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Published in Andrew Schofield, Paul Schofield, The Complete SAQ Study Guide, 2019
Andrew Schofield, Paul Schofield
Osteoarthritis is the commonest condition to affect joints. The knee and hip joints are most commonly affected. Risk factors include increasing age, female sex and obesity. Pain in osteoarthritis is typically worse at the end of the day and with exercise. Rest pain occurs as the condition progresses. As well as lifestyle changes, initial management consists of analgesia, physiotherapy and walking aids. In more severe osteoarthritis, intra-articular steroid injections may provide temporary relief, but the definitive treatment is joint arthroplasty.
The cardiovascular system
Published in Peter Kopelman, Dame Jane Dacre, Handbook of Clinical Skills, 2019
Peter Kopelman, Dame Jane Dacre
Patients with mild chronic arterial occlusive disease may have no symptoms. Those who do develop symptoms usually present with intermittent claudication. The pain of intermittent claudication is most commonly felt in the calf muscles because the most common site for chronic arterial occlusive disease is the superficial femoral artery, which provides the blood supply to the calf; however, occlusive disease of the iliac arteries, or even the aorta, may give rise to claudication pain in the thighs or buttocks. Ischaemic rest pain is felt in the foot, is typically worst in bed at night, causes sleep deprivation and may make the patient hang the leg out of bed or get up and hobble about. Patients presenting with ulceration or soft tissue necrosis on the foot or ankle often have a history of claudication and/or rest pain. The onset of rest pain or tissue loss indicates that the survival of the limb is threatened.
Vascular
Published in Michael Gaunt, Tjun Tang, Stewart Walsh, General Surgery Outpatient Decisions, 2018
Take a general and vascular history. Rest pain may first start at night when the foot is lifted on to the bed thereby losing the help of gravity to supply blood to the foot. Patients may describe attaining relief from the pain by dangling the foot over the side of the bed. Eventually, even with the leg dependent there is still not enough blood supply and the foot is painful all the time. Pain starts at the point furthest away from the heart and spreads proximally.
Life-style counseling program and supervised exercise improves walking distance and quality of life in patients with intermittent claudication
Published in Physiotherapy Theory and Practice, 2022
Asger Jacobsen, Kim Christian Houlind, Amrit Rai
This is a prospective study where selected groups of people diagnosed with IC were treated with SET along with counseling to modify the risk factors. Eligible participants were patients from the municipality of Fredericia, Denmark, diagnosed with intermittent claudication and ABI below 0.9. Patients with rest pain and tissue loss were excluded. The other inclusion and exclusion criteria are as shown in the Table 1. Participants were referred either from the general practitioner or from the Department of Vascular Surgery at Lillebælt Hospital, Kolding Denmark. The patients were recruited in the period from May 2018 to September 2019. Written informed consent was obtained from all participants. According to Danish legislation, waiver for the need of ethical approval was obtained from the Research Ethics Committee as the study was based on a noninvasive intervention, questionnaires and did not handle biological material (# 20192000–96).
Chronic postsurgical pain after total knee arthroplasty: A prospective cohort study in Japanese population
Published in Modern Rheumatology, 2021
Koji Aso, Masahiko Ikeuchi, Shogo Takaya, Natsuki Sugimura, Masashi Izumi, Hiroyuki Wada, Yusuke Okanoue, Jyunpei Dan
The etiology of CPSP after TKA is multifactorial and likely involves both patient- and treatment-related factors [17]. Our study showed that preoperative severe pain was a significant patient-risk factor of CPSP after TKA, which is in accordance with previous studies [13, 18,19]. Furthermore, rest pain was an independent risk factor in patients with well-aligned TKA. Increased knee pain is associated with enhanced temporal summation, an indicator of preoperative central sensitization in knee OA patients [20]. Accumulating evidence suggests that central sensitization is one of risk factors of CPSP after TKA [21,22]. Recent prospective randomized controlled study [23] showed that the use of duloxetine that potentiates the descending inhibitory pain pathways in the central nervous system reduces postoperative pain at 3 months after TKA in patients with preoperatively identified central sensitization. In addition to the suppression of nociceptive pain by nonsteroidal anti-inflammatory drugs or cyclooxygenase-2 inhibitors, the preoperative use of centrally acting analgesics (e.g. duloxetine) may minimize the possibility of CPSP after TKA in patients with central nervous system hyperexcitability.
Validity, reliability, and factor structure of the Istanbul Low Back Pain Disability Index in axial spondyloarthritis
Published in Modern Rheumatology, 2021
Mehmet Tuncay Duruöz, Sevtap Acer Kasman, Nilay Şahin, İlhan Sezer, Hatice Bodur, Ayşegül Ketenci, Sami Hizmetli, Didem Erdem Gürsoy, Ali Nail Demir, Ahmet Kıvanç Menekşeoğlu, Ahmet Karadağ, Hatice Şule Baklacıoğlu
Factors should explain at least 50% of the variance (72.18% for our study) to support construct validity [12]. ILBPDI represented three-factor groups of activity in the current study: Axial bending, sitting/rest, and standing activities. First, axial bending activities are related to the flexibility of the spine. Disability due to the decreased flexibility is one of the major components of the disease [1]. Second, pain due to Ax-SpA differs from mechanical back pain conditions by its characteristics. For instance, rest pain is aggravated by sitting or lying and relieved by activities [1,6]. Therefore, disability in rest or sitting is an expected complaint in these patients. The relations between inflammatory pain and disability have been shown in the literature which supports this result [25]. Third, standing activities in Ax-SpA may cause disability due to the axial load. Consequently, three factor groups found in our study finely reflect the disability-specific dimensions. Assessing multi-dimensions of functional disability in inflammatory back pain is another advantage of ILBPDI.