scholarly journals O Diagnóstico da Raquialgia no Atleta Jovem – uma Revisão Bibliográfica

2021 ◽  
Vol 12 (3) ◽  
pp. 12-14
Author(s):  
Cristiana Lopes Martins ◽  
◽  
Ana Sabugueiro ◽  
Joana Capela ◽  
◽  
...  
Keyword(s):  
Back Pain ◽  
Neurological Examination ◽  
Young Athlete ◽  
Clinical History ◽  
Physical Exam ◽  
Physiological Characteristics ◽  
Proper Treatment ◽  
Sports Activity ◽  
Immature Spine ◽  
Sport Specific Injuries

Back pain in the young athlete is as frequent as its diagnosis is challenging due to the multiplicity of diagnostic hypotheses. Although most cases are based on poor mechanics and muscle strains, not all are innocent or self-limited. The physician must know the anatomical and physiological characteristics of immature spine, as well as the sport-specific injuries. It is imperative to obtain a complete clinical history and a complete physical exam, including neurological examination and specific provocative tests. After finding the pathology, proper treatment can help the patient returning safely to sports activity.

scholarly journals Aortic thrombosis presenting with low back pain and paraplegia: a medical alert

2021 ◽  
Author(s):  
Fernanda Fenner ◽  
Francisco José Luis de Sousa ◽  
Hilton Mariano da Silva Jr ◽  
Andrei Fernandes Joaquim
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Neurological Examination ◽  
Survival Rates ◽  
Clinical History ◽  
Sudden Onset ◽  
Lower Limbs ◽  
Low Back ◽  
Vascular Surgeon ◽  
Axial Tomography

Context:The importance of a thorough neurological examination of the patient should always include research into differential diagnoses such as vascular syndromes, increasingly common in our population. Case report: A 46-year-old man evaluated and screened by the Neurosurgery’s department team, after an initial complaint of sudden onset low back pain and acute weakness in both lower limbs. The patient was healthy before the event. Patient didn’t have pathological history or use of chronic medications, referring only to use sporadic medication for sexual impotence, approximately 6 months ago. Observation revealed pale cold lower limbs, with livedo reticularis. Pulses of the femoral artery were absent bilaterally. Neurological examination revealed complete flaccid paraplegia with neurological level of L1. Below this level loss of pain, light touch and temperature sensation (0/2 in all dermatomes on both extremities), muscle weakness (0/5 in all neurotomes bilaterally), absent tendon and plantar reflexes. Axial tomography of the lumbar spine didn’t reveal vertebral lesions or pressure within the spinal canal. Consultation of the vascular surgeon confirmed absence of blood flow through femoral arteries and emergency angiotomography of the abdominal aorta showed complete occlusion of the descending aorta, upper renal arteries. Patient underwent percutaneous embolectomy treatment, with successful revascularization of lower extremities; unfortunately died about 10 hours after surgery due the development of revascularization syndrome. Conclusions: Acute aortic occlusion is a catastrophic event and can present itself as flaccid paraplegia, leading to misdiagnosis and loss of valuable time for positive outcome. Vascular examination should always be performed on each patient with neurological deficit in lower limbs, especially patients with clinical history of peripheral vascular disease. Immediate start of treatment is imperative to improve survival rates.

scholarly journals Interlaminar Versus Transforaminal Epidural Steroids for the Treatment of Subacute Lumbar Radicular Pain: A Randomized, Blinded, Prospective Outcome Study

2011 ◽  
Vol 6;14 (6;12) ◽  
pp. 499-511 ◽  
Author(s):  
Christopher G. Gharibo
Keyword(s):  
Back Pain ◽  
Rating Scale ◽  
Steroid Injection ◽  
Relative Effectiveness ◽  
Radicular Pain ◽  
Physical Exam ◽  
Therapeutic Effects ◽  
Outcome Study ◽  
Lumbar Radicular Pain ◽  
Epidural Steroids

Background: There is uncertainty in the literature over the relative effectiveness of lumbar epidural interlaminar (IL) steroid injection versus transforaminal (TF) steroid injection for lumbar radiculopathy. Most studies to date have been retrospective, or technically focused. Objective: To complete a randomized, blinded, prospective outcome study of the short-term benefit for IL versus TF epidural steroids for the treatment of subacute lumbar radicular pain. Study design: Prospective, randomized, blinded, subacute efficacy trial. Setting: Tertiary care pain management center, major metropolitan city, United States Methods: After institutional review board approval, 42 age-matched patients with similar lower back pain and unilateral radicular symptoms were enrolled and randomized in a patient and evaluating physician blinded trial to IL or TF epidural steroids from 2007 through 2009. Prior to intervention and 10-16 days after injection, each participant was evaluated by questionnaire and physical exam by an independent physician. All injections were performed by the same physician. Thirty-eight participants completed the study, 18 in the IL group and 20 in the TF group. Four participants required a repeat injection, and 2 participants crossed over to the alternative injection type (IL to TF). Results: Overall, physical exam, diagnostic testing, disability, activity, depression measures, and opioid pill use were similar between the 2 groups, both pre-injection baseline and postinjection improvement. In primary outcomes, the post-injection follow-up Numeric Rating Scale (NRS) was more greatly reduced in the TF group. The NRS decreased from 7.0 ± 1.9 to 3.9 ± 3.1 (mean values +/- standard deviation) in the IL group and 6.4 ± 2.1 to 1.7 ± 1.4 in the TF group. The Oswestry Disability Index was reduced from 37.5 ± 12.6 to 19.0 ± 16.7 in the IL group and 38.3 ± 6.4 to 21.6 ± 16.8 in the TF group. In secondary outcomes, the depression scale was reduced from 4.39 ± 3.22 to 2.28 ± 3.20 in the IL group and 4.10 ± 1.94 to 1.65 ± 1.63 in the TF group. Walking tolerance was increased from 8.1 ± 4.6 blocks to 10.6 ± 4.4 in the IL group and 8.9 ± 5.3 blocks to 11.8 ± 4.2 in the TF group. Limitations: The study did not examine long-term outcomes. A single experienced interventionalist performed all injections. Conclusion: Results suggest that patients may experience greater subjective relief, at least initially, from TF epidural steroid injections over IL. However, more objective, and likely subacute, therapeutic effects are similar. Key words: epidural, steroids, interlaminar, transforaminal, lumbar, lumbosacral, radicular, low back pain

Young Athlete with Back Pain

2008 ◽  
pp. 23-23
Author(s):  
Edward G. Walsh ◽  
William J. Brady
Keyword(s):  
Back Pain ◽  
Young Athlete

scholarly journals TRPV4 and TRPM8 as putative targets for chronic low back pain alleviation

2020 ◽  
Author(s):  
Stefania Fozzato ◽  
Nicolò Baranzini ◽  
Elena Bossi ◽  
Raffaella Cinquetti ◽  
Annalisa Grimaldi ◽  
...  
Keyword(s):  
Low Back Pain ◽  
Back Pain ◽  
Chronic Low Back Pain ◽  
Transient Receptor Potential ◽  
Trp Channels ◽  
Receptor Potential ◽  
Clinical History ◽  
Low Back ◽  
Transcript Levels ◽  
Transient Receptor

Abstract The purpose of this study is to investigate the presence of nervous fibers and expression of TRP channels in samples harvested during decompressive/fusion spine surgeries from patients affected by chronic low back pain (CLBP). The aim was to understand if members of this family of receptors played a role in detection and processing of painful stimuli, to eventually define them as potential targets for CLBP alleviation. Expression of transient receptor potential (TRP) channels (A1, V1, V2, V4, and M8) was evaluated in samples from different periarticular sites of 6 patients affected by CLBP, at both protein and transcript levels. The capsular connective pathological tissue appeared infiltrated by sensitive unmyelinated nervous fibers. An increase in TRP channel mRNAs and proteins was observed in the pathological capsule compared with tissues collected from the non-symptomatic area in five of the six analyzed patients, independently by the location and number of affected sites. In particular, TRPV4 and TRPM8 were consistently upregulated in pathological tissues. Interestingly, the only patient showing a different pattern of expression also had a different clinical history. TRPV4 and TRPM8 channels may play a role in CLBP and warrant further investigations as possible therapeutic targets.

scholarly journals Reconstruction of the Middle Patelofemoral Ligament with Quadricipital Autoinjerto and Use of the 3D Preoperative TAC to establish Femoral Anatomic Point

2018 ◽  
Vol 6 (12_suppl5) ◽  
pp. 2325967118S0017
Author(s):  
Camilo Hernández Córdoba
Keyword(s):  
Quadriceps Tendon ◽  
Clinical History ◽  
Anatomical Location ◽  
Surgical Time ◽  
Sports Activity ◽  
Intraoperative Fluoroscopy ◽  
History Of ◽  
Axial Ct ◽  
Unnecessary Radiation ◽  
Ct And Mri

Objectives: In recent years, the reconstruction of the LPFM has gained importance. The most used technique is with autograft of hamstring tendons. In some series, reports of complications are greater than 26%. This work aims to demonstrate the utility of the quadriceps autograft for the reconstruction of the LPFM, without patellar tunnels and without the use of intraoperative fluoroscopy. Methods: Patients with a clinical history of at least two episodes of dislocation were included. Radiographic series, axial CT, patellae, 3D CT and MRI were taken in all patients. 24 patients, 16 women and 8 men, with an average age of 23 years, met the selection criteria. Results: In our study we observed the improvement of scores on the scales of Lysholm, Tegner and Kujala in the postoperative period with controls at 6, 12 and 18 months. No new episodes of patellar dislocation or other relevant complications. There was a return in all cases to sports activity. Conclusion: This study reaffirms that the quadriceps tendon is a graft that reproduces better the anatomy of the LPFM, presents figures comparable or better functionally with the other grafts used at present. With the preoperative protocol of TAC3D, the adductor and medial epicondyle tubules have been identified individually and with the anatomical specificity of each patient, giving greater certainty in the anatomical location of the LPFM femoral insert. With the additional advantages of decreasing surgical time, and avoiding unnecessary radiation in the surgical team.

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