Biomedical subjects

C Aprill

Publications and source records attributed to C Aprill.

12 recordsLinked to original sources

PubMed2002

Occipital headaches stemming from the lateral atlanto-axial (C1-2) joint.

Studies in normal volunteers have demonstrated that the lateral atlanto-axial joints (C1-2) are capable of causing pain in the occiput, but few clinical studies have validated this source of occipital headache. The present study tested the null hypothesis that the lateral atlanto-axial joints are not a common source of occipital headache. Patients presenting with occipital pain underwent diagnostic blocks of their lateral atlanto-axial joints if they demonstrated clinical features presumptively suggestive of a C1-2 origin for their pain. Of 34 patients investigated, 21 obtained complete relief of their headache following diagnostic blocks, indicating that a C1-2 source of occipital pain is not rare. The clinical features used to select patients for blocks, however, had a positive predictive value of only 60%. Further study of headaches from C1-2 seems justified in order to establish more definitively the prevalence of this condition and how it might become better recognized in practice.

Adult↗

PubMed2001

Costovertebral joint erosion in ankylosing spondylitis.

We describe a patient with ankylosing spondylitis who had severe pain in the thoracic spine area owing to a destructive arthropathy of a costovertebral joint. A computed tomographic scan revealed severe osteolysis of the head of the right eleventh rib, with hypertrophic sclerotic arthropathy of the joint as the source of the patient's pain. Costovertebral arthropathy should be considered in ankylosing spondylitis patients with severe thoracic pain.

Adult↗

PubMed1997

A prospective study of centralization of lumbar and referred pain. A predictor of symptomatic discs and anular competence.

STUDY DESIGN: The presence or absence of rapidly centralizing, peripheralizing, or abolishing low back and radiating pain, as identified during a McKenzie mechanical lumbar assessment of patients with chronic lumbar pain, was compared prospectively with discographic pain provocation and anular competency. OBJECTIVES: To evaluate any relation between the responses of centralization and peripheralization with discographic findings. SUMMARY OF BACKGROUND DATA: Centralization of referred pain has been reported as a very common occurrence during McKenzie assessment and treatment. Patients whose pain centralizes have been shown to achieve superior treatment outcomes. A dynamic internal disc model has been hypothesized as an underlying mechanism for centralization that has not been studied previously. METHODS: Patients with chronically disabling low back pain who were referred for discography underwent preliminary blinded McKenzie clinical assessment and were categorized into three groups by their pain response. Patterns, or lack thereof, of pain response were then compared with blinded discographic pain provocation and anular findings. RESULTS: During the McKenzie assessment, the referred pain of 50% centralized with 74% having positive discograms, of which 91% had an intact anulus. The pain of 25% peripheralized only (would not centralize); 69% of these had positive discograms, but only 54% had an intact anulus. The distal pain of 25% did not respond at all, and only 12.5% of these had positive discograms. CONCLUSION: The McKenzie assessment process reliably differentiated discogenic from nondiscogenic pain (P < 0.001) as well as competent from an incompetent anulus (P < 0.042) in symptomatic discs and was superior to magnetic resonance imaging in distinguishing painful from nonpainful discs.

Adult↗

PubMed1994

Reported pain during lumbar discography as a function of anular ruptures and disc degeneration. A re-analysis of 833 discograms.

STUDY DESIGN: This re-analysis was based on 833 computed tomography/discograms collected from 306 candidates for back surgery. OBJECTIVES: The goal was to test the hypothesis that outer anular ruptures are the main determinant of the pain of discography. SUMMARY OF BACKGROUND DATA: Previous analyses indicated univariate associations of pain with disc degeneration and anular ruptures. METHODS: If present, pain was classified as "exact", "similar", or "dissimilar" reproduction of the previously experienced pain. For each disc, ruptures and degeneration were separately evaluated by a four-point scale. Multiple logistic regression with random effects was used in the analysis. RESULTS: Outer anular ruptures were the only predictor of the responses "similar" and "exact". General disc degeneration was the only predictor of the response "dissimilar". There was no effect modification due to gender, age, and spinal level. CONCLUSIONS: During discography, the outer anulus appears to be the origin of pain reproduction.

Adult↗

PubMed1992

The prevalence of cervical zygapophyseal joint pain. A first approximation.

A null hypothesis was tested to the effect that cervical zygapophyseal joint pain was uncommon. The prospectively recorded responses were reviewed of 318 consecutive patients with intractable neck pain who underwent provocation discography and cervical zygapophyseal joint blocks. Symptomatic zygapophyseal joints were encountered in 25% of the sample with a possibility that a further 38% suffered zygapophyseal pain but were not appropriately investigated. The null hypothesis was rejected. Cervical zygapophyseal joint pain is not rare, and is worthy of further consideration not just in research but in clinical practice.

Adult↗

PubMed1992

Abnormal instantaneous axes of rotation in patients with neck pain.

Instantaneous axes of rotation for cervical motion segments C2-3 to C6-7 were determined in 109 patients with uncomplicated neck pain. Their location in each patient was compared to normal ranges determined in a previous study of 46 asymptomatic individuals. Unequivocally abnormal instantaneous axes of rotation were found in 46% of patients, and marginally abnormal instantaneous axes of rotation were found in a further 26% of patients. Abnormal instantaneous axes of rotation significantly correlated with the presence of neck pain, but the location of an abnormal axis did not correlate with the segmental source of pain as determined by provocation discography or zygapophyseal joint blocks.

Adult↗

PubMed1992

High-intensity zone: a diagnostic sign of painful lumbar disc on magnetic resonance imaging.

The prevalence, validity and reliability of high-intensity zones in the annulus fibrosus seen on T2-weighted magnetic resonance images of patients with intractable low-back pain were determined. This sign was readily recognized by two independent observers. It occurred in 28% of 500 patients undergoing magnetic resonance imaging for back pain. The presence of a high-intensity zone correlated significantly with the presence of Grade 4 annular disruption and with reproduction of the patient's pain. Its sensitivity as a sign of either annular disruption or pain was modest but its specificity was high, and its positive predictive value for a severely disrupted, symptomatic disc was 86%. This sign is diagnostic of painful internal disc disruption.

Back Pain↗

PubMed1990

Cervical zygapophyseal joint pain patterns. I: A study in normal volunteers.

The pain patterns evoked by stimulation of normal cervical zygapophyseal joints were determined in five volunteers. Under fluoroscopic control, joints at segments C2-3 to C6-7 were stimulated by distending the joint capsule with injections of contrast medium. Each joint produced a clinically distinguishable, characteristic pattern of pain, which enabled the construction of pain charts that putatively could be of value in determining the segmental location of symptomatic joints in patients presenting with cervical zygapophyseal pain.

Cervical Vertebrae↗

PubMed1990

Cervical zygapophyseal joint pain patterns. II: A clinical evaluation.

To test the predictive value of segmental pain charts, ten patients with suspected cervical zygapophyseal pain were studied. Their pain distribution was recorded on a body diagram, and using pain charts derived from studies on normal volunteers, predictions were made by two observers of the segmental location of the symptomatic joint. Correct predictions were made in all nine patients who were shown to have symptomatic joints on the basis of diagnostic joint blocks. The results vindicate the accuracy of pain charts for predicting the segmental location of symptomatic joints in patients with cervical joint pain.

Cervical Vertebrae↗

PubMed1990

Lumbar discography in normal subjects. A controlled, prospective study.

Major advances in the techniques of discography since 1968, in conjunction with major strides in the evaluation of pain in recent years, prompted a study in which Holt's work on the specificity of discography was replicated and extended. For the present study, seven patients who had low-back pain and ten volunteers who had been carefully screened, with a questionnaire and a physical examination, to ensure that they had no history of problems with the back, had an injection at three levels, and all sessions were videotaped. After each injection, the participant was interviewed about the pattern and intensity of the pain, and then the discs were imaged with computed tomography. Five raters, who were blind to the condition of the participant, graded each disc as normal or abnormal on the basis of findings on magnetic resonance images that had been made before the injection and computed tomography (discography) were done. There was only one disagreement between the ratings that were made on the basis of the magnetic resonance images and those that were made on the basis of the discograms. Each participant's pain-related response was evaluated independently by two raters who viewed the videotapes of the discography. Inter-rater reliability was 0.99, 0.93, and 0.88 for the evaluation of intensity of the pain, pain-related behavior, and similarity of the pain to pain that the subject had had before the injection. In the asymptomatic individuals, the discogram was interpreted as abnormal for 17 per cent (five) of the thirty discs and for five of the ten subjects.(ABSTRACT TRUNCATED AT 250 WORDS)

Adult↗

PubMed1989

Pain provocation and disc deterioration by age. A CT/discography study in a low-back pain population.

The computed tomography (CT)/discograms and discographic pain provocation reports of 291 clinical patients, 790 discs (mean age, 38; range, 17-79) were collected. The CT/discograms were classified separating anular disruption and degeneration and recording the pain provoked during discography as no pain, dissimilar, similar, or exact reproduction of the patient's clinical pain. Nondegenerated discs usually were found to be painless, and deteriorated discs painful. The proportion of severely degenerated but painless discs increased with age, as did the discs producing dissimilar pain. This may help explain the poor correlation of low-back pain with radiographic degenerative changes reported in previous epidemiologic studies.

Adult↗

PubMed1988

Disc deterioration in low-back syndromes. A prospective, multi-center CT/discography study.

Disc deterioration and pain provocation in different low-back pain syndromes was studied using computed tomography (CT) discography. Data were prospectively collected for 300 patients (816 discs). Patients were classified by their pre-discography diagnosis of disc herniation (DH), degenerated disc (DD), lumbar syndrome (LS), lumbar radicular syndrome (LRS), or other. The CT/discograms were classified by discographic pain response, the amount of degeneration and annular disruption. Eighty-two percent of DH patients, 80% of DD, 56% of LS, and 59% of LRS patients had both positive discographic pain provocation and moderate or severe disc deterioration. The study indicates that intradiscal pathology plays a major role in nonspecific low-back pain syndromes.

Back Pain↗