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Diagnosis of Chronic Fatigue Syndrome
Published in Jay A. Goldstein, Chronic Fatigue Syndromes, 2020
The number of musculoskeletal abnormalities related to fibromyalgia or myofascial pain syndrome is enormous. The physician must know how to elicit them on physical exam, or the patient may be diagnosed as having a somatoform pain disorder or a somatization disorder. The writings of Fishbain et a1.11 attest to the misdiagnosis of myofascial pain syndromes in the chronic pain patient because trigger point tenderness was not appropriately elicited by the examining physician. Other findings on musculoskeletal exam are not different than in the general population. Arthropathies are not common. EMGs are normal, not even suggesting focal muscle spasm or ongoing denervation. Sometimes bilateral leg pain may be due to a sensory neuropathy. Evidence for this hypothesis is that this symptom is often improved by capsaicin cream (Zostrix).
Musculoskeletal
Published in Vincent Helyar, Aidan Shaw, The Final FRCR, 2017
This is a haemolytic anaemia resulting from the presence of abnormal β-globin chains within haemoglobin. Musculoskeletal abnormalities may be due to the effects of chronic anaemia (e.g. marrow proliferation/reconversion, extramedullary haematopoiesis or bone softening/infarction) or infection (up to 70% due to Salmonella).
Cardiac surgery
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Many of these patients are young in chronological age as well as mental capacity with learning disabilities, which can make anaesthetic management difficult, including issues with consent. Appropriate support in the postoperative period, including the help of relatives to facilitate ICU care, is important. Some of these patients have additional problems with mobility and musculoskeletal abnormalities. These need careful preoperative assessment.
Effects of adjustments to wheelchair seat to back support angle on head, neck, and shoulder postures in subjects with cerebral palsy
Published in Assistive Technology, 2021
Afnan M. Alkhateeb, Noha S. Daher, Bonnie J. Forrester, Bradford D. Martin, Hatem M. Jaber
People with CP usually experience trunk and extremity motor impairments, which can lead to difficulties with maintaining the appropriate antigravity postural control (Chung et al., 2008). One of the serious complications of CP is the inability to control sitting posture (Liao et al., 2003). In particular, those with diplegia and quadriplegia spend much of their daily life seated because standing with a small base of support (BOS) requires a higher postural control ability than sitting (Liao et al., 2003). Researchers have reported that appropriate alignment and stability during sitting can enhance functional execution (Liao et al., 2003). For example, proper alignment and stabilization of lower body in children with CP were shown to improve truck posture by decreasing forward and lateral trunk deviations and the visual focus-vertical angle, and thus can help with the writing biomechanics when combined with different writing tools (Cheng et al., 2013). Individuals with CP display various seating issues (Fife, Armstrong, Gregson, & Field, 1991). Those with severe CP are usually unable to sustain an erect sitting posture due to their inability to control the postural muscles of their neck and trunk (Cherng, Lin, Ju, & Ho, 2009). Asymmetrical posture can lead to an increase in musculoskeletal abnormalities in individuals with CP, however precautionary interventions can minimize some of the serious complications (Rodby-Bousquet et al., 2014).
Enzyme replacement combinational therapy: effective treatments for mucopolysaccharidoses
Published in Expert Opinion on Biological Therapy, 2021
Azam Safary, Hakimeh Moghaddas-Sani, Mostafa Akbarzadeh-Khiavi, Alireza Khabbazzi, Mohammad A. Rafi, Yadollah Omidi
Although ERT, as a single treatment modality, relatively improves some of the musculoskeletal abnormalities, it does not prevent the progression of the disease, and further interventions such as surgery are mostly required [136]. It has been revealed that the lysosomal storage of GAGs can stimulate the toll-like receptor 4 (TLR4) inflammatory pathway and activates the production of ceramide, proapoptotic lipids, and inflammatory cytokines such as TNF-α and interleukin-1β in MPS animal models. These factors can activate a series of cell functions, which in turn lead to skeletal abnormalities due to increased apoptosis (e.g., articular chondrocytes), inflammation, and hyperplasia (synovial membranes) [136]. The priming of microglia in the brains of MPS IIIB mice via the HS oligosaccharides accumulation and TLR4 pathway activation has already been reported [137]. Among different cytokines, TNF-α (a downstream factor of the TLR4 pathway) is considered the most important target in the joint tissue of the MPS animal models. Several anti-TNF-α Abs such as infliximab (Remicade®) and adalimumab (Humira®) have been used for the treatment of inflammatory diseases.
Perspectives on the pharmacological management of dystonia
Published in Expert Opinion on Pharmacotherapy, 2021
Marina Svetel, Aleksandra Tomić, Nikola Kresojević, Nataša Dragašević, Vladimir Kostić
Although the treatment should be personalized taking into consideration the individual needs, severity, age, type, symptoms distribution, presence of non-motor symptoms, musculoskeletal abnormalities and acceptable side-effect profile, some rules and recommendation should be followed for the most optimal result [17]. In its mildest form, even untreated, patients could live normally. If severely affected, patients may be disabled due to fixed abnormal postures and consequential deformities [1]. Treatment of dystonia has to be applied in time, before appearance of fixed dystonic contractures and consequent definite musculoskeletal abnormalities. Due to possible side effects of different medications, it is important to be careful especially in the elderly, and to evaluate severity, related symptoms and their quality of life before starting of any kind of treatment.