No abstract

SUMMARYBrachial neuritis following vaccination is an uncommon but clinically important presentation of severe shoulder and arm pain associated with globally reduced range of movement. It may be confused with the more common diagnoses of rotator cuff pathology, adhesive capsulitis (frozen shoulder), shoulder arthritis or cervical spondylosis. We present a case of acute brachial neuritis, which posed a clinical diagnostic challenge to emergency, acute medical and rheumatology clinicians. BACKGROUND

Novel signs are reliable, easy to perform, and present in chronic pain patients. FP and BS have significant clinical utility in predicting persistent pain in a fracture group thereby allowing targeted early intervention.

The recreational use of novel psychoactive substances in the UK has increased markedly within the last decade. The variety of new substances synthesised and sold as ‘legal’, often under the pretence of being ‘plant food’ or ‘bath salts’ is similarly increasing. This presents challenges to clinicians: they may be unaware of these substances or unable to identify them and their potential for complications and drug interactions. This case describes a patient who ingested a novel psychoactive substance and presented with severe agitation following a delay of several days. He experienced renal, hepatic and neurological complications requiring critical care input. Our case adds to the current repertoire of knowledge regarding the effects of ingestion of novel cathinones.

Inflammatory arthritis and sacroilitis are common presentations to rheumatology clinics. Owing to the physiological changes of pregnancy, the first presentation can be post partum with back pain and an accompanying oligoarthritis or polyarthritis. We present a woman with lower back pain who demonstrated clinical and radiological features consistent with sacroilitis and an inflammatory arthritis but was found to have an unusual presentation of another common cause of arthritis.