ABSTRACT
Not all sciatica-like manifestations are of lumbar spine origin. Some of them are caused at points along the extra-spinal course of the sciatic nerve, making diagnosis difficult for the treating physician and delaying adequate treatment. While evaluating a patient with sciatica, straightforward diagnostic conclusions are impossible without first excluding sciatica mimics. Examples of benign extra-spinal sciatica are:piriformis syndrome, walletosis, quadratus lumborum myofascial pain syndrome, cluneal nerve disorder, and osteitis condensans ilii. In some cases, extra-spinal sciatica may have a catastrophic course when the sciatic nerve is involved in cyclical sciatica, or the piriformis muscle in piriformis pyomyositis. In addition to cases of sciatica with clear spinal or extra-spinal origin, some cases can be a product of both origins; the same could be true for pseudo-sciatica or sciatica mimics, we simply don’t know how prevalent extra-spinal sciatica is among total sciatica cases. As treatment regimens differ for spinal, extra-spinal sciatica, and sciatica-mimics, their precise diagnosis will help physicians to make a targeted treatment plan. As published works regarding extra-spinal sciatica and sciatica mimics include only a few case reports and case series, and systematic reviews addressing them are hardly feasible at this stage, a scoping review in the field can be an eye-opener for the scientific community to do larger-scale prospective research.
ABSTRACT
Objective: To assess the mid-term functional outcome of arthroscopic assisted anterior cruciate ligament [ACL] reconstruction using bone-patellar tendon-bone [BPTB] graft based upon subjective scores. Study Design: Cross sectional study. Place and Duration of study: Department of Orthopaedics and Spine, Doctors Hospital and Medical Centre, Lahore, Pakistan from Jan to Dec 2016
Patients and Methods: After fulfilling the inclusion criteria 52 patients who underwent arthroscopic assisted ACL reconstruction were enrolled into the study. Patients were subjectively evaluated with Lysholm knee scoring scale and Tegner activity scale. Preoperative scores were obtained and compared with those obtained 6 months after surgery and were analyzed using wilcoxon signed-rank test on IBM SPSS statistics version 20
Results: Mean difference between preoperative and 6 months postoperative Lysholm scores was 30.04 +/- 13.42 [p<0.001] and mean difference in Tegner activity scale was 2.88 +/- 1.11 [p<0.001]. Excellent scores were obtained in 40 [77%] patients, good in 1 [2%], fair in 7 [13%] and poor in 4 [8%] of patients. Postoperative complications included anterior knee pain in 3 [5.76%], superficial surgical site infection in 1 [1.9%], deep surgical site infection in 1[1.9%] and joint stiffness in 1 [1.9%] patient
Conclusion: Arthroscopic assisted ACL reconstruction using BPTB autograft showed an excellent functional outcome explained in terms of subjective evaluation as depicted by Lysholm knee scoring scale and Tegner activity scale
ABSTRACT
To study the results of treatment of fractures of shaft of Humerus using percutaneous Titanium Nails. This is a quasi-experimental, prospective, interventional, study of 30 clinical cases that were operated with retrograde, per cutaneous elastic Titanium nails for treatment of diaphyseal fractures of adult Humerus. Cases close to either ends of the bone, those presenting with Grade II open fractures and neurovascular injury were excluded along with pathological fractures. All complications were noted. All cases were followed up for one year postoperatively. The age range of the 30 patients included in the study was 33.50 + 11.08 [18-65] years with a follow up period of one year. There were 21[70%] male patients and 9[30%] female patients in the study. We observed clinical and radiological union in 23 patients, delayed union in 5[bone grafting done later], non union in 2 patients. Both these nonunion cases were treated later with internal fixation with plating. All united fractures were in acceptable range of angulation and rotation. On an average radiological union occurred between 3 to 4 months. We observed average 10 degree of limitation in shoulder abduction and extension lag of 10 degree at elbow joint. Two cases reported with deep infection. The use of Titanium Elastic Nails in the treatment of diaphyseal Humerus fractures seems to be a safe option with minimal morbidity. Percutaneous fixation of adult Humerus fracture is a less time consuming procedure with minimal blood loss, minimal soft tissue disruption and facilitates natural healing at fracture site.
ABSTRACT
BACKGROUND: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. METHODS: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. RESULTS: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. CONCLUSIONS: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.