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C W Slipman

Publications and source records attributed to C W Slipman.

26 records · Page 2Linked to original sources
PubMed2000

An unusual case of shoulder pain.

Shoulder pain is a common musculoskeletal ailment. The process of determining the etiology of shoulder pain can be difficult. The differential diagnoses include: both intracapsular and extracapsular lesions; and neurologic, vascular, postural, and visceral causes. We present an unusual case of shoulder pain accompanied by loss of shoulder range of motion (ROM), initially thought to be caused by an intrinsic shoulder disorder. However, it ultimately was determined that a cervical radicular disorder caused both the impaired ROM and the patient's shoulder pain.

Journal Article↗
PubMed1999

An unusual extraspinal cause of bilateral leg pain.

Low back pain with pain radiating to the lower extremities is common in patients referred to a spine center. Lumbar spine pathology is commonly the etiology of such symptoms, but extraspinal causes of back and leg pain can manifest as a radicular disorder. Extraspinal etiologies must be considered in the workup of back and leg pain. This report describes an unusual case of spontaneously occurring bilateral femoral neck stress fractures presenting as low back pain with seemingly bilateral L4 radicular symptoms.

Adult↗
PubMed1998

Symptom provocation of fluoroscopically guided cervical nerve root stimulation. Are dynatomal maps identical to dermatomal maps?

STUDY DESIGN: This prospective study consisted of mechanical stimulation of cervical nerve roots C4 to C8 in patients with cervical radicular symptoms undergoing diagnostic selective nerve root block. OBJECTIVES: To document the distribution of pain and paresthesias that result from stimulation of specific cervical nerve roots and compare that distribution to documented sensory dermatomal maps. SUMMARY OF BACKGROUND DATA: Cervical dermatomes were first studied in the late 19th century. The results of those studies underpin current clinical decision making for patients with neck and arm pain. However, it has been observed that patients with radicular symptoms may have cervical pathology by radiographic imaging that is not corroborative, or have imaging studies that suggest a lesion at a level other than the one suggested by the patient's dermatomal symptoms. These observations may suggest that cervical dermatomal mapping is inaccurate or the distribution of referred symptoms (dynatome) from cervical root irritation is different than the sensory deficit outlined by dermatomal maps. METHODS: Inclusion criteria consisted of consecutive patients undergoing fluoroscopically guided diagnostic cervical selective nerve root blocks from C4 to C8. Immediately preceding contrast injection, mechanical stimulation of the root was performed. An independent observer interviewed and recorded the location of provoked symptoms on a pain diagram. Visual data was subsequently compiled using a 793 body sector bit map. Forty-three clinically relevant body regions were defined on this bit map. Frequencies of symptom provocation and likelihood of symptom location from C4 to C8 stimulation of each nerve root were generated. RESULTS: One hundred thirty-four cervical nerve root stimulations were performed on 87 subjects. There were 4 nerve root stimulations at C4, 14 at C5, 43 at C6, 52 at C7, and 21 at C8. Analyzing the frequency of involvement of the predetermined clinically relevant body regions either individually or in various combinations yielded more than 1,000 bits of data. Although the distribution of symptom provocation resembled the classic dermatomal maps for cervical nerve roots, symptoms were frequently provoked outside of the distribution of classic dermatomal maps. CONCLUSION: The current study demonstrates a distinct difference between dynatomal and dermatomal maps.

Cervical Vertebrae↗
PubMed1998

The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.

OBJECTIVE: To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). DESIGN: Prospective constructive cohort study using sacroiliac joint block (SIJB) as the diagnostic gold standard. SETTING: Tertiary care center. PATIENTS: Consecutive patients describing low back pain including the region of the sacral sulcus. Physical examination revealed a positive response to three provocative SIJ maneuvers, two of which had to be Patrick's test and pain with palpation over the ipsilateral sacral sulcus. INTERVENTIONS: All subjects underwent fluoroscopically guided SIJB. MAIN OUTCOME MEASURES: Response to SIJB was assessed with visual analog scale (VAS) ratings before and after the block. A reduction of the VAS rating by at least 80% was considered a positive response to SIJB. RESULTS: Fifty consecutive patients met our criteria and underwent SIJB. Thirty patients had positive response to SIJB, making up the positive SIJS group. Twenty patients had less than 80% pain reduction with SIJB and thus comprised the negative SIJS group. The positive predictive value of provocative SIJ maneuvers in determining the presence of SIJS is therefore 60%. CONCLUSIONS: Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.

Adolescent↗
PubMed1996

The value of radionuclide imaging in the diagnosis of sacroiliac joint syndrome.

STUDY DESIGN: A prospective study was done to assess the diagnostic value of radionuclide imaging (bone scan) in the evaluation of sacroiliac joint syndrome OBJECTIVES: To determine the sensitivity and specificity of radionuclide imaging in establishing a diagnosis of sacroiliac joint syndrome in patients with low back pain. SUMMARY OF BACKGROUND DATA: There is no pathognomonic symptom or sign to establish the diagnosis of sacroiliac joint syndrome. It has been accepted that confirmation of sacroiliac joint syndrome requires relief of pain, a positive response to a sacroiliac joint block. Bone scanning has been proposed as a useful imaging technique to evaluate for sacroiliac joint syndrome. The authors explored the use of nuclear imaging as a cost-effective and noninvasive technique in the diagnostic algorithm of sacroiliac joint syndrome. METHODS: Patients presenting to the author's Spine Center with complaints of low back pain including the region of the sacral sulcus were screened for inclusion into this study. Positive response to three provocative Sacroiliac joint maneuvers was requisite, two of which had to be Patrick's test and pain with palpation over the sacral sulcus. Patients who met these criteria were entered into a physical therapy program comprised of lumbar spine stabilization techniques and excluded any interventions considered specific for sacroiliac joint syndrome. Those whose symptoms failed to improve with this program underwent bone scan and fluoroscopically guided sacroiliac joint block. Response to sacroiliac joint block was assessed with pre- and post-block visual analog scale scores completed by the patient. A reduction of the VAS rating by at least 80% was considered a positive response to sacroiliac joint block. RESULTS: Fifty consecutive patients met the author's criteria and underwent bone scan and sacroiliac joint block. Thirty-one patients who had positive responses to sacroiliac joint block comprised the positive sacroiliac joint block group. Nineteen patients had less than 80% pain reduction with sacroiliac joint block and were labeled the negative sacroiliac-joint block group. Four patients had positive bone scans, all of whom were in the positive sacroiliac joint group. CONCLUSIONS: The results demonstrated very low sensitivity and high specificity of nuclear imaging in the evaluation of sacroiliac joint syndrome. The authors do not recommend bone scan in the diagnostic algorithm for sacroiliac joint syndrome.

Adolescent↗
PubMed1987

Postamputation neuromas and other symptomatic stump abnormalities: detection with CT.

One of the potentially troublesome sequelae of limb amputations is the development of stump neuromas at the severed ends of major nerves. The ability to define them and to distinguish them from other causes of stump pain is of considerable clinical significance. Computed tomography was performed on ten lower limb amputees with stump pain. Five patients had neuromas that were manifest as focal or generalized alteration in the caliber, size, or contour of the nerve trunk in the affected stump. The remaining five patients each had an abnormality detected; these abnormalities included heterotopic bone formation, popliteal artery aneurysm, lipoma, scar tissue, and abscess in the contralateral limb.

Adult↗