ABSTRACT
Recent cross-sectional studies in children of most music schools show that there is a continuously increasing development of musculoskeletal symptoms and disorders due to an asymmetry of posture which is given by the kind of the musical instrument played by the pupils. An ergonomic adaptation of music instruments according to body size, but also specific muscular training, a consequent warm up before playing and rigorous time management can help to avoid these overuse or repetitive strain syndromes that often interfere with the ability to play the instrument as usual.
Subject(s)
Musculoskeletal Diseases/prevention & control , Music , Occupational Diseases/prevention & control , Students , Adolescent , Age Factors , Body Constitution , Body Height , Child , Cross-Sectional Studies , Ergonomics , Female , Humans , Male , Motor Activity , Muscle Stretching Exercises , Musculoskeletal Diseases/epidemiology , Musculoskeletal Diseases/etiology , Occupational Diseases/epidemiology , Occupational Diseases/etiology , Practice, PsychologicalABSTRACT
We describe a 33-year-old woman with a bilateral fracture of the sacrum associated with pregnancy. Dual-energy X-ray absorptiometry of the lumbar spine and femoral neck showed normal bone mineral density, whereas bilateral osteopenic areas in the massae laterales were demonstrated by the initial CT-scan. The question remains whether the correct diagnosis is so-called insufficiency fracture due to transient osteoporosis of the sacrum associated with pregnancy or so-called fatigue fracture due to unaccustomed stress related to rapid and excessive weight gain in the last trimester of pregnancy.
Subject(s)
Fractures, Stress/diagnosis , Pregnancy Complications/diagnosis , Sacrum/injuries , Absorptiometry, Photon , Adult , Female , Follow-Up Studies , Fractures, Stress/diagnostic imaging , Fractures, Stress/physiopathology , Humans , Magnetic Resonance Imaging , Pregnancy , Pregnancy Complications/diagnostic imaging , Pregnancy Complications/physiopathology , Pregnancy Trimester, Third , Radionuclide Imaging , Sacrum/diagnostic imaging , Tomography, X-Ray Computed , Weight GainABSTRACT
Heavy physical work load is a known determinant of osteoarthritis of the hip, which may account for the high risk observed among farmers. On the other hand, the data on influence of heavy manual work in the pathogenesis of hand osteoarthritis are still controversial. We examined 25 retired farm laborers who strenuously worked for more than 50 years. The investigation included a history of professional activity, clinical and radiological examination of the hands, hips and knees, MRI of hand and laboratory evaluation of 4 participants. Interestingly, the farm laborers with osteoarthritis of the hands, hardly complained. In many of the proximal interphalangeal joints, a discrepancy was observed between the clinical hypertrophic changes and the radiological osteoarthritis which was weak or absent. This difference was less pronounced in the distal interphalangeal joints. Furthermore the distribution pattern of the osteoarthritis of the hand was striking with an over-proportional involvement of the metacarpophalangeal joints and less pronounced of the intercarpal joints. Most often both hands have been affected and the typical localization of the metacarphophalangeal joint osteoarthritis was the first, second and third finger. In all but one participant we found at least unilateral osteoarthritis of the hip and compared to the hands, complaints were more severe. Our findings support the hypothesis that the distribution of osteoarthritis in the hand is affected by lifelong farming. As shown by the data on proximal interphalangeal joints, the periarticular tissue can adapt to the mechanical load in the strength grip.
Subject(s)
Agricultural Workers' Diseases/etiology , Hand Deformities, Acquired/etiology , Osteoarthritis/etiology , Aged , Aged, 80 and over , Agricultural Workers' Diseases/diagnosis , Hand Deformities, Acquired/diagnosis , Humans , Magnetic Resonance Imaging , Male , Metacarpophalangeal Joint/pathology , Middle Aged , Osteoarthritis/diagnosis , Osteoarthritis, Hip/diagnosis , Osteoarthritis, Hip/etiology , Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/etiologyABSTRACT
The rationale and indication, but also the efficacy and limitation of lumbar epidural corticosteroid injection in patients suffering from acute lumbosacral radicular pain are explained. Epidural administration of corticosteroids with longterm effect and bupivacaine by a translumbar approach in patients suffering from acute low back pain and sciatica causes an immediate, persistent pain relief and a more prompt regression of nerve root compression compared to patients just treated by bed rest and analgesics. The state of the art is based on recent meta-analyses and the understanding of the pathophysiology of discal hernia which includes inflammation. Contemporary concepts and data from recent reviews are summarized to elucidate current recommendations and suggestions for the management of patients with acute sciatica. The postulate of an application performed by an experienced anaesthesiologist is stressed. Advantages of this invasive form of therapy include reduction of addictive analgesic drugs, decreased time of absolute immobilisation, respectively strict bed rest, and of hospitalisation.
Subject(s)
Intervertebral Disc Displacement/complications , Nerve Compression Syndromes/etiology , Spinal Nerve Roots , Acute Disease , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/therapeutic use , Anesthetics, Local/administration & dosage , Bed Rest , Bupivacaine/administration & dosage , Humans , Injections, Epidural , Intervertebral Disc Displacement/drug therapy , Lumbar Vertebrae , Nerve Compression Syndromes/drug therapyABSTRACT
Two patients suffering from candida albicans spondylitis in the lumbar spine are reported. Both had been operated on because of malignancy. One patient's clinical course was complicated by candida septicemia, and later on, serious candida endophthalmia developed. Conventional X-rays, combined with technetium scintigraphy, showed inflammatory destruction of the end plates of neighbouring vertebrae. Computerized tomography was done in the second patient, when an abscess was detected on both sides in the psoas muscle. Consecutively, operative removal and a spondylodesis were performed. Candida albicans could be isolated from removed discal material. Treatment by fluconazole for six months, in the first case in the beginning also by amphotericin B, lead to the healing of fungal spondylitis, accompanied by partial osseous consolidation.
Subject(s)
Candida albicans/isolation & purification , Candidiasis/microbiology , Lumbar Vertebrae , Spondylitis/microbiology , Aged , Antifungal Agents/therapeutic use , Candidiasis/drug therapy , Female , Fluconazole/therapeutic use , Humans , Male , Middle Aged , Spondylitis/drug therapyABSTRACT
In 106 shoulder joints of 94 patients suffering from calcifying shoulder (calcifying tendinitis), needling and lavage were performed. Patients were prospectively investigated before and after treatment to examine if location, size, number and density of calcium deposits would predict outcome after the above-mentioned lavage. Excellent and good results were seen for subacromial calcifications and those situated near the tuberculum majus. Density and number of calcifications were without discriminating value, whereas large calcium deposits (> 1,5 cm) and fairly small calcifications (< 1,0 cm) responded very well to conservative treatment as described above.
Subject(s)
Calcinosis/therapy , Shoulder Joint , Tendinopathy/therapy , Adult , Aged , Calcinosis/diagnosis , Calcinosis/diagnostic imaging , Female , Humans , Male , Middle Aged , Prognosis , Prospective Studies , Radiography , Shoulder Joint/diagnostic imaging , Tendinopathy/diagnosis , Tendinopathy/diagnostic imaging , Therapeutic IrrigationABSTRACT
Felty's syndrome is a rare but serious extra-articular manifestation of rheumatoid arthritis. Morbidity as well as mortality are increased on account of greater susceptibility to infectious agents. We report on two patients suffering from Felty's syndrome who were successfully treated by cyclophosphamide. A review of the literature with special regard to treatment of Felty's syndrome is given.
Subject(s)
Antirheumatic Agents/therapeutic use , Arthritis, Rheumatoid/drug therapy , Cyclophosphamide/therapeutic use , Felty Syndrome/drug therapy , Adult , Female , Humans , Male , Middle Aged , Prognosis , Treatment OutcomeABSTRACT
Technetium-99m-DPD and gallium bone scanning were concomitantly performed in patients suffering from either infectious spondylitis or erosive spondylopathy. This comparative study in 5 patients with spinal infections and in 7 patients with lumbar erosive intervertebral osteochondrosis shows a distinct enhancement of the isotopes used such that differentiation between infections and aggressive degeneration is possible. Combined scintigraphy may be a helpful diagnostic tool in such cases.
Subject(s)
Osteochondritis/diagnosis , Spondylitis/diagnosis , Adult , Aged , Aged, 80 and over , Diagnosis, Differential , Diagnostic Imaging , Diphosphonates , Female , Gallium Radioisotopes , Humans , Male , Middle Aged , Organotechnetium Compounds , Prospective Studies , Spinal Diseases/diagnosisABSTRACT
Analysis of the synovial fluid is the major investigation of monoarthritis. Appearance, viscosity (low if inflamed), cell number and differential, presence of crystals or organisms are all relevant. If septic arthritis is suspected, culture of other sites such as blood, urine, sputum etc. is essential, and may alone yield the organism. If mycobacterium is possible, synovial membrane staining and culture is usually necessary. Gonococcal may be lost in culture if the specimen is not immediately processed. Partially treated sepsis may produce sterile culture, and early work suggests that P.C.R. may diagnose these cases. Other investigations such as erythrocyte sedimentation rate, C-reactive protein indicate inflammatory activity, though they are not specific. Antibodies such as antinuclear antibodies, rheumatoid factors lead towards an "autoimmune" disease diagnosis, that do not alone measure activity. Specific antibodies to virus e.g. parvovirus may be diagnostic. The monoarthritis must be seen in the total patient context, where often clues e.g., asymptomatic uveitis (in juvenile chronic arthritis) and psoriasis may give the diagnosis.
Subject(s)
Arthritis/diagnosis , Clinical Laboratory Techniques , Adolescent , Adult , Antibodies, Antinuclear/analysis , Arthritis, Gouty/diagnosis , Arthritis, Infectious/microbiology , Arthritis, Reactive/diagnosis , Blood Cells , Blood Sedimentation , C-Reactive Protein/analysis , HLA-B27 Antigen/analysis , Humans , Microbiological Techniques , Rheumatoid Factor/analysis , Synovial Fluid/chemistry , Synovitis/diagnosisABSTRACT
Prodromes, articular signs and the different courses in the early stage of rheumatoid arthritis are explained. Atypical forms and variants of rheumatoid arthritis are especially described. These are the following syndromes: palindromic rheumatism, polymyalgic rheumatoid arthritis, Sjögren-syndrome with rheumatoid arthritis, acute symmetric polyarthritis with pitting edema of elderly people. Furthermore the significance of radiological procedures and the investigation for rheumatoid factors in the early stages are discussed. Early diagnosis and consecutively early therapeutic strategies in patients suffering from rheumatoid arthritis are of paramount importance for prognosis.
Subject(s)
Arthritis, Rheumatoid/diagnosis , Adult , Arthritis/classification , Arthritis/diagnosis , Humans , Middle Aged , Rheumatoid Factor/isolation & purificationABSTRACT
The symptomatic and disease-modifying efficacy of low-dose corticosteroids in rheumatoid arthritis is explained. A possible therapeutic effect of low-dose corticosteroids is shown by long-term studies which include radiological evaluation. The safety and side-effects of low-dose corticosteroids are described. Steroid-induced osteoporosis in rheumatoid arthritis is discussed especially based on recently accomplished longitudinal bone density studies. Finally consequences in the management of rheumatoid arthritis are defined.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Arthritis, Rheumatoid/drug therapy , Adrenal Cortex Hormones/administration & dosage , Adrenal Cortex Hormones/adverse effects , Humans , Osteoporosis/chemically inducedABSTRACT
Aims, methods and effects of physiotherapy in treatment of patients suffering from ankylosing spondylitis are represented by a review. For a thorough understanding of therapeutic approaches pathology and pathogenesis are outlined in the introduction. The principles mainly of a regular active exercise programme are emphasized and explained.
Subject(s)
Physical Therapy Modalities/methods , Spondylitis, Ankylosing/rehabilitation , Exercise Therapy , Humans , SportsABSTRACT
The inflammatory stage of osteoarthritis when secondary synovitis contributes to the characteristic clinical presentation is first explained. During episodes of acute synovitis nonsteroidal antiinflammatory drugs may be particularly beneficial. Guidelines for a prescribing policy are given in which a safety first approach is adopted. Propionic acid derivatives or newer drugs with similar properties are proposed as initial therapy to control symptoms of osteoarthritis. Special problems of patients at risk (ulcer patients, renal insufficiency, heart failure) are considered.
Subject(s)
Anti-Inflammatory Agents, Non-Steroidal/therapeutic use , Osteoarthritis/drug therapy , Pain/drug therapy , Humans , Osteoarthritis/physiopathology , Risk FactorsABSTRACT
A tight but painless soft-tissue swelling in the left parasternal region, with chronic cough and lumbo-ischial pain becoming progressively more severe over several months, occurred in a 27-year-old man. The chest X-ray film was normal, radiography of the iliosacral joints revealed right-sided sacroiliitis. In the further course of the illness night sweat, nightly fever up to 38 degrees C and weight loss of 7 kg in two months, as well as severe treatment-resistant earache developed. When hospitalized, another chest X-ray film showed disseminated small nodular foci pointing to tuberculosis. Sputum and irrigation fluid from the right middle-ear contained Mycobacterium tuberculosis. Biopsy material from the parasternal tumour and middle-ear mucosa contained caseous granulomas, confirming the diagnosis of tuberculous sacroiliitis as part of multi-organ tuberculosis. Tuberculostatic treatment--400 mg isoniazid, 600 mg rifampicin, and 1,500 mg pyrazinamide daily (the latter discontinued after 8 weeks)--normalized the appearance in the chest X-ray film. The patient returned to his home in Holland and, four years later, reported that he was free of any symptoms, even during sport activity.
Subject(s)
Sacroiliac Joint , Tuberculosis, Osteoarticular/etiology , Tuberculosis, Spinal/complications , Adult , Antitubercular Agents/therapeutic use , Drug Therapy, Combination , Humans , Inflammation/diagnosis , Inflammation/drug therapy , Inflammation/etiology , Male , Otitis Media/complications , Otitis Media/diagnosis , Otitis Media/drug therapy , Tuberculosis, Miliary/complications , Tuberculosis, Miliary/diagnosis , Tuberculosis, Miliary/drug therapy , Tuberculosis, Osteoarticular/diagnosis , Tuberculosis, Osteoarticular/drug therapy , Tuberculosis, Pulmonary/complications , Tuberculosis, Pulmonary/diagnosis , Tuberculosis, Pulmonary/drug therapy , Tuberculosis, Spinal/diagnosis , Tuberculosis, Spinal/drug therapyABSTRACT
Previous history, clinical findings, course and therapeutic outcome in 149 elderly patients with lumbar disk hernia were analyzed and compared with younger adult patients. 21% of all patients with lumbar disk hernia undergoing surgical treatment, and 25% under conservative treatment, were aged over 60 years. In these patients no history of low back pain is present in one third, the course is prolonged and motor deficits are more often encountered. Concomitant osseous narrowing (spinal stenosis, narrowed recessus lateralis) were present in 72% of this elderly group. Surgical complications are increased (34%) and are due to age-related diseases. Functional results are excellent after both conservative treatment and surgical therapy.
