Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 1998
Case ReportsHyperthermia, rhabdomyolysis, and disseminated intravascular coagulation associated with baclofen pump catheter failure.
A 29-year-old man with C6 tetraplegia (ASIA A) using an implanted baclofen pump and intrathecal catheter infusion system for spasticity control developed severe spasticity, hyperthermia, hypotension, rhabdomyolysis, and disseminated intravascular coagulation after catheter disconnection. Tracheal intubation and mechanical ventilation were necessary. Extensive workup for a concurrent infection was negative except for urine cultures. ⋯ Spasticity control and his clinical condition, including body temperature, did not improve until his catheter was surgically replaced and intrathecal baclofen administration was resumed. The pharmacopathology of abrupt baclofen withdrawal and the similarities between this presentation, sepsis, neuroleptic malignant syndrome, and malignant hyperthermia are discussed. High-dose dantrolene was not used; however, based on similarities between this patient's presentation and neuroleptic malignant syndrome, it may have been the drug of choice.
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Arch Phys Med Rehabil · Mar 1998
The predictive value of provocative sacroiliac joint stress maneuvers in the diagnosis of sacroiliac joint syndrome.
To determine the clinical validity of provocative sacroiliac joint (SIJ) maneuvers in making the diagnosis of sacroiliac joint syndrome (SIJS). ⋯ Our results do not support the use of provocative SIJ maneuvers to confirm a diagnosis of SIJS. Rather, these physical examination techniques can, at best, enter SIJS into the differential diagnosis.
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Arch Phys Med Rehabil · Mar 1998
Case ReportsMyofascial trigger points in intercostal muscles secondary to herpes zoster infection of the intercostal nerve.
Chronic pain in the chest wall is a major complication after herpes zoster infection of intercostal nerves. It is usually difficult to control pain of such origin. Two cases are reported of postherpetic neuralgia after herpes zoster infection involving the intercostal nerves. ⋯ One patient had complete pain relief after three series of injections. The effect of pain relief for the other patient lasted for 1 to 2 weeks after the initial injection and lasted progressively longer (up to 2 months) after repeated injections. It appears that many of the tender spots formed in intercostal muscles after herpes zoster are myofascial trigger points that respond to injection with referred pain, local twitch responses, and immediate pain relief.
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Arch Phys Med Rehabil · Mar 1998
Incidence, acute care length of stay, and discharge to rehabilitation of traumatic amputee patients: an epidemiologic study.
To examine patterns of trauma-related amputations over time by age and gender of the patient and by level and type of amputation, and to explore factors affecting acute care length of stay and discharge to inpatient rehabilitation. ⋯ Findings suggest a substantial decline in incidence rates of both major and minor amputations over the 15-year study period, a low rate of disposition to inpatient rehabilitation services of patients sustaining major amputations, and an apparent role of firearms as a cause of trauma-related amputations in patients younger than 25 years of age. The consequences of increasingly shorter acute care hospital stays and low rates of discharge to inpatient rehabilitation on the long-term outcomes of persons who have had traumatic amputation should be examined.