Lateral epicondylitis; steroid injections for the management

To find out effectiveness of steroid injection for early management of lateral epicondylitis. One hundred and twenty Patients of both genders presenting with unilateral lateral epicondylitis of less than two weeks duration reporting at Outpatient Department at Armed Forces Institute of Rehabilitation Medicine, Rawalpindi. Quasi experimental study. Out patient department of Armed Forces Institute of Rehabilitation Medicine, which is the largest rehabilitation facility in the country at present offering a multidisciplinary approach in the management of disability and musculoskeletal disorders17. 01 yrs. Both groups had sixty cases each with a mean age of 35.1 +/- 6.22 and 36.08 +/- 5.98 respectively. There were 54[45%] males and 66[55%] females. At four weeks and three months follow up assessments there was significant improvement in pain relief and pain free grip strength in the Group A[steroids] as compared to Group B [NSAIDs]. Local steroid injection is an effective treatment with an advantage over nonsteroidal anti-inflammatory drugs [Diclofenac]. It results in a rapid and better relief of symptoms, which is sustained over a period of three months

Pit falls in stroke rehabilitation: a Pakistani perspective

To identify short comings in the stroke rehabilitation referral and consultation in Pakistan. Observational study. Stroke Clinic at Armed Forces Institute of Rehabilitation Medicine [AFIRM] Rawalpindi from March 2005 to September 2005. 171 patients of stroke fulfilling the inclusion criteria were enrolled in the study. Detailed history was obtained and a thorough examination with emphasis on neurological and musculoskeletal system was performed. Medical records and radiological investigations were reviewed. There were 132 [77.2%] males and 39 [22.8%] female patients. Radiological investigations were not available in some patients. In the remaining patients the frequency of Ischemic vs Hemorrhagic was 82% and 18% respectively .Involvement of right and left cerebral hemisphere was almost equal with 53% and 47% respectively. Majority, i.e 153 [89.5%] of the patients were referred as OPD cases while indoor rehabilitation consultation was made only for 18 [10.5%] patients. Only 04 [2.3%] patients were seen within 48 hours of stroke onset. In 39 [22.8%] cases consultation was made between one week to one month and for 116 [67.8%] between one to six months, while it was delayed beyond six months in 12 [7%] patients. Important shortcomings identified were non availability of physicians in rehabilitation medicine, late/ no referrals, inadequate referrals, long term placement of indwelling catheters and lack of patient and family education. Stroke is an important cause of long-term disability. Timely and comprehensive stroke rehabilitation minimizes the impairments and leads to successful reintegration of individual into the society. It is a poorly understood concept in Pakistan. Physicians are either not aware of the concept and significance of stroke rehabilitation or often confuse it with physiotherapy alone. There is a need to improve the stroke rehabilitation services in the country

Uro-dynamic evaluation

drsaqii1711@hotmail.com To describe the pattern of Urodynamic evaluation at Armed Forces Institute of Rehab Medicine, Rawalpindi. Descriptive study. This study was conducted on 466 patients reporting for urodynamic evaluation at Urodynamic/Incontinence Clinic at A F Institute of Rehab Medicine from Feb 2003 to Dec 2006. We considered the age, gender, etiology, reason for referral, and presenting complaints whereas results were formulated according to Classification of voiding disorders by International society of Incontinence. Data was analyzed using statistical package for Social Science version 10. In all [466] patients, 58% were males and 42% were females. Mean age was 46.8 years. Increased frequency [61%] and incontinence [52%] were the most common presenting complaints, 158[34%] had spinal cord injuries, 58 were cases of myelodysplasias and 128 reported with stress incontinence. Urodynamic studies showed that 152[33%] had hyperactive bladders, 110[24%] had a contractile/hypo-contractile bladders, 104[22%] had stress incontinence and 56[12%] cases had normal results. Urodynamics helps in diagnosis of potentially life threatening urinary problems. The availability of this equipment and trained staff must be encouraged at tertiary care hospital. More research is required in this regard in Pakistan, which shall help in formulating better management protocols in future

Role of therapeutic exercises in neurogenic thoracic outlet syndrome

Neurogenic Thoracic Outlet Syndrome [TOS] is a set of signs and symptoms existing due to compression of brachial plexus in the cervical area. We performed the study to highlight the role of therapeutic exercises on patients with neurogenic thoracic Outlet Syndrome. This quasi-experimental study was carried out at Armed Forces Institute of Rehabilitation Medicine [AFIRM], Rawalpindi. Fifty consecutive patients of neurogenic TOS of both genders and all ages were selected. Patients were diagnosed clinically and the diagnosis was confirmed by electrodiagnosis. These patients were asked to follow a therapeutic exercises program for 6 months. Outcome measures included Visual Analogue Scale [VAS] and Ulnar Nerve Conduction Velocity across neck. Results were compared by applying relevant tests of significance on follow up visits at 3 and 6 months. Mean age was 39.1 +/- 7.79 years. Thirty seven [74%] cases were females and thirteen [26%] were males. On each visit, statistical analysis showed significant improvement with therapeutic exercises. After 6 months of conservative treatment, 17 [34%] of patients showed full recovery, 14 [28%] had marked improvement, 16 [32%] had partial improvement while 3 [6%] patients reported with persistent severe symptoms. Current study shows that a trial of therapeutic exercises provides relief of symptoms of Neurogenic Thoracic Outlet Syndrome in majority of patients