scholarly journals Carpal boss: An uncommon cause of dorsal wrist mass and chronic pain in children. A case report

2021 ◽  
Vol 0 ◽  
pp. 1-7
Author(s):  
Florencia Turazza ◽  
Javier Masquijo
Keyword(s):  
Chronic Pain ◽  
Wrist Joint ◽  
Ganglion Cyst ◽  
Pediatric Population ◽  
Treatment Options ◽  
Acute Injury ◽  
Common Cause ◽  
Adolescent Population ◽  
Uncommon Case ◽  
Operative Measures

Pain referred to the wrist joint, is a common affection among the pediatric and adolescent population, either due to acute injury or chronic stress. Even though the most common cause of a wrist mass associated with chronic pain in this patient population is a ganglion cyst, other pathologies should also be considered. We report an uncommon case of a 10-year-old girl with a carpal boss that was treated with surgery after non-operative measures failed to achieve symptom resolution. The diagnosis was established based on clinical examination and imaging findings. Although rare in the skeletally immature population, carpal boss should be considered as a differential diagnosis in a pediatric-adolescent patient with a dorsal wrist mass and chronic pain. The purpose of the present study was to describe the presentation and anatomical findings in our patient, that differ from the cases reported to date, as well as to review treatment options of this condition in the pediatric population.

scholarly journals ARE SPORTS INJURIES THE MOST COMMON CAUSE OF MOREL-LAVALLEE LESIONS IN THE PEDIATRIC POPULATION?

2021 ◽  
Vol 9 (7_suppl3) ◽  
pp. 2325967121S0002
Author(s):  
Indranil Kushare ◽  
Ramesh Babu Ghanta ◽  
Nicole A. Wunderlich
Keyword(s):  
Lower Extremity ◽  
Conservative Management ◽  
Sports Injuries ◽  
Pediatric Population ◽  
Case Series ◽  
Lower Leg ◽  
Functional Score ◽  
Imaging Features ◽  
Associated Injuries ◽  
Common Cause

Background: Traumatic internal degloving injury i.e. Morel-Lavallée lesion (MLL) develops as a result of blunt trauma with tangential shear forces. In the pediatric population, these have been described only as small case reports till date. Purpose: To describe the largest case series of lower extremity Morel-Lavallée lesion (MLL) in the pediatric population, to determine its etiology (especially its relationship to sports), treatment and outcomes. Methods: Retrospective study of patients <18 years presenting to a tertiary children’s hospital with MLL between 2013-2019. Demographics, clinical data, imaging features, treatment and outcomes data was collected. Descriptive statistical analysis was conducted. Results: 38 patients (21 males, 17 females) having MLL with mean age 14.6 years were classified into 2 groups- hip/thigh MLL (9 patients) and lower leg MLL (29) (Table 1.1). Most common cause of lower leg MLL was sports injury (79%). Most commonly implicated sports in MLL were football and baseball(24% each). Associated injuries were seen in 9 (23%) patients. Radiographs done in 58% of patients showed no bony abnormalities. Imaging modality of choice was MRI for lower leg MLLs (72%) and US for hip/thigh MLL (67%)(Fig.1.2). MLL size was larger for hip/thigh MLL (168 cm3) as compared to leg MLL (38.6 cm3). 25 (65.8%) of MLLs were treated with conservative management,12 (31.5%) with minimally invasive methods and 1(2.6%) needed surgical management. 2/9 (22.2%) of the associated injuries required operative management. 2/38 (5%) patients were given prophylactic antibiotics. 72.4% Lower leg MLLs were treated with conservative management while intervention was needed more in hip/thigh MLLs (55.6%). Patients returned to activities at 14.3 weeks for hip/thigh MLL;9.1 weeks for lower leg MLL. 24 patients with adequate documentation demonstrated lower extremity functional score (LEFS) and pain level of 74/80 (92.5%) and 0.7/10 respectively at mean 12.5 months follow-up. Leg cellulitis was seen as a complication in one patient. Conclusion: The largest case series on MLL exclusively in the pediatric population suggests that they are more common in knee/leg region region and usually caused by sports injuries which is notably different as compared to adult population. Most pediatric injuries are treated conservatively, especially sports related MLLs. Although return to activities takes longer for hip/thigh injuries, majority of patients regain satisfactory functionality post-injury. [Table: see text][Figure: see text]

An overview of proximal suspensory ligament desmitis

UK-Vet Equine ◽  
2019 ◽  
Vol 3 (5) ◽  
pp. 175-181
Author(s):  
Jonathan Anderson
Keyword(s):  
Treatment Options ◽  
Poor Performance ◽  
Diagnostic Techniques ◽  
Common Cause ◽  
Suspensory Ligament ◽  
The Common ◽  
Hindlimb Lameness

Proximal suspensory disease is a common cause of both forelimb and hindlimb lameness and poor performance in the horse. The following article describes the common presentations, diagnostic techniques and treatment options for the condition in both the forelimbs and the hindlimbs.

Treatment Options for Failed Back Surgery Syndrome Patients With Refractory Chronic Pain

Spine ◽  
2017 ◽  
Vol 42 ◽  
pp. S41-S52 ◽  
Author(s):  
Kasra Amirdelfan ◽  
Lynn Webster ◽  
Lawrence Poree ◽  
Vishad Sukul ◽  
Porter McRoberts
Keyword(s):  
Chronic Pain ◽  
Treatment Options ◽  
Failed Back Surgery Syndrome ◽  
Failed Back Surgery ◽  
Back Surgery

scholarly journals Surgical Management of Pediatric Gastroesophageal Reflux Disease

2013 ◽  
Vol 2013 ◽  
pp. 1-8 ◽  
Author(s):  
Hope T. Jackson ◽  
Timothy D. Kane
Keyword(s):  
Gastroesophageal Reflux Disease ◽  
Gastroesophageal Reflux ◽  
Surgical Management ◽  
Reflux Disease ◽  
Clinical Presentation ◽  
Pediatric Population ◽  
Treatment Options ◽  
Failure To Thrive ◽  
Solid Diet ◽  
Esophageal Sphincter

Gastroesophageal reflux (GER) is common in the pediatric population. Most cases represent physiologic GER and as the lower esophageal sphincter (LES) matures and a solid diet is introduced, many of these patients (>65%) experience spontaneous resolution of symptoms by two years of age. Those who continue to have symptoms and develop complications such as failure to thrive, secondary respiratory disease, and others are classified as having gastroesophageal reflux disease (GERD). Goals of GERD treatment include the resolution of symptoms and prevention of complications. Treatment options to achieve these goals include dietary or behavioral modifications, pharmacologic intervention, and surgical therapy. This paper will review the clinical presentation of GERD and discuss options for surgical management and outcomes in these patients.

scholarly journals Treatment Options for Vestibular Migraine

US Neurology ◽  
2016 ◽  
Vol 12 (01) ◽  
pp. 39 ◽  
Author(s):  
Steffen Naegel ◽  
◽  
Manjit Matharu ◽  
Mark Obermann ◽  
◽  
...  
Keyword(s):  
Prophylactic Treatment ◽  
International Headache Society ◽  
Controlled Trial ◽  
Treatment Options ◽  
Evidence Base ◽  
Vestibular Migraine ◽  
Controlled Trials ◽  
Common Cause ◽  
Randomized Controlled ◽  
Trial Testing

Although vestibular migraine is a common cause of vertigo, affecting approximately 1% of the Western world’s population, it remains widely under-recognized and is under-diagnosed. Diagnostic criteria for vestibular migraine were recently published in collaboration with the International Headache Society and the Bárány-Society. Trials investigating the treatment of vestibular migraine are sparse but some are now underway. This review focuses on the treatments options available for vestibular migraine, based on the existing evidence base where available. Regarding acute treatments, there are two randomized controlled trials that provide evidence for the use of triptans (zolmitriptan and rizatriptan) for the management of vestibular migraine attacks. For prophylactic treatment, the evidence base is largely non-existent, since the only multicenter randomized placebo-controlled trial testing metoprolol versus placebo is still underway. Consequently, the treatment recommendations for the prophylactic treatment of vestibular migraine are mainly based on expert opinion and the treatments guidelines for migraine with and without aura.

Cushing Syndrome

2019 ◽  
Author(s):  
Lynnette Nieman
Keyword(s):  
Chronic Exposure ◽  
Laboratory Tests ◽  
Adrenocorticotropic Hormone ◽  
Cushing Syndrome ◽  
Treatment Options ◽  
Clinical Manifestations ◽  
Screening Tests ◽  
Imaging Studies ◽  
Common Cause ◽  
Pituitary Adrenal Axis

Cushing syndrome is a condition with protean manifestations that are caused by chronic exposure to excess glucocorticoids. Treatment with supraphysiologic doses of glucocorticoids is the most common cause. Pathologic hypercortisolism may result from autonomous adrenal production or as a result of the action of excessive adrenocorticotropic hormone (ACTH) production by a tumor, which stimulates adrenal cortisol production. Primary adrenal forms include unilateral adenoma or carcinoma or, rarely, bilateral hyperplasia and/or nodules. This chapter covers the epidemiology, etiology, pathophysiology, and diagnosis of Cushing syndrome. Clinical manifestations, physical examination findings, and laboratory tests, including tests of the blood and other body fluids, imaging studies, and biopsy, are discussed. The differential diagnosis, treatment options, complications, and prognosis are described. Tables outline clinical features and causes of Cushing syndrome, abnormalities associated with primary adrenal causes of Cushing syndrome, diagnostic accuracy of screening tests, endogenous hypercortisolism without Cushing syndrome, and medical therapy for Cushing syndrome. Figures illustrate the causes of Cushing syndrome and a comparison of the hypothalamic-pituitary-adrenal axis in patients with ACTH-dependent Cushing syndrome and those with pseudo–Cushing syndrome. Algorithms show the evaluation of possible Cushing syndrome and evaluation of the causes of Cushing syndrome. Second-line treatments for Cushing syndrome when surgery fails or is not possible are also detailed. This chapter contains 5 figures, 7 tables, 50 references.

Opioid-Sparing Analgesics in Chronic Pain Management

2017 ◽  
Author(s):  
Maricela Schnur ◽  
Michael Fitzsimons ◽  
Fangfang Xing
Keyword(s):  
Chronic Pain ◽  
Treatment Options ◽  
Primary Treatment ◽  
Opioid Therapy ◽  
Nonsteroidal Antiinflammatory Drugs ◽  
Prescription Opioid ◽  
Antiinflammatory Drugs ◽  
Opioid Sparing ◽  
Pharmacologic Treatments ◽  
Chronic Pain Therapy

Chronic pain impacts the lives of millions of people in significant medical and psychosocial ways. Pharmacologic treatments are steering away from chronic opioid therapy due to serious side effects, an epidemic of prescription opioid abuse, and a lack of clear long-term benefit.  Therefore, nonopioid medications such as nonsteroidal antiinflammatory drugs, acetaminophen, tricyclic antidepressants, lidocaine patch, and anticonvulsants are important opioid-sparing or primary treatment options. Agents such as capsaicin, cannabis, botulinum toxin, and ketamine are less frequently prescribed adjuncts that are under active investigation to determine their roles in chronic pain therapy. Understanding the research can help the clinician determine the risks and benefits of these medications for their patients. In the future, dose and delivery optimization, combination therapy, elucidating the biology of pain, and developing novel agents will improve pharmacologic approaches to treatment.          

Craniopharyngioma

2019 ◽  
pp. 207-216
Author(s):  
Lissa C. Baird
Keyword(s):  
Initial Treatment ◽  
Pediatric Population ◽  
Intraoperative Complications ◽  
Treatment Options ◽  
Benign Neoplasm ◽  
Tumor Control ◽  
Delayed Treatment ◽  
Pituitary Dysfunction ◽  
Treatment Morbidity

Pediatric craniopharyngioma is a histologically benign neoplasm with potential for malignant clinical behavior. Presenting vision and endocrine deficits are common, and the natural history carries unacceptable morbidity, including blindness, complete hypothalamic and pituitary dysfunction, and death. The goal of initial treatment for craniopharyngioma in the pediatric population should be permanent tumor control or cure in order to minimize morbidity from recurrent and progressive disease. Treatment-related morbidity is acute with surgical intervention and requires immediate postoperative endocrinological care. Radiotherapy is associated with delayed treatment morbidity, and long-term monitoring is critical. Inadequate tumor control after initial treatment will result in inevitable recurrence, with more complex and less effective treatment options and higher associated treatment morbidity. Unexpected intraoperative complications can be avoided with careful preoperative planning and good surgical technique.

scholarly journals Beyond Amitriptyline: A Pediatric and Adolescent Oriented Narrative Review of the Analgesic Properties of Psychotropic Medications for the Treatment of Complex Pain and Headache Disorders

Children ◽  
2020 ◽  
Vol 7 (12) ◽  
pp. 268
Author(s):  
Robert Blake Windsor ◽  
Michael Sierra ◽  
Megan Zappitelli ◽  
Maria McDaniel
Keyword(s):  
Chronic Pain ◽  
Pain Treatment ◽  
Treatment Options ◽  
Narrative Review ◽  
Mood Stabilizers ◽  
Complex Nature ◽  
Multidisciplinary Teams ◽  
Complex Population ◽  
Heterogenous Population ◽  
Psychiatric Conditions

Children and adolescents with recurrent or chronic pain and headache are a complex and heterogenous population. Patients are best served by multi-specialty, multidisciplinary teams to assess and create tailored, individualized pain treatment and rehabilitation plans. Due to the complex nature of pain, generalizing pharmacologic treatment recommendations in children with recurrent or chronic pains is challenging. This is particularly true of complicated patients with co-existing painful and psychiatric conditions. There is an unfortunate dearth of evidence to support many pharmacologic therapies to treat children with chronic pain and headache. This narrative review hopes to supplement the available treatment options for this complex population by reviewing the pediatric and adult literature for analgesic properties of medications that also have psychiatric indication. The medications reviewed belong to medication classes typically described as antidepressants, alpha 2 delta ligands, mood stabilizers, anti-psychotics, anti-sympathetic agents, and stimulants.

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