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At least 1,135 records · Page 63Linked to original sources
PubMed2004

Pelvic pain during pregnancy: a descriptive study of signs and symptoms of 870 patients in primary care.

STUDY DESIGN: The authors conducted a cross-sectional analysis. OBJECTIVE: The objective of this study was to describe the signs and symptoms of pregnant women with pain and dysfunction in the pelvic area. SUMMARY OF BACKGROUND DATA: Pelvic pain during pregnancy is common with incidence rates of 48% to 56%. The exact cause of pelvic pain during pregnancy is still unclear. Also unclear is the association between physical examination and the occurrence of pelvic pain during pregnancy. METHODS: Pregnant women with pelvic pain were sent for treatment to 2 physical therapy practices between January 1997 and January 2002. A standardized clinical examination protocol and an extensive questionnaire were used to obtain relevant clinical and demographic characteristics. RESULTS: In total, 870 women were included. The average score of the overall severity of the complaints was 7.8 (scale 0-15). Main complaints were located around the sacroiliac joints (76.6%) and the pubic symphysis (57.2%). The area of pain was not related to positive signs in passive hip movements and sacroiliac tests. The highest positive test results were found for Patrick sign (71.7%), active straight leg raise (ASLR) test (66.4%), resisted adduction (54.4%), and passive hip abduction (36.9%). Overall severity of complaints was related to age, number of weeks pregnant, passive hip flexion and internal rotation, and swimming. The total explained variance of these factors was 15.9%. No relationship was found between overall complaints and sacroiliac tests, pelvic pain during a previous pregnancy, extremely painful or type of previous deliveries. CONCLUSIONS: Pregnant patients with pelvic pain show a considerable level of complaints. The overall severity of complaints is not related to previous peripartum pelvic pain or type of deliveries or to commonly used tests. Further study on the role of clinical examination, including passive flexion and internal rotation of the hip joints, is recommended.

Adolescent↗
PubMed2000

Manipulation under joint anesthesia/analgesia: a proposed interdisciplinary treatment approach for recalcitrant spinal axis pain of synovial joint origin.

BACKGROUND: Manipulation under joint anesthesia/analgesia (MUJA) is an approach to treatment for patients with chronic, recalcitrant spinal axis pain of synovial joint origin. MUJA is the synthesis of fluoroscopically and corticosteroid agents with targeted, manual mobilizations and/or manipulations of the injected joint(s). DISCUSSION: MUJA should be viewed with guarded optimism because its success is based solely on anecdotal experience. Many physicians (specializing in targeted intraarticular "blocks" of spinal synovial joints) and chiropractors (specializing in manual mobilization and manipulation of spinal synovial joints) in the Tyler, Texas, area have treated more than 1000 patients over a 7-year period with the MUJA protocol. This protocol includes treatment of the atlanto-occipital and lateral atantoaxial joints of the upper cervical spine, the zygapophysial joints of the cervical spine from C2-3 to C6-7, the thoracic spine and the lumbar spine, and the pelvic sacroiliac joints. CONCLUSION: The following patient types are suitable candidates for MUJA: patients with dominant spinal axis pain who have been unable to progress despite the passage of sufficient time (>2 months) and the delivery of prior treatments, including spinal manipulative therapy; patients with pain so severe that standard manipulative therapy cannot be delivered with technical success; and patients with complex problems in whom the diagnosis of synovial joint-mediated spinal pain must be established before the safe delivery of manipulative therapy.

Analgesics↗
PubMed2003

[Clinical characteristics of children with enthesitis related arthritis].

OBJECTIVE: To study clinical characteristics of children with enthesitis related arthritis (ERA). METHODS: Twelve patients fulfilling the international league of associations for rheumatology (ILAR) criteria for classification of juvenile idiopathic arthritis (JIA) and ERA were referred to our department between August and November, 2002. Their gender, age, family history, clinical manifestations, imaging data, laboratory data and treatment regimens were analyzed retrospectively. RESULTS: Of the 12 patients, 11 were male, only one was female; their age ranged from 4 to 16 years, and the median age was 10.5 years. Ten (83%) of the patients were older than eight years. Among their first degree relatives, one had definite ankylosing spondylitis (AS), and 3 presented with a history of inflammatory low back pain. Enthesitis occurred in 9. Synovitis occurred in 11, most of which were oligoarthritis, predominantly affecting large joints of the lower limbs in an asymmetric pattern. Seven patients underwent CT scan, and only one had erosions of the sacroiliac joints to achieve a diagnosis of juvenile AS. Ten had fever at the onset, and one had a history of diarrhea preceding the symptoms of arthritis. Urethritis and balanitis circinata occurred in 3 cases fulfilling the classification criteria of Reiter's syndrome, with conjunctivitis in 2 and corneitis in one. Elevated inflammatory indicators such as white blood cell, neutrophil, platelet, erythrocyte sedimentation rate, C-reactive protein, immunoglobulins and serum complement C3 were common during the acute illness. Mild anemia was found in 4, and reactive hemophagocytosis in 4 bone marrow specimens. DNA of human parvovirus B19 was detected in sera of 2 cases. One had positive IgM antibody to coxsackie virus B. All 12 cases were rheumatoid factor negative and HLA-B27 positive. Nonsteroidal anti-inflammatory drugs and sulfasalazine were the mainstay of treatment. Corticosteroids were added in 3 cases as a "bridge" therapy due to the severe systemic inflammation. Methotrexate was used in 4 cases with refractory disease or with the hip involved, and in 2 of them cyclophosphamide was added. CONCLUSION: The clinical characteristics of ERA can facilitate an early diagnosis so as to avoid joint damage and disabilities.

Adolescent↗
PubMed1988

Chronic sclerosing osteomyelitis of the iliac bone. Etiological possibilities.

An adolescent with chronic recurrent multifocal osteomyelitis located to both iliac bones and an adult with pustulotic arthro-osteitis, involving the left iliac bone, an invertebral space, and the sternoclavicular, first sternocostal, manubriosternal and single peripheral joints are described. Their iliac bone changes were identical, except for the occurrence of bilateral changes in the adolescent, and ankylosis of the sacroiliac joint in the adult. It is suggested that chronic recurrent multifocal osteomyelitis and pustulotic arthro-osteitis may be related diseases with age-dependent differences.

Adolescent↗
PubMedDate not supplied

[Ochronotic arthropathy: the value of bone scintigraphy in alkaptonuria].

We report the case of a 62 year old man diagnosed of alkaptonuria who was referred to our department to undergo bone scintigraphy for polyarthralgia. The patient had a history of pain in lumbar and thoracic spine, right shoulder and left knee. Bone scintigraphy showed multiple joint disease with increased uptake in both shoulders, knees and spine. Higher uptake stood out in painful right shoulder and left knee joints. Ochronotic arthropathy that is developed in alkaptonuric patients is a degenerative joint disease. X-ray studies in this patient showed marked degenerative arthrosis in knees and shoulders, without more intense involvement in the symptomatic joints. Lumbar spine X-rays showed intervertebral disk calcification with disk collapse and fusion of the vertebral bodies with relative sparing of sacroiliac joint, which is a classic feature of ochronotic arthropathy. This case highlights the utility of bone scintigraphy in the evaluation of joint involvement as well as its correlation with clinical course and potential usefulness in the follow-up of this disease.

Alkaptonuria↗
PubMed1994

Problems and paradigms in joint pathology.

This short review outlines aspects of joints relevant to current problems in articular, connective tissue disease and describes the pathology of rheumatoid arthritis and osteoarthrosis. The synovial joints display greatly varying degrees of anatomical specialisation. There is also heterogeneity of microscopic structure, to illustrate which the synovial components of the sacroiliac joints are considered. The chondron is regarded as a functional unit of hyaline articular cartilage but the responses of this tissue in disease are strongly influenced by its avascularity and by the need for chondrocytes to communicate with each other and with their local and systemic environments. Hyaline cartilage is capable of molecular replacement or substitution but not of repair by regeneration; it can, however, be replaced by fibrocartilage. The bearing surfaces of hyaline articular cartilage are never planar or smooth. Rheumatoid arthritis is a paradigm of connective tissue disease. It is not only a systemic disorder which may abbreviate life but, characteristically, is an aseptic form of symmetric polyarthritis. The inheritance of HLA-DR beta 1 and of female sex predispose to rheumatoid arthritis but the cause is unknown; it may be viral. Central to the disease is destruction of articular cartilage by sustained inflammation in which activated macrophages and TH cells, possibly of restricted clonality, combine to release cytokines, proteinases and the mediators of inflammation. Osteoarthrosis is a synovial joint syndrome, not a single disease. It is characterised by a loss of and change in the composition of cartilage proteoglycans leading to failure of normal responses to stress. The results include cartilage fibrillation and loss, bone exposure and a clinical syndrome of pain and disability. Rare forms of heritable chondrodysplasia lead to premature osteoarthrosis but, in most instances, the cause of osteoarthrosis appears to be either excess, inappropriate or insufficient mechanical demand, or traumatic, infective, inflammatory, endocrine or metabolic disease. There remain idiopathic ('primary') cases in which no cause is demonstrable.

Arthritis, Rheumatoid↗
PubMed1977

Juvenile ankylosing spondylitis.

The clinical histories and radiographs of 28 patients with ankylosing spondylitis were reviewed. Symptoms developed before the age of 17 in all cases. Juvenile ankylosing spondylitis affected youths in their early teens, who presented most commonly with appendicular joint complaints rather than low back pain. The disease was progressive, with the characteristic changes of ankylosing spondylitis eventually occurring in the spine and sacroiliac joints, frequently accompanied by widespread and severe changes in the appendolar joints. HLA B 27 antigen was present in 8 of the 9 patients tested. Thorough clinical, radiographic, and laboratory examination should prevent confusion with juvenile rheumatoid arthritis.

Adolescent↗
PubMed1954

[Sacroiliites].

Explore the source record for details and available documents.

Disease↗
PubMedDate not supplied

Interventional musculoskeletal radiology.

Interventional procedures constitute a significant proportion of musculoskeletal radiology. Percutaneous needle biopsy is the ultimate diagnostic technique for the evaluation of musculoskeletal neoplasms and infections. The procedure is accurate, rapid, and safe. It is ideally suited for the diagnosis of metastatic disease and round cell neoplasms. Several needle procedures have been used for the diagnosis and treatment of low back pain. Diskography is primarily a diagnostic test used to determine the symptomatic disk level when multilevel disk disease is present and also to diagnose internal disk disruption. Nerve block with local anesthetic is also used to locate the symptomatic level in patients with multilevel abnormalities. Epidural steroid injection is a therapeutic procedure that commonly is used in patients with low back pain and has been shown to be most effective in patients with disk herniation. Facet joint injection with local anesthetic and steroid is performed to diagnose and treat the facet syndrome. Other needle procedures in the musculoskeletal system include sacroiliac joint aspiration and injection, prosthetic joint aspiration to evaluate potential infection, distention arthrography, and injections of the coccyx for coccydynia.

Adrenal Cortex Hormones↗