- Can the Neck Contribute to Persistent Post-Concussion Symptoms? A Prospective Descriptive Case Series. [Journal Article]J Orthop Sports Phys Ther 2019; :1-31JO
- CONCLUSIONS: Multiple findings were indicative of concurrent neck injury, particularly involving the upper cervical spine. These neck-related findings are important to recognise as they have the potential to contribute to persistent post-concussion symptoms, and may respond to neck treatment. J Orthop Sports Phys Ther, Epub 1 Jun 2019. doi:10.2519/jospt.2019.8547.
- Calcium pyrophosphate dihydrate crystal deposition disease and MRSA septic arthritis of the atlantoaxial joint in a patient with Tourette syndrome. [Case Reports]BMJ Case Rep 2019; 12(3)BC
- A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte …
A 45-year-old male patient with Tourette syndrome presented to the emergency department with worsening neck pain and stiffness of 1-week duration. Associated symptoms included headache, hoarse voice, trismus and odynophagia. The patient was haemodynamically stable without fevers or leucocytosis. He exhibited cervical spinal and paraspinal tenderness with very limited range of motion. Erythrocyte sedimentation rate and C reactive protein were elevated, and blood cultures grew methicillin-resistant Staphylococcus aureus (MRSA). Lumbar puncture was unremarkable. CT and MRI of the neck showed calcification of the longus colli, fluid and capsular distention of C1-C2 joints, enhancement of the joint capsule and retropharyngeal oedema suggestive of septic arthritis. Fluid was aspirated from C1 to C2 joint by interventional radiology and showed calcium pyrophosphate crystals and heavy MRSA colonisation, consistent with both pseudogout and septic arthritis of the cervical vertebrae. The patient was started on a 6-week course of daptomycin and showed gradual improvements in neck pain and mobility.
- [Diagnosis of pelvic inflammatory disease: Clinical, paraclinical, imaging and laparoscopy criteria. CNGOF and SPILF Pelvic Inflammatory Diseases Guidelines]. [Journal Article]Gynecol Obstet Fertil Senol 2019; 47(5):404-408GO
- The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic diagnosis excluded. An adnexal pain or cervical motion tenderness are the signs that allow a positive diagnosis of PID (LE2). Associated signs (fever, leucorrhoea, metrorrhagia) reinforce clinical diagnosis (LE2). In a woman consult…
The objective of this literature review is to update the recommendations for clinical practice about the diagnosis of pelvic inflammatory disease (PID), microbiologic diagnosis excluded. An adnexal pain or cervical motion tenderness are the signs that allow a positive diagnosis of PID (LE2). Associated signs (fever, leucorrhoea, metrorrhagia) reinforce clinical diagnosis (LE2). In a woman consulting for symptoms compatible with PID, a pelvic clinical examination is recommended (grade B). In cases of suspected PID, hyperleukocytosis associated with a high C-reactive protein suggests a complicated PID or a differential diagnosis such as acute appendicitis (LE3). The absence of hyperleukocytosis or normal CRP does not rule out the diagnosis of PID (LE1). When PID is suspected, a blood test with a blood count and a CRP test is recommended (grade C). Pelvic ultrasound scan does not contribute to the positive diagnosis of uncomplicated PID because it is insensitive and unspecific (LE3). However, ultrasound scan is recommended to look for signs of complicated PID (polymorphic collection) or differential diagnosis (grade C). Waiting for an ultrasound scan to be performed should not delay the start-up of antibiotic therapy. In case of diagnostic uncertainty, an abdominal-pelvic CT scan with contrast injection is useful for differential diagnosis of urinary, digestive or gynaecological origin (LE2). Laparoscopy is not recommended for the unique purpose of the positive diagnosis of PID (grade B).
- Guideline Adherence of Veterans Health Administration Primary Care for Abnormal Uterine Bleeding. [Journal Article]Womens Health Issues 2019 Mar - Apr; 29(2):144-152WH
- CONCLUSIONS: VA primary care has high guideline adherence when caring for postmenopausal women with AUB. Quality improvement and educational initiatives are needed to improve primary care for AUB in younger women veterans.
- Clinics in diagnostic imaging (192). Flexion teardrop fracture. [Case Reports]Singapore Med J 2018; 59(11):562-566SM
- An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4-6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, …
An 82-year-old woman presented with neck pain and bilateral upper limb paraesthesia after sustaining an unwitnessed fall at home the day before. Physical examination revealed tenderness over the C4-6 region but no evidence of step deformity or neurological deficit. Magnetic resonance imaging of the cervical spine revealed multiple small fractures at the anteroinferior endplate corners of the C3, C5 and C6 vertebrae with focal kyphosis and marrow oedema at these levels, as well as associated disruption of the anterior longitudinal ligament and central spinal canal stenosis. The diagnosis of multiple flexion teardrop fractures was made based on these imaging findings, and the patient subsequently received conservative management. This paper illustrates the radiological features of flexion teardrop fractures and highlights the importance of prompt diagnosis and management of such cases.
- The use of dry needling as a diagnostic tool and clinical treatment for cervicogenic dizziness: a narrative review & case series. [Case Reports]J Bodyw Mov Ther 2018; 22(4):947-955JB
- CONCLUSIONS: This case series with narrative review covers various testing procedures for cervicogenic dizziness and explores the use of dry needling targeting the suboccipital muscles to evaluate and treat this patient population. The physiologic changes that occur in the periphery, the spine and the brain secondary to dry needling and their potential relevance to the mechanisms driving cervicogenic dizziness are discussed in detail.
- Clearing the cervical spine in patients with distracting injuries: An AAST multi-institutional trial. [Journal Article]J Trauma Acute Care Surg 2019; 86(1):28-35JT
- CONCLUSIONS: Negative clinical examination may be sufficient to clear the cervical spine in awake and alert blunt trauma patients, even in the presence of a distracting injury. These findings suggest a potential source for improvement in resource utilization.
- Prevalence of Infections After In-Office Hysteroscopy in Premenopausal and Postmenopausal Women. [Multicenter Study]J Minim Invasive Gynecol 2019 May - Jun; 26(4):733-739JM
- CONCLUSIONS: The present study suggests that routine antibiotic prophylaxis is not necessary before hysteroscopy because the prevalence of infections following in-office hysteroscopy is low (0.06%).
- StatPearls: Stress Reaction and Fractures [BOOK]StatPearls Publishing: Treasure Island (FL)BOOK
- Stress injuries represent a spectrum of injuries ranging from periostitis, caused by inflammation of the periosteum, to a complete stress fracture that includes a full cortical break. They are relatively common overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time. Stress injuries are often seen in running and jumping athletes and are associated with in…
Stress injuries represent a spectrum of injuries ranging from periostitis, caused by inflammation of the periosteum, to a complete stress fracture that includes a full cortical break. They are relatively common overuse injuries in athletes that are caused by repetitive submaximal loading on a bone over time. Stress injuries are often seen in running and jumping athletes and are associated with increased volume or intensity of training workload. Most commonly, they are found in the lower extremities and are specific to the sport in which the athlete participates. Upper extremity stress injuries are much less common than lower extremity stress injuries, but when they do occur, they are most commonly seen in the ulna. Similar to the lower extremity injuries, upper extremity stress injuries are the result of overuse and fatigue. Rib stress fractures are an uncommon site of stress injuries. First rib fractures are the most common, and these are seen in pitchers, basketball players, weightlifters, and ballet dancers. Stress fractures in ribs 4 through 9 are seen in competitive rowers, and posteromedial rib stress fractures can be seen in golfers. Stress fractures of the pelvis can be vague clinically and mimic other causes of groin and hip pain, for example, adductor strain, osteitis pubis, or sacroiliitis. The most common location is the ischiopubic ramus and sacrum. These injuries are seen most commonly in runners. Femoral neck stress fractures make up approximately 11% of stress injuries in athletes. The patient complains of hip or groin pain which is worse with weight bearing and range of motion especially internal rotation. There are 2 types of femoral neck stress fractures: tension-type (or distraction) fractures and compression-type fractures. Tension-type femoral neck stress fractures involve the superior-lateral aspect of the neck and are at highest risk for complete fracture; thus, these should be detected early. Compression-type fractures are seen in younger athletes and involve the inferior-medial femoral neck. A trial of non-surgical management can be attempted for patients without a visible fracture line on radiographs in compression type injuries. This injury is common in runners. Stress fractures of the femoral shaft are well documented in the literature, and in one study among military recruits, they represented 22.5% of all stress fractures. Patients typically complain of poorly localized, insidious leg pain often mistaken for muscle injury. An exam is often nonfocal, although the “fulcrum test” test can be used by providers to localize the affected pain and suggest the diagnosis. If there is no evidence of a cortical break on imaging, a non-surgical approach can be attempted. The patella is a rare location for a stress fracture and can be oriented either transverse or vertical. Transverse fractures are at higher risk for displacement and immobilization is recommended. Tibial stress injuries are the most common location of stress reactions and fractures. Medial tibial stress syndrome (MTSS), also known as shin splints or tibial periostitis, can be difficult to distinguish from medial tibial stress fractures. Typically, the patient will be tender over the medial posterior edge of the tibia often made worse with a motor exam. Stress injuries will present with pain during activities of daily living, while MTSS is generally limited to exertional activity. Anterior cortex tibial stress fractures are less common than the posteromedial ones and are found in jumping and leaping athletes. These patients may have the “dreaded black line” on x-ray. They are at a greater risk of nonunion and full cortical break and require aggressive conservative therapy. If that fails, surgical management such as an intramedullary rod or flexible plate is indicated. Stress fractures of the medial tibial plateau are uncommon but can be confused for meniscus injury or pes anserine bursitis, and thus, a high index of suspicion is needed. Fibular stress fractures are common and most commonly located in the lower third of the fibula, proximal to the tibiofibular ligament. Patients will have reproducible pain on palpation of the affected bone. Medial malleolus stress fractures are uncommon. Running and jumping athletes can develop vertical stress fractures at the junction of the medial malleolus and tibial plafond. If full cortical disruption is identified, surgical fixation is typically indicated. Calcaneal stress fractures present as localized tenderness over the heel of the calcaneus posterior to the talus. Patients will have a positive squeeze test. Stress fractures can develop in the navicular, medial cuneiform, and lateral process of the talus. Navicular stress fractures are difficult to diagnose early on and are at high risk of nonunion due to poor vascular flow, primarily in the middle third. These are common in basketball players and runners. They are usually tender on the navicular bone. Metatarsal stress fractures account for 9% of all stress fractures in athletes. The second and third metatarsals are most commonly affected and are usually in the neck or distal shaft. They will be point tender with localized swelling over the affected bone. Dancers fracture is a stress fracture at the base of the second metatarsal. Stress fractures distal to the tuberosity of the fifth metatarsal are termed Jones fractures but must be distinguished from an acute Jones fracture. Sesamoid stress injuries of the great toe present as gradual unilateral plantar pain with the medial (tibial) sesamoid most frequently affected. Direct tenderness or pain with passive extension of the toe aid in diagnosis.
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- Orofacial pain of cervical origin: A case report. [Case Reports]J Bodyw Mov Ther 2018; 22(2):276-280JB
- CONCLUSIONS: This case study demonstrates the importance of considering, assessing and treating the cervical spine as a possible source of orofacial pain, and the positive role of cervical mobilization on these disorders.