Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 1992
Case ReportsAmitriptyline and carbamazepine in the treatment of dysesthetic pain in spinal cord injury.
Dysesthetic pain after spinal cord injury is a common problem. The pathophysiology of this disorder is unclear and treatment modalities have been of inconsistent effectiveness. Various pharmacologic approaches have been advocated for treatment of chronic pain in spinal cord injury, including the use of either anticonvulsants or antidepressants. This case report describes the successful use of carbamazepine in conjunction with amitriptyline in the treatment of dysesthetic pain in a patient with spinal cord injury.
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Arch Phys Med Rehabil · Jan 1992
Case ReportsThe Lambert-Eaton myasthenic syndrome: a cause of delayed recovery from general anesthesia.
A 70-year-old man required prolonged ventilation after surgery to remove a rectal neoplasm. The cause of the slow recovery from the effects of neuromuscular blocking agents used during his anesthetic was the Lambert-Eaton myasthenic syndrome (LEMS). Before surgery, he had no neuromuscular symptoms, even in retrospect. LEMS should be considered in the diagnosis of prolonged recovery from neuromuscular blockade, even in previously asymptomatic patients.
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Four cases of long thoracic mononeuropathy associated with sports participation are presented. Each patient developed shoulder pain or dysfunction after an acute event or vigorous activity, and demonstrated scapular winging consistent with serratus anterior weakness. ⋯ It is suggested that the athletic activity caused a stretch injury to the long thoracic nerve. Conservative management, consisting of range of motion exercises for the shoulder and strengthening of the serratus anterior muscle, resulted in a favorable outcome in all patients.
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Arch Phys Med Rehabil · Jan 1992
Case ReportsAcross-tarsal-tunnel motor-nerve conduction technique.
Tarsal tunnel syndrome is a commonly considered compression of the tibial nerve and its plantar divisions as the nerve curves behind the medial malleolus underneath the flexor retinaculum. Motor, sensory, and/or mixed-nerve conduction studies are used to confirm or exclude the presence of compression of the posterior tibial nerve and its plantar divisions. In previous studies, stimulation has been done either proximal to the tunnel or distally in the sole of the feet or in the toes. ⋯ For the medial plantar nerve with active electrodes placed over the medial head of the flexor pollicis brevis, the calculated mean + 2SD across tunnel onset latency is 3.2msec, peak latency is 2.9msec, and amplitude decrement is 29.3%. For the lateral plantar division, the calculated across-tunnel onset latency is 3.2msec, peak latency is 2.9msec, and amplitude decrement is 27.2%. Medial plantar nerve latency distal to the tarsal tunnel for the mean + 2SD is 5.9msec to onset and 9.5msec to peak, and the lateral plantar nerve latency is onset 5.9msec and peak 9.7msec.
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Arch Phys Med Rehabil · Jan 1992
Upper extremity pain in the postrehabilitation spinal cord injured patient.
The purpose of this study was to determine the prevalence of upper extremity (UE) pain in outpatients with chronic spinal cord injury (SCI). A total of 239 SCI outpatients (136 with quadriplegia and 103 with paraplegia) were interviewed for the presence of UE pain at the shoulder, elbow, wrist, and hand. The average age of the subjects at the time of interview was 37.4 years, and the average time since onset was 12.1 years. ⋯ Sixty-four percent of patients with paraplegia reported UE pain. Complaints related to carpal tunnel syndrome were the most common, followed by those related to shoulder pain. This study documents the prevalence and nature of UE pain in chronic SCI patients and emphasizes the need for further research to develop strategies for prevention and treatment of pain syndromes.