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

Six patients with osteonecrosis of the medial femoral condyle were seen during a 3 1/2-year period in a rheumatology unit. This condition, which may not be rare, is characterized by the sudden onset of pain in the knee of elderly people (usually women) without significant trauma. Physical signs include effusion and tenderness at the medial margin of the knee joint. Radiographic changes may not be evident for weeks or even months. The later appearances are characteristic and the site of the lesion is remarkably constant.
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PMID:Spontaneous osteonecrosis of the medial femoral condyle. 97 18

Inability to accurately diagnose infection in granulocytopenic patients is a major cause for morbidity and mortality, and prompted this study of 344 infections (pharyngitis, skin infection, pneumonia, anorectal infection, and urinary tract infection) in a select group of cancer patients. Strikingly similar alterations in clinical presentation were found for all infections that developed in profoundly granulocytopenic patients. Physical findings of exudate, fluctuation, ulceration or fissure, local heat, swelling, and regional adenopathy were all less prevalent in the granulocytopenic patient, while fever was much more common. Only erythema and local pain or tenderness were present in practically all patients regardless of site of infection or level of granulocyte count. A better understanding of how granulocytopenia affects the presentation of infection should lead to earlier and more accurate diagnosis and potentially to more successful therapy.
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PMID:Clinical presentation of infection in granulocytopenic patients. 105 68

The case records, radiographs, and nuclear bone scans of 58 horses with stress reactions or stress fractures of the proximal palmar aspect of the third metacarpal bone (MC3) were reviewed. There were 47 Standardbreds, 4 Quarter Horses, 3 Thoroughbreds, 2 Arabians, 1 Oldenburg, and 1 Pony of America. Fifty-six of the horses were racehorses or performance horses. The mean and median ages of affected horses were 4 and 3 years, respectively. Lameness ranged from mild to severe. Physical findings were usually subtle and included signs of pain on deep palpation of the proximal palmar aspect of MC3 and slight effusion of the middle carpal joint in some cases. Lameness was commonly improved by high palmar and palmar metacarpal nerve blocks or anesthesia of the middle carpal joint. Fifty-three horses had higher than normal radiopharmaceutical uptake in the proximal palmar aspect of MC3 in the left or right limb. The other 5 horses had higher than normal radiopharmaceutical uptake bilaterally. Fifty-six of the 63 limbs with abnormal bone scans also had abnormal radiographs. Treatment consisted of a variable period of rest (1 to 6 months). Healing was best assessed by follow-up bone scans. Of the 45 horses for which follow-up information was adequate, 29 (64%) returned to their previous level of performance.
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PMID:Stress reactions and stress fractures of the proximal palmar aspect of the third metacarpal bone in horses: 58 cases (1980-1990). 148 18

Presenting symptoms, physical findings and treatment were reviewed in 70 patients over 65 years old who underwent oesophago-gastro-duodenoscopy in the Royal Victoria Hospital, Belfast, during an 18-month period. Most frequent indications for the procedure were epigastric pain, retrosternal pain or haematemesis. Physical signs were present in only 54%. Abnormal endoscopic findings were detected in 97%. The majority of patients responded to subsequent treatment. It was not possible to identify clinical features associated with major gastrointestinal pathology, which aided selection of those subgroups of elderly patients who would most benefit from endoscopy.
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PMID:Outcome and benefits of upper gastrointestinal endoscopy in the elderly. 260 71

Nineteen cases of rupture of the pectoralis major muscle are presented. In 16 cases the rupture was repaired; in 3 cases repair was not performed. Physical findings and surgical technique are described and the anatomy of the insertion of the pectoralis major muscle is reviewed. Nine of the patients in this series sustained their injury while performing the bench press. The majority of the remaining patients were also involved in sports when injury occurred. Eleven of the ruptures were in the nondominant arm and eight in the dominant arm. All of the patients complained of weakness, pain, and deformity, with weakness being the major complaint. Following surgery and rehabilitation, all 16 patients who underwent repair were relieved of pain. The deformity was corrected in all 16 patients, although 2 patients who had a 5 year interval from repair to rupture did not achieve a completely normal contour. Thirteen of the 16 patients reported a full return to strength. The others had significant improvements. Ruptures of the pectoralis major muscle are uncommon, but not rare. Ruptures occurring under tension tear at or near the insertion onto the humerus, as in all 19 cases in this series. Distal ruptures are usually complete, despite physical signs that may be misleading. Distal tears are reparable, even after a delay to treatment. After surgical repair, the majority of patients may expect relief of pain, return of strength and normal contour, and maintenance of range of motion.
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PMID:Rupture of the pectoralis major muscle. 278 27

Physical signs, medical history and social factors were analyzed and evaluated in 52 patients (17 women and 35 men) with chronic low back pain, in order to determine if any factors were predictive for return to work after rehabilitation. Factors discriminating between the working and sick-disabled groups were: Sex (only men returned to full time work), Duration of sick-leave (the older half of the study population exhibited a negative correlation between time on sick-leave and frequency of return to work), Reported need for analgesics (the working group reported less need of analgesics), Pain in the cervical and dorsal areas of the spine as well as in the lumbar region (less frequent in the working group), The patients' attitude to his own ADL-capacity (those who returned to full-time work were more positive), After work fatigue (less frequent in the working group).
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PMID:Clinical and social factors in rehabilitation of patients with chronic low back pain. 294 Jun 78

Dislocation of the ankle without accompanying malleolar fracture has been regarded as a rare lesion, with few cases reported in the literature. To date, there has been no precedent for accurate descriptions of the mechanisms, optimum treatment, and long-term prognosis of this injury. Our goal was to evaluate these variables by a retrospective review of cases from our institution. We identified eight patients who had sustained ankle dislocation without fracture and were treated at the University of Iowa during the period 1958 to 1986. We interviewed and examined each patient and obtained ankle radiographs at an average of 11.5 years postinjury (range 2 to 24 years). After analyzing our cases and other reported in the literature, we have found that this injury is most common in young people (average age 31 years, range 10 to 73 years) and males (72%), and occurs most frequently in falls, motor vehicle accidents, and sports (86%). Medial displacement occurs most frequently (27%). Disruption of the mortise occurs variably. The most likely mechanism appears to be anterior or posterior extrusion of the talus from the mortise secondary to a force applied to the plantarflexed foot. Final displacement is then determined by the position of the foot and the direction of the force applied. Physical findings are commensurate with the deformity. Neurovascular compromise is uncommon (10%). Closed reduction is almost invariably accomplished easily unless the deformity is accompanied by posterior tibiofibular dislocation. Optimum treatment appears to be immobilization in a short leg cast for 6 weeks with no weightbearing for the first 3 weeks. Long-term follow-up revealed the following. Results were all good to excellent considering the following variables: return to work and sports activities, pain, instability, swelling, and ankle and subtalar joint motion. No patient reported instability and all returned to work and sports participation. We noted mild pain and swelling that was not severe enough to require medication in 25% of patients. Range of motion was normal in all but four patients; none of these lacked more than 10 degrees of motion in any plane. Radiographic abnormalities consisted of minor ligamentous or capsular calcification in all patients, small osteophytes in four patients, and minimal joint space narrowing in one patient. No patient had normal radiographs.
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PMID:Ankle dislocation without fracture. 306 23

For normal development of the hip joint to occur, there must be a delicate, genetically determined balance between growth of the acetabular and triradiate cartilages and a well-centered femoral head. This balance may be profoundly affected by the intrauterine environment. Without treatment, it is uncertain how many dysplastic, unstable hips will retain their dysplastic features throughout life. The natural history of untreated complete dislocation varies considerably and is affected by societal considerations. There may be little, if any, functional disability in many cases. Significant roentgenographic degenerative disease and poor clinical results, however, may develop in completely dislocated hips with well developed false acetabulae. In unilateral cases, ipsilateral knee deformity and pain may develop. Congenital subluxations have a particularly poor long-term outcome. A significant percentage of these patients have roentgenographic degenerative joint disease and clinical disability. The age of symptom onset and roentgenographic degenerative joint disease is related to the amount of subluxation and dysplasia. The natural history of acetabular dysplasia in the absence of subluxation is difficult to predict. Physical signs may be absent, and the diagnosis only established with symptom onset or as an incidental roentgenographic finding. While degenerative joint disease may ensue, current roentgenographic parameters are not predictive.
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PMID:Natural history of congenital hip dislocation (CDH) and hip dysplasia. 331 82

A case of thenar numbness, with concomitant carpal tunnel syndrome is presented. Physical findings and the result of injection of a local anesthetic into two different sites of tenderness suggested coexistence of entrapment and/or compression of the palmar cutaneous branch of the median nerve and the main trunk of the median nerve at the carpal tunnel. At operation, constriction of the palmar cutaneous branch of the median nerve by the fascia of seemingly normal flexor digitorum superficialis was observed beneath the site of maximum tenderness. After decompression of this nerve, combined with carpal tunnel release, the patient lost all pain and numbness; there was no recurrence at 5 months follow-up.
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PMID:Entrapment neuropathy of the palmar cutaneous branch of the median nerve by the fascia of flexor digitorum superficialis. 341 65

Overuse injury (RSI) of the upper limb is a common and distinct clinical entity brought about by hard continuous use of the limb. Pain is felt in the muscles and joint ligaments whose biological tolerance has been exceeded; this tolerance varies individually and must be genetically determined. These structures are normally non-tender. Physical signs in overuse injury consist of tenderness in these injured structures. Such signs in the intrinsic muscles of the hand and ligaments of the wrist joint and carpometacarpal joint of the thumb are virtually diagnostic of overuse injury.
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PMID:Physical signs in the hand and wrist seen in the overuse injury syndrome of the upper limb. 346 70


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