Analysis of misdiagnosed cases of neck, shoulder, waist and leg pain caused by bone metastases and early warning measures / 中国基层医药

Objective:To investigate the cause of misdiagnosis of neck, shoulder, waist, and leg pain caused by bone metastases and to improve the outpatient diagnosis rate.Methods:Five misdiagnosed cases of bone metastases who were admitted to the Traditional Chinese Medicine Department of Orthopedics and Traumatology, School of Traditional Chinese Medicine, Southern Medical University from January 2019 to July 2020 were included in this study. Their clinical manifestations, diagnosis results (outside hospital diagnosis and outpatient diagnosis), and imaging manifestations were retrospectively analyzed.Results:Five cases of bone metastases were misdiagnosed to have cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain. Accelerated red blood cell sedimentation rate and increased C-reactive protein level were found in all five cases. Bone metastases were confirmed by X-ray, CT, and MRI examination results. All of them had warning signs for bone metastasis: age > 50 years, history of a tumor, unexplained weight loss, general malaise, neck, shoulder, waist, and leg pain without an obvious cause, sudden worsening of pain, night pain, resting pain, pain on direct palpation, no obvious improvements in these symptoms after symptomatic treatment for 1 month, disease development not conforming to the general law of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, increases in red blood cell sedimentation rate, C-reactive protein, and alkaline phosphatase levels, which are not consistent with the symptoms of cervical spondylosis, lumbar disc herniation, femoral head necrosis, femoral shaft fracture, and ankle sprain, and slight external force leading to fractures.Conclusion:Further tests and imaging examinations should be performed according to warning signs. Clinical schemes of malignant bone tumors suitable for general practitioners can easily, economically, and effectively identify malignant bone tumors.

Calf pain as a prominent feature of Behçet's Disease

Objective@#This study aimed to present four cases of Behçet's disease (BD) wherein recurrent calf pain was the first and prominent symptom experienced by the patients. @*Methodology@#The case series described the clinical features, disease development, management, and outcomes of these patients. Written consent was obtained from each participant for the review and publication of their case. @*Results@#All cases presented with chronic and recurrent calf pain, three of whom were bilateral. All four had skin changes on the lower extremities that may have contributed to leg pain. Only probing was a history of oral ulcers reported in all four; none had genital ulcers, eye abnormality, or sensory or motor deficits. All presented with elevated acute phase reactants. Based on the 2013 International Criteria for Behçet’s Disease (ICBD), a diagnosis of possible BD was made due to the presence of oral ulcers, skin lesions, and absence of other findings pointing to another connective tissue disease or systemic vasculitides. All four cases were given oral corticosteroids and colchicine, but two required the addition of methotrexate and azathioprine for control of symptoms. @*Conclusion@#A complaint of recurrent calf pain warrants inquiry and examination of the skin lesions over the affected area and other areas like the oral cavity and genital area. It also warrants consideration of a vasculitic process, especially in the background of oral ulcers and skin changes. In such cases, BD is the right differential diagnosis to be considered.

Tuina combined hot compress for low back pain due to lumbar disc herniation / 国际中医中药杂志

Objective:To explore the efficacy of Tuina combined hot compress in the treatment of lumbar disc herniation (LDH).Methods:A total of 90 patients with LDH low back and leg pain in Shijiazhuang Traditional Chinese Medicine Hospital from January 2019 to June 2020 were divided into two groups, 45 in each group. The control group was treated with Aceclofenac Sustained-release Tablets and Mecobalamin, and the observation group was treated with Tuina combined hot compress. Both groups were treated for 1 month and followed up 6 months. The Visual Analogue Scale (VAS) was used to evaluate the degree of pain. The Oswestry Dysfunction Index (ODI) was used to evaluate the recovery of lumbar function, and the improvement of daily activities of patients after treatment was evaluated. The conduction velocity of tibial nerve motor conduction velocity (TNMCV) and common peroneal nerve motor conduction velocity (CPNMCV) were measured by electromyography. The clinical effect was evaluated.Results:After 6 months of follow-up, the response rate of the observation group was 51.1% (23/45) and that of the control group was 28.9% (13/45) ( χ2=3.98, P=0.046). The VAS score of the observation group was significantly lower than that of the control group ( t=11.26, P<0.01). The ODI scores at 1 month after treatment and 6 months after follow-up were significantly lower than those in the control group ( t values were 7.19, 18.30, respectively, all Ps<0.001). The observation group 1 month after CPNMCV treatment and 6 months of follow-up ( t=2.08, 1.99), 1 month after TNMCV treatment and 6 months of follow-up ( t values were 2.46, 2.12, respectively) were significantly higher than those in the control group ( P<0.05). Conclusion:Tuina combined with hot compress can improve the nerve conduction velocity of lower limbs, relieve the symptoms of low back and leg pain in patients after LDH operation.

Meta analysis of clinical study on lumbago and leg pain treated by Yaotongning Capsule / 中草药

Objective: To systematic evaluate the efficacy and safety of Yaotongning Capsule in the treatment of lumbago and leg pain. Methods: The databases of CNKI, VIP, Wanfang and Chinese science citation were searched by computer, and the randomized controlled trials of Yaotongning Capsule in the treatment of lumbago and leg pain were collected. Two researchers independently selected literatures, entered data, and evaluated the quality of literature methodology. Review Manager 5.3 software was used for Meta analysis. Results: This study included 11 RCTs, 1 200 patients, 599 cases in Yaotongning group and 601 cases in control group. Meta analysis showed that the effective rate of Yaotongning Capsule in the treatment of lumbocrural pain was better than that of the control group (OR = 4.13, 95% CI [2.90, 5.88]), P < 0.000 01; The improvement of VAS pain score of Yaotongning Capsule was better than that of the control group (SMD = -1.22, 95% CI [-1.71, -0.73]), P < 0.000 01, (SMD = -2.09, 95% CI [-2.14, -2.04]). The improvement of JOA function score was better than that of the control group (SMD = 6.78, 95% CI [5.21, 8.26]), P<0.000 01, the difference was statistically significant. Conclusion: Yaotongning Capsule can effectively improve the lumbar activity function and clinical symptoms of patients with lumbocrural pain, and the degree of pain relief is positively correlated with the course of treatment and dose. However, the included sample size and observation indicators may lead to bias. It is expected that more researchers can conduct multi center, large sample, scientific and complete research to evaluate the efficacy and safety of Yaotongning Capsule in the treatment of lumbocrural pain.

Two Cases of Leg Pain Successfully Treated Using the Kampo Medicine Chikujountanto in Consideration of Phlegm-Fluid Retention / 日本東洋医学雑誌

Few reports have described the effect of phlegm-­fluid retention on the development of pain. We herein rep­ort two successful treatment cases of lower leg pain using chikujountanto in consideration of phlegm-­fluid re­tention. Case 1 (a 63-year-old woman) complained dull pain in the right calf. The pain persisted despite the ad­ministration of sokeikakketsuto for over two weeks. Case 2 (a 42-year-old woman) suffered from right buttock pain that had developed after a traffic accident. The pain persisted even at three months following the accident. The pain in both patients resolved within one week after treatment with chikujountanto, which was given on the basis of the patients' insomnia, thickened yellow fur on the tongue, and pain in the gallbladder meridian. We concluded that the concept of phlegm-­fluid retention should be considered for differential diagnosis when we treat pain.

Modified transobturator tape for female stress urinary incontinence / 中华泌尿外科杂志

Objective To explore the efficacy and safety of modified transobturator tape (TOT) for female stress urinary incontinence (SUI).Methods From June 2015 to June 2017,a total of 87 SUI patients,including 35 patients underwent standard TOT operation (standard TOT group) and 52 patients underwent modified TOT operation (modified TOT group),were retrospectively reviewed.There was no statistical difference of age [(59.7 ± 10.3) yea~ vs.(56.3 ± 9.1) years],BMI [(24.I ± 9.7) kg/m2 vs.(24.6 ± 9.3) kg/m2],diabetes history [31.4％ (11/35) vs.26.9％ (14/52)],mixed urinary incontinence [45.7％ (16/35) vs.48.1％ (25/52)] and the daily amount of urine pad [(4.3 ±2.7) vs.(3.9 ± 2.1)] between the two groups (P ＞ 0.05).The operative time,intraoperative complications,and postoperative complications were collecteded in two groups.Patients were followed up at 3 months,6 months,and 1 year after surgery.Results There was no significant difference in operation time [(21.1 ± 4.3) min vs.(20.5 ± 5.7) min],intraoperative hemorrhage [(18.3 ± 9.1) ml vs.(25.7 ± 8.3) ml] and postoperative incidence of urinary retention [2.9％ (1/35) vs.3.8％ (2/52)] between the two groups (P ＞ 0.05).The incidence of postoperative leg pain was significantly lower in modified TOT group than in TOT group[1.9％ (1/52) vs.20.0％ (7/35),P ＜ 0.05].There was no significant difference in subjective cure rate and objective cure rate between the two groups at 3 months,6 months and 1 year after surgery (P ＞ 0.05).Conclusions Compared with the standard TOT,the modified TOT of modified puncture port has a similar cure rate and efficiency.However,the use of modified TOT can significantly reduce the incidence of postoperative short-term leg pain,but the long-term efficacy still needs to be further followed-up.

Clinical research progress of straight leg raising test / 中国医师杂志

As a clinical diagnosis and treatment of low back pain,straight leg raising test has been used most commonly more than 100 years.It is simple and practical,and has a high clinical value.As a very mature orthopedic special examination,straight leg raising test progress in non-orthopedic applications more often than orthopedic aspects.Of course,the most important thing is the diagnosis of low back pain,followed by the treatment of low back pain,and then can be used as a respiratory and circulatory aspect of diagnosis and treatment options.This article elaborated the principle of straight leg raising test and the clinical research progress in order to give the clinician some guidance.

A Retrospective Study Assessing Kampo Medicine for the Treatment of Lower Extremity Symptoms Caused by Lumbar Spinal Diseases / 日本東洋医学雑誌

We assessed the efficacy of Kampo medicine for lower extremity symptoms caused by lumbar spinal diseases, such as lumbar spondylosis, spinal canal stenosis, and post-spinal surgery syndrome. In particular, we evaluated its usefulness for lower extremity pain, coldness, and numbness. In addition, the efficacy of antecedent drug selection and pain treatment was also assessed. In accordance with Japanese traditional herbal medical practice, keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto were prescribed primarily for lower extremity symptoms caused by lumbar disease. Thirty-two of 60 (53%) cases with lower extremity pain, 17 of 34 (50%) cases of pain with coldness, and 4 of 19 cases (21%) of pain with numbness were improved by these drugs. We conclude that the addition of keishikajutsubuto, shimbuto, ryokyojutsukanto, tokishigyakukagoshuyushokyoto, goshajinkigan, and shakuyakukanzoto after antecedent pain therapy was effective in treating lower extremity symptoms caused by lumbar disease.

Painful legs and moving toes syndrome in a 16-year-old girl / 소아과

Painful legs and moving toes (PLMT) syndrome is characterized by spontaneous movements of the digits and pain in one or both lower extremities. Of the reported cases, a majority of the patients was female, and the mean age of onset was 58 years. Only one pediatric case has been reported so far. Herein, we report the first adolescent case of PLMT in Korea. A 16-year-old girl complained of tingling pain in the left leg and involuntary movement of the ipsilateral great toe one month after a second untethering surgery. Three years ago, she had undergone untethering surgery to correct lipomeningomyelocele at the S2 level of the conus medullaris. At that time, she was diagnosed with polyradiculopathy at the left L5 level with axonal involvement. We diagnosed her with PLMT syndrome and prescribed gabapentin. Her symptoms diminished within a day. Complete relief from involuntary movement of the toe was achieved within four months. PLMT is a rare syndrome but it should be considered in the differential diagnosis of children and adolescents with limb pain and spontaneous movement in their toes.

Diagnostico del sindrome compartimental inducido por el ejercicio mediante resonancia magnetica post-esfuerzo / Post-exercise MRI for diagnosis of chronic exertional compartmental syndrome

RESU MEN: El SCIE representa la causa del 27% de los cuadros de dolor anterior de pierna en atletas. El origen del dolor en este cuadro es aún discutido. La medición de la presión intracompartimental es el gold standard en el diagnóstico, aunque es un estudio invasivo. El desarrollo e interpretación de nuevas secuencias en RMN, aportaron una alternativa en el diagnóstico incruento del SCIE. La RMN post-esfuerzo es una opción atractiva y atraviesa en la actualidad su proceso de validación. MATERIAL Y MÉT ODOS Se evaluaron 22 pacientes con diagnóstico clínico de síndrome compartimental inducido por el ejercicio, con una media de seguimiento de 5 años (1-10 años). Todos fueron evaluados mediante examen clínico, RM pre y post actividad física y medición de presión intracompartimental pre y post actividad física. La resonancia magnética se realizó en reposo y luego de la prueba de esfuerzo. La medición de presión intracompartimental se realizó con la técnica de Whitesides, el diagnóstico se realizó con los criterios de Pedowitz. RESULTADOS De los 22 pacientes, 19 tuvieron una medición intracompartimental positiva (15 masculino, 4 femenino) y 3 una medición negativa. Todos los pacientes tuvieron una RMN normal en reposo. En los 3 pacientes que tuvieron medición intracompartimental negativa, la RMN post-esfuerzo fue normal. De los 19 pacientes restantes, la RMN detectó señal hiperintensa en T2 y STIR en 15 de ellos (78,95%). CONCLUSIONES La RMN podría tener un lugar en el diagnóstico, para lo cual debería mejorarse la sensibilidad de este método. No obstante, la medición intracompartimental pre y post-esfuerzo sigue siendo el gold-standard. Nivel de evidencia: IV

BACKGROUND: Chronic exertional compartment syndrome (CECS) is the cause of 27% of anterior leg pain in athletes. The source of pain in this condition is still debated. Measurement of intracompartmental pressure is the gold standard diagnosis, albeit an invasive study. The development and interpretation of new MRI sequences has provided a non-invasive alternative to CECS diagnosis. Post-exercise MRI is an attractive option which is currently undergoing its validation process. METHODS: 22 patients with a clinical diagnosis of CECS were included, with a median follow-up of 5 years (1-10 years). All the patients were evaluated by clinical examination, pre- and post-exercise MRI and pre-and post-exercise intracompartmental pressure measurement. Pressure was measured with Whitesides technique, and diagnosis was carried out by Pedowitz criteria. RESULTS: Out of the total 22 patients, 19 had positive intracompartmental measurement (15 male, 4 female) and 3 had negative measurement. All the patients had a normal MRI at rest. The three patients who had negative intracompartmental measurement had a normal post-stress MRI. Out of the remaining 19 patients, the MRI detected hyperintense signal in T2 and STIR weighted in 15 of them (78,95%). CONCLUSIONS: MRI could be relevant for diagnosis, for which case the sensitivity of this method should be improved. Nevertheless, pre- and post-stress intracompartmental measurement continues to be the gold-standard. Level of evidence: IV

High-resolution CT Reconstruction and Diagnosis in Syndrome for Hypertrophy of Transverse Process of the Fifth Lumbar Vertebra / 中国医学影像学杂志

Purpose To investigate the diagnostic value of high-resolution CT reconstruction techniques on the same slice in hypertrophy of transverse process of the fifth lumbar vertebra (HTPL5V), and to provide a basis for clinical diagnosis and treatment. Materials and Methods Twenty-two cases of clinically diagnosed HTPL5V and 20 normal adults were examined with GE LightSpeed 16-slice spiral CT (36 cases) and Philips iCT 256-slice (6 cases). L5 transverse process and the fifth lumber nerve were reconstructed and observed on the workstations. Results In 22 cases of HTPL5V, there were 26 pseudarthrosis formation and 2 sides with L5 transverse process touching the sacral ala. In 28 sides the iffth lumber nerve traveled through false foramina of the HTPL5V including 6 cases of bilateral compression and 16 cases of unilateral compression. In 21 cases, the nerve was compressed by hyperosteogeny on 27 sides (96.4%) and 1 side due to stenosis (3.6%). On 25 sides (89.3%) the compressed nerves were curved in shaper. There was bulging and/or herniated lumbar disc on 9 sides in 7 cases (32.1%). Conclusion High-resolution CT reconstruction techniques can demonstrate the iffth lumbar nerve of HTPL5V and provide evidence for clinical diagnosis and treatment.

Effect of traditional Chinese medicine wine combired with electromagnetic therapy for the neck,shoulder, back and leg pain / 现代临床护理

Objectives To explore the effect of traditional Chinese medicine wine combired with electromagnetic therapy for the neck,shoulder,back and leg pain. Methods Eighty cases of patients with neck,shoulder,back and leg pain were randomly divided into 2 groups,with 40 cases in each group,treatment group was given the traditional Chinese medicine wine and electromagnetic therapy,the control group was prescribed(only with electromagnetic therapy),use the numerical rating scale to observe the effects of two groups before therapy,3 days and 7 days after therapy . Result After treatment,the pain of the treatment group was relieved significantly better than that of the control group(P<0.05). Conclusion Traditional Chinese medicine wine combired with electromagnetic therapy for the neck,shoulder,back and leg pain has satisfactory effect,and is worthy to promotion.

Non-Hodgkin Lymphoma Occurred in Psoas Muscle / 대한정형외과학회잡지

One fourth of cases of non-Hodgkin lymphoma were reported as extranodal type and skeletal muscle involvement rarely seen as a primary event and local dissemination. The psoas involved lesion with spine mimicking pain is caused mainly by infection rather than non-infected conditions such as tumor. We report on a rare case of non-Hodgkin lymphoma occurring in psoas muscle, which required differentiation from a psoas abscess.

The Complication after Lumbar Puncture in Patients in Children and Adolescents / 대한소아신경학회지

PURPOSE: Children and adolescents develop different kinds of complication, such as back pain or headache after lumbar puncture. But there are few researches about complications after lumbar puncture. So we investigated the incidence of complications and the factors that might influence the occurrence of complications. METHODS: We reviewed the medical record of 101 patients who have conducted lumbar puncture because they were suspected of meningitis between April 2008 and August 2008 at Sanggye Paik Hospital. We evaluated for the existence of complications and the factors that might influence postlumbar complications. RESULTS: The total incidence of complications was 58 of 101(57.4%) patients. The complications were as followed; backache(47/101, 46.5%), headache(16/101, 15.8%), leg pain (14/101, 13.9%), nausea and vomiting(5/101, 5%) and dizziness(3/101, 3%). There was no significant correlation between various factors and the occurrence of the complications. But patients who had conducted lumbar puncture with 21-gauge or 22-gauge suffered longer duration of backache than 24-gauge cannula. CONCLUSION: The occurrence of complications after lumbar puncture was 57.4% and the complications were various, for example, backache, headache, leg pain and so on. Patient's age, gender, disposable puncture needle, and character of CSF(cerebrospinal fluid) were not correlated to the occurrence and duration of complications. But patients who had conducted lumbar puncture with large gauge cannula suffered longer duration of backache.

Eythromelalgia Mimicking Lower Leg Pain of Spinal Origin : Case Report / 대한정형외과학회잡지

Erythromelalgia is a rare condition, of uncertain etiology, characterized by episodic erythema, intense burning pain and warmth of the hands and/or feet. We present here a case of erythromelalgia that was almost mistaken for lower leg pain of spinal origin. The diagnosis is based on a thorough history and physical exam during a painful episode along with diagnostic test to exclude other causes. A 69-year-old man developed recurrent attacks of redness, swelling and burning painful sensations of both feet. His symptom was aggravation of pain with warm water immersion. His symptom improved by antidepressant and steroid. To be learned an important general lesson is to pay attention to performing extensive diagnostic and therapeutic procedures. It should be appreciated that discontinuation of medication can also be used as a simple diagnostic test for clinical syndromes, such as erythermalgia.

Herpes Zoster Confused with Radiculopathy / 대한정형외과학회잡지

PURPOSE: To describe the clinical features of herpes zoster that can be easily misdiagnosed as cervical or lumbar radiculopathy. MATERIALS AND METHODS: We retrospectively reviewed the medical records and diagnostic studies of 7 patients with herpes zoster-related arm or leg pain. RESULTS: Except one immunocompromised patient with suspected postherpetic neuralgia or sequelae of herpetic myelitis, the other 6 patients with herpes zoster complained of very severe initial pain of sudden onset. Three patients did not show skin lesions on initial examination, and 2 of 5 patients with an MRI of the cervical or lumbar spine had findings consistent with their arm or leg pain and may have been confused with radiculopathy. Conservative treatment, including antiviral agents, improved the symptoms of all patients except the immunocompromised one. Selective nerve root blocks of the corresponding dermatomes were performed in 5 patients and extremity pain decreased over 50% in 4 of them. CONCLUSION: Herpes zoster can be confused with radiculopathy in patients with arm or leg pain if the typical skin lesions have not been developed. Unnecessary treatments including surgery should be avoided by early, correct diagnosis through prudent history taking and physical examination.

Application of the Kappa statistic in MRI diagnosis of lumbar disk herniation / 中华放射学杂志

Objective To assess the concordance of MRI diagnosis for patients suspected of lumbar disk herniation by using Kappa statistic.Methods One hundred patients(48 males and 52 females)with lumbosaeral radicular pain,aged from 17 to 86(average 61).All patients underwent fast spin-echo T1 and T2 weighted imaging on a 3.0 T MR scanner and spine surface coil.Two radiologists(doctor A and doctor B)evaluated the lumbar disks from L3-4,L4-5.and L5-S1 in 50 out of the 100 patients independently.The presence of a bulging disk or a herniation was reported.Images were interpreted twice:once before and once after disclosure of clinical information.And disks of 52 patients out of the 100 samples were interpreted by the two radiologists independently without clinical information as well.The Kappa statistics was employed to assess the concordance of each radiologist's diagnoses as well as the observer variation of the two radiologists.Results Diagnoses before and after disclosure to clinical information were concordant in 114 disks for doctor A and in 109 for doctor B.respectively.Diagnoses before and after disclosure to clinical information were not concordant in 36 disks for doctor A and in 41 disks for doctor B,respectively.The Kappa values were 0.60±0.06 and 0.57±0.06 for doctor A and doctor B,respectively.The concordance was moderate.After disclosure to elinical information.the numbers of reported bulging disks increased significantly.by 10 and 31 for doctor A and doctor B,respectively.Without clinical information,the diagnoses of the two radiologists were concordant in 77 disks,while not concordant in 79 disks.The interobserver agreement was poor(Kappa=0.24±0.06).The diffcrence on diagenoses made between with and without clinical information mainly happened on the differential diagnosis of normal disks and bulging disks.The different,diagnoses made between with and without clinical information were on 20 disks and on 30 disks for doctor A and doctor B,respectively;that accounted for 55.6%(20/36)and 73.2%(30/41)of total variation respectively.The diagnostic difference between the 2 doctors happened mainly on differentiation of bulging disks and normal disks,which happened in 56 disks,aceountiong for 70.9%(56/79)of total variation.Conclusion Variation on diagnoses of the same radiologist or between tworadiologists was mainly caused by disagreement on bulging disks.

Chronic Exertional Compartment Syndrome in Behcet's Disease : A case report

We experienced a patient who presented recurrent episode of pain, swelling, and weakness of right lower leg. She was diagnosed as Behcet's disease 1 year ago. The symptom was developed after exercise and was relieved by rest. After several different examinations and differential diagnoses, we confirmed the diagnosis as chronic exertional compartment syndrome on the basis of measuring intramuscular compartmental pressure. The patient was recommended to take a rest and she got a shoe-modification, prescription of ankle- foot orthosis, and physical therapy. She experienced symptom relief after that. Chronic exertional compartment syndrome is uncommon disease caused by reversible ischemia secondary to increased pressure within a closed osseofascial compartment after exercise producing expansion of muscle volume.