Presence Of Tenderness Research Articles

Prevalence of priformis syndrome in sciatica patients: Predictability of specific tests and radiological findings for diagnosis.

The traditional approach for diagnosing piriformis syndrome (PS) is to rule out other causes of sciatica. This approach may lead to unnecessary radiological examinations and a waste of time. In contrast to the traditional approach, we aimed to first exclude PS and determine its prevalence by injecting patients with priformis tenderness. This observational cross-sectional study included patients diagnosed with PS who had sciatica and tenderness on palpation of the priformis muscle and whose pain was reduced by at least 50% with local injection. Age, sex, pain duration, presence of tenderness in the piriformis muscle, Freiberg test, PACE sign, FADIR, Visual Analog Scale (VAS) score, Douleur Neuropathique 4 Questions (DN4) score, and radiological findings were compared between patients who responded and those who did not respond to the priformis injection. A total of 110 patients with sciatica were evaluated, of whom 66 with tenderness on palpation of the primiformis muscle underwent local injection. In 27 of the 66 patients (40.9%), a decrease in the NRS score of >50% was observed after injection, and PS was diagnosed. There were no statistically significant differences in age, sex, pain duration, Pace, FADIR test positivity, radiological findings, NRS, and DN4 scores, but Freiberg test positivity was statistically higher in patients diagnosed with PS. PS is more common than is thought to be a cause of sciatica. A positive Freiberg test is predictive for the diagnosis of PS, but it should be confirmed by tenderness of the priformis muscle and local injection. Many pathologies can be detected incidentally radiographically in PS; however, they are not predictive of the diagnosis.

Is Tenderness of Medial Malleolus Circumference a Sign of Syndesmosis Injuries?

Syndesmosis injuries occur in approximately 10% of all ankle fractures. The integrity of the deltoid ligament is important in the decision of surgical treatment of lateral malleolus fractures. Patients who were operated on for Weber B ankle fracture were evaluated retrospectively, and the relationship between tenderness around the medial malleolus and syndesmosis injury was investigated. Patients with visual analog scale, Foot and Ankle Ability Measure daily living, and sports activity scores in their files were included. This study enrolled 38 patients. The patients were divided into two groups. Group 1 consisted of patients with a medial space greater than 4 mm on preoperative radiographs and a positive intraoperative Cotton test, in which a syndesmosis screw was used. Group 2 consisted of patients with a medial space less than 4 mm on preoperative radiographs and negative intraoperative Cotton test, for whom no syndesmosis screw was used. In 17 of 38 patients, syndesmosis screws were used because of intraopeative positive Cotton test. In 21 patients, the Cotton test was negative and the syndesmosis screw was not used. Comparing the groups statistically revealed no statistically significant difference in all scores. Tenderness around the medial malleolus was detected in two patients in group 2 and nine patients in group 1. A statistically significant difference was detected in terms of medial clear space values and tenderness around the medial malleolus between both groups. The absence of tenderness around the medial malleolus in Weber B ankle fractures indicates no syndesmosis injury, whereas the presence of tenderness around the medial malleolus does not mean that there is a syndesmosis injury.

A case report on surgeon’s perseverance: post ileal type appendicular perforation with concealed abscess-laparoscopic appendectomy

In humans, the vermiform appendix is not a vestigial organ, but rather a lymphoid structure that, when inflamed, causes major problems. Acute appendicitis is characterized by pain and soreness in the right iliac fossa, along with nausea and anorexia. Depending on the location of the appendix, it may appear in an unusual manner. In post-ileal type appendicitis, pain is more concentrated around the umbilicus, and pain shifting may be absent. In this scenario, an ultrasound of the abdomen may not be particularly useful, but a CT scan of the abdomen may aid in the diagnosis. A delay in diagnosing and treating acute appendicitis can have disastrous consequences. We now present the case report of a 20-year-old male patient with chief complaints of sudden onset of abdominal pain over umbilical region, squeezing type radiating to right lumbar region, for 3 days. On clinical examination, the patient had presence of tenderness at McBurney’s point over the right iliac fossa and periumbilical area. The diagnostic investigations of GI endoscopy report showed grade A esophagitis and hemorrhagic gastropathy. CT report shows acute appendicitis with contained perforation and appendiceal abscess. Post ileal appendicular perforation with concealed abscess was treated with laparoscopic appendectomy under general anesthesia.

Approach to dysmenorrhoea in primary care.

Approach to dysmenorrhoea in primary care.

Postoperative Pain Following Root Canal Instrumentation Using ProTaper Next or Reciproc in Asymptomatic Molars: A Randomized Controlled Single-Blind Clinical Trial.

Aim: The development of postoperative pain following root canal instrumentation may impair patient’s comfort and undermine their trust in the dentist. This study assessed the effect of root canal instrumentation techniques (rotary (PTN; ProTaper Next®) and reciprocating (R; Reciproc®)) on the postoperative pain intensity (primary outcome) and tenderness on biting (secondary outcome) of patients’ asymptomatic molars. Methodology: This study protocol was registered with ReBec-WHO (U1111-1182-2800). From a pool of 112 patients evaluated for eligibility (healthy adults (≤18 years old)), with a single asymptomatic molar (maxillary or mandibular) indicated for root canal treatment, diagnosed with asymptomatic irreversible pulpitis (including chronic hyperplastic pulpitis), 75 were randomly allocated in similar proportions to receive the intervention (two-appointment root canal therapy) in either the PTN or R group. The allocated procedures were performed using standardized protocols. Participants (blinded to the instrumentation technique) rated their pain intensity at 6, 12 and 24 h and from day 2 to day 7 following the root canal instrumentation appointment using a VAS and an NRS; the ibuprofen tablets taken and the presence of tenderness on biting were recorded. The instrumentation time was registered. Univariate and multivariate statistics measured the effect of independent variables on the outcomes. Results: From the 75 patients allocated, 8 patients (4 from each group) were lost; in total, 33 patients were analyzed in the PTN group and 34 in the R group. The frequencies of postoperative pain (p > 0.05) and tenderness on biting (p > 0.05) were similar between groups. The medication intake (mean of 1.31 tablets) and the time of instrumentation (approximately 11 min) were similar between groups. Conclusion: ProTaper Next and Reciproc® caused a slight risk of tenderness on biting and contributed to similar self-reported postoperative pain (low intensity) up to 7 days following root canal shaping.

Distal Interphalangeal Joint Involvement May Be Associated with Disease Activity and Affected Joint Distribution in Rheumatoid Arthritis.

We investigated the relationship between distal interphalangeal (DIP) joint involvement and disease activity in 10,038 patients with adult-onset rheumatoid arthritis (RA). The affected joint distribution was investigated using the joint indices (JI) x, y, and z, corresponding to the upper and lower joints, and the predominance of large-joint involvement, respectively. DIP joint involvement (defined by the presence of tenderness and/or swelling in DIP joints) was present in 206 (2.1%) of 10,038 patients with RA. Patients with RA exhibiting DIP joint involvement were significantly younger, and more frequently women. DIP joint involvement was positively associated with Disease Activity Score-28 using C-reactive protein, and clinical variables related to high RA disease activity, including JIs x and y, and was negatively associated with JI z. JI x was significantly higher than JI y in RA patients with DIP joint involvement. An odds ratio analysis revealed that small-to-medium sized and upper-extremity joints ranked first, second, and fourth among the eight variables significantly associated with DIP joint involvement. The correlation coefficients revealed that small-sized and upper-extremity joints ranked first and second among the five significant variables. DIP joint involvement, albeit rare, is significantly associated with high RA disease activity with predominance of small-sized and upper-extremity joints.

Efficacy of neural prolotherapy versus local corticosteroid soft tissue injection for treatment of chronic anserine bursitis: a prospective randomized clinical trial

BackgroundAnserine bursitis is characterized by the presence of spontaneous pain with tenderness at the inferomedial aspect of the knee joint. Neural prolotherapy aims to relieve pain of a variety of chronic musculoskeletal disorders. The study aim was to explore the short-term efficacy of neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) versus local corticosteroid injection for pain relief and improvement of function in patients with chronic anserine bursitis. The enrolled patients were randomly assigned to receive neural prolotherapy (subcutaneous perineural injection of dextrose 5% solution) (neural prolotherapy group) or a single local soft tissue injection of corticosteroid (corticosteroid group). Outcome measures included Western Ontario McMasters Universities osteoarthritis index, assessment of overall anserine bursitis pain severity using the visual analogue scale, patient’s global assessment of anserine bursitis severity using the visual analogue scale, and clinical assessment for the presence of tenderness on the anserine bursa region. Patients were evaluated before injection and after intervention by 4 weeks.ResultsThe study included 67 lower limbs from 43 patients with chronic anserine bursitis. No significant differences were found between both treatment groups regarding all assessed parameters at the start of the study. After 4 weeks, within-group analysis showed that there was a statistically significant improvement in Western Ontario McMasters Universities osteoarthritis index and its subscales (P ≤ 0.0001), overall anserine bursitis pain severity (P ≤ 0.0001), and patient’s global assessment of anserine bursitis severity (P ≤ 0.0001), as well as there was significant improvement regarding the presence of tenderness at the anserine bursa region in both groups in comparison to the preinjection assessment. At the postinjection assessment, between-group analysis showed that there were no significant differences regarding all assessed outcome parameters. All patients in both groups tolerated the injection procedure and were satisfied with the procedure. There was no significant difference between the two groups regarding patients’ satisfaction to the procedure results. Improvement was achieved in 86.4% of patients included in the neural prolotherapy group versus 95.2% of patients included in the corticosteroid group.ConclusionsNeural prolotherapy was effective in relieving pain, improving local tenderness and function in patients with chronic anserine bursitis similar to local corticosteroid injection.Trial registrationClinicalTrials.gov, registration number: NCT04509440. Registered 12 August 2020—Retrospectively registered,

PENATALAKSANAAN FISIOTERAPI PADA PLANTAR FASCIITIS DENGAN MODALITAS TENS, IR DAN TERAPI LATIHAN DI RSUD KAJEN KABUPATEN PEKALONGAN

<span style="font-size: 10.0pt; mso-bidi-font-size: 12.0pt; line-height: 115%; font-family: 'Calibri','sans-serif'; mso-ascii-theme-font: minor-latin; mso-fareast-font-family: 'Times New Roman'; mso-hansi-theme-font: minor-latin; mso-bidi-font-family: 'Times New Roman'; mso-ansi-language: EN-US; mso-fareast-language: EN-US; mso-bidi-language: AR-SA;">Plantar fasciitis is an inflammation of the plantar fascia. Physiotherapy problems that occur are: (1) The presence of pain in the soles of the feet, (2) The presence of muscle spasm m. gastrocnemius, (3) the limited range of motion of the bilateral ankle joint (4) the presence of bilateral ankle muscle weakness, (5) There is a decrease in functional activity, (6) The presence of tenderness in the calcaneus. This research was conducted at Kajen Hospital, Pekalongan Regency with the design used was a case study on bilateral plantar fasciitis et causa calcaneus spur patients who had been given physiotherapy interventions in the form of tens (transcutaneous eletrical nerve stimulation), infrared, and exercise therapy (free active exercise, calf raises). and active stretching). Methods of data collection and data analysis using auto history. Instruments focused on pain conditions, muscle spasm, LGS, muscle strength, functional activity. Based on the therapy carried out 4 times, the following results were obtained: (1) there was a decrease in pain from T1: 1.8 to T4: 0 (2) there was a decrease in spasm from T1: 1 to T4: 0 (3) there was an increase in ROM dorso flexion right from T1: 15<sup>o</sup> to T4: 25<sup>o</sup>, right eversion from T1: 10<sup>o</sup> to T4: 15<sup>o</sup>, dorso left flexion from T1: 10<sup>o</sup> to T4: 20<sup>o</sup>, left eversion from T1: 5<sup>o</sup> to T4: 15<sup>o</sup>, (4) there is an increase in strength muscle from T1: 4 to T5: 5 (5) there is an increase in daily functional activities. The conclusion of this study is that the TENS (transcutaneous electrical nerve stimulation), infrared, and exercise therapy (free active exercise, calf raises, active stretching) modality can reduce the problems caused by bilateral plantar fasciitis et causa calcaneus spur conditions.</span><h1 style="margin: 0cm; margin-bottom: .0001pt; text-align: justify; text-indent: 1.0cm; line-height: normal;"><span style="font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;" lang="IN">Plantar fasciitis is an inflammation of the plantar fascia. Physiotherapy problems that occur are: (1) The presence of pain in the soles of the feet, (2) The presence of muscle spasm m. gastrocnemius, (3) the limited range of motion of the bilateral ankle joint (4) the presence of bilateral ankle muscle weakness, (5) There is a decrease in functional activity, (6) The presence of tenderness in the calcaneus. This research was conducted at Kajen Hospital, Pekalongan Regency with the design used was a case study on bilateral plantar fasciitis et causa calcaneus spur patients who had been given physiotherapy interventions in the form of tens (transcutaneous eletrical nerve stimulation), infrared, and exercise therapy (free active exercise, calf raises). and active stretching). Methods of data collection and data analysis using auto history. Instruments focused on pain conditions, muscle spasm, LGS, muscle strength, functional activity. Based on the therapy carried out </span><span style="font-size: 10.0pt; mso-bidi-font-size: 12.0pt; mso-ansi-language: EN-US; font-weight: normal; mso-bidi-font-weight: bold;">4</span><span style="font-size: 10.0pt; mso-bidi-font-size: 12.0pt; font-weight: normal; mso-bidi-font-weight: bold;" lang="IN"> times, the following results were obtained: (1) there was a decrease in pain from T1: 1.8 to T4: 0 (2) there was a decrease in spasm from T1: 1 to T4: 0 (3) there was an increase in ROM dorso flexion right from T1: 15<sup>o</sup> to T4: 25<sup>o</sup>, right eversion from T1: 10<sup>o</sup> to T4: 15<sup>o</sup>, dorso left flexion from T1: 10<sup>o</sup> to T4: 20<sup>o</sup>, left eversion from T1: 5<sup>o</sup> to T4: 15<sup>o</sup>, (4) there is an increase in strength muscle from T1: 4 to T5: 5 (5) there is an increase in daily functional activities. The conclusion of this study is that the TENS (transcutaneous electrical nerve stimulation), infrared, and exercise therapy (free active exercise, calf raises, active stretching) modality can reduce the problems caused by bilateral plantar fasciitis et causa calcaneus spur conditions.</span></h1>

PENATALAKSANAAN FISIOTERAPI PADA KONDISI PLANTAR FACITIS SINISTRA DENGAN MODALITAS INFRA MERAH, ULTRASOUND, MASSAGE FRICTION DAN ACTIVE STRETCHING DI RSUD BENDAN KOTA PEKALONGAN

Plantar fascitis is heel pain caused by inflammation or irritation of the plantar fascia. Plantar fascitis is characterized by complaints of pain in the heel during the first step in the morning, when walking pain is usually reduced. Signs and symptoms that arise in the condition of Plantar Facitis are the presence of tenderness, the presence of motion pain, the presence of oedem, a disturbance of functional activity (Assad et al, 2016).In this case the technology was chosen to overcome the above problems by using infra merah modalities, <em>ultrasound</em>, friction massage, <em>active stretching </em>. This research was conducted at Bendan Hospital in Pekalongan City with a descriptive analytic research design. The research subjects in Scientific Writing are patients with Plantar facitis conditions who will be given physiotherapy intervention with infra merah modalities, <em>ultrasound</em>, friction massage, <em>active stretching </em>. Methods of data collection and data analysis using the Autoanamnesis method. The research instrument consisted of examining Pain with VAS, spasm with palpation, edema with antopometry and Functional Activity Ability with the Foot Funtional Index.The results after the 1st treatment until the fourth therapy there was a decrease in pain from T1 silent pain 0, motion pain 3, tenderness 4 to T4 to silent pain 0, motion pain 1, tenderness 3, There was a decrease in muscle spasm from T1 = 1 to T4 becomes 0, there is a decrease in oedem from the left T1 25cm right 24cm to T4 becomes the left T1 24cm dektra 24cm. There is an increase in fungional activity in T3.The conclusion of this study is that the modalities of physiotherapy with infra merah, <em>ultrasound</em>, friction massage, <em>active stretching </em> can help reduce the problems that arise in the condition of Plantar Facitis.

Predictive factors of renal and ureteric stone disintegration by the extracorporeal shock wave lithotripsy

Objective The objective of this work was to evaluate possible predictive variables for the outcome of shock wave lithotripsy of renal and ureteric stones. Background Nephrolithiasis is a common disease affecting the population with a peak incidence at around the third to fourth decade of life. The prevalence of stone disease is increasing with increasing annual expenditure. Extracorporeal shock wave lithotripsy (ESWL) is the preferred treatment for renal and several ureteral calculi owing to its noninvasive characteristic and its favorable clinical outcome. Patients and methods This study was carried out on 100 patients who are supposed to be treated with ESWL and diagnosed with renal or ureteric stone. All cases were evaluated before, during, and after the procedure as follows: full medical history, clinical examination, laboratory investigations, and radiological investigations. Results A total of 91 of the studied patients were males. Age of the studied patients ranged from 24 to 58 years, with a mean of 38.72 years. There is a significant relation between need for second session and presence of tenderness, hypertension and stone site, international normalized ratio, operation duration, complaint duration, stone size, and Hounsfield unit. Presence of renal stone significantly protects from that risk. There are significant relations between postoperative complications and smoking, BMI, urine analysis, hypertension, and past history of stone. There are significant relations between postoperative complications and need for second session, serum creatinine, operation duration, and stone size. Conclusion ESWL is an effective and reasonable initial therapy in the management of ureteral stones 2 cm or less at all levels of the ureter.

A Clinical Approach to Diagnosing Trigger Wrist.

Trigger wrist is a relatively unusual condition, produced by wrist or finger motion. The various causes of trigger wrist can originate from flexor tendon, extensor tendon, bones, or tumour. A proper clinical approach is required to diagnose and manage patients with trigger wrist. A keyword search was performed across Google Scholar and PubMed. Articles describing trigger wrist conditions were analysed. Based on the information obtain from the articles, the clinical manifestations and approach to diagnosing the cause of trigger wrist is discussed. A detailed history alone may lead to a reasonably accurate diagnosis. Patients can present with trigger wrist occurring during movement of the fingers or with wrist movements. Presence of tenderness around A1 pulley suggest trigger finger. Absence of tenderness over the A1 pulley may suggest trigger wrist. The wrist should be examined for any swelling or malunion around the wrist joint. Palpate for any bony prominence, clicking, or crepitus with the movement of the wrist. Examination for the presence of carpal tunnel syndrome should be performed. A simple radiograph of the wrist joint is needed to see any possible bony pathology such as malunion, instability or arthritis of the carpal bone. For soft tissue assessment ultrasound would be a good choice and can be done during finger or wrist movement. MRI is useful for further assessment of space occupying lesion within the carpal tunnel and is useful for surgical planning. Nerve conduction study is indicated for patients with median nerve compression symptoms. During the initial stage, the patient should be advised for activity modification to reduce the wrist and finger movements. Surgical treatment will depend on the causative factor. Surgery done under local anaesthesia has the advantage of reconfirming with the patient, resolution of triggering during surgery by asking the patient to actively move the fingers or wrist. Trigger wrist is a relatively rare condition compared with trigger finger, which is the most common disorder of the hand. To avoid inadequate and ineffective treatment of patients with trigger wrist, careful examination and proper diagnosis are vital.

Ultrasound assessment, unlike clinical assessment, reflects enthesitis in patients with psoriatic arthritis.

Enthesitis is a major musculoskeletal manifestation of psoriatic arthritis (PsA). It is conventionally assessed clinically, by the presence of tenderness, despite its low reliability. However, ultrasound (US) provides a sensitive and feasible method for evaluating enthesitis. We investigated enthesitis as assessed clinically and by US in patients with PsA. Forty-seven patients with PsA underwent US examination of the bilateral humeral medial epicondyles and insertions of the triceps, distal quadriceps, proximal/distal patellae, Achilles tendons, and plantar fascia. These 14 entheses were also clinically evaluated by tenderness. The correspondence between US and clinical enthesitis was evaluated, as well as their associations with inflammatory markers (C-reactive protein [CRP], matrix metalloproteinase-3 [MMP-3]), disease activity indices (Disease Activity in Psoriatic Arthritis [DAPSA], Disease Activity Score 28 joints [DAS28-CRP], Psoriatic Arthritis Screening and Evaluation [PASE], Psoriasis Area Severity Index [PASI]), radiographic damage (modified Total Sharp Score [mTSS]), and functional status (health assessment questionnaire [HAQ]), and axial involvement. Among 47 patients with PsA, 37 and 23 had US and clinical enthesitis, respectively. US and clinical enthesitis had very low concordance (kappa coefficient 0.04), with no correlation between enthesitis counts (r=0.15, p=0.30). The US enthesitis count correlated only with the MMP-3 level (r=0.41, p=0.007), whereas the clinical enthesitis count correlated with the DAPSA, DAS28-CRP, HAQ, and PASE (r=0.50, p<0.001; r=0.44, p=0.002; r=0.41, p=0.008; r=0.54, p<0.001, respectively). US and clinical enthesitis are completely different entities. US enthesitis, but not clinical enthesitis, reflects inflammatory conditions.

Acute chylous peritonitis: Report of a case and literature review

Acute chylous peritonitis is an extensively rare condition; chylous ascites may result from many pathological conditions, including congenital defects of the lymphatic system, trauma, peritoneal infections, and malignant neoplasms. In most cases, the presence of tenderness and rebound leads the patients to be misdiagnosed with acute appendicitis. In our case, the preoperative diagnosis was perforated acute appendicitis.

Comparative Outcomes of Platelet Rich Plasma, Autologous Blood and Corticosteroid Injections in the Treatment of Lateral Epicondylitis

Comparative Outcomes of Platelet Rich Plasma, Autologous Blood and Corticosteroid Injections in the Treatment of Lateral Epicondylitis ABSTRACT Objectives Lateral epicondylitis is a disorder in which the dominant extremity is usually affected, and its prevalence ranges between 1% and 3% in the general population. It appears to be more common and severe in women between ages 30 and 60. Platelet rich plasma (PRP), autologous blood and corticosteroid injections are widely applied treatment modalities with various success rates. We aimed to investigate clinical outcomes of these three injection techniques. Study Design is Prospective randomized clinical trial. Methods Fifty two patients (19 men, 33 women) whom were diagnosed lateral epicondylitis between the years 2011 and 2013, with a mean age 43,7years (min 18, max 62) were randomized into three groups according to application order. Each group received one of the injection treatments: PRP, autologous blood or corticosteroid. Comparative clinical outcomes evaluated prospectively. Assessments performed by a blind evaluator by visual analog scale (VAS), presence of tenderness, QuickDASH scores, grip strength measurements in pre-injection period and in post-injection first, third and sixth months. Statistical analyses performed in SPSS 21 software by Pearson’s chi-squared, Anova, Kruskar Wallis and McNemar tests. Results Changes of VAS and QuickDASH scores in each group were significant according to pre-injection and post-injection first, third, sixth month evaluations (p

Vitamin D Deficiency as a Cause of Flank Pain

Introduction: Loin pain is a relatively common complaint seen in a variety of clinical settings. Many of these cases seek medical advice of urologists and nephrologists based on the impression that this pain originates from the urinary tract. In spite of the importance of diseases of the urinary tract as causes of loin pain, many of the patients presenting with this complaint are devoid of any urinary abnormalities. Methods: Differential diagnosis includes musculoskeletal, respiratory, gastrointestinal, neurologic and cutaneous causes. In this work, we present a series of 187 cases presenting to our center with loin pain that did not prove a renal cause. Results: During physical examination of these cases, tenderness over the lowermost ribs above the flank at the posterior and mid axillary lines was eminent. Within the laboratory and radiologic work-up performed to these cases, very low serum level of 25 (OH) vitamin D was a constant feature. Vitamin D replacement was associated with complete relief of the pain in most of these cases. Conclusion: The presence of tenderness over the costal margin rather than the renal angle proper should alert examining physician to the possibility of disease in the ribs. After exclusion of trauma as a cause of this pain and tenderness, estimation of vitamin D level is a mandate.

SAT0224 Macrophage Targeting by Positron Emission Tomography (PET) Imaging Detects Subclinical Synovitis in Hands and Wrists in Early RA Patients in Clinical Remission

BackgroundIn rheumatoid arthritis (RA), intensive treatment regimens aim to achieve a status of clinical remission (CR). Unfortunately, recurrent flares in RA patients in CR are not an uncommon phenomenon1. Studies...

Association of low back pain, somatic dysfunction, and lumbar bone mineral density: reproducibility of findings.

Somatic dysfunction as diagnosed by palpation should be associated with an objective measure. Bone mineral density (BMD) has been shown to be elevated in lumbar vertebrae with somatic dysfunction and in the lumbar region of individuals with chronic low back pain (LBP). To investigate the association of lumbar somatic dysfunction and BMD T-score variability in participants with chronic LBP and without LBP (non-LBP) and to determine the reproducibility of previously published results. Two examiners, blinded to symptom history, evaluated participants for tissue texture abnormalities, rotational asymmetry, anterior motion restriction, and tenderness at vertebral levels L1 to L4. Participants also underwent dual-energy x-ray absorptiometry of vertebral levels L1 to L4 for the assessment of BMD T scores. Generalized linear models were used to compare the chronic LBP and non-LBP groups on the presence and severity of somatic dysfunction and to test whether group and the presence and severity of somatic dysfunction were related to BMD T scores. Forty-three chronic LBP (54%) and 36 non-LBP participants (46%) completed the study. Although the presence of somatic dysfunction in the 2 groups was not significantly different, the presence of tenderness was significantly more common in the chronic LBP group (P<.001), as was the severity for tissue texture abnormalities (P=.03), motion restriction (P=.04), and tenderness (P<.001). Of the 316 vertebrae assessed, 31 (10%, all in the chronic LBP group) had moderate/severe tenderness. The vertebral somatic dysfunction burden score, the total somatic dysfunction burden score, the vertebral somatic dysfunction severity score, and the total somatic dysfunction severity score were higher in the chronic LBP group (all P<.001). The vertebral BMD T score was significantly higher for vertebrae demonstrating moderate/severe rotational asymmetry compared with those demonstrating mild or no rotational asymmetry (P=.01) and for vertebrae demonstrating moderate/severe tenderness compared with those demonstrating no tenderness (P=.04). Study results suggest that somatic dysfunction was more significant in chronic LBP participants. Although the correlation between the presence of somatic dysfunction and segmental BMD T scores was not reproduced, BMD T scores were higher for vertebrae demonstrating moderate/severe rotational asymmetry and tenderness.

FRI0216 Does ultrasonography guidance increase the yield of temporal artery biopsy in patients with giant cell arteritis? Results from a single-blinded randomized study

BackgroundTemporal artery biopsy (TAB) is the gold standard to diagnose giant cell arteritis (GCA), but is negative in approximately 20% of patientsObjectivesThe study aimed to establish whether Color-doppler-ultrasonography (CDU)-guided TAB...

White lesions in the oral cavity: a clinicopathological study from a tertiary care dermatology centre in kerala, India.

Context:White lesions in the oral cavity may be benign, pre-malignant or malignant. There are no signs and symptoms which can reliably predict whether a leukoplakia will undergo malignant change or not. Many systemic conditions appear initially in the oral cavity and prompt diagnosis and management can help in minimizing disease progression and organ destruction.Aim:The aim of the paper was to study the clinical and histopathological patterns of white lesions in the oral cavity presented at the study setting and to study the factors associated with the histopathological patterns of the lesions.Settings and Design:A hospital based cross-sectional study of patients with white lesions in the oral cavity attending the Department of Dermatology and Venereology, Medical College, Thiruvananthapuram was done.Materials and Methods:After taking a detailed history, microscopic examination of Potassium hydroxide smear and an oral biopsy with histopathologial examination was done.Results:Out of the 50 patients in the study, clinically the diagnoses made were Lichen planus (32 patients; 64%), Frictional Keratosis (4;8%), Dysplasia (2;4%), Oral Hairy Leukoplakia (1;2%), Pemphigus Vulgaris (2;4%), Cutaneous Lupus Erythematosus (1;2%), Oral Submucous fibrosis (3;6%) and Oral Candidiasis alone (5;10%). Out of the 45 patients who had undergone biopsy, 25 (55.6%) had Lichen planus, 9 (20%) had Frictional Keratosis and mild Dysplasia was found in 4 (8.9%) patients.Conclusion:The measure of agreement between the clinical and pathological diagnosis was only 32%. Older age, difficulty in opening the mouth, consumption of non-smoked tobacco, site of the lesion (gingival, floor of mouth or lingual vestibule) and presence of tenderness on the lesion were significantly associated with Dysplasia.

Case Report of a Male Primary Breast Carcinoma of Axillary Accessory Mammary Gland

A 65-year-old male patient noticed a mass about 2 cm in diameter in the right axillary region in 2008. He consulted a local dermatologist and the mass was diagnosed as benign. In May 2010, after follow-up of 2 years, the mass began to enlarge at a discernible rate, with the presence of tenderness. There was no history of fever, cough, weight loss, decreased appetite, altered bowel habits, melena, or rectal bleeding. He was transferred to the surgical department of an academic medical center for further treatment. At the initial visit, physical examination revealed an elastic hard, nonmobile mass measuring 5.5 cm, with tenderness to palpation in the right axilla. Part of the skin covering the mass was reddish. There was no significant enlargement of other superficial lymph nodes. Both breasts were normal on palpation. Physical examination was otherwise unremarkable.