Gene/Protein Disease Symptom Drug Enzyme Compound
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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

We studied the effect of intra-articullar saline vs. bupivacaine + morphine or bupivacaine morphine + methylprednisolone after diagnostic knee arthroscopy. In a double-blind randomized study, 60 patients undergoing diagnostic knee arthroscopy without a therapeutic procedure were allocated to groups receiving intra-articular saline, intra-articular bupivacaine 150 mg + morphine 4 mg or the same dose of bupivacaine + morphine + intra-articular methylprednisolone 40 mg at the end of arthroscopy during general anesthesia. All patients were instructed to resume normal activities immediately after the procedure. Pain during movement and walking, leg muscle force and joint effusion, use of crutches and duration of sick leave were assessed. A combination of bupivacaine and morphine reduced pain, duration of immobilization and of convalescence. The addition of methylprednisolone further reduced pain, use of more analgesics, joint swelling and convalescence.
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PMID:Combined intra-articular glucocorticoid, bupivacaine and morphine reduces pain and convalescence after diagnostic knee arthroscopy. 1207 15

Twenty-four healthy, mixed-breed hound-type dogs were evenly and randomly assigned to a placebo control group, one of four dosages of deracoxib (0.3, 1, 3, or 10 mg/kg), or carprofen (2.2 mg/kg). Oral dosing of placebo, carprofen, or deracoxib was done 30 minutes before intraarticular injection of urate crystal suspension for induction of synovitis. Ground reaction forces, subjective clinical lameness scores, pain, joint effusion, and quantitative pain threshold responses were measured in a blinded fashion before induction of synovitis and 2, 4, 6, 8, 12, and 24 hours after injection. The medium and high dosages of deracoxib were effective in preventing lameness and pain associated with synovitis. Carprofen was also somewhat effective in attenuating the severity of urate-induced synovitis but to a lesser degree than the medium dose of deracoxib. Preemptive deracoxib treatment at dosages as low as 1 mg/kg reduced lameness and pain of synovitis associated with intraarticular administration of urate crystals.
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PMID:Effect of deracoxib, a new COX-2 inhibitor, on the prevention of lameness induced by chemical synovitis in dogs. 1258 83

Using an immunohistochemical technique, we examined synovial tissue from 46 temporomandibular joints (TMJ) with internal derangement in 44 patients. As controls, we examined synovial tissue specimens from 7 joints with habitual dislocation without pain. In synovial tissues from 21 of the 46 joints with internal derangement, interleukin 6 (IL-6) was expressed in the synovial lining cells and in the mononuclear cells infiltrating the periphery of the blood vessels. The density of IL-6-stained cells in specimens with internal derangement correlated significantly with the grade of joint effusion shown by magnetic resonance imaging (P=0.01, r=0.32).
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PMID:Expression of interleukin 6 in synovial tissues in patients with internal derangement of the temporomandibular joint. 1269 1

Family physicians frequently encounter patients with knee pain. Accurate diagnosis requires a knowledge of knee anatomy, common pain patterns in knee injuries, and features of frequently encountered causes of knee pain, as well as specific physical examination skills. The history should include characteristics of the patient's pain, mechanical symptoms (locking, popping, giving way), joint effusion (timing, amount, recurrence), and mechanism of injury. The physical examination should include careful inspection of the knee, palpation for point tenderness, assessment of joint effusion, range-of-motion testing, evaluation of ligaments for injury or laxity, and assessment of the menisci. Radiographs should be obtained in patients with isolated patellar tenderness or tenderness at the head of the fibula, inability to bear weight or flex the knee to 90 degrees, or age greater than 55 years.
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PMID:Evaluation of patients presenting with knee pain: Part I. History, physical examination, radiographs, and laboratory tests. 1367 39

It has been reported that joint effusion, the excessive accumulation of joint fluid in and around the joint, is related to temporomandibular joint (TMJ) disorders such as pain and disk displacement. However, there have been no longitudinal studies of this phenomenon. We performed a longitudinal study on the relationship between joint fluid and various pathological disk conditions. The subjects were 17 patients who visited our facility for orthodontic treatment and were diagnosed using MRI as having internal derangement of one or both TMJs (three males and 14 females; age 12-31 years; mean age 20.5 years). MRI was performed before, during, or after treatment for their disorders. We evaluated the relationship between changes in joint fluid in the joint space and the state of the disk, as well as the presence or absence of pain. Joint fluid was evaluated by classifying the extent of high-signal areas in the upper and lower articular cavities on T2-weighted images. The extent of high-signal areas was classified into five levels. Disk displacement and the extent of displacement were evaluated using proton density-weighted images. Statistical analysis was performed using the chi-square test, and differences in the distribution among the groups were examined. Effusion was noted on the first MRI in nine of the eleven joints (81.8%) in which joint fluid decreased on the second MRI (p<0.01). Displacement remained unchanged or worsened in 18 of the 21 joints (85.7%) that showed joint fluid on the first MRI (p<0.01). Pain was alleviated or absent in all joints in which the fluid decreased. These results suggest that joint fluid may be a factor in the outcome of disk recapture treatment as well as in the evaluation of pain.
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PMID:A longitudinal study of magnetic resonance (MR) evidence of temporomandibular joint (TMJ) fluid in patients with TMJ disorders. 1496 39

The main principle for treatment of ankle fractures is anatomic reduction until bony union is achieved. Old fractures of the ankle with residual diastasis, however, may cause persistent pain, joint effusion, and range-of-motion limitation, and make eventual ankle arthrodesis inevitable. Restoration of the integrity of the ankle mortise is the determining factor for successful repair of this type of ankle fracture. Old ankle fracture, where malunion has already occurred, is a great challenge for the orthopedic surgeon. Twelve such patients were treated by means of reconstructive corrective-elongation osteotomy without bone graft at the authors' institution from 1997 to 1999. These patients had persistent symptoms and radiographic evidence of a fibula that had healed in a shortened, rotated position, resulting in widening of the ankle mortise. The average time interval between injury and reconstructive operation was 18 months. At follow-up, which averaged 34 months, greatly improved ambulation and level of joint function was noted for all patients, and follow-up x-ray confirmed good ankle mortise geometry. The short-term results for these patients were good, with further follow-up planned to determine efficacy long term. In conclusion, reconstructive corrective-elongation osteotomy is a worthwhile procedure for old ankle fracture with malunion, and it can also postpone degenerative change in the ankle joint.
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PMID:Corrective-elongation osteotomy without bone graft for old ankle fracture with residual diastasis. 1500 31

Temporomandibular joint (TMJ) abnormalities cannot be reliably assessed by a clinical examination. Magnetic resonance imaging (MRI) may depict joint abnormalities not seen with any other imaging method and thus is the best method to make a diagnostic assessment of the TMJ status. In patients with temporomandibular joint disorder (TMD) referred for diagnostic imaging the predominant TMJ finding is internal derangement related to disc displacement. This finding is significantly more frequent than in asymptomatic volunteers, and occurs in up to 80% of patients consecutively referred for TMJ imaging. Moreover, certain types of disc displacement seem to occur almost exclusively in TMD patients, namely complete disc displacements that do not reduce on mouth opening. Other intra-articular abnormalities may additionally be associated with the disc displacement, predominantly joint effusion (which means more fluid than seen in any asymptomatic volunteer) and mandibular condyle marrow abnormalities (which are not seen in volunteers). These conditions seem to be closely related. Nearly 15% of TMD patients consecutively referred for TMJ MRI will have joint effusion, of whom about 30% will show bone marrow abnormalities. In a surgically selected material of joints with histologically documented bone marrow abnormalities nearly 40% showed joint effusion. Disc displacement is mostly bilateral, but joint effusion seems to be unilateral or with a lesser amount of fluid in the contralateral joint. Abnormal bone marrow is also mostly unilateral. Many patients have unilateral pain or more pain on one side. In a regression analysis the self-reported in-patient TMJ pain side difference was positively dependent on TMJ effusion and condyle marrow abnormalities, but negatively dependent on cortical bone abnormalities. Of the joints with effusion only one fourth showed osteoarthritis. Thus, there seems to be a subgroup of TMD patients showing more severe intra-articular pathology than disc displacement alone, and mostly without osteoarthritis. It should, however, be emphasized that patients with TMJ effusion and/or abnormal bone marrow in the mandibular condyle seem to constitute only a minor portion (less than one fourth) of consecutive TMD patients referred for diagnostic TMJ imaging. The majority of patients have internal derangement related to disc displacement, but without accompanying joint abnormalities. In patients with rheumatoid arthritis and other arthritides TMJ involvement may mimick the more common TMDs. Using MRI it is possible, in most cases, to distinguish these patients from those without synovial proliferation.
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PMID:Role of magnetic resonance imaging in the clinical diagnosis of the temporomandibular joint. 1608 29

Hypertrophic osteoarthropathy (HOA) is one of the paraneoplastic syndromes most commonly associated with non-small-cell lung cancer. Although pulmonary metastasis is the second most common initial site of melanoma metastasis, HOA is rarely detected in patients with metastatic melanoma in the lung. We report a case of a 45-year-old woman with advanced melanoma who developed HOA after her disease had progressed through first-line systemic therapy. The patient's diagnosis of HOA was made on the basis of digital clubbing, arthralgia, pain, joint effusion and periosteal bone formation on X-ray with negative rheumatologic laboratory studies. Only six cases of HOA in metastatic melanoma have been reported previously. This diagnosis should be considered with lung metastases and the presentation of polyarthralgia with appropriate laboratory and imaging findings. Interestingly, the patient responded to bisphosphonates and second-line chemotherapy with carboplatin and paclitaxel, which is commonly used for lung cancer, not advanced melanoma. As with many paraneoplastic syndromes, successful treatment of the underlying disease was associated with a rapid resolution of the symptoms.
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PMID:Hypertrophic osteoarthropathy associated with metastatic melanoma. 1631 44

The main intra-articular (IA) treatments used in osteoarthritis are corticosteroids and hyaluronan injections. Data concerning their short- and long-term efficacy and their potential side-effects are reviewed here. IA corticosteroids are effective for reducing short-term pain and appear to have no long-term deleterious effects on the cartilage; they may be more efficacious in patients with joint effusion and/or symptom flares. IA hyaluronan have a modest but long-lived symptomatic effect on pain and functional outcome in knee osteoarthritis; the level of evidence is poor concerning their efficacy in other joints. The differences in efficacy related to the molecular weight of the hyaluronan are a subject of debate. There is a risk of acute painful reactions, which seem more frequent with higher-molecular-weight hyaluronan. Some data--mainly from animal studies--suggest a possible long-term chondroprotective effect of hyaluronan. This treatment seems more efficacious in non-radiologically severe osteoarthritis with no or mild effusion.
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PMID:Do intra-articular therapies work and who will benefit most? 1648 12

The ideal articular cartilage repair tissue should be durable and well-integrated. We have been performing osteochondral multiple autograft transfers (OMAT) since 1996 with the experience we had using carbon fiber implants. We call this technique OMAT instead of mosaicplasty because we use uniform osteochondral autografts. Osteochondral multiple autograft transfer (OMAT) was performed either by arthrotomy or arthroscopy on 12 patients (6 male and 6 female) for the treatment of cartilage defects in the knee joint. The patients ranged in age from 20 to 63 years (mean: 38 years). All had weightbearing-related pain or decrease in the range of motion. None had instability or malalignment. The average follow-up time was 4 years (range: 2 to 8 years). Clinical results were satisfactory. All of the paients were improved initially by the procedure and 85% are still pain free. The mean Lysholm knee rating score was 56 points preoperatively and 86 points postoperatively. Second-look arthroscopy (five patients) demonstrated a normal shiny appearance and color of the grafted area. We observed slight joint effusion postoperatively that disappeared in two months. There was no donor site morbidity. OMAT is a promising surgical technique for the treatment ofarticular cartilage defects. Long-term follow-up with more patients and histological and biomechanical evaluation of chondral interfaces are the subjects of our continuing study.
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PMID:Osteochondral multiple autograft transfer (OMAT) for the treatment of cartilage defects in the knee joint. 1653 17


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