Impact of three-phase bone scintigraphy on the diagnosis and treatment of complex regional pain syndrome type I or reflex sympathetic dystrophy

To determine the impact of three-phase bone scintigraphy [TPBS] on the diagnosis and management of complex regional pain syndrome type I [CRPSI] or reflex sympathetic dystrophy [RSD]. Twenty consecutive patients with a recent clinical evidence of CRPSI were referred for TPBS as part of their routine management plan. All patients underwent neurological examinations with special attention to the evaluation of clinical features of vasomotor, sudomotor, motor and sensory dysfunction. Patients were followed prospectively. When both the clinical and TPBS results supported the diagnosis of CRPSI, patients were started on treatment. Of the 20 patients, TPBS supported the diagnosis of RSD in 9 who were treated with steroids and physiotherapy. Complete follow-up was available for 7 of them and all had a satisfactory response to treatment. For the remaining 11 patients RSD was diagnosed clinically but not confirmed by TPBS. On follow-up there was no evidence that TPBS failed to identify RSD in these 11 patients. The results indicate that TPBS confirmed the clinical diagnosis of RSD, and, more importantly, had a significant impact on its management.

Incidence of musculoskeletal pain in adult Kuwaitis using the validated Arabic version of the WHO-ILAR COPCORD Core Questionnaire

The WHO-ILAR Community Oriented Program for Control of Rheumatic Diseases [COPCORD] primarily aims to estimate the burden of musculoskeletal symptoms/disorders. We estimated the incidence of musculoskeletal pain in the first community-based COPCORD study in Kuwait. The validated Arabic version of the WHOILAR COPCORD Core Questionnaire was used in a survey of 2500 randomly selected Kuwaiti households to assess the frequency of musculoskeletal pain, disability, and health-seeking behavior in adult Kuwaitis. Those subjects reporting no musculoskeletal pain were identified and followed-up for a period of one year by contacting them every 2 weeks. Once a respondent reported pain, an appointment to report to hospital was offered and the subject was examined by a rheumatologist using American College of Rheumatology [ACR] criteria. Of 5159 adults who were non-complainers in an earlier prevalence phase of the study, 3341 responded to phone calls [response rate of 65%]. The incidence of musculoskeletal pain was 6.6% [95%CI, 3.4%- 9.7%]. Age- and sex-adjusted incidence rates were 7.2% [95%CI, 3.4%- 10.5%] for females and 6.1% [95%CI, 3.1%-9.2%] for males. The incidence rate increased with increasing age, body mass index, and with being married. The common sites of pain were knee, low back and shoulder. The incidence of musculoskeletal pain among Kuwaiti adults is reported for the first time. Further studies adopting the same instrument in other communities are warranted to compare with our findings

Rheumatic diseases: knowledge update on scintigraphic assessment

Scintigraphy has a role in the diagnosis and follow up of rheumatic diseases, in that it can provide important complementary information along with the clinical and radiographic evaluations of different disease conditions of the joints and periarticular structures. The scintigraphic pattern of different arthropathies varies depending on the type and phase of the condition. Some conditions affect mainly small or large joints while others affect both, in either a symmetric or asymmetric fashion. Radionuclides used in the diagnosis and follow up of these conditions include Tc99m MDP [Methylene diphosphonate], In-Ill labeled leucocytes, labeled poly and monoclonal antibodies such as Tc99m-labeled human polyclonal immunoglobulin G and Tc99m-anti-E-selectin-Fab, Tc99m-HIVIPAO labeled leukocytes, Tc99m SC [Sulfur Colloid], Tc99m nanocolloid and F-18 FDG [Fluorodeoxyglucose]. SPECT [Single Photon Emission Computed Tomography] and pinhole techniques add a diagnostic value to the scintigraphic methods. F-18 FDG positron emission tomography has a potential to quantitatively assess the degree of arthritis activity

Is low back pain prevalent among Kuwaiti children and adolescents?

To measure the magnitude of the problem of low-back pain among 10- to 18-year-old Kuwaiti schoolchildren in Hawalli Governorate. Subjects and A cross-sectional multistage stratified random sample of 400 schoolchildren [199 males and 201 females] of ages 10-18 years were selected from two junior and two high schools in Hawalli Governorate, Kuwait. Data on age, gender and characteristics of low-back pain such as duration, location and frequency were collected through personal interviews using a questionnaire. Low-back pain was defined as pain in the back from the 12th rib to the buttock area. According to our definition, reported lifetime prevalence of low-back pain was found to be 57.8% [50.8% in male and 64.7% in female students], while the point prevalence was 35% [20.6% in male and 39.3% in female students]. More female students reported low-back pain than male students, and the prevalence of low-back pain was found to increase with age in both sexes. The age of onset of low-back pain was 14 years in males and 13 years in females. The majority of students [92.1% in males, 84.6% in females] reported pain in the low back. Almost 46% of students related their low-back pain to accidents. A significantly higher proportion of male students [58.4%, compared to females 36.2%] reported low-back pain caused by accident or with duration of recovery less than a week [21.8% for males as compared to 16.2% for female students]. Female students reported more recurrent or continual low-back pain. Low-back pain is common among Kuwaiti students in Hawalli Governorate. Prevalence of low-back pain increased with age in both sexes. Female students reported more frequent low-back pain than male students

Prevalence of low back pain among physical therapists in Kuwait

To determine the life and point prevalence rates and study the characteristics of work-related and non-work-related low back pain [LBP] among physical therapists in Kuwait and its effect on their regular activities. Subjects and A specially designed self-administered questionnaire was distributed to 143 physical therapists in Kuwait. The questionnaire included demographic data, history and characteristics of LBP before and after working as a physical therapist, the effect of LBP on regular activities and current LBP. A visual analogue scale was used to score the intensity of the pain. One hundred [70%] of the 143 physical therapists completed the questionnaire; mean age and standard deviation of the respondents were 35.9 +/- 8.45 years. The lifetime prevalence of work-related LBP was 70% [61.8% in males and 74.2% in females] and the point [current] prevalence rate was 57% [31.6% in males and 68.4% in females]. All the 100 therapists were college graduates who worked full-time and 82% were employed in general hospitals and rehabilitation centers. The most common areas of specialty were orthopedics [32%] and neurology [23%]. Fifty% reported that LBP affected their regular activities, 28.6% reported limitation due to pain and 11.4% changed their work settings because of LBP. The main site of pain was at low back and buttocks. Pain intensity was scored similarly among male and female physical therapists. Work-related and point prevalence rates of LBP among physical therapists in Kuwait are high and affect their daily activities, necessitating changes in work settings

Normal values of lower limb nerve conduction in Kuwait. Part II

To establish the normal electrophysiological values of the common lower limb nerves and to study the relationship of conduction velocity [CV] of the lower limb nerves to height and age in healthy adult subjects. Nerve conduction investigations were performed on the lower limbs of 51 screened healthy volunteers using standard electrophysiological techniques. Fifty-one subjects [21 males and 30 females] participated in the study. The mean [ +/- SD] ages of the subjects were 38 [ +/- 8.82] and 36 [ +/- 8.58] years for males and females, respectively. The tibial motor nerve showed a mean [ +/- SD] CV of 46.1 [ +/- 3.3] m/s, distal latency [DL] 4.4 [ +/- 0.8] ms, and amplitude 8.8 [ +/- 3.4] mV for males. For females, the results were CV 47.8 [ +/- 3.4] m/s, DL 3.9 [ +/- 0.85] ms and amplitude 12.0 [ +/- 3.4] mV. Peroneal motor parameters were CV 47.1 [ +/- 3.3] m/s, DL 3.9 [ +/- 0.53] ms, amplitude 5.6 [ +/- 2.2] mV for males and 49.3 [ +/- 2.3] m/s, 4.0 [ +/- 0.56] ms, 6.0 [ +/- 2.2] mV for females, respectively. The sural sensory nerve parameters were CV 48.7 +/- 6.0 m/s, DL 2.9 [ +/- 0.3] ms, amplitude 18.9 [ +/- 3.3] micro V for males and 51.5 [ +/- 4.9] m/s, 2.7 [ +/- 0.24] ms and 21.6 [ +/- 6.3] micro V for females. Most CV values were significantly correlated with height, and there was a significant difference between males and females. However, after adjustment for height by the linear regression method, all significant gender differences disappeared. This study established the normative conduction parameters of the commonly tested nerves of the lower limbs for our electromyography laboratory in Kuwait. Gender differences disappeared when the data were adjusted for age and height