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

Intraarticular injections of hyaluronic acid have been advocated for treatment of symptomatic knee osteoarthritis. Appropriate indications and favorable patient response factors, such as radiographic disease severity and age, are not clearly defined for this therapy. The current review of 80 knees with symptomatic osteoarthritis treated with hyaluronic acid revealed that approximately 2/3 of treated knees received 2/3 relief of pain. Hyaluronic acid treatment is not appropriate for all patients with knee osteoarthritis. Overall, less than 50% of treated knees achieved satisfactory results, and only 35% reported increased activity. Twenty-two patients (28% of knees; 22 knees) underwent surgery within 7 months of their index injection, suggesting an inadequate response to treatment. The treatment is not without complication because 11 patients (15% of knees; 12 knees) experienced adverse reactions, including one case of septic arthritis. The authors recommend intraarticular hyaluronic acid only for patients with symptoms and significant surgical risk factors and for patients with mild radiographic disease in whom conservative treatment has failed (physical therapy, weight loss, nonsteroidal antiinflammatory medication, and intraarticular steroid injection). It is inadvisable to treat patients with a complete collapse of joint space or bone loss with intraarticular hyaluronic acid, given their poor clinical response.
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PMID:Efficacy of intraarticular hyaluronic acid injections in knee osteoarthritis. 1155 Aug 64

Fourteen children (average 9 years) with primary hematogenous osteomyelitis of the calcaneus are reported. Four were seen early and 10 late. Clinical presentation was dramatic, with fever, pain, swelling, and fluctuance around the foot and ankle. The diagnosis was missed initially in 8 cases because the patients were treated for septic arthritis of the ankle, cellulitis, and subcutaneous abscess. The 4 patients seen early healed well, with no complications. The 10 patients seen late had chronic osteomyelitis with growth arrest; shortening of the foot; limb length deficiency; fusion of subtalar, calcaneocuboid, and ankle joints; calcaneus and equinus deformity; avascular necrosis of the talus; and phalangeal loss. Hospital stay was prolonged in 4 patients. Total calcanectomy (3 patients) and talectomy (2 patients) with heel pad preservation were useful salvage procedures avoiding ablation of the limb in chronic cases.
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PMID:Hematogenous osteomyelitis of the calcaneus in children. 1167 46

Multiple complications of varicella have been described. Musculoskeletal complications (osteomyelitis, septic arthritis, and necrotizing fasciitis) as well as neurologic complications (ataxia, encephalitis, and transverse myelitis) are well-known. We describe the cases of 2 children, ages 18 months and 5 years, who were admitted recently to 2 pediatric hospitals in Montreal with a resolving varicella, abdominal and lumbar pain, and a refusal to walk and in whom a diagnosis of epidural abscess caused by group A streptococcus (GAS) was established. No previous case of epidural abscess caused by GAS in the context of varicella has been reported. Epidural abscesses are rare in pediatrics and are caused mainly by hematogenous spread of Staphylococcus aureus. The diagnosis in pediatrics is challenging because it is rare and does not present as classically as in adults. The prognosis is related to the presence of neurologic deficits before surgery and to the rapidity with which the diagnosis and the intervention are made. These cases highlight a new clinical association in children of epidural abscess caused by GAS and varicella. An early clinical diagnosis requires a high index of suspicion when back or abdominal pain with or without neurologic signs and symptoms occurs during or soon after varicella.
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PMID:Group a streptococcus spinal epidural abscess during varicella. 1177 82

Avascular osteonecrosis of the femoral head (AONFH) usually goes through the four stages described by Arlet and Ficat: normal radiographs, heterogeneity and sclerosis of the femoral head, subchondral fracture with an individualized sequestrum, and secondary osteoarthritis. Arlet and Ficat individualized a specific pattern of AONFH which they called ischemic hip disease, in which cartilage damage seen as concentric joint space loss precedes the bony alterations. Although radiological and pathological studies of ischemic hip disease have been published, no clinical data are available. We report the case of a 65-year-old man admitted for a 1-month history of severe hip symptoms with concentric joint space loss but no osteophytes. Laboratory tests and examination of fluid aspirated from the hip ruled out septic arthritis and inflammatory hip disease. Two magnetic resonance imaging (MRI) studies done 1 month apart showed diffuse edema involving not only the femoral head but also the neck and trochanter, as well as major synovial hypertrophy. This atypical MRI appearance prompted synovial membrane and pertrochanteric core biopsies, which showed reactive synovitis and stage IV osteonecrosis, respectively. The pain, disability, and joint space loss worsened. Total hip arthroplasty was performed 1 month after the biopsy. Histological examination of the femoral head showed diffuse necrosis; no evidence of another condition was found on histological sections of the entire synovial membrane. This case corroborates the hypotheses put forward by Lequesne that some cases of rapidly destructive hip osteoarthritis may be ascribable to ischemia.
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PMID:Can ischemic hip disease cause rapidly destructive hip osteoarthritis? A case report. 1185 62

Two cases of bacterial adductor myositis that presented as painful hips in boys aged 4 and 9 years are reported. Clinically, there was severe pain and a high pyrexia, a raised C-reactive protein and positive blood cultures but a negative hip ultrasound. Urgent magnetic resonance imaging demonstrated changes throughout the adductor muscles in keeping with bacterial myositis. Both boys settled with intravenous antibiotic therapy. We propose that magnetic resonance imaging is a valuable tool in the assessment of infection around the hip and should be indicated when other investigations have excluded a septic arthritis but the child remains unwell.
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PMID:Adductor myositis as a cause of childhood hip pain. 1248 78

Limping is a common and often challenging problem in children and adolescents. A limp is defined as asymetric deviation from a normal gait pattern. A systematic approach is necessary to determine the cause of the limp, so the radiologist should combine a thorough history, clinical information and pertinent radiologic testing. The possible differential diagnosis is extensive and includes many pathologies of the lower extremity and spine like trauma, infection, neoplasia, furthermore inflammatory, developmental and congenital disorders. In cases with knee or tight pain, an underlying hip condition should be considered. The childs age can narrow the possible differential diagnoses, because certain entities are age-related. Despite this wide bandwidth of entities, potential catastrophic causes like septic arthritis and malignant disease should be excluded first. Plain radiographs are often diagnostic. The choice of further imaging modalities like ultrasonography, magnetic resonance imaging, computed tomography and bone scan should be guided by the history and clinical findings.
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PMID:[The limping child. Differential radiologic diagnosis of acute gait disorder in childhood and adolescence]. 1196 36

Septic arthritis due to Streptococcus Pneumoniae appears to be relatively uncommon. Single- or clustered-case histories constitute the majority of reports on pneumococcal septic arthritis. A 70-year-old man presented with a 7-day history of pain, erythema and swelling of the left shoulder. Physical examination of the left shoulder revealed a warm, swollen, erythematous, and markedly tender to light palpation. The patient was unable to elevate his arm more than 30 degrees without pain. Arthrocentesis performed on admission produced 30 cc of grossly purulent fluid whose culture demonstrated S. Pneumoniae. The septic arthritis was treated with intravenous vancomycin and imipenem. The antibiotics were substituted when the sensitivities were known with oral ciprofloxacin and rifampycin to complete 8 weeks' total treatment. On follow-up examination 1 year later, the patient has remained afebrile and asymptomatic without evidence of increasing joint effusion or acute joint inflammation. Pneumococcal arthritis is classically described as a painful monoarticular arthritis complicating an active pneumococcal infection, generally a primary pulmonary infection. Pneumococcal arthritis appears to be predominantly a disease affecting the elderly. Clinical presentation ranges from septicemia to indolent infection with few systemic symptoms. With adequate antibiotic therapy and aspiration or drainage of the joint, the prognosis for return of normal joint function appears to be excellent. Although pneumococcal organisms are not likely causes, this bacteria should certainly be considered as a possible cause of arthritis or prosthetic infection.
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PMID:Pneumococcal septic arthritis of the shoulder. Case report and literature review. 1203 36

A 4-year-old boy presented with fever, septic arthritis, and persistent neutropenia. Bone marrow biopsy revealed no evidence of neoplasia. Additional history disclosed that the patient had been given metamizole for pain before onset of his illness. Metamizole, a nonsteroidal antiinflammatory agent, is prohibited in the United States because of the risk of agranulocytosis but is widely used in Mexico and other countries. The increasing number of Latinos in the United States and the extensive cross-border transfer of medicines raise concerns that metamizole use and associated complications may become more frequent. After identification of the index patient, additional inquiry revealed that the patient's mother was hospitalized previously for overwhelming sepsis associated with metamizole use. These cases prompted an investigation of metamizole use in an urban pediatric clinic, which revealed that 35% of Spanish-speaking Latino families had used metamizole; 25% of these families had purchased the medication in the United States. We conclude that metamizole use is common and may be underrecognized in immigrant Latino patients. Physicians in the United States, especially those who practice primary care, hematology/oncology, and infectious diseases, must be aware of the availability and use of metamizole in specific patient populations and its potential for harmful side effects.
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PMID:Metamizole use by Latino immigrants: a common and potentially harmful home remedy. 1204 92

Between 1995 and 2000, 29 patients who had excessive pain or limitation of motion after a shoulder arthroplasty underwent arthroscopy. Preoperative diagnoses of impingement syndrome in 10 patients (treated by arthroscopic subacromial decompression), large rotator cuff tear in 1, loose bodies in 1, unstable cuff arthropathy in 1, and septic arthritis in another were confirmed at arthroscopy. Of the 15 patients without a preoperative diagnosis, 7 had postarthroplasty capsular fibrosis, with 6 undergoing arthroscopic capsular release. A malpositioned glenoid component was found in 1 patient. Loose or worn components were found in 4 of the shoulders, impingement with a small partial-thickness cuff tear was identified in 1, a florid synovitis was present in another, and in 1 no abnormality could be found. The procedures were often hindered by limited access and reflection from the prosthesis. Arthroscopy after shoulder arthroplasty is useful for the diagnosis and treatment of pain and loss of motion in selected patients but can be technically challenging.
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PMID:The role of arthroscopy for the problem shoulder arthroplasty. 1207 Apr 94

All 302 children treated at the rheumatology clinic of a children's hospital in Santo Domingo between September 1985 and September 1986 were included in a prospective study of the causes of joint pain in children. The 137 girls and 165 boys were grouped in five categories according to the underlying condition. The largest group, reactive arthritic conditions, affected 78 patients (25.9%). 72 of the 78 had rheumatic fever. The second largest category, hematological processes, affected 75 patients (22.6%); 40 of the 75 patients had sickle cell disease, 25 had hemophilia or other conditions, and 8 had neoplasias. 63 patients (20.8%) had infectious processes, including 33 with septic arthritis, 17 with abscesses and cellulitis, 7 with arthritis and osteomyelitis, and 6 with osteomyelitis. Prostration and pain on movement were more pronounced in patients with septic arthritis. 42 children (12.6%) had collagen vascular disease. 32 had juvenile rheumatoid arthritis, 4 had lupus, 3 vasculitis, 2 dermatomyositis, and 1 each had scleroderma and erythum nodosum. 25 patients (8.2%) had a miscellaneous array of other conditions. Sickle cell disease or neoplasia were most likely when anemia was also present. Extreme prostration and signs of inflammation suggested infectious processes. The small joints were primarily affected in juvenile rheumatoid arthritis and sickle cell disease.
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PMID:[Causes of joint pain in children]. 1229 May 50


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