ABSTRACT
Background: Diagnostic dilemma exists in differentiating between neck and shoulder pathology, as both can give a rise to shoulder and arm symptoms. In addition, the hypersensitivity of magnetic resonance imaging (MRI) scans may wrongly highlight non-clinically significant changes as potential targets for surgical intervention. The arm- squeeze test is a recognised recognized method used to help differentiate pathology arising from the shoulder or the neck. Performing this test preoperatively may prevent needless surgical intervention when diagnostic difficulties exist, even when MRI scans are not helpful. Case Presentation: We report the case of a 41-year-old male who initially presented with numbness and pins and needles in both arms. Following clinical review and an MRI scan of the cervical spine, the patient underwent an Anterior Cervical Discectomy and Fusion. Unfortunately, there was no relief of symptoms following surgery. A post- operative clinical review identified the shoulder as a potential cause of the symptoms. Conclusion: The arm- squeeze test is not popular and is not routinely used in shoulder and cervical spine examinations. However, it is recommended by National Institute for health and care excellence to help differentiate between neck and shoulder pathology, and, hence, dissemination of this information is vital.
ABSTRACT
BACKGROUND: Evidence regarding the effectiveness of using orthotics in improving comfort, increasing running speed and helping to reduce injury rate during running is limited and mixed. Alongside the increasing popularity of running is the increasing rate of running-related injuries (RRIs). Further research into whether orthotics could be used to help reduce RRIs would be highly beneficial for those affected. Additionally, there is a need to clarify whether orthotics use increases comfort during running and helps improve running speed. AIM: To investigate whether running with Aetrex Orthotics improves comfort and performance and reduces injury whilst running. METHODS: Runners were recruited on a voluntary basis if they were 18 or older with no serious health conditions, ongoing foot pain or deformity, previous foot surgery in their lifetime or any surgery in the past 6 mo. Participants were randomly assigned to either an intervention group or a control group. All participants were asked to complete runs and provide quantitative data regarding comfort during running, running time and distance, and any RRIs over an 8-wk study period. Participants in the intervention group ran with Aetrex L700 Speed Orthotics, whilst participants in the control group ran without orthotics. Other than the addition of orthotics for participants in the intervention group, all participants were asked to run as they usually would. This report presents preliminary data from the first 47 participants recruited for this study. Running speed was calculated from running distance and time and given in miles per hour. For each outcome variable, the mean for each group, effect size and 95% confidence interval were calculated, and a t-test was performed to determine if between-group differences were statistically significant. RESULTS: Data for all three primary outcomes was provided from a total of 254 runs by the 23 participants in the intervention group and a total of 289 runs by the 24 participants in the control group. Participants in the intervention group reported higher comfort scores (8.00 ± 1.41 vs 6.96 ± 2.03, P ≤ 0.0001), faster running speeds (6.27 ± 1.03 vs 6.00 ± 1.54, P = 0.013), and lower RRI rates (0.70 ± 1.01 vs 1.21 ± 1.53, P = 0.18) than those in the control group. These findings were statistically significant for comfort and running speed but not for RRI rate, with statistical significance considered if P < 0.05. No adjustments were made for group differences in age, gender, tendency for RRIs or usual running speed. CONCLUSION: This preliminary report provides evidence for orthotics use in increasing comfort levels and running speed, but no significant difference in RRI rate.
ABSTRACT
The number of spinal surgeries performed is increasing. Along with this comes an increase in iterative surgeries. Each surgery that a patient undergoes has an increased risk of complication and a decreased success rate compared to the last. We present a case of a 51-year-old female who continues to experience debilitating low back pain following three double fusions performed over four years. The patient describes that she is in more pain now than before any previous surgical intervention. Following these surgeries, the patient has been forced to take early retirement, frequently uses a wheelchair and requires assistance with daily activities. The role of iterative surgery in healthcare needs to be re-assessed. The poor outcomes, especially following tertiary and quaternary surgery, question the use of iterative surgery entirely.
