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At least 613 records · Page 34Linked to original sources

PubMed2003

Evaluation of patients presenting with knee pain: Part II. Differential diagnosis.

Knee pain is a common presenting complaint with many possible causes. An awareness of certain patterns can help the family physician identify the underlying cause more efficiently. Teenage girls and young women are more likely to have patellar tracking problems such as patellar subluxation and patellofemoral pain syndrome, whereas teenage boys and young men are more likely to have knee extensor mechanism problems such as tibial apophysitis (Osgood-Schlatter lesion) and patellar tendonitis. Referred pain resulting from hip joint pathology, such as slipped capital femoral epiphysis, also may cause knee pain. Active patients are more likely to have acute ligamentous sprains and overuse injuries such as pes anserine bursitis and medial plica syndrome. Trauma may result in acute ligamentous rupture or fracture, leading to acute knee joint swelling and hemarthrosis. Septic arthritis may develop in patients of any age, but crystal-induced inflammatory arthropathy is more likely in adults. Osteoarthritis of the knee joint is common in older adults.

Adolescent↗

PubMed1982

Developmental asymmetry of roots of the cauda equina at metrizamide myelography: report of seven cases with a review of the literature.

The myelographic findings of developmental asymmetry of the lumbo-sacral nerve root sheaths are described in seven patients and details of the clinical presentation and management are presented. Six of the seven patients had referred pain to the leg on the side of the anomaly. There were no significant associated plain film findings. Adherence to recommended techniques of metrizamide myelography is stressed, with particular reference to horizontal beam decubitus oblique projections, which profile the root sheaths to best effect. Minimal signs in the frontal projection are also described, which may be the initial clue to diagnosis. The possibility of erroneous diagnosis of lateral disc protrusion is emphasised if this anatomical variant is not recognised.

Adult↗

PubMedDate not supplied

Pain location and psychological characteristics of patients with chronic pain.

The authors assessed psychological characteristics of 140 medical outpatients with chronic non-malignant pain referred for psychiatric consultation. Subjects completed the Toronto Alexithymia Scale, Somatosensory Amplification Scale (SSAS), and Counter-dependency Scale (CDS). The only psychological measure able to differentiate the chronic pain group from the control subjects was the CDS. However, SSAS scores were significantly higher in subjects having pain involving the head, chest, abdomen, or pelvis than in subjects having pain only in their backs or extremities. The latter subgroup had significantly higher CDS scores. The findings suggest that there are discrete subgroups within the chronic pain population defined by pain location and specific psychological characteristics.

Adult↗

PubMed2003

[Analysis of nursing registries of pain and analgesia in hospitalized patients].

This study analyzed nursing records on pain and analgesia of patients admitted at a cancer treatment hospital, between October and November of 1999, and compared then to the patients reports. Thirty-eight patients that referred pain were interviewed and had their medical charts analyzed. Presence or lack of pain was documented in 94.8% of the charts. The distribution of this type of record throughout the day was: 50% in the morning, 79% in the afternoon, and 89% at night. Pain assessment was restricted to intensity (44.7%) and location (71.1%). Sixty-eight percent of patients were satisfied with the analgesia provided whereas about 33% mentioned some level of dissatisfaction.

Adult↗

PubMed2006

[Abdominal pain].

Abdominal and pelvic pain are the most common causes of referral to a gastroenterologist or gynaecologist, and the understanding of visceral pain mechanisms may contribute to a better diagnosis and treatment. Visceral pain is often perceived as a deep, dull and vague sensation with referral to somatic and other visceral structures, but when the peritoneum is involved the pain is more distinct and localised. Long duration or recurrence of the pain may produce permanent changes in the central nervous system, resulting in an increased sensitivity to external stimuli. These changes often involve other organs and somatic structures in the referred pain area. Finally, options for treating visceral pain are described.

Abdominal Pain↗

PubMed1985

Acute otalgia in Nigerian children.

A study of 112 referred children with acute otalgia labeled 'acute otitis media' by the referring physicians was carried out at the E.N.T. clinic of Lagos University Teaching Hospital in 1981-1982. Only 11% of these were actually due to acute otitis media, reflecting poor technique at otoscopy. Of the acute otalgia cases 56% were due to ear pathology while 44% resulted from referred pain. Otological causes included foreign body in the ear (23%), acute otitis media (11%), otitis externa (10%), secretory otitis media (6%) and myringitis bullosa haemorrhagica (4%). Cases due to referred otalgia were from tonsillitis (21%), foreign body in the pharynx (5%), traditional uvulectomy (5%), and foreign body in the nose (2%). Thus, there is a need for more careful examination of the ear in all cases of acute otalgia.

Acute Disease↗

PubMed1995

Noninvasive testing in women presenting with chest pain: evidence for diagnostic uncertainty.

OBJECTIVE: To gain insight into the diagnostic utility of exercise stress testing in women. DESIGN: Observational prospective cohort study. SETTING: The Victoria General Hospital, Halifax, Nova Scotia. PARTICIPANTS: Consecutive women with chest pain referred by cardiologists or internists for exercise stress testing between May 30, 1992 and November 30, 1992 and followed prospectively to February 28, 1993. INTERVENTION: The proportion of patients subsequently referred for thallium scintigraphy and/or coronary angiography and their clinical profiles were determined. MAIN RESULTS: Of 183 patients studied, stress testing was positive in 48 (26.2%), negative in 48 (26.2%) and nondiagnostic in 87 (47.5%). Women with negative results were more likely to have had normal baseline electrocardiograms (ECGs) (P = 0.002) and least likely to have undergone prior angiography (P = 0.0003). Subsequent thallium scintigraphy and/or coronary angiography was undertaken in 33.3%, 18.8% and 27.6% with positive, negative and nondiagnostic index stress tests, respectively. None of chest pain, cardiac risk factors, previous cardiac investigations or baseline ECG discriminated 33 patients with negative or nondiagnostic stress results who had additional tests from 102 who did not. CONCLUSION: Exercise stress testing poorly screens women with chest pain for coronary artery disease (diagnostic in only 52.5%). Further study was undertaken in 27.6% with nondiagnostic tests and, surprisingly, in 18.8% with negative results. Why certain women with nondiagnostic, and so many with negative, stress tests were referred for further investigation was unclear. These results suggest diagnostic uncertainty when females presenting with chest pain are assessed.

Adult↗

PubMed2004

Animal welfare implications of neonatal mortality and morbidity in farm animals.

Much has been learnt during the last 50 years about the causes of neonatal mortality and morbidity and about practical means for minimising them in newborn lambs, kids, bovine calves, deer calves, foals and piglets. The major causes of problems in these newborns are outlined briefly and include hypothermia due to excessive heat loss or to hypoxia-induced, starvation-induced or other forms of inhibited heat production. They also include maternal undernutrition, mismothering, infection and injury. The published literature reveals that the scientific investigations which clarified these causes and led to practical means for minimising the problems, involved iterative successions of self-reinforcing laboratory and field or clinical investigations conducted over many years. These studies focused largely on solutions to the problems, not on the suffering that the newborn might experience, so that an analysis of the associated welfare insults had not apparently been conducted until now. The present assessment focuses on potentially noxious subjective experiences the newborn may have. The account of the causes of neonatal mortality and morbidity outlined early in this review indicates that the key subjective experiences which require analysis in animal welfare terms are breathlessness, hypothermia, hunger, sickness and pain. Reference to documented responses of farm animals and, where appropriate, to human experience, suggests that breathlessness and hypothermia usually represent less severe neonatal welfare insults than do hunger, sickness and pain. Major science-based improvements in the management of pregnancy and birth have markedly reduced the overall amount of welfare compromise experienced by newborn farm animals and further improvements may be expected as knowledge is refined and extended in the future.

Animal Husbandry↗

PubMed2000

Clinical and experimental aspects of temporomandibular disorders.

Temporomandibular disorders (TMDs) are currently viewed as a family of related pain conditions in the craniofacial muscles, temporomandibular joint, and associated structures. The etiology and pathophysiology of pain is still far from being known, but several important neurobiological aspects have emerged in the last decade. This article reviews the present knowledge on three clinically relevant topics in TMD: referred pain mechanisms, somatosensory changes, and sensory-motor integration in the craniofacial region. It is proposed that the synthesis of this information from systematic studies in experimental animals and healthy human volunteers together with controlled clinical trials in well-defined patient populations is an essential prerequisite in order to advance the diagnostic procedure and management of TMD pain.

Adaptation, Physiological↗

PubMed1997

Toothache with a multifactorial etiology: a case report.

A case report of orofacial pain originating from both dental and nondental conditions is presented. The spontaneous throbbing pain initiated from the left maxillary second premolar and spread throughout the entire upper part of the face to the frontoparietal area. Root canal treatment of the maxillary second premolar did not resolve the chief complaint. Magnetic resonance imaging examination revealed hypertrophy of the left inferior turbinate and soft tissue haziness in the left maxillary sinus floor. After antrostomy, submucosal turbinectomy, and endodontic treatment, the patient was free from pain. The final diagnosis of this case, in addition to pulpitis, was maxillary sinusitis with chronic rhinitis. The multiple factors associated with the etiology made the diagnosis difficult. The mechanism of referred pain from the maxillary sinus and paranasal mucosa to the maxillary teeth and face is discussed.

Chronic Disease↗

PubMed1994

Myofascial pain syndrome. Primary care strategies for early intervention.

Diagnosis of myofascial pain syndrome may become less challenging as clinical criteria become better defined. The mechanisms are not well known, and the syndrome occurs in a wide variety of settings. Trigger points with referred pain are the most common feature. Treatment consists of physical modalities (spray-and-stretch techniques and trigger point block) combined with a program of graded muscle stretching and strengthening. Early, aggressive treatment yields an improved prognosis.

Chronic Disease↗

PubMed1986

Fibrositis/fibromyalgia: a form of myofascial trigger points?

The diagnostic criteria for fibrositis and primary fibromyalgia are similar to those for myofascial pain syndromes due to trigger points. Tender points in muscles are likely to be myofascial trigger points; nonmuscular tender points clearly are not myofascial trigger points, but may be areas of tenderness referred from such trigger points. Myofascial trigger points refer pain to a distance and restrict range of motion of the muscle. They are associated with a palpable taut band that exhibits a local twitch response of the muscle, and they are responsive to treatment. Persistence of myofascial trigger points is due to perpetuating factors that can usually be corrected. Although their number is unknown, it is likely that some patients who are diagnosed as having fibrositis/fibromyalgia have multiple myofascial trigger points aggravated by a powerful perpetuating factor and also have a systemic disease process independent of the myofascial trigger points. Since myofascial pain syndromes are treatable, these patients would benefit greatly by identification and relief of the myofascial component of their pain.

Diagnosis, Differential↗

PubMed1992

Ruptured ectopic pregnancy in a patient with a recent intrauterine abortion.

The case of a 33-year-old woman who presented with abdominal pain referable to the lower abdomen is discussed. She had had an uncomplicated intrauterine abortive procedure two weeks earlier. It was determined that a ruptured ectopic pregnancy was the etiology of her abdominal pain. The rare phenomenon of combined intrauterine and extrauterine pregnancy is discussed.

Abdominal Pain↗

PubMed1986

Temporomandibular joint dysfunction in infancy.

Temporomandibular joint (TMJ) dysfunction describes a pain-dysfunction phenomenon that usually afflicts persons in their 4th or 5th decade. The syndrome can be produced by a variety of etiologic factors including occlusal disharmony, articular disorders, and muscle imbalance. It may cause severe otalgia and refer pain to the temple, occiput, nape of neck, and shoulders. Often, associated joint clicking or popping, aural fullness, vertigo, tinnitus, subjective hypoacusis, and nausea occur. As it has not been previously reported in infants, we would like to describe our experience with this disorder in an 11-month-old boy who was referred to our clinic with a presumed diagnosis of otitis media. The embryology of the temporomandibular joint is reviewed and appropriate treatment with anti-inflammatory analgesics, warm compresses, orthodontics, and external brace appliances is discussed. Because of referral patterns in the infant age group, the pediatric otolaryngologist should be similar with this entity and its presentation in children.

Diagnosis, Differential↗

PubMed2003

Endometriosis is associated with central sensitization: a psychophysical controlled study.

Endometriosis is a pain syndrome representing a major cause of pelvic pain in women of reproductive age. The aim of this study was to test the hypothesis that persistent nociceptive input from endometriotic tissues leads to central sensitization manifested by somatic hyperalgesia and increased referred pain areas to experimental saline-induced muscle pain in patients with endometriosis, compared to healthy control subjects. Ten women with laparoscopically confirmed endometriosis and 10 healthy, age-matched women participated in the study. Hypertonic saline (0.5 mL, 5.8%) was injected intramuscularly, in random succession, into 1 site of menstrual pain referral (the multifidus muscle at the low back) and into 1 non-pain control site (first dorsal interosseous muscle [FDI] of the hand). The post-saline pain intensity and pain areas at the FDI were significantly greater in patients with endometriosis than in control subjects (P <.05) but were not different between the groups for the back. An absence of enhancement of post-saline pain responses at the back in the endometriosis group suggests that saline-induced pain at the back appears to activate segmental inhibitory systems in patients with endometriosis. Manifestation of central sensitization in women with endometriosis is demonstrated by increased muscle nociceptor input in the form of increased post-saline pain intensity, pain areas at the FDI, and hypersensitivity to pressure stimulation. These findings provide new insights into the complex pain mechanisms associated with endometriosis.

Adult↗

PubMed2006

Effects of pelvic skeletal asymmetry on trunk movement: three-dimensional analysis in healthy individuals versus patients with mechanical low back pain.

STUDY DESIGN: Comparative analysis and correlational research design were used to investigate the association between anthropometry and biomechanical performance among asymptomatic subjects and patients with low back pain (LBP). OBJECTIVES: To examine the association between pelvic asymmetry and patterns of trunk motion in asymptomatic and LBP subjects. Secondary objective was to investigate the association between restricted trunk motion, laterality of referred pain, and pelvic asymmetry. SUMMARY OF BACKGROUND DATA: Subtle pelvic asymmetry (exhibited as either lateral pelvic tilt or iliac rotational asymmetry), which is common among normal individuals, has not been convincingly linked to abnormalities in back movements. Given the difficulty in diagnosing most LBP, a classification using pelvic asymmetry and patterns of movement could be helpful in establishing a rational treatment plan. METHODS: Fifty-nine subjects with no history of LBP and 54 patients with mechanical unilateral LBP were tested. An anthropometric frame was used to measure pelvic asymmetry in standing. Dynamic motion data, comprised of the principal and coupled movements, were collected using the Qualysis Motion Capture System. RESULTS: While the groups did not differ in the total range of lumbar movement, the LBP group exhibited significantly higher asymmetry in the principal motion. The groups differed significantly in the pattern of coupled rotation during lateral flexion. Asymmetry in lumbar lateral flexion was highly related to two types of pelvic asymmetry: lateral pelvic tilt (LPT) and iliac rotation asymmetry (IRA). Asymmetry in lumbar axial rotation was highly related to IRA but weakly related to LPT. CONCLUSIONS: This study demonstrates objective differences in patterns of lumbar movement between asymptomatic subjects and patients with LBP. The study also demonstrates that subtle anatomic abnormality in the pelvis is associated with altered mechanics in the lumbar spine. We suggest that asymmetry of lumbar movement may be a better indicator of functional deficit than the absolute range of movement in LBP.

Adult↗

PubMed2005

Gender differences in the cause of low back pain in British soldiers.

OBJECTIVES: To explore gender differences in the cause of low back pain in a population of military personnel who are expected to undertake high levels of sport, exercise and physical military training. METHODS: A prospective study of trained British soldiers, with symptomatic low back pain, referred to the Colchester Garrison Sports Injury and Rehabilitation Centre over a four year period. RESULTS: The study demonstrates that 928 (17.8%) of the 5214 referrals were for new cases of low back pain. The incidence of low back pain in female soldiers is higher than their male counterparts with an odds ratio of 3.17 (95% CI 2.31 - 4.35) There was a highly significant cross gender difference in low back pain caused by activities in the followining categories: military physical traininong (OR 2.65, 95% CI 1.70 - 4.02), work or occupation (OR 2.49, 95% CI 1.56 - 3.87) and off-duty pursuits (OR 2.91, 95% CI 1.72 - 4.72). There was no cross gender difference in low back pain caused by sport, road traffic accidents or activities pre-dating military service. CONCLUSIONS: Female soldiers are significantly more likely to suffer low back pain as a result of physical military training, their occupation, or off-duty activities. Sporting activities do not cause low back pain in women to a greater extent than men By demonstrating the scale of the problem and by determining of the cause of injury, it should now be possible to propose methods of effective intervention to reduce injury, implement those interventions and audit effectiveness.

Adult↗

PubMed2004

[Anterior knee pain in the absence of patellofemoral instability].

A wide range of disorders other than patellofemoral instability may be responsible for anterior knee pain and should therefore be included in the differential diagnosis in children and adolescents. The role of overuse and repetitive trauma is of utmost importance in these disorders. Moreover, systemic or local malignancies, referred pain especially from the hip, and psychiatric features specific to this age group should always be kept in mind. This article revisits anterior knee pain in the absence of patellofemoral instability with regard to etiology, examination methods, diagnosis, and treatment in the light of recent data and clinical experience.

Adolescent↗