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

Seven cases of pyogenic arthritis of the sacro-iliac joint in children were observed between 1968 and 1981. Their analysis is discussed with the conclusions of the too much rare publications in the recent literature. Taking in to account the anatomic particularities the necessity of very precise roentgenographic technics in order to assess the sacro-iliac joint, especially in children because of incomplete ossification, the authors replace this pathology into the osteomyelitis in children. From the clinical aspects of the disease, with its typically localized pain, and its acute clinical and biological septicemic syndrome, the authors attempt to demonstrate that the classical idea of a delayed diagnosis, is not absolute. Even in this particular localization, an early "up to date" diagnosis is possible allowing rapid treatment with efficient antibiotherapy directed towards the responsible germ after their isolation (especially staphylococcus aureus). Indubitable progress has been gained with systematic radio-nuclide bone scanning in emergency.
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PMID:[Pyogenic sacroiliac arthritis in children. Analysis and commentary apropos of 7 cases]. 685 Sep 70

Six episodes of septic arthritis involving 5 patients and eleven joints were documented in the last 7 years in a population receiving 450 patient-years of dialysis treatment. The same micro-organisms were often cultured simultaneously from the joint, blood and/or arteriovenous fistula, suggesting hematogenous spread. A tendency toward multiarticular involvement was also observed. Early diagnosis is mandatory to avoid severe joint damage. Since such patients have other potential causes of arthritis and periarticular pain not due to infection, it is important to culture the joint fluid promptly whenever the possibility of infection exists.
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PMID:Septic arthritis in hemodialyzed patients. 698 72

Degenerative arthrosis is perhaps the most common debilitating disease of performance horses. Treatment should be based upon a knowledge of the anatomy and physiology of normal joints and upon an understanding of the processes of degeneration and repair. These topics are briefly reviewed. Although rest is probably, the most beneficial therapy, physical and pharmaceutical treatments are often employed in an effort to speed recovery. The effects and relative benefits of intrasynovial injections of corticosteroids, hyaluronica cid, and Arteparon are considered in detail. Although local corticosteroid therapy is inexpensive and is effective in reducing lameness caused by degenerative joint disease, it is rarely indicated. Septic arthritis and "steroid arthropathy" are two serious sequelae. Whereas the incidence of the former may be avoided through careful technique, the latter effect is inherent in the action of the drug. The accelerated rate of joint destruction observed in steroid arthropathy is due to suppression of chondrocyte metabolism and thus the processes of cartilage maintenance and repair. Hyaluronic acid is present in the synovial fluid and within the matrix of cartilage. The commercial preparation is no approved for use in the United States, but it is commonly obtained from other countries. Although hyaluronate apparently does not function in the lubrication of cartilage surfaces, it may improve lubrication of soft tissues thus decreasing resistance to joint movement and lessening pain. Reports substantiate the effectiveness of hyaluronic acid in treating early cases of degenerative arthrosis despite the fact that the drug does not significantly promote cartilage healing. Arteparon, a polysulfated glycosaminoglycan, has been used in Europe for two decades in the treatment of degeneration joint disease and is currently being tested in this country. The drug is deposited within diseased cartilage and improves the functional properties of the cartilage as well as stimulates cartilage metabolism.
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PMID:Corticosteroid and hyaluronic acid treatments in equine degenerative joint disease. A review. 703 40

In 22 drug addicts, the clinical diagnosis of osteomyelitis and/or septic arthritis was suspected because of symptoms of sepsis and pain in various locations. All patients underwent bone scintigraphy with 17-20 mCi of 99mTc labeling either pyrophosphate or methylene diphosphonate. Whole body and spot scans located the area of disease in most patients. This permitted biopsy of the affected area when the pathogen recurs. One of the two patients whose scintigrams were normal was on adequate treatment before the bone scintigram and the other was on oxacillin. Radiographs of the affected areas were normal, which indicates bone scintigraphy should be preferred to radiography in the early diagnosis of osseous infections.
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PMID:Bone scintigraphy in drug addiction. 720 20

Thirteen patients suffering from rheumatoid arthritis had 19 stress fractures of the tibia or fibula. These patients characteristically presented with sudden, severe, unexplained pain with localised tenderness just below the knee or above the ankle. In seven patients examination of the adjacent joint indicated a flare-up of disease activity or a pyogenic arthritis. In six patients the diagnosis was delayed by the late appearance of callus in minute fractures. All patients had rheumatoid deformities of the ipsilateral lower limb: valgus deformities of the knee and subtalar joints occurred most frequently. All patients had osteoporosis; all except two had received steroid treatment and five had abnormalities of calcium metabolism. We suggest that deformities of the knee and ankle predispose patients with rheumatoid arthritis and osteoporosis to stress fractures of the tibia and fibula.
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PMID:Stress fractures of the lower limb in patients with rheumatoid arthritis. 721 49

Septic arthritis of the hip is uncommon in the school-age child. Presenting signs may be subtle and consequently may delay the diagnosis. This case report deals with a ten-year-old child who presented with an eight-day history of pain in the inner thigh associated with decreased range of motion of her hip, fever, and an inability to bear weight. Radiographic findings included demineralization of the femoral head. Initial laboratory findings showed leukocytosis and a sharply elevated Westergren sedimentation rate. Joint fluid Gram stain showed gram-positive cocci. Blood culture and joint culture grew Staphylococcus aureus. Therapy involved immediate operative drainage of purulent joint fluid, immobilization of the joint, and intravenous antibiotic therapy. Initial antibiotics were chosen based on synovial fluid Gram stain and the age of the patient. During therapy with antistaphylococcal penicillin, the patient developed a drug induced neutropenia.
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PMID:Septic hip in a child. 721 1

Although synovial cysts are most commonly associated with rheumatoid arthritis and osteoarthritis, they may occur in many other conditions. The clinical manifestations of these cysts are numerous and may result from pressure, dissection or acute rupture. Vascular phenomena occur when popliteal cysts compress vessels, and result in venous stasis with subsequent lower extremity edema or thrombophlebitis. Rarely, popliteal cysts may cause arterial compromise with intermittent claudication. Neurological sequelae include pain, paresthesia, sensory loss, and muscle weakness or atrophy. When synovial cysts occur as mass lesions they may mimic popliteal aneurysms or hematomas, adenopathy, tumors or even inguinal hernias. Cutaneous joint fistulas, septic arthritis or osteomyelitis, and spinal cord and bladder compression are examples of other infrequent complications. Awareness of the heterogeneous manifestations of synovial cysts may enable clinicians to avoid unnecessary diagnostic studies and delay in appropriate management. Arthrography remains the definitive diagnostic procedure of choice, although ultrasound testing may be useful.
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PMID:Clinical manifestations of synovial cysts. 723

This study was aimed at assessing the MR patterns of transient osteoporosis of the hip and, consequently, the role of MRI in the diagnosis and follow-up of this condition. Even though this condition was originally observed in pregnant women, young or middle-aged men are most frequently affected. There is a spontaneous onset of pain, usually progressing over several weeks. The patients have no risk factors for osteonecrosis; they may have a history of minor trauma and there is a possible relationship to the third trimester of pregnancy. Laboratory values are negative. Pain may be severe enough to cause the patient to limp and to impair joint function. The possible causes of transient osteoporosis have been debated by many authors and include trauma, synovitis, neurovascular dysfunction and transient or reversible ischemia. Transient osteoporosis is a self-limiting disease which does not require surgical treatment. The differential diagnosis of transient osteoporosis of the hip is very important because this condition may simulate cancer, septic arthritis, osteomyelitis or avascular necrosis. We report the initial and follow-up features of transient osteoporosis of the hip on the MR images of 6 patients (M/F = 5/1; age: 37-49 years, mean: 41.8 years). The right side was involved in 3 patients, the left side in 2 patients. The patient with bilateral transient osteoporosis was a woman in the 3rd trimester of pregnancy. In all patients, MRI was performed with an 0.5 T MR unit. The MR changes in our 6 patients were rather uniform and included heterogeneous decrease in the signal intensity of the affected bone marrow on T1-weighted images and increased signal intensity on T2-weighted and STIR images, with no evidence of focal lesions. This pattern is known as the "bone marrow edema" (BME) pattern. All the patients received conservative treatment. The clinical symptoms and the MR abnormalities regressed completely within 6-10 months, with no late sequelae. To conclude, this follow-up MR study demonstrates the transient, reversible character of transient osteoporosis of the hip. Until the natural history of the BME pattern is better understood, we suggest a conservative management of this condition, especially in the patients with no risk factors for osteonecrosis. Radiographic and MR follow-up is recommended.
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PMID:[Transient osteoporosis of the hip in magnetic resonance imaging]. 750 20

Thirty-four children under the age of 3 years with septic arthritis presented to Mukinge Hospital between 1 January 1992 and 31 March 1993. Twenty-six of these cultured Salmonella spp. The salmonella group comprised 17 males and 9 females with an average age of 10 months. Most patients were anaemic and all were under 50th centile for weight. The commonest presentation was swelling, pyrexia and non-use of the limb. The mean white cell count (WBC) was 14,000/mm3 and the mean erythrocyte sedimentation rate (ESR) was 15.8 mm/h, but in many cases both the WBC and ESR were normal. All patients were treated with drainage and antibiotics. All made a good recovery and were discharged pain free, apyrexial and using the affected joint. One patient was readmitted because of recurrent infection. Nine patients reviewed after 1 month had continued good function. We consider that malnutrition and local trauma are predisposing factors to the development of salmonella septic arthritis in a population where salmonella is endemic.
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PMID:Salmonella septic arthritis in Zambian children. 750 24

Toxic synovitis, an acute inflammatory condition of the hip, is the most common cause of limp and acute pain of the hip in children under 10 years of age. Usually, the synovitis and joint effusion are present unilaterally. The etiology of the condition is unknown, although in a few cases a recent history of an upper respiratory tract infection may be present. The child with toxic synovitis may complain of a limp and pain in the hip, the anteromedial aspect of the thigh, and the knee. The white cell count and erythrocyte sedimentation rate may be slightly elevated, as is the body temperature. Ultrasound is recommended as the primary imaging tool in the diagnosis and treatment of toxic synovitis. Septic arthritis, Perthes disease, and osteomyelitis are a few of the differential diagnoses that the practitioner should consider. Most cases can be managed with bed rest at home and administration of a nonsteroidal anti-inflammatory medication. Follow-up care should occur 2 weeks after diagnosis to ensure there is no recurrence of the joint effusion or progression to avascular necrosis. Radiographs of the hip should be repeated at 1 month and 3 months to complete the patient follow-up.
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PMID:Toxic synovitis of the hip in children. 759 30


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