American journal of physical medicine & rehabilitation
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The cold pressor test elicits an emotional/motivational pain experience from the immersion of a limb in cold water. It has been widely used to evaluate (experimental and chronic) pain. However, normative models for quantification and comparison for pain tolerance have not previously been established. ⋯ The results indicate that at any given age Anglo-Saxon males have the longest tolerance time followed by non-Anglo-Saxon males, Anglo-Saxon females, and finally non-Anglo-Saxon females. There is a consistent decrease in tolerance time as the male age increases and minimal change in tolerance time as the female age increases. Chronic pain patients exhibited the same type of pain response pattern as healthy volunteers when corrected for age, sex, and ethnocultural subgroup.
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Am J Phys Med Rehabil · Dec 1988
Case ReportsAn unusual presentation of gluteal hematoma during anticoagulation therapy for deep venous thrombosis in spinal cord injury.
Soft tissue bleeding can be manifested clinically by swelling, skin discoloration, pain and tenderness. Early recognition can be difficult in the spinal cord-injured population in whom sensation is impaired. We are presenting a case of occult bleeding into the gluteal region during anticoagulation therapy in a paraplegic patient that presented as migrating pain and tenderness in the hip and pelvic area.
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Am J Phys Med Rehabil · Jun 1988
Risk factors for early occurring pressure ulcers following spinal cord injury.
We carried out a prospective study to determine the association between immobilization in the immediate postinjury period and the development of pressure ulcers in spinal cord-injured patients following their admission to Charity Hospital, New Orleans. Of 39 patients consecutively admitted to the hospital, 23 (59%) developed a grade one ulcer within 30 days, mostly in the sacral region (57%), the peak time of onset being day 4 postinjury (6/23 cases). ⋯ Time on the spinal board was also significantly associated with ulcers developing within 8 days (P = 0.01), but not with ulcers developing within 30 days (P = 0.09). An unexpected finding was the significant inverse association between systolic blood pressure and the development of ulcers both within 8 days (P = 0.03) and within 30 days (P = 0.02), suggesting that reduced tissue perfusion increases the spinal cord-injured patient's susceptibility to pressure ulcers.
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Am J Phys Med Rehabil · Apr 1988
Case ReportsDiagnostic peripheral nerve block resulting in compartment syndrome. Case report.
A hemiplegic patient with severe upper extremity spasticity 2 years after a cerebrovascular accident received a diagnostic median nerve block below the elbow with bupivacaine. He had been placed on Coumadin as prophylaxis for cerebrovascular arteriosclerotic disease, and prothrombin time was kept at twice the control value. ⋯ Compartment syndrome has not previously been reported as a complication resulting from a nerve block procedure. We conclude that (1) compartment syndrome may develop after a peripheral nerve block procedure for spasticity, (2) prophylactic anticoagulation may increase the risk for hemorrhagic events resulting from percutaneous injection and (3) early recognition is essential and appropriate decompressive fasciotomy may be indicated if a compartment syndrome develops after a nerve block procedure.