1,283 results match your criteria The Approach to the Painful Joint


A Novel Approach to New-Onset Hemiplegic Shoulder Pain With Decreased Range of Motion Using Targeted Diagnostic Nerve Blocks: The ViVe Algorithm.

Front Neurol 2021 28;12:668370. Epub 2021 May 28.

Canadian Advances in Neuro-Orthopedics for Spasticity Congress, Victoria, BC, Canada.

Hemiplegic shoulder pain (HSP) is the most common pain disorder after stroke with incidence estimates of 30-70% and associated with reductions in function, interference with rehabilitation, and a reduced quality of life. Onset may occur as soon as a week after stroke in 17% of patients. Management of HSP represents a complex treatment pathway with a lack of evidence to support one treatment. Read More

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Local treatment of pain in Tietze syndrome: A single-center experience.

Turk Gogus Kalp Damar Cerrahisi Derg 2021 Apr 26;29(2):239-247. Epub 2021 Apr 26.

General Directorate of Emergency Medical Services, Republic of Turkey, Ministry of Health, Ankara, Turkey.

Background: In this study, we present our experiences with local injections of triamcinolone and prilocaine in patients diagnosed with Tietze syndrome.

Methods: Between January 2016 and January 2019, a total of 28 patients (12 males, 16 females; median age: 33 years; range, 21 to 51 years) who were diagnosed with TS in our clinic were retrospectively analyzed. Triamcinolone hexacetonide and prilocaine hydrochloride were injected into painful joints. Read More

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Case of vaso-occlusive retinopathy in Kikuchi-Fujimoto and lupus overlap syndrome.

BMJ Case Rep 2021 May 31;14(5). Epub 2021 May 31.

Department of Ophthalmology, Medical Eye Unit, Guy's and St Thomas' Hospitals NHS Trust, London, UK.

A 35-year-old woman presented with a constellation of systemic symptoms: rashes, weight loss, arthralgia and mouth ulcers. Six months afterwards, she experienced bilateral and sequential reduction in vision, and was found to have bilateral vaso-occlusive retinopathy, with critical macular ischaemia in the left eye. Her serological markers were consistent with a diagnosis of lupus. Read More

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[Manual medicine, manual treatment : Principles, mode of action, indications and evidence].

Authors:
Hermann Locher

Unfallchirurg 2021 Jun 19;124(6):433-445. Epub 2021 May 19.

Zentrum für Orthopädie und Unfallchirurgie, Lindauerstr. 16, 88069, Tettnang, Deutschland.

Manual medicine is the medical discipline that comprehensively deals with the diagnosis, treatment and prevention of reversible functional disorders of the musculoskeletal system and other related organ systems. The article illustrates the neuroanatomical and neurophysiological basic elements and mechanisms of manual medical diagnostics and treatment. Based on the most recent literature and in consideration of various scientific guidelines, the evidence-based effectiveness of manual medical procedures is presented. Read More

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Neglected posterior dislocation of elbow: A review.

J Clin Orthop Trauma 2021 Jul 24;18:100-104. Epub 2021 Apr 24.

Department of Orthopaedics, 5 th Floor, New Surgery Building, Sarojini Naidu Medical College, Agra, 282001, Uttar Pradesh, India.

Untreated traumatic posterior dislocation of the elbow joint, 3 weeks or older, is defined as "neglected posterior dislocation of the elbow". Around 90% of these are of posterolateral type. These are much more common in the developing and underdeveloped countries. Read More

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The significance of synovial biopsy in the diagnostic workup of the low-grade periprosthetic joint infection of shoulder arthroplasty.

Arch Orthop Trauma Surg 2021 May 15. Epub 2021 May 15.

Department of Joint Replacement, Orthopaedic Clinic Markgröningen, Kurt-Lindemann-Weg 10, 71706, Markgröningen, Germany.

Introduction: A common reason for painful shoulder arthroplasties and revision surgery is a low-grade periprosthetic joint infection (PJI). Diagnosing a low-grade infection is, however, a major diagnostic challenge. This applies even more to the shoulder, which differs from other large joints in terms of clinical features and microbiological spectrum. Read More

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Painful Total Hip Arthroplasty: A Systematic Review and Proposal for an Algorithmic Management Approach.

Pain Physician 2021 May;24(3):193-201

Pain Clinic, Hospital Universitario Sanitas La Moraleja, Madrid, Spain; Consultores en Dolor, Madrid, Spain.

Background: The etiological diagnosis of painful primary total hip arthroplasty and its management is a complex clinical challenge for pain physicians. Extrinsic sources of pain in the hip joint might be efficiently treated by clinical pain units, although the topic remains controversial.

Objectives: To conduct a literature review and suggest an evidence-based algorithmic approach to managing painful hip arthroplasty. Read More

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Novel Insights Into Rheumatoid Arthritis Through Characterization of Concordant Changes in DNA Methylation and Gene Expression in Synovial Biopsies of Patients With Differing Numbers of Swollen Joints.

Front Immunol 2021 22;12:651475. Epub 2021 Apr 22.

R&D GlaxoSmithKline, Stevenage, United Kingdom.

In this study, we sought to characterize synovial tissue obtained from individuals with arthralgia and disease-specific auto-antibodies and patients with established rheumatoid arthritis (RA), by applying an integrative multi-omics approach where we investigated differences at the level of DNA methylation and gene expression in relation to disease pathogenesis. We performed concurrent whole-genome bisulphite sequencing and RNA-Sequencing on synovial tissue obtained from the knee and ankle from 4 auto-antibody positive arthralgia patients and thirteen RA patients. Through multi-omics factor analysis we observed that the latent factor explaining the variance in gene expression and DNA methylation was associated with Swollen Joint Count 66 (SJC66), with patients with SJC66 of 9 or more displaying separation from the rest. Read More

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Integrated nanomaterials for non-invasive photothermal therapy of rheumatoid arthritis.

Drug Discov Today 2021 May 5. Epub 2021 May 5.

National Institute of Pharmaceutical Education and Research-Ahmedabad (NIPER-A), An Institute of National Importance, Government of India, Department of Pharmaceuticals, Ministry of Chemicals and Fertilizers, Palaj, Gandhinagar 382355, Gujarat, India. Electronic address:

Rheumatoid arthritis (RA) is a chronic systemic inflammatory autoimmune disease that causes swelling, redness, and arthralgia of multiple joints. Despite significant research and development on the treatment modalities for RA, there is still no established effective treatment option for eradicating joint damage and inflammation. In recent years, photothermal therapy (PTT) has emerged as a practical approach to treat RA. Read More

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Two stage surgical treatment of cuboid osteomyelitis. A case report and review of the literature.

Foot (Edinb) 2021 Jun 12;47:101796. Epub 2021 Mar 12.

Third Department of Orthopaedic Surgery, University of Athens Medical School, KAT Hospital, Nikis Avenue 2, Kifisia, 14651, Athens, Greece.

Isolated osteomyelitis of the cuboid bone is an extremely rare condition. A 32 year old man was evaluated for a painful and swollen right foot after a penetrating trauma and the presence of a sinus in the lateral aspect the midfoot. MRI findings were consistent with the presence of cuboid osteomyelitis. Read More

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Is the Anterior Injection Approach Without Ultrasound Guidance Superior to the Posterior Approach for Adhesive Capsulitis of the Shoulder? A Sequential, Prospective Trial.

Clin Orthop Relat Res 2021 May 5. Epub 2021 May 5.

Z. Rijs, Department of Orthopedic Surgery, Leiden University Medical Center, Leiden, the Netherlands.

Background: Shoulder injections for conditions such as adhesive capsulitis are commonly performed and can be administered through image-based or landmark-based injection approaches. Ultrasound-guided injections are widely used and accurate because ultrasound allows real-time visualization of the needle and injected contrast. Landmark-based injections would be advantageous, if they were accurate, because they would save the time and expense associated with ultrasound. Read More

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Opioid-free anesthesia for patients with joint hypermobility syndrome undergoing craneo-cervical fixation: a case-series study focused on anti-hyperalgesic approach.

Orphanet J Rare Dis 2021 Apr 13;16(1):172. Epub 2021 Apr 13.

Servei Central D'Anestesiología (Anestalia), Centro Médico Teknon, Carrer Vilana 12, 08022, Barcelona, Spain.

Background: Patients with Ehlers-Danlos Syndrome/Hypermobility Type (EDS-HT/JHS) and Craneo-Cervical Instability frequently suffer from severe widespread pain which is difficult to control. Chronic neuroinflammation, opioid-induced hyperalgesia, and central sensitization may explain this painful condition. The aim of this study was to determine if opioid-free anesthesia plus the postoperative administration of lidocaine, ketamine and dexmedetomidine can reduce postoperative pain and the need of methadone rescues in comparison with opioid-based management in these patients undergoing Craneo-Cervical Fixation (CCF). Read More

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Rotator Cuff-Related Shoulder Pain: Is It Time to Reframe the Advice, "You Need to Strengthen Your Shoulder"?

J Orthop Sports Phys Ther 2021 04;51(4):156-158

Synopsis: Progressive resistance exercise, in isolation or in combination with other noninvasive therapies such as therapeutic touch, is the first-line approach to managing nontraumatic rotator cuff-related shoulder pain (RCRSP). Resistance exercise may be effective for people with RCRSP secondary to improving mechanical features of the shoulder, including strength, kinematics, and muscle timing and activation. However, strength gains are often small and clinically unimportant when measured during clinical trials. Read More

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Using Bayesian Networks to identify musculoskeletal symptoms influencing the risk of developing Psoriatic Arthritis in people with psoriasis.

Rheumatology (Oxford) 2021 Mar 26. Epub 2021 Mar 26.

Department of Mathematical Sciences, University of Bath, Bath, UK.

Objectives: To explore Bayesian networks (BNs) in understanding the relationships between musculoskeletal symptoms and the development of PsA in people with psoriasis.

Methods: Incident cases of psoriasis were identified between 1998 and 2015 from the UK Clinical Research Practice Datalink. Musculoskeletal symptoms identified by medcodes were concatenated into primary groups, each made up of several sub-groups. Read More

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[Differential diagnoses of inflammatory hip joint].

Radiologe 2021 Apr 25;61(4):395-404. Epub 2021 Mar 25.

Department of Radiology, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, OX3 7LD, Oxford, Großbritannien.

The differential diagnoses of inflammatory hip diseases play an important role for the diagnosis of hip pain. The radiological manifestations of rheumatic inflammatory hip pain with the corresponding use of imaging modalities were dealt in part 1 of the CME article. In this second part a systematic approach is explained in order to differentiate the many rheumatic diseaeses from degeneration, synovial tumors and infections. Read More

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People Prefer to Continue with Painful Activities Even if They Lead to Earlier Surgery.

Clin Orthop Relat Res 2021 Mar 22. Epub 2021 Mar 22.

M. M. Amiri, D. Ring, A. Fatehi, Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Texas, USA.

Background: The degree to which physical activity results in arthritis progression is unknown, but it probably is less than most people believe. But the belief that painful activity is harmful has notable associations both with greater pain intensity and greater activity intolerance among people seeking care for painful conditions such as osteoarthritis. If there were evidence that people not seeking care would prefer to accommodate a painful cherished activity, even if such accommodation is harmful, this might remind surgeons that many people seeking their care also hold this value. Read More

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The pre-clinical phase of rheumatoid arthritis: From risk factors to prevention of arthritis.

Autoimmun Rev 2021 May 18;20(5):102797. Epub 2021 Mar 18.

Institute of Rheumatology and Department of Rheumatology, 1st Faculty of Medicine, Charles University in Prague, Czech Republic.

Rheumatoid arthritis (RA) is a chronic autoimmune disease considered as a multistep process spanning from the interaction of genetic (e.g., shared epitope or non-HLA loci), environmental and behavioral risk factors (e. Read More

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Reconstruction of a Chronic Posterior Dislocation of the Shoulder using a Limited Posterior Deltoid-splitting Approach: A Case Report.

J Orthop Case Rep 2020 Nov;10(8):88-92

Department of Orthopaedic Surgery, All India Institute of Medical Sciences, Rishikesh, Uttarakhand, India.

Introduction: Chronic posterior dislocation is a very rare injury. Various methods have been described for its treatment. This report describes a rare case of post-traumatic chronic posterior dislocation of the shoulder. Read More

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November 2020

Incisionless Synovium and Bone Biopsy of a Painful Total Knee Arthroplasty.

Arthrosc Tech 2021 Feb 18;10(2):e475-e479. Epub 2021 Jan 18.

Marshall University, Scott Depot, West Virginia, U.S.A.

Knee arthroscopy has evolved greatly from its inception in the 20th century. Arthroscopic synovectomy is performed in the case of infection or significant synovitis. We continue to develop more minimally invasive procedures, and the NanoScope (Arthrex, Naples, FL) has provided a new generation of possibilities. Read More

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February 2021

Pediatric Behçet's Disease.

Front Med (Lausanne) 2021 3;8:627192. Epub 2021 Feb 3.

Department of Pediatric Rheumatology, Cerrahpasa Medical School, Istanbul University-Cerrahpasa, Istanbul, Turkey.

Behçet's Disease (BD) is a systemic vasculitis firstly described as a disorder causing aphthous lesion in oral and genital mucosae and uveitis. The disease has an extremely unique distribution characterized by the highest incidence in communities living along the historical Silk road. Although our understanding of the etiopathogenesis of BD has expanded over time, there are still lots of unidentified points in the underlying mechanisms of the disease. Read More

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February 2021

Promising Effect of Visually-Assisted Motor Imagery Against Arthrogenic Muscle Inhibition - A Human Experimental Pain Study.

J Pain Res 2021 3;14:285-295. Epub 2021 Feb 3.

Department of Rehabilitation Center, Kochi Medical School Hospital, Nankoku, Kochi, Japan.

Purpose: Clinically, arthrogenic muscle inhibition (AMI) has a negative impact on functional recovery in musculoskeletal disorders. One possible technique to relieve AMI is motor imagery, which is widely used in neurological rehabilitation to enhance motor neuron excitability. The purpose of this study was to verify the efficacy of visually-assisted motor imagery against AMI using a human experimental pain model. Read More

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February 2021

[How I explore… a non-traumatic gonalgia].

Rev Med Liege 2021 Feb;76(2):122-127

Service de Chirurgie de l'Appareil locomoteur, CHU Liège, Belgique.

Because the knee is the joint of the human body with the largest surface, it is no wonder that gonalgia is one of the most common complaints in the general population. Although the management of a painful traumatic knee is relatively well standardized, that of a non-traumatic knee pain is less codified. History and a rigorous systematic clinical examination play a key role in the management of nontraumatic gonalgia. Read More

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February 2021

[Basis for the multidisciplinary approach to shoulder pseudoparesis and pseudoparalysis due to rotator cuff pathology].

Acta Ortop Mex 2020 Jul-Aug;34(4):242-248

Escuela de Fisioterapia y Rehabilitación. Universidad Marista de Mérida. Mérida, Yucatán, México.

Introduction: The painful shoulder is an entity that generates much of the orthopedic consultations worldwide, although it can affect at any stage of life, its prevalence is higher as age increases. Rotator cuff condition is often the most relevant cause of pain and dysfunction. Two common consequences of rotator cuff condition are pseudoparesis and pseudoparalysis, and even though they share similar etiology and symptomatology, their clinical differentiation is critical for optimal management and timely resolution. Read More

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February 2021

A rheumatologic approach to granulomatous mastitis: A case series and review of the literature.

Int J Rheum Dis 2021 Apr 1;24(4):526-532. Epub 2021 Feb 1.

Division of Arthritis and Rheumatic Diseases, Department of Medicine, Oregon Health & Science University, Portland, OR, USA.

Aim: Idiopathic granulomatous mastitis (IGM) is an enigmatic inflammatory breast disorder. IGM responds to immunomodulatory treatment and may be associated with systemic manifestations such as arthritis and erythema nodosum. These patients are increasingly referred to rheumatologists for management, but IGM is rarely discussed in the rheumatology literature. Read More

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Hormone replacement therapy after breast cancer: Yes, No or maybe?

Mol Cell Endocrinol 2021 04 26;525:111180. Epub 2021 Jan 26.

Department of Surgery, Texas Tech University Health Sciences Center, Lubbock, TX, USA. Electronic address:

Over nine million breast cancer survivors worldwide suffer compromised quality of life attributable to estrogen depletion related symptoms of menopause and side effects of cancer therapy. Hormone Replacement Therapy (HRT) is very effective in managing these symptoms in general population and in breast cancer survivors. However, the concern of breast cancer recurrence as a result of HRT use keeps many oncologists from using this approach in symptom management. Read More

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Anterior and Posterior Ankle Impingement Syndromes: Arthroscopic and Endoscopic Anatomy and Approaches to Treatment.

Foot Ankle Clin 2021 Mar 9;26(1):155-172. Epub 2020 Sep 9.

UFMG - Federal University of Minas Gerais, Brazil. Electronic address:

Ankle impingement refers to a chronic painful mechanical limitation of ankle motion caused by soft tissue or osseous abnormality affecting the anterior or posterior tibiotalar joint. Impingement can be associated with a single traumatic event or repetitive microtrauma. These syndromes are a possible etiology of persistent ankle pain. Read More

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Endoscopic resection of a localized tenosynovial giant cell tumor causing posterior ankle impingement in a 15-year-old athlete: A case report.

Jt Dis Relat Surg 2021 6;32(1):234-238. Epub 2021 Jan 6.

Beyzadeoglu Clinic, Orthopaedics and Traumatology, 34728 Kadıköy, Istanbul, Turkey.

Tenosynovial giant cell tumor (TGCT) is a systematically benign but locally aggressive lesion arising from the synovium, tendon sheath or joint bursae. Even in athletes, soft tissue tumors may be the underlying reason or a component of posterior ankle impingement, although the most common mechanism is forceful and repetitive plantar flexion. In this article, we present a case of localized TGCT in a 15-year-old female patient presenting with symptoms of posterior ankle impingement. Read More

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Concomitant Dislocation of the Hallucal Interphalangeal Joint and Extra-Articular Dislocation of Its Sesamoid: A Case Report.

JBJS Case Connect 2020 12 24;10(4):e20.00388. Epub 2020 Dec 24.

Department of Orthopaedic Surgery, Altnagelvin Hospital, Londonderry, Northern Ireland, U.K.

Case: A 22-year-old man sustained closed dislocation of the hallucal interphalangeal joint (HIPJ). Painful limitation of movements persisted 2 months after closed reduction. Magnetic resonance imaging revealed dislocation of the hallucal interphalangeal joint sesamoid (HIPJS) from its intra-articular attachment on the superior surface of the plantar plate to an extra-articular subcutaneous location, plantar and lateral to the flexor hallucis longus tendon. Read More

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December 2020

Resistance exercises improve physical function in chronic Chikungunya fever patients: a randomized controlled trial.

Eur J Phys Rehabil Med 2021 Jan 15. Epub 2021 Jan 15.

Department of Physical Therapy, Federal University of Pernambuco, Pernambuco, Brazil -

Background: Chikungunya fever is an arboviral disease, caused by an alphavirus, the Chikungunya virus, characterized by fever and joint pain that is generally disabling in the acute phase and may last from months to years, with the potential to evolve into chronic musculoskeletal symptoms, as polyarthralgia and arthritis, which can lead to significant impairment of physical function. The non-pharmacological treatment is very important for these patients, and resistance exercises may be one rehabilitation option.

Aim: This study aimed to evaluate the efficacy of a resistance exercise protocol on the physical function, pain, and quality of life of patients with chronic Chikungunya fever. Read More

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January 2021

The Basic Knee Revision.

Instr Course Lect 2021 ;70:247-258

The number of revision total knee arthroplasties (TKAs) is greatly increasing. It is important to know how to approach the painful and malfunctioning TKA to determine the etiology and establish surgical plan, and also how to perform a basic revision TKA. Following the conclusion of this chapter, the reader should feel familiar with the full spectrum of treatment for patients who may be indicated for revision TKA. Read More

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January 2021