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)

Between 1994 and 1998, we have treated eleven patients with intraarticular fractures of the base of the middle phalanx including impaction, dislocation, and pilon types of injuries. All patients were evaluated after a median follow-up period of 25.8 (8 to 57) months. Treatment was carried out according to Suzuki's technique with a dynamic PIP-joint distraction fixator consisting of Kirschner wires and rubber bands. In five cases, there was additional osteosynthesis (Kirschner wires, resorbable hemicerclage) or cancellous bone-grafting for reconstruction of the joint surface. Early mobilisation commenced with active exercises for the PIP joint on the day of surgery. The dynamic extension fixator was applied for an average duration of 28 (15 to 42) days. By the time of follow-up examinations, we found a range of motion on an average of 64 (0 to 105) degrees including a lack of extension of 11 (0 to 60) degrees and a median flexion capacity of 75 (30 to105) degrees. All fractures healed uneventfully with restored joint stability. Eight patients were completely painfree, three complained of mild occupational pain.
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PMID:[The dynamic treatment of intraarticular fractures of the base of the middle phalanx with the Suzuki dynamic fixator]. 1151 89

A consecutive series of 20 joints in 13 patients underwent arthroplasty with the RMS PIP joint surface replacement implant. Twelve joints were treated for painful osteoarthritis (all females). Two joints were implanted for rheumatoid arthritis, two for post-traumatic pain and stiffness, two for post-traumatic stiffness and one each for post-traumatic pain and pain-free post-traumatic instability. Excellent, often total long-term pain relief was obtained in 18 joints. The other two patients with (compensible work-related) post-traumatic pain and stiffness reported "50-70% pain reduction". No patients lost movement and 14 out of 20 joints were pain-free with a 73.1 degrees average arc of motion. Six joints from the first half of the series had poor motion (average arc of 19.6 degrees ), even after open extensor tenolysis or manipulation under anaesthesia. As experience was gained, reliably better results were achieved with a more intensive regimen of hand therapy, particularly within the first post-operative week.
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PMID:Proximal interphalangeal joint surface replacement arthroplasty. 1167 61

Report on 6 individuals, occurring in three successive generations of a single family, who were affected by "classical" tricho-rhino-phalangeal syndrome type I. Besides pear-shaped noses, enlarged philtrum, hypotrichosis, premature alopecia, coned epiphysis at the proximal interphaleangeal joints with consecutive ulnar deviation of the long fingers, dysostotic feet, Perthes-like hip dysplasia with multilocated joint laxity and hyposomia were impressing. Height was 168 cm, corresponding to the 50 (th) percentile. Radiographs and 3D-reconstruction of both hands showed asymmetrical brachymetacarpia, brachymesophalangia and painful invaginations of the middle phalanx bases (type 12 according to Giedion). Angular deformities are seen predominantly in the index finger decreasing to the ring finger. Painful cone-shaped epiphyses with ulnar dislocation of the PIP joints were stabilized following resection arthrodesis with tension band osteosynthesis. At reexamination 48 months postoperatively a painfree and powerful pinch grip function of both hands was restored. All family members who showed the phenotypical features of TRPS type I revealed in genetic analysis also identical mutations. Inside the exon 4 in position 1831 there was a nonsens mutation C --> T. Non-afflicted relatives did not show this mutation.
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PMID:[Surgical therapy of cone-shaped epiphyses of the proximal interphalangeal joints in tricho-rhino-phalangeal syndrome type I: a survey among three successive generations of a single family]. 1561 9

We reviewed 110 trigger digits, treated surgically, to compare the outcomes of trigger finger and trigger thumb in terms of peri-operative characteristics and complications. The patients with trigger thumb complained mainly of pain on motion, while those with trigger finger complained of triggering or limited range of motion. Trigger fingers had a significantly longer duration before surgery than did trigger thumbs. Trigger fingers took significantly longer for the symptoms to subside. In our series, 64% of trigger fingers had a flexion contracture of the PIP joint more than three weeks after surgery. Our results suggest that the peri-operative characteristics and outcomes differ between trigger finger and thumb, and that the surgical outcome for trigger finger was poorer than that for trigger thumb, partly due to flexion contracture of the PIP joint.
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PMID:Comparison of the surgical outcomes for trigger finger and trigger thumb: preliminary results. 1610 5

Injuries about the PIP joint of the finger are commonly encountered by primary care physicians and are associated with significant morbidity, including pain, stiffness, instability, premature degenerative arthritis, and residual deformities. An accurate understanding of the regional anatomy and appreciation of the mechanism of injury allows for classification so that a treatment protocol can be formulated for each injury pattern. Emphasis on careful consideration of the implications of open reduction, rational splinting, and early, active, protected motion provides for the most favorable outcome.
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PMID:Management of proximal interphalangeal joint injuries. 1684 90

Seventeen pyrocarbon PIP prostheses were implanted into 14 patients, followed prospectively and reviewed clinically. The patients were assessed after a mean follow-up of 20.5 months subjectively by a VAS pain scale and radiographically. Significant pain relief was noted in all patients from a mean of 7.6 pre-operatively to 1.3 at final follow-up. Migration of one, or both, components was observed radiographically in eight joints and radiolucent lines were evident in three more cases. The clinical results of the implants which had migrated were less favourable for range of motion and grip strength than the stable joints of this series, although, statistically, the results were not significant. The number of possibly unstable prostheses in this series raises the question as to whether pyrocarbon is suitable for uncemented pressfit fixation in combination with early functional rehabilitation.
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PMID:Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results. 1704 19

Proinflammatory agents trypsin and mast cell tryptase cleave and activate PAR2, which is expressed on sensory nerves to cause neurogenic inflammation. Transient receptor potential A1 (TRPA1) is an excitatory ion channel on primary sensory nerves of pain pathway. Here, we show that a functional interaction of PAR2 and TRPA1 in dorsal root ganglion (DRG) neurons could contribute to the sensation of inflammatory pain. Frequent colocalization of TRPA1 with PAR2 was found in rat DRG neurons. PAR2 activation increased the TRPA1 currents evoked by its agonists in HEK293 cells transfected with TRPA1, as well as DRG neurons. Application of phospholipase C (PLC) inhibitors or phosphatidylinositol-4,5-bisphosphate (PIP(2)) suppressed this potentiation. Decrease of plasma membrane PIP(2) levels through antibody sequestration or PLC-mediated hydrolysis mimicked the potentiating effects of PAR2 activation at the cellular level. Thus, the increased TRPA1 sensitivity may have been due to activation of PLC, which releases the inhibition of TRPA1 from plasma membrane PIP(2). These results identify for the first time to our knowledge a sensitization mechanism of TRPA1 and a novel mechanism through which trypsin or tryptase released in response to tissue inflammation might trigger the sensation of pain by TRPA1 activation.
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PMID:Sensitization of TRPA1 by PAR2 contributes to the sensation of inflammatory pain. 1757 Nov 67

Agonist-induced desensitization of the transient receptor potential vanilloid receptor-1 (TRPV1) is one of the key strategies that offer a way to alleviate neuropathic and inflammatory pain. This process is initiated by TRPV1 receptor activation and the subsequent entry of extracellular Ca(2+) through the channel into sensory neurones. One of the prominent mechanisms responsible for TRPV1 desensitization is dephosphorylation of the TRPV1 protein by the Ca(2+)/calmodulin-dependent enzyme, phosphatase 2B (calcineurin). Of several consensus phosphorylation sites identified so far, the most notable are two sites for Ca(2+)/calmodulin dependent kinase II (CaMKII) at which the dynamic equilibrium between the phosphorylated and dephosphorylated states presumably regulates agonist binding. We examined the mechanisms of acute Ca(2+)-dependent desensitization using whole-cell patch-clamp techniques in human embryonic kidney (HEK) 293T cells expressing the wild type or CaMKII phosphorylation site mutants of rat TRPV1. The nonphosphorylatable mutant S502A/T704I was capsaicin-insensitive but the S502A/T704A construct was fully functional, indicating a requirement for a specific residue at position 704. A point mutation at the nearby conserved residue R701 strongly affected the heat, capsaicin and pH-evoked currents. As this residue constitutes a stringent CaMKII consensus site but is also predicted to be involved in the interaction with membrane phosphatidylinositol 4,5-bisphosphate (PIP(2)), these data suggest that in addition to dephosphorylation, or as its consequence, a short C-terminal juxtamembrane segment adjacent to the transient receptor potential box composed of R701 and T704 might be involved in the decelerated gating kinetics of the desensitized TRPV1 channel.
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PMID:Functional changes in the vanilloid receptor subtype 1 channel during and after acute desensitization. 1786 38

This paper presents a retrospective series of 20 LPM semi-constrained ceramic coated cobalt chrome proximal interphalangeal joint arthroplasties performed consecutively in 12 patients for arthritis of the proximal interphalangeal joint by a single surgeon between 2000 and 2004. Eleven were performed for osteoarthritis, four for post-traumatic arthritis and five for rheumatoid arthritis. Although 12 joints had an improvement in pain and an increased functional arc of movement, six joints required revision surgery for implant failure at an average of 19 months, with clinical signs of increasing pain, deteriorating motion and radiological signs of implant loosening and subsidence. This rate of revision is higher than in published series for other PIP joint implants and, therefore, close surveillance of all patients with this prosthesis currently in situ is recommended. Use of the prosthesis has ceased in this unit.
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PMID:Two to five year follow-up of the LPM ceramic coated proximal interphalangeal joint arthroplasty. 1833 18

Fracture dislocations and comminuted fractures of the PIP joint are considered as severe injuries with uncertain outcome. Short-term results of several traction devices in the treatment of PIP joint fractures have been published. But the further course concerning the injured joint surface has not been described yet. From 1995 to 2001 we treated 26 patients who suffered comminuted intraarticular fractures and fracture dislocations with the digital dynamic external fixator from Suzuki. The time of follow-up was 8 years (median) with a range of 5 - 11 years. Due to this rather long period only 13 patients were available for follow-up. The flexion of PIP joint gained a median value of 95 degrees (range: 35 - 100 degrees ), extension loss was 0 degrees (median; range: 0 - 35 degrees ). Range of motion of the PIP joint was 85 degrees (median; range: 0 - 100 degrees ). The evaluation of the X-rays shows an initial anatomic reduction with complete joint congruency in only 20 % of the cases, but over time there was a remodelling of the joint surface in 89 % without obvious signs of degeneration of the joint. We suppose that the surprisingly good long-term results are linked to this extraordinary remodelling. No patient complained about pain using the affected finger without load and only 2 patients experienced mild pain on heavy use. Compared to the 2-years results of another patient group that we published in 2001 the long-term results tend to be slightly better. We conclude that dynamic traction and early motion of intraarticular PIP joint fractures are the treatment of choice, as virtually pain-free and good motion is achieved also in the long-term due to the remarkable remodelling capacity of the joint surface.
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PMID:[Long-term follow-up of fracture dislocations and comminuted fractures of the PIP joint treated with Suzuki's pin and rubber traction system]. 1863 85


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