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Clinical signs and Symptoms:臨床徴候・症状

診断に関する表現(レシピ①)

  1. The diagnosis of recurrent instability was made on the basis of any of the following;
  2. The diagnosis and classification of the shoulders into the traumatic and atraumatic groups was based on a carefully taken history, a physical examination and evaluation of radiography.
  3. The clinical diagnosis included A in 8 patients, B in 27 patients, C in 17 patients, and D in 6 patients.
  4. In ten shoulder, the diagnosis was primary osteoarthritis and in ten, inflammatory arthritis.
  5. Two patients referred with a diagnosis of recurrent posterior dislocation were found to have anterior instability.
  6. Although it is well described in the literature, suprascapular nerve entrapment has been regarded as a relatively unknown condition that is easily overlooked in differential diagnosis of shoulder discomfort.
  7. Carpal tunnel syndrome was diagnosed in 44% of patients in whom surgery was performed to treat cubital tunnel syndrome. Carpal tunnel syndrome was diagnosed in 52% of females and 40% of males.

痛みやしびれに関する表現(レシピ②)

  1. They all had long-standing and progressively increasing pain that was worse at night, was exacerbated by use and activity, and was more intense by movement of the humerus against the scapula.
  2. All patients were initially seen for varying degrees of shoulder pain.
  3. Pain was consistently brought about or aggravated by forward flexion and medial rotation.
  4. Activity often associated with pain was driving a car, or the follow-through phase of throwing.
  5. Two patients complained of the pain during the follow-through phase of the pitching motion, one during the late cocking phase.
  6. This pain was often associated with paresthesia, which never corresponded with the sensory area of a cervical root or a peripheral nerve.
  7. Abduction to 90 °combined with medial rotation was restricted and was consistently painful; sometimes it reproduced the radiation to the upper and forearm.
  8. Pain in the elbow with radiation down the ulnar aspect of the forearm to the hand is particularly common.
  9. Patients typically have elbow pain that radiates distally during active pronation and supination.
  10. Right shoulder pain was intensified by active movement.
    Active movement intensified right shoulder pain.
  11. Most of the stiffness had resolved with a good therapy program,but the patient had persistent pain with her arm at or above shoulder level and with activities of daily living.
  12. The post-injury course was complicated by shoulder pain, weakness, and stiffness.
  13. The main symptom in patients with proven subcoracoid impingement was a dull pain in front of the shoulder.
  14. Physical examination revealed an exquisitely tender coracoid tip.
  15. The only consistent physical examination findings were tenderness on palpation of the posteroinferior glenoid region.
  16. Pain relief could only be achieved when the articular surfaces of both sides were replaced.
  17. All patients had pain in the involved shoulder with overhead athletic activities, and 30 had pain with activities of daily living.
  18. Physical examination may reveal tenderness to palpation over the ulnar collateral ligament complex, most often at the distal insertion, depending on the degree of inflammation at the time of examination.
  19. Six had pain in the elbow in the past but not while playing in the Little League.
  20. Thirty reported increasing pain with overhead activities, and 17 reported clicking sounds.
  21. His pain was relieved with several days' rest, but recurred each time he attempted full flexion or extension of the elbow during his gymnastics practice.
  22. He stated that about 3 weeks ago, when lifting a heavy object, he had felt a sharp pain in the proximal half of the forearm, accompanied by a feeling of "something tearing inside".
  23. Symptoms are exacerbated as the elbow is brought into extension.
  24. All patients had moderate-to-severe pain and functional impairment.
  25. Patients may experience some relief from pain but may develop sensory loss or experience awkwardness during thumb movement.

可動域に関する表現(レシピ③)

  1. Passive total elevation of the shoulder ranged from 10 to 160 degrees, with an average of 90 degrees.
  2. The range of elevation was from 0 degrees to 90 degrees.
  3. Most abduction was achieved by lateral rotation of the scapula, which appeared to be normal in all cases.
  4. The amount of active abduction was associated with the severity of disease of the rotator cuff.
  5. The range of motion postoperatively averaged 174 °of forward elevation and 69°of external rotation with the arm at the side; the internal rotation was to the thumb level of T-8.
  6. No patient had loss of motion in the affected arm compared with the unaffected arm.
  7. All patients were able to flex and adduct their operative thumb to the head of the fifth metacarpal.
  8. MP and IP joint motion average 77% and 97% of the opposite thumb respectively.
  9. Stiffness was more marked in patients who were older at onset of disease and when treatment was delayed by more than 6 months. Total ankylosis occurred only in the group that was operated on.
  10. The elbow was flexed only 25°while the arm was externally rotated 64°, abducted 93°, and horizontally adducted 6°.
  11. A patient with a good result had painless motion of at least 120 degrees of abduction of the shoulder or a loss of no more than 20 degrees of abduction of the shoulder or a loss of no more than 20 degrees of flexion and extension of the elbow.
  12. All patients had decreased elbow flexion and extension with preserved pronation and supination.
  13. The average range of active forward elevation in all of the shoulders improved from 71 to 100 degrees, and both external and internal rotation improved as well.
  14. For the entire study group, abduction in the plane of the scapula increased an average of 75 degrees, from a preoperative average of 33 degrees to a postoperative average of 108 degrees.
  15. On the average, sectioning of the interval capsule increased the range of flexion by a mean of 6 degrees, extension by 7 degrees, external rotation in the neutral position by 6 degrees.

不安定性(感)に関する表現(レシピ④)

  1. Examination of every patient under anesthesia demonstrated anterior instability of the shoulder with the ability to subluxate the humeral head over the anterior part of the glenoid rim.
  2. The patients complained of instability to actively elevate or externally rotate the shoulder.
  3. Recurrent instability occurred from a minimum of ten times to a maximum of one hundred times before operation.
  4. In physical examination, patients with labral tears often demonstrate objective instability with or without clicking during glenohumeral rotation.
  5. Despite immobilization, supervised rehabilitation, and a gradual return to full activity, recurrence rates remain high in young patients.
  6. Pain but not apprehension during this maneuver, which is relieved by the relocation test, suggests mild anterior instability.
  7. There was no excessive laxity or instability on stress testing when compared with the uninjured thumb.

ADL,スポーツ活動,就労に関する表現(レシヒ⑤)

  1. Despite this disappointing range of movement, all 14 patients were independent for eating and toilet hygiene.
  2. All but one patient noted substantial improvement in function.
  3. After surgery, four patients had minimal disability due to fatigue, but they were improved from their preinjury status.
  4. The patient is usually back at office work or school in two weeks.
  5. Six patients experienced shoulder fatigue at work and four patients had difficulty with sports activities.
  6. In all shoulders the symptoms, signs and operative findings were alike, irrespective of the cause of impingement.
  7. They were disabled in activities of daily living, often precluding laboring occupational and athletic activities.
  8. A high-performance thrower with a large lesion, however, carries a poor prognosis for a full return to activity.
  9. Four patients had difficulty with sports activities because of weakness and fatigue.
  10. However, 4 of these patients had a 10% or more decrease in intensity during highest activity level.
  11. Although 82% of athletes returned to their primary sports, only 48% thought their performance equaled their preinjury status.
  12. Although the resulting instability may not impair the activities of daily living, it may preclude participation in throwing sports.

骨折・変形などに関する表現(レシピ⑥)

  1. The patients presented with extreme groin pain upon any active hip motion, and the left lower limb was found to be shortened and there was a large amount of swelling in the thigh.
  2. The fracture was replated and grafted, and union took place in four months.
  3. In the one case of non-union, the plate fractured 18 months after injury.
  4. The 3 patients under 65 years of age all had union of the fracture and good functional result, with Constant scores of 90, 86, and 82, respectively.
  5. Union is considered to be achieved when bridging callus is seen and patients can use their arms freely with no pain.
  6. Union occurred when a s.olid bar of periosteal callus crossed the site of fracture and no motion or pain occurred on palpation or manipulation of the arm.
  7. Fracture fragment displacement ranged from 0 to 3mm (average, 1mm) and rotation ranged from 15°to 90°(average,47°).
  8. Ten patients had varus deformity with flexion contracture and shortening, whereas 13 knees were without deformity.
  9. The bone injury occurred from the palmar aspect of the proximal phalanx in all cases.

感染に関する表現(レシヒ⑦)

  1. The infection, treated with antibiotics, resolved with no persisting osteomyelitis, and the plate was removed later.
  2. Culture of the drainage and a blood culture were positive for Staphylococcus aureus.
  3. Continuous suction irrigation was used for ten days.
  4. Patients with septic arthritis (true and presumed: forty-seven hips) differed significantly from patients with transient synovitis (118 hips) with regard to the erythrocyte sedimentation rate, differential of serum white blood-cell count, total white blood-cell count, gender, previous healthcare visits, and history of fever.