Spontaneous Iliopsoas Tendon Rupture: An Uncommon Cause of Hip Pain in Elderly Patients.

Iliopsoas tendon rupture is a relatively rare cause of hip pain. It has been described in children, in adults with pathologic avulsion secondary to metastatic disease, and in older individuals with multiple chronic illnesses. We are reporting a case of apparently spontaneous iliopsoas tendon rupture that occurred in an elderly patient presenting with severe debilitating hip pain whose etiology initially was unrecognized. Magnetic resonance imaging of the hip confirmed the diagnosis. This case highlights the importance of considering iliopsoas tear in the differential diagnosis of unexplained acute onset hip pain and illustrates that geriatric patients with this condition can be treated conservatively with satisfactory functional outcome.

Integrating complementary/alternative medicine into primary care: evaluating the evidence and appropriate implementation.

The frequency with which patients utilize treatments encompassed by the term complementary/alternative medicine (CAM) is well documented. A number of these therapies are beginning to be integrated into contemporary medical practice. This article examines three of them: osteopathic manipulation, yoga, and acupuncture, with a focus on their physiological effects, efficacy in treating medical conditions commonly encountered by practitioners, precautions or contraindications, and ways in which they can be incorporated into clinical practice. Physicians should routinely obtain information about use of CAM as part of their patient history and should consider their role based on physiological effects and clinical research results.

Medicare coverage for vision assistive equipment.

Vision loss that cannot be corrected medically, surgically, or by refractive means is considered low vision. Low vision often results in impairment of daily activities, loss of independence, increased risk of fractures, excess health care expense, and reduced physical functioning, quality of life, and life expectancy. Vision rehabilitation can enable more independent functioning for individuals with low vision. The Centers for Medicare and Medicaid Services recognizes the importance of rehabilitation for achieving medically necessary goals but has denied Medicare coverage for vision assistive equipment that is necessary to complete these goals, although they provide coverage for assistive equipment to provide compensation for other disabilities. We believe that this is discriminatory and does not comport with congressional intent. The Centers for Medicare and Medicaid Services should provide coverage for vision assistive equipment, allowing beneficiaries with vision loss to benefit fully from Medicare-covered rehabilitation to achieve the cost-effective results of these services.

Saphenous nerve injury following medial knee joint injection: a case report.

Knee joint injection is a procedure commonly performed for pain management of osteoarthritis. Although several techniques have been described, it is usually performed by either medial or lateral approach with the lower limb extended on the examination table. We present the case of a patient who developed saphenous neuropathy following knee joint injection via medial approach. The clinical picture suggests that the needle pierced the nerve during the procedure. The patient was moderately obese. This is the first case report in the literature of saphenous nerve injury following medial knee joint injection. Practitioners should be aware of this complication in choosing an approach to the knee joint injection, especially when the patient is obese and the anatomic landmarks are obscured.

Reflex sympathetic dystrophy following traumatic myelopathy.

Two cases of reflex sympathetic dystrophy in the upper extremity of patients with traumatic cervical spinal cord injuries are reported. Both patients had very incomplete lesions with early neurological recovery, suggesting an underlying central cord syndrome. Although reflex sympathetic dystrophy is often seen following stroke, it has only rarely been documented in traumatic myelopathy, and it should be considered in the differential diagnosis of unexplained pain syndromes in the extremities of paraplegic or quadriplegic patients.