Pathological Conditions, Signs and Symptoms Commons^™

Piriformis Syndrome With A Variant Presentation, Roberto Chuapoco, Ryan E. Linford

Annual Research Symposium

Piriformis syndrome has long been a diagnostic quandary due to its tendency to present as other nerve-related conditions. Piriformis syndrome is commonly caused by entrapment of the sciatic nerve as it travels through the greater sciatic foramen due to hypertrophy of the piriformis muscle. However, its constellation of symptoms, including radiating pain down the thigh, can easily be mistaken for lumbosacral radiculopathy. This case report aims to address the misdiagnosis of piriformis syndrome which has prolonged pain for many patients and increased the cost of medical care. It demonstrates a 76-year-old female with a confounding presentation of piriformis syndrome: buttock …

Diagnosing Acute Compartment Syndrome: A Surgical Emergency, Kallin J. Austin, Lara Laughrey, Marco Trevino, Eric Liou, Matthew Hazel, Brody Harn

Annual Research Symposium

Determine best practices for diagnosing acute compartment syndrome in the lower limb by comparing the sensitivity and specificity of commonly use techniques.

A Suspected Case Of Levetiracetam Induced Rhabdomyolysis, Luke Merrill Ms, Layne Hohn Ms, Marlee Jones Ms, Sydney Gibson Ms, Ty Moody Md, Anthony Breemo Md

Aesculapius Journal (Health Sciences & Medicine)

Background: Levetiracetam is a broad-spectrum antiseizure drug which works to terminate convulsions and is used in the treatment of certain types of seizures. It is commonly used to treat epilepsy in adults, and has proven an effective treatment for adults with focal seizures. This drug is normally well tolerated, but commonly reported adverse effects include fatigue, somnolence, and dizziness. A few less common effects have been noted as well, including behavioral disturbances, thrombocytopenia, and—in very few cases—rhabdomyolysis.

Case Report: Our case reports a 55-year-old male who presented to a rural emergency department for active convulsing and unresponsiveness. Initial …

Prevalence And Clinical Characteristics Of Temporomandibular Disorders In Adults: An Epidemiological Study In The Mediterranean Region Of Türkiye, Esra Yavuz, Selmi Yardimci, Humeyra Tercanli

Journal of Dentistry Indonesia

The prevalence and clinical characteristics of temporomandibular disorders (TMD) in the Mediterranean region of Türkiye have not yet been thoroughly investigated. Objective: This study aimed to determine the prevalence and severity of TMD in a sample of the population in this region and to characterize the clinical findings related to TMD. Methods: Four hundred and one participants were included in this study. “Presence of TMD” in the participants was evaluated using the Fonseca Anamnestic Index. Through clinical examination, the findings in the participants were classified as limited mouth opening, deviation, temporomandibular joint (TMJ) sounds, TMJ pain, and muscle …

Minoxidil Weakens Newly Synthesized Collagen In Fibrotic Synoviocytes From Osteoarthritis Patients, Stefan Sarkovich, Peter P. Issa, Andrew Longanecker, Davis Martin, Kaitlyn Redondo, Patrick Mcternan, Jennifer Simkin, Luis Marrero

School of Medicine Faculty Publications

Purpose: Synovial fibrosis (SFb) formation and turnover attributable to knee osteoarthritis (KOA) can impart painful stiffness and persist following arthroplasty. To supplement joint conditioning aimed at maximizing peri-operative function, we evaluated the antifibrotic effect of Minoxidil (MXD) on formation of pyridinoline (Pyd) cross-links catalyzed by Plod2-encoded lysyl hydroxylase (LH)2b that strengthen newly synthesized type-I collagen (COL1) in fibroblastic synovial cells (FSCs) from KOA patients. MXD was predicted to decrease Pyd without significant alterations to Col1a1 transcription by FSCs stimulated with transforming growth factor (TGF)β1. Methods: Synovium from 10 KOA patients grouped by SFb severity was preserved for picrosirius and LH2b …

Stellate Ganglion Block For Refractory Raynaud’S Phenomenon- A Case Report, William J. Naber Ii, Derik J. Scribner, Gabriel Howard

Graduate Medical Education Research Journal

Introduction: Raynaud’s phenomenon (RP) is predominately a sympathetically mediated ischemic vasospastic disease involving the distal limbs and is associated with sharp pains, numbness, and dermatological color changes. The symptoms are commonly induced by cold weather, stress, and trauma and it is known to affect 4.85% of the population. There are few well-defined treatments for patients with RP that are refractory to 1st-line therapies. We present a case of intractable RP with corresponding response to stellate ganglion block (SGB) which demonstrates the efficacy profile and safety of SNS blocks in treatment of resistant RP.

Methods: Per Bon Secours Mercy Health …

Posttreatment Lyme Disease Syndrome And Myalgic Encephalomyelitis/Chronic Fatigue Syndrome: A Systematic Review And Comparison Of Pathogenesis, Natalie Bai, Christie Richardson

Rowan-Virtua School of Osteopathic Medicine Faculty Scholarship

Lyme disease is the most common vector-borne illness in the United States and has been causing significant morbidity since its discovery in 1977. It is well-documented that about 10% of patients properly treated with antibiotics never fully recover, but instead go on to develop a chronic illness dubbed, posttreatment Lyme disease syndrome (PTLDS) characterized by severe fatigue, cognitive slowing, chronic pain, and sleep difficulties. This review includes 18 studies that detail the symptoms of patients with PTLDS and uses qualitative analysis to compare them to myalgic encephalitis/chronic fatigue syndrome (ME/CFS), a strikingly similar syndrome. In the majority of the PTLDS …

Case Report: Use Of Bedside Handheld Ultrasound To Diagnose Finger Dislocation, Frank Wheeler, Philip Carhart, James Espinosa, Alan Lucerna, Henry Schuitema

Rowan-Virtua Research Day

Here we present the case of a 37-year-old male with a finger injury in which finger dislocation was suspected clinically. A bedside pocket ultrasound was performed using a water submersion technique, which identified a posterior dislocated right 2nd digit at the PIP joint. This finding was confirmed with an x-ray. This case report demonstrates that ultrasonography can be utilized to correctly identify finger dislocation. Although larger studies need to be performed to validate the accuracy of this imaging technique, the implications may improve care of the patient. It would also be particularly beneficial for this technique to be applied to …

Case Report And Review: Hawthorne Root Toxicity, James Espinosa, Darren Finn, Alan Lucerna

Rowan-Virtua Research Day

Here we present the case of a patient who purchased a hawthorn root product, Raiz de Tejocote, for weight loss purposes. The side effect profile seen, including a positive digoxin level, are consistent with hawthorn root. This case reinforces the importance of asking a patient about all medications, including over the internet medications.

Impact Of Osteopathic Manipulative Therapy (Omt) On Morbidity In Pregnant Persons Aged 18-39, Jessica-Sophie Chang Horoschak

Rowan-Virtua Research Day

Background: Rates of maternal morbidity and mortality in the United States continue to rise.1 Pregnant persons are more vulnerable to stress and morbidities associated with the physiological changes of pregnancy. Low back pain and posterior pelvic pain are of high incidence experienced in pregnant persons.2 Prevention strategies are necessary to improve maternal health outcomes in the United States. Some studies have shown that Osteopathic Manipulative Therapy (OMT) can be an effective treatment modality for pregnant patients experiencing somatic pain. These studies, however, are limited and of small sample size.

Purpose: To examine the current literature on the impact of OMT …

Outcomes Of Arthroscopic Vs. Open Biceps Tenodesis For Treatment Of Slap Lesion In Female Patients, Adeeb Hanna, Matthew Wallingford, William Johns, John Sonner, Emma Johnson, Sommer Hammoud, Brandon Erickson, Steven Cohen, Michael Ciccotti, Meghan Bishop

Rowan-Virtua Research Day

Background: Biceps tenodesis (BT) is one alternative treatment to repair of superior labrum anterior to posterior (SLAP) tears. It can be performed as an arthroscopy or open procedure. While there have been studies comparing the outcomes of SLAP repair procedures with BT for the treatment of SLAP tears, literature comparing arthroscopic and open BT for the treatment of SLAP tears is limited. Additionally, no previous study has specifically examined the outcomes of these procedures in female patients.

Hypothesis/Purpose: The purpose of this study was to compare outcomes following Arthroscopic BT and Open BT for SLAP tears in females. The authors …

Adaptive Changes Of The Ulnar Collateral Ligament Of Professional Baseball From Different Climates Over Multiple Seasons: An 18-Year Study, Adeeb Hanna, Brian Fliegel, John Sonnier, Matthew Sherman, Michael Ciccotti, Robert Jack, Steven Cohen

Rowan-Virtua Research Day

Background: The ulnar collateral ligament (UCL) is put under high levels of stress through the overhead throwing motion typical of professional baseball pitchers. In response to repetitive stress the UCL undergoes adaptive changes including thickening of the ligament and increased joint laxity under valgus stress. Studies examining the adaptive changes in the elbows of professional pitchers over multiple seasons are limited. Investigations such as this one offer insight into the changes in the UCL of professional pitchers over multiple years of professional play as well as the risk for injuries that may be associated with these changes.

Purpose/Hypothesis: The purpose …

Case Report Of Hemarthrosis In Patient With Alcohol Related Cirrhotic Liver Disease, Benjamin Haight

Far West Division Research Day 2023

No abstract provided.

Atypical Presentation Of Ankylosing Spondylitis, Chandni Patel, Milvin Shroff, Maleeha Memon, Shideh Doroudi, Christine Leroy

Rowan-Virtua Research Day

Radiographic axial spondyloarthritis axSpA ) or typical ankylosing spondyloarthritis (AS) is a classification of axial spondyloarthritis with the classic radiographic features of sacroiliitis. Axial spondyloarthritis is a disabling spondyloarthropathy of the spine that presents with chronic back pain usually before the age of 45. It may be associated with extraspinal features including dactylitis , synovitis, and enthesitis in addition to other nonarticular signs. Chronic back pain is one of the most common presenting symptoms for AS , but frequently there is a 5-7 year delay between the onset of symptoms and diagnosis of the disease . A standard AP plain …

Exploring The Viability Of A Microglia Attenuating Treatment Model For Fibromyalgia Patients, Rohan Yarlagadda

Rowan-Virtua Research Day

Fibromyalgia refers to a rheumatic condition experienced as pain all over the body without a specific cause. This is considered a diagnosis of exclusion. This classification seems to suggest that any treatment options for it are purely symptomatic and are not disease targeted. Its complex diagnosis and underlying pathology contribute to the challenge of medically addressing fibromyalgia. Without a strict cause, fibromyalgia is often treated symptomatically with CBT and SNRIs. However, recent research suggests that existing therapeutic approaches are not very effective, especially when considering long term benefits for this chronic condition. This beckons for novel treatment options for these …

The Effects Of The Covid-19 Stay-At-Home Orders On Pain And Mental Health In Omm Patients, Sylvia Orozco Silberman, Philip Collins, Danielle Cooley, James Bailey, Steven M. Brunwasser Phd, Nicholas Averell

Rowan-Virtua Research Day

New Jersey was placed in a state of emergency and a statewide stay-at-home order during the COVID-19 pandemic

Very little has been published examining the effects of chronic pain after stopping osteopathic manipulative medicine (OMM), although it seems unethical to stop a treatment shown to work so well that is both minimally invasive and cost effective

We hypothesized OMM patients experienced an increase in pain since the onset of COVID-19 pandemic and closure of OMM/Family Medicine offices

Does Prehabilitation Prior To Ulnar Collateral Ligament Surgery Affect Return To Sport Rate Or Time In Baseball Players With Partial Ucl Tears?, Joshua Spada, Kourtney Snigar, Ryan W. Paul, Usman Zareef, Anya Hall, Brandon J. Erickson, Michael G. Ciccotti, Stephen J. Thomas

Rowan-Virtua Research Day

Those who suffer a partial thickness ulnar collateral ligament (UCL) tear often undergo a period of nonoperative management including physical therapy rehabilitation. This treatment is aimed at optimizing range of motion (ROM) and strengthening the supporting structures around the elbow to help offload the UCL.

Unfortunately, some of these patients fail nonoperative management and require surgical intervention. This creates a unique set of patients who essentially underwent “prehabilitation” prior to their UCL surgery. Prehabilitation is considered a period of structured physical therapy rehabilitation aimed at strengthening structures surrounding an injured tendon or ligament, to allow for dissipation of stress away …

Use Of Osteopathic Manipulative Treatment In Alleviating Hypertonic Chest Wall Pain, David Ho, James Espinosa, Alan Lucerna

Rowan-Virtua Research Day

We present the case of a 20-year-old male patient with no cardiac history coming in for left sided chest pain described as “burning” sensation. On physical exam, it was noted that patient had hypertonic chest wall muscles that were tight and spastic when palpated on the left chest wall. We used Osteopathic Manipulative Treatment (OMT) to help patient relieve hypertonic muscle. We chose to use muscle energy technique (MET) since this relies on reciprocal inhibition with the end result being relaxation of the target muscle.

The patient had resolution of chest pain after applying the technique. Although we did not …

Latarjet Surgery Leads To Decreased Rates Of Subjective Instability Compared To Bankart Repair With Concomitant Remplissage, Joshua Spada, Ryan W. Paul, Manoj Reddy, Gabriel Onor, John Hayden Sonnier, Ari Clements, Meghan E. Bishop, Brandon J. Erickson

Rowan-Virtua Research Day

Background: Predictive factors for performing remplissage concomitantly with arthroscopic Bankart repair include the presence of humeral or glenoid defects >11% and/or revision surgery. International and societal consensus statements support these findings, as surgeons recommend the Latarjet procedure for patients with significant glenoid bone loss (>15-20%) while remplissage is recommended for patients with off-track or engaging Hill-Sachs lesions without significant glenoid bone loss. While several studies have compared outcomes between Latarjet surgery and remplissage, these studies have only evaluated patients with engaging Hill-Sachs lesions, not consecutive patient cohorts indicated for each surgery.

Purpose: To compare rates of recurrent instability, re-operation, …

Flexor Tenosynovitis After Bite By Sugar Glider, Dominick Siconolfi, James Espinosa, Alan Lucerna, Russell Mordecai

Rowan-Virtua Research Day

Flexor tenosynovitis is one of the few orthopedic emergencies, often first identified in the emergency department. Pyogenic flexor tenosynovitis is an infection of the flexor tendon sheath of a finger causing local inflammation and tissue destruction. The pathognomonic symptoms of flexor tenosynovitis are known as Kanavel’s signs, a constellation of symptoms that include: pain with passive extension of the finger, tenderness over the flexor tendon sheath, fusiform swelling of the affected finger, and the finger held in passive flexion. The most common cause of flexor tenosynovitis is penetrating trauma into the flexion tendon sheath. Our case involves a 59-year-old male …

Minimally Invasive Surgery For Septic Arthritis Of The First Metatarsophalangeal Joint: An Uncommon Approach Utilizing Small Joint Arthroscopy, Michael Thomas, Hinal Patel, Jeffrey Belancio

Rowan-Virtua Research Day

Small joint arthroscopy can be utilized for septic arthritis, synovitis, osteochondral lesions, arthritis, and various other pathologies. However, information regarding arthroscopy of the first metatarsophalangeal joint (MTPJ) is limited in the literature. This case report discusses the use of arthroscopy for septic arthritis of the 1st MTPJ.

Septic Arthritis With Concomitant Pseudogout, Ravin Patel, James Schuck, Nicole Zucconi, David Aderholdt

Rowan-Virtua Research Day

Monoarticular joint pain is a common complaint, however it demands a broad differential diagnosis. These differentials include fracture, dislocation, septic arthritis, gout, pseudogout and several others. The diagnosis of septic arthritis requires a high index of suspicion as early diagnosis is a vital part of initial treatment.

We present a case with multifactorial joint pathology contributing to a patient’s presentation, specifically septic joint and pseudogout. The incidence of these entities being present in the same patient, let alone the same joint, is not well documented in the literature.

The presentation of these diseases have a multitude of similarities and differences, …

A Fatal Rectus Sheath Hematoma After A Myasthenia Crisis Case Report, Robert G. Michaud, Lesley B. Gordon

Journal of Maine Medical Center

Introduction: Rectus sheath hematomas (RSH) generally occur due to damage to the inferior epigastric artery. They are rare causes of abdominal pain or acute blood loss anemia, but are an important diagnostic consideration because they can be cryptic and are potentially fatal.

Clinical Findings: An 85-year-old female who had been admitted to the hospital for 10 days with a myasthenia crisis was found to be abruptly hypotensive with a tender abdominal mass in the left lower quadrant subtly crossing midline. She was on prophylactic anticoagulation during her hospitalization.

Main diagnosis, therapeutics, interventions, and outcomes: The patient was initially stabilized with …

Oral Contraceptives As Possible Acl Injury Prevention Method, Haley Schweizer

Capstone Showcase

ABSTRACT

Introduction: Anterior Cruciate Ligament (ACL) injuries are an upsetting setback for many athletes that require a long and costly recovery process. The injury rates are four times greater in women than men. Preventative measures that help to prevent ACL injuries are limited to stretching and strengthening. Therefore, this review aims to investigate if oral contraceptive [I] usage provides a possible new avenue for prevention of ACL injury [O] in young female athletes (ages 18-30) [P] compared to those that do not take oral contraceptives [C].

Methods: A literature review was performed though PubMed, Google Scholar, SCOPUS Database, and ClinicalKey …

Felty's Syndrome: Triad Not Always Evident, Pablo G. Dubon Md, Frederick Lim Md, Shfali Bhandari Md, Sukhmani Chauhan Md, Puja Solanki Md, Luis Silva Md

Internal Medicine

No abstract provided.

Gigantic Stomach: A Rare Manifestation Of Duchenne Muscular Dystrophy, Amaninder Dhaliwal, Sarvani Madiraju, Banreet S. Dhindsa, Getaw W. Hassen, Fedja A. Rochling

School of Medicine Faculty Publications

Duchenne muscular dystrophy (DMD) is characterized by degeneration and atrophy of skeletal, cardiac, and smooth muscles after a latent period of apparently normal development and function. The gastrointestinal manifestations start in the second decade of life and are mainly due to atrophy of smooth muscle layers. Refractory gastroparesis and chronic constipation can lead to severe gastric and small bowel dilatation, which can be life threatening. Here, we present a case of a 21-year-old male with a gigantic stomach secondary to DMD resolved with conservative management and no surgical intervention.

Investigating The Mechanism Of Ectopic Mineralization In A Mouse Model Of Diffuse Idiopathic Skeletal Hyperostosis (Dish), Neil A. Tenn

Electronic Thesis and Dissertation Repository

Equilibrative nucleoside transporter 1 (ENT1) transfers adenosine across plasma membranes. Mice lacking ENT1 (ENT1^-/-) develop pathological calcification of spinal tissues resembling diffuse idiopathic skeletal hyperostosis (DISH) in humans. Our goal was to investigate the mechanism underlying ectopic mineralization in ENT1^-/- mice. We detected aberrant alkaline phosphatase (ALP, promoter of mineralization) activity in the annulus fibrosus (AF) of ENT1^-/- mice. In vitro, AF cells from ENT1^-/- mice exhibited greater ALP activity than cells from wild-type (WT) mice. Inhibition of ENT1 in the presence of extracellular adenosine modeled in WT cells the phenotype of ENT1 …

Malignant Hyperthermia: A Clinical Crisis, Eric Reing

Nursing Student Class Projects (Formerly MSN)

Malignant hyperthermia, though uncommon, is a serious and life threatening condition. Malignant hyperthermia is an autosomal dominant disorder that affects skeletal muscle. It can be caused by various general anesthetic agents like succinylcholine and several inhaled anesthetics. Malignant hyperthermia is a relevant topic to certified registered nurse anesthetists due to the potentially fatal result if not recognized and treated promptly. In understanding the pathophysiology, risk factors, signs and symptoms, epidemiology, and current treatments the health care provider can help to prevent complications due to this disorder (Nagelhout, 2014).

Development Of A Protocol To Measure Gene Expression In The Mouse Tibia, Daniel Hoover

Biomedical Engineering

Numerous molecular factors active in bone tissue direct fracture repair and remodeling which can be altered by disease conditions such as Peripheral Arterial Disease (PAD) and Osteoporosis. Methods of molecular biology are commonly applied to investigate the expression and role of these molecular factors. This project presents a robust three-step protocol for examining gene expression in the mouse tibia. The protocol begins with isolating RNA from a flash frozen tibia sample. The isolated RNA is reverse transcribed into cDNA. Finally, PCR is performed to indentify expressed genes. Establishing this protocol will allow further research into the mechanisms of bone remodeling …

Heterotopic Ossification: Cellular Basis, Symptoms, And Treatment, Brian Wolfe

Senior Honors Theses

Heterotopic ossification (HO) is the process by which calcified bone develops in soft tissues. Because of the abnormal calcification, complications such as bone deformation, loss of range of motion, and joint immobility adversely affect patients. There are many genetic types of heterotopic ossification, namely fibrodysplasia ossificans progressiva, progressive osseous heteroplasia, and Albright hereditary osteodystrophy. However, this condition can also arise from surgery, burns, or traumatic injuries, so it is seen as an important area for research in the future. There are various treatments available such as non-steroidal anti-inflammatory drugs and radiation therapy, as well as combinations of the two. The …