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

Serratia appears as a pathogen of increasing frequency and clinical significance in bone and joint infections in heroin users. This is the fifth case report of septic arthritis due to Serratia marcescens in intravenous heroin users. The clinical and laboratory features were not different from other acute pyogenic arthritides. Signs of infection were obscure even in the presence of debilitating disease. Although Pseudomonas and Staphylococcus are more common organism in bone and joint infections of heroin users, Serratia should be considered as a possible pathogen in such patients. In the present case, immediate open drainage followed by systemic Gentamicin treatment gave rapid relief of pain and restoration of full range of motion of the joint.
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PMID:Serratia marcescens arthritis in heroin addicts. 31 29

One hundred thirteen patients with 120 episodes of septic arthritis were seen during a 14-year period. The most common bacteria cultured from joint fluid or blood during the acute episodes were gonococci, staphylococci, and streptococci. Seventeen other bacteria were the infecting organisms in one or more cases each. Other infections and medical conditions frequently were present. In some instances the septic arthritis was a complication of another infection. In other patients septic arthritis appeared to occur because of diminished resistance to infection. The majority of patients responded well to medical treatment, but eight died and 26 had persistence of articular pain at follow-up examination.
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PMID:Infectious arthritis. 48 44

A case of septic arthritis diagnosed by combined 99m Tc-phosphate and 67Ga imaging, which preceded positive cultures of the infecting organism, is presented. A previously healthy 10-year-old girl complained of pain in her left hip with persistent fever. Initial laboratory studies showed a normal white cell count and negative blood cultures. A septic process was not confirmed. Blood flow studies and bone images with 99mTc-phosphate showed markedly increased perfusion in the left hip joint without extension to bone. Subsequent 67Ga images revealed a marked increase in radioactivity in the same region, indicating the presence of a septic process. Serial blood cultures and arthrocentesis showed Staphylococcus aureus. The patient improved on antibiotics.
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PMID:Utility of combined 99mTc-phosphate and 67Ga imaging in diagnosis of septic arthritis. 63 Jul 66

Disorders of the sacroiliac joint are often overlooked during an initial physical examination because the patient is usually in a supine position and the posteriorly located joint is not accessible. Local pain and tenderness at the sacroiliac joint on lateral compression of the pelvis, together with Gaenslen and Fabere maneuvers, may direct the physician's attention to the joint. However, these symptoms are not specific or pathognomonic. Unusual presentation of septic sacroiliitis, which does not show radiologic changes during the early stages, may mimic gluteal, lumbar disc or intra-abdominal syndromes, leading to unnecessary abdominal exploration or lumbar discectomy. Computed tomography (CT), with its superb delineation of osseous, synovial and peri-articular structures, was applied to diagnose septic sacroiliitis in three patients. In Patient 1, septic arthritis and juxta-articular osteomyelitis with sequestrum formation were demonstrated by CT four weeks before abnormalities were shown on a roentgenogram. In Patients 2 and 3, inflammatory processes affected the synovium and peri-articular muscles; thus, abnormalities were shown by CT but not by a roentgenogram. We consider CT to be helpful and superior to conventional radiography in the diagnosis of septic sacroiliitis.
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PMID:Computed tomography in diagnosis of septic sacroiliitis: report of three cases. 135 34

Rheumatic manifestations are common and varied in infective endocarditis. We performed a retrospective case analysis on 87 patients with 93 episodes of infective endocarditis admitted to Flinders Medical Centre over an 11 year period (1980-1990). Disabling musculoskeletal symptoms and signs were documented in 22 (25%) of the patients. Thirteen patients developed severe or moderately severe low back pain during their illness, two with radiological evidence of a septic discitis or vertebral osteomyelitis. Two patients developed polyarthralgia/arthritis, four had septic arthritis (all with acute Staphylococcus aureus endocarditis), three developed severe loin pain, two acute gout, two had severe buttock pain and sacroiliac joint tenderness and two each developed disabling jaw/facial pain, neck/scapular pain and flank pain respectively. Five patients presented initially to the orthopaedic or rheumatological unit for management of their musculoskeletal symptoms. Four of seven patients with Streptococcus bovis endocarditis demonstrated prominent low back pain supporting a previously noted association between this organism and back symptoms. Furthermore, in one patient who had three separate episodes of endocarditis involving three different organisms, florid back symptoms were only seen in the infective episode involving Streptococcus bovis.
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PMID:Rheumatic manifestations of infective endocarditis. 141 Oct 84

Pain in infants and children may be manifest by deformity, altered function, or discomfort. These manifestations are highly age related. Pseudoparalysis may be the only manifestation of septic arthritis of the hip in the neonate; a limp is often the presenting complaint in Perthes' disease, and scoliosis may be the primary manifestation of a herniated disc in an adolescent. New imaging methods aid in diagnosis. Ultrasound is helpful in assessing joint effusions; bone scans localize the cause of a limp; and magnetic resonance imaging shows spinal cord and root lesions. The traditional methods of assessment have not been replaced. History and physical examination are most essential to provide a rational basis on which to select the appropriate imaging study.
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PMID:Pain of musculoskeletal origin in children. 141 12

We treated 96 cases of pyogenic arthritis from January 1, 1980, to December 31, 1990, 16 of whom had adjacent osteomyelitis. Presenting symptoms in the latter were indistinguishable from those in 80 cases of primary pyogenic arthritis with regard to involved joints, aspirate findings and pathogens; however, adjacent osteomyelitis patients tended to be younger and were more likely to be symptomatic more than 7 days and to have received prior antibiotics. Prompt joint drainage was done in 15 of 16 cases but adjacent osteomyelitis was recognized in only 5. Bone scan was misleading in 3 of the 4 cases where it was performed as part of the initial evaluation. Persistent pain, swelling and/or fever occurred in 9 patients, 6 of whom underwent further joint drainage. Radiographs were diagnostic in 1 patient at admission, 10 during hospitalization and in 5 at follow-up. Sequelae were found in 8 of 13 patients with bone and joint infections vs. 8 of 41 patients with primary joint infection. Patients with a positive culture from the hip or shoulder who had been pretreated with antibiotics had the worst prognosis. Osteomyelitis should be considered in patients who present with symptoms and signs of pyogenic arthritis for longer than 1 week, especially if they have received prior antibiotics. Earlier recognition and bone debridement may improve outcome.
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PMID:Pyogenic arthritis associated with adjacent osteomyelitis: identification of the sequela-prone child. 154 19

In-111 labeled leukocyte scintigraphy was performed on a 90-year-old woman who had a fever and left lower extremity pain for 3 days. Leukocyte images demonstrated abnormal activity in the left knee and ankle. Aspiration of the left knee joint yielded cloudy yellow fluid with a leukocyte count of 30,000 per mm3 (75% polymorphonuclear leukocytes, 1% lymphocytes, and 24% monocytes). Cultures of the aspirate were reported as no growth. Microscopic examination of the aspirate revealed the presence of rod-shaped crystals of calcium pyrophosphate dihydrate, confirming the diagnosis of calcium pyrophosphate deposition disease, also known as pseudogout. The acute arthritis of pseudogout stimulates an intense leukocyte response; therefore, labeled leukocyte images performed on patients suspected of having this condition must be interpreted cautiously because scintigraphically it may not be possible to distinguish pseudogout from septic arthritis.
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PMID:In-111 labeled leukocyte imaging in a case of pseudogout. 158 41

The spectrum of orthopaedic problems in eight congenitally insensate patients was reviewed. The conditions included congenital insensitivity to pain, Riley-Day syndrome, and Lesch-Nyhan syndrome. In each of these conditions, the patient has an abnormality of interpretation of painful stimuli or lacks normal pain avoidance, leading to self-inflicted damage. The orthopaedic problems and complications included fracture, self-mutilation, autoamputation, osteomyelitis, septic arthritis, Charcot joints, scoliosis, and dislocation. Effective management consists of early diagnosis and patient/parent education to prevent as many complications as possible. Fractures may be treated conservatively, while progressive scoliosis requires operative intervention. Osteomyelitis, septic arthritis, and Charcot joints require appropriate operative treatment.
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PMID:Orthopaedic manifestations in congenitally insensate patients. 169 84

Septic sacroiliitis (SSI) is a rare form of pyogenic arthritis, which unrecognized or inadequately treated may cause longterm morbidity and eventually lasting disability. SSI is most frequently diagnosed among young adults, especially in drug abusers. Based on a literature survey three cases of SSI are presented, each representing characteristic aspects of SSI. The condition should be considered in cases of acute or subacute onset of pain in the gluteal region, hip or low back accompanied by fever. Laboratory findings are variable and non-specific. Definite bacteriologic diagnosis is only achieved in about 75% of the cases. In almost all of the cases, Tc-99m-MDP bone scintigraphy will in almost all the cases show increased uptake in the affected joint within one week after onset of symptoms. Generally antibiotic treatment leads to complete recovery.
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PMID:[Septic sacroiliitis]. 173 31


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