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The pain is mechanical in nature generic 2 mg artane with visa, accentuated by knee extension and localized to the posterolateral portion of the popliteal fossa cheap artane 2 mg online. On clinical examination direct compression over the lateral head of the gastrocnemius tendon at its site of insertion onto the lateral condyle will exquisitely reproduce the 105 Pain syndromes of adolescence symptoms. The syndrome is associated with an ossified sesamoid bone in the majority of cases, although it can occur in association with a cartilaginous fragment or even in association with a thickened tendon. The source of the pain remains obscure, although it may evolve from a localized synovitis much like in the patellofemoral compression pain syndrome. Simple conservative methods combined with temporary restriction of activities and occasional corticosteroid injections have produced satisfactory results in roughly half of the cases. Recalcitrant cases with intermittent recurring pain and inability to perform leisure time activities have led to surgical removal of a (b) portion of the lateral gastrocnemius tendon and sesamoid, if present. The results of surgery, although uncommonly required, have been successful in well over 90 percent of cases. Failure to obtain initial pain relief within a six- to eight-week period should prompt appropriate orthopedic referral. It is basically a disorder in which a segment of articular cartilage and subchondral bone becomes at least radiographically separated from the surrounding bone and cartilage. The osteochondritis dissecans fragment may remain totally in continuity with the adjacent bone and cartilage from which it arises, may be partially separated, or may become a completely loose fragment. The etiology of osteochondritis dissecans is unknown, although several theories have been proposed. A hereditary background is noted in many cases, and it is uncommon to have more than one location within the appendicular skeleton. Trauma has been routinely implicated, and probably is etiologic in a number of cases. Localized ischemia to the area has been theorized, but has not been Adolescence and puberty 106 supported by appropriate histopathologic studies. In some cases avascular necrosis of the subchondral bone in the fragment is noted, and in others the bone is perfectly normal.
An RCT of an audiotaped relaxation intervention in patients undergoing total knee or hip replacement revealed similar negative results purchase artane 2 mg, producing no decrease in re- ported pain or analgesic requirements compared to patients getting surgi- cal education information (Daltroy discount artane 2mg visa, Morlino, Eaton, Poss, & Liang, 1998). The authors of this latter study noted problems in being able to provide pa- tients with the relaxation instructions sufficiently in advance of surgery to allow practice of the skills: Only 65% of patients reported practicing the technique at least once prior to surgery (Daltroy et al. This level of noncompliance may be a common occurrence in surgical situations in which minimally supervised audiotaped interventions are used. Results of several RCTs in various other surgical settings do provide some support for use of adjunctive psychological interventions for acute pain. For example, a large-scale RCT (n = 500) comparing audiotaped relax- ation (jaw relaxation and controlled breathing), music, and combined relax- ation/music to a no-intervention control among patients undergoing major abdominal surgery reported positive results (Good et al. Patients in all three treatment groups reported lower pain intensity and distress than controls across both postsurgical days examined (Good et al. In an- other large-scale study (n = 241), patients undergoing percutaneous vascu- lar and renal surgical procedures who received a combined intervention including relaxing imagery, muscle relaxation, and positive coping self- statements reported significantly less pain and used significantly less anal- gesic medication than did standard care controls (Lang et al. PSYCHOLOGICAL INTERVENTIONS FOR ACUTE PAIN 257 tervention in the Lang et al. It may be of clinical rele- vance that both interventions significantly reduced pain despite differing substantially in the amount of staff time required. In contrast to the numerous studies of relaxation-related and cognitive interventions in the surgical context, information provision interventions have received fewer controlled tests with regard to postsurgical pain out- comes. However, similar results have been reported in two such RCTs (Doering et al. An information provision intervention- (sensory and procedural) delivered in person to patients undergoing gyne- cological laparoscopic surgery did not reduce pain levels postsurgically compared to no-intervention controls (Reading, 1982).
