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

Osteoarthritis of the hip is rapidly progressive in 5% of cases, particularly in patients of advanced age. At times there is total destruction of the femoral head. Nineteen such cases are described and the literature is reviewed. The clinical picture is dominated by rapidly progressive pain and limping; the radiographic picture by the absence of osteophytosis. The pathology of rapid progression is subdivided into primary and secondary. Several hypotheses of the pathogenesis are discussed. These are related to mechanical overloading factors, local cortisone therapy, anoxia, synovitis. Differential diagnosis is with subacute septic arthritis, monarticular rheumatoid arthritis, and idiopathic osteonecrosis of the femoral head. Prosthetic replacement is the only treatment indicated and the long-term results do not differ from those obtained in prosthetic replacement for the more common type of osteoarthritis.
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PMID:Rapidly progressive osteoarthritis of the hip. 345 17

Sonography was successfully used to diagnose an effusion in the hips of three adults with septic arthritis and four with aseptic synovitis. The effusions were confirmed by aspiration. All the patients had markedly increased intracapsular pressure which, in the extended position, exceeded the systolic blood pressure and could well compromise the blood supply to the head of femur. Aspiration reduced pain and intracapsular pressure, as did flexion of the hip to 45 degrees.
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PMID:Sonography and joint pressure in synovitis of the adult hip. 354 29

The only aim of this retrospective study of 35 patients who had undergone resection of shoulder is to report overall results of this well established operation. Although no result could be rated as excellent, those in one half of the patients were evaluated as good and in one quarter as acceptable. The shoulder can be used in two-thirds of cases and of major importance is that pain is absent in two-thirds and tolerable in 80% of cases. In addition to cases of septic arthritis and poorly tolerated recurrent luxations, this operation is indicated for elderly patients with a fracture-luxation or compound fracture of upper end of humerus. However, the operation requires very strict conditions and re-attachment of the cap of rotator muscles. Resection of shoulder should therefore conserve a place in the therapeutic arsenal of shoulder disorders.
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PMID:[Arthroplastic resection of the shoulder. Results and indications apropos of 35 cases]. 355 14

Early detection of an inflammatory process involving bone and joints is very important in children with extremity pain. We reviewed the efficacy and pitfalls of three-phase bone scans in 100 consecutive children with acute extremity pain. Sixty-one of the subjects showed abnormalities on bone scans. The sensitivity and specificity of three-phase bone scans for acute osteomyelitis were 84% and 97%, respectively. Sensitivity and specificity for both acute septic joint and cellulitis were 93% and 100%, respectively. Pitfalls in interpretation of three-phase bone scans include simulation of infection by fracture and obscuration of osteomyelitis by septic arthritis, prior antibiotic treatment, and the occasional "cold" defect due to ischemia.
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PMID:Scintigraphic evaluation of extremity pain in children: its efficacy and pitfalls. 387 40

Acute leukemia of childhood may present with various clinical manifestations that mimic orthopaedic conditions. The osseous radiographic abnormalities of this disease, although well described in the literature, are not pathognomonic, and certain changes may not be as frequent as was previously thought. In a retrospective study, we reviewed the cases of 107 patients, less than eighteen years old, who had been seen at the Winnipeg Children's Hospital. The mean follow-up was 4.6 years for the fifty-eight patients who were still alive and 2.0 years for the forty-nine non-survivors. In twenty-two (20.6 per cent) of the patients, the presenting complaints were pain in the extremities, back pain, osteomyelitis, septic arthritis, or fracture. The radiographic abnormalities, which were present in forty-seven (43.9 per cent) of the children at the time of diagnosis, were osteopenia, lytic lesions, metaphyseal bands, periosteal new bone, and sclerotic lesions. Since the initial symptoms of leukemia commonly involve the musculoskeletal system, a high index of suspicion must be maintained by orthopaedic surgeons.
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PMID:Orthopaedic manifestations of leukemia in children. 395 74

Four patients whose rheumatoid arthritis (RA) was complicated by staphylococcal arthritis were identified. All patients had active, long-standing disease with destructive changes. Affected joints included hip (two patients), knee (one patient), and shoulder (one patient). Pain and loss of motion in the affected joint were prominent, but toxic features of pyogenic infections--hectic fever, chills, sweats, local warmth, or erythema--were conspicuously absent. Two patients had moderate fever and three patients had mild leukocytosis. No patient was leukopenic. When present, fever was attributed to infected decubiti or urinary tract infection and treated with antibiotics. Therapy with corticosteroids and nonsteroidal antiinflammatory drugs (NSAIDs) probably masked symptoms and delayed the correct diagnosis. Purulent synovial effusions were discovered serendipitously--during arthrography (knee), attempted Girdlestone procedure (hip), and aspiration prior to steroid injection (shoulder). Sepsis was included in the preoperative diagnoses only once (hip). Prior instrumentation (aspiration or injection) of the affected joint was not a feature in any patients, although one patient had undergone insertion of a knee prosthesis one year prior to sepsis. Infectious organisms were Staphylococcus aureus in three patients and Staphylococcus epidermidis in one. Severe sequelae ensued in three of four patients: death from recurrent sepsis (one patient), loss of prosthesis leading to knee arthrodesis (one patient), and protracted sepsis with additional pyarthrosis (one patient). The only patient to regain preseptic joint function (shoulder) had not been on long-standing corticosteroids. Pyarthrosis must be considered in RA patients with unusually painful or stiff joints even in the absence of toxic symptoms.
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PMID:Unrecognized staphylococcal pyarthrosis with rheumatoid arthritis. 408 87

The Girdlestone procedure was performed in 36 cases of septic arthritis of the hip, most of which arose following operation. In 21 instances, the greater trochanter was inserted into the acetabulum and the hips were fixed by external fixators. In 15 instances a standard operation was performed followed by traction. The results were better after simple procedures; there was less pain and more mobility but the hip was more unstable. It is concluded that the simple procedure is preferable especially when it is planned to perform a further arthroplasty later.
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PMID:[Comparative results of hip resection and coaptation for septic arthritis. Apropos of 36 cases]. 622 62

Since 1970, when the concept of continuous passive motion (CPM) was originated by one of the authors (R.B.S.), he and a succession of his research fellows have investigated its biological effects on the healing and regeneration of articular tissues in a wide variety of experimental models in rabbits. From this basic research he concluded that CPM is well tolerated, seems to be painless, stimulates the healing and regeneration of articular tissues, prevents joint stiffness, and permits the normal healing of arthrotomy incisions. Beginning in 1975, one of the authors (H.W.H.), and in 1978, the remaining authors, (from two additional Canadian cities) applied the knowledge from the basic research on CPM to the orthopaedic care of human patients. The CPM devices for humans (CPM Mobilimbs), which have been designed in collaboration with University of Toronto engineers, include, to date, devices for the ankle-knee-hip, the elbow, and the finger. Indications for CPM in patients have been the immediate postoperative management following such operative procedures as open reduction and internal fixation of fractures, arthrotomy and arthrolysis for post-traumatic arthritis, synovectomy, surgical drainage for septic arthritis, release of extraarticular contractures, metaphyseal osteotomies, total joint replacement, and ligamentous reconstruction. The case reports of nine selected patients are presented as examples of the clinical application of CPM. These patients have been relatively free of pain, have maintained the increased motion gained at operation, and have accepted the application of CPM well. There have been no complications of CPM; the operative wounds have healed well and the period of hospitalization has not been prolonged. The authors believe that the clinical application of CPM is feasible and that the clinical and radiographic results of CPM in these patients are encouraging. Long-term, prospective clinical investigations (including control patients in whom CPM is not used) will be required to assess the efficacy of CPM in relation to the various stated indications.
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PMID:Clinical application of basic research on continuous passive motion for disorders and injuries of synovial joints: a preliminary report of a feasibility study. 648 15

Rheumatic pain is usually generalized, but in a variety of conditions it may present as localized and often remain so. These conditions include palindromic rheumatism, osteoarthritis, gout or pseudogout, seronegative spondyloarthropathy, septic arthritis, tendinitis and bursitis, radiculopathy and nerve entrapment, nodular growth, and tendon enlargement. When the presenting feature is focal pain in muscles, joints, or fibrous tissue, the differential diagnosis should include these considerations.
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PMID:Localized rheumatologic diseases. Common diagnostic challenges. 660 May 15

A new nuclear scanning technique was found more specific for bone, joint, and soft tissue infections than any previously described scanning technique. The leukocyte scan, whereby a patient's own cells are labeled with a radioactive tagging agent (111In oxine), can distinguish an active infectious process from other pain-inducing conditions. Ninety-seven 111In labeled autologous leukocyte scans were performed in 88 patients. The findings in 17 of 40 patients scanned for possible acute osteomyelitis, six of nine for suspected septic arthritis, and six for possible soft tissue infections, were positive. Subsequent clinical courses verified the infectious nature of these processes in all patients. Patients who had chronic osteomyelitis (14), bony metastases (four patients), heterotopic ossification (three), and degenerative arthritis (two) demonstrated negative findings. Of the seven patients scanned for acute long-bone fractures, one demonstrated positive findings. Nine scans demonstrated positive findings without determined causes. The leukocyte scan is a useful addition to the diagnostic tools of the orthopedic surgeon.
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PMID:The white blood cell scan in orthopedics. 680 87


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