Bilateral spontaneous anterior shoulder dislocation: A missed orthopedic injury mistaken as proximal neuropathy / 中华创伤杂志(英文版)

A number of orthopedic injuries can occur during epileptic seizures. Anterior shoulder dislocation is one such orthopedic injury that is quite rare. The shoulder dislocation may injure the brachial plexus. Besides seizures, the nerves can also be damaged by anticonvulsive therapy. Muscle wasting following a seizure can misguide a clinician to investigate only neural or muscular pathologies. We report here an individual with epilepsy who was referred to us for electrodiagnostic evaluation of proximal muscle wasting related to a suspected proximal neuropathy. He was found to have a normal electrodiagnostic evaluation and later on discovered to have had bilateral shoulder dislocation on X-rays. This report advocates a thorough clinical appraisal, radiographs, and electrodiagnostic evaluation in a case with muscle wasting following a seizure.

Congenital anonychia totalis: a rare occurrence in a Pakistani family

Anonychia totalis is a rare disease characterized by complete absence of finger and toe nails. Possible associations include anomalies of bones, teeth, skull, hair, skin and sweat glands besides hearing and intelligence impairments. We report here a 60-year-old woman with low back pain and tenderness at the lumbosacral spine who was found to have complete absence of all nails, abnormal teeth, dry skin and left ectropion. She was educated about the disease and managed for the backache on rehabilitation guidelines. Gene mapping of her whole family was planned, but she was lost to follow up. This case provides evidence of the presence of this condition in Pakistani population. There is a need for further investigation and pooling of cases to build clinical data about phenotypes and the inheritance patterns of this disorder in our population

diagnostic dilemma of progressive muscular atrophy

Progressive muscle atrophy is a rare subtype of motor neuron disease that affects only the lower motor neurons and presents as asymmetrical rapidly progressive muscle weakness, atrophy and normal sensations. The diagnostic electrophysiological findings are denervation potentials in three out of four body segments [bulbar, cervical, thoracic and lumbosacral]. The disease is fatal and the management is supportive. We present the report of a 45-year-old female patient who presented with unilateral foot drop and rapidly progressed to profound weakness in muscles of all limbs, neck and back along with dysarthria and dysphagia. She had been operated twice for suspected cervical and lumbosacral intervertebral disc herniations and ultimately guided in right direction after muscle biopsy, nerve conduction studies and electromyography

Frequency and the related socio-demographic and clinical factors of phantom limb pain in traumatic amputees presenting at a tertiary care rehabilitation setup

Objective: To find out the frequency of phantom limb pain [PLP] in a sample of Pakistani amputee population presenting with amputation due to trauma and to investigate its relationship with different sociodemographic and clinical factors

Study Design: A cross-sectional descriptive study

Place and Duration of Study: Armed Forces Institute of Rehabilitation Medicine, Rawalpindi from August 2010 to October 2013

Material and Methods: Through non-probability purposive sampling, patients of both genders and all ages having a traumatic etiology of amputation were sampled from the outdoor amputee clinic and the indoor amputee ward. Patients having diabetes mellitus, polyneuropathy, memory loss, cognitive deficits and established history of psychiatric disorders were excluded. Through face to face semi structured interviews, information was obtained about presence of PLP, gender, location [urban or rural], ethnicity based on Pakistani provinces [Punjab, Sindh, Khyber Pakhtunkhwa, Balochistan, Azad Jammu and Kashmir], monthly income in Pakistani Rupees [PKR] [<10,000, 10,000 - <50,000 and >50,000], level of education [grade <5, grade 5 - 10, and grade >10], level of amputation and cause of trauma [fall from height, motor vehicle accident, blast injury, bullet injury or others]

Results: Out of 268 patients [mean age 28 +/- 6 years], 266 [99.3%] were male and 2 [0.7%] were female. Majority [79.1%] were rural based, Punjabis [44.8%], had a monthly income <10,000 PKR [85.4%], education from grade 5 - 10 [80.2%] and a lower limb amputation [86.9%]. The commonest cause was blast injuries [72.8%]. PLP was present in 42.5% [n=114] of the individuals and it was not significantly related to gender, living location, ethnicity based on Pakistani provinces, level of education, monthly income, cause of traumatic amputation and level of amputation

Conclusion: PLP was found in 42.5% of our sample of Pakistani traumatic amputees. The frequency was not related to gender, monthly income, ethnicity based on provinces, education, rural or urban based living and etiology or level of amputation

Frequency, character, intensity and impact of neuropathic pain in a cohort of spinal cord injury patients

The purpose of this study was to determine frequency, character, approximate location and intensity of neuropathic pain in spinal cord injury and its impact on the quality of life. A cross-sectional survey. Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi from Feb 2009 to Feb 2010. Through non-probability convenience sampling 87 patients of both genders diagnosed with spinal cord injury based on American Spinal Injury Association criteria and admitted within a year of injury were included. Those in spinal shock, having poor cognition, inability to communicate, concurrent brain injury and history of chronic pain before injury were excluded. The history, localization and characteristics of the pain and interference with life activities were recorded. Neuropathic pain of patients was evaluated with Leeds Assessment of Neuropathic Symptoms and Signs Pain Scale. Visual analogue scale was used to measure the severity of pain. Out 87 [mean age 36.9 years] seventy four were male and 13 were female. Seventy patients [80%] were AIS-A, 6 [7%] were AIS-B and 11 [13%] were AIS-C. Neuropathic pain was present in 57.5% [n=50]. Most of the patients localized their pain below the neurological Ievel of injury [78%] and rated pain intensity as [moderate pain] [54%]. Majority [48%] described the pain as burning fallowed by electric shock like [42%], stabbing [8%] and pricking [2%]. 48% patients reported that their quality of life was affected due to pain. 52% required two analgesics of different groups to relieve pain followed by 40% requiring three Analgesics and 8% requiring one analgesic. Neuropathic pain is prevalent in people with spinal cord injury and adversely affects life quality. Neuropathic pain is primarily described as a burning sensation of moderate intensity mostly referred to below the neurological level of injury

Spinal cord injury without radiographic abnormalities [SCIWORA] in a preschool child: a case report

A 3, 1/2 year old boy presented at the Soldiers' Family Rehabilitation Unit, Armed Forces Institute of Rehabilitation Medicine, Rawalpindi with 2, 1/2 years' history of weakness and numbness in legs and loss of control over bowel and bladder following run over by a vehicle. At presentation, the child was unable to stand without support with power of 2/5 in iliopsoas, 3/5 in extensor hallucis longus and 0/5 in ankle plantar flexors on both sides. The power in quadriceps was0/5 on right and 2/5 on left side. The knee and ankle jerks were absent bilaterally. Sensations to both light touch and pin prick were impaired below T9 level on both sides. Perianal sensations were intact but voluntary anal contraction was absent. He was categorized as a case of Spinal Cord Injury T9 as classified by American Spinal Injury Association [ASIA] with impairment Scale C. X-Rays and Magnetic Resonance Imaging Scans were normal. These investigations aided by relevant clinical features qualified him as a case of Spinal Cord Injury without Radiographic Abnormalities

Congenital insensitivity to pain with anhidrosis: a case report from Pakistan and literature review

Congenital insensitivity to pain with anhidrosis is a rare disease with an autosomal recessive inheritance. The patients present in early childhood with frequent episodes of fever and absence of sweating. Painless fractures, bruises and cuts are quite common. Defective lacrimation and mental retardation are strongly diagnostic. Repeated injuries often lead to a reduced life expectancy. The diagnosis depends on relevant clinical features, abnormal sensory response on nerve conduction studies and nerve biopsy showing loss of the unmyelinated and small myelinated fibers. We report here a 5 year old female child who presented for electrodiagnostic evaluation and was found to have this disease