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

Lyme disease is transmitted by the tick Ixodes dammini ("deer tick") or a related ixodid tick. Early diagnosis of children with Lyme disease is difficult because the bite of the ixodid tick often goes unnoticed. Furthermore, erythema chronicum migrans, the characteristic rash of the disease, occurs in less than 50% of cases. However, an awareness of orthopaedic complications of Lyme disease may facilitate an early diagnosis of this disease. Orthopaedic complications of Lyme disease include those which are oligoarticular in nature. Brief intermittent attacks of swelling and pain in one or more joints--primarily large ones--is the pattern of disease most frequently presented. The knee is the joint most commonly affected. In most cases, pain is not severe enough to debilitate the patient or prevent weight-bearing activity. An elevated sedimentation rate is the only consistently abnormal routine laboratory finding in Lyme disease. The only radiographic abnormalities noted in children are effusion and osteopenia. However, the radiograph of a patient known to have Lyme disease may not show any abnormalities at all. Lyme disease shares symptoms in common with septic arthritis and juvenile rheumatoid arthritis. Whenever a distinction between Lyme arthritis and septic arthritis is difficult to make, treatment should be directed at septic arthritis while serological tests for Lyme disease are pending. The physician should consider Lyme disease to be a possible diagnosis of any patient with arthritis and a history of rash or fever, idiopathic neurological disease, or a cardiac conduction defect--especially if there is a history of possible exposure to the carrier tick.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Orthopaedic complications of Lyme disease in children. 268 66

To determine whether imaging techniques can differentiate osteomyelitis from bone infarction in sickle cell disorders, 39 sets of bone scans (BS) and bone marrow scans (BMS) were performed on 31 patients with sickling disorders and bone pain. In addition, three patients who had either a BS or a BMS were included. Results were analyzed according to whether scans were performed three days or less (Period 1), four to six days (Period 2), or seven or more days (Period 3) after the onset of pain. Regardless of the period, all but five BMS for 34 episodes of assumed infarction showed decreased uptake. BS findings varied depending on the time interval, with none of the ten in Period 1 showing increased uptake, but all 11 in Period 3 showing increased uptake. However, in Period 2, about half of the 13 BS showed increased uptake. All three patients with osteomyelitis in Period 3 had increased uptake on BS. The BMS done in one of these patients showed decreased uptake. Three patients with cellulitis had normal BS and BMS. One patient with septic arthritis had normal BMS, but slightly increased uptake on BS. Although typical imaging patterns are present in early and late infarction (Periods 1 and 3), the patterns for late infarction may not differ from those of advanced osteomyelitis. Therefore, imaging studies are only of value in differentiating infarction from osteomyelitis when both BS and BMS are performed soon after the appearance of symptoms.
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PMID:Differentiation of bone and bone marrow infarcts from osteomyelitis in sickle cell disorders. 270 66

The results of forty-eight resection arthroplasties (Girdlestone procedures) in forty-three patients were analyzed. The indications were sepsis after a total hip replacement (thirty-three procedures), aseptic loosening of a total hip replacement (ten procedures), and primary septic arthritis (five procedures). The resection arthroplasty effectively eradicated the sepsis in all but three patients, who had a recurrence. Pain was alleviated in nearly all of the patients, but the ability to walk and the level of activity improved only slightly. Shortening of the limb ranged from three to eleven centimeters, and all patients used a support for walking. The six patients who had a bilateral procedure were able to walk using double supports. With regard to relief of pain, walking, and function, the results were significantly poorer in the women, particularly the older ones. The results were also significantly inferior in the patients who had had sepsis after a total hip replacement. Generally, walking, function, and the level of activity were better when much of the proximal end of the femur had been retained. Resection arthroplasty should spare as much of the proximal end of the femur as possible if a future replacement of the hip is contemplated.
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PMID:Resection arthroplasty of the hip. 273 55

The rheumatic manifestations of familial hypercholesterolemia include recurrent Achilles pain or tendinitis, acute mono/oligoarthritis and migratory (rheumatic fever-like) polyarthritis. Diagnosis is made by finding skin and tendon xanthomas, hypercholesterolemia, and ruling out other rheumatic conditions such as rheumatic fever, gout, pseudogout and septic arthritis. A patient, homozygous for familial hypercholesterolemia, with a rheumatic fever-like migratory arthritis is presented.
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PMID:Hypercholesterolemic (type II hyperlipoproteinemic) arthritis. 275 74

Pyogenic arthritis of the sacro-iliac joint is uncommon in children; 6 cases were observed over 4 years. The diagnosis may be difficult and should include specific examination of the sacro-iliac joint. Posterior pain with a febrile illness needs radiological examination and a skeletal scintigraphy, which has always been positive in our experience. All the patients had a very good functional recovery after antibiotherapy and rest (bed or plaster).
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PMID:[Pyogenic sacroiliac arthritis in children. Apropos of 6 cases]. 306 22

Twenty eight patients who had received haemodialysis for more than 10 years were reviewed to establish the incidence of joint problems. Only six patients had no joint symptoms, one had avascular necrosis, one had had recent septic arthritis, and four had hyperparathyroidism. The remaining 16 patients had no evidence of hyperparathyroidism yet had an arthropathy causing pain and stiffness in many joints, particularly the shoulders. Ten of these 16 patients had a recurrent carpal tunnel syndrome requiring repeated surgical decompressions, which resulted in only partial improvement. Of the eight patients who had received dialysis for more than 15 years, seven had this "dialysis arthropathy" and six had recurrent carpal tunnel syndrome. Dialysis arthropathy is a common and often severe and disabling complication of long term treatment with haemodialysis. The cause is not known, but amyloid was found in a synovial biopsy specimen from one patient.
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PMID:Dialysis arthropathy: complication of long term treatment with haemodialysis. 308 Jan 16

The role of arthroscopy in the diagnosis and treatment of shoulder disorders is evolving. Arthroscopic subacromial decompression is an alternative to open anterior acromioplasty in the treatment of chronic stage II impingement syndromes prior to the development of full thickness rotator cuff tear. Patients with massive and otherwise unrepairable cuff tears have achieved significant pain relief from arthroscopic decompression and debridement of the floppy and irregular cuff margins. Routine repairable full thickness cuff tears are best treated by open reconstruction. The arthroscope is an adjunct in confirming the diagnosis and direction of shoulder instability. Arthroscopic stabilization is most feasible when the anterior glenohumeral ligament/labral complex is detached. The introduction of a metal staple is controversial, however, reported complications are diminishing with experience. Alternate methods of stabilization are being investigated. Effective arthroscopic techniques have been established for the removal of loose bodies, the treatment of calcific tendinitis, septic arthritis, and other disorders. Shoulder arthroscopy will undoubtedly achieve an appropriate place in the armamentarium of the orthopedic surgeon.
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PMID:Shoulder arthroscopy: current indications and techniques. 328 Nov 54

Acute infections of bone and joints is a curable condition and the chance of cure is related to a number of factors like type and virulence of the organism, resistance of the host, choice of antibiotics, early drainage of the joint in septic arthritis and appropriate treatment after early diagnosis with adequate dosage and duration of antibiotic therapy. Late diagnosis and inadequate treatment can often lead to high mortality and morbidity and leave the patient with crippling sequelae like chronic osteomyelitis, joint destruction, pain, shortening, deformity and limp.
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PMID:Acute pyogenic bone and joint infections. 331 54

The cases of seventeen children whose ages ranged from two to eighteen years and who were treated for a disorder of a sacro-iliac joint between 1975 and 1983 were reviewed retrospectively. Thirteen children were acutely ill, with a temperature of more than 38 degrees Celsius, and four had chronic symptoms that had persisted for three weeks to one year. Pain in the hip, thigh, and buttock was the most common symptom. Of the thirteen acutely ill patients, eleven had septic arthritis of a sacro-iliac joint, while one who had ankylosing spondylitis and one who had juvenile rheumatoid arthritis had acutely painful arthritis of a sacro-iliac joint. Of the four patients who had chronic symptoms, two had septic arthritis of a sacro-iliac joint; one, ankylosing spondylitis with sacro-iliac involvement; and one, eosinophilic granuloma of the ilium. Thus, thirteen patients had septic arthritis of a sacro-iliac joint and four had some other disorder. For the seventeen children who had acute or chronic symptoms, at admission the white blood-cell count ranged from 3,500 to 26,200 per cubic millimeter (average, 11,100 per cubic millimeter) and the sedimentation rate, as determined by the Westergren technique, ranged from twenty-two to sixty-five millimeters per hour (average, fifty millimeters per hour). Twelve of the plain radiographs of the seventeen patients were negative. The initial bone scans of all seventeen patients were positive in eleven and negative in six. Of these six, five had septic arthritis and one, juvenile rheumatoid arthritis. A computed tomographic scan was performed in four patients and was positive in all of them: three had septic arthritis and one had ankylosing spondylitis. Organisms were cultured successfully from blood, from material aspirated from the sacro-iliac joint, or from stool of all thirteen patients who had sepsis. The thirteen infections responded well to appropriate antibiotics, which were administered intravenously to seven patients and first intravenously and then orally to six.
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PMID:Disorders of the sacro-iliac joint in children. 333 71

A psoas abscess is a recognized complication of Crohn disease. Less commonly, septic arthritis has been described with this entity. The occurrence of both these complications together in Crohn disease is quite rare. A 56-year-old patient with Crohn disease presented with weakness and pain in both lower extremities. Computerized body tomograms demonstrated a large psoas abscess with fistulous connections to the bowel as well as extending into the capsule of the left hip joint. X-ray examination revealed evidence of acute septic arthritis. Electromyographic studies demonstrated lumbosacral plexus involvement bilaterally. The patient subsequently underwent ileocolectomy with drainage of the left psoas abscess, followed by extensive inpatient rehabilitation. Some immediate strength improvement was noted bilaterally. At discharge, the patient remained paraparetic. In patients with known history of Crohn disease, a psoas abscess should be considered when there are symptoms of lower extremity pain, hip flexion contractures, and progressive weakness.
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PMID:Paraparesis in a patient with Crohn disease resulting from septic arthritis of the hip and psoas abscess. 334 26


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