Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Sep 1989
Case ReportsGroin and hip pain due to fractures at or near the pubic symphysis.
Three patients with fractures at or near the pubic symphysis presented with groin pain simulating hip fracture or arthritis. A 71-year-old osteoarthritic woman was treated with a nonsteroidal antiinflammatory drug (NSAID) and exercises for right-sided sciatic pain after a minor fall, but developed left groin pain and tenderness over the pubic symphysis after two days of exercise. She had an impacted fracture of the left pubic symphysis which responded to use of a cane. ⋯ Twenty-four cases of os pubis fractures without major trauma or symphysis disruption have been reported. All patients had osteoporosis, and six had rheumatoid arthritis. Our three cases are presented to increase awareness of pubic symphysis fractures as a cause for groin pain, especially in patients with osteoporosis and rheumatoid arthritis.
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Arch Phys Med Rehabil · Jun 1989
Case ReportsHeparin-associated thrombocytopenia and thrombosis syndrome in a rehabilitation patient.
Heparin-associated thrombocytopenia and thrombosis (HATT) syndrome is a severe complication of heparin therapy. Since patients admitted for rehabilitation are at high risk for deep-vein thrombosis and pulmonary embolism, prophylactic doses of subcutaneous heparin are frequently used. We report the case of a 73-year-old woman with a history of heparin exposure, admitted to a comprehensive rehabilitation program for management of severe back pain. ⋯ On intravenous heparin therapy, the platelet count continued to decline. The thrombocytopenia resolved with discontinuation of heparin. This case illustrates a devastating complication of heparin therapy and emphasizes that physiatrists should be aware of this acute and preventable drug reaction.
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Arch Phys Med Rehabil · Apr 1989
The Functional Assessment Screening Questionnaire: application for evaluating pain-related disability.
The Functional Assessment Screening Questionnaire (FASQ) is a 15-item checklist which was developed for primary care populations and may serve as a questionnaire method for evaluating disability which is associated with chronic pain. One hundred fifty-eight patients completed the FASQ as part of an initial multidisciplinary evaluation of chronic pain. Reliability was reaffirmed through split-half and alternate-form methods. ⋯ Patients with back pain reported the most difficulty; those with head pain and genital pain reported the least difficulty. An internal structure appropriate to chronic pain populations was discerned, with two general factors measuring either physical-motoric or cognitive-social aspects of disability. Aside from constraints associated with the use of self-report methods, the FASQ may be helpful as part of efforts to portray pain-related disability.
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Arch Phys Med Rehabil · Mar 1989
Ventilator management in Duchenne muscular dystrophy and postpoliomyelitis syndrome: twelve years' experience.
The ventilator management protocol followed over the last 12 years in 23 patients with Duchenne muscular dystrophy (DMD) and six polio survivors with chronic respiratory failure (CRF) secondary to the late effects of poliomyelitis or postpolio syndrome (PPS) is reviewed. After the onset of respiratory failure, patients with DMD continued to show a classic course of progressive, generalized muscle weakness and a steadily declining vital capacity from an average of 482mL to 336mL. The DMD group required an average increase of 0.95 hours in their daily use of assisted ventilation per year. ⋯ Members of the postpolio group, to date, have shown no significant decrease in muscle strength nor have they needed more than nocturnal ventilation. Recommended evaluation and pulmonary follow-up for patients with CRF secondary to neuromuscular disease is outlined. Most of these patients can be managed for a number of years with body ventilators before a tracheotomy is necessary.
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Nitrofurantoin is frequently used by the physiatrist for treatment of urinary tract infections or for urinary antimicrobial prophylaxis. There is a substantial risk of acute and chronic pulmonary side effects with this medication. ⋯ A case is reported of a 47-year-old spinal cord injured woman with an acute pulmonary reaction to nitrofurantoin. The literature pertaining to pulmonary toxicity of nitrofurantoin is reviewed.