Degenerative physiochemical events in the pathological intervertebral disc.

Low back pain is one of the commonest musculoskeletal complaints that affects individuals of all ages and is a leading contributor towards work loss worldwide. The range of current treatment modalities involving surgeries, injectable agents, and medications is promising but cannot address the reasons behind the occurrence of pain in patients with degenerative disc pathologies. One possible factor for the limited success is the lack of evidence behind the identification of early, intermediate, and late stages of painful changes methodologically in a vast group of populations and the manifestation of the diseases in terms of increased physical activity, hereditary patterns, and various risk factors. However, despite these challenges, steady progress has been achieved in understanding the parameters in abnormally loaded progressively degenerating discs and these features have been elucidated at a physical, biochemical, and cellular level. These recent findings can likely lead to the development of therapeutic interventions that will identify and retard tissue damage, decrease pain, and improve the quality of life in these patients. Therefore, the main aim of this review is to integrate recent updates in intervertebral disc degeneration research for the development of evidence-based screening protocols and more targeted interventions in the management of low back pain.

Variations of extensor pollicis brevis tendon in Indian population: A cadaveric study and review of literature.

OBJECTIVES: Variations of the tendons of the first dorsal compartment of the wrist may be one of reasons of treatment failure and recurrence in De Quervain's tenosynovitis (DQT). The present cadaveric study was designed to look into the variations of the Extensor pollicis brevis (EPB) tendon in Indian population. METHODS: Seventy-seven formaldehyde-fixed cadaveric upper limbs of Indian origins were dissected to observe the number of EPB tendons and its variations. RESULTS: The EPB muscle was found to be absent in one hand (1.3%). The EPB muscle was found with single tendon, two tendons and three tendons in 73 limbs (94.8%), 2 limbs (2.6%) and one limb (1.3%) respectively. The muscle originated from the posterior surface of the radius and the adjacent interosseous membrane. The EPB muscle with single tendon was found to be inserted into the distal part of dorsal surface of the proximal phalanx of the thumb in 44 limbs (57.1%). In limbs with bitendinous EPB, the tendon slips were inserted into the base of proximal phalanx and into the base of distal phalanx of the thumb. An Osseo-fibrous septum separating EPB from Abductor Pollicis Longus (APL) was observed in 45 limbs (58%). CONCLUSION: EPB in first extensor compartment of Indians is usually monotendinous. It mostly inserts into the distal part of dorsal surface of proximal phalanx of thumb and into the base of distal phalanx. In majority of the wrists, one may find an osseofibrous ridge separating EPB from APL. These anatomical variations may be helpful to guide proper treatment in de Quervain's tenosynovitis.

Anatomical variation of abductor pollicis longus in Indian population: A cadaveric study.

BACKGROUND: Many authors have reported the anatomical variation of abductor pollicis longus (APL) around the wrist and its association with de Quervain tenosynovitis (DQT), first carpo-metacarpal arthritis, and trapezio-metacarpal subluxation. From Indian subcontinent, there is only one original article and a few case reports on the variability of APL tendon insertion. MATERIALS AND METHODS: Fifty formaldehyde preserved cadaveric wrists were dissected to look for the anatomical variation of APL in the Indian population. RESULTS: The APL was found with single tendon in 2, double in 31, triple in 8, and quadruple in 8 extremities. A maximum of 6 tendon-slips were found in one cadaveric wrist. In all hands, the APL had at least one attachment to first metacarpal bone and in 46 hands (92%), there was second insertion to the trapezium bone. Of all tendon-slips of APL (n = 126), 44% of tendons (68 tendons) were inserted into the base of the first metacarpal bone. This was followed by the insertion into the trapezium in 42% tendons (52 tendons). CONCLUSION: Bi-tendinous APL is commonly observed on the dorsal compartment of the wrist in Indian population and these tendon-slips are commonly attached to the first metacarpal base and trapezium. This variation must be understood by the Indian Orthopedic surgeons as the response to treatment of DQT and reason for first carpo-metacarpal arthritis can be dependent on this anatomical variation.