Search

Objective. To investigate the effectiveness of the application of hardware myofascial release with thermal influence and longitudinal traction in patients with dorsal pain, caused by spine degenerative diseases. Methods. A prospective study of the results of treatment of 297 patients with dorsal pain, caused by spine degenerative diseases. All patients were divided into 3 groups: D (158) — dorsal pain; DIK (31) — dorsal pain with irradiation in the lower limb; DIS (108) — dorsal pain with irradiation in the buttock. The comparison group consisted of 43 volunteer athletes. With the help of the Nuga Best N5 device, all participants underwent a course of treatment (10 sessions within two weeks, thermal influence — 45‒60 °C, depending on the comfort of the patient). Before and after treatment, patients were examined according to the visual analog scale (VAS), the Oswestry questionnaire, volunteers — according to the Oswestry scale. Statistical analysis was performed. The results. In patients of group D, after treatment, the Josw index decreased from 37.1 (24; 51) % to 9.1 (2; 14) % (QV, p < 0.01), VAS — from 29.6 (20; 40) mm to 11.2 (10; 10) mm (KV, p < 0.01). In the DIK group, a decrease in the Josw index was determined from 24.7 (12; 34) % to 7.3 (2; 13) % (QV, p < 0.01), VAS — from 41.9 (20; 60) mm to 14.7 (10; 20) mm (KV, p < 0.01). In the patients of the DIS group, after treatment, the Josw index decreased from 30.5 (18; 41) % to 8.2 (2; 11) % (QV, p < 0.01), VAS — from 24.9 (20; 30) mm to 11.3 (10; 10) mm (KV, p < 0.01). In the group of volunteers, the Josw index decreased from 5.9 (2; 4) % to 3.0 (2; 2) % (QV, p < 0.01), VAS — from 12.6 (10; 10) mm to 2.1 (0; 0) mm (KV, p < 0.01). Conclusions. The hardware myofascial release with thermal influence and longitudinal traction significantly reduces pain caused by tendopathies and muscle structural-functional disorders, improves the quality of life in patients with back pain caused by spine degenerative diseases. In practically healthy people, this method of treatment can be used to restore working capacity, get rid of muscle pain after physical exertion., Мета. Дослідити ефективність застосування апаратного міофасціального релізу з термальним впливом і поздовжньою тракцією у хворих на дорсалгії, обумовлені дегенеративними захворюваннями хребта. Методи. Проведено проспективне дослідження результатів лікування 297 пацієнтів із дор­салгіями, обумовленими дегенеративними захворюваннями хребта, у 3 групах: Д (158) — дорсалгії; ДІК (31) — дорсалгії й іррадіація в нижню кінцівку; ДІС — дорсалгії й іррадіація в сідницю. Групу порівняння склали 43 волонтери-спортсмени. За допомогою апарата Nuga Best N5 усім учасникам проведений курс лікування (10 сеансів протягом двох тижнів, тепловий вплив — 45‒60 °С залежно від комфорту хворого). Пацієнтів до та після лікування обстежено за візуальною аналоговою шкалою (ВАШ), опитувальником Oswestry, волонтерів — за шкалою Oswestry. Виконано статистичний аналіз. Результати. У пацієнтів групи Д після лікування показник Josw знизився від 37,1 (24; 51) % до 9,1 (2; 14) % (КВ, p < 0,01), ВАШ — від 29,6 (20; 40) мм до 11,2 (10; 10) мм (КВ, p < 0,01). У групі ДІК визначено зниження показника Josw від 24,7 (12; 34) % до 7,3 (2; 13) % (КВ, p < 0,01), ВАШ — від 41,9 (20; 60) мм до 14,7 (10; 20) мм (КВ, p < 0,01). У пацієнтів групи ДІС після лікування показник Josw знизився від 30,5 (18; 41) % до 8,2 (2; 11) % (КВ, p < 0,01), ВАШ — від 24,9 (20; 30) мм до 11,3 (10; 10) мм (КВ, p < 0,01). У групі волонтерів показник Josw знизився від 5,9 (2; 4) % до 3,0 (2; 2) % (КВ, p < 0,01), ВАШ — від 12,6 (10; 10) мм до 2,1 (0; 0) мм (КВ, p < 0,01). Висновки. Застосування апаратного міофасціального релізу з теплом і поздовжньою тракцією значно знижує біль, спричинений тендопатіями та структурно-функціональними порушеннями в м’язах, підвищує якість життя хворих на дор­салгії, обумовлені дегенеративними захворюваннями хребта. У практично здорових людей зазначений метод лікування можна застосовувати для відновлення працездатності, позбавлення м’язового болю після фізичних навантажень.

Jeder Mensch kennt das: Rückenschmerzen. Dabei spielt das Alter meist keine Rolle, da die häufigste Ursache im falschen und zu langen Sitzen liegt oder durch unvorteilhafte Haltung beim Gehen bedingt sein kann; sie können aber auch durch Erkrankungen der Wirbelsäule verursacht werden. Rückenschmerzen können sich in ihrer Entstehung und Auswirkung unterscheiden, haben aber Gemeinsamkeiten bei Untersuchungen, Behandlungsmethoden und -zielen.

Background:Dorsal pain from osteoarthritic midfoot joints is thought to be relayed by branches of the medial and lateral plantar, sural, saphenous, and deep peroneal nerves (DPN). However, there is no consensus on the actual number or pathways of the nervous branches for midfoot joint capsular innervation. This study examined the DPN’s terminal branches at the midfoot joint capsules through anatomic dissection and confirmation of their significance in a clinical case series of patients with midfoot pain relief after DPN block.Methods:Eleven cadaveric lower leg specimens, 6 left and 5 right, were dissected using operative loupe magnification. We preserved the terminal branches and recorded their paths and branching patterns. Joint capsular innervations were individually noted. To confirm our hypothesis of significant dorsal midfoot joint capsular innervation by the DPN, we also performed an institutional review board–approved retrospective chart review of 37 patients with painful dorsal midfoot osteoarthritis who underwent diagnostic local anesthetic injection block of the DPN. The percentage of temporary pain relief after the injection was recorded.Results:Terminal innervation of the DPN branches showed distribution of the second and third tarsometatarsal joints in all specimens. Inconsistent innervation of the naviculocuneiform (9/11), fourth (7/11), first (6/11), and fifth (4/11) tarsometatarsal and calcaneocuboid joints (1/11) were observed. The retrospective review of pain relief in patients with dorsal midfoot pain due to arthritis after diagnostic injection demonstrated a mean of 92.1% improvement.Conclusion:Innervation of the dorsal midfoot joint capsule appears to follow a consistent distribution across 3 joints: second and third tarsometatarsal joints and the naviculocuneiform joint. Acute relief of dorsal midfoot arthritic pain after diagnostic injection suggests that dorsal midfoot nociceptive pain is at least partly transmitted by the DPN.Level of Evidence:Level IV, case series.

We present the case of a healthy 15-month-old boy, who presented to our emergency department with intermittent unspecified dorsal pain and periods of irritability for the last 2 weeks. During the last week, parents reported significant worsening of his general condition with episodes of polypnoea

Primary retroperitoneal non Hodgkin lymphoma is extremely rare, its diagnosis is often difficult and it may requires a time consuming and a costly diagnostic workup. We report the case of a 46-year-old patient complaining of abdominal fullness and dorsal pain, who was diagnosed with an extra-nodal non-Hodgkin lymphoma presenting as a unique and large retroperitoneal mass. The suggested diagnosis was a malignant retroperitoneal tumor and the patient underwent an excision of the tumor throw a lombotomy followed by an R-CHOP chemotherapy regimen with good outcome. Keywords: Lymphoma, Large B-cell lymphoma, Diffuse lymphoma, Retroperitoneal extra-adrenal mass

Hipertrofia virginal mamaria es caracterizada por un crecimiento excesivo y difuso de uno o ambos senos y se presenta en mujeres cerca del inicio de la pubertad. Dada la escasa información de esta patología en edades tempranas, es relevante describir el comportamiento clínico y terapéutico de esta paciente de 10 años 2 meses de edad, con evolución de un año de rápido crecimiento asimétrico de ambas mamas, con mastalgia y dolor dorsal.

Spinal cord ischaemia is a rare condition in children in which imaging diagnosis can be difficult and treatment guidelines are not well established. We describe a case of a previously healthy 13-year-old girl admitted to the emergency department with an acute flaccid paralysis of the lower limbs, abdominal and dorsal pain, and bladder dysfunction. A few hours earlier, she had been playing on a swing with hyperextension and an arched back position. Spinal cord MRI was normal in the first hours, but ischaemic signs were described in a second examination performed some hours later. We discuss the extensive investigation for differential diagnosis and the management of this case.

In order to evaluate the favorable effect of whole-body electromyostimulation (WB-EMS) on low back pain (LBP), an aspect which is frequently claimed by commercial providers, we performed a meta-analysis of individual patient data. The analysis is based on five of our recently conducted randomized controlled WB-EMS trials with adults 60 years+, all of which applied similar WB-EMS protocols (1.5 sessions/week, bipolar current, 16–25 min/session, 85 Hz, 350 μs, and 4–6 s impulse/4 s impulse-break) and used the same pain questionnaire. From these underlying trials, we included only subjects with frequent-chronic LBP in the present meta-analysis. Study endpoints were pain intensity and frequency at the lumbar spine. In summary, 23 participants of the underlying WB-EMS and 22 subjects of the control groups (CG) were pooled in a joint WB-EMS and CG. At baseline, no group differences with respect to LBP intensity and frequency were observed. Pain intensity improved significantly in the WB-EMS (p<.001) and was maintained (p=.997) in the CG. LBP frequency decreased significantly in the WB-EMS (p<.001) and improved nonsignificantly in the CG (p=.057). Group differences for both LBP parameters were significant (p≤.035). We concluded that WB-EMS appears to be an effective training tool for reducing LBP; however, RCTs should further address this issue with more specified study protocols.

espanolEl dolor de espalda es un sintoma frecuente entre la poblacion general que ocupa gran parte de las consultas de atencion primaria y de las urgencias, hospitalarias y no hospitalarias, siendo quizas la dorsalgia menos frecuente que los dolores referidos a la columna lumbar y cervical. En la mayor parte de los casos son dorsalgias mecanicas, pero no podemos olvidar que hay ocasiones en las que el dolor dorsal no es sino expresion de un proceso patologico grave. En estos tiempos de adelantos tecnicos y de pruebas complementarias sofisticadas y accesibles la historia clinica continua siendo una herramienta barata, sencilla y eficaz que nos va a permitir realizar el diagnostico diferencial y sentar las bases de una actuacion reglada y sujeta a dos premisas fundamentales: sensatez y eficacia. Presentamos el caso de un varon que acude en varias ocasiones a urgencias por dolor en la columna dorsal y aprovechamos su desenlace para ilustrar brevemente la entidad subyacente: espondilodiscitis infecciosa. EnglishBack pain is a frequent symptom among the general population that occupies a large part of primary and emergency care consultations, both hospital and non-hospital, with dorsalgia being less frequent than pain related to the lumbar and cervical spine. In most cases they are mechanical dorsalgias but we cannot forget that there are occasions in which dorsal pain is but an expression of a serious pathological process. In these times of technical advances and complementary and sophisticated tests medical history continues to be a cheap, simple and effective tool that will allow us to make the differential diagnosis and lay the basis for a regulated performance and subject to two fundamental premises: sensible And effectiveness. We present the case of a man who visits the emergency department several times for pain in the dorsal spine and we use his outcome to briefly illustrate the underlying entity: infectious spondylodiscitis.

Background Hemangiomas are benign vascular malformations that can involve the spine. Pure epidural hemangiomas are rare and represent only 4% of all epidural lesions. Most hemangiomas are of the cavernous type; the capillary variant is atypical, and only ten cases have been reported in the literature. Case description A 69-year-old female presented with nonspecific dorsal pain. Magnetic resonance imaging (MRI) showed a spinal epidural tumor at the T9-T10 level. Following a T9-T11 laminectomy, the lesion was completely resected en bloc. Histopathologic analysis showed a pure epidural capillary hemangioma with adipose tissue mesenchyma. Conclusions Although epidural capillary hemangiomas are extremely rare, they should be considered among the differential diagnoses of extradural, extramedullary spinal lesions. Further, they must be differentiated from other more common lesions such as meningiomas and schwannomas. The recommended surgical management is en bloc gross total excision.

Primary bone angiosarcoma is rare, and is only seen in 1% of all sarcomas. These tumours are more often found in the long bones. Primary spinal involvement has been reported in 10% of angiosarcomas. As a result of its rarity, its pathological, clinical and therapeutic characterists are largely unknown. We presnt the case of a patient with a primary vertebral epithelioid angiosarcoma in D8 which initially presented as dorsal pain and paraparesis, with the aim of contributing to a better knowlwedge of this rare process.

A case report of an adult patient with an osteoid osteoma of the lamina of 9th thoracic vertebra is presented. The long history of progressively worsening nocturnal dorsal pain which was relieved by non-steroid anti-inflammatory drugs, and an essentially clinical examination, are typical of this condition in which the CT and radionuclide bone scans are the investigation of choice. Complete relief was obtained following excision of the lesion. The literature is reviewed.

The wide spectrum of athletic activities places various demands on the wrists, which can result in injuries of the soft tissues of the wrist. Increased awareness of injuries particular to a sport and technologic and clinical advances have helped examiners to approach these injuries with a treatment plan that allows the athlete to return to competition quickly. Many of these injuries and their pathomechanics, diagnosis, and treatment are discussed in this article. The material presented on dorsal pain disorders, carpal instability, and the triangular fibrocartilage complex serves as a starting point for increasing understanding of wrist injuries in the athlete.

The authors report a case of unilateral primary adrenal lymphoma presenting with abdominal and dorsal pain. Primary lymphoma of the genitourinary tract, specifically adrenal localisation, is a rare disease. CT is the current best imaging modality for evaluating retroperitoneal masses and improving detection, characterization as well as assessing extension. Diagnosis is based on histology.

Objective: 1) Review anatomy of the nasolacrimal apparatus. 2) Learn about common primary tumors of the nasolacrimal apparatus and their clinical presentation. 3) Present a rare type of nasolacrimal duct tumor. 4) Discuss the utility of combined endoscopic and external techniques for removal of nasolacrimal duct tumors.Method: Retrospective case report and review of literature.Results: A 67-year-old woman presented with cough and post-nasal drip. Examination revealed a right-sided nasal cavity mass anterior to the middle turbinate. Upon further questioning, she reported a history of right nasal dorsal pain, but denied epiphora, epistaxis, and ocular symptoms. Imaging revealed a mass originating from the right nasolacrimal duct with extension into the right peri-orbital soft tissues. The tumor was completely excised via combined endoscopic and external approaches. Histopathologic examination identified the lesion as Warthin tumor. At 1 year postoperatively, the patient is disease- and symptom-free.Conclusi...

Presentation of Case A 67-year-old man was admitted to the hospital because of increasing back pain and osteolytic changes in the 11th and 12th thoracic vertebras. There was a history of coronary artery disease with multiple subendocardial infarcts, which had led to coronary-artery bypass surgery 19 years earlier. During the year before admission the patient experienced mild, intermittent low dorsal pain. Ten months before entry an electronic pacemaker was implanted because of the sick sinus syndrome. The alkaline phosphatase was 224 U per liter. Seven months before admission the patient returned to the hospital because of recurrent anterior chest pain. . . .

Back and neck pain are a very common medical problem and a predominant cause for visits and medical consultations [15] The reported lifetime prevalence of back pain ranges up to 84% [5] and that of neck pain to 67% [6]. Dorsal (thoracic) pain is much less frequent. The 1-year prevalence of dorsal pain was 17% compared to 64% for neck and 67% for low-back pain in a Finnish study [25]. More than 90% of patients initially presenting with back pain can be managed non-operatively with physical therapy and analgetic medication and will return to an acceptable pain level within 3 weeks, and even to normal within 3 months [10]. These figures indicate that spinal pain is a benign and self-limiting disorder (see Chapter 6).

A 39-year-old man complained of acute dysphagia and dorsal pain while eating fish. Radiologic and endoscopic studies revealed a retroesophageal mass, which was later shown to be a hematoma.

Purpose This article describes a previously unreported fifth metacarpal stress fracture. Case summary A female softball pitcher presented with gradual development of dorsal pain in her pitching hand. A radioisotope scan showed increased uptake in the fifth metacarpal. This supported a clinical diagnosis of a stress fracture, and the patient was treated with a period of relative rest. At 6 weeks, the patient was able to return to pitching with technique modification. Discussion Seven cases of metacarpal stress fractures have been reported, yet none involved the fifth metacarpal. The causes of a fifth metacarpal stress fracture differ from those of other metacarpals and may be a combination of extrinsic forces from the ball and intrinsic forces from muscle pull. Although treatment involves the standard rest period, technique must be assessed and appropriately adjusted. Relevance Metacarpal stress fractures should be considered in athletes with persistent hand pain where repetitive grip function is used.

We appreciate the interest expressed by Dr MacGowan in our paper [1], which emphasizes the risk of esophageal perforation during transesophageal echocardiography (TEE). Dr MacGowan presents a new case revealed at the post-mortem examination in a ventilated patient. We have found nine cases of esophageal perforation after TEE reported in the literature until now. MacGowan’s report is an interesting paper, which emphasizes difficulties to diagnose esophageal tear in sedated patients. Diagnosis of esophageal perforation is often late even in non-sedated patients. In our series of thoracic esophageal perforation free interval before diagnosis was more than 24 h in 23 (45%) of our 51 cases [2]. We agree with Dr MacGowan that in sedated patients dorsal pain, fever or subcutaneous emphysema are absent and uncontrolled sepsis may be the only diagnostic clue. Maybe the diagnosis would be made sooner by a bronchoscopy in the case reported by MacGowan? We have written flexed position of the tip of the probe for a long time and moving of the probe in a locked position are favoring factors that must be avoided [1]. Furthermore, underlying ischemia of the esophageal tissues might be increased by a high pressure ventilation. After all, MacGowan emphasizes the interest of postmortem examination, which is becoming more and more difficult to perform nowadays in our country.