ABSTRACT
OBJECTIVE: To provide a perspective on "whiplash" injury in Australia by examining conflicting evidence, which suggests on the one hand that the disorder is a culturally conditioned and legally sanctioned illness and on the other, that it is an occult injury which can cause chronic pain. DATA SOURCES: The published English language literature derived from MEDLINE covering epidemiological, pathogenetic and psychological aspects of "whiplash" injury, post-traumatic stress disorder, abnormal illness behaviour and iatrogenicity; the Australian legal literature; the printed news media; the Transport Accident Commission of Victoria and the State Government Insurance Commission of South Australia. DATA SYNTHESIS AND CONCLUSIONS: Comparative studies suggest that "whiplash" is an illness reinforced by legal and social sanction. Evidence from Victoria indicates that the reported incidence of "whiplash" can be reduced by minor legislative change. Occult injury to cervical intervertebral discs, vertebral end plates and cervical zygapophysial joints may be responsible for "whiplash" symptoms in some who are involved in motor vehicle accidents. This is likely to be confined to a small number of those involved in unexpected rear-end collisions.
Subject(s)
Whiplash Injuries , Accidents, Traffic/legislation & jurisprudence , Australia , Chronic Disease , Culture , Humans , Pain/etiology , Sick Role , Whiplash Injuries/classification , Whiplash Injuries/economics , Whiplash Injuries/physiopathologyABSTRACT
OBJECTIVE: To evaluate the currently perceived status of thermography in the diagnosis of musculoskeletal disorders. DATA SOURCES: Medical and legal journals published from 1956 onwards; report of the United States Office of Health Technology Assessment and personal communication with the author of that report. STUDY SELECTION: Confined to application of thermography to musculoskeletal and neurological medicine. DATA EXTRACTION AND SYNTHESIS: Weighted towards prospective and controlled studies. CONCLUSION: Little evidence exists of any application of thermography in which it is unequivocally superior to conventional diagnostic imaging methods.
Subject(s)
Bone Diseases/diagnosis , Muscular Diseases/diagnosis , Thermography , Bone Diseases/complications , Bone Diseases/physiopathology , Evaluation Studies as Topic , Humans , Muscular Diseases/complications , Muscular Diseases/physiopathology , Myofascial Pain Syndromes/diagnosis , Myofascial Pain Syndromes/physiopathology , Neck , Pain/etiology , Pain/physiopathology , Reflex Sympathetic Dystrophy/diagnosis , Reflex Sympathetic Dystrophy/physiopathology , Sciatica/diagnosis , Sciatica/physiopathology , Skin Temperature/physiology , Thermography/methods , Whiplash Injuries/diagnosis , Whiplash Injuries/physiopathologyABSTRACT
OBJECTIVE: To review the current medical and legal status and future directions of thermography. DATA SOURCES: Medical and legal journals published from 1956 onwards; report of the United States Office of Health Technology Assessment and personal communication with the author of that report; report of Australian Institute of Health and personal communication with the author; personal communication with members of the Therapeutics and Technology Assessment Subcommittee, American College of Neurology and with the Chairperson of the Commission of Technology Assessment and Efficacy Studies, American College of Radiology. STUDY SELECTION: Reports and position statements of statutory bodies and specialist colleges in the United States and Australia; legal judgments in both these countries. CONCLUSION: Acceptance of thermography is largely confined to those who use it and profit by its use.
Subject(s)
Bone Diseases/diagnosis , Forecasting , Muscular Diseases/diagnosis , Thermography/trends , Australia , Evaluation Studies as Topic , Humans , Income , Thermography/economics , Thermography/standards , Time Factors , United States , United States Office of Technology AssessmentABSTRACT
Of 50 patients in whom Morton's metatarsalgia was diagnosed during an 18-year period, 12 (24%) had rheumatoid arthritis at the time of presentation. After conservative management had failed, 20 patients had subtotal excision of the intermetatarsophalangeal bursa and associated digital nerve; in two patients, only the nerve was excised. During the follow-up period ranging from two months to 15 years, an additional eight patients developed sero-positive rheumatoid arthritis. Thus, a total of 20 patients (40%) presenting with Morton's metatarsalgia had rheumatoid disease at initial presentation or later developed this disease. Histological changes in the intermetatarsophalangeal bursa consistent with rheumatoid arthritis were found in ten patients. Of these, two were known already to have rheumatoid arthritis, three subsequently developed rheumatoid arthritis, and five do not yet have other evidence of the disease. The evidence suggests that Morton's metatarsalgia is associated with rheumatoid arthritis and is the basic etiology in a significant number of patients.
Subject(s)
Arthritis, Rheumatoid/complications , Bursitis/etiology , Metatarsophalangeal Joint , Toe Joint , Adult , Aged , Arthritis, Rheumatoid/diagnosis , Bursitis/pathology , Female , Humans , Male , Middle Aged , Neuralgia/etiology , SyndromeABSTRACT
Three case histories of patients with histologically proved malignant disease and an associated nonmetastatic symmetrical polyarthropathy are analysed. No evidence of a pathogenetic role for immune complexes was found in hypertrophic osteoarthropathy, whereas there is considerable evidence suggesting that the nonmetastatic polyarthritis associated with malignant lymphoma is an immune complex phenomenon.
Subject(s)
Antigen-Antibody Complex/analysis , Arthritis/immunology , Osteoarthropathy, Secondary Hypertrophic/immunology , Aged , Arthritis/etiology , Humans , Lymphoma/complications , Male , Middle Aged , Neoplasms/complications , Osteoarthropathy, Secondary Hypertrophic/etiologyABSTRACT
Surgical fusion of the upper cervical spine was used to treat atlanto-axial subluxation in 7 patients with rheumatoid arthritis. Postsurgical follow-up was 3 to 16 yr. Despite progressive and often severe radiological changes in the cervical spine, no patient has had a clinical recurrence of neck symptoms requiring further surgery. These results suggest that surgical fusion is successful in the longterm, despite the often dramatic radiological changes which occur in the cervical spine with the passage of time.
Subject(s)
Arthritis, Rheumatoid/complications , Axis, Cervical Vertebra/injuries , Cervical Atlas/injuries , Cervical Vertebrae/surgery , Joint Dislocations/etiology , Joint Dislocations/surgery , Spinal Fusion , Adult , Cervical Vertebrae/diagnostic imaging , Female , Follow-Up Studies , Humans , Male , Middle Aged , Postoperative Period , RadiographyABSTRACT
Ten patients with rheumatoid arthritis who were unable to tolerate anti-inflammatory doses of non-steroidal anti-inflammatory drugs (NSAIDs) were admitted to the study. After endoscopy three patients were taken out of the study because of frank gastric ulceration. Seven patients entered the six-week study during which anti-inflammatory doses of NSAIDs were preceded by 30 minutes by a 10-mg dose of oral metoclopramide. The insults of this pilot study suggest that pretreatment with metoclopramide enables patients with rheumatoid arthritis who have non-ulcer dyspepsia to tolerate full dosage of NSAIDs.
Subject(s)
Anti-Inflammatory Agents/adverse effects , Arthritis, Rheumatoid/drug therapy , Metoclopramide/therapeutic use , Adult , Aged , Drug Therapy, Combination , Female , Gastrointestinal Diseases/chemically induced , Gastrointestinal Diseases/prevention & control , Humans , Male , Middle Aged , PremedicationABSTRACT
A case of hypertrophic osteoarthropathy associated with carcinoma of the lung is presented. The symptomatology of the former usually dominates the clinical picture so that early diagnosis of the underlying carcinoma often depends on recognition of hypertrophic osteoarthropathy. A brief review of the literature is given.
Subject(s)
Carcinoma/diagnosis , Lung Neoplasms/diagnosis , Osteoarthropathy, Secondary Hypertrophic/diagnosis , Carcinoma/complications , Diagnosis, Differential , Humans , Lung Neoplasms/complications , Male , Middle Aged , Osteoarthropathy, Secondary Hypertrophic/etiologyABSTRACT
A case of the yellow nail syndrome with associated bronchiectasis, arterial insufficiency and Raynaud's disease is presented. A brief review of some of the literature on the yellow nail syndrome is made. A relationship between these problems is postulated.
