Orthopedic testing was positive for low back pain with Kemp’s on the left. Tenderness to palpation was found over the plantar aspect and along the lateral aspect of the calcaneus, as well as over the soleus, gastrocnemius, gluteus medius, and iliolumbar ligament on the left. There was no evidence of navicular drift. His navicular drop test measured 5 mm on the right and 7 mm on the left. Taking Co-Q 10 will lessen the MSK side effects.Įxamination revealed no nerve-root compression or traction signs, as DTRs, sensation and motor strength tests of the upper and lower extremity were WNL. Have patients taking statins discuss a two- to four-week trial of abstinence with their PCP to determine if their MSK pain is related to a statin side effect. Therefore, it must always be considered a potential causative agent when patients present with MSK pain. Medications include losartan for hypertension, Lipitor for cholesterol management and a prescription B-complex.Ĭlinical Tip: The side effects of statins include musculoskeletal manifestations including tendinopathy of the rotator cuff and hand (trigger finger). For work, he wears dress loafers with a thin rubber sole. In addition, he walks 20 minutes from the train station to his office every day. He walks for exercise on the treadmill 2x/week at a brisk pace, with hand weights and 5 degrees elevation. He felt that his shoes “pinch” and are not fitting correctly anymore. It began insidiously, was worse upon awakening in the morning and loosened up during the day. Sam is a 60-year-old male standing 6’1” and weighing 195 lbs, who presented with pain on the bottom of his left foot and heel that had been persistent for 4-5 weeks. Let’s look at an interesting case of heel pain and how it responded to a multimodal approach to care. Thus, the radiographic Resnick and Niwayama DISH criteria cannot be directly adapted to CT.ĬT Computed tomography DISH classification criteria degenerative changes disc height spine.Heel pain, worse in the morning when arising, after sitting a long time, and often loosens up after walking a bit – sounds like plantar fasciitis, right? Maybe. Conclusion The presence of degenerative intervertebral changes on thoracic CT should not deter from diagnosing DISH. Costovertebral degenerative changes were more prevalent in DISH patients ( P < 0.05) and, except for vacuum phenomenon (more prevalent in controls), other DID changes were as prevalent in DISH as in controls. Average intervertebral disc height was significantly lower in the DISH group compared with both control groups (DISH/Control 1/Control 2 = 4.55/5.13/5.01 mm, P < 0.001). Results A total of 158 participants (DISH/Control 1/Control 2 = 54/54/50 106 men, 52 women average age = 70.6 years) were evaluated. Parameters were compared with two age- and gender-matched control groups of individuals whose entire spine CT lacked evidence of DISH (Control 1 individuals < 2 flowing osteophytes, Control 2 individuals < 4 and ≥ 2 flowing osteophytes). Parameters evaluated were disc space height, disc protrusion, subchondral cysts/sclerosis, Schmorl nodes, vacuum phenomenon, and posterior elements including costovertebral and facet joints. Material and Methods Intervertebral space (D1-L1) on chest CT examinations of DISH patients was retrospectively evaluated for the presence of DID. Purpose To assess for the presence and prevalence of such changes on CT examinations of the thoracic spine of individuals with DISH. However, although DID was previously described in DISH, no systematic computed tomography (CT) analysis has been reported so far. Background Degenerative intervertebral disease (DID) is an exclusion criterion in the Resnick and Niwayama radiographic classification for diffuse idiopathic skeletal hyperostosis (DISH).
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