Valproic acid as an adjuvant analgesic: adult Fanconi syndrome

We report an 80-year-old woman who developed severe hypophosphataemia and elevated urinary phosphate levels while started on valproic acid. This occurred within 1-2 days of starting valproic acid. There are rare single-patient reports of the association of valproic acid with adult Fanconi syndrome. This generally occurs after long-term exposure to valproate. This is the first reported experience of Fanconi's syndrome in an adult with acute exposure to valproic acid. Clinicians should be aware of the possible association.

Shoulder rehabilitation for the arthritic glenohumeral joint: preoperative and postoperative considerations

Arthritis of the glenohumeral joint can cause pain, weakness, and limit motion. Preoperative treatment consists of physical therapy to manage pain, increase shoulder motion, and increase rotator cuff and scapulothoracic muscle strength. The postoperative three-phase rehabilitation program described is structured, supervised, and involves the cooperation of the patient, surgeon, and physical therapist. Rate of progression and ultimate outcome is based on underlying pathology, surgical technique, and patient tolerance to exercise. Patients with an intact rotator cuff should be expected to tolerate a more aggressive rehabilitation program and expect a higher functional outcome. Those with a deficient cuff mechanism can expect more modest gains oriented toward restoring pain-free functional activity.