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CARPAL TUNNEL SYNDROME (DIAGNOSIS AND MANAGEMENT) 腕管综合征(诊断和治疗)
Pub Date : 2021-03-01 DOI: 10.21776/UB.JPHV.2021.002.01.2
Devi Annisa, S. Rianawati, Masruroh Rahayu, N. Raisa, S. Kurniawan
Carpal Tunnel Syndrome (CTS) is a neuropathy disease that affects the median nerve with an incidence of around 90%. Carpal Tunnel Syndrome appears in 3.8% of the general population, with the highest prevalence occurring in women. There are several risk factors associated with CTS, namely medical and non-medical factors. The mechanism of carpal tunnel syndrome until now is still very complex and is not known with certainty, but compression and traction factors in the median nerve are thought to be the most common cause of CTS. Carpal Tunnel Syndrome can manifest clinically with subjective signs such as paresthesia, proprioceptive changes, and paresis, as well as objective signs, such as changes in motor sensitivity and function, positive Tinel and Phallen tests, and thenar muscle atrophy. The diagnosis of Carpal Tunnel Syndrome is based on the classic symptoms of pain, numbness, tingling, and/or burning sensation in the distribution of the median nerve in the hand, as well as the abnormal function of the median nerve based on nerve conduction studies. Conservative therapy is an option. Especially in Carpal Tunnel Syndrome patients with mild to moderate symptoms. Conservative therapy can be given in the form of corticosteroid and physical therapy. Patients with severe CTS or whose symptoms have not improved after four to six months of conservative therapy should be considered for surgical treatment.
腕管综合征(Carpal Tunnel Syndrome, CTS)是一种影响正中神经的神经病变,发病率约为90%。腕管综合征出现在3.8%的普通人群中,女性患病率最高。有几个与CTS相关的危险因素,即医疗和非医疗因素。到目前为止,腕管综合征的发病机制仍然非常复杂,尚不确定,但正中神经的压迫和牵引因素被认为是导致腕管综合征的最常见原因。腕管综合征在临床上可表现为感觉异常、本体感觉改变、轻瘫等主观体征,也可表现为运动敏感性和功能改变、Tinel和Phallen试验阳性、鱼际肌萎缩等客观体征。腕管综合征的诊断是基于手部正中神经分布的疼痛、麻木、刺痛和/或烧灼感的经典症状,以及基于神经传导研究的正中神经功能异常。保守治疗是一种选择。尤其适用于有轻至中度症状的腕管综合征患者。保守治疗可采用皮质类固醇和物理治疗的形式。严重CTS或保守治疗4 ~ 6个月后症状仍未改善的患者应考虑手术治疗。
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引用次数: 0
MENIERE’S DISEASE 梅尼埃病(又名内耳眩晕病)
Pub Date : 2021-03-01 DOI: 10.21776/UB.JPHV.2021.002.01.5
Helena Era Millennie, Badrul Munir, Zamroni Afif, Ria Damayanti, Shahdevi Nandar Kurniawan
Meniere’s disease is a disorder of the inner ear resulting in symptoms of episodic vertigo, tinnitus, hearing loss and aural pressure. Although the exact etiology is uncertain, it is associated with raised pressure in the endolymph of the inner ear (endolymphatic hydrops). The diagnosis of Meniere's disease is based on the clinical setting of the patient. This disease usually presents with unilateral ear symptoms but can be also bilateral. Meniere's disease attacks are usually random and episodic (approximately 6-11 per year), with periods of remission that can last from months to years. Investigations are audiometry, electronystagmogram, vestibular evoked myogenic potentials (VEMPs) and imaging.The management consist pharmacological and non pharmacological. Meniere's disease is initially progressive but fluctuates unexpectedly. It is difficult to distinguish natural resolutions from treatment effects.
梅尼埃氏病是一种内耳疾病,其症状包括间歇性眩晕、耳鸣、听力丧失和耳压。虽然确切的病因尚不清楚,但它与内耳内淋巴压力升高(内淋巴积液)有关。梅尼埃病的诊断是基于患者的临床情况。这种疾病通常表现为单侧耳部症状,但也可以是双侧。梅尼埃氏病的发作通常是随机和偶发的(每年约6-11次),缓解期可持续数月至数年。调查包括听力学、眼震电图、前庭诱发肌源电位(VEMPs)和影像学。治疗分为药物治疗和非药物治疗。梅尼埃氏病最初是进行性的,但病情波动出乎意料。很难区分自然消退和治疗效果。
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引用次数: 1
COMPARATIVE OF INTRAARTICULAR INJECTION BETWEEN DEXTROSE PROLOTHERAPY VERSUS TRIAMCINOLONE ACETONIDE IN KNEE OSTEOARTHRITIS 膝关节骨性关节炎关节内注射葡萄糖前驱治疗与曲安奈德治疗的比较
Pub Date : 2020-09-01 DOI: 10.21776/ub.jphv.2020.001.02.1
W. M. Santoso, Andhy Indriyono, B. Munir, Alidha Nur Rakhman, M. Husna
Knee osteoarthritis (OA) is one of the most common cartilage degenerative disorders that is a major problem because it causes chronic pain and disability. Therefore the method of treatment and prevention of old age is a big challenge. The results of Dextrose Prolotherapy compared to Triamcinolone therapy research are still varied. Objective: to compare the effectiveness of Dextrose Prolotherapy and Triamcinolone Acetonide (TA) in the treatment of moderate knee knee OA.True experimental single blind study, at the Neurology Polyclinic Dr. Saiful Anwar General Hospital Malang for 6 months (July-December 2019). Group I; Dextrose Prolotherapy (15%) intraarticularly injected 3 times every 4 weeks and group II; TA onetime intraarticular injection. The parameters studied were The Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Score, Numeric Rating Scale (NRS), and Range of Motion (ROM), weeks 0, 4, 8, 12 and 24. Forty samples consisted of; the 20 samples of the Dextrose Prolotherapy group consisted of; male: female = 2 (10%): 18 (90%), age 62.4 + 7.28, BMI 25.6 + 3.69 kg / m2, pain duration 22.35 + 20.10 months, history of physiotherapy 40.27 + 20.79 times. Kellgren–Lawrence osteoarthritis severity grade II; 17 (85%), grade III 3 (15%). TA group; male: female = 5 (25%):15 (75%), age 62.5 + 9.02, BMI 28.4 + 5.01 kg/m2, pain duration 15.95 + 16.55 months, history of physiotherapy 34 + 24.87 times. Kellgren – Lawrence osteoarthritis severity grade II; 18 (90%), grade III; 2 (10%). Comparison of NRS at rest Dextrose Prolotherapy vs TA of week 4 (2.60 vs 1.25), week 8 (1.65 vs 1.40), week 12 (0.8 vs 2.05), week 24 (0.75 vs 3.35). Comparison of NRS during activity Dextrose Prolotherapy vs TA week 4 (4.45 vs 3.35), week 8 (3.25 vs 3.55), week 12 (2.55 vs 4.30), week 24 (2.55 vs 5.80). Comparison of ROM flexion Dextrose Prolotherapy vs TA week 4 (127.05° vs 123.60°), week 8 (130.85° vs 122.95°), week 12 (130.85° vs 122.95°), week 24 (131.05° vs 122.10°). Comparison of WOMAC score Dextrose Prolotherapy vs TA week 4 (30.05 vs 22.45), week 8 (22.90 vs 23.95), week 12 (19.30 vs 29.05), week 24 (18.95 vs 35.40). Intraarticular Injection Dextrose Prolotherapy is more effective for the long term based on pain scale NRS, WOMAC score and ROM. Whereas short-term TA is more effective than Dextrose Prolotherapy. Keyword : Osteoarthritis, Dextrose Prolotherapy, Triamcinolone Acetonide
膝骨关节炎(OA)是最常见的软骨退行性疾病之一,是一个主要问题,因为它会导致慢性疼痛和残疾。因此,治疗和预防老年的方法是一个很大的挑战。与曲安奈德治疗相比,葡萄糖前列洛治疗的研究结果仍存在差异。目的:比较葡萄糖prolove与曲安奈德(Triamcinolone Acetonide, TA)治疗中度膝关节炎的疗效。真正的实验性单盲研究,在麻琅的神经病学综合诊所赛弗·安华医生综合医院进行了6个月(2019年7月至12月)。组我;葡萄糖prololotherapy(15%)关节内注射3次,每4周和II组;TA一次性关节内注射。研究的参数是西安大略省和麦克马斯特大学骨关节炎指数(WOMAC)评分、数值评定量表(NRS)和活动范围(ROM),第0、4、8、12和24周。40个样本包括;葡萄糖前驱治疗组20例:男:女= 2(10%):18(90%),年龄62.4 + 7.28,BMI 25.6 + 3.69 kg / m2,疼痛持续时间22.35 + 20.10个月,物理治疗史40.27 + 20.79次。Kellgren-Lawrence骨关节炎严重程度II级;17 (85%), III级3(15%)。助教组;男:女= 5(25%):15(75%),年龄62.5 + 9.02,体重指数28.4 + 5.01 kg/m2,疼痛持续时间15.95 + 16.55个月,物理治疗史34 + 24.87次。Kellgren - Lawrence骨关节炎严重程度II级;18人(90%),三级;2(10%)。葡萄糖前治疗与TA的静息NRS比较:第4周(2.60 vs 1.25)、第8周(1.65 vs 1.40)、第12周(0.8 vs 2.05)、第24周(0.75 vs 3.35)。活动葡萄糖前体治疗与TA第4周(4.45 vs 3.35)、第8周(3.25 vs 3.55)、第12周(2.55 vs 4.30)、第24周(2.55 vs 5.80)期间NRS的比较。ROM屈曲葡萄糖前疗法与TA的比较,第4周(127.05°vs 123.60°),第8周(130.85°vs 122.95°),第12周(130.85°vs 122.95°),第24周(131.05°vs 122.10°)。葡萄糖前治疗与TA治疗的WOMAC评分比较:第4周(30.05 vs 22.45)、第8周(22.90 vs 23.95)、第12周(19.30 vs 29.05)、第24周(18.95 vs 35.40)。基于疼痛量表NRS、WOMAC评分和ROM,关节内注射葡萄糖前驱治疗长期更有效,而短期TA比葡萄糖前驱治疗更有效。关键词:骨关节炎,葡萄糖Prolotherapy,曲安奈德
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引用次数: 0
PARACETAMOL, MIGRAINE, AND MEDICATION OVERUSE HEADACHE (MOH) 扑热息痛、偏头痛和药物滥用性头痛(卫生部)
Pub Date : 2020-09-01 DOI: 10.21776/ub.jphv.2020.001.02.5
H. Hidayati, Anung Kustriyani
Paracetamol is a nonopioid synthesized p-aminophenol derivative that used as an antipyretic and an analgesic. Paracetamol is an over the counter medicine. 15.6% of migraine patients took paracetamol for headache relief. In migraine, paracetamol is used long term. This triggers paracetamol to cause Medication Overuse Headache (MOH). Animal studies associated paracetamol induced MOH based on pathophysiology migrenes. There three mechanism underline MOH include effect to korteks cerebral, effect to system trigeminal nociception, and effect to central modulating systems.
扑热息痛是一种非阿片类合成的对氨基酚衍生物,用作退烧药和镇痛药。扑热息痛是一种非处方药。15.6%的偏头痛患者服用扑热息痛缓解头痛。对于偏头痛,扑热息痛是长期使用的。这会引发扑热息痛,导致药物过度使用头痛(MOH)。基于病理性偏头痛的对乙酰氨基酚诱导MOH的动物研究。MOH的作用机制主要包括对大脑的影响、对三叉神经痛觉系统的影响和对中枢调节系统的影响。
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引用次数: 9
TRIGEMINAL NEURALGIA CAUSED BY ARTERIOVENOUS MALFORMATION OF THE POSTERIOR FOSSA : A CASE REPORT 后窝动静脉畸形所致三叉神经痛1例
Pub Date : 2020-03-01 DOI: 10.21776/ub.jphv.2020.001.01.4
W. M. Santoso, Opik Jamaludin, C. Setianto, N. Raisa
Trigeminal neuralgia (TN) is a sudden, severe, brief, stabbing, and recurrent pain within one or more branches of the trigeminal nerve. Trigeminal neuralgia has a prevalence of 0.1-0.2 per thousand and an incidence ranging from about 4-5/100,000/year up to 20/100,000/year after age 60. A 35 year old woman presented with 1 year history of right facial pain. Physical examination showed hyperalgesia and allodynia in all division of right trigeminal nerve. Magnetic resonance imaging with contrast demonstrated flow void signal in the right cerebellopontine angle. Computed tomography angiography confirmed the diagnosis of AVM (arteriovenous malformation), and demonstrated the malformed niduses were fed by the right posterior inferior cerebellar artery and the right superior cerebellar artery, and drained vein into basal vein of rosenthal, without hemorrhage or aneurysm intranidal appearance. carbamazepin 2x100 mg per oral for 7 days effectively decreased the facial pain significantly (from the numeric rating scale (NRS) score 8 to 5). Open surgical was not prefered for this patient because the AVM was small, unruptured, and located in eloquent area. Radiosurgery is considered if the medication fails. Trigeminal neuralgia with facial pain affecting all devision of nervus trigeminus with pulsatile headache can be suspected symptomatic TN. Radiological examination such as Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) angiography can be performed to detect the cause of TN.
三叉神经痛(TN)是一种发生在三叉神经一个或多个分支内的突然、严重、短暂、刺痛和复发性疼痛。三叉神经痛的患病率为千分之0.1-0.2,60岁后的发病率约为4-5/100,000/年至20/100,000/年。35岁女性,右侧面部疼痛1年。体格检查显示右三叉神经各分支均有痛觉过敏和异常性痛。磁共振造影显示右侧桥小脑角血流空洞信号。ct血管造影证实为动静脉畸形(AVM),显示畸形病灶由右侧小脑后下动脉和右侧小脑上动脉供血,静脉引流至罗森塔尔基底静脉,无出血及动脉瘤样膜内表现。卡马西平2x100 mg /次口服7天,有效地显著减轻面部疼痛(从数字评定量表(NRS)评分8到5分)。由于AVM小,未破裂,且位于雄辩区,因此不建议对该患者进行开放手术。如果药物治疗失败,则考虑放射治疗。三叉神经痛伴面部疼痛累及三叉神经所有分支,并搏动性头痛可怀疑为症状性神经痛,可行磁共振成像(MRI)、计算机断层扫描(CT)血管造影等影像学检查,以确定神经痛的病因。
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引用次数: 0
COMPLEX REGIONAL PAIN SYNDROME (CRPS) DIAGNOSIS : A CASE REPORT 复杂区域性疼痛综合征(crps)诊断1例
Pub Date : 2020-03-01 DOI: 10.21776/ub.jphv.2020.001.01.1
S. Kurniawan, Made Ayu Hariningsih Sunaga, Sri Budi Rianawati, Masruroh Rahayu
Complex regional pain syndrome (CRPS) is a term that describes a variety of chronic pain conditions that are believed to result from dysfunction in the central or peripheral nervous systems. Epidemiological data from 2 major studies show a CRPS incidence between 5.5 and 26.2 cases per 100,000 people per year. A women, 35 years old came to the neurologic policlinic with complain of persistent pain in half left body since a year ago. Pain characteristic was pains and needles sensation, sometimes numbness, tingling that spreaded from left neck until left fingers.we found vasomotor, sensoric and motoric disorder that appropriated with budapest criteria. To diagnose CRPS need to holistic examination and deeper anamnesa to prevent wrong diagnosis. Pain treatment in this patient was not easy. She already has undergone 7 times epidural block and taken medicines nevertheless quality of pain decreased in small number with VAS score 7-8.
复杂局部疼痛综合征(CRPS)是一种描述各种慢性疼痛状况的术语,被认为是由中枢或周围神经系统功能障碍引起的。两项主要研究的流行病学数据显示,CRPS的发病率为每年每10万人5.5至26.2例。女性,35岁,因左半身体持续疼痛一年前来到神经科就诊。疼痛的特点是疼痛和针感,有时麻木,刺痛,从左颈部扩散到左手手指。我们发现血管舒缩、感觉和运动障碍符合布达佩斯标准。诊断CRPS需全面检查,加深记忆,防止误诊。该患者的疼痛治疗并不容易。患者已接受7次硬膜外阻滞和药物治疗,但仍有少数患者疼痛质量下降,VAS评分为7-8分。
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引用次数: 0
MYOFASCIAL PAIN SYNDROME 肌筋膜疼痛综合征
Pub Date : 2020-03-01 DOI: 10.21776/ub.jphv.2020.001.01.5
S. Kurniawan, N. Suriani, Eko Arisetijono Marhaendraputro, Dessika Rahmawati
Pain is a sensory experience that is responded to as an unpleasant stimulus that is often caused by tissue damage. Perdossi defines pain as an unpleasant sensory and emotional experience due to tissue damage, both actual and potential, or which is described in the form of such damage. Pain can affect everyone regardless of sex, age, race, social status, and occupation. Myofascial pain syndrome (MPS) is a term used to describe the condition of acute or chronic pain in musculoskeletal soft tissue. This is indicated by the findings of sensory, motoric, and autonomic symptoms related to myofascial trigger points (MTRP). The symptoms can be local or far from MTRP. In MPS that are far from MTRP, the pain patterns that appear are usually pain is pervasive The most common location for MPS is the neck and back. The purpose of writing this literature review is to explain epidemiology, clinical manifestations, pathogenesis mechanisms, pathophysiology mechanisms, and management in patients with myofascial pain syndrome. Myofascial pain syndrome is a pain syndrome in muscles that includes musculoskeletal abnormalities and MPS management shows that most interventions, both medical therapy and non-medical therapy, still need studies to prove its effectiveness.
疼痛是一种感官体验,通常是由组织损伤引起的不愉快刺激。Perdossi将疼痛定义为由于组织损伤(包括实际的和潜在的)或以这种损伤的形式描述的一种不愉快的感觉和情绪体验。疼痛可以影响每个人,不分性别、年龄、种族、社会地位和职业。肌筋膜疼痛综合征(MPS)是用来描述肌肉骨骼软组织急性或慢性疼痛的一个术语。与肌筋膜触发点(MTRP)相关的感觉、运动和自主神经症状表明了这一点。症状可以是局部的,也可以是远离MTRP的。在远离MTRP的MPS中,出现的疼痛模式通常是普遍的,MPS最常见的部位是颈部和背部。本文就肌筋膜疼痛综合征的流行病学、临床表现、发病机制、病理生理机制及治疗进行综述。肌筋膜疼痛综合征是一种包括肌肉骨骼异常的肌肉疼痛综合征,MPS的管理表明,大多数干预措施,无论是药物治疗还是非药物治疗,仍然需要研究来证明其有效性。
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引用次数: 1
LOW BACK PAIN 腰痛
Pub Date : 1900-01-01 DOI: 10.21776/ub.jphv.2021.002.01.4
Andaru Cahya S, Widodo Mardi Santoso, M. Husna, B. Munir, Shahdevi Nandar Kurniawan
Low back pain is the most common symptom found in the primary health care and is the number one cause of disability throughout worldwide. It is estimated that around 60 – 80% the world population will experience back pain during their lifespan. There are three different source of pain in the spine: axial-lumbosacral, radicular and reffered pain. All of these source brings different clinical presentations. Low back pain could be classified as acute, subacute and chronic low back pain. The pain could be nociceptive or neuropathic, the most common symptoms reported are “pressure pain” and “pain attack”. The physician should be aware of “red flags” symptoms that lead into more serious condition beside back pain and, therefore the patient has to be investigated to further examination whenever these symptoms present. The management of low back pain consist of severe modalities, both therapeutic and rehabilitative procedure. Oftentimes, the management needed multidisciplinary approach. It is important to general practitioners to identify and treat low back pain appropriately to reduce the burden of the disease and to prevent the disabilties caused by this condition.
腰痛是初级卫生保健中最常见的症状,也是全世界致残的头号原因。据估计,大约60 - 80%的世界人口在其一生中会经历背痛。脊柱疼痛有三种不同的来源:轴性腰骶痛、神经根性疼痛和指涉性疼痛。所有这些来源都会带来不同的临床表现。腰痛可分为急性、亚急性和慢性腰痛。疼痛可能是伤害性或神经性的,最常见的症状是“压痛”和“疼痛发作”。医生应该意识到“危险信号”症状会导致更严重的背部疼痛,因此,每当出现这些症状时,必须对患者进行进一步的检查。腰痛的管理包括严重的模式,治疗和康复程序。通常,管理需要多学科的方法。对于全科医生来说,适当地识别和治疗腰痛是很重要的,以减轻疾病的负担,并预防由这种情况引起的残疾。
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引用次数: 1
期刊
JPHV (Journal of Pain, Vertigo and Headache)
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