Ultrasound-guided continuous costoclavicular block through retrograde stimulating catheter technique for postoperative analgesia in shoulder surgery: a case series

Abstract In five patient undergoing surgery for proximal humerus fracture we investigated into postoperative analgesia provided by continuous costoclavicular block using continuous stimulating catheter. The postoperative pain scores were less than 4 in all patients except in two patients who required intravenous tramadol 50 mg as a rescue analgesic. The radiocontrast dye study executed in two patients revealed contiguous contrast spread through the brachial plexus sheath with the catheter tip in the interscalene space. We propose that a continuous costoclavicular block with a retrograde stimulating catheter is a feasible alternative regional anesthesia technique for postoperative analgesia in shoulder surgery.

Circumpsoas block - an anterior myofascial plane block for lumbar plexus elements: case report

Abstract In an attempt to improvise the analgesia in patients with femoral fractures, we aimed at depositing local anesthetic deep to anterior psoas fascia (APf) under ultrasound (US) guidance to block lumbar plexus elements which emerge lateral, anterior, and medial to the psoas major muscle. We termed this as circumpsoas block (CPB). Clinical and computed tomography contrast studies revealed that a continuous CPB infusion with a catheter provided a reliable block of the lumbar plexus elements. No adverse were events noted. We conclude that US guided CPB is a reliable technique for managing postoperative pain after surgery of femur fractures.

Correlation of scapulothoracic muscle strength and functional activity in volleyball players

Background:Volleyball is the game in which upper extremities are mostly involved. This game needs repeated forceful high-speed upper limb activities required during training sessions and matches; which are reported to high incidence of shoulder injuries. This study is to correlate scapulothoracic muscle strength and functional activity in volleyball players.Methods:Study is cross sectional;correlational study was done with convenient sampling. Sample size was 55. Subjects were selected from all over Pune. Scapulothoracic muscles strength was measured (using the handheld dynamometer) in volleyball players which fitted in the inclusion and exclusion criteria and filleddisabilities of the arm, shoulder and hand (DASH)scale by every participantincluded in study. Correlated evaluated data using spearman rho method.Results:Study shows that all muscle carry good strength. Statistical analysis shows no significance, p value for all tested muscle is (p>0.05). Also DASHscale shows lesser score which indicates lesser difficulty to do functional activities.Conclusions:This study proves that there is no correlation between scapulothoracic muscle strength and functional activity in volleyball players

Immediate Effect Of Dry Needling Vs Ultrasound On Releasing Trigger Points In Quadriceps In Patients With Patello-Femoral Pain Syndrome On Pain

Background: Patello-femoral pain syndrome is a very common complaint seen in adolescence and young adults characterized by pain around and behind the patella. There has been prevalence of trigger points in the quadriceps leading to disruption of the VMO/VL firing pattern due to muscle inhibition by pain. Current studies suggest the use of strengthening exercises for hip and knee not focusing on releasing the trigger points. Releasing these trigger points could give additional benefit to the patient and can also be employed along with other conventional therapies. Purpose of the study: To find out which treatment method gives faster results and works directly on the pain and function of the patient. Objectives: To assess the immediate effect of Dry Needling Vs Ultrasound on releasing Trigger points in Quadriceps in patients with Patello-femoral Pain Syndrome on pain and knee/lower extremity function. Study Design: Randomized Control trail Setting: OPD setting. Participants: 70 patients with chronic anterior knee pain, without any ligament, bony or sensory involvement around the knee. Main outcome measures: Numerical Pain rating scale and Pressure Algometer. Results: In the ultrasound group there was a change of 38.60% seen in NRPS post values with a mean difference of 2.21±1.21 and for pressure algometer a change of 36.23% was seen with a mean difference of 3.08±4.40. In the dry needling group there was a change of 64.53% seen in NRPS post values with a mean difference of 3.07±1.48 and for pressure algometer a change of 56.86% was seen with a mean difference of 8.36±6.90. When compared within group dry needling had a better effect than ultrasound on both NRPS and Pressure algomter. Conclusion: The current study indicates that Dry needling is more effective than ultrasound for reducing pain and increasing functional outcome in patients with patellofemoral pain syndrome.

Study Of Relationship Between Fear Of Falling & Ability To Sit On & Rise From The Floor In Elderly Population

Background: Falls has been well established as one of the leading causes of mortality and morbidity among older adults.Falling in elderly persons can lead to disability, hospitalizations, and premature death. It can also lead to reduced levels of independence, poorer quality of life, and high levels of anxiety. It is proven that the elderly develop a fear of fall (FOF) due to the above mentioned consequences. They develop FOF with or without the history of fall. Increasing age is a significant predictor of FOF. FOF thus cause restriction in social participation and also restrictions in activities of daily living (ADL). Sitting on the floor is a tradition or a habit of Indians during activities like eating, praying, socializing etc., thus making it an important ADL. Thus, sitting and rising from the floor is a basic functional task for Indian population. The inability to sit and get up from the floor is closely related to the risk of falling, and if a fall has occurred, the capacity to return to an upright position is critical. Materials and Methods: The study included 210 community dwelling elderly population of an age group of 60-90 yrs, with an ability to sit on and get up from the floor. Individuals with any musculoskeletal, cardiorespiratory and neurological conditions were excluded. A physical assessment was done which included two tests. 1. Falls Efficacy Scale – International (in hindi) to assess fear of fall 2. Sitting Rising Test (SRT) to assess the ability to sit on and get up from the floor. A partial correlation analysis was conducted to find a relationship between Fear of Fall and the ability to sit on the floor after controlling for age. Alpha level is set as 0.05. Spearman’s rho test was used. Result: According to Spearman’s Rho’s Test of Correlation, Correlation between Fall Efficacy Scale – International & Sitting – Rising Test is -0.352. Thus showing that there is a Low Negative Correlation between the Fear of Fall and Ability to Sit on and Get up From the Floor. Conclusion: There is a relationship between Fear of Fall and the ability to sit on and get up from the floor in the elderly population.

Is The Unaffected Side Of Stroke Patients Actually Normal?

Objective: The aim of the study was to find how affected is the unaffected side of stroke population. Methods: 20 participants were recruited who met the inclusion criteria of more than 3-month first time unilateral both male and female stroke patients of age group 40-60 years were assessed and evaluated for the 3 parameters using grip dynamometer, peg board and reaction time machine respectively and compared it to the normal healthy age, gender and dominance matched individuals. Results: The unaffected side of stroke patients was significantly affected in gross motor strength, fine motor dexterity, reaction time audio and visual when compared to normal population. Conclusion: There are significant motor deficits seen in the unaffected side of stroke patients.

Effect Of Yogasanas On Menstrual Cramps In Young Adult Females With Primary Dysmenorrhea

Background: Dysmenorrhea- one of the most common gynecological complaints among young adult females. The effect of various yogasanas has proven to reduce the pain caused during menstruation as a result of hormonal changes. In spite of the various methods, most women usually prefer to take analgesics as a primary treatment and do not seek other forms of medical help. This study aims to underscore the importance of performing yogasanas and to highlight its importance as a non-pharmacological form of treatment. Method: This study was an experimental study which included a total of 80 subjects. Age group was between 18-22 years (mean age 20.3 ± 2.1). They were divided into 2 groups – experimental and control group .The experimental group were made to perform yogasanas while the control group was made to perform core exercises for 4 sessions in a week of which 2 were supervised sessions. Subjects were recruited using the Verbal Multidimensional Scoring System for Dysmenorrhea (VMSS) and they were assessed using Moo’s Menstrual Distress Questionnaire and Perceived Stress Scale. Statistical analysis was done of the Pre and Post data. Result: There was a significant difference within the groups (Experimental and Control) in regards to all the 3 outcome measures (P < 0.05). Between the groups, there was a significant difference (P < 0.05) in the VMSS and Moo’s MDQ questionnaire while there was no significant change in the PSS score (P 0.641). Conclusion: Both, yogasanas and core exercises can be used in reducing menstrual pain. These are cost effective and can be done as a home exercise to aid in menstrual well-being and to help improve one’s quality of life.

Is There A Correlation Of Muscle Strength With Respect To Energy Expenditure And Ambulatory Capacity In Patients With Spinal Cord Injury?

Background: Following the Spinal Cord Injury, patient’s ability for gait and endurance is been limited. Hence this further causes difficulty in managing activities of daily living and transfers. Thus reducing the ambulatory capacity and increasing patients dependability to be wheelchair bond and significantly affecting the use of lower limb muscle strength. This will eventually land in secondary complications. Muscle strengthening has been proved to be one of the important intervention. The purpose of this study is to quantify muscle strength with respect to its energy expenditure and later target those muscle group in improving their ambulatory capacity. Materials and Methods: Seventeen incomplete spinal cord injury patients were recruited. Their initial pre-assessment was done. Muscle strength and Ambulatory capacity was graded using Manual Muscle Testing and Ambulatory Capacity grading. Energy expenditure was calculated using Physiological Cost Index. Initial heart rate at rest was taken. Later subject had to walk for six minutes and post heart rate and laps were taken. Using Mac-Gregor equation energy expenditure was calculated. Results: The results interpreted that muscle strength to physiological cost index is negative correlation and to ambulatory capacity it is a positive correlation. Conclusion: There is correlation of muscle strength with respect to energy expenditure and ambulatory capacity in an incomplete spinal cord injury.

Determining The Prevalence Of Trigger Points In Acute Shoulder Pain Patients

Background: Shoulder pain due to its high prevalence has great significance in its contribution to morbidity. It’s the third most common musculoskeletal problem.There are two types of trigger points found they are active and latent trigger points.Active trigger points are the one which when palpated causes spontaneous pain or referred pain and latent trigger points are the one which do not cause any pain except they are present either in form of taut band or nodules. MyofascialTrigger points (MTrPs) cause a local pain syndrome. The main cause of myofascial pain syndrome are trigger points. Purpose of the study: The purpose of the study was to determine the exact muscles that have the tendency for developing trigger points in acute shoulder pain pathologies and to see the trigger points developed are due to the shoulder pathology. Materials and Methods: A observational study was performed. Patients were selected by convenient sampling. 70 people participated within the age of 18-65, pain duration within 3 months, males and female included with no history of recent trauma, neurovascular injuries, degenerative pathology and shoulder dislocation. Patients were assessed for myofascial trigger points (MTrPs) on both affected and non-affected side. MTrPs were assessed on different muscles by manual palpation method. Results: The result shows that the muscle affected maximum is upper trapezius with 84.28% and pectoralis major with 71.42%. Also on the affected side, upper trapezius with 37.14% and pectoralis major and subscapularis with 20.00%. Conclusion: This study showed the prevalence of trigger points in acute shoulder pain pathologies is66.59% . Each patient of any acute pathology had the presence of more than 3 trigger points in the affected side proving trigger points to be of significant importance and it is due to underlying shoulder pathology.

Prevalence of work related musculoskeletal disorders in truck drivers and its associated risk factors

Background: The main purpose of the study was to find out the different joints affected in the truck drivers and the associated-risk factors for musculoskeletal pain in this population due to the paucity of literature pertaining to Indian truck drivers.Methods: A self-administered closed-ended validated questionnaire was prepared by the researcher incorporated with Nordic musculoskeletal questionnaire and numeric pain rating scale and the participants were questioned using the same questionnaire and response was recorded by the researcher.Results: This study found a prevalence rate of work-related musculoskeletal pain to be 76.92% in truck drivers and the most commonly affected joints are lower back followed by the knee, shoulder and cervical spine. The factors which are found to be responsible for work related musculoskeletal pain in truck drivers are age, years of driving, number of driving days in a week, number of driving hours in a day, rest duration, posture, stress, vibration & poor condition of roads.Conclusions: It can be concluded from the results of this study that extrinsic factors do play a significant role in the causation of work-related musculoskeletal pain in truck drivers and are a leading cause for affecting the health of truck drivers and a frequent cause of sickness absente

Prevalence, severity and characteristics of work-related musculoskeletal disorders amongst obstetrics and gynaecology professionals

Background: Backache is a common cause of morbidity among doctors and 50% of the obstetricians and gynaecologists suffering from this attribute it to working posture. Occupational injuries are poorly analyzed amongst these professionals. Work related injuries have adverse effect on health and work performance due to discomfort caused by pain. Awareness of ergonomics, correct posture and strategical assessment of risk factors is needed for the prevention of work related musculoskeletal injuries amongst obstetricians and gynaecologists.Methods: A survey based study was performed. Informed consent was taken for participation. The questionnaire included 16 questions categorised into: demographics; injury data; impact of injury; and general mental health. Hard copy of the questionnaire and online forms of the questionnaire were used to complete the data collection.Results: The response rate for the survey was 85% of the doctors who reported to have experienced pain in the last year. The most common site was back, which was followed by the neck and knees. 71.4% of doctors reported injuries attributed to work.Conclusions: The result demonstrates the prevalence of work related musculoskeletal injuries and their effects. These injuries are highly underreported. Ergonomics and work related injury prevention in this profession is a suggestion for solution as more data is needed regarding the analysis and risk factor assessment.

Prevalence and risk factors for work related musculoskeletal disorders in flight attendants

Background: Flight attendants are the cabin crew members working in different commercial airlines. Their main job is to ensure safety and comfort of all the passengers. They are exposed to certain ergonomic stressors like long standing, irregular working hours and working in confined spaces and thus are likely to experience work related musculoskeletal disorders. The purpose of this study was to find out the prevalence and risk factors for work related musculoskeletal disorders in flight attendants.Methods: A survey-based study was performed. Self-made questionnaire was used and was validated by 3 experts in the Physiotherapy field. Workplace stress scale was also used to determine the level of mental stress that they experience. Informed consent was taken by each flight attendant participating in the study. Questionnaire was given to flight attendants working for different airlines like Spice Jet, Air India and Jet Airways. Hard copy of the questionnaire and online forms of the questionnaire were used to complete the data collection.Results: A total of 82% flight attendants reported to have work related pain in one or more body regions. Pain was commonly reported in feet and ankle, lower back and neck. Common risk factors were lack of rest breaks, prolonged standing/long working hours, wearing heels and mental stress.Conclusions: Thus, the study shows high prevalence of work-related musculoskeletal disorders in flight attendants.

Correlation between 6-minute walk distance and spirometry parameters in stable chronic obstructive pulmonary disease patients

Background: Six minute walk test (6MWT) is a sub-maximal exercise test, used as a clinical indicator of the functional capacity, in patients with cardiopulmonary diseases. It is simple, objective and reproducible test. The present study was designed to assess correlation of six minute walk test with spirometry parameters, in patients with chronic obstructive pulmonary disease.Methods: In this cross sectional study, fifty patients diagnosed with chronic obstructive pulmonary disease (GOLD criteria) coming to tertiary center were recruited according to inclusion and exclusion criteria. All patients underwent spirometric measurement. Spirometric indices including FEV1, FVC, FEV1/FVC and MVV were tested using computerized spirometer. 6MWT was performed following American Thoracic Society (ATS) guidelines. Percent (%) predicted 6MWD was calculated. Correlation between spirometry and 6MWT was assessed.Results: It was found that correlation between 6MWT and spirometry is statistically significant. There is significant strong positive correlation between percent predicted 6MWD and FEV1 (r=0.850 and p= <0.001), whereas there is significant moderate correlation between percent predicted 6MWD and FVC (r=0.554 and p= <0.001), FEV1/FVC (r=0.509 and p= <0.001) and MVV (r=0.615 and p= <0.001).Conclusions: In chronic obstructive pulmonary disease, percent predicted 6mwd significantly correlated with the spirometry parameters (FEV1, FVC, FEV1/FVC, and MVV). 6MWD decreases as there is decline in the pulmonary function. 6MWT can be a useful replacement of spirometry in assessment of severity of COPD.