Images in Clinical Rheumatology
Camptocormia: Case Presentation
Camptocormia: a propósito de un caso
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Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">a</span>" "identificador" => "aff0005" ] 1 => array:3 [ "entidad" => "Servicio de Rehabilitación, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">b</span>" "identificador" => "aff0010" ] 2 => array:3 [ "entidad" => "Servicio de Radiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, Spain" "etiqueta" => "<span class="elsevierStyleSup">c</span>" "identificador" => "aff0015" ] ] "correspondencia" => array:1 [ 0 => array:3 [ "identificador" => "cor0005" "etiqueta" => "⁎" "correspondencia" => "Corresponding author." ] ] ] ] "titulosAlternativos" => array:1 [ "es" => array:1 [ "titulo" => "Camptocormia: a propósito de un caso" ] ] "resumenGrafico" => array:2 [ "original" => 0 "multimedia" => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 796 "Ancho" => 900 "Tamanyo" => 139630 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial L4 CT. Selective atrophy of the posterior paravertebral musculature and fat degeneration/substitution (yellow arrows).</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">The patient is an 86-year-old male, who performed activities of daily living independently and a history of ischemic heart disease, chronic atrial fibrillation, diabetes mellitus type I and hypothyroidism. He consulted due to back pain and mechanical instability, without previous trauma. It was accompanied by a harmonic progressive kyphosis, reductible when upright and recumbent. The physical examination showed increased anteroposterior curvature of the spine, which conditioned contact of the ribs to the pelvis and was reduced when prone (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>), with slight flexion of the knees and retroversion of the pelvis. The remaining physical examination was unremarkable. Radiographs were performed and on the lumbar spine (anteroposterior and lateral) showed no significant alterations except for degeneration. With the suspected diagnosis of camptocormia, we requested a CT scan of the lumbar spine which showed selective posterior paravertebral muscle atrophy (<a class="elsevierStyleCrossRef" href="#fig0010">Fig. 2</a>), consistent with the initial workup. Analgesic treatment and rehabilitation was started.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><elsevierMultimedia ident="fig0010"></elsevierMultimedia><span id="sec0005" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Discussion</span><p id="par0010" class="elsevierStylePara elsevierViewall">Camptocormia or “bent spine syndrome” is an acquired postural impairment, disabling, characterized by flexion of the thoracolumbar spine, pelvis retroversion and flexion of the knees to make the center of gravity stay on the feet. The term derives from the Greek ‘camptos “meaning double and “corms”, which refers to the trunk.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a> It was first described by Brodie in 1818, who suggested that the etiology of low back pain and abnormal curvature of the spine had a psychogenic origin. Years later, in 1915, Rosanoff and Souques used the term camptocormia to describe this disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">Although the first reported cases suggested a psychogenic etiology, several studies have shown organic causes such as lesions involving the nucleus lenticularis,<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> Parkinson's<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a> disease, dystonia and neuromuscular alterations,<a class="elsevierStyleCrossRef" href="#bib0025"><span class="elsevierStyleSup">5</span></a> paraneoplastic syndromes, Graves disease and drugs.<a class="elsevierStyleCrossRefs" href="#bib0030"><span class="elsevierStyleSup">6,7</span></a> In a retrospective study of 16 patients, it was described in 69% of patients with Parkinson disease, 25% dystonia and one patient with a Gilles de Tourette<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">8</span></a> syndrome.</p><p id="par0020" class="elsevierStylePara elsevierViewall">It is a rare disorder with little epidemiological data. Prevalence was 6.9% in an analysis that included 275 patients diagnosed with Parkinson's disease. The development of this condition was related to severe neurological disease.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0025" class="elsevierStylePara elsevierViewall">The mean age at diagnosis is 65 years. Regarding the clinical features, it is characterized by involuntary flexion of the trunk as a result of progressive weakness of the extensor muscles of the vertebral column. In limited cases, it presents with back pain which is most often asymptomatic. A high percentage of patients had spondyloarthritis, something that suggests that camptocormia may be a risk factor for its development.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0030" class="elsevierStylePara elsevierViewall">The diagnosis is clinical, supported by additional tests such as a CT scan of the lumbar and dorsal column, which typically shows hypodensity and atrophy of the paravertebral muscles and is interpreted as an involution of fat. Given the heterogeneous etiology of this disorder, other examinations such as an electromyogram may be performed; hormonal, bone metabolism and muscle enzymes studies, cranial computed tomography and/or MRI to study basal ganglia may be affected in patients with Parkinson's camptocormia. Patients may also undergo a muscle biopsy.<a class="elsevierStyleCrossRef" href="#bib0005"><span class="elsevierStyleSup">1</span></a></p><p id="par0035" class="elsevierStylePara elsevierViewall">Treatment is limited and usually ineffective. It combines rehabilitation and symptomatic pharmacological treatment. In some cases more invasive measures such as surgery has been employed.</p><p id="par0040" class="elsevierStylePara elsevierViewall">A prospective study of 15 patients diagnosed with camptocormia evaluated the effectiveness of orthoses and associated toracopélvica physiotherapy, getting increases in the quality of life in more than 90% of cases.<a class="elsevierStyleCrossRef" href="#bib0045"><span class="elsevierStyleSup">9</span></a> IV immunoglobulin has proven effective in cases with inflammatory myopathy. <span class="elsevierStyleSmallCaps">l</span>-Dopa in patients with Parkinson's disease does not usually lead to results. The injection of botulinum toxin in the abdominal and iliopsoas muscle has been effective in some cases reviewed in the literature.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,10</span></a></p></span><span id="sec0010" class="elsevierStyleSection elsevierViewall"><span class="elsevierStyleSectionTitle">Ethical disclosures</span><p id="par0050" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Protection of human and animal subjects.</span> The authors declare that no experiments were performed on humans or animals for this investigation.</p><p id="par0055" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Confidentiality of Data.</span> The authors declare that they have followed the protocols of their work centre on the publication of patient data and that all the patients included in the study have received sufficient information and have given their informed consent in writing to participate in that study.</p><p id="par0060" class="elsevierStylePara elsevierViewall"><span class="elsevierStyleBold">Right to privacy and informed consent.</span> The authors have obtained the informed consent of the patients and /or subjects mentioned in the article. The author for correspondence is in possession of this document.</p></span></span>" "textoCompletoSecciones" => array:1 [ "secciones" => array:4 [ 0 => array:2 [ "identificador" => "sec0005" "titulo" => "Discussion" ] 1 => array:2 [ "identificador" => "sec0010" "titulo" => "Ethical disclosures" ] 2 => array:2 [ "identificador" => "xack53851" "titulo" => "Acknowledgement" ] 3 => array:1 [ "titulo" => "References" ] ] ] "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara">Please cite this article as: Tejera B, et al. Camptocormia: a propósito de un caso. Reumatol Clin. 2012. <span class="elsevierStyleInterRef" href="doi:10.1016/j.reuma.2012.05.004">http://dx.doi.org/10.1016/j.reuma.2012.05.004</span>.</p>" ] ] "multimedia" => array:2 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 792 "Ancho" => 1251 "Tamanyo" => 143755 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">Increase in the spinal curvature, which becomes more pronounced with walking.</p>" ] ] 1 => array:7 [ "identificador" => "fig0010" "etiqueta" => "Fig. 2" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr2.jpeg" "Alto" => 796 "Ancho" => 900 "Tamanyo" => 139630 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0010" class="elsevierStyleSimplePara elsevierViewall">Axial L4 CT. Selective atrophy of the posterior paravertebral musculature and fat degeneration/substitution (yellow arrows).</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:10 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Etiolgy, diagnosis and management of camptcormia" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "J. Finsterer" 1 => "W. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 November | 15 | 17 | 32 |
| 2024 October | 106 | 34 | 140 |
| 2024 September | 103 | 26 | 129 |
| 2024 August | 98 | 39 | 137 |
| 2024 July | 117 | 33 | 150 |
| 2024 June | 111 | 35 | 146 |
| 2024 May | 86 | 61 | 147 |
| 2024 April | 87 | 32 | 119 |
| 2024 March | 108 | 49 | 157 |
| 2024 February | 73 | 26 | 99 |
| 2024 January | 90 | 37 | 127 |
| 2023 December | 64 | 33 | 97 |
| 2023 November | 89 | 41 | 130 |
| 2023 October | 91 | 42 | 133 |
| 2023 September | 114 | 40 | 154 |
| 2023 August | 92 | 32 | 124 |
| 2023 July | 89 | 34 | 123 |
| 2023 June | 95 | 20 | 115 |
| 2023 May | 80 | 23 | 103 |
| 2023 April | 88 | 14 | 102 |
| 2023 March | 116 | 43 | 159 |
| 2023 February | 97 | 35 | 132 |
| 2023 January | 104 | 32 | 136 |
| 2022 December | 86 | 34 | 120 |
| 2022 November | 113 | 37 | 150 |
| 2022 October | 105 | 40 | 145 |
| 2022 September | 130 | 49 | 179 |
| 2022 August | 119 | 70 | 189 |
| 2022 July | 79 | 41 | 120 |
| 2022 June | 60 | 33 | 93 |
| 2022 May | 76 | 36 | 112 |
| 2022 April | 92 | 42 | 134 |
| 2022 March | 93 | 50 | 143 |
| 2022 February | 88 | 44 | 132 |
| 2022 January | 112 | 36 | 148 |
| 2021 December | 85 | 38 | 123 |
| 2021 November | 89 | 47 | 136 |
| 2021 October | 95 | 38 | 133 |
| 2021 September | 71 | 35 | 106 |
| 2021 August | 82 | 32 | 114 |
| 2021 July | 57 | 32 | 89 |
| 2021 June | 100 | 30 | 130 |
| 2021 May | 275 | 33 | 308 |
| 2021 April | 117 | 74 | 191 |
| 2021 March | 58 | 23 | 81 |
| 2021 February | 45 | 21 | 66 |
| 2021 January | 28 | 15 | 43 |
| 2020 December | 38 | 18 | 56 |
| 2020 November | 19 | 22 | 41 |
| 2020 October | 21 | 14 | 35 |
| 2020 September | 27 | 21 | 48 |
| 2020 August | 31 | 11 | 42 |
| 2020 July | 21 | 30 | 51 |
| 2020 June | 38 | 14 | 52 |
| 2020 May | 27 | 13 | 40 |
| 2020 April | 25 | 12 | 37 |
| 2020 March | 17 | 7 | 24 |
| 2019 January | 1 | 0 | 1 |
| 2018 May | 7 | 0 | 7 |
| 2018 April | 39 | 7 | 46 |
| 2018 March | 43 | 7 | 50 |
| 2018 February | 24 | 5 | 29 |
| 2018 January | 27 | 8 | 35 |
| 2017 December | 34 | 2 | 36 |
| 2017 November | 29 | 5 | 34 |
| 2017 October | 30 | 5 | 35 |
| 2017 September | 33 | 11 | 44 |
| 2017 August | 56 | 9 | 65 |
| 2017 July | 47 | 2 | 49 |
| 2017 June | 75 | 9 | 84 |
| 2017 May | 72 | 11 | 83 |
| 2017 April | 59 | 6 | 65 |
| 2017 March | 44 | 2 | 46 |
| 2017 February | 28 | 4 | 32 |
| 2017 January | 23 | 4 | 27 |
| 2016 December | 64 | 13 | 77 |
| 2016 November | 52 | 7 | 59 |
| 2016 October | 75 | 5 | 80 |
| 2016 September | 113 | 4 | 117 |
| 2016 August | 64 | 5 | 69 |
| 2016 July | 35 | 3 | 38 |
| 2016 March | 0 | 8 | 8 |
| 2016 February | 5 | 0 | 5 |
| 2015 December | 2 | 0 | 2 |
| 2015 November | 1 | 0 | 1 |
| 2015 October | 1 | 15 | 16 |
| 2015 September | 3 | 0 | 3 |
| 2015 August | 5 | 0 | 5 |
| 2015 July | 30 | 5 | 35 |
| 2015 June | 43 | 8 | 51 |
| 2015 May | 63 | 8 | 71 |
| 2015 April | 55 | 11 | 66 |
| 2015 March | 60 | 3 | 63 |
| 2015 February | 40 | 7 | 47 |
| 2015 January | 68 | 12 | 80 |
| 2014 December | 54 | 11 | 65 |
| 2014 November | 56 | 8 | 64 |
| 2014 October | 47 | 10 | 57 |
| 2014 September | 43 | 17 | 60 |
| 2014 August | 52 | 11 | 63 |
| 2014 July | 60 | 16 | 76 |
| 2014 June | 76 | 11 | 87 |
| 2014 May | 73 | 12 | 85 |
| 2014 April | 72 | 12 | 84 |
| 2014 March | 63 | 13 | 76 |
| 2014 February | 76 | 13 | 89 |
| 2014 January | 54 | 12 | 66 |
| 2013 December | 53 | 8 | 61 |
| 2013 November | 43 | 9 | 52 |
| 2013 October | 72 | 11 | 83 |
| 2013 September | 43 | 11 | 54 |
| 2013 August | 60 | 16 | 76 |
| 2013 July | 45 | 7 | 52 |
| 2013 June | 60 | 35 | 95 |
| 2013 May | 11 | 5 | 16 |
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