Case Studies

In the present study, a case of a 28-year-old sub-Saharan female is presented with insidious onset of painful burning sensations on the upper trunk, symmetrical numbness and tingling sensation on the hands and feet, progressing over a 5 year period. These symptoms began as intermittent burning sensations on the scapulae and pectoral regions of the upper trunk, which progressed to numbness and paraesthesia of the upper and lower limbs respectively. These were associated with mild weakness of the hands and feet, insomnia, irritability and constipation. There were no urinary symptoms, paralysis, gait disturbances, tremors, jaundice, limb swelling, changes in skin colour, or delusion.

20min read    

A 62-year-old African American male had a long-standing history of chronic joint damage and tophi deposition in his hands. He complained of slowly progressive blurred vision in both eyes and metamorphopsia in the left eye.

 

These symptoms are associated with which of the following disease?

a) Gout

b) Conjunctivitis

c) Anterior uveitis

14min read    

A 31-year-old female patient reported severe pain in the left forearm, right hand, right knee, right hip, and lower back following a fall sustained three days before presentation. The patient had a history of end-stage renal disease (ESRD) and received maintenance hemodialysis. Medical records revealed that she had poor compliance with her diet, medications, and dialysis treatments. Laboratory values were significant for marked elevation in serum parathyroid hormone level (1735 pg/mL), as well as hyperphosphatemia and normal serum calcium levels.

These symptoms are most consistent with which of the following disease?

a) Renal failure
b) Hyperparathyroidism
c) Brown tumour

22min read    

A 41-year-old Albanian man was admitted to the emergency department following a pedestrian-vehicle accident five days earlier. He had severe upper thoracic pain, chest deformity, dyspnea, tachycardia, subcutaneous emphysema, and hematoma. Hypoventilated lung fields and minor pleural effusion was detected in the chest radiography. As per the computed tomographic scans, there were displaced fractures of right lateral ribs 5 –11, hyperdensity regions from bone fragments, and pulmonary contusion. The treatment comprised of surgical fixation of ribs 7–10 using titanium reconstruction plates and cortical locking screws. The patient’s clinical condition improved postoperatively. After six weeks follow-up, a full return to preoperative daily activities and high quality of life was confirmed.

What will be most helpful in the treatment of multiple rib fractures?

  • Small notch titanium reconstruction plates
  • Precontoured locking plates of the MatrixRIB™ Fixation System (DePuy Synthes)
29min read    

A 79-year-old Caucasian retired physician presented to the clinic with a severe complaint of bilateral hip pain that had been persisting since last 2 years with unbearable episodes of pain over the previous three months. His pain was dull and achy, and started anteriorly in both the hips with occasional radiation to the groin. The pain ratings at its most severe point were 7 and 5 on a ten-point scale in the left and the right hip, respectively. The pain was most severe in the morning, when the patient woke up and in the evening after completion of all day to day activities. Acetaminophen 650mg bid as well as tid was no longer effective in relieving his pain. However, Ibuprofen 400 mg tid did show some improvement. The patient was unwilling to begin NSAIDs because of the fear of having gastrointestinal (GI) adverse events. Tramadol, hydrocodone, and oxycodone in the past lead to troublesome lightheadedness.

What will most likely explain the symptoms reported by the patient in this case?

  • Bilateral Hip Osteoarthritis
  • Spinal Stenosis
  • Greater Trochanteric Bursitis
  • Osteonecrosis

23min read