Dextrose Prolotherapy to Treat Pain, Improve Activities of Daily Living, and Improve Quality of Life in an Ewing's Sarcoma Patient Following Radiation and Chemotherapy Treatment.

Advances in the treatment and survival of Ewing's sarcoma patients create a need to treat underlying symptoms that limit activities of daily living and quality of life. This case describes the treatment of pain in a 25-year-old female pediatric nurse with Ewing's sarcoma of the pelvis that was in remission following radiation and chemotherapy. She reported medication side effects and limitations in her activities of daily living and quality of life with the chronic use of topical and oral pain medications. A dextrose prolotherapy approach was used to treat her pain, which allowed her to discontinue her pain medication regimen, resulting in an improvement in her activities of daily living and quality of life. The improvement was sustained at the three-year follow-up after the last procedure.

Treatment of an Upper Extremity Chronic Repetitive Strain Injury of 28 Years Duration in a Professional Jazz Saxophonist Using 5% Dextrose.

The treatment of chronic repetitive strain injury is a frustrating discourse of potential pathoanatomical causes and their treatments. This case describes an overlooked pathoanatomical cause and successful treatment for a chronic and debilitating repetitive strain injury of the upper extremities that lasted for 28 years and was resistant to a variety of conventional and alternative treatments in a professional jazz saxophone player. A series of fascial tissue infiltrations using 5% dextrose was used to successfully downregulate c-fiber activity within the upper extremities. This treatment resulted in the complete resolution of upper extremity pain and dysfunction with a full return to normal instrument practice and performance that has been sustained without recurrence for four years following treatment.

Resolution of a Greater Than 50-year History of Severe, Chronic Low Back Pain Following an Ultrasound-guided Platelet-rich Plasma Infiltration of the Thoracolumbar Fascia.

The diagnosis of chronic low back pain is a scourge of society that does not take into account the pathoanatomical cause of pain. This case describes a six-year search for the pinpoint pathoanatomical diagnosis of a patient's 50-plus year history of debilitating chronic low back pain after he failed the standard nonoperative and operative treatment modalities. Ultrasound-guided diagnostic blocks identified a potential space within the thoracolumbar fascia. This was treated with platelet-rich plasma, yielding a complete resolution of his pain and a full return to normal activities of daily living for three years since the procedure.

Musculoskeletal performance and hydration status.

Maximal performance during competition is the drive many competitors use to train harder. However, there are several variables that contribute to impair a competitor's performance. These variables work by altering the homeostatic mechanisms within the body. Once homeostasis is altered the competitor's body is no longer optimized to face the stresses of the athletic competition. The environment works as an all encompassing variable that will affect sweat rate. During increased environmental heat strain, one must adjust for critical variables, such as temperature regulation, hydration status, and electrolyte levels, as they can contribute to impaired performance. Acclimatization through training and competition will reduce or slow down the effects of these stress factors. Ever evolving recommendations are produced to aid competitors in maintaining homeostasis. Despite all the generic recommendations that are made, however, every athlete needs to individualize their training and competition regimens to optimize personal performance.

Industrial medicine and acute musculoskeletal rehabilitation. 2. Medications for the treatment of acute musculoskeletal pain.

UNLABELLED: This self-directed learning module highlights medications used in the treatment of acute musculoskeletal pain in the context of industrial rehabilitation. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article compares various skeletal muscle relaxants, addresses issues related to nonsteroidal anti-inflammatory medications, provides an algorithm for acute pain management in an injured worker, and discusses topical medications for the treatment of pain. OVERALL ARTICLE OBJECTIVE: To summarize medication options in the treatment of acute musculoskeletal pain in the setting of injured workers.

Industrial medicine and acute musculoskeletal rehabilitation. 3. Work-related musculoskeletal conditions: the role for physical therapy, occupational therapy, bracing, and modalities.

UNLABELLED: This chapter focuses on the use of modalities, therapeutic exercise, and orthotic devices in the treatment of lateral epicondylitis, carpal tunnel syndrome, plantar fasciitis, neck pain and low back pain. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To review the medical literature that may help clinicians make treatment decisions regarding modalities, therapeutic exercise, and orthotic devices for treating common work-related conditions in the upper and lower limbs.

Industrial medicine and acute musculoskeletal rehabilitation. 4. Interventional procedures for work-related cervical spine conditions.

UNLABELLED: This self-directed learning module outlines the use of interventional techniques in the treatment of neck pain with and without referred pain into the arm. It is part of the supplement on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on interventions used to diagnose or treat the conditions commonly seen in patients with neck pain or referred pain into the upper limb. Techniques reviewed include the use of botulinum toxin injections in the treatment of myofascial pain, cervical zygapophyseal joint injections and radiofrequency neuroablation in the treatment of posterior column disorders, and epidural steroid injections in the treatment of cervical radicular and referred upper-limb pain. OVERALL ARTICLE OBJECTIVE: To give an overview of the current state of the art regarding diagnostic and nonsurgical invasive treatment procedures for neck pain with and without referred upper-limb pain.

Industrial medicine and acute musculoskeletal rehabilitation. 5. Interventional procedures for work-related lumbar spine conditions.

UNLABELLED: This chapter emphasizes the importance of establishing a differential diagnosis for low back pain (LBP) with and without referred lower-limb pain and outlines potential interventional treatments appropriate for each diagnosis. It is part of the study guide on industrial rehabilitation and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. The article specifically focuses on the various interventions used to diagnose or treat those conditions commonly seen in patients with work-related LBP or referred pain in the lower limb. Current criterion treatments for lumbar disk pain, including surgical options, are reviewed. OVERALL ARTICLE OBJECTIVE: To give an overview of the current state of diagnosis and treatment options for low back pain with or without referred leg pain focusing on interventional procedures.

Industrial medicine and acute musculoskeletal rehabilitation. 6. Upper- and lower-limb injections for acute musculoskeletal injuries and injured workers.

UNLABELLED: This self-directed study module focuses on the use of corticosteroids and other injections in the treatment of lateral epicondylitis, de Quervain's tenosynovitis, carpal tunnel syndrome, Achilles' tendinitis, and plantar fasciitis. It is part of the study guide on industrial rehabilitation medicine and acute musculoskeletal rehabilitation in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVE: To review the medical literature to help clinicians make treatment decisions regarding corticosteroid and other injections in the upper and lower limbs in injured workers.

Industrial medicine and acute musculoskeletal rehabilitation. 1. Diagnostic testing in industrial and acute musculoskeletal injuries.

UNLABELLED: This self-directed learning module reviews the history and physical examination of common acute musculoskeletal conditions that occur in the occupational setting. It is part of the industrial medicine and acute musculoskeletal rehabilitation study guide in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article presents case vignettes to review the diagnostic evaluation of heel pain, whiplash, repetitive strain injuries, and low back pain. OVERALL ARTICLE OBJECTIVE: To understand the important components of a history, physical examination, and concise diagnostic testing when evaluating acute industrial and musculoskeletal injuries.

Industrial medicine and acute musculoskeletal rehabilitation. 7. Acute industrial musculoskeletal injuries in the aging workforce.

UNLABELLED: This learning module highlights the unique challenges faced by physicians treating the aging workforce. It is part of the industrial medicine and acute musculoskeletal rehabilitation study guide in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. Factors intrinsic and extrinsic to the patient that increase the risk of injury with aging are outlined. Low back injuries are the most common musculoskeletal complaint in the aging workforce. A conceptual framework for low back pain with aging, a differential diagnosis, and appropriate laboratory and radiographic investigations are also presented. Determination of causation in the setting of comorbid medical conditions and rehabilitation strategies are reviewed. OVERALL ARTICLE OBJECTIVE: To recognize diagnosis and treatment issues that are unique to the aging worker.

Dengue in Grenada.

OBJECTIVES: Dengue fever is endemic in the country of Grenada and is grossly underreported as a source of morbidity. The goal of this study was to assess the status of dengue fever in a representative community in Grenada. METHODS: Surveys were conducted in the Mont Tout/Grand Anse Valley area in the parish of St. George's from March to June 1996. The objectives of the survey were to: (1) to assess the knowledge, attitudes, and practices (KAP) of residents; (2) to determine the presence of larval and adult Aedes aegypti and their potential breeding sites; and (3) to identify the seroprevalence of specific immunoglobulin G (IgG) dengue antibodies in the local population. RESULTS: Out of the 102 respondents to the KAP survey, 100 of them (98%) reported never having had dengue fever. Of the 75 persons who agreed to have blood samples taken, 70 of them (93%) (95% confidence interval = 85.1%-97.8%) tested positive with the IgG enzyme-linked immunosorbent assay, indicating past exposure. In terms of water storage, 98 of 102 respondents (96%) stored fresh water in containers. The vector survey found 57 of the 102 households (56%) had Ae. aegypti larvae in water containers on their property, and 94 of 102 dwellings (92%) had adult Ae. aegypti mosquitoes indoors. CONCLUSIONS: Although many people were familiar with dengue fever and mosquitoes, the 1996 survey found that their knowledge of the important relationships among mosquitoes, human behavior, and disease transmission was incomplete. Since 1996, continued education efforts have been made in the public school system and with national public health campaigns, yet little effort has been specifically targeted towards our study community. These data suggest Grenada has a need for continued community education that addresses dengue fever transmission and Ae. aegypti reduction.

Treatment of myofascial shoulder pain in the spinal cord injured population using static magnetic fields: a case series.

OBJECTIVE: Magnetic therapy has been used in the treatment of a wide variety of chronic pain syndromes. It has not been studied in the treatment of myofascial shoulder pain in persons with spinal cord injury (SCI). Because this type of pain is commonly refractory to traditional therapy, alternative treatments often are considered. The primary objective is to determine whether myofascial shoulder pain in persons with SCI can be temporarily ameliorated with static magnetic fields. DESIGN: Case series. SETTING: Clinic of a university hospital system. PARTICIPANTS: A volunteer sample of 8 participants with SCI; 3 women, 5 men; mean age = 45 years; mean duration of injury = 12.3 years. INTERVENTIONS: Placement of a commercially available magnet with a static magnetic field of 500 gauss on the affected shoulder for 1 hour. MAIN OUTCOME MEASURES: Pretreatment and posttreatment scores on the short-form McGill Pain Questionnaire and pressure algometry were compared. RESULTS: The short-form McGill Pain Questionnaire descriptors demonstrated significant decreases: stabbing, 0.75 +/- 0.71 (P < 0.02); sharp, 0.50 +/- 0.53 (P < 0.033); and tender, 0.88 +/- 0.83 (P < 0.021). They also demonstrated a significant decrease in the present pain intensity of 0.63 +/- 0.52 (P < 0.011). Participants demonstrated a nonsignificant decrease of 0.813 +/- 0.998 (P < 0.55) on the visual analog scale. Pressure algometry was nonsignificant with a difference of 0.062 +/- 1.17 (P < 0.885). CONCLUSION: Static magnetic fields may decrease the sensory dimensions and intensity of myofascial shoulder pain in persons with SCI.