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

Long digital extensor tendon avulsion is reported in a 5 month old Great Dane. Clinically the dog presented with a unilateral weight-bearing pelvic limb lameness. Joint effusion was present and there was pain and crepitance associated with flexion of the stifle. Orthopedic evaluation and radiographs were suggestive of a long digital extensor tendon injury which was confirmed by computed tomography and magnetic resonance imaging. The injury was surgically repaired with screw and spiked washer fixation.
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PMID:Radiographic, computed tomographic and magnetic resonance imaging evaluation of a chronic long digital extensor tendon avulsion in a dog. 923 87

Transient patellar dislocation is a rare finding. It is usually due to direct trauma in mediolateral direction or to indirect trauma related to violent quadriceps muscle contraction. The clinical diagnosis of transient forms is usually rather difficult because the associated signs (hemarthros and pain at the joint and/or at the vastus medialis insertion) are not specific. Conventional radiography and CT are very accurate in bone studies, but exhibit major limitations in the detection of capsular injuries with intramedullary and/or cartilaginous bone involvement. We investigated MR diagnostic reliability in the study of the injuries caused by transient patellar dislocation. 526 MR examinations of the knee were reviewed retrospectively; fifteen of them were positive for transient patellar dislocation. We used a .5 T superconductive MR unit with a circumferential extremity coil. Axial, coronal and sagittal T1-weighted spin echo, T2*-weighted gradient echo and axial STIR images were acquired. The following criteria were considered specific for the diagnosis of former lateral patellar dislocation: retinacular changes; patella site; signal intensity changes in femoral and patellar intramedullary bone; joint effusion; cartilage and subchondral bone changes. All the patients with transient patellar dislocation had hemarthros with inner retinaculum involvement. The femoropatellar joint was incongruous in 115 cases; patellar subluxation was external in 8/11 patients and lateral in the remaining 3 patients. Medullary bruises were found in 8/15 cases and cartilage injuries in 13/15. Finally, other joint components, such as the posterior horn of the medial meniscus or the anterior cruciate ligament were involved in 6/13 cases. Arthroscopy was performed in 6 patients with associated injuries and confirmed all MR findings (100% agreement). To conclude, in our experience MRI was a very reliable tool to study the injuries due to transient patellar dislocation because it showed specific changes and possible associated traumas, which helps choose the most suitable treatment.
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PMID:[Biomechanics and semiology of transient lateral patellar dislocation: reliability of magnetic resonance diagnosis]. 941 12

The retrospective results of carbon prostheses for knee ligament reconstruction in 120 patients, as established by questionnaire, are reported at 10 +/- 2 years follow-up. Eighty patients could also be reviewed clinically. Some 60% of the patients showed good subjective function at reduced activity level. Complications were seen in 72.5% of the patients with rupture of the carbon prosthesis and in 68% of those with synovitis. X-ray showed osteoarthritis in up to 59% of the patients. Carbon prostheses for collateral ligament reconstruction (85% medial, 5.8% lateral) were successful in 75% of cases. Activity and time seem to be less responsible for failure of the carbon prostheses than the features of growing in. Destruction of the knee joint over time is due to reactive synovitis and catabolic enzyme reaction and correlates with joint effusion and pain. If these problems appear, (arthroscopic) resection of the synovia is indicated to interrupt the circulus vitiosus.
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PMID:[Carbon-fiber implants for knee ligament reconstruction. 10-year results]. 951 2

Rheumatoid arthritis (RA) is a chronic multisystemic disease affecting mainly the joints and characterised by a poor prognosis. In a four month open study we evaluated the efficacy and tolerability of a combination therapy in 14 patients with active and refractory RA (non responsive to MTX or CsA monotherapy). After three pulses of methyl-prednisolone (125 mg/die i.v. for 3 days), at day the 4 patients received methotrexate (MTX 15/mg/week p.os) and cyclosporine (CsA 3 mg/kg/day p.os). At the end of treatment period, patients had a statistically significant improvement in the tender-joint count (Ritchie Index) in the swollen-joint count and in the pain as recorded on a 100-mm visual-analogue scale. Following the criteria of the American College of Rheumatology for response to treatment in RA, 6 patients (60%) met these criteria, whereas 2 had a worsening. We could not detect any clear difference in serological parameters (ESR, CRP and Hb levels) between the beginning and the end of the therapy. A significant difference in the score of edema/joint effusion was documented at the RM analysis. Side-effects were not substantially increased as compared to MTX or CsA in single therapy. Combination therapy with CsA and MTX seems to be a safe and effective treatment for patients with active and refractory RA.
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PMID:[Therapy of refractory rheumatoid arthritis. Cyclosporin and methotrexate combination]. 954 86

A 22 year old male patient with antiphospholipid-antibody syndrome (APL) developed severe bilateral avascular necrosis of both femoral condyles. Extensive synovectomy and arthrolysis in combination with an arthroplastic remodeling of both knee joints resulted in reduction of pain and joint effusion. Therefore, synovectomy and arthroplastic remodeling might be a promising therapy to extend the period of time to prosthetic joint replacement in young patients with APL.
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PMID:[Surgical treatment of aseptic bone necroses of both knee joints in antiphospholipid antibody syndrome (APL) by synovectomy, arthrolysis and arthroplasty]. 978 3

Convalescence after arthroscopic meniscectomy is dependent on pain and the inflammatory response. The aim of the study was therefore to investigate the effect of intra-articular bupivacaine + morphine + methylprednisolone versus bupivacaine + morphine or saline on postmeniscectomy pain, mobilisation and convalescence. In a double-blind randomized study 60 patients undergoing arthroscopic meniscectomy were allocated to intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg. All patients were instructed to resume normal activities immediately after operation. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. Combined bupivacaine and morphine significantly reduced pain, time of immobilisation and duration of convalescence. Addition of methylprednisolone further reduced pain, use of additional analgesics, joint swelling and convalescence, improved muscle function and prevented the inflammatory response (acute phase protein) (P < 0.05). A multimodal analgesic and anti-inflammatory treatment may enhance post-arthroscopic convalescence, which depends on the trauma induced inflammatory response and pain.
Pain 1998 Nov
PMID:Intra-articular glucocorticoid, bupivacaine and morphine reduces pain, inflammatory response and convalescence after arthroscopic meniscectomy. 983 23

Between 1990 and 1995, 25 painful primary posterior cruciate ligament retaining total knee arthroplasties were revised for flexion instability. These patients shared typical clinical presentations that included a sense of instability without frank giving way, recurrent knee joint effusion, soft tissue tenderness involving the pes anserine tendons and the retinacular tissue, posterior instability of 2+ or 3+ with a posterior drawer or a posterior sag sign at 90 degrees flexion, and above average motion of their total knee arthroplasty. The primary total knee arthroplasty was performed for osteoarthritis in 23 patients and rheumatoid arthritis in two patients. There were 13 male and 12 female patients and their mean age was 65 years (range, 35-77 years). Before the revision operation, Knee Society knee scores averaged 45 points (range, 17-68 points) and function scores averaged 42 points (range, 0-60 points). Twenty-two of the knee replacements were revised to posterior stabilized implants and three underwent tibial polyethylene liner exchange only. Nineteen of the 22 knee replacements revised to a posterior stabilized implant were improved markedly after the revision surgery. Only one of three knee replacements that underwent tibial polyethylene exchange was improved. After the revision for flexion instability, Knee Society knee scores averaged 90 points (range, 82-99 points) and function scores averaged 75 points (range, 45-100 points) for the 20 knees with a successful outcome. This study suggests that flexion instability can be a cause of persistent pain and functional impairment after posterior cruciate ligament retaining total knee arthroplasty. A revision operation that focuses on balancing the flexion and extension spaces, in conjunction with a posterior stabilized knee implant, seems to be a reliable treatment for symptomatic flexion instability after posterior cruciate retaining total knee arthroplasty.
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PMID:Flexion instability after primary posterior cruciate retaining total knee arthroplasty. 991 66

The central one third of the patellar tendon autograft is popular because the bone-tendon-bone (BTB) construct provides several graft fixation options, robust graft incorporation, and a mechanically sufficient substitute. Interference screw fixation is one method used to secure the graft. Bioabsorbable interference screws may offer advantages over metal interference screws. Bioabsorbable screws are made from poly L-lactic acid (PLLA) and are absorbed by the body. This prospective, randomized study compared the safety and efficacy of the PLLA screw with that of the metal cannulated interference screw for anterior cruciate ligament reconstruction. There were 204 patients randomly assigned to the Bioscrew (Linvatec, Largo, FL) (n = 103) or the metal interference screw (n = 101) groups at four sites. The mean age was 30 years. There were 66 women and 138 men. Mean follow-up was 30 months for Bioscrews and 28 months for metal screws; the average follow-up interval was 2.4 years. The Lysholm mean scores at 4 years for the 32 patients seen at this interval were 95.0 and 97.2 for the Bioscrew and metal screw group, respectively. Ligament laxity comparisons made with an instrumented arthrometer at manual maximum force resulted in side-to-side mean score differences of B = 1.8mm and M = 1.6mm. The Tegner activity level score means were B = 6.1 and M = 5.8. Other variables examined included pain, thigh size, meniscal tests, Lachman's test, range of motion, anterior drawer, pivot shift, patellofemoral crepitus and tenderness, and joint effusion. None of these variables showed a statistically significant difference between groups. No radiographic evidence of osteolytic change or bone resorption around the Bioscrews was observed. There were no complications related to loss of fixation, toxicity, allergenicity, or other evidence of osteolytic or inflammatory reaction. In every assessment between groups there was no difference found. There were 12 PLLA screws that broke during insertion without any adverse effects. The PLLA headless cannulated interference fit screws produce equal results to similarly designed metal screws.
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PMID:Bioabsorbable interference screws for graft fixation in anterior cruciate ligament reconstruction. 1042 49

Pigmented villonodular synovitis is an uncommon disease that remains a diagnostic challenge. Presenting complaints commonly involve one joint, most often the knee or hip. Symptoms of pain and swelling characteristically have an insidious onset and are slowly progressive. The physical examination may be completely normal. Radiographs of the knee may appear normal or may show a periarticular soft tissue density, expansion of the suprapatellar pouch and local osseous changes confined to the patellofemoral articulation. Radiographs of the hip may show erosions in the head and neck of the femur and acetabulum. Magnetic resonance imaging usually demonstrates key diagnostic features, which include joint effusion, elevation of the joint capsule, hyperplastic synovium and low signal intensity resulting from hemosiderin deposition. The diagnosis of pigmented villonodular synovitis is confirmed by biopsy, and the treatment of choice is synovectomy.
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PMID:Pigmented villonodular synovitis of the hip and knee. 1052 85

The structures of the posterolateral aspect of the knee were evaluated with axial MR images. One hundred twelve knees of clinical cases without posterolateral injury were retrospectively reviewed, and 30 knees of 15 volunteers with no history of knee injury or pain were evaluated. The amount of joint effusion and visualization of the lateral collateral ligament (LCL) and popliteal tendon were classified according to three grades. The LCL and popliteal tendon were identified in 111 clinical cases (99%) and 28 volunteer knees (93%). Visualization of the LCL and popliteal tendon was facilitated in the presence of both joint effusion and fluid collection between the LCL and popliteal tendon. Fluid collection posterior to the femoral attachment of the popliteal tendon was seen in 79 clinical cases (71%) and 20 volunteer knees (67%). Based on cadaveric study, this was considered to be a potential fluid space for communication to the joint space.
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PMID:[MR imaging of the posterolateral aspect of the knee]. 1061 5


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