Necrotizing fasciitis (NF) is a deep infection of the subcutaneous tissue that progressively destroys fascia and fat; it is associated with systemic toxicity, a fulminant course, and high mortality. NF most frequently develops from trauma that compromises skin integrity, and is more common in patients with predisposing medical conditions such as diabetes mellitus, atherosclerosis, alcoholism, renal disease, liver disease, immunosuppression, malignancy, or corticosteroid use. Most often, NF is caused by polymicrobial pathogens including aerobic and anaerobic bacteria. NF caused by Staphylococcus aureus as a single pathogen, however, is rare. Here we report a case of NF that developed in a healthy woman after an isolated shoulder sprain that occurred without breaking a skin barrier, and was caused by Staphylococcus aureus as a single pathogen.
*Arm ; Coagulase/metabolism ; Fasciitis, Necrotizing/*etiology/microbiology/pathology/surgery ; Female ; Humans ; Middle Aged ; Shoulder Joint/*injuries ; Sprains and Strains/*complications ; Staphylococcal Infections/*etiology/microbiology ; Staphylococcus aureus/enzymology/isolation & purification

BACKGROUNDMagnetic resonance imaging (MRI) is the most sensitive technique for evaluating the healing process and should be performed before the patients return to their exercise routines. The aim of this research was to diagnose chronic lumbago associated with lumbar muscle strain and to monitor healing process by MRI.

METHODSSixty-fve symptomatic cases of chronic lumbago caused by lumbar muscle strain were collected from March 2009 to October 2011. MRI was used to examine, diagnose and monitor the healing process. The control group included 65 random cases of asymptomatic volunteers. MRI methods included routine sequences of GRE T1WI, TSE T2WI and special sequences of T2-STIR-FS, combined with DWI. We compared the MRI characteristics of symptomatic cases before and after healing and with asymptomatic controls.

RESULTSThe important MRI characteristics of chronic lumbago with lumbar muscle strain included: (1) The low back muscle showed edema. (2) The low back intermuscular spaces showed edema and/or fluid. (3) The low back spaces beside the spinous process showed edema and/or fluid. (4) The low back vertebral articular process fossae or transverse process fossae showed fluid. Of these image characteristics, the intermuscular space edema provided the best diagnostic sensitivity, Se = 83%, with YI = 0.63, p = 74%. The low back muscle edema provided the best diagnostic specificity, Sp = 100%, with YI = 0.66, Π = 83%. And the spaces edema beside the spinous process provided the best diangnostic accuracy, Π = 86%, with YI = 0.71, Se = 80%, Sp = 91%. The diagnosis accurate could be improved by combining multiple MRI characteristics. The diagnostic accuracy could achieve Π = 93%, with YI = 0.86, Se = 100% and Sp = 86% when two characteristics were combined. After rehabilitation care, the edema disappeared on the repeated MRI.

CONCLUSIONSMRI may well be a useful diagnostic method for lumbago with lumbar muscle strain. Combining routine sequences with T2-STIR-FS and DWI sequences could demonstrate the pathological changes of lumbar muscle strain and monitor the healing.

Adult ; Chronic Disease ; Diffusion Magnetic Resonance Imaging ; Female ; Humans ; Low Back Pain ; diagnosis ; etiology ; Magnetic Resonance Imaging ; methods ; Male ; Middle Aged ; Sprains and Strains ; complications ; Wound Healing

The electrical stimulation of acupoint (ESA) releases several endogenous neuropeptides, which play important roles in management of pain and inflammation. ESA with low and high frequencies has been shown to release different neuropepides, suggesting its various therapeutic effects. Pain and edema are major problems for ankle sprain. However, there have been few reports on the effects of ESA for ankle sprain. We aimed to investigate that ESA can reduce pain and edema resulting from ankle sprain, and whether there is a difference in therapeutic effects between low and high frequency ESA. To induce ankle sprain in Sprague-Dawley rats, the ankle of right hindpaw was overextended in direction of simultaneous inversion and plantar flexion. Stepping force and edema in the paw of the sprained ankle were measured by electronic balance and plethysmometer, respectively. In both 2 and 100 Hz ESA groups, stepping force was increased significantly in similar degrees (p<0.05). Only 2 Hz ESA produced the significant rapid decrease in ankle edema. This study demonstrates that ESA of 2 Hz and 100 Hz shows comparable analgesic effects, but only 2 Hz ESA can facilitate the reduction of edema caused by ankle sprain.
Treatment Outcome ; Sprains and Strains/diagnosis/etiology/*physiopathology/*prevention & control ; Rats, Sprague-Dawley ; Rats ; Male ; Electroacupuncture/*methods ; Edema/diagnosis/etiology/physiopathology/prevention & control ; Arthralgia/diagnosis/etiology/physiopathology/*prevention & control ; Ankle Injuries/complications/diagnosis/*physiopathology/*therapy ; Animals