DOCSLIB.ORG

Rheumatology: Symptoms and Syndromes

Total Page：16

File Type：pdf, Size：1020Kb

Download full-text PDF Read full-text
Rheumatology: Symptoms and Syndromes Rheumatology Efim Benenson Rheumatology Symptoms and Syndromes Author Efim Benenson, MD Professor of Medicine Department of Internal Medicine University of Cologne Germany The work was first published as a part of a work published in 2009 by Shaker Media in German laquage with the following title: Rheumatologie: Syndrome and Algorithmen Translation: Beverley Taylor ISBN: 978-1-84996-461-6 e-ISBN: 978-1-84996-462-3 DOI: 10.1007/978-1-84996-462-3 Springer Dordrecht London Heidelberg New York British Library Cataloguing in Publication Data A catalogue record for this book is available from the British Library Library of Congress Control Number: 2010936498 © Springer-Verlag London Limited 2011 Apart from any fair dealing for the purposes of research or private study, or criticism or review, as per- mitted under the Copyright, Designs and Patents Act 1988, this publication may only be reproduced, stored or transmitted, in any form or by any means, with the prior permission in writing of the publishers, or in the case of reprographic reproduction in accordance with the terms of licences issued by the Copyright Licensing Agency. Enquiries concerning reproduction outside those terms should be sent to the publishers. The use of registered names, trademarks, etc. in this publication does not imply, even in the absence of a specific statement, that such names are exempt from the relevant laws and regulations and therefore free for general use. Product liability: The publisher can give no guarantee for information about drug dosage and application thereof contained in this book. In every individual case the respective user must check its accuracy by consulting other pharmaceutical literature. Cover design: eStudioCalamar, Figueres/Berlin Printed on acid-free paper Springer is part of Springer Science+Business Media (www.springer.com) I dedicate this book to my wife, Irina, for her patience and support, our children, Anna and Vladimir, and to our grandchildren, Patrick, Paulina, and Wlada Preface “Symptoms and Syndromes” is aimed at teachers who are providing their trainees with further education and instruction in the relevant areas of clinical practice. Features of the book: • The classic textbook content of rheumatology is presented in the form of syndromes (or signs), as stable combinations of symptoms and usually with morphological and patho- physiological backgrounds, building a bridge or link between symptoms and diseases • The principle of syndrome diagnosis which, in addition to the indispensable description of entities, should be integrated into the initial stages of clinical practice • How to approach and structurally classify diseases from the viewpoint of morphologi- cal manifestations, as a fast route to diagnosis • The clinical work from patient to disease, enabling preclinical and clinical knowledge on the concrete clinical case to be interlinked and stored in the long-term memory • Algorithms of clinical reasoning, leading to integrated staged diagnostics based on morphology and pathophysiology • A basic program of rheumatology comprising all teaching points (symptoms, syn- dromes, and diseases) linked to morphological structures, and connecting them to all clinical disciplines according to the broadly recognized terms of rheumatic diseases (see Contents) • Inclusion of therapeutic and prognostic aspects of inflammatory arthritides, also touch- ing on current therapeutic strategies and integrating them into the treatment concepts. Practice-oriented clinical tuition (from syndromes and algorithms to diseases) is provided as a supplement to traditional descriptive teaching theory (from symptoms or disease pat- tern to diagnosis). On the one hand the book provides summaries of the most important clinical, imaging, and immunological syndromes as modules of rheumatology, while at the same time describing the medical approach to structured thinking, as an important tool for clinical practice. Such an approach enables the diversity of patients with rheumatic dis- eases to be clearly structured and categorized diagnostically. The structure of the book reflects the said distinguishing features of other rheumatology books, providing fundamental information on the symptoms, signs, and therapeutic aspects of the diseases described therein. The Contents, in which all syndromes are easy to find and are linked to morphological structures, is both a manual and list of contents for this book. vii viii Preface Symptoms and Syndromes provides case-specific syndromes based on morphology and pathophysiology (Section 1, Articular and Musculoskeletal Disorders, Chapter 1-4 and Section 2, Connective Tissue Disease and Vasculitis, Chapter 8-10; Chapter 5 presents the paraneoplastic syndromes in rheumatology). These syndromes are linked in the text to specific diagnoses and represent a wide spectrum of differential diagnostics in internal medicine and its related fields. The approach relies on (auto) immunological phenomena and serological diagnostics (Chapter 11), and treatment-induced and associated conditions and diseases (Chapter 12) with a case-by-case study. The algorithms and integrated staged diagnostics, using examples from Articular and Musculoskeletal Disorders (Chaps. 6 and 7), as well as Connective Tissue Diseases and Vasculitis (Chaps. 13 and 14), describe how the patient’s information is to be analyzed. Actual therapeutic aspects of inflammatory rheumatic diseases are provided as examples in Chaps. 7.3 and Chaps 14.1–14.3. This textbook is a reference work on the symptoms and syndromes of rheumatic dis- eases. It complements Rheumatology: Clinical Scenarios (E. Benenson, Springer 2011) with its 73 clinical situations and 164 illustrations, wherein all syndromes and symptoms from this collection are discussed with many other examples from my own practice as teaching modules in several chapters of Symptoms and Syndromes. This stimulating concept combines Symptoms and Syndromes with Clinical Scenarios as case-based training, complementing one another in the same way as knowledge and its application, offering teachers an alternative training concept for trainees. The book takes an alternative approach to rheumatic diseases. Thus it can help to reduce the time an experienced rheumatologist and physician requires for making a diagnostic decision, by applying structured knowledge, the syndrome principle of diagnosis and learning “to think clinically.” By this means traditional teaching – from knowledge about diseases to the patient – is complemented. The critical comments on this book are really welcome ([email protected]). Efim Benenson Acknowledgments Sincere thanks to my colleagues Professor of Medicine Michael Hallek, Director of Department I of Internal Medicine, University of Cologne for his advice and support, and my former boss, Professor of Medicine Volker Diehl, for welcoming me kindly to this Clinic in 1994, and especially Ursula Voigt-Pfeil for her active support in realizing this project. ix Contents Part I Articular and Musculoskeletal Disorder 1 Articular Disorders .....................................................................................................3 1.1 Arthralgia ...............................................................................................................3 1.2 Morning Stiffness ...................................................................................................5 1.3 Arthritis ..................................................................................................................5 1.3.1 Exudative (Inflammatory) Arthritis ..............................................................6 1.3.2 Proliferative Arthritis ...................................................................................6 1.3.3 Fibrosing and Ankylosing Arthritis ..............................................................7 1.3.4 Erosive Arthritis ...........................................................................................7 1.3.5 Non-erosive Arthritis ....................................................................................8 1.4 Osteoarthritis ..........................................................................................................8 1.4.1 Noninflammatory OA ...................................................................................8 1.4.2 Inflammatory OA .........................................................................................9 1.4.3 Secondary OA ............................................................................................10 1.4.4 Erosive OA .................................................................................................10 1.4.5 Chondrocalcinosis ......................................................................................11 1.4.6 Chondromatosis ..........................................................................................11 1.4.7 Arthritis and Osteoarthritis .........................................................................11 1.5 Arthropathy ..........................................................................................................12 1.5.1 Neuropathic Arthropathy ............................................................................13 1.5.2 Endocrinological Arthropathy ....................................................................14 1.5.3 Metabolic Arthropathy ...............................................................................14 1.5.4 Hematological Arthropathy ........................................................................15
Load more

Recommended publications
  • 18-0969: R.S. and DEPARTMENT of the ARMY, WALTER
    United States Department of Labor Employees’ Compensation Appeals Board __________________________________________ ) R.S., Appellant ) ) and ) Docket No. 18-0969 ) Issued: March 27, 2019 DEPARTMENT OF THE ARMY, WALTER ) REED NATIONAL MILITARY MEDICAL ) CENTER, Bethesda, MD, Employer ) _________________________________________ ) Appearances: Case Submitted on the Record Appellant, pro se Office of Solicitor, for the Director DECISION AND ORDER Before: CHRISTOPHER J. GODFREY, Chief Judge PATRICIA H. FITZGERALD, Deputy Chief Judge VALERIE D. EVANS-HARRELL, Alternate Judge JURISDICTION On April 10, 2018 appellant filed a timely appeal from a December 22, 2017 merit decision of the Office of Workers’ Compensation Programs (OWCP). Pursuant to the Federal Employees’ Compensation Act1 (FECA) and 20 C.F.R. §§ 501.2(c) and 501.3, the Board has jurisdiction over the merits of this case.2 ISSUE The issue is whether appellant has met her burden of proof to establish lumbar and/or right shoulder conditions causally related to an April 7, 2016 employment incident. 1 5 U.S.C. § 8101 et seq. 2 The Board notes that following the December 22, 2017 decision, OWCP received additional evidence. However, the Board’s Rules of Procedure provides: “The Board’s review of a case is limited to the evidence in the case record that was before OWCP at the time of its final decision. Evidence not before OWCP will not be considered by the Board for the first time on appeal.” 20 C.F.R. § 501.2(c)(1). Thus, the Board is precluded from reviewing this additional evidence for the first time on appeal. Id. FACTUAL HISTORY On April 15, 2016 appellant, then a 64-year-old radiology technology supervisor, filed a traumatic injury claim (Form CA-1) alleging that on April 7, 2016 she injured her lower back and right shoulder while in the performance of duty.
    [Show full text]
  • Facet Joint Pathology
    CLINICAL Facet Joint Pathology REVIEW Indexing Metadata/Description › Title/condition: Facet Joint Pathology › Synonyms: Facet joint syndrome; zygapophyseal joint pathology; facet joint arthropathy › Anatomical location/body part affected: Spine, specifically facet joint/s › Area(s) of specialty: Orthopedic rehabilitation › Description • Facet joints(1) –Fall under the category of synovial joints –Also called zygapophyseal joints • Types of facet joint pathology(1) –Sprain –Trauma to the capsule –Degenerative joint disease/osteoarthritis –Rheumatoid arthritis –Impingement - Pain and spasm result upon injury to the meniscoid - Generally occurs when the individual completes a quick or atypical movement - The movement typically entails spinal flexion and rotation –Prevalence of facet joint pathology has been estimated to be between 15% and 45% in patients with chronic low back pain(29) › ICD-9 codes • 724.8 other symptoms referable to back [facet syndrome] › ICD-10 codes • M24.8 other specific joint derangements, not elsewhere classified • M53.8 other specified dorsopathies • M54.5 low back pain Authors • M54.8 other dorsalgia Amy Lombara, PT, DPT • optional subclassification to indicate site of involvement for M53 and M54 Ellenore Palmer, BScPT, MSc –0 multiple sites in spine Cinahl Information Systems, Glendale, CA –5 thoracolumbar region Reviewers –6 lumbar region Rudy Dressendorfer, BScPT, PhD –7 lumbosacral region Cinahl Information Systems, Glendale, CA –8 sacral and sacrococcygeal region Lynn Watkins, BS, PT, OCS –9 site unspecified
    [Show full text]
  • Tuberculous Spondylitis, Pyogenic Spondylitis, X-Ray and Tomographic Features
    American Journal of Medicine and Medical Sciences 2021, 11(5): 398-401 DOI: 10.5923/j.ajmms.20211105.08 X-Ray and Tomographic Manifestations of Tuberculous Spondylitis Babоev Abduvakhob Sakhibnazarovich Bone and Joint Tuberculosis Department of Rebuplican Specialized Scientific Practical Medical Center of Phtiziology and Pulmonology, Tashkent, Uzbekistan Abstract X-ray and tomographic data of seventy-eight patients with spine disorders (31 patients with tuberculous spondylitis, 23 patients with pyogenic spondylitis, and 24 patients with degenerative spondylopathy) after clinical, laboratory, bacteriologic, and histologic verification of diagnosis was comparatively analyzed. Current X-ray and tomographic features of tuberculous spondylitis are relatively equal thoracic and lumbosacral spine segments localization, with more than two adjacent vertebrae involvement in 22,6±7,5% of cases, the collapse of the vertebra(s) in 35.5 ± 8.6% of cases, unclear or osteoporotic border of bone tissue around TB focus in 64.5 ± 8.6%, formation of abscesses in 74.2±7.9% and their subligamentous spread to more than two vertebrae in 25,8±7,9% of cases, intact intervertebral disc in 16.1 ± 6.6% of cases, and specific process in the lungs in 48.4 ± 9.0% of cases. Keywords Tuberculous spondylitis, Pyogenic spondylitis, X-ray and tomographic features identify differential diagnostic features of tuberculous 1. Introduction spondylitis (TS). X-ray and tomographic (MRI and CT) methods of examination play a leading role in the diagnosis of 3. Materials and Methods tuberculous (TB) lesions of the spine [1,2,3]. Features of radiological changes of spine TB depend on The study was conducted at the bone and joint TB the activity and duration of the specific process [1,2].
    [Show full text]
  • Neurological Impairment in a Patient with Concurrent Cervical Disc Herniation and POEMS Syndrome
    European Spine Journal (2019) 28 (Suppl 2):S51–S55 https://doi.org/10.1007/s00586-019-05914-5 CASE REPORT Neurological impairment in a patient with concurrent cervical disc herniation and POEMS syndrome Tingxian Ling1 · Limin Liu1 · Yueming Song1 · Shilian Zhou1 · Chunguang Zhou1 Received: 24 July 2018 / Revised: 16 December 2018 / Accepted: 9 February 2019 / Published online: 13 February 2019 © Springer-Verlag GmbH Germany, part of Springer Nature 2019 Abstract Purpose POEMS syndrome is a rare clonal plasma cell disease characterized by polyneuropathy, organomegaly, endocrinopa- thy, M protein, and skin changes. We report a rare case of neurological impairment in patients with concurrent cervical disc herniation and POEMS syndrome. Methods A patient presented to a local hospital with C3/4 and C4/5 disc herniation, apparent spinal cord compression con- comitant with neurological signs, and concurrent POEMS syndrome. Anterior cervical discectomy and fusion was performed. Results The limb numbness was only slightly alleviated, and 10 days postoperatively the patient complained of muscle weak- ness of the extremities and was referred to our hospital. The patients exhibited non-typical neurological signs and an enlarged liver and spleen that could not be explained. Electroneuromyography and immunofxation electrophoresis produced abnormal results. We diagnosed concurrent POEMS syndrome, for which drug therapy was prescribed. The patient’s symptoms receded. Conclusion Patients presenting with cervical spondylopathy and non-typical neurological signs and symptoms or other systemic problems should be evaluated for the presence of concurrent disease and ruled out diferential diagnoses. Keywords Neurological impairment · POMES syndrome · Cervical disc herniation · Cervical spondylosis Introduction a chronic demyelinating autoimmune disease that has symp- toms similar to those associated with myelopathy: spasticity, Cervical disc herniation is a common spinal disorder that sensory disturbances, gait ataxia, weakness.
    [Show full text]
  • ICD-9 to ICD-10 Mapping Tool Courtesy Of: the Paperwork Project
    ICD-9 to ICD-10 Mapping Tool Courtesy of: The Paperwork Project Spinal Subluxation ICD-9 ICD-10 M99.00 Segmental and somatic dysfunction, Head region (occipito-cervical) 739.0 Segmental and somatic dysfunction, Head region (occipito-cervical) M99.10 Subluxation complex (vertebral), Head region M99.01 Segmental and somatic dysfunction, Cervical region 739.1 Segmental and somatic dysfunction, Cervical region M99.11 Subluxation complex (vertebral), Cervical region M99.02 Segmental and somatic dysfunction, Thoracic region 739.2 Segmental and somatic dysfunction, Thoracic region M99.12 Subluxation complex (vertebral), Thoracic region M99.03 Segmental and somatic dysfunction, Lumbar region 739.3 Segmental and somatic dysfunction, Lumbar region M99.13 Subluxation complex (vertebral), Lumbar region M99.04 Segmental and somatic dysfunction, Sacral region 739.4 Segmental and somatic dysfunction, Sacral region M99.14 Subluxation complex (vertebral), Sacral region M99.05 Segmental and somatic dysfunction, Sacroiliac, hip, pubic regions 739.5 Segmental and somatic dysfunction, Sacroiliac, hip, pubic regions M99.15 Subluxation complex (vertebral), Pelvic region 839.08 Closed dislocation, Multiple cervical vertebra (injury) S13.101_ Dislocation of unspecified cervical vertebra (injury) ** 839.20 Closed dislocation, Lumbar vertebra (injury) S33.101_ Dislocation of unspecified lumbar vertebra (injury) ** 839.21 Closed dislocation, Thoracic vertebra (injury) S23.101_ Dislocation of unspecified thoracic vertebra (injury) ** 839.42 Closed dislocation, Sacrum,
    [Show full text]
  • IN the UNITED STATES COURT of FEDERAL CLAIMS OFFICE of SPECIAL MASTERS No
    IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS No. 10-565V Filed: June 11, 2014 For Publication * * * * * * * * * * * * * * * * * * * * * * * * * * * * MEGAN L. GODFREY, * HPV Vaccine; Gardasil; Juvenile * Ankylosing Spondylitis; JAS; Petitioner, * Causation-in-Fact; Expert; v. * Qualifications. * SECRETARY OF HEALTH * AND HUMAN SERVICES, * * Respondent. * * * * * * * * * * * * * * * * * * * * * * * * * * * * * Milton Clay Ragsdale, IV, Ragsdale LLC, Birmingham, AL, for petitioner. Jennifer Reynaud, U.S. Department of Justice, Washington, DC, for respondent. DECISION1 Vowell, Chief Special Master: On August 20, 2010, Megan Godfrey [“petitioner”] filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 [the “Vaccine Act” or “Program”]. The petition alleged that the human papillomavirus [“HPV”] and meningococcal conjugate vaccines Ms. Godfrey received on August 22, 2007, caused her to develop juvenile rheumatoid arthritis. Petition at 1-2. 1 Because this decision contains a reasoned explanation for my action in this case, it will be posted on the United States Court of Federal Claims’ website, in accordance with the E-Government Act of 2002, Pub. L. No. 107-347, 116 Stat. 2899, 2913 (Dec. 17, 2002). As provided by Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any information furnished by that party: (1) that is a trade secret or commercial or financial in substance and is privileged or confidential; or (2) that includes medical files or similar files, the disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule 18(b). Otherwise, the entire decision will be available to the public. 2 National Childhood Vaccine Injury Act of 1986, Pub.
    [Show full text]
  • Sacroiliac Joint Dysfunction a Case Study
    NOR200188.qxd 3/8/11 9:53 PM Page 126 Sacroiliac Joint Dysfunction A Case Study CPT William Murray Pain is a widespread issue in the United States. Nine of physical therapist. She was evaluated and her treatment 10 Americans regularly suffer from pain, and nearly every consisted of a transcutaneous electrical nerve stimula- person will experience low back pain at one point in their lives. tion unit while in the PT clinic, aqua therapy, and ice Undertreated or unrelieved pain costs more than and heat application. $60 billion a year from decreased productivity, lost income, After several weeks, Ms. T returned to the primary care and medical expenses. The ability to diagnose and provide ap- provider and informed her that the pain has not decreased and “feels like that it is getting worse.” She also informed propriate medical treatment is imperative. This case study ex- the provider that she was having difficulty sleeping and amines a 23-year-old Active Duty woman who is preparing to constantly feeling tired secondary to pain. Throughout the be involuntarily released from military duty for an easily cor- next several months, the primary care provider tried nu- rectable medical condition. She has complained of chronic low merous medication trials with no relief for the patient. Ms. back pain that radiates into her hip and down her leg since ex- T gives a history of being prescribed numerous medica- periencing a work-related injury. She has been seen by numer- tions within several drug classifications. She stated vari- ous providers for the previous 11 months before being referred ous side effects that are related to the medications and to the chronic pain clinic.
    [Show full text]
  • Indications for and Benefits of Lumbar Facet Joint Block: Analysis of 230 Consecutive Patients
    Neurosurg Focus 13 (2):Article 11, 2002, Click here to return to Table of Contents Indications for and benefits of lumbar facet joint block: analysis of 230 consecutive patients ALAN BANI, M.D., UWE SPETZGER, M.D., AND JOACHIM M. GILSBACH, M.D. Department of Neurosurgery, Klinikum Duisburg-Wedau, Duisburg; Department of Neurosurgery, Municipal Hospital Klinikum, Karlsruhe; and Department of Neurosurgery, Medical Faculty, University of Technology, Aachen, Germany Object. The authors evaluated the effectiveness of using a facet joint block with local anesthetic agents and or steroid medication for the treatment of low-back pain in a medium-sized series of patients. Methods. Over a period of 4 years, the authors performed 715 facet joint injections in 230 patients with variable- length histories of low-back pain. The main parameter for the success or failure of this treatment was the relief of the pain. For the first injection—mainly a diagnostic procedure—the authors used a local anesthetic (1 ml bupivacaine 1%). In cases of good response, betamethasone was injected in a second session to achieve a longer-lasting effect. Long-lasting relief of the low-back pain and/or leg pain was reported by 43 patients (18.7%) during a mean follow- up period of 10 months. Thirty-five patients (15.2%) noticed a general improvement in their pain. Twenty-seven patients (11.7%) reported relief of low-back pain but not leg pain. Nine patients (3.9%) suffered no back pain but still leg pain. One hundred sixteen patients (50.4%), however, experienced no improvement of pain at all.
    [Show full text]
  • Doctoral Thesis Effectiveness of Tumor Necrosis Factor Inhibitors in Patients
    Bente Glintborg 2018 Glintborg Bente UNIVERSITY OF COPENHAGEN FACULTY OF HEALTH AND MEDICAL SCIENCES Effectiveness of Effectiveness Doctoral thesis Doctoral thesis Bente Glintborg, 2018 Bente Glintborg, 2018 tumor Effectiveness of tumor necrosis factor inhibitors in patients necrosis factor inhibitors in patients with psoriatic arthritis and arthritiswithaxial psoriatic inhibitorsin patients factor necrosis with psoriatic arthritis and axial spondyloarthritis – treatment response, drug retention and predictors thereof Results from the nationwide DANBIO registry Copenhagen Center for Arthritis Research (COPECARE) Center for Rheumatology and Spine Diseases Centre of Head and Orthopaedics Rigshospitalet, Glostrup spondyloarthritis ISBN 978-87-970989-0-5 Doctoral thesis Effectiveness of tumor necrosis factor inhibitors in patients with psoriatic arthritis and axial spondyloarthritis – treatment response, drug retention and predictors thereof Results from the nationwide DANBIO registry Bente Glintborg, MD, PhD 2018 The DANBIO registry and Copenhagen Center for Arthritis Research, COPECARE Center for Rheumatology and Spine Diseases Centre of Head and Orthopedics Rigshospitalet 1 © Bente Glintborg 2018 ISBN 978-87-970989-0-5 All rights reserved. No parts of this publication may be reproduced or transmitted, in any form or by any means, without permission The Faculty of Health and Medical Sciences at the University of Copenhagen has accepted this dissertation, which consists of the already published dissertations listed below, for public defence
    [Show full text]
  • Sacroiliac Joint Dysfunction and Piriformis Syndrome
    Classic vs. Functional Movement Approach in Physical Therapy Setting Crista Jacobe-Mann, PT Nevada Physical Therapy UNR Sports Medicine Center Reno, NV 775-784-1999 [email protected] Lumbar Spine Intervertebral joints Facet joints Sacroiliac joint Anterior ligaments Posterior ligaments Pelvis Pubic symphysis Obturator foramen Greater sciatic foramen Sacrospinous ligament Lesser sciatic foramen Sacrotuberous ligament Hip Capsule Labrum Lumbar spine: flexion and extension ~30 total degrees of rotation L1-L5 Facet joints aligned in vertical/saggital plane SI joints 2-5 mm in all directions, passive movement, not caused by muscle activation Shock absorption/accepting load with initial contact during walking Hip Joints Extension 0-15 degrees 15% SI joint pain noted in chronic LBP patients Innervation: L2-S3 Classic signs and symptoms Lower back pain generally not above L5 transverse process Pain can radiate down posterior thigh to posterior knee joint, glutes, sacrum, iliac crest sciatic distribution Pain with static standing, bending forward, donning shoes/socks, crossing leg, rising from chair, rolling in bed Relief with continuous change in position Trochanteric Bursitis Piriformis Syndrome Myofascial Pain Lumbosacral Disc Herniation and Bulge Lumbosacral Facet Syndrome J. Travell suspects Si joint pain may causes piriformis guarding and lead to Piriformis syndrome… Tenderness to palpation of PSIS, lower erector spinae, quadratus lumborum and gluteal muscles Sometimes positive SLR Limited hip mobility
    [Show full text]
  • Low Back Pain: a Pathway to Prioritisation
    National Health Committee – Low Back Pain: A Pathway to Prioritisation National Health Committee Low Back Pain: A Pathway to Prioritisation Page 1 National Health Committee – Low Back Pain: A Pathway to Prioritisation National Health Committee (NHC) The National Health Committee (NHC) is an independent statutory body charged with prioritising new and existing health technologies and making recommendations to the Minister of Health. It was reformed in 2011 to establish evaluation systems that would provide the New Zealand people and the health sector with greater value for money invested in health. The NHC Executive is the secretariat that supports the Committee. The NHC Executive’s primary objective is to provide the Committee with sufficient information for it to make decisions regarding prioritisation and reprioritisation of interventions and services. They do this through a range of evidence-based products chosen according to the nature of the decision required and timeframe within which decisions need to be made. The New Zealand Government has asked that all new diagnostic and treatment (non-pharmaceutical) services, and significant expansions of existing services, are to be referred to the NHC. In August 2011 the NHC was appointed with new Terms of Reference and a mandate to establish the capacity to assess new and existing health technologies. Its objectives (under Section 4.2 of its Terms of Reference – www.nhc.health.govt.nz) include contributing to improved value for money and fiscal sustainability in the health and disability sector by: providing timely advice and recommendations about relative cost-effectiveness based on the best available evidence; providing advice and recommendations which influence the behaviour of decision makers including clinicians and other health professionals; providing advice and recommendations which are reflected in resource allocation at national, regional and local levels; and contributing to tangible reductions in the use of ineffective interventions and improved targeting to those most likely to benefit.
    [Show full text]
  • Facet Syndrome
    A MEDICAL-LEGAL NEWSLETTER FOR PERSONAL INJURY ATTORNEYS BY DR. STEVEN W.SHAW Facet Syndrome The concept of facet joint mediated pain is not a new concept but it is one that is overlooked frequently in the medical legal world and commonly misinterpreted as radiculopathy by many lay “experts”. Facet joint pain, also commonly known as facet syndrome, is pain that originates from the posterior joints of the vertebral motor unit. The joints of the vertebral motor unit include two adjacent vertebra and the related intervertebral disc in the anterior and the two facet joints in the posterior. These posterior joints are also known as the Apophyseal joints, Zygopophyseal joints, Zed joints, Z joints. For purposes of this newsletter, I will be discussing primarily Lumbar Facet syndrome but most of the concepts will apply also to the cervical spine. Characteristic symptoms of facet mediated pain include localized unilateral spine pain, Localized facet or transverse process pain to palpation, pain directly over the joint capsule, lack of radicular features (dermatomal distribution or motor weakness), pain reduced on flexion, Pain worse with extension and loading, referred pain not extending beyond the knee or elbow, pain reduction after diagnostic facet or medial branch blockade. It is important to point out that facet joint pain, both in the neck and lower back, may have a referral pattern to the extremities but it does not follow a regional dermatomal pattern. A dermatomal pattern of referral is expected with a disc herniation with resulting nerve root involvement or other nerve root compromising lesions and will follow the anatomical distribution of the sensory root for that nerve.
    [Show full text]