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Chronic Pain: What Is It?
Published in Michael S. Margoles, Richard Weiner, Chronic PAIN, 2019
A 5- or 10-minute examination of a chronic pain patient with intractable pain will never suffice. I have been saddened to see some doctors report findings to be normal when my examination of the same patient showed grossly abnormal findings. This relates to deep tendon reflex testing, pinprick sensation testing, and more. In general, I find that some doctors may not know how to interpret abnormal findings in the muscles, especially in patients with myofascial pain syndrome.
Focal neurological deficit
Published in Sherif Gonem, Ian Pavord, Diagnosis in Acute Medicine, 2017
– Reflexes are sluggish or absent with lower motor neuron lesions and brisk with upper motor neuron lesions, except immediately after spinal cord injury. Each tendon reflex tests the function of a particular peripheral nerve and spinal cord level, as follows:
Diagnosis in orthopaedics
Published in Ashley W. Blom, David Warwick, Michael R. Whitehouse, Apley and Solomon’s System of Orthopaedics and Trauma, 2017
Louis Solomon, Charles Wakeley
A deep tendon reflex is elicited by rapidly stretching the tendon near its insertion. A sharp tap with the tendon hammer does this well; but all too often this is performed with a flourish and with such force that the finer gradations of response are missed. It is better to employ a series of taps, starting with the most forceful and reducing the force with each successive tap until there is no response. Comparing the two sides in this way, we can pick up fine differences showing that a reflex is ‘diminished’ rather than ‘absent’. In the upper limb we test biceps, triceps and brachioradialis; and in the lower limb the patellar and Achilles tendons.
Significance of the neurological level of injury as a prognostic predictor for motor complete cervical spinal cord injury patients
Published in The Journal of Spinal Cord Medicine, 2023
Osamu Kawano, Takeshi Maeda, Hiroaki Sakai, Muneaki Masuda, Yuichiro Morishita, Tetsuo Hayashi, Kensuke Kubota, Kazu Kobayakawa, Kazuya Yokota, Hironari Kaneyama
It is difficult to assess the recovery potential in individual patient with complete CSCI in the acute phase. With respect to the prognostic predictors of SCI, while there have been reports indicating the possibility of recovery based on the AIS in the acute phase as a percentage of the whole2,3,7,11–13,15,17 or the prediction of recovery using finding from MRI18,19 and other imaging modalities, there are few reports concerning predictors indicating whether or not an individual patient will be able to recover. Aarabi et al. reported that intramedullary lesion length on MRI is a strong predictor of AIS conversion.27 Because they used postoperative MRI to predict prognosis, the results may not reflect the true prognosis of SCI. Morishita et al. reported that motor recovery could be expected in a very high percentage of patients with patellar tendon reflex (PTR) within 72 h of injury.20 In addition, they emphasized that, as all physicians should be familiar with the PTR, this seems to be a simple and extremely useful sign for predicting improvement of motor paralysis during the acute stage of CSCI.
Acute parkinsonism in patients with systemic lupus erythematosus: a case report and review of the literature
Published in International Journal of Neuroscience, 2022
Chayasak Wantaneeyawong, Nuntana Kasitanon, Kullanit Kumchana, Worawit Louthrenoo
The main clinical features of parkinsonism, including masked face, resting tremor, rigidity, bradykinesia or akinesia, postural instability and gait difficulty were reported in 13, 20, 25, 22, 10 and 18 patients, respectively. Asymmetrical involvement was noted in 10 patients. Alteration of consciousness, cognitive dysfunction, headache, abnormal speech and dystonia were noted in 14, 7, 6, 14 and 3 patients, respectively. Mutism was noted in six patients, of which all were juvenile SLE. Emotional disturbance (restlessness, agitation, anxiety, depression and self-injury) and focal neurological deficits (ptosis, diplopia, hemiparesis and facial weakness) have been mentioned occasionally. Brisk deep tendon reflex and positive extensor plantar response (Babinski’s sign) were noted in 8 of 14 and 7 of 12 patients, respectively (Supplementary Table 2).
Spinal brucellosis with large circumscribed paraspinal and epidural abscess formation: a case report
Published in British Journal of Neurosurgery, 2021
Majid Reza Farrokhi, Seyed Reza Mousavi
A 21-year-old female referred to our clinic in Shiraz, Iran, complaining of a 1-year history of severe LBP and limitation in all back movements. She was emaciated and had intermittent episodes of chills and fever, 6 kg weight loss over the course of 6 months, general skeletal pain and fatigue. She and her husband were living at her father’s farm and she was involved with stock-breeding. She had a history of consuming unpasteurized homemade dairy products. On examination, she had no neurological deficits, but there was marked tenderness in her back. She had no history of hepatitis, hypertension, diabetes mellitus or tuberculosis. Her family also had no history of infectious diseases. Examination found moderate tenderness of the L4–5 area and bilateral paraspinal muscle spasm. There was decreased sensation in the left leg. Motor power and deep tendon reflex examination were normal.