[Show abstract][Hide abstract] ABSTRACT: The contents of this review may appear odd. After a brief description of the coxofemoral joint, the entities discussed include ilioinguinal neuropathy within the context of the nerves that may be damaged during lower abdominal surgery, meralgia paresthetica, piriformis syndrome with the appropriate caveats, trochanteric syndrome, "ischial bursitis" and trochanteric syndrome caused by ischemia. These cases were chosen to stress our belief that rheumatologists are first and foremost internists. We further believe that being current in other pathologies such as peripheral neuropathies and certain vascular syndromes sooner or later benefits our patients.
[Show abstract][Hide abstract] ABSTRACT: Greater trochanteric pain syndrome (GTPS) is a common cause of extra-articular lateral hip pain. The underlying etiology of GTPS ranges from gluteus medius and minimus tendinopathy or tears, to external coxa saltans or iliotibial band syndrome. Historically, this source of lateral hip pain was typically diagnosed as trochanteric bursitis as it was believed to be due to inflammation of the subgluteus maximus bursa. However, recent imaging and histopathological studies have shown that most cases are instead due to underlying gluteus medius or minimus tendon disorders. Identifying the specific pain generator in GTPS is important as the treatment differs depending on the cause. Strengthening should be prescribed in cases of gluteal tendinopathy; corticosteroid injections and NSAIDs may be helpful in cases of primary bursitis; and surgery may be indicated in functionally limiting gluteal tendon tears unresponsive to conservative treatment.
[Show abstract][Hide abstract] ABSTRACT: The aim of this study was to compare the efficacy of four analgesia techniques on postoperative pain after per-trochanteric femur fracture. A retrospective cohort study was conducted on 131 consecutive patients older than 75 years enrolled in an 18-month period and who underwent per-trochanteric fracture repair under spinal analgesia. Patients received postoperative analgesia from: G1 (n = 36), intravenous analgesia on demand only; G2 (n = 28) administration of acetaminophen at fixed hours; G3 (n = 50) continuous morphine infusion; G4 (n = 17), preoperative echo-graphic guided femoral nerve block. Continuous opioid infusion failed to prevent the onset of pain at the end of the effects of subarachnoid anesthesia (rescue dose of analgesic in 48 % of patients in G3 vs. 22 % in G2 in the first day; p < 0.05). The greater effectiveness was achieved by preventing the onset of pain with drugs administered at time intervals (rescue dose of analgesic in 48 % of patients in G3, 58 % in G1 and 48 % in G4 vs. 22 % in G2 in the first day and rescue dose of analgesic in 32 % of patients in G3, 67 % in G1 and 76 % in G4 vs. 18 % in G2 in the second day; p < 0.05). Our study does not confirm the effectiveness of a single shot femoral nerve block on postoperative pain in per-trochanteric femur fracture (PAIN VAS score > 3 at t1 in 23 % of patients in G1 and 19 % in G4 vs. 10 % in G2 and G3; p < 0.05).
Aging - Clinical and Experimental Research 09/2014; 27(3). DOI:10.1007/s40520-014-0272-5 · 1.22 Impact Factor
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