A Significant Injury with Just a Speck of Pain

​BY ARJUN BHARADWAJ &KHALID MALIK, MDA 58-year-old man who lived at a nursing facility came to the emergency department complaining of abdominal pain for three days. His pain was localized to the epigastrium and periumbilical regions. The nursing home staff indicated that he was hypotensive and possibly hypoxic.The patient said he never had similar pain before, which he said pain was mild and constant in severity and did not radiate to the chest, back, pelvis, or shoulders. He also reported nausea but no trauma, falls, vomiting, fever, chills, dizziness, chest pain, shortness of breath, trouble walking, or change in bowel movements or urination.He had a history of schizoaffective disorder, type 2 diabetes mellitus, hypertension, and hyperlipidemia. He said he did not use illicit drugs and that he had quit smoking more than three years before. He used to consume ethanol daily, but had stopped when he was admitted to the nursing home two years earlier. His vital signs were a heart rate of 116 bpm, a blood pressure of 70/42 mm Hg, a temperature of 97.1°F, a respiration rate of 29 bpm, an oxygen saturation of 97% on two L nasal cannula, and pain severity of 2/10.His neck and pharynx were normal, and he had no tenderness to chest or chest wall palpation. His breathing was not labored, but he had decreased bilateral breath sounds. A cardiac exam showed a regular rate and rhythm, he had no peripheral edema, and his peripheral pulses were equal bilaterally. His abdomen was ...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research

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This study seeks to use the relative refractory period, a sensitive parameter for detecting early change in peripheral polyneuropathies, as a tool for early detection of diabetic polyneuropathy. Design The relative refractory period of the median and sural sensory nerves was measured in 57 diabetic patients (male 31, female 26) and 23 healthy controls (male 16, female 7). The shortest interstimulus interval, where the latency of the response to the second stimulus recovers to normal, was defined as the relative refractory period. Results The relative refractory period of the median and sural nerves were significantly...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Original Research Articles Source Type: research
Conclusions The results of the present study may be indicative for an impaired oxidative metabolism in work-related trapezius myalgia. However, additional research is necessary to confirm this hypothesis.
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Original Research Articles Source Type: research
This study aims to assess whether ultrasound-guided injection of platelet-rich plasma can safely and effectively treat symptoms associated with acetabular hip labral tears. Design Institutional review board approval was gained for a prospective study of eight patients (N = 8), who have previously failed conservative management, to receive ultrasound-guided injection of platelet-rich plasma at the site of hip labrum tear. We assessed pain reduction and functional ability at baseline and then 2, 6, and 8 wks after injection, using the visual analog scale and Harris Hip Score, respectively. Results Statistically signifi...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Original Research Articles Source Type: research
Introduction Ozone has been recently used as a safe alternative treatment in musculoskeletal disorders with fewer adverse effects than corticosteroids. The aim of this study was to compare the efficacy of a single injection of ozone with that of a corticosteroid in the treatment of shoulder impingement. Design Thirty patients with shoulder pain and clinical signs and symptoms of impingement were randomly assigned into two groups: ultrasound-guided injection with ozone or corticosteroid. Patients’ symptoms were evaluated by visual analog scale, constant score, shoulder pain and disability scale, shoulder range of...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Original Research Articles Source Type: research
Bone stress injury is a common overuse injury in athletes. Risk factors for bone stress injury in athletes include the female athlete triad (triad); this has not been evaluated in para athletes. The aim of this study was to identify risk factors, prevalence, and anatomical distribution of bone stress injury in para athletes. A cross-sectional online survey on health characteristics and previous fractures including bone stress injury was completed by para athletes training for the 2016 or 2018 Paralympic Games. Two hundred sixty para athletes completed the survey (659 invited, response rate = 40%). Half reported previous fr...
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Brief Report Source Type: research
We describe a case of posttraumatic chronic intercostal neuralgia, in which successful pain relief was achieved via repeated injections of local anesthetic and steroid combinations in the serratus anterior plane under ultrasonographic guidance. This novel technique is easy to administer, reliable, and warrants further investigation with regard to its use for rehabilitation of patients who are experiencing posttraumatic chronic neuropathies of the chest wall.
Source: American Journal of Physical Medicine and Rehabilitation - Category: Rehabilitation Tags: Case Report Source Type: research
ConclusionsStructural and functional changes meta-analyzed in this paper may contribute to elucidating the central pathophysiological mechanisms involved in TN/TNP. These results may be used as biomarkers to predict the response to medication and, ideally, in the future to offer personalized treatments.
Source: NeuroImage: Clinical - Category: Radiology Source Type: research
Publication date: Available online 16 October 2019Source: Journal of the American College of RadiologyAuthor(s): Cindy Yuan, Kirti Kulkarni, Brittany Z. DashevskyAbstractObjectiveTo evaluate the impact of comorbid conditions and age on mammography use.MethodsWe used data from the 2011 to 2015 Medical Expenditure Panel Survey, which contained records for 40,752 women over the age of 40. Use was defined as a mammogram within the previous 1 or 2 years, analyzed separately. A logit model was employed to evaluate associations between use and comorbidities and age. Statistical significance was defined by a P value
Source: Journal of the American College of Radiology - Category: Radiology Source Type: research
Authors: Robinson J, Lang B, Clippinger D Abstract The complexity and cost of diabetes care are barriers to a free health clinic attempting to provide quality care to uninsured patients. The alphabet strategy intervention was selected to increase the number of patients with diabetes receiving care according to the American Diabetes Association guidelines because it is simple and cost-effective. The project results revealed statistically significant increases in clinic uptake of diabetes education, blood pressure interventions, proteinuria, glucose control measurement and intervention, eye exams, and foot exams. The...
Source: Journal of Community Health Nursing - Category: Nursing Tags: J Community Health Nurs Source Type: research
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Source: Minerva Urologica e Nefrologica - Category: Urology & Nephrology Tags: Minerva Urol Nefrol Source Type: research
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