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Case 15
Published in Edward Schwarz, Tomos Richards, Cases of a Hollywood Doctor, 2019
Edward Schwarz, Tomos Richards
Pain relief is the mainstay of treatment together with early mobilization. Early mobilization can only be achieved if there is adequate pain relief and so an aggressive regime should be adopted. Back pain is a leading cause of time off work in the UK and costs the country millions of pounds. It is important to warn patients that they may be debilitated for some time. Pain management should follow an increasing strength stepwise approach but would start with an NSAID, tramadol (or codeine) and a short course of diazepam if the pain is really bad to help relieve muscle spasms. (Note: there is some recent evidence that finds no overall benefit with paracetamol for back pain.) Neuropathic agents such as amitriptyline or gabapentin could be considered if there is sciatica or nerve root pain.
Central nervous system
Published in Brian J Pollard, Gareth Kitchen, Handbook of Clinical Anaesthesia, 2017
Muscle spasms, rigidity and autonomic disturbance occur. Masseter and facial muscle spasm give rise to the characteristic ‘lockjaw’ and ‘risus sadonicus’. Limb spasms may be severe enough to fracture bones and avulse tendons. Spasm of the laryngeal/pharyngeal muscles can occlude the airway while spasm and rigidity of the chest wall may result in respiratory failure. Spasms may occur spontaneously or in response to the slightest of visual, auditory or touch stimulation. Autonomic dysfunction is common. Resting tachycardia and hypertension are frequent but during autonomic storms can rapidly convert to severe hypotension and bradycardia.
Neuromuscular disorders
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Painful muscle spasms occur in some patients and, if so, they tend to worsen with time. As with the other hereditary peripheral neuropathies, the more common orthopaedic complaints are a progressive cavo-varus foot deformity that is usually rigid, the development of clawed toes and a scoliosis. In general, the earlier the onset of the disease the greater is the risk of significant curve progression. In the more severe cases, functional and neurological deterioration may be rapid with the development of a cardiomyopathy and death in early to mid adulthood. Despite the potentially poor prognosis, surgical correction of foot and spine deformities is worthwhile.
Black widow spider bite in Johannesburg
Published in Southern African Journal of Infectious Diseases, 2018
Teressa Sumy Thomas, Alan Kemp, Kim Pieton Roberg
Following the bite, he experienced the typical features of latrodectism. Symptoms included intense muscle pain and rigidity over the bite site, which radiated to his trunk, arms and neck. On examination he had a mild tachycardia. Muscle spasm was evident. He was flushed, sweaty and anxious (Figure 3). Inspection revealed an erythematous area on the right lower quadrant of his abdomen, which was thought to be the bite mark (see Figure 3). His blood pressure, temperature and neurological state remained stable throughout his admission. Blood investigations revealed a mild leucocytosis of 13.61 x109 cells/l and a creatine kinase of 1171 U/l. The remainder of the full blood count, urea and electrolytes, calcium, magnesium, phosphate, C-reactive protein and liver function tests were all normal. A toxicology screen for over-the-counter medication (paracetamol, barbiturates, salicylates and benzodiazepines), cerebrospinal fluid examination and blood cultures were all negative.
Work-related musculoskeletal disorders among workers in an MDF furniture factory in eastern Thailand
Published in International Journal of Occupational Safety and Ergonomics, 2018
Anamai Thetkathuek, Parvena Meepradit
In order to minimize bending, the working posture should be adjusted according to the height of the front of the workstation. Stretching the muscles during breaks is encouraged to reduce extended muscle spasms. As well as administrative controls, such as worker rotation, greater task variety and increased rest should be provided for workers so as to reduce the risk factors for the development of MSDs. The results of this study show that the surfaces of working areas were too hard, and therefore floor standing areas should be improved by providing better footwear or anti-fatigue mats, which corresponds to the results from Gell et al. [38] showing a relationship between fatigue in the lower part of the body and the use of shoes and reducing the amount of standing required while working. The study by Gell et al. [38] suggests that standing on a carpet can reduce such fatigue.
Antispasmodic medications may be associated with reduced recovery during inpatient rehabilitation after traumatic spinal cord injury
Published in The Journal of Spinal Cord Medicine, 2018
Eric R. Theriault, Vincent Huang, Gale Whiteneck, Marcel P. Dijkers, Noam Y. Harel
Spasticity represents one symptom of the upper motor neuron syndrome, characterized by exaggerated tendon stretch reflexes and involuntary muscle spasms.1 Spasticity affects roughly two thirds of individuals with spinal cord injury (SCI).2,3 However, only a minority of those individuals report that spasticity significantly decreases quality of life, most often via painful spasms and decreased mobility.1,3–7 Qualitative evidence suggests that clinicians may at times prescribe medications for signs of spasticity without sufficient regard to patient complaints of detrimental symptoms of spasticity.8 Whether this potentially unnecessary administration of antispasmodics affects outcomes in acute SCI is unknown.