Medical management of iliocostal pain.
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Biomedical subjects
Publications and source records attributed to G G Hirschberg.
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On manual testing for skinfold tenderness greater resistance has been reported in patients with marked skinfold tenderness. On objective measurement of skin mobility, by raising a skinfold with a vacuum pump and by establishing a stress/strain curve, no difference in skin mobility was found between subjects with and without skinfold tenderness. Furthermore, contrary to manual testing, the suction testing causes no pain in subjects with clinical skinfold tenderness. In a second series of suction tests, comparing skin mobility in a subject with relaxed and contracted underlying muscles, it was found that muscular contraction reduces skin mobility by 50%. The conclusion is that resistance felt by manual skinfold testing is not inherent in the structures, but is caused by contraction of underlying muscles because of pain caused by the manual skinfold test.
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Most cases of low back pain fall into the category of nonspecific low back pain in which no specific pathology can be detected by x-ray, laboratory tests, or biopsy. In the authors' experience about 50% of the patients falling into this group have a clinical picture characterized by symptoms and signs localized at one iliac crest. The symptoms can be abolished temporarily by infiltration of the posterior iliac crest with lidocaine. Because of the location of the findings and the unknown etiology the term iliolumbar syndrome is suggested. Distinguishing the iliolumbar syndrome from the root irritation syndrome may avoid unnecessary surgery. Chronic iliolumbar syndrome is a frequent cause of permanent low back disability, a fact not commonly recognized.
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Successful rehabilitation of the elderly hemiplegic patient means achievement of ambulation of self-care. The patient's potential for reaching this goal can be determined shortly after the stroke by the stand-up test. Delay of an adequate rehabilitation program, often caused by administrative obstacles to proper care, decreases the potential. Rehabilitation of the elderly hemiplegic also is often hampered by impairment of communication. However, with correction of organic abnormalities causing mental disturbance and with use of simple techniques to facilitate communication, it is possible to achieve ambulation even in patients with marginal ability to communicate.
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