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PubMed2006

[Orthopedic manifestations of the antiphospholipid syndrome].

PURPOSE: The antiphospholipid syndrome (APS) is characterized by arterial and/or venous thrombosis, and pregnancy morbidity in association with antiphospholipid antibodies. Since its classical description 22 years ago, the clinical spectrum of APS has embraced the realms of obstetrics, nephrology, cardiology, neurology, gastroenterology, angiology and now, possibly orthopaedics. This is not surprising given that this disease can affect virtually any organ system and blood vessel of any size and nature. Just as venous thrombosis may affect limbs and internal organs, arterial thrombosis has been shown to affect organs such as the brain, eye, heart, kidney, liver and may also involve the skeleton. CURRENT KNOWLEDGE AND KEY POINTS: In this review, we describe the orthopedic aspects of APS recently reported, bone metatarsal fractures, osteonecrosis and more exceptional complications, ie algodystrophy and bone marrow necrosis. We briefly discuss postulated pathogenesis and possible implications of anticoagulation. FUTURE PROSPECTS AND PROJECTS: This data need further confirmation. They may suggest complementary physiopathologic and therapeutic implications.

Antiphospholipid Syndrome↗
PubMed1976

Radionuclide joint imaging.

Modern radionuclide techniques of joint imaging involve the use of either 99mTc-pertechnetate or 99mTc-phosphate compounds in conjunction with the Anger camera. In general, images obtained with both types of radiocompound are nonspecific--although increased uptake of 99mTc-pertechnetate usually denotes the presence of synovitis. The most popular uses of the technique are in documenting the extent and severity of inflammatory joint disease, assessing the effect of therapy, and establishing the diagnoses of Legg-Perthes disease and septic arthritis. The method is also useful in judging the extent of involvement in osteoarthritis of the knee prior to surgical intervention. Radionuclide joint imaging is more sensitive than clinical or radiographic techniques in detecting early joint involvement but usually it must be supplemented by other techniques to establish a specific diagnosis.

Adult↗
PubMed1997

Soft-tissue rheumatism: diagnosis and treatment.

Soft tissue rheumatism is one of the most common and most misunderstood categories of disorders facing the primary care physician. Among the more common types are subacromial bursitis, epicondylitis, trochanteric bursitis, anserine bursitis, and fibromyalgia. The keys to the diagnosis of soft-tissue rheumatism are the history and, more importantly, the physical examination. Extensive laboratory testing and radiographs are not as helpful in evaluating patients with these complaints. Treatment consists of nonsteroidal anti-inflammatory drugs (NSAIDs) and nonnarcotic analgesics. Especially in patients with localized disorders, intralesional injections of corticosteroids are particularly effective and safe and should be part of the armamentarium of the primary care practitioner. Fibromyalgia is a particularly challenging form of nonarticular rheumatism. The clinical presentation is rather characteristic, with the patient typically being a woman 30-60 years of age who presents with diffuse somatic pain. Patients often give a history of sleep disturbance, may be depressed, and show characteristic tender areas, or trigger points. Laboratory findings are normal. Management includes reassurance, correction of the underlying sleep disturbance with low doses of a tricyclic antidepressant, treatment with muscle relaxants and nonnarcotic analgesics or NSAIDs, and an exercise program with a strong aerobic component.

Bursitis↗
PubMed1994

Pamidronate disodium and possible ocular adverse drug reactions.

Ciba-Geigy Central Epidemiology and Drug Safety Center has received 23 reports of suspected ocular adverse drug reactions associated with the use of intravenous pamidronate disodium, an inhibitor of bone resorption that is used primarily in the management of tumor-induced hypercalcemia and Paget's disease of the bone. Anterior uveitis, bilateral in six of seven patients, occurred within 24 to 48 hours after the drug was administered. The anterior uveitis recurred in four of the five patients who were rechallenged. Three reports involved unilateral episcleritis or scleritis occurring within one to six days after the administration of the drug. Only the episcleritis patient was rechallenged five months later, when the patient again had the episcleritis occur in the same eye. Thirteen patients reported nonspecific transitory conjunctivitis within six to 48 hours after pamidronate disodium was given intravenously. This was positive on rechallenge in six of eight patients. These data indicate that, on rare occasions, pamidronate disodium is a probable cause of anterior uveitis or nonspecific transitory conjunctivitis and is a possible cause of episcleritis or scleritis.

Adolescent↗
PubMed2003

Arthrographic and clinical findings in patients with hemiplegic shoulder pain.

OBJECTIVES: To identify the etiology of hemiplegic shoulder pain by arthrographic and clinical examinations and to determine the correlation between arthrographic measurements and clinical findings in patients with hemiplegic shoulder pain. DESIGN: Case series. SETTING: Medical center of a 1582-bed teaching institution in Taiwan. PARTICIPANTS: Thirty-two consecutive patients with hemiplegic shoulder pain within a 1-year period after first stroke were recruited. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Clinical examinations included Brunnstrom stage, muscle spasticity distribution, presence or absence of subluxation and shoulder-hand syndrome, and passive range of motion (PROM) of the shoulder joint. Arthrographic measurements included shoulder joint volume and capsular morphology. RESULTS: Most patients had onset of hemiplegic shoulder pain less than 2 months after stroke. Adhesive capsulitis was the main cause of shoulder pain, with 50% of patients having adhesive capsulitis, 44% having shoulder subluxation, 22% having rotator cuff tears, and 16% having shoulder-hand syndrome. Patients with adhesive capsulitis showed significant restriction of passive shoulder external rotation and abduction and a higher incidence of shoulder-hand syndrome (P=.017). Those with irregular capsular margins had significantly longer shoulder pain duration and more restricted passive shoulder flexion (P=.017) and abduction (P=.020). Patients with shoulder subluxation had significantly larger PROM (flexion, P=.007; external rotation, P<.001; abduction, P=.001; internal rotation, P=.027), lower muscle tone (P=.001), and lower Brunnstrom stages of the proximal upper extremity (P=.025) and of the distal upper extremity (P=.001). Muscle spasticity of the upper extremity was slightly negatively correlated with shoulder PROM. Shoulder joint volume was moderately positively correlated with shoulder PROM. CONCLUSIONS: After investigating the hemiplegic shoulder joint through clinical and arthrographic examinations, we found that the causes of hemiplegic shoulder pain are complicated. Adhesive capsulitis was the leading cause of shoulder pain, followed by shoulder subluxation. Greater PROM of the shoulder joint, associated with larger joint volume, decreased the occurrence of adhesive capsulitis. Proper physical therapy and cautious handling of stroke patients to preserve shoulder mobility and function during early rehabilitation are important for a good outcome.

Adult↗
PubMed1996

Improved arousal and initiation following tricyclic antidepressant use in severe brain injury.

Three patients with severe traumatic brain injury demonstrated significant improvement in arousal and initiation after administration of tricyclic antidepressants. The first patient showed improved motor and speech initiation in response to amitriptyline following several months of functional plateau. The second patient was minimally responsive 2 months after injury and demonstrated improved arousal following the use of desipramine. Both patients deteriorated when the medications were discontinued and improved again when they were restarted. These two cases provide strong evidence for a medication effect. The third patient began to verbalize following desipramine administration, despite being mute for more than a year after injury. Previous case reports describe cognitive-enhancing effects, such as improved arousal, attention, memory, and initiation, of dopaminergic agents, and in the case of tricyclic antidepressants, effects on agitation. The role of norepinephrine in promoting neurological recovery after brain lesions has been demonstrated in animals. The cases presented here provide some of the first data to show similar efficacy in humans and underscore the need for controlled trials to better determine which patients will benefit.

Activities of Daily Living↗
PubMed2001

Neuroimmune alterations in the complex regional pain syndrome.

This review focuses on some clinical aspects of the complex regional pain syndrome, such as oedema, local temperature changes and chronic pain, as a result of supposed neurogenic inflammation. Involvement of the immune system could imply the subsequent release of neuropeptides, pro-inflammatory cytokines and eicosanoids, which in turn leads to a complex cross-talk of primary and secondary generated mediators of inflammation. The development and application of drugs that act through selective receptor antagonism or enzymatic synthesis inhibition to prevent further stimulation of this cascade that could inevitably lead to chronicity of this disease are extensively discussed.

Animals↗
PubMed1997

Long-term outcome following sympathectomy for complex regional pain syndrome type 1 (RSD).

We performed a retrospective study of 29 patients with CRPS1 (RSD) who were initially examined between 1983 and 1993, and had either transthoracic (lower third of stellate ganglia to T3) or lumbar (L2-L4) sympathectomy. The patients were followed from 24 to 108 months after surgery. Patients with unsuccessful surgical outcomes had significantly longer duration of symptoms before surgery (median, 36 months) than those with successful outcomes (median, 16 months) by Wilcoxon rank sum test (chi2=8.69, df=1, P<0.01). All seven patients (100%) who had sympathectomy within 12 months of injury, nine of 13 patients (69.2%) who had sympathectomy within 24 months of injury, and only four of nine patients (44.4%) who had sympathectomy after 24 months of injury obtained permanent (greater than 24 months) symptom relief. Patient age, sex, occupation, site of injury, type of injury, presence of trophic changes, and duration of follow-up were not significantly related (P>0.05) to surgical outcome.

Adult↗
PubMed1998

Antinociceptive effects of neurotropin in a rat model of painful peripheral mononeuropathy.

A non-protein extract isolated from the inflamed skin of rabbits inoculated with vaccinia virus (Neurotropin, NTP), has been clinically used in Japan for the treatment of chronic painful conditions such as low back pain, osteoarthritis, postherpetic neuralgia, subacute myelo-opticoneuropathy, and so on. Recent studies have shown its efficacy on patients with complex regional pain syndrome (CRPS). The chronic constriction injury (CCI) model described by Bennett and Xie has been thought to show similar painful conditions to those seen in CRPS patients. Thus, the antinociceptive effects of NTP were tested in CCI model. In rats with mechanical hyperalgesia 2 weeks after nerve injury, i.p. injection of NTP (100 Neurotropin Unit, NU/kg) produced an analgesic effect that lasted for at least 50 min. An analgesic effect lasting up to 30 min. was observed in rats with heat hyperalgesia 2 weeks after nerve injury. Seven daily i.p. injections (50 NU/kg) of NTP commencing 1 week after surgery produced an early recovery from heat hyperalgesia. Prior studies suggest that NTP produces analgesia by activation of a descending pain inhibitory system. Thus, our findings suggest the possibility that the dysfunction of the descending pain inhibitory system could be related to the hyperalgesia in the nerve injury model, and perhaps also in people who suffer from painful peripheral neuropathies.

Analgesics↗
PubMed1999

Postinjury neuropathic pain syndromes.

Pain is clearly one of the most daunting problems of modern medicine. Posttraumatic neuropathic pain syndromes are a major component of the clinical problem. Structural lesions affecting roots, nerves, the plexi, and central structures can be imaged noninvasively. The molecular biology of the intraneural cascades that cause sensitization of the central pain-projecting neurons of the dorsal horn and subsequent allodynia, hyperalgesia, and hyperpathia is a subject of intense inquiry. The role of the clinician in identifying and eliminating the source of the pain is crucial before the effects of excitotoxicity and central sensitization permanently alter the physiology of the central pain-projecting neurons and make treatment ineffectual.

Brachial Plexus↗
PubMed1986

Rheumatologic manifestations of cancer.

A variety of musculoskeletal syndromes have been described in association with malignancy. The majority of such descriptions have dealt with the connective tissue disorder as a paraneoplastic syndrome, frequently the presenting feature of an otherwise occult malignancy. This may range from the well known syndrome of HOA, heralding lung cancer, to a lesser known association of pyogenic arthritis due to an unusual enteric pathogen, signaling colon cancer. Conversely, the connective tissue disorder may precede the malignancy, and by virtue of its pathophysiology or its therapy, foster the subsequent development of cancer. Awareness of these associations may lead to earlier cancer detection, and hence, potentially more effective therapy.

Amyloidosis↗