Outcome of manipulation under anaesthesia in adhesive capsulitis patients

Frozen shoulder although considered self remitting disease causes significant level of pain and stiffness. This study was planned to determine the immediate outcome of manipulation under anaesthesia [MUA] in patients with adhesive capsulitis in terms of gain of range of movement [ROM] and pain relief. Diagnosed cases of adhesive capsulitis [30 in number], who had symptoms of pain and stiffness lasting more than 2 months eventually underwent MUA. They were interviewed immediately before and after MUA to check the difference in pain intensity and ROM. All the subjects had significant improvement [p < 0.001] in range of motion in flexion followed by abduction and medial rotation. Least improvement [mean 2.06 / n=30] was observed in range of movement in external rotation. Significant decrease [p < 0.001] in pain intensity from mean intensity of 3.66 to 2.1 was seen. Hence, MUA is treatment indicated for those who are not responding to conservative methods of treatments.

Leg length discrepancy; the reliability of tape measure method

Leg length discrepancy [LLD] has been deemed one of the causative factors for back, sacroiliac conditions and hip pathologies in patients. Increased LLD can exacerbate musculoskeletal impairments in patients that would require the clinician to reflect on the appropriate treatment strategies. The objective of the study was to measure the reliability of "Tape Measure Method" in Leg length discrepancy. This is a hospital based study. The procedures for obtaining leg length measures in the study were similar to those described by Magee DJ [Orthopedic physical assessment. 5thed].The primary investigator briefly reviewed the procedures for measuring the leg length with the subjects. Only the subject's right side was measured for the study. The subject's weight and height were measured using a standard scale and recorded. The first rater palpated the prominent aspect of the ASIS. The rater then guided the string to the prominent aspect of the MM. The rater repeated this procedure three times for each subject. After the first rater obtained three strings that correspond to the leg length, the second rater repeated the three measurements using the same procedure. After all cuts of strings were obtained each rater measured the lengths of his three strings with a standard tape measure and was recorded on a separate data sheet. Each rater was blinded to the other measures. Means and standard deviation for each subject's age, height, weight and BMI were measured. Mean standard deviation and 95% Confidence interval [95% CI] for leg length measurements for both raters are provided in Table 2. According to the results derived from data there were no significant differences in leg length measures between Rater 1 and Rater 2 [t-value = - 0.000; df = 58; p-value = .9981]. The ICC [3, 3] for Rater 1 was .999, [95% CI = .998 to .999]. This value indicates almost perfect agreement between the measures for Rater 1. The ICC [3, 3] for Rater 2 was .979 [95% CI = .962 to .990]. These findings are indicative of almost perfect agreement between the measures. The ICC [2, 2] between Rater 1 and Rater 2 was .987 [95% CI = .972 to .994]. A Bland-Altman plot identifies any bias between the two raters. The bias line is almost on zero, indicating no bias between the two raters. It can be concluded that any observed bias was not clinically important. Conclusions and Discussion: It was concluded measuring leg length using the tape measure was simple and highly reliable. There were several limitations that may have influence overall results of the study