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

Surgical radiolunate arthrodesis appears to be an appropriate procedure to stabilize ulnar translation of the carpus, to correct radial deviation of the wrist and consequently ulnar drift of the fingers and restore neutral orientation of the lunate when collapse occurs. From 1979 to 1988, radiolunate arthrodesis was performed on 21 unstable rheumatoid wrists with subluxation of the lunate (20 cases combined with an ulnar head resection and one case without). Average follow-up was 4 years and 1 month. Wrist collapse increased in 3 cases and remained stable in 6 cases (9 documented cases). When ulnar drift of the fingers is present (6 cases), the ulnar angulation of the third finger shows a 14-degree average improvement. Thirteen wrists were painfree, one presented a painful click, 4 patients were dissatisfied because of pain and recurrence of the disease. Three patients had died. Average ROM was 41 degrees in extension, 28 degrees in flexion, 8 degrees radial deviation and 23 degrees ulnar deviation. Grip, measureable in 9 wrists, showed improvement with an average range of 12,6 kg on right side and 9 kg on left side. Surgical procedure and complications are described.
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PMID:Radiolunate arthrodesis in rheumatoid wrist (21 cases). 171 54

Over the period 1982 to 1988, 31 consecutive patients at the Hand Surgery Unit of the Sheba Medical Centre were subjected to elbow joint arthrolysis to treat restriction of range of motion solely due to trauma. This retrospective study aims to evaluate the relative influence of the followings factors on functional outcome: sex, age, type of original injury and initial management, presence of para-articular ossification, delay between injury and arthrolysis, and the use of manipulation and a continuous passive motion device (CPM) following surgery. The range of motion was recorded prior to arthrolysis and after operation (excluding one patient who subsequently underwent arthrodesis for intractable pain). Follow-up averaged 15.3 months (+/- 5.4). In the 24 patients with extension deficit (greater than 20 degrees), the mean improvement was of 26.9 degrees (greater than 23.1 degrees); in the 21 patients with flexion deficit the mean improvement was of 21.2 degrees (greater than 18 degrees). The mean improvement for total range of motion in the series overall was of 35.2 degrees (+/- 23.8 degrees). 90% showed an improvement of at least 10 degrees and 30% attained normal ROM. All of these improvements in range were statistically highly significant (p less than 0.0001). None of the variables had predictive value with regard to improvement of flexion. With regard to improvement in extension, the only variable of value was the use of a continuous passive motion device following surgery; those patients subjected to CPM showed a mean improvement of 32.6 degrees (+/- 19.0 degrees), while those without averaged 12.8 degrees (+/- 27.5 degrees) (p less than 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Factors influencing elbow arthrolysis. 171 58

Complete knee dislocation is an uncommon but potentially devastating injury with a reported high rate of neurovascular injury. Treatment of this ligamentous injury is controversial. The operative (repair of all ligaments) and nonoperative management of ligament injuries appears to result in a stiff knee (decreased range of motion [ROM]), and/or a significant incidence of clinical instability and pain. We report our data on low-velocity knee dislocations and present a treatment plan of noninvasive assessment of the vascular status, a stabilizing procedure centered on posterior cruciate ligament reconstruction (PCL) and an aggressive rehabilitation program that can result in improved ROM, acceptable stability, and a more optimal functional outcome.
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PMID:Low-velocity knee dislocation. 174 65

The shoulder apparatus is of elegant structural design, affording great ROM with substantial power in many planes of movement. It is the underlying anatomic relationships that allow great mobility that also render the shoulder susceptible to injury. Injury in repetitive overhand activities is usually in the form of impingement, which may result from many factors, including multidirectional instability, anterior subluxation, and imbalanced force couple mechanisms, among others. Diagnosis requires a thorough history and physical examination. The impingement sign and test are among the most useful diagnostic maneuvers available. Rehabilitation is individualized, depending upon the cause of impingement, severity of injury, and response to therapy. Overuse syndromes mandate rest and control of inflammation through the use of ice, NSAIDs, and local injections of steroids followed by passive, active-assist, and active ROM; stretching; and mobilization exercises. As pain and inflammation subside, isometric or isotonic exercises are prescribed initially to strengthen the rotator cuff musculature and, therefore, the caudal glide mechanism. Subsequent strengthening exercises then are performed in other planes of movement to strengthen the remaining shoulder-complex muscles. The patient is then advanced to isokinetic training. Stretching is emphasized as an essential preparatory activity for all types of exercise. Maintaining contralateral and lower-limb strength, and cardiovascular conditioning is necessary if athletic activities are to be resumed at the previous level of performance. Following return to athletic performance, an analysis of training habits should be made and a prescription for exercise issued based on the avoidance of aggravating factors and cultivation of activities that enhance existing static and dynamic shoulder stabilizers. Any return of symptoms should prompt an immediate reappraisal with the proper intervention, including adjustment of activity level and exercises as deemed appropriate. With proper conservative therapy, relatively few athletes should require surgical treatment.
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PMID:Diagnosis and rehabilitation of the shoulder impingement syndrome in the overhand and throwing athlete. 208 87

Intra- and periarticular fractures about the elbow joint are treated with open reduction and internal fixation. This allows early functional after-treatment. Nevertheless, the range of motion remains more or less unsatisfactory. In these cases open arthrolysis provides a considerable improvement in joint function. We therefore recommend this operation when the hardware is removed about 9 months after the accident. The reasons for post-traumatic contracture of the elbow could be intrinsic such as interposed fragments, intra-articular adhesions, incongruity of the articular surfaces--or extrinsic--like contractures of the capsule and ligaments, adhesions of different layers, ectopic bone formations. In most cases a combination of both can be found. Important conditions for successful arthrolysis are mostly intact joint surfaces, failure of all conservative efforts to improve the arc of motion, a motivated patient who understands clearly the risks and benefits that could reasonably be expected by the operative procedure and rehabilitation and, last but not least, a skilled, experienced surgeon. The choice of the approach depends on the main location of the post-traumatic changes and on previous incisions. Osteotomy of the radial epicondyle gives a much better view of the joint and should be performed whenever necessary. The exact course of the operation may not be standardized. The main point is to remove scarred adhesions and bony irregularities. An individually modified rehabilitation program is as important as the operative procedure itself to achieve the best results possible. In general, the exercises should not cause pain. In the first few days plaster casts in flexion and extension are used. Physiotherapy is supported by CPM machines as early as possible. Patients must be prepared with the help of drugs and the application of ice bags. Even after months improvement of motion can be obtained. In a retrospective follow-up study, 125 out of 168 patients with arthrolysis of the elbow joint were reviewed. Most patients sustained a fracture of the distal humerus. In 77%, the results were graded as very good, good or satisfactory, i.e., the average relative improvement amounted to at least 40% according to the criteria of W. Blauth. Patients with very severe (preoperative ROM 0-30 degrees) and severe (preoperative ROM 30-60 degrees) contractures profited more (relative improvement 60%) than the others (relative improvement 45%). Overall, the average arc of total motion increased 49 degrees; the relative improvement of motion increased by 58%.
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PMID:[Arthrolysis of the elbow in posttraumatic contracture]. 227 6

The problems encountered with pseudarthrosis of the clavicle reviewed with reference to 28 patients. Non-union was posttraumatic in 25 cases, due to osteotomy in 2, and postradiation in 1. The preceding treatment had been conservative in 16 cases and surgical in 12. In 26 cases ORIF was performed, with additional bone grafting in 21 cases. Symptoms leading to operation were pain and weakness of the shoulder. In addition, plexus irritation was present in 3 and a thoracic outlet syndrome in 2 cases. At follow-up, bony healing had been achieved in 24 of the 26 cases. No symptoms were present in 23 patients, and these all had a normal ROM of the shoulder. In 1 patient - who had undergone multiple previous operations and local irradiation - slight pain and limited motion were observed despite bony union. In 2 cases non-union is still present, with persistent symptoms.
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PMID:[Results of the treatment of clavicular pseudarthrosis]. 272 10

Two design rationales for threaded acetabular components, the S-ROM Anderson cup and S-ROM SuperCup, are discussed. Components have been followed for at least six months, with a range of six to 24 months. The average follow up is nine months. One hundred components in 96 patients had sufficient follow up and full clinical and roentgenographic evaluations to be included in this study. The 100 hips were divided into four groups based on S-ROM Anderson cup versus S-ROM SuperCup and on primary versus revision. Each hip was evaluated on a clinical and radiologic basis. Based on clinical and roentgenographic evaluations of both the primary and revision situations of the S-ROM SuperCup, consistently good to excellent results were observed. To date, no case has undergone revision for clinical or roentgenographic failure. Dramatic pain relief was exhibited by 96% of patients. Although early results are very encouraging, longer follow ups are necessary.
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PMID:Works in progress #2. Threaded acetabular components. Design rationale and preliminary clinical experience. 317 10

Eighty-one patients with symptomatic osteoarthritis of the thumb took part in a blinded, controlled study to assess the effectiveness of 0.9 mw continuous wave HeNe laser treatment. The subjects were randomly placed in either a control group or a treatment group. In each group the carpometacarpal (CMC), metacarpophalangeal (MCP), and interphalangeal (IP) joints of the most symptomatic thumb were "treated" with 15 sec irradiations at four equally spaced intervals around each joint three times a week for three weeks. The same protocol was used for both groups except that a hidden switch on the laser was placed in the "on" position for the treated group and in the "off" position for the control group. Although the laser-treated group noted slightly lessened tenderness of the treated MCP and IP joints (p less than 0.01 and 0.05, respectively, Wilcoxon signed-rank test), and a small increase in three-finger chuck pinch strength (p less than 0.04, paired t-test), changes in ROM, pain, joint tenderness, grip and pinch strength, activity level, and medication use, did not significantly differ between the groups. Adverse effects were rare (one in each group), minimal, and subjective. We conclude that HeNe laser irradiation at 0.9 mw is safe, but that it is not an effective treatment of osteoarthritis of the thumb.
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PMID:Low-energy helium neon laser treatment of thumb osteoarthritis. 331 90

Rotator cuff tears (RCT) are frequent and increase with age. Why do only a relatively small percentage cause a permanent severe handicap justifying surgery? Is there a relationship between size and site of the tear and the clinical symptoms? How do they influence the postoperative result? These questions were answered in a prospective study of 76 operated patients. We adopted D. Patte's classification of the RCT into four groups according to the site and size of the lesion. Our figures were compared with those obtained by Patte in an analogous study of 256 cases. Of the tears in our series, 56.5% belonged to groups I and II, which means that only the supraspinatous and occasionally also the subscapular muscles were involved. In 100% of the cases in group I we found only pain, whereas a pure symptomatology with pain alone was presented in only 51% of group II, in 48% of group III, and in 0% of group IV. Groups III (35.5%) and IV (8%) represent more extensive tears, involving not only the anterior part of the rotator cuff, e.g., the supraspinatous tendon, but also to a more or less severe extent, the infraspinatous and sometimes even the teres minor. In group IV the extensive tear is combined with osteoarthritic changes. In both groups a mixed symptomatology (pain and pseudoparalysis) is the rule. The result of operative treatment is satisfactory in all groups as far as pain relief is concerned. The improvement of active ROM is not as evident and seems, as expected, to be related to the severity of the lesion.(ABSTRACT TRUNCATED AT 250 WORDS)
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PMID:Rotator cuff tear--relationship between clinical and anatomopathological findings. 334 38

Between January 1982 and May 1985, eight patients with avulsion fractures of tibial tuberosity were seen at the University of South Alabama Medical Center. All were boys, average age, 15 years 8 months. Six of eight had a positive history of Osgood-Schlatter disease. Seven patients underwent open reduction and internal fixation, one had closed reduction and cast. Followup ranged from 5 months to 3.5 years, averaging 19.5 months. All, except one who had lateral meniscectomy, regained practically full ROM and reported no pain or limitation of activities. No patient developed genu recurvatum deformity or leg length discrepancy due to the injury. Open reduction and internal fixation is the treatment of choice in displaced intra-articular fractures. Lateral parapatellar incision is a more direct approach to this fracture and is less likely to injure the infrapatellar branch of the saphenous nerve.
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PMID:Avulsion fracture of the tibial tuberosity in late adolescence. 335 12


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