RESUMEN
Botulinum injection is a well-known non-surgical intervention utilized in the management of myofascial pain syndrome (MPS). However, sparse evidence exists regarding the utility of ultrasound guidance of injectate or lidocaine as a predictive marker of patient response to botulinum toxin A (BTX-A). A 39-year-old male active duty service member demonstrated typical signs and symptoms of MPS. He reported a 10-year history of neck and back spasms that were triggered by exertion but also could occur spontaneously. Based on the characteristic regional motor-sensory defects, treatment options were discussed. With shared decision-making, the patient opted to try ultrasound-guided injection of lidocaine followed by xenomin brand BotoxA. Immediately following lidocaine injection, the patient reported complete relief of symptoms. Both injections were uncomplicated, and the patient reported great reduction in symptoms during the subsequent visit 2 months later. Relief of pain following ultrasound-guided injection of lidocaine may serve as an indicator of successful patient response to BTX-A in patients with MPS.
RESUMEN
Pyogenic flexor tenosynovitis (PFT) is an orthopedic emergency that necessitates prompt diagnosis and treatment. Unfortunately, the diagnosis is largely clinically based on Kanavel's four cardinal signs with all four symptoms being present approximately 22% to 56% of the time. Evidence suggests that PFT diagnosed within 48 h of onset does not need surgical intervention. Ultrasonography can be used to aid in the diagnosis of PFT. It has a sensitivity of 94.4% and a negative predictive value of 96.7%. This illustrative case report demonstrates ultrasound's utility to not only aid in diagnosis but also serve as a tool for monitoring patient response.
Asunto(s)
Mano/diagnóstico por imagen , Tenosinovitis/diagnóstico por imagen , Ultrasonografía , Adulto , Antibacterianos/uso terapéutico , Antiinflamatorios no Esteroideos/uso terapéutico , Cefalexina/uso terapéutico , Diagnóstico Diferencial , Humanos , Masculino , Personal Militar , Naproxeno/uso terapéutico , Tenosinovitis/tratamiento farmacológicoAsunto(s)
Gota/diagnóstico por imagen , Ultrasonografía , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Chronic exertional compartment syndrome (CECS) is a debilitating condition that is not uncommon in athletes and military service members. The only curative treatment for this condition, surgical fascial release, was first described in 1956. In the ensuing 62 years, this has remained the standard therapy despite symptom recurrence in 45% of military service members who underwent surgery. In 2013, a case series introduced intracompartmental injections of botulinum toxin A as a non-surgical treatment option for CECS, which proved effective in 15 out of 16 patients. In this case report, we present the case of a U.S. military service member treated with BoNT-A for bilateral lower leg CECS. This patient remains pain free at 11 months after initial treatment. This case, coupled with previously published cases series, demonstrates the potential of this novel treatment as a long-term, non-surgical alternative for CECS in the U.S. military population.
Asunto(s)
Toxinas Botulínicas Tipo A/uso terapéutico , Síndromes Compartimentales/tratamiento farmacológico , Personal Militar/estadística & datos numéricos , Toxinas Botulínicas Tipo A/farmacología , Síndromes Compartimentales/epidemiología , Síndromes Compartimentales/fisiopatología , Humanos , Masculino , Neurotoxinas/farmacología , Neurotoxinas/uso terapéutico , Esfuerzo Físico/fisiología , Estados Unidos/epidemiología , Adulto JovenRESUMEN
A thorough history and physical examination, revisited on subsequent follow-up, was necessary to properly diagnose pain emanating from both the shoulder and upper arm.
RESUMEN
Thousands of military members self-medicate with dietary supplements containing unknown quantities of pharmacologically active compounds. These poorly regulated substances can cause real harm to the military population, especially when they contain stimulants such as caffeine. When taken regularly, caffeine has several performance-enhancing benefits. However, when used excessively or in vulnerable populations, caffeine can cause several unwanted side effects such as nervousness, sensory disturbances, insomnia, arrhythmia, excitability, inattentiveness, restlessness, mood changes, gastrointestinal disturbances, and even psychosis. Vulnerable patients include the caffeine-naïve, physiologically stressed, young, and mentally ill patients. One such case describes a caffeine-naïve service member who suffered an adverse reaction after taking an allegedly moderate dose of caffeine from a pill he obtained from a teammate. This case highlights the importance of supplement awareness among service members, increased provider vigilance, third party verification, and enhanced regulation on the approval and marketing of dietary supplements.