Joint Pain Ebooks Catalog
No studies to date have evaluated genetic predictors of response to treatment with IL-1Ra. The genes for IL-1 and IL-1Ra are found on the long arm of chromosome 2. In one study, a polymorphism within the IL-1 promoter sequence (at position 511) was overrepresented in an RA population who had required joint surgery, compared with both patients who had not required surgery and healthy controls (95). This polymorphism may therefore be a marker of RA severity. However, Huang et al. (96) looked at the same polymorphism in a Taiwanese population and did not find an increased allele frequency in the RA group compared with the controls. These and other gene polymorphisms in the IL-1 family may be hypothesized to influence responses to IL-1Ra therapy and clearly require further evaluation.
A decision is made after a complete radiological evaluation of joint disease. The degree and location of synovial proliferation are systematically evaluated prior to PBS by means of magnetic resonance imaging (MRI) with intravenous administration of gadolinium or arthrography combined with computed tomography (CT). Gadolinium-enhancement MRI is especially
Several studies have examined the nature and prevalence of medicines prescribed for old people living in the community. One of the best known is that by Cartwright and Smith (1988) which was based on a random sample of people aged 65 and over drawn from the electoral registers of 10 parliamentary constituencies in England. Information was obtained from 78 (805 patients) of the 1032 included in the original sample. Of these 805 patients, 60 had taken one or more prescribed medicines within the preceding 24 hours. Drugs for diseases of the heart and circulation were widely prescribed and diuretics formed a therapeutic category in most widespread use. Diuretics were followed by analgesics, hypnotics, sedatives and anxiolytics drugs for rheumatism and gout and then -adrenoceptor antagonists. Similar findings were recorded in two studies from Southampton (Ridout et al, 1986 Sullivan and George, 1996). A more recent review by Jones and Poole (1998) has confirmed the rising use of...
Sickle cell anemia is a serious anemia that is predominant in people of black race. The erythrocytes of a person who has sickle cell anemia become sickle-shaped and, therefore, are not efficient carriers of gases or nutrients. The sickle-shaped cells also increase the viscosity of the blood that leads to decreased circulation in the small arteries and capillaries. Symptoms of sickle-cell anemia include pain of certain organs, bone and joint pain, fever, and cerebral thrombosis. The spleen is not usually enlarged. Complications associated with sickle cell anemia are leg ulcers, osteomyelitis, and occasionally, cardiac enlargement. The treatment for sickle cell anemia is usually symptomatic as the actual cause of the condition is unknown. Blood transfusions are usually involved in most treatment regimens.
Coderre, T.J., Katz, J., Vaccarino, A.L., and Melzack, R. (1993). Contribution of central neuroplasticity to pathological pain review of clinical and experimental evidence. Pain, 52, 259-85. Kehlet, H. (1993). General vs. regional anesthesia. Principles and practice of anesthesiology, pp. 1218-34. Mosby Year Book, St Louis, MO. Murray, M.J. and Plevak, D.J. (1994). Analgesia in the critically ill patient. New Horizons, 2, 56-63. Schaible, H.G. and Grubb, B.D. (1993). Afferent and spinal mechanisms of joint pain. Pain, 55, 5-54.
On the basis of using intra-articular injections or nerve blocks as the reference standard, the prevalence of the z-joint as a nociceptor in chronic axial-type neck pain has been reported from about 35 in a specialist referral setting (27) to about 50 in postwhiplash patients (28). The level most commonly involved in either group was C5-C6. The C3-C4 level was the most common in the nonwhiplash group and C2-C3 was the most common in the whiplash group. Cervical z-joint pain is common among chronic neck pain patients after whiplash and is of significant clinical importance. In evaluating this patient population, placebo controlled comparative blocks should be the algorithm employed. It has been shown that uncontrolled diagnostic blocks are compromised by substantial false positive rates and diminish the specificity of this modality (29). An alternative to an intra-articular injection is a medial branch block. In this procedure, a needle is placed along the expected course of the medial...
There are sufficient data to support that the definitive diagnosis of lumbar z-joint-mediated pain is based on selective analgesic injections of these joints or their nerve supply (the medial branch of the dorsal ramus). Notwithstanding, one must be cautious of the false positive rate of uncontrolled diagnostic blocks (40). The false positive rate of uncontrolled blocks approaches 38 with a positive predictive value of only 31 , when compared to the reference (criterion) standard of using comparative and confirmatory blocks. Given that the prevalence of predominantly lumbar z-joint pain is likely to be less than 50 in all patients with low back pain, this is felt to be an unacceptably high false positive rate. There are numerous uncontrolled trials evaluating the therapeutic effect of lumbar z-joint injections. The preponderance of evidence is that intra-articular lumbar z-joint injections and anesthetic nerve blocks are diagnostic tests, but neither is satisfactory for chronic low...
The continued use of opioids results in the development of physical dependence, as demonstrated by the appearance of a characteristic abstinence syndrome upon interruption or cessation of use. The symptoms of withdrawal include hyperactivity, anxiety, restlessness, yawning, diarrhea, vomiting, chills, fever, lacrimation, and runny nose. Piloerection (gooseflesh or cold turkey), mydriasis, increased blood pressure and heart rate, and hyperpyrexia may be observed. Tremors, abdominal cramps, and muscle and joint pain may be present. Drug craving is an important feature of opioid withdrawal. In contrast to some other drugs of abuse, withdrawal is not life threatening.
No recent history of long bone stress fractures, osteoporosis, or severe hip or knee joint disease a bone density test is advisable in cases of women over 40 years or patients who are many years (10 or more) beyond date of injury (the author had a patient 40 years postinjury who had no problem and was accepted to the FES ambulation program)
Since nuclear medicine methods are designed to identify sites of active inflammation, whether acute or chronic, absence of inflammation can be a very useful tool in determining when antimicrobial therapy should be discontinued. For example, it is often difficult to know when to stop treating chronic diabetic osteomyelitis or a prosthetic joint infection that has been managed with several weeks or months of antibiotics. Some markers that can be used to monitor progress include acute phase reactants such as erythrocyte sedimentation rate and repeat radiographs to look for improvement in anatomical defects. However, nuclear medicine methods can add a level of reassurance by confirming the absence of inflammatory activity, thus aiding in the decision to discontinue antibiotic therapy.
This fungus has a strong predilection for the central nervous system, causing meningitis and, occasionally, brain abscesses. Patients present subacutely with low-grade temperature, headache, and altered mental status. Signs of frank men-ingismus are usually absent. Alternate presentations include pulmonary disease with pneumonitis, nodules, and lung abscess soft tissue, skin or joint infection and fever of unknown origin.
Crossover RCT, evaluated a below-the-knee cast and stretch in patients with traumatic head injury who had ankle contractures. This study reported a significant improvement in passive ankle dorsiflexion motion during the intervention period compared to the control period.376 The third study evaluated the 'Dynasplint', which applies a prolonged stretch unilaterally, in geriatric patients, and found no beneficial effect of treatment.374 An RCT, in people with joint disease, of a cream containing chlorproethazine, a muscle relaxant (not available in the UK), found significant improvements in a range of outcomes including pain intensity, tender point palpitation, patients evaluation of treatment, and contracture severity in patients receiving the active cream compared to those receiving a placebo cream. No effects were found for one of the outcomes investigated (limitation of movement).377 No beneficial effect was found for a bed-positioning treatment programme in older patients.378
The most serious side effect of some amino-bisphophonates (pamidro-nate, zoledronate) is renal impairment, which is uncommon and only seen with intravenous amino-bisphonates after protracted (more than 2 years) therapy. Other toxicities are bone and joint pain, gastrointestinal problems (oral agents only), and injection site problems such as swelling, redness, and, rarely but with increasing awareness, osteonecrosis of the jaw has been reported such that it is now advised that patients needing dental
Any history of constitutional symptoms or signs (intermittent fever, rash, abdominal pain, mouth sores, lymphade-nomegaly, joint symptoms, weight gain or loss) These symptoms and signs could be features of significant underlying disease causing proteinuria (eg, systemic lupus erythematosus, hemolytic uremic syndrome, Henoch-Schonlein purpura, among others).
Allergic reactions (contact dermatitis) have occurred with topical use in sensitized individuals, and ingestion may also produce allergic reactions in people with preexisting allergies to members of the Compositae family. Feverfew has caused contractions in term pregnancy and has been implicated in cattle abortions and so should be avoided in pregnancy and lactation. A feverfew withdrawal syndrome consisting of joint pain and muscle stiffness may occur following abrupt discontinuation. Theoretically, because of its antiprostaglandin effects, feverfew should not be coadministered with anticoagulants or antiplatelet drugs.
Muscle-toning exercises are performed within the first week after surgery. These exercises require progression dependent on the patient's tolerance but should not be overly aggressive. Isometric exercises are the simplest and least likely to aggravate underlying joint symptoms these include isometric sets for the gluteals, quadriceps, hamstrings, adductor and abductor muscle groups, and lower abdominals. Addi-
In cases involving mandibulotomy, best occlusal results are obtained when the internal fixation or reconstruction plate (compressive or locking) is modeled on the buccal and labial contour spanning the anticipated mandibulotomy site. In the instance of compression- and tension-band plate placement, the two medial holes of each plate should be drilled appropriately eccentrically and neutrally positioned, respectively. Subsequent plate holes can be drilled at the time of mandibulotomy repair, because this will assure good compression across the mandibulotomy site. Similarly, in cases of segmental mandibulectomy, pre-contouring the reconstruction plate is crucial for maintaining the best occlusal relationships and temporomandib-ular function. Even in edentulous cases, this planning and early effort can maintain a more natural contour and good joint function. If there is involvement and or distortion of the buccal or labial cortex of the mandible, direct plate contouring to the bone is...
Causing hypercalcemia with attendant decreases in serum parathyroid hormone (PTH). Other symptoms include hypercalciuria, anorexia, nausea, vomiting, headache, diarrhea, thirst, polyuria, muscle weakness, fatigue, joint pain, demineralization of bones, pruritus, nervousness, disorientation, psychosis, and tremor. Hypervitaminosis D is a serious problem, because it can result in irreversible deposition of calcium and phosphorus in the heart, lungs, kidneys, and other soft tissues. Therefore, it is important to detect early signs of vitamin D toxicity. It is fortunate that serum 25-hydrox-yvitamin D is the best screen for both hypervitaminosis and hypovitaminosis D (102).
PMS is characterized by symptoms including mood swings, irritability, insomnia, joint pain, tender breasts, headache, and bloating and starts approximately 2 weeks before menstruation begins. The cause is likely a hormonal imbalance, too much estrogen being produced by the body as opposed to the amount of progesterone. In studies, eating complex carbohydrates such as bread, potatoes, pasta, rice and oats throughout the day has relieved symptoms due either to the release of serotonin, a neurotransmitter that elevates mood, or to the stabilization of blood sugar levels. Caffeine-sensitive individuals have experienced relief when the beverage has been eliminated from the diet. Estrogenic foods such as soy and other legumes stabilize hormone levels by interfering with and limiting the uptake of estrogen that the body produces. Regular exercise has been shown to reduce symptoms of PMS.
If any of your joints whether your hips, knees, or shoulders are tight, you may find that the number of positions you can move into independently is limited. This, in turn, may limit the types of activities you can do for yourself. Range-of-motion exercises are the most basic element of an activity program for people with MS. Moving joints through their full range of motion even once a day will help to prevent development of contractures (frozen joints) and of permanently reduced range of motion of a particular joint. Maintaining the flexibility of your joints and of the structures around them will also decrease spasticity of your muscles.
Lincomycin and clindamycin penetrate most tissues well, including bone. Therefore, bone and joint infections caused by susceptible organisms respond well to treatment with clindamycin. These drugs also concentrate within phagocytic cells, which may offer a therapeutic advantage. Lincomycin and clindamycin do not readily penetrate the normal or inflamed meninges. They do, however, pass readily through the placental barrier. Their half-life is 2 to 2.5 hours.
Other ICU infections caused by Ps. aeruginosa include meningitis, brain abscess, eye infection, hematogenous bone and joint infection (osteomyelitis), urinary tract infection, and gastrointestinal infection. Central nervous infections can arise from direct extension (e.g. paranasal sinusitis, where Ps. aeruginosa is the most common nosocomial isolate), inoculation (surgery, head trauma), or hematogenous seeding. Ps. aeruginosa is a frequent and devastating ocular pathogen, causing rapidly progressive destructive infections that are difficult to treat because antibiotics penetrate poorly. It is a genuine medical emergency, as preservation of vision is rare after infection has progressed to endophthalmitis. Gastroenteritis due to Ps. aeruginosa usually affects infants or neutropenic cancer patients.
What does it mean to be physically fit The American College of Sports Medicine (ACSM) has defined physical fitness as a set of characteristics (i.e., the work capacity of your heart and lungs, the strength and endurance of your muscles, and the flexibility of your joints) that relate to your ability to perform physical activities. Regular physical activity leads to improved physical fitness and many other physiologic, cosmetic, and psychological benefits. Depending on personal goals and job requirements the level of physical fitness to attain can range from basic, health-related to more specific, performance-related fitness (Figure 4-1).
Minimally Invasive Surgery (MIS), also referred to as minimal access surgery, endoscopic surgery, or keyhole surgery, is a relatively new surgical area. Surgery, the work of the surgeon's hand, has been revolutionized by the introduction of the endoscope, an instrument with a tiny video camera on the end, that enables surgeons to view inside a body cavity. Depending on which internal cavity is being viewed, the surgery is named accordingly for example, laparoscopic for abdominal, thoracoscopic for chest, arthroscopic for joint surgery. Initially, endoscopes were used to see inside the body for exploratory and diagnostic purposes only. Eventually, surgeons were able to manipulate target tissues in the internal cavities to achieve surgical goals with specialized laparoscopic instruments. Thus, the purpose of such minimally invasive surgeries evolved from diagnostic to therapeutic. Although the focus of this discussion is primarily on laparoscopic procedures (see also Scott-Conner,...
A 17-year-old boy presented 2 years following closed treatment of a posterior column fracture of the right acetabulum. He had developed progressive mechanical hip joint symptoms including pain, catching, and a sensation of giving way, with discomfort localized to the groin area. Radiographs revealed changes consistent with his previous fracture and areas suggestive of in-traarticular loose bodies (Figure 2.1A). Multiple cartilaginous and osseous loose bodies were confirmed by double-contrast arthrography followed by CT scan (Figure 2.1B). At arthroscopy, multiple loose bodies were identified (Figure 2.1C). Many were too large to be retrieved through large-diameter cannulas but could be removed free-hand and with extra-length pituitary rongeurs.
Skeletal shortening is essential to allow direct approximation and repair of the soft tissues, except perhaps in the guillotine injury where the zone of injury is narrow as in distal replants. Also, it facilitates periosteal and quality extensor apparatus repair. In general, shortening from the amputated segment is preferable, provided it will not compromise joint function, so as to maintain the maximum length of the digit should the replant fail. Skeletal fixation needs to be secure to allow mobilization of adjacent joints during the early postoperative period, and the method depends on the level of skeletal injury relative to the joints and the extent of the associated fracture pattern. Provided good soft tissue cover is expected, cort-icocancellous bone grafts are used to stabilize the skeletal construct where there is a segmental defect. Good secure alignment is technically difficult and frustrating, but time spent perfecting this will lay the foundation for a smooth sequence of...
Some patients experience mild pain and tenderness in the days following the procedure. Joint effusion and hemarthrosis (7) are very rare. Use of a strict aseptic technique makes a joint infection unlikely. However, this risk is much higher in patients with immunodeficiency, especially in those with chronic renal failure undergoing hemodialysis. With these patients, special attention must be paid to the indication of PBS.
Arthroscopic lavage for acute bacterial sepsis of the hip has been described in the pediatric literature by Chung et al.80 Blitzer described similar indications for lavage and debridement in an adult population, and Bould et al. have published a case report as well.81,82 Arthroscopic visualization of the joint is better than can be accomplished with an open approach unless the hip is dislocated intraoperatively. More important, the morbidity of arthroscopy is significantly less and may be especially important when joint infection occurs in a medically compromised patient. A seriously ill patient may be capable of withstanding an arthro-
Which places the hip in internal rotation. Sitting may be uncomfortable, especially if the hip is placed in excessive flexion. Rising from the seated position is especially painful, and the patient may experience an accompanying catch or sharp stabbing sensation. Symptoms are worse with ascending or descending stairs or other inclines. Entering and exiting an automobile is often difficult with accompanying pain as this loads the hip in a flexed position along with twisting maneuvers. Dyspareunia is often an issue due to hip joint pain this is commonly a problem among female patients, but may be a difficulty for male patients as well. Difficulty with shoes, socks, or hose may simply result from pain or may reflect restricted rotational motion and more advanced hip joint involvement.
Active range of motion and resisted active range of motion may also reproduce joint symptoms. However, when carefully interpreted, a distinction can be made between symptoms of a muscle strain and hip pain. This differentiation may be least clear with a strain of the hip flexors. In this setting, active hip flexion reproduces pain while passive flexion should not.
When you walk, keep your back straight and your stride comfortable. Do not use ankle or hand weights because they increase the stresses placed on your joints. If you have been sedentary, start by walking for 15 minutes on a flat surface at a pace that allows you to talk somewhat easily. Walk every other day. Each week increase the time you walk by 10 until you can walk for 20 minutes continuously. Next, increase your distance by 10 each week (staying at the 3.0 m.p.h. pace) until you can walk continuously for 2 miles. Then follow the program outlined in Table 6-1.
Lincomycin (Lincocin) has been used in the past to treat serious streptococci, pneumococci, and staphylococci infections but has generally been replaced by safer and more effective antibiotics. Clindamycin (Cleocin) is a semisynthetic derivative of lincomycin and has a similar mechanism but is more effective. It is indicated for the treatment of bone and joint infections, pelvic (female) and intraabdominal infections, bacterial septicemia, pneumonia, and skin and soft tissue infections. In a normal dose, lincosamides prevent the growth of bacteria (bacteriostatic). In larger doses, it kills bacteria (bacteriocidal).
Primary SI joint pain is noted to be maximal below the level of L5, but on palpation sacral sulcus tenderness is present. However clinical findings are not reliable (1). There are not any Using diagnostic intra-articular blocks producing temporary symptomatic relief as the reference (criterion) standard, the prevalence of primary SI joint pain and chronic low back pain is in the range of 18 to 30 based on two studies (2,3). The SI joint has a diffuse innervation pattern without a fixed course for the efferent nerves. Therefore, there is no effective nerve block for the SI joint and only intra-articular injections can selectively anesthetize the SI joint. One confounder may be the degree of pain the patient is in at the time of the injection. If the patient is not in a high level of pain, then the opportunity for demonstrating dramatic improvement is lessened. Control injections (control blocks) are useful in mitigating the placebo effect. Because of the risks of a false positive...
Physical fitness includes activities that will improve your strength, endurance, flexibility, and balance. It is divided into the following components cardiorespiratory endurance, which is the ability of your heart and lungs to transport oxygen through your body and is commonly referred to as aerobics-, muscular strength and endurance, which is the ability of your muscles to lift objects such as weights or groceries, and also helps you maintain good sitting posture if you use a wheelchair or better standing balance- flexibility, which is the ability of your muscles and tendons to move your joints through various angles and ranges, and balance, which involves your ability to maintain your center of gravity in a position that does not risk a fall. Depending on your condition, each of these components will require a greater or lesser amount of your attention. For example, someone with poor balance will have to spend more time performing exercises that will help maintain or improve...
The presenting symptoms include three p's pain, polyarthral-gia, and proximal muscle weakness. Most patients present with pain of insidious onset. The pain may be progressive and involve the spine, rib cage, pelvis, and the limb girdles. Several areas may be painful and tender simultaneously, thus simulating fibromyalgia and other systemic diseases. Many patients complain of bilateral joint pain and diffuse muscle aches. Polyarthralgia with synovitis of the hands and feet may develop. Myopathy can result in proximal muscle weakness, especially of antigravity muscles such as the quadriceps. The weakness gradually evolves and brings about functional deficits. Initially the patients complain of fatigue. Later on they develop difficulties getting up from the seated position, stair climbing, and maintaining their balance, and they eventually suffer falls. In longstanding untreated patients bony deformities such as kyphosis, scoliosis, bowed legs, and protrusio acetabuli may develop.
The following algorithm is proposed for athletes with recent injury, hip joint symptoms, and MRI evidence of labral pathology. The hip should be rested for 2 to 4 weeks to see if symptoms subside. If the pain subsides sufficiently, the athlete can then begin to resume activities and return to competition. If the symptoms are stable, it is unlikely that any further
Tumors adjacent to joints can be treated. Although the articular cartilage is at risk for a focal injury, none of our patients has had joint symptoms following the procedure. Bleeding has not been a problem with this technique, despite the fact that most patients take significant amounts of nonsteroidal anti-inflammatory medications and presumably have prolonged bleeding times.
Ing in loss of revenue from industry, as well as increased work load for general practitioners, hospital doctors, physiotherapists and other supporting staff. Back pain can be classified into acute (of less than 6 weeks' duration), sub-acute (of between 6 and 12 weeks' duration) and chronic (of greater than 12 weeks' duration). Pain practitioners tend not to be involved in the care of acute back pain, which is generally managed by patient education, physical rehabilitation with early return to normal activity, manipulation and simple analgesia. Most referrals to the pain clinic are for the management of mechanical or degenerative problems and are from general practitioners, orthopedic and neurosurgeons and rheumatologists, with the patients having generally been thoroughly examined and investigated. This section will outline the pain clinic management of non-specific mechanical back pain, as well as discuss in slightly greater detail the management of facet joint pain and radicular...
Sustained viremia (meaning viruses circulating in the bloodstream). The blood transports the virus to various body tissues, including the skin and joints. Humoral and cell-mediated immunity develop against the virus, and the resulting antibody-antigen complexes probably account for the rash and joint symptoms.
Extraarticular sources of hip pain can be the lumbar spine, sacroiliac joint, or sciatic nerve. Strains of certain muscles, such as the hip adductors or flexors, can also imitate hip joint symptoms. When deep tendinous involvement occurs, such as from the piriformis or iliopsoas tendon, it may be difficult to differentiate these symptoms from mechanical hip symptoms. Although uncommon, a femoral hernia also produces groin pain. Crepitus may be felt as the hips are put through range of motion. Manual muscle testing is a crude measure of hip function but may elicit symptoms localized to a specific muscle injury. Resisted active range of motion may also reproduce joint symptoms. The affected hip may have restricted range of motion because of pain or a mechanical block such as a loose body. The most specific indicator for hip joint pain is log rolling of the patient's leg. This action moves only the femoral head in relation to the acetabulum and the surrounding capsule. The absence of...
Pathomechanics of the hip and pelvis are viewed as primarily reflecting the joint pathology and secondarily reflecting joint compensation. For example, for a patient with degenerative changes within the joint, the primary disorder is the antalgic gait caused by joint pain. Secondary dysfunction may ensue due to weakness of the gluteus medius, presenting as an abductor lurch (Trendelenburg's gait). Disorders of the sacroiliac joint (S-I joint) and lumbar spine also become considerations with chronic hip dysfunction because of altered gait and weight-bearing mechanics (Figures 17.1, 17.2).
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Arthritis Joint Pain
Arthritis is a general term which is commonly associated with a number of painful conditions affecting the joints and bones. The term arthritis literally translates to joint inflammation.