Extracorporeal shock wave therapy for treatment of plantar fasciitis.

OBJECTIVE: To explore the effect of extracorporeal shock wave therapy in patients with chronic plantar faciitis. METHODS: The prospective study was conducted at Department of Orhopaedic, Regional Hospital, Limerick, Ireland from January to December 2004 and comprised 70 heels in 62 patients with chronic plantar fasciitis in whom conventional conservative treatment consisting of non-steroidal anti-inflammatory drugs, heel cup, orthoses and/or shoe modifications, local steroid injections had failed, and they were treated with low energy extracorporeal shock wave therapy. Patients were reviewed at 6, 12 and 24 weeks post treatment. RESULTS: At follow-up there was significant decrease in pain on the visual analogue scale (p < 0.027), with significant improvement in pain score (p < 0.009) and in functional score (p < 0.001). The comfortable walking distance had increased significantly and there were no reported side effects. CONCLUSION: Extracorporeal shock wave therapy is a new modality providing good pain relief and a satisfactory clinical outcome in patients with chronic plantar fasciitis.

Limited knee extension--a reliable indicator of a successful closed reduction of developmental dysplasia of hip.

A clinical observation of 49 hips in children who had closed reduction and application of hip spica for developmental dysplasia of hip (DDH) was undertaken in our department. A clinical sign of "Limited Extension at ipsilateral knee" was observed after successful closed reduction of the hip. This sign was absent if the hip was not reduced. This sign was due to hamstring tightness after successful closed reduction. We suggest that the presence of this sign is a reliable indicator of successful closed reduction and also an indicator of the vulnerability of the proximal femoral epiphysis to increased pressures during positions of immobilization.

Myeloma with predominant phalangeal involvement.

A case of plasma cell myeloma involving the middle phalanx of the ring finger is reported. This was a case of a non-secretory myeloma; however, monoclonal immunoglobulins were demonstrated by immunohistochemical studies. Plasma cell myeloma with phalangeal involvement is extremely rare: our literature search disclosed only two well-documented cases. Plasma cell myeloma may occur in the hand, so it should be considered in the pre-biopsy differential diagnosis when bone lesions radiologically consistent with myeloma are encountered.

Medium to long-term functional outcome of patients after chemonucleolysis.

Chemonucleolysis is an established modality in the treatment of lumbar disc prolapse and has been widely used for over 39 years since its introduction by Lyman Smith in 1963. We report the medium to long-term functional outcome of patients who had chemonucleolysis for single level disc prolapse. One hundred and twelve patients were reviewed retrospectively with a mean follow-up of 9.5 years. The Oswestry Disability Index questionnaire was used to estimate the functional outcome of chemonucleolysis. An excellent or good response occurred in 79 patients (70.5%) while 12 patients (10.7%) showed moderate response with minimal disability. Treatment failed in 21 patients (18.5%) who showed poor response and 12 of these 21 patients went for surgery within a mean period of 6 months. One patient had surgery at a different level than chemonucleolysis. There was only one incident of procedure termination because of epidural contrast leak. There was no case of anaphylaxis or discitis. We concluded on the basis of our results that in carefully selected patients, chemonucleolysis is a safe and effective treatment modality for lumbar disc herniation with good medium to long-term functional outcome.