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

55 patients with 60 shoulders painful at rest, and with limitation of all ranges of movement, were treated with multiple injections of methylprednisolone acetate into the subacromial space and glenohumeral joint cavity. Pain was abolished in 80%, two weeks after starting therapy and 95% were pain-free four weeks after the first injection. Maximum functional recovery (at least 150 degrees abduction, 80 degrees internal rotation, and 45 degrees external rotation), was achieved in 90% of patients eight weeks after starting treatment. It is suggested that the "frozen" shoulder--i.e., pain-free shoulder with severe limitation of all movement--is the end result of a neglected painful shoulder and it is essential that painful shoulders be treated as early as possible if normal function is to be preserved.
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PMID:Management of painful shoulder. 5 12

A retrospective study shows several factors that influence the ultimate prognosis of fracture-dislocations of the hip. The magnitude of the initial injury worsens the prognosis as far as functional recovery and residual pain are concerned. The most difficult cases are those with anterior and posterior fractures of the acetabulum. The quality of reduction is often imperfect and the techniques of surgical repair are very difficult and time consuming. Provided there is no associated lesion of the sciatic nerve, the more simple fracture (transverse and posterior) gives better operation results. Reduction is often entirely successful if the surgical technique is adequate. Despite proper treatment, some patients develop aseptic necrosis of the femoral head and are left with most severe sequela.
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PMID:[Therapeutic difficulties encountered in the treatment of fractures of the acetabulum. Retrospective study of 44 cases of osteosynthesis of the acetabulum]. 42 84

Total replacement of the knee and of a long segment of the femur or tibia provided functional recovery of the knee joint in thirteen patients in whom the length of the bone replaced ranged from seventy-five to 150 millimeters. Nine patients had benign bone tumors, three had malignant lesions, and one patient had salvage of a failed total knee arthroplasty, associated with loss of bone structure. After follow-up of two years or more, all patients had a stable extremity, excellent relief of pain, and a useful range of motion, although one patient required revision for loosening.
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PMID:Prosthetic replacement of the knee and a large segment of the femur or tibia. 47 35

Twenty cases of patellectomy for fracture and 14 cases of patellectomy for chondromalacia evaluated for postoperative strength, endurance, pain and functional complaints, revealed satisfactory results in 85% of the fracture group and 79% of the chondromalacia group. Some quadriceps weakness was usually present, but quadriceps strengthening overcame the loss of mechanical efficiency caused by patellectomy. A vigorous rehabilitation program should be followed for at least one year after surgery to secure the fullest recovery of function.
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PMID:Function after patellectomy. 67 37

The authors review the literature and report on the treatment of metastatic pathological fractures, on the basis of their own experience of 51 operations. They review the radiological and pathological aspects of the lesions, and the methods of investigation. They stress the need for close collaboration between oncologists, radiologists and orthopedic surgeons, and emphasize the role of surgical treatment in the restoration of function and the relief of pain, by stable synthesis of the affected part. The methods employed are those used in traumatology, together with arthroprosthetic replacement. The importance of ensuring a stable synthesis, for the patients' limited life expectancy, justifies the use of acrylic cement, which often establishes continuity that otherwise would not be attainable. The indications for operation are not related to prolonging life but only to improvement in the quality of remaining life as measured by absence of pain and recovery of function. The results should be assessed primarily from the patient's point of view, the aim being to restore his mode of living before the fracture occurred. This has psychological as well as functional value.
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PMID:Pathological fractures due to metastases. 78 86

The incidence and prognostic significance of fractures of acrylic cement related to the stem of a femoral head prosthesis in total hip replacement are examined. These fractures are demonstrated when the cement has been rendered radio-opaque by the addition of barium sulphate. One and a half percent of the radiographs of 6,649 patients showed these fractures, which were sometimes associated with subsidence of the prosthesis. Fracture of the cement was usually evident at the six-month post-operative review, if it occurred at all. This radiological complication was devoid of symptoms in the majority of cases and tended to occur in patients with excellent functional recovery. In a minority of patients pain in the thigh during the first six months seemed likely to be explained by this fracture. Slight subsidence of the prosthesis in the cement bed appeared to result in a new and final position of stability. The prognosis was very good; only when separation of the fracture exceeded about 4 millimetres was the prognosis doubtful, in which case a chronic deep infection might be suspected. Possible mechanical and structural causes of fracture of the cement are discussed.
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PMID:A radiological study of fractures of acrylic cement in relation to the stem of a femoral head prosthesis. 115 41

A prospective study of randomized analysis treatment of 50 cases of frozen shoulder was carried out in 3 Swiss medical centres. Three separate aetiological groups were studied: post-traumatic (40%), neurological (14%) and idiopathic (46%). An increased radioisotope bone scan (99 mTc diphosphonate) was found in 96% of cases, regardless of aetiology. The so-called idiopathic frozen shoulder showed a scapulo-humeral increase in radioisotope uptake in several areas (in 82% of cases) without involvement of the ipsilateral carpus. Clinically, the neurological type was associated with a shoulder-hand syndrome with positive bone scan of the shoulder and the wrist in all cases. The post-traumatic type showed a diffuse (in 50% of the cases) or at several circumscribed areas (also in 50%) increase in radioisotope uptake in the shoulder. In 45% of the post-traumatic type, there was also a shoulder-hand syndrome with uptake in the wrist also. A physical treatment and early mobilization, associated with the administration of subcutaneous salmon calcitonin for 21 days (100 U Calcitonin Sandoz) had a statistically significant increased effect on pain compared to treatment with physiotherapy alone by patients with post-traumatic frozen shoulders (p < 0.02). There was no significant difference, however, in the speed of recovery of function between the two treatment groups. These observations strengthen the hypothesis that adhesive capsulitis behave like an algoneurodystrophic process.
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PMID:The frozen shoulder: diagnosis and treatment. Prospective study of 50 cases of adhesive capsulitis. 128 Oct 62

From July 1984 to June 1990, seven cases of spontaneous spinal epidural hematoma (SSEH) were studied. The common clinical pictures in these cases were rather typical with an apoplectic onset of severe spinal pain followed in hours (median: four hours) by signs of progressive spinal cord compression. All cases underwent myelography and computed tomographic (CT)-myelographic studies which showed in all cases a block by a posterior extradural lesion in the spinal column; however, the correct diagnosis of SSEH was made preoperatively in only three cases. The neurologic deficits prior to surgery were complete or nearly complete paraplegia in five cases and a high grade of paraparesis in the other two. The median interval of paralysis or paresis before surgery was 28 hours. The final outcome was evaluated by the grade of functional recovery, and the following were found to be the favorable factors: 1) incomplete preoperative neurologic deficits; 2) a slow course of clinical progression, especially a long duration of pain before the onset of paralysis; 3) no delay in surgery; 4) involvement of short spinal segments; and 5) lumbosacral lesions. Particular emphasis is made on early diagnosis and prompt surgery for a favorable outcome.
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PMID:Spontaneous spinal epidural hematoma: report of seven cases. 136 22

The article presents a retrospective study of a series of 213 patients treated for cervical spondylotic radiculopathy by anterior surgery. The follow-up period ranged from 2-8 years. The overall functional outcome of surgery showed a rate of improvement of 91.5% at late follow-up. In 8.5% of the patients there was no change, and none considered themselves as being worse than before surgery. The various selective symptoms and signs were analyzed. Improvement of root pain was obtained in 93.4% of the patients, of sensory deficits in 90.7% and of motor deficits in 81.8%. The rate of improvement for neck pain was 44.6%. In this series, mortality was zero and there was no peroperative neurological deterioration. 3.3% of the patients were re-operated at the previous level. A second operation at another level or levels was necessary in 5.2% of the patients. Early surgical treatment, and possibly the degree of neurological deficits, were the only factors found to influence overall functional recovery. In contrast to the overall results, and in spite of large individual variations, neither sensory nor motor deficits, nor root pain, were statistically influenced by degree of root deficits or duration of symptoms.
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PMID:[Cervical disk defects. Results of surgical treatment of cervical vertebral radiculopathy]. 155 53

Synovectomy, total arthroplasty and arthrodesis are the main surgical methods for rheumatoid arthritis. Although recurrent synovitis and radiological deterioration after synovectomy have been reported, the procedure can be an effective treatment if it is performed in the early stage where articular cartilage and bone are minimally damaged. Arthrodesis is indicated for severely destroyed joints. However, since loss of motion in the proximal joints often leads to severe disability, its indication is limited to the distal joints, such as the wrist and ankle. Total rthroplasty seems to be an ideal method because relief of pain and recovery of function can be obtained simultaneously. However, there are some complications, such as loosening and wear of the prosthesis. Solution of these would bring much benefit to the disabled rheumatoid arthritis patient.
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PMID:[Surgical treatment of rheumatoid arthritis]. 158 44


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