Exercise-Associated Muscle Cramps (EAMC) in the calf are common in rugby league. To date, the aetiology and predictors of calf cramping are poorly understood. The aim of this study was to undertake a prospective investigation to identify predictors of calf cramping in rugby league players. Demographic and anthropometric data, as well as calf cramp and injury history, were collected in the preseason. Hydration status, number of games played and calf cramps were recorded on game days. Male rugby league players (n = 103, mean age 18.8 ± 4.1 years) were classified as either EAMC (experienced at least one incident of calf cramps in the season) or no EAMC (no calf cramps). The following were investigated as possible predictors of EAMC using logistic regression modelling: competition level, age, ethnicity, playing position, history of cramping, pre-cramping, low back pain, foot orthotic usage, foot posture, foot strike, muscle flexibility, calf girth, hydration status and number of games played. Half the players, n = 52, experienced at least one incidence of calf cramping. Playing in a senior competition level (OR 0.21; 95% CI 0.06,0.75; p= 0.016), a history of calf cramping (10.85; 2.16,54.44; p=0.004) and a history of low back pain resulting in missed field minutes (4.50, 1.37,14.79; p=0.013) were found to predict EAMC. This study suggests that there is a high incidence of calf cramping in rugby league, especially at senior competition levels, and supports pre-season screening in senior players to identify those at risk of calf cramping and the development of possible preventative strategies.

We report a case of acute myelitis associated with hepatitis C virus (HCV) infection. A Japanese woman developed left calf pain and weakness, but this quickly generalised to paraplegia. We diagnosed acute myelitis based on the results of clinical manifestations, an MRI examination and a cerebrospinal fluid (CSF) examination. The clinical condition and spinal cord lesions improved following intravenous administration of methylprednisolone. The patient had been diagnosed with HCV infection 11 years before the onset. We detected HCV RNA in the CSF, supporting the strong association of our patient's myelitis. However, it is difficult to conclude whether the neurological condition was caused directly by the viral load or indirectly by the immune response. We suggest that testing for HCV infection is important in patients with myelitis. In particular, anti-HCV antibody and HCV RNA should be measured in the patients' serum as well as CSF.

Benign acute childhood myositis (BACM) is a post-respiratory tract infection condition of school-age children. Presentation is typically with acute onset calf pain and tenderness and refusal to walk or altered gait during the convalescent period of an influenza A or B infection. We describe a unique cluster of children with BACM following infection with human parainfluenza 1 virus, with no evidence of influenza A or B infection. BACM is a commonly missed diagnosis of altered gait in children presenting to the emergency department. This is the first report to describe a cluster of human parainfluenza virus type-1 associated BACM. We discuss the presentation, clinical examination and investigation results of the children identified. Furthermore, we review the current research surrounding BACM, overview the clinical presentation to healthcare professionals, and present an interesting case of a child presenting for the second time with BACM.

AIMS:

The main aim of the case series was to inform further experimental research to determine the effectiveness of myofascial trigger point (MTrP) therapy for the treatment of triceps surae dysfunction.

PARTICIPANTS:

Ten participants with triceps surae dysfunction were recruited (4 females and 6 males); mean age±standard deviation=43±7.1 years.

METHODS:

Participants were screened for inclusion/exclusion criteria and the following outcomes measures were assessed at baseline and discharge; lower extremity functional scale (LEFS), verbal numerical rating scale (NRS), MTrP prevalence, ankle dorsiflexion range of movement (ROM) and pressure pain threshold (PPT). Intervention involved trigger point (TrP) pressure release, self MTrP release and a home stretching programme.

RESULTS:

There was a high prevalence of active/latent MTrPs and possible myofascial pain syndrome (MPS) for all 10 participants at baseline. Active MTrP prevalence decreased to 0%, while latent MTrPs were still present at discharge. There were positive changes in most outcome measures (LEFS, NRS, ROM and PPT) for all 10 participants. Short term to medium term treatment outcomes (6 week post discharge) showed an overall mean LEFS increase of 11 points from 61/80 at baseline to 72/80 at discharge.

CONCLUSION:

This case series suggests that a brief course of multimodal MTrP therapy would be helpful for some patients with sub-acute or chronic calf pain. Important preliminary data was gathered, that will inform more rigorous research in this under investigated area.

We report a rare finding of the coexistence of splenic hemangioma and progressive vascular malformation of the left lower extremity in a child. The lesion on the left calf was described as a vascular malformation in computed tomography and magnetic resonance. At the age of one year, the abdominal Doppler ultrasound was normal. The examination was repeated at the age of six years due to recurrent pain in the left hypochondrium and revealed giant multiple splenic hemangiomas. The girl underwent splenectomy at the age of 14 years. Histological findings demonstrated multiple cavernous hemangiomas. We present our case report regarding the diagnosis of spleen hemangioma and indications for surgical management in children.

The patient was an 8-year-old girl who was referred to a physical therapist by her pediatrician for a chief complaint of worsening proximal right calf pain and progressive right-sided toe walking for the past 6 weeks. Due to concern that the patient's symptoms were nonmusculoskeletal in nature, the physical therapist discussed the history and physical examination findings with the patient's pediatrician and an orthopaedic surgeon. Subsequent magnetic resonance imaging and percutaneous biopsy led to a diagnosis of a low-flow venolymphatic malformation of the proximal gastrocnemius muscle.

OBJECTIVES:

: To describe and understand varieties and characteristics of sensitization contributing to hyperalgesia in participants with chronic pain conditions.

METHODS::

Thermal stimulation was delivered to the face, forearm, and calf of pain-free participants and individuals with irritable bowel syndrome, temporomandibular pain disorder (TMD), and fibromyalgia syndrome (FM). Three-second contacts by a preheated thermode occurred at 30-second intervals in ascending and then in descending series (0.7°C steps).

RESULTS::

Thermal pain ratings during ascending series were greater at each site in individuals diagnosed with chronic pain. Intense pain at the time of testing further enhanced the ratings at all sites, but mild or moderate clinical pain did not have this effect. Thermal pain in all participants was greater during descending series compared with the ascending series of arm and leg stimulation. The hypersensitivity during the descending series was comparable in pain-free, FM and TMD participants but was increased in duration for arm or leg stimulation of FM participants.

DISCUSSION:

: The widespread sensitization for irritable bowel syndrome and TMD participants does not rely on mechanisms of spatial and temporal summation often invoked to explain widespread hyperalgesia associated with chronic pain. Increased sensitivity during descending series of stimulation of an arm or leg but not the face indicates a propensity for sensitization of nociceptive input to the spinal cord. Abnormally prolonged sensitization for FM participants reveals a unique influence of widespread chronic pain referred to deep somatic tissues.

Abstract

Background:

Diffuse muscle hypertrophy is a rare complication of acquired hypothyroidism. When accompanied by stiffness, weakness, and painful muscle cramps, the condition is known as Hoffmann's syndrome (HS). HS is usually seen in young adults due to long-standing untreated primary hypothyroidism. We report a very rare case of HS with muscle hypertrophy and pituitary hyperplasia complicating hypothyroidism in an adolescent. Case: A 12-year-old male admitted with muscle pain, headache, and fatigue. He had marked hypertrophy of both calf and shoulder muscles. Laboratory tests indicated elevated muscle enzymes and lipids with an elevated thyrotropin and low thyroxine levels. Hashimoto thyroiditis was confirmed on thyroid studies. He had also papilledema bilaterally and magnetic resonance imaging showed an enlargement of the pituitary gland. Treatment with thyroid hormone resulted in complete improvement of symptoms within 3 months.

Conclusions:

HS is a rare but treatable form of acquired myopathies and can be seen in children due to untreated hypothyroidism. All patients with an acquired myopathy and muscular pseudohypertrophy should be screened regarding thyroid hormones.