 primary, 9 revision) underwent isokinetic dynamometer testing for quantitation of peak quadriceps and hamstring torque. The knee score, indicative of pain relief, averaged 82.5 in the primary group (16 good/excellent, 1 fair, 1 poor), 86.5 in the revision group (12 good/excellent, 1 fair, 1 poor), and 93.9 in the control group (13/13 excellent). The function score averaged 59.7 in the primary group (6 good/excellent, 6 fair, 6 poor), 60.0 in the revision group (5 good/excellent, 2 fair, 7 poor), and 80.9 in the control group (12 good/excellent, 1 fair). The lower function scores predominantly reflected the patients' difficulty in independently climbing or descending stairs. This was also reflected in their higher flexion to extension peak torque ratios. There was one failure in the primary group requiring a revision and one failure in the revision group requiring a knee fusion. There was no radiographic evidence of impending failure in any of the remaining knees. No clinical or radiographic differences were found between the patients with osteoarthritis or rheumatoid arthritis. Although the knee and function scores were lower in the patellectomized patients, the overall results were generally satisfactory without a high incidence of failures. Satisfactory results were obtained in the primary TKAs using the minimally constrained prostheses when the posterior cruciate ligament was intact. Revision TKAs, in which the posterior cruciate ligament was absent, also demonstrated satisfactory results with the more constrained, posterior cruciate ligament-substituting prostheses.
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PMID:Total knee arthroplasty in patellectomized patients. 824 94

The purpose of this paper is to emphasis the signification of total elbow replacement in the treatment of rheumatoid arthritis. Total elbow replacement were performed in twenty elbows in fourteen patients who had rheumatoid arthritis from 1982 to 1990. The follow-up period ranged from 2 to 9 years. Pain relief was complete in twelve patients. Preoperation flexion averaged 119 degrees, increasing to 127 degrees. Preoperation extension averaged -34 degrees, increasing to -24 degrees postoperation. There were no infection and fracture postoperatively. Radiolucent lines were seen in four humeral components, in one ulnar component. Proximal subsidence of the humeral component were found in two elbows. Posterior dislocation occurred in three elbows. In two cases, reduction was successful by three weeks immobilization in a plaster cast with the elbow in the flexion position. Transient ulnar nerve palsy was evident in two elbows. Revision surgeries were performed in two cases, which occurred dislocation and progressive subsidence. Multiple replacements of major joints were performed in ten patients. Two joints were replaced in two patients, three joints were replaced in six patients, four joints were replaced in two patients. Four total elbow replacements were performed accompanied with other joints replacement in the same anesthesia. We recommended two joint replacements in the same anesthesia in patient with good general condition. All patients had functional improvements after total elbow replacement, especially reaching of the arm. Four patients improved the walking by being able to use stich after total elbow replacement.
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PMID:[The signification of total elbow replacement in the treatment of rheumatoid arthritis]. 831 4

Posterior tibial tendon rupture is often misdiagnosed. The authors have presented a retrospective study of a new variation to the repair of this tendon. The anatomy, physiology, etiology, clinical manifestations, radiographic and magnetic resonance imaging, and historical methods are reviewed. A classification scheme based on location and appearance is discussed. A review of 17 cases was performed with results of 88% pain relief following the discussed procedure.
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PMID:Posterior tibial tendon rupture: classification, modified surgical repair, and retrospective study. 831 56

Certain atypical forms of osteoarthritis of the hip are misleading: forms with very severe pain, forms with pain predominantly in the sitting position, forms with disproportionate pain. These atypical features can sometimes be explained by certain anatomical arrangements: superomedial narrowing over an aggressive double line, posterior osteoarthritis of the hip which can only be demonstrated on a false lateral view in the form of posteroinferior narrowing with its corollaries: anterosuperior diastasis and marked osteophytes of the posterior horn appearing to advanced underneath the femoral head on the lateral view. These atypical forms frequently only last several months or years. Posterior osteoarthritis of the hip has a less severe and slower course than the usual forms with superior narrowing.
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PMID:[Unusual secondary coxarthrosis and posterior coxarthrosis]. 833 1

A comparative study of cervical spines from 16 subjects who died of major trauma and 16 control subjects who died of natural causes, showed clefts in the cartilage plates of the intervertebral discs in 15 of 16 spines from the trauma victims. These were quite distinct from the uncovertebral clefts and central disc fissures that are a normal feature of aging in cervical discs. Posterior disc herniation through a damaged anulus fibrosus and hemarthrosis in facet joints were also observed. No directly comparable lesions were found in the control subjects, but two discs in this group showed "rim lesions," which may be old injuries. Disc lesions are common in injured cervical spines where translation is much greater than in the lumbar spine and these lesions are slow to heal. It is suggested that such injuries could cause the pain experienced by patients with neck sprain.
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PMID:Acute injuries to cervical joints. An autopsy study of neck sprain. 836 16

Peripheral nerve lesions are uncommon but serious injuries which may delay or preclude an athlete's safe return to sports. Early, accurate anatomical diagnosis is essential. Nerve lesions may be due to acute injury (e.g. from a direct blow) or chronic injury secondary to repetitive microtrauma (entrapment). Accurate diagnosis is based upon physical examination and a knowledge of the relative anatomy. Palpation, neurological testing and provocative manoeuvres are mainstays of physical diagnosis. Diagnostic suspicion can be confirmed by electrophysiological testing, including electromyography and nerve conduction studies. Proper equipment, technique and conditioning are the keys to prevention. Rest, anti-inflammatories, physical therapy and appropriate splinting are the mainstays of treatment. In the shoulder, spinal accessory nerve injury is caused by a blow to the neck and results in trapezius paralysis with sparing of the sternocleidomastoid muscle. Scapular winging results from paralysis of the serratus anterior because of long thoracic nerve palsy. A lesion of the suprascapular nerve may mimic a rotator cuff tear with pain a weakness of the rotator cuff. Axillary nerve injury often follows anterior shoulder dislocation. In the elbow region, musculocutaneous nerve palsy is seen in weightlifters with weakness of the elbow flexors and dysesthesias of the lateral forearm. Pronator syndrome is a median nerve lesion occurring in the proximal forearm which is diagnosed by several provocative manoeuvres. Posterior interosseous nerve entrapment is common among tennis players and occurs at the Arcade of Froshe--it results in weakness of the wrist and metacarpophalangeal extensors. Ulnar neuritis at the elbow is common amongst baseball pitchers. Carpal tunnel syndrome is a common neuropathy seen in sport and is caused by median nerve compression in the carpal tunnel. Paralysis of the ulnar nerve at the wrist is seen among bicyclists resulting in weakness of grip and numbness of the ulnar 1.5 digits. Thigh injuries include lateral femoral cutaneous nerve palsy resulting in loss of sensation over the anterior thigh without power deficit. Femoral nerve injury occurs secondary to an iliopsoas haematoma from high energy sports. A lesion of the sciatic nerve may indicate a concomitant dislocated hip. Common peroneal nerve injury may be due to a direct blow or a traction injury and results in a foot drop and numbness of the dorsum of the foot. Deep and superficial peroneal nerve palsies could be secondary to an exertional compartment syndrome. Tarsal tunnel syndrome is a compressive lesion of the posterior tibial nerve caused by repetitive dorsiflexion of the ankle--it is common among runners and mountain climbers.(ABSTRACT TRUNCATED AT 400 WORDS)
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PMID:Peripheral nerve injuries in athletes. Treatment and prevention. 837 68

Posterior instability in athletes is a diagnostic and therapeutic challenge. Athletes have recurrent posterior subluxations rather than true dislocations, and they have pain rather than instability, which makes the diagnosis difficult. The pathology is usually capsular laxity rather than a true reverse Bankart lesion. There is not one diagnostic test, including computed tomography (CT) arthrogram, magnetic resonance imaging (MRI), or arthroscopy, that will always help with the diagnosis. Most athletes respond to conservative care with an exercise program designed to strengthen the posterior deltoid, the infraspinatus, and the teres minor; but, there is still a select group of athletes that cannot perform their sport after an extensive rehabilitation program. The surgical options for these athletes are varied, and the results in most cases are less than ideal. A posterior capsulorrhaphy was performed to treat this problem. This was initially performed with a staple, but this technique has been abandoned for a suture capsulorrhaphy to avoid staple problems. The 40 athletes treated operatively that had adequate follow-up evaluation reflected a 40% failure rate. Most of the failures were related to ligamentous laxity and unrecognized multidirectional instability not treated at the time of surgery. There may be subtle differences between a patient with posterior subluxation and multidirectional instability; these must be differentiated before operation. Also, the higher the competitive level of athlete, the worse the overall results. The high-level athlete must be informed that even if his or her shoulder is stabilized, the functional results may not allow him or her to continue at the same competitive level.
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PMID:The treatment of posterior subluxation in athletes. 850 91


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