Radial nerve injuries; presenting as wrist drop-analysis of 100 patients

To highlight etiological factors leading to radial nerve injury resulting in wrist drop, with particular reference to iatrogenic causes. Retrospection and Descriptive. One hundred patients of all ages and both sexes with wrist drop. Data of clinical assessment after detailed history and examination as well as electro diagnostic studies was recorded on pre-designed assessment proforma. The outcome was charted down for frequency of etiology of the wrist drop. Rehabilitation Medicine Department of Combined Military Hospital [CMH] Multan and Armed Forces Institute of Rehabilitation Medicine [AFIRM]. The major cause of injury was splinter/gun shot injury 31%, mis-placed injection at mid-arm 21%fracture of humerus was 21%, compression neuropathy 16%, and stab wound 11% caused wrist drop. Electro-physiological studies revealed that 85% patients had injury to radial nerve at mid-arm, 9% had injury to posterior interosseous nerve while 4% had injury to superficial branch of radial nerve and only 2% had normal study. Electrodiagnostic studies also revealed that majority of the patients suffered from axonotmesis [44%] and neurapraxia [38%], whereas [16%] were neurotmesis. The most common cause of radial nerve injury is trauma. It is also found that the frequency of radial nerve palsy due to iatrogenic causes is quite high. In addition to the clinical examination, the nerve conduction studies and electromyography proved to be the better investigation technique in the assessment of the location, severity and extent of the peripheral nerve injury and subsequently guides in starting the proper treatment option due to early referral of patient to the concerned fields

Treatment of acute lumbago; low dose diclofenac sodium with vitamin-B complex compared with diclofenac alone

To determine whether concomitant use of vitamins B1, B6, B12 along with low dose of diclofenac sodium causes quicker pain relief in patients of acute lumbago compared with diclofenac sodium alone. A randomized clinical trial. Surgical Department of C M H Attock. From September 2004 to August 2005. A total of 50 patients were selected for the study. The patients complaints were of acute lumbago of less than 3 days duration with severe impairments of movements. The age group of patients was between 20 and 65 years. The patients were randomly assigned into two groups. Group I was prescribed tablet diclofenac sodium 25mg along with vitamin B-complex containing combination of 100mg thiamine nitrate [B1], 100mg pyridoxine hydrochloride [B6], and 200mcg cyanocobalmine [B12] three times a day. Group II patients were prescribed 25mg of tablet diclofenac sodium alone. Improvement in the intensity of pain at rest and during movements [as assessed by the patients] was noted in accordance to visual analogue scale 1 to 10. The effectiveness of diclofenac sodium in combination with vitamin-B complex with diclofenac sodium alone was judged on the basis of extent of pain relief after 7 days of treatment. A total of 25 patients were treated with combination of diclofenac sodium and vitamin-B complex [Group I] and 25 were treated with diclofenac sodium alone [Group II]. As far as the extent of pain relief in first 7 days is considered, 22 patients [88%] belonging to group I and 10 patients [12%] belonging to group II had an excellent pain relief and were able to carry on with their normal routine activities. Remaining 3 patients in group I were completely relieved of pain in next 3 days while 15 patients in group II had to complete another 10 days for complete cure. To test the statistical significance of the result chi-square test was applied and the result showed that patients of Group I responded significantly well to the treatment as compared to those in Group II. Using the parameters of pain relief and movements of vertebral column, the combination of diclofenac sodium and vitamin-B complex was found to be more effective mode of treatment as the duration of treatment and the dosage of diclofenac sodium was less and also relief of pain was more rapid