Sensori-motor Recovery In Post-stroke Shoulder Subluxation: A Non Invasive Correlation Study

Background: Stroke is the most common neurological condition causing long term disabilities in various ways.Post-stroke shoulder subluxation, mainly the Gleno-humeral Subluxation (GHS) of the affected side is oftendetected as a complication. Numerous theories exist to explain the pathomechanics of developing GHS,butstudies regarding its relationship with the sensori-motor recovery of the affected limb is still controversial.Aim of Study: To ascertain the correlation between Gleno-humeral subluxation with sensori-motor recovery ofthe affected upper limb following stroke.Method: This correlation study was conducted on 30 patients of both sexes within the age group of 45-65 yearswith post-stroke (duration < 6weeks) Gleno-humeral subluxation( GHS). Screening of GHS was done by palpationand degree of GHS was quantified by High resolution USG by measuring the Acromion - Greater TuberosityDistance difference (AGTDD) between two shoulders. Sensorimotor recovey of the affected limb was assessed byFugl - Meyer Assessment Scale of Upper Extremity (FMA-UE). Data collected at the baseline (visit1), at 6 weeks(visit 2), 12 weeks (visit 3) and at the end of the study i.e 24 weeks (visit 4).Results: Pearson Correlation (r) in all visits (V1: r=-0.926, p=0.000. V2: r=- 0.947, p=0.000. V3: r=- 0.912, p=0.000.V4: r=- 0.924, p=0.000) established a statistically significant negative correlation between degree of shouldersubluxation and sensory-motor recovery.Conclusion: Post-stroke GHS is a significant complication which undoubtedly plays a cardinal negative roleduring sensori-motor recovery of the affected upper limb.KEY WORDS: Gleno-humeral subluxation (GHS), Acromion-Greater Tuberosity Distance difference (AGTDD),

Ontogeny Recapitulates Phylogeny: Communication Between the Musculocutaneous Nerve: A Case Report.

Neural variations of the brachium constitute important anatomical and clinical entity.Abnormal variations of median nerve, musculocutaneous nerve and their communicating branches have been reported very frequently by the anatomists in the past. The nerves of the extremities are particularly vulnerable to injury because of their long course and superficial distribution. Present report describes a case of a single abnormal communication between median and musculocutaneous nerve encountered in a 55 year old Indian male cadaver during routine undergraduate dissection. Knowledge of such anatomical variations is important while planning surgery in the region of axilla or arm as these nerves are more liable to be injured during surgical procedures as well as may result in unusual entrapment neuropathies. Clinical significance of such type of variation in the light of its developmental origin has been discussed.

Unilateral Incomplete Superficial Palwar Arch: A Case Report.

The functional importance of hand is revealed by its rich vascularity contributed by superficial and deep palmar arches (SPA and DPA).Superficial palmar arch is located superficial to flexor tendons, and deep palmar arch deep to lumbrical muscles. Variations are found more often in SPA than DPA, later being more or less constant. During routine undergraduate dissection, we observed, unilateral incomplete SPA being formed by superficial palmar branches of ulnar and radial artery in the right hand of a male cadaver. These two arteries remained independent without anastomosis forming incomplete arch (SPA).The superficial branch of ulnar artery entered hand superficial to flexor retinaculum and supplied middle, ring and little finger by three branches. The superficial branch of radial artery via its two branches supplied index finger and thumb. Classical SPA formation was seen on left side. The presence of an incomplete SPA as in this case is a potential danger in RA harvesting for CABG.Variations in SPA play a pivotal role in microvascular surgical procedures of hand, RAinterventions and arterial graft applications.

Bodies do Matter: Rethinking Anatomical Pedagogy, from the Scalpel to the Mouse: A Review.

Anatomy and dissection have long been considered a cornerstone in medical education, irrespective of nation, racial background or medical school. By learning gross anatomy, medical students get a first “impression” about the structure of human body which is the basis for understanding pathologic and clinical problems. Anatomy teaching methodology has been revolutionized in the 2Ist century, due to time constraints, less availability of cadavers, stress on computer aided learning, scarcity of qualified teachers, changes in the demands of medical profession and neglect of vertical integration of anatomy teaching. Until recently, dissection and didactic lectures were its sole pedagogy, worldwide. But over the last few decades, traditional anatomy teaching based on topographical structural anatomy taught in lectures and gross dissection classes has been replaced by a vivid range of study modules like problem based learning(PBL) and computer assisted learning(CAL),and curricula integration. Though the anatomy curriculum is undergoing international reformation but it lacks uniformity among institutions. The available modern international literature, describing various methodologies for teaching/learning anatomy conclude that Anatomists are constantly debating over the following questions-How much to teach, when to teach and how to teach gross anatomy. We endeavor to answer these questions and contribute to the debate on the ideal methodology for teaching /learning anatomy. Alternative strategies and resources are also discussed so that we can re establish more effective teaching /learning tools while maintaining the beneficial values of orthodox dissection .If we are not concentrating on optimum anatomy education, it will inevitably lead to incompetent anatomists and healthcare professionals, leaving patients to face unwanted consequences of medical error.

Reminiscencing the Genetics of Orofacial Clefting.

Cleft lip with or without cleft palate is the most common craniofacial birth defect (1/1000 live births), caused by a complex interaction of chromosome rearrangements, genemutations as well as environmental influences. The frequent occurrence of orofacial clefting, along with their extensive psychological, surgical, speech and dental involvement emphasize the importance of identifying the underlying etiology. Rare cleft forms, where they occur as a component ofmultiple congenital anomaly syndromes, haveMendelian or Teratogenic origins; the non-syndromic forms of orofacial clefts are more common and are probably due to secondary geneenvironment interactions. The purpose of our review is to provide a short summary of the vast spectrum of genetic architecture of orofacial clefting covering both syndromic as well as nonsyndromic forms of clefting .Although the gene identification process for orofacial clefting in humans is in an early stage (especially in India); the research pace is rapidly accelerating worldwide. Ongoing human genomewide linkage studies have identified regions that are likely to contain genes that when mutated cause orofacial clefting .Our main aim is to bring together a discussion of new and previously identified candidate genes to create a more cohesive picture of interacting pathways that shape the human craniofacial region. In addition, sequencing of protein coding regions in candidate genes and screening for genetic variation in noncoding regulatory elements, will help in the area of advanced research. Furthermore, statistical geneticists are developing new methods to characterize both gene-gene and gene-environment inter-actions, for explaining the pathology of this common birth defect. The ultimate goal of these studies is to provide knowledge for more accurate risk counseling and the development of preventive therapies. Though India has an estimated population of one million untreated cleft patients, facilities for its treatment have been limited and are not evenly distributed across the country. Paucity of committed cleft surgeons, poverty, illiteracy, superstitions, poor connectivity in some remote areas; severely limit the chances of an average cleft lip Indian child from receiving rational and effective treatment for his malady. The Oscar winning documentary film “Smile Pinki” highlighted the plight of cleft patients in our country. The film stood testimony to the passion of dedicated doctors, social workers and paramedical staffs toiling in the Indian heartland as they treated unfortunate cleft children with the support of the “Smile Train Project”.

Hemimelia: Mystery Unravelled.

Hemimelia (Greek Hemi + melos i.e Half limb) is a developmental anomaly characterized by the absence or gross shortening of lower portion of one ormore of the limbs. The condition may involve either or both bones of distal arm or leg. It is designated according to which bone is absent or defective as fibular, radial, tibial or ulnar hemimelia. In this study, I have analysed the details of a series of case reports, comprising of tibial (rarest form) and fibular (commonest form) hemimelia. The cases have been managed by physical medicine experts. The subjects aremanaging their ADL (Activities of daily living) bymeans of orthoprosthesis provided to them. Though the exact etiology is unknown, probable causes are- disruptions during the critical period of embryonic limb development (i.e 4th to 7th week of IUL), vascular dysgenesis, viral infections ,trauma and environmental influences ( like smoking) and thalidomide embryopathy etc. For optimum functional result in hemimelia patients our target is – “Reconstructive surgery and prosthesis adapted to growth together with regular post operative follow up and rehabilitation.”

Brittle Bones, Unbreakable Spirit: Osteogenesis Imperfecta: A Case Report.

Osteogenesis imperfecta (OI, Fragilitis Ossium or Brittle bone disease) is a group of rare inherited disorders with a broad spectrum of clinical and genetic variability. It is characterized by fragile bones that are prone to fracture often from mild trauma or with no apparent cause. People with OI are born with defective connective tissue or without the ability to make it, usually because of a deficiency of Type1 collagen. Incidence of OI is estimated to be one per twenty thousand live births. Eight types of OI can be distinguished. Most cases are caused by mutations in the COL1A1 and COL1A2 genes. We have reported a special case of OI, probably belonging to Type III group. The subject visited the PMR (Physical Medicine & Rehabilitation) OPD of Bankura Sammilani medical college (BSMC), Bankura ,West Bengal, India.. The details of etiology, diagnosis, genetic causes and treatment will be discussed in the study. Diagnosis of OI is based on clinical features and may be confirmed by collagen or DNA testing. There is no cure for OI. Our management is aimed at increasing over all bone strength to prevent fracture and maintain mobility. Nevertheless, life style modifications by adaptive equipments, oral drugs (Bisphosphonates) and Intramedullary rod insertions, provide a significant degree of autonomy to OI patients.

Medical Mystery: Ectrodactyly A Case Report.

Congenital absence of all or part of one ormore fingers or toes is defined as Ectrodactyly. It is the word derived from Greek ektromameaning “abortion” and dactylymeaning digits. Also called split hand or footmalformation (SHFM), Ectrodactyly is a rare limb malformation with median cleft of hand and foot and aplasia or hypoplasia of the phalanges, metacarpals andmetatarsals. Irregular pattern of inheritance exists for ectrodactyly;may be autosomal dominant, autosomal recessive or X linked. In this condition, themedian cleft of the hand gives the hand, the appearance of lobster claws- so also called ‘Lobster Claw Hand”. Ectrodactylymay be very commonly associated with other anomalies of face, eyes and skeletal system. We report a rare case of unilateral ectrodactyly of right hand .The present case is not associated with any other anomaly as described in various textbooks and reference articles. The details of etiology, diagnosis, genetic causes, association with other anomalies and treatment will be discussed.