Sonographically guided intratendinous injections of hyperosmolar dextrose/lidocaine: a pilot study for the treatment of chronic plantar fasciitis.

OBJECTIVE: To report on the effectiveness of sonographically guided injections of hyperosmolar dextrose at reducing the pain associated with chronic plantar fasciitis. DESIGN: Case series. SETTING: Ultrasound division of St Paul's Hospital. PATIENTS: 20 referrals (3 men, 17 women; age 51 (SD 13) years) from local sports medicine primary care practitioners who had failed previous conservative treatments. INTERVENTIONS: A 27-gauge needle administered a 25% dextrose/lidocaine solution under sonographic guidance at 6 week intervals returning for a median of three consultations. MAIN OUTCOME MEASURES: Visual analogue scale (VAS) items for pain levels at rest (VAS1), activities of daily living (VAS2), and during or after physical activity (VAS3) were recorded at baseline and at the final treatment consultation (post-test). A telephone interview conducted an average of 11.8 months after the post-test consultation provided a measure of long-term follow-up. RESULTS: 16 patients reported a good to excellent outcome, while the symptoms in 4 patients were unchanged. There was a significant decrease (p<0.001) in all mean VAS items from pre-test to post-test: VAS1 (36.8 (SD 25.6) to 10.3 (10.9)), VAS2 (74.7 (20.8) to 25.0 (27.7)) and VAS3 (91.6 (9.2) to 38.7 (35.1)) and there were no apparent changes after the follow-up interview. CONCLUSIONS: Sonographically guided dextrose injections showed a good clinical response in patients with chronic plantar fasciitis insofar as pain was reduced during rest and activity. Further studies including a control group are needed to validate these outcomes.

Work-related repetitive strain injury and leisure-time physical activity.

OBJECTIVE: To investigate the relationship between leisure-time physical activity and work-related repetitive strain injury (RSI), adjusted for sociodemographic characteristics and work-related physical and stress factors. METHODS: The data source was the 2003 Canadian Community Health Survey, a national cross-sectional survey of 134,072 respondents. The analysis was limited to a sample of the survey population reporting full-time work during the past 12 months (n = 58,622). The outcome of interest was work-related RSI of the upper body. Multiple logistic regression was used to examine the relationship between the outcome and leisure-time physical activity level, adjusted for sociodemographic, health, and occupational characteristics. The potential effect of leisure-time physical activity with a high upper-body load was investigated in a secondary analysis. RESULTS: The prevalence of upper-body work-related RSI was 5.9% in the Canadian population in 2003. An active lifestyle during leisure time was associated with a lower prevalence of work-related upper-body RSI (odds ratio 0.84, 99% confidence interval 0.75-0.95), after adjustment for work physical demands and other covariates. Female sex, obesity, smoking, age, work-related stress, and work physical demands were associated with RSI. In the secondary analysis, we did not find that participating in leisure-time activities with a high upper-body load was a risk factor for RSI. CONCLUSION: Our study results indicate that being physically active during leisure time is associated with a decreased risk of upper-body occupational RSI, adding another potential health benefit to participation in leisure-time physical activity.

Effect of body posture and time on grip strength in patients with cervical spondylosis.

Ninety-eight patients with cervical spondylosis were tested for grip strength in different spinal postures (standing and sitting), but with standard upper arm position. Unilateral symptoms of cervical spondylosis significantly affected grip strength in that arm whether or not it was the dominant upper limb, in contrast to normals. Grip strength is stronger in the standing position than in a sitting posture with the neck flexed (P < 0.01; at 10 min), and this effect is increased by duration in the posture.

Fatal outcome of pelvic radiotherapy for carcinoma of the cervix in a patient with systemic lupus erythematosis.

Although there is an impression that patients with connective tissue disorders tolerate radiotherapy less well than other patients, this is not well documented in the literature. We present the case of a patient with a 7-year history of systemic lupus erythematosis who developed fatal pelvic necrosis as an unexpectedly severe complication after radiotherapy for carcinoma of the cervix.

Clinical skills of medical residents: a review of physical examination.

Students are introduced to techniques of physical examination at medical school. However, their skills are deficient at the time of graduation, and with the increasing shift of clinical teaching away from the bedside and into the conference room it is expected that these skills will weaken in succeeding generations of physicians. A practical and satisfactory method of addressing this problem during internship and residency training has not been forthcoming because of the lack of a regular forum for the teaching of clinical skills in busy tertiary referral hospitals and the shortage of teachers with the necessary skills and commitment to teaching a large number of house staff. We describe a program whose unique hierarchical approach has permitted a detailed ongoing review of physical examination. One clinician was able to teach 24 residents by instructing a small group of senior residents, who in turn, after practising with clinical clerks, taught groups of junior residents.

Physician retirement: a case for concern in Canadian hospitals.

Mandatory retirement is being challenged on the basis of age discrimination, and physicians are not divorced from this social trend. In January 1982 legal precedent was set by the Manitoba Court of Appeal concerning the retirement policy for physicians in Canada. Currently, Canadian hospital bylaws include clauses that require a change in membership status once a physician reaches 65 years of age. The main arguments in favour of this change include easier physician manpower management, ensured public safety and, in some instances, greater productivity. The main arguments against this change include loss of income to physicians, loss of skilled manpower to the profession and adverse effects on the mental and physical health of retiring physicians. In an effort to resolve this conflict some Canadian hospitals are developing strategies for reviewing the specific privileges and responsibilities physicians will retain once they reach age 65. The medical staff of the Victoria General Hospital in Halifax, NS have addressed this issue through their annual reappointment process.