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Psoas abscess mimicking facetogenic pain on initial presentation: A case report [Meeting Abstract]

Vanushkina, M; Mandalaywala, N; Cantir, M; Seo, Y I L; Sackheim, K A; Kim, C; Portugal, S
Case/Program Description: The patient is an 88-year-old woman with history of hysterectomy who was referred for evaluation of acute onset low back and buttock pain of 2 weeks duration without any reported provocation or injury. The pain was 4/10, intermittent, aching, exacerbated by walking, alleviated by resting, sitting, Tylenol and Advil. There were no associated fevers, chills, radicular symptoms, bowel or bladder dysfunction, reported changes in weight, prior or recent injections or instrumentation of the spine. Exam was notable for an antalgic gait, pain with end flexion and bilateral oblique extension, tenderness over paraspinal muscles and facet joints as well as the left sacroiliac joint and posterior superior iliac spine. Motor, sensory, and deep tendon reflexes were intact. Setting: Outpatient Spine Center. Results: Lumbar radiographs showed multilevel degenerative disc disease, spondylosis, and multilevel facet arthrosis. Patient was started on naproxen and referred to outpatient physical therapy. She presented for early follow up 11 days later, with increasing 7/10 pain radiating to left anterior thigh. Exam notable for new tenderness over anterior midthigh, positive left Ober test, reproduction of left anterior thigh pain with Ely test, mild weakness of left hip flexors and diminished left lower reflexes. Lumbar MRI showed left L3-4 facet joint abnormality, adjacent marrow edema, and soft tissue abscess of the multifidus and psoas muscles. She was emergently referred for inpatient admission, and required a prolonged hospitalization. Discussion: Psoas abscess is a rare infectious disease with nonspecific clinical presentation and often insidious onset that frequently results in diagnostic difficulty and delays. Delays are often associated with high morbidity and mortality in these patients. Conclusions: It is crucial to maintain a high index of suspicion for infectious etiologies and utilize a combination of laboratory and imaging studies when working up back pain
EMBASE:620886368
ISSN: 1934-1482
CID: 2977642

Pain management and palliative care : a comprehensive guide

Sackheim, Kimberly A
New York : Springer, 2015
Extent: xix, 389 p.
ISBN: 1493924613
CID: 2063362

Chronic pelvic and abdominal pain

Chapter by: Gober, Joslyn; Howell, Melanie; Shah, Sovrin M; Sackheim, Kimberly
in: Pain management and palliative care : a comprehensive guide by Sackheim, Kimberly A [Eds]
New York : Springer, 2015
pp. 155-166
ISBN: 1493924613
CID: 2063392

Rehab clinical pocket guide : rehabilitation medicine

Sackheim, Kimberly A
New York ; London : Springer, c2013
Extent: xxxiii, 695 p. : ill., col. port. ; 21 cm.
ISBN: 1461454190
CID: 1068932

Neurologic Examination: Motor Testing : Lower Myotomes

Chapter by: Sackheim, Kimberly
in: Spinal cord injury by Bryce, Thomas N [Eds]
New York : Demos Medical, c2010
pp. ?-?
ISBN: 1933864478
CID: 1084912

Neurologic Examination: Motor Testing : Upper Myotomes

Chapter by: Sackheim, Kimberly
in: Spinal cord injury by Bryce, Thomas N [Eds]
New York : Demos Medical, c2010
pp. ?-?
ISBN: 1933864478
CID: 1084922

Compression modalities and dressings: their use in venous ulcers

Sackheim, Kimberly; De Araujo, Tami S; Kirsner, Robert S
Among the standard of care for venous ulcer treatment are the use of compression therapy to reverse the effect of venous hypertension and the use of occlusive dressings to maintain a moist wound-healing environment and for treatment of abnormalities of the ulcer bed. The use of multilayered elastic bandages for compression in patients with normal arterial flow currently provides the treatment with the highest level of evidence for treatment of venous ulcers. Additionally, treatment of the ulcer bed, especially with cadexemer iodine dressings, is also supported by evidence from randomized controlled trials, whereas newer dressings provide less well proven alternative opportunities to speed the healing of venous ulcers.
PMID: 17199676
ISSN: 1396-0296
CID: 1066642