Résumé
Abstract Introduction: Facet joint pain is a common source of non-radicular back pain worldwide. Non-surgical interventional modalities remain the mainstay in the treatment of facetogenic back pain and comprise the second most commonly performed interventional pain procedures in the USA. Case: A 36 year-old man with chronic cervical pain secondary to C6-C7 facet arthrosis radiographically, underwent diagnostic local anesthetic bilateral facet joint injection under fluoroscopic guidance. The left side was injected uneventfully; however, 1-2 min following injection of the right side the patient complained of unwellness and became very anxious. He referred paresthesias of the bilateral upper extremities, chest and upper abdomen. Physical examination showed sensory deficits roughly from C5 to T7 without motor deficits; resuscitation measures were not warranted. The deficits were completely resolved by 35-40 min in the recovery area. Discussion: Facet joint injections are a common and safe method of treating back pain secondary to facet arthropathy. Despite excellent safety profiles, rare and sometimes, life-threatening complications can occur. Our case hypothesizes intrathecal injection of local anesthetic during facet joint injection. Few reports have described similar situations. We hypothesize a mechanism of entry through the facet joint, given the proximity of the ligamentum flavum, and the intrathecal space to the anterior aspect of the facet joint. This report reinforces the need for resuscitation and airway management equipment to be readily available where interventional procedures are performed, as well as the need for adequate proficiency in airway management and resuscitation techniques in Pain Medicine training.
Resumo Introdução: A dor nas articulações facetárias é uma fonte mundialmente comum de dores nas costas não radiculares. As modalidades de intervenções não cirúrgicas continuam sendo os pilares no tratamento da dorsalgia facetária e ocupam o segundo lugar entre os procedimentos mais comumente feitos nos EUA para o manejo da dor. Relato de caso: Paciente do sexo masculino, 36 anos, com dor cervical crônica secundária à artrose facetária em C6-C7 (confirmada por radiografia), submetido a exame diagnóstico bilateral das facetas com injeção de anestésico local sob orientação fluoroscópica. O lado esquerdo foi injetado sem intercorrências; porém, um-dois minutos após a injeção do lado direito, o paciente queixou-se de mal-estar e ficou muito ansioso. Mencionou parestesia nos braços, no tórax e no abdome superior. O exame físico revelou déficits sensoriais de, aproximadamente, C5 a T7, sem déficit motor; medidas de reanimação não eram justificáveis. Os déficits foram completamente resolvidos em 35-40 minutos na área de recuperação. Discussão: A aplicação de injeções nas articulações facetárias é um método comum e seguro de tratar a dor nas costas secundária à artropatia facetária. Apesar dos excelentes perfis de segurança, complicações raras e, às vezes, com risco de morte podem ocorrer. Nosso caso relata a injeção intratecal de anestésico local durante injeção nas facetas articulares. Poucos relatos descreveram situações semelhantes. Levantamos a hipótese de um mecanismo de entrada através da faceta articular, por causa da proximidade do ligamento amarelo e do espaço intratecal com o aspecto anterior da faceta articular. Esse relato reforça a necessidade de reanimação e de equipamentos para o manejo das vias aéreas estarem prontamente disponíveis quando procedimentos intervencionistas são feitos, bem como a necessidade de estabelecer o domínio do conhecimento no manejo das vias aéreas e das técnicas de reanimação e treinamento em medicina da dor.
Sujets)
Humains , Mâle , Adulte , Maladies du rachis/induit chimiquement , Bupivacaïne/administration et posologie , Bupivacaïne/effets indésirables , Articulation zygapophysaire , Anesthésiques locaux/administration et posologie , Anesthésiques locaux/effets indésirables , Injections rachidiennes , Bupivacaïne/usage thérapeutique , Dorsalgie/complications , Dorsalgie/traitement médicamenteux , Erreurs médicales , Injections articulaires/effets indésirables , Anesthésiques locaux/usage thérapeutiqueRésumé
Spondyloepiphyseal dysplasia (SED) tarda is an inherited skeletal arthropathy. Because SED tarda involves the joints and resemble the clinical findings of chronic arthropathies, this disease is frequently misdiagnosed as juvenile idiopathic arthritis (JIA). We report here on three patients (father and his two daughters) in one family with SED tarda. All patients had back pain and polyarthralgia. Their radiographs revealed typical changes for SED tarda including platyspondyly and dysplastic bone changes. This rare disease has major clinical importance in that it is similar with JIA or rheumatoid arthritis.
Sujets)
Adulte , Femelle , Humains , Mâle , Jeune adulte , Arthralgie/complications , Dorsalgie/complications , Ostéochondrodysplasies/complications , Pedigree , République de CoréeRésumé
ABSTRACT Objective: To correlate epidemiological data, lifestyle, and psychosocial factors as predictors for clinical manifestation of back pain in patients treated at the orthopedic emergency unit of a Brazilian tertiary care hospital, and to evaluate their interest in participating in a hypothetical program for physical rehabilitation. Methods: This is an observational cross-sectional study. We evaluated 210 patients from the emergency department of a tertiary hospital with a major complaint of back pain. We used: epidemiological multiple-choice questionnaires developed for this study; Oswestry questionnaire for physical disability; Hospital Anxiety and Depression Scale (HAD) scale. Data analyses were performed using SAS - Statistical Analysis System (SAS Institute, 2001). Measurements were performed with the SAS functions Proc MEANS and Proc Freq. Results: The mean age was 39.1 years and there was no predominance between genders. The usual work activity was administrative (65.2% of cases). The mean body mass index was 26.0, indicating overweight. The majority (83.3%) of patients had low physical disability (Oswestry 0 – 40%). The number of medical visits in the previous 6 months (p=0.04) and the scores of anxiety and depression (p=0.05), independently, were correlated with physical disability. Most patients (77%) would agree to participate in a hypothetical program of physical rehabilitation for prevention of back pain. Conclusion: Patients with back pain complaints were predominantly young adults, sedentary or hypoactive, overweight, and with recurrent complaints of symptoms. Most participants had low levels of physical disability and would accept participation in a hypothetical physical rehabilitation program for the prevention of back pain. .
RESUMO Objetivo: Correlacionar dados epidemiológicos, hábitos de vida e fatores psicossociais como preditivos para manifestação clínica de dorsolombalgia em pacientes atendidos no setor de urgências ortopédicas de hospital terciário brasileiro, além de avaliar o interesse em participar de programa hipotético para reabilitação física. Métodos: Trata-se de estudo observacional do tipo transversal. Foram avaliados 210 pacientes provenientes do pronto atendimento de um hospital terciário, com queixa predominante de dor nas costas. Foram utilizados: questionários epidemiológicos do tipo múltipla escolha desenvolvidos para o presente estudo; questionário Oswestry para incapacidade física; e escala Hospital Anxiety and Depression Scale (HAD). As análises dos dados foram realizadas por meio do programa SAS - Statistical Analysis System (SAS Institute, 2001). Os cálculos foram realizados com as funções Proc MEANS e Proc Freq do SAS. Resultados: A média de idade foi de 39,1 anos e não houve predominância entre os gêneros. A atividade laborativa mais frequente foi a administrativa (65,2% dos casos). Observou-se índice de massa corporal médio de 26,0, que indicou sobrepeso. A maioria (83,3%) dos pacientes apresentou baixa incapacidade física (Oswestry de 0 – 40%). O número de visitas nos 6 meses anteriores (p=0,04) e os escores de ansiedade e depressão (p=0,05), isoladamente, tiveram correlação com a incapacidade física. A maioria dos pacientes (77%) aceitaria participar de programa hipotético de reabilitação física para prevenção de dores nas costas. Conclusão: Os pacientes com queixa de dorsolombalgia foram, predominantemente, adultos jovens, sedentários ou hipoativos, com sobrepeso e com queixas recorrentes dos sintomas. A maioria dos participantes apresentou baixa incapacidade física e aceitaria participar de programa hipotético de reabilitação física para a prevenção de dores nas costas. .
Sujets)
Adulte , Femelle , Humains , Mâle , Adulte d'âge moyen , Dorsalgie/épidémiologie , Évaluation de l'invalidité , Mode de vie , Lombalgie/épidémiologie , Acceptation des soins par les patients/psychologie , Anxiété/complications , Anxiété/diagnostic , Indice de masse corporelle , Dorsalgie/complications , Dorsalgie/psychologie , Brésil/épidémiologie , Études transversales , Dépression/complications , Dépression/diagnostic , Service hospitalier d'urgences/statistiques et données numériques , Lombalgie/complications , Lombalgie/psychologie , Échelles d'évaluation en psychiatrie , Indice de gravité de la maladie , Répartition par sexe , Sports , Enquêtes et questionnaires , Fumer/épidémiologie , Centres de soins tertiaires/statistiques et données numériquesRésumé
OBJECTIVES: to measure the pain intensity, identify the disability and depression levels in people with chronic back pain and to correlate these variables. A cross-sectional, descriptive and exploratory study was undertaken at the Pain Treatment Clinic of the University of São Paulo at Ribeirão Preto Hospital das Clínicas, between February and June 2012, after receiving approval from the Ethics Committee at the University of São Paulo at Ribeirão Preto College of Nursing. METHOD: sixty subjects with chronic back pain participated. The instruments used were: the 11-point Numerical Category Scale, the Roland-Morris Disability Questionnaire and the Beck Depression Inventory. To analyze the data, the arithmetic means, standard deviations and Spearman's correlation coefficient were calculated. RESULTS: the findings show that the participants presented high pain, disability and depression levels. The correlation between pain intensity and disability and between pain intensity and depression was positive and weak and, between disability and depression, positive and moderate. CONCLUSION: the study variables showed moderate and weak indices and the mutual correlations were positive. .
OBJETIVOS: mensurar a intensidade dolorosa, identificar a incapacidade e os níveis de depressão em pessoas com dor lombar crônica e correlacionar essas variáveis. Trata-se de estudo transversal descritivo-exploratório, realizado na Clínica para o Tratamento da Dor do Hospital das Clínicas de Ribeirão Preto, entre fevereiro e junho de 2012, após aprovação do Comitê de Ética da Escola de Enfermagem de Ribeirão Preto - USP. MÉTODO: participaram 60 sujeitos com dor lombar crônica. Os instrumentos utilizados foram: a Escala de Categoria Numérica de 11 pontos, o Questionário Roland Morris de Incapacidade e o Inventário de Depressão de Beck. Para análise dos dados, foram calculadas as médias aritméticas, os desvios-padrões e o coeficiente de correlação de Spearman. RESULTADOS: os achados mostraram que os participantes apresentaram elevados níveis de dor, de incapacidade e de depressão. A correlação entre intensidade de dor e incapacidade e entre intensidade de dor e depressão foi positiva fraca, e entre incapacidade e depressão foi positiva moderada. CONCLUSÃO: as variáveis estudadas apresentam índices moderados e fracos e as correlações foram positivas entre si. .
OBJETIVOS: medir la intensidad del dolor, identificar la incapacidad y los niveles de depresión en personas con dolor lumbar crónico y correlacionar estas variables. Se trata de un estudio transversal, descriptivo y exploratorio realizado en la Clínica para Tratamiento del Dolor del Hospital de las Clínicas de Ribeirao Preto, entre febrero y junio de 2012, después de la aprobación del Comité de Ética de la Escuela de Enfermería de Ribeirao Preto - USP. MÉTODO: participaron 60 sujetos con dolor lumbar crónico. Los instrumentos utilizados fueron: la Escala de Categoría Numérica de 11 puntos, el Cuestionario Roland Morris de Incapacidad y el Inventario de Depresión de Beck. Para analizar los datos, fueron calculados los promedios aritméticos, las desviaciones estándar y el coeficiente de correlación de Spearman. RESULTADOS: los hallazgos mostraron que los participantes presentaron elevados niveles de dolor, de incapacidad y de depresión. La correlación entre la intensidad del dolor e incapacidad y entre intensidad del dolor y depresión fue positiva débil y entre incapacidad y depresión fue positiva moderada. CONCLUSIÓN: las variables estudiadas presentan índices moderados y débiles y las correlaciones fueron positivas entre sí. .
Sujets)
Humains , Mâle , Femelle , Adulte , Adulte d'âge moyen , Sujet âgé , Sujet âgé de 80 ans ou plus , Jeune adulte , Dorsalgie/complications , Douleur chronique/complications , Évaluation de l'invalidité , Dépression/étiologie , Mesure de la douleur , Activités de la vie quotidienne , Dorsalgie/diagnostic , Dorsalgie/physiopathologie , Études transversales , Douleur chronique/diagnostic , Douleur chronique/physiopathologie , Enquêtes et questionnairesRésumé
OBJECTIVES: People who have chronic diseases, as well as gait imbalance or psychiatric drug use, may be susceptible to injuries from falls and slips. The purpose of this study was to evaluate the effect of musculoskeletal diseases on incidental fall-related injuries among adults in Korea. METHODS: We analyzed data from the 4th Korea National Health and Nutrition Examination Survey (2007-2009), which are national data obtained by a rolling survey sampling method. The 1-year incidence of fall-related injuries was defined by health service utilization within the last year due to injury occurring after a slip and fall, and musculoskeletal diseases included osteoarthritis, rheumatoid arthritis, osteoporosis, and back pain. To evaluate the effects of preexisting musculoskeletal diseases, adults diagnosed before the last year were considered the exposed group, and adults who had never been diagnosed were the unexposed group. RESULTS: The weighted lifetime prevalence of musculoskeletal disease was 32 540 per 100 000 persons. Musculoskeletal diseases were associated with a higher risk of fall-related injury after adjustment for sex, age, residence, household income, education, occupation, visual disturbance, paralysis due to stroke, and medication for depression (odds ratio [OR], 1.41; 95% confidence interval [CI], 1.03 to 1.93). As the number of comorbid musculoskeletal diseases increased, the risk of fall-induced injuries increased (p-value for trend <0.001). In particular, patients who had any musculoskeletal condition were at much higher risk of recurrent fall-related injuries (OR, 6.20; 95% CI, 1.06 to 36.08). CONCLUSIONS: One must take into account the risk of fall-related injuries and provide prevention strategies among adults who have musculoskeletal diseases.
Sujets)
Adolescent , Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Jeune adulte , Chutes accidentelles/statistiques et données numériques , Facteurs âges , Polyarthrite rhumatoïde/complications , Dorsalgie/complications , Enquêtes de santé , Incidence , Maladies ostéomusculaires/complications , Arthrose/complications , Ostéoporose/complications , République de Corée/épidémiologie , Facteurs de risque , Facteurs sexuels , Facteurs socioéconomiquesRésumé
Background: The prevalence of work-related musculoskeletal complaints in dentists is high and the past two decades have witnessed a sharp rise in the incidence of various disorders. The prevalence of musculoskeletal pain ranges between 64% and 93%. The most effected regions have been back and neck. Various studies have been done to record stress levels and health-related behaviors of dentists in other countries but limited data is available among the Indian dentists. Materials and Methods: Therefore a questionnaire survey was carried out among 102 Indian dentists belonging to different fields having at least one musculoskeletal disorder in last 6 months. Results: The total sample consists of 80 males and 22 females. Out of the 102 over 97 of dentists had sought medical advice for these disorders during the previous 06 months and 74 of them also consulted the physiotherapist for exercises and ergonomic advice. The number of sessions taken for regular physical exercises was minimum 6 till 44 the most. The percentage of improvement in symptoms varied between 20% and 80%. Conclusions: A significant direct correlation between the number of sessions taken for physical activity and the self-perceived improvement in the symptoms was found using the Pearson correlation test. The work-related musculoskeletal disorders among dentists not only decrease their efficiency but also is a major concern among them. Self-awareness and benefits of regular exercise is the need of the hour.
Sujets)
Dorsalgie/complications , Dorsalgie/prévention et contrôle , Dorsalgie/rééducation et réadaptation , Odontologie , Dentistes , Traitement par les exercices physiques , Femelle , Connaissances, attitudes et pratiques en santé , Ingénierie humaine , Humains , Inde , Mâle , Activité motrice , Maladies ostéomusculaires/complications , Maladies ostéomusculaires/prévention et contrôle , Maladies ostéomusculaires/rééducation et réadaptation , Cervicalgie/complications , Cervicalgie/prévention et contrôle , Cervicalgie/rééducation et réadaptation , Maladies professionnelles/prévention et contrôle , Maladies professionnelles/rééducation et réadaptationRésumé
A cross-sectional population-based study was conducted to identify the prevalence of common mental disorders and verify the association with chronic non-communicable diseases (NCDs) and the self-reported number of chronic diseases. The Self-Reporting Questionnaire (SRQ-20) was applied in a multi-stage random sample of 1,276 adults aged 40 and older. Socio-demographic, behavioral, and health-related variables were also obtained using a structured questionnaire. Prevalence of common mental disorders was 30.2 percent. Lower schooling and social class and the 46-55-year age bracket were associated with psychiatric morbidity. Each chronic illness was independently associated with common mental disorders. However, a stronger association was found between common mental disorders and the total number of self-reported chronic conditions, with a prevalence ratio of 4.67 (95 percentCI: 3.19-6.83) for five or more self-reported NCDs. The current study emphasizes the importance of common mental disorders in chronically ill patients, particularly in those with more total chronic conditions.
Estudo transversal de base populacional foi conduzido tendo como objetivos avaliar a prevalência dos transtornos mentais comuns e verificar sua associação com determinadas enfermidades crônicas e com o número de doenças crônicas relatadas pelo indivíduo. Para a avaliação de transtornos mentais comuns, o Self-Reporting Questionnaire (SRQ-20) foi aplicado em 1.276 adultos com 40 anos ou mais. Variáveis sócio-demográficas, comportamentais e relacionadas à saúde foram obtidas por meio de um questionário estruturado. Os transtornos mentais comuns apresentaram uma prevalência de 30,2 por cento, estando associados à baixa escolaridade e classe social, e à faixa etária de 46-65 anos. Todas as doenças crônicas pesquisadas mostraram-se associadas aos transtornos mentais comuns. Entretanto, o número de enfermidades apresentadas pelo indivíduo teve maior importância do que cada uma delas individualmente, com uma razão de prevalência de 4,67 e intervalo de 95 por cento de confiança: 3,19-6,83 para cinco ou mais doenças relatadas. O presente estudo realça a importância de se atentar para os transtornos mentais em indivíduos com enfermidades crônicas, principalmente naqueles que se apresentam com um grande número de doenças.
Sujets)
Adulte , Sujet âgé , Femelle , Humains , Mâle , Adulte d'âge moyen , Dorsalgie/épidémiologie , Complications du diabète/épidémiologie , Hypertension artérielle/épidémiologie , Maladies articulaires/épidémiologie , Troubles mentaux/épidémiologie , Facteurs âges , Dorsalgie/complications , Brésil/épidémiologie , Maladie chronique , Études transversales , Hypertension artérielle/complications , Maladies articulaires/complications , Troubles mentaux/complications , Surveillance de la population , Prévalence , Facteurs socioéconomiquesRésumé
Investigamos, en 180 pacientes de los cuales 114 fueron mujeres y 66 fueron varones - sus características y rasgos clínicos; así también, lo que creen de ella dichos pacientes. El diagnóstico se estableció aplicando en forma prospectiva un protocolo con datos generales y criterios dirigidos a evaluar la lumbalgia en el periodo 1995-1996. Encontramos que esta dolencia ocurrió con mayor frecuencia en personas de 35 a 44 años; que tuvo una duración de 1 a 2 años, prevaleciendo en las amas de casa (mujeres) y en choferes (varones). Predominó el inicio de dolor lumbar en forma incidiosa en 113 pacientes (62.8 por ciento) y en forma brusca en 67 pacientes (37.2 por ciento). Su presentación fue predominantemente bilateral, irradiada en especial a un solo miembro inferior, y se intensificaba con la bipedestación. Existió alteración tanto en el eje de la curvatura lumbar como en la línea de las crestas iliacas, y digitopresión dolorosa en las masas musculares lumbares en 141 pacientes (78.3 por ciento). Se observó signo de Lasegué positivo en 74 pacientes (41.1 por ciento) y negativo en 106 pacientes (58.9 por ciento). Se solicitaron un hemograma y un examen completo de orina (no urocultivo). El hemograma normal en 170 pacientes (94.4 por ciento) y con alguna alteración en 10 pacientes (5.6por ciento). Examen completo de orina estuvo normal en 163 pacientes (90.6 por ciento) y anormal en 17 pacientes (9.4 por ciento). Se tomaron solamente 39 placas (incidencias antero-posterior) y estas mostraron alteraciones radiográficas en el total de placas tomadas (100.0). Además todos presentaban dos o más alteraciones rediográficas. Existió una alta presentación de dismetría de caderas, espondiloartrosis, sacroileítis, alteración en los psoas iliacos, etc.. La lumbalgia puede diagnosticarse de manera rápida y segura en forma ambulatoria, ahorrándoles tiempo y dinero a los pacientes y mejorándoles su calidad de vida.
Sujets)
Humains , Dorsalgie/complications , TraumatologieSujets)
Humains , Dorsalgie , Dorsalgie/complications , Dorsalgie/diagnostic , Dorsalgie/étiologie , Dorsalgie/soins infirmiers , Dorsalgie/anatomopathologie , Traumatismes cranioencéphaliques , Traumatismes cranioencéphaliques/diagnostic , Traumatismes cranioencéphaliques/anatomopathologie , Traumatismes cranioencéphaliques/thérapie , Anatomopathologie , Anatomopathologie/classification , Anatomopathologie/statistiques et données numériques , Traumatismes cranioencéphaliques , Traumatismes cranioencéphaliques/complications , Traumatismes cranioencéphaliques/diagnostic , Traumatismes cranioencéphaliques/étiologie , Traumatismes cranioencéphaliques/anatomopathologie , Neurologie/classification , Neurologie/organisation et administrationRésumé
El objetivo fue indentificar los factores de riesgo entre trabajadores portadores de hernia de disco intervertebral lumbar dictaminada invalidante para el trabajo. Se realizó estudio de casos y controles: 120 trabajadores con dictamen de invalidez por hernia de disco lumbar (HDL) y 30 trabajadores con HDL que continúan laborando. En el análisis estadístico, se utilizó básicamente cálculo de razón de momios. Los resultados más destacados fueron: antecedente familiar de lumbalgia, antecedentes quirúrgicos, traumas previos sobre columna y alteraciones congénitas de columna lumbar. De acuerdo a lo observado, el examen médico previo a la contratación de trabajadores debe explorar: antecedente familiar de lumbalgia, antecedente quirúrgico y alteraciones congénitas de columna lumbar. La asociación entre estos factores y la invalidez por HDL alienta a establecer medidas de prevención laboral.