Sport specialization of female figure skaters: cumulative effects on low back injuries.

Objective: 1) to determine the proportion of sport specialization among female figure skaters, 2) to compare proportion of low back injuries between specialized female figure skaters and non-specialized female figure skaters, and 3) to identify an independent risk factor(s) for low back injuries in female figure skaters.Methods: A cross-sectional questionnaire study was used. Young female figure skaters were asked questions related to sport specialization and any history of low back injuries. The primary outcome variables were status of sport specialization, weekly training hours, and low back injury. Descriptive statistics, t-test, chi-square analyses, and binary logistic regressions were used.Results: Responses from 132 female figure skaters (mean age: 16.3 ± 2.7 years, age range: 8-22 years) were analyzed. Sixty-two percent (82/132) of figure skaters were specialized. Specialized female figure skaters spent more time in training (11.3 ± 6.5 hours/week) than non-specialized skaters (7.6 ± 4.9 hours/week, p = 0.001). No statistical differences were found in proportion of low back injury history between specialized (25.6%) and non-specialized female figure skaters (24.0%, p = 0.836). Chronological age was also identified as an independent risk factor for low back injuries in female figure skaters (aOR: 1.24, 95%CI: 1.00, 1.54, p = 0.048).Conclusions: The majority of female figure skaters in this cohort were specialized. An association between chronological age and low back injuries, found in the current study, may be a result of cumulative effects of participating in figure skating over time.

Back Injuries.

When searching for evidence-based answers about treating athletes with low back injury/pain, there are some difficulties. The first is defining who is an athlete. The second problem is that the lifetime prevalence of low back pain in the general population in our country approaches 100. Last, most studies published only deal with a narrow population of athletes, often performing very different types of physical activity. We searched the literature for studies that specifically evaluated athletes longitudinally. This article reviews the demographics, diagnostic challenges, history and physical examination, imaging choices, treatment, and controversies encountered when treating this population.

Increased overall and cause-specific mortality associated with disability among workers' compensation claimants with low back injuries.

BACKGROUND: Mortality tends to be higher among people who do not work than among workers, but the impact of work-related disability on mortality has not been well studied. METHODS: The vital status through 2015 was ascertained for 14 219 workers with an accepted workers' compensation claim in West Virginia for a low back injury in 1998 or 1999. Mortality among the cohort compared with the West Virginia general population was assessed using standard life table techniques. Associations of mortality and disability-related factors within the cohort were evaluated using Cox proportional hazards regression. RESULTS: Compared to the general population, mortality from accidental poisoning was significantly elevated among the overall cohort and lost-time claimants. Most deaths from accidental poisoning in the cohort were due to drug overdoses involving opioids. Mortality from intentional self-harm was also significantly elevated among lost-time claimants. In internal analyses, overall mortality and mortality from cancer, heart disease, intentional self-harm, and drug overdoses involving opioids was significantly associated with lost time. Overall mortality and mortality from drug overdoses involving opioids were also significantly associated with amount of lost time, permanent partial disability, and percent permanent disability. Heart disease mortality was also significantly associated with the amount of lost time. CONCLUSIONS: The results suggest that disability itself may impact mortality risks. If confirmed, these results reinforce the importance of return to work and other efforts to reduce disability.

Relationship between early prescription dispensing patterns and work disability in a cohort of low back pain workers' compensation claimants: a historical cohort study.

OBJECTIVES: To examine and compare whether dispensing of prescription opioids, non-steroidal anti-inflammatory drugs (NSAIDs) and skeletal muscle relaxants (SMRs) within 8 weeks after a work-related low back pain (LBP) injury is associated with work disability. METHODS: A historical cohort study of 55 571 workers' compensation claimants with LBP claims in British Columbia from 1998 to 2009 was conducted using linked compensation, dispensing and healthcare data. Four exposures were constructed to estimate the effect on receipt of benefits and days on benefits 1 year after injury: drug class(es) dispensed, days' supply, strength of opioids dispensed and average daily morphine-equivalent dose. RESULTS: Compared with claimants receiving NSAIDs and/or SMRs, the incidence rate ratio (IRR) of days on benefits was 1.09 (95% CI 1.04 to 1.14) for claimants dispensed opioids only and 1.26 (95% CI 1.22 to 1.30) for claimants dispensed opioids with NSAIDs and/or SMRs. Compared with weak opioids only, the IRR for claimants dispensed strong opioids only or strong and weak opioids combined was 1.21 (95% CI 1.12 to 1.30) and 1.29 (95% CI 1.20 to 1.39), respectively. The incident rate of days on benefits associated with each 7-day increase in days supplied of opioids, NSAIDs and SMRs was 10%, 4% and 3%, respectively. Similar results were seen for receipt of benefits, though effect sizes were larger. CONCLUSIONS: Findings suggest provision of early opioids leads to prolonged work disability compared with NSAIDs and SMRs, though longer supplies of all drug classes are also associated with work disability. Residual confounding likely partially explains the findings. Research is needed that accounts for prescriber, system and workplace factors.

[Traumatic dissection of the left renal pedicle in a young adult]. / Dissection traumatique de l'artère rénale gauche chez un adulte jeune.

Blunt trauma rarely causes renal pedicle dissection. Clinical signs are minimal and inconsistently reported. The diagnosis is based on computed tomographic angiography; arteriography is still useful when revascularization is considered. We report here a case of traumatic dissection with thrombosis of a juxta-aortic renal pedicle monitored in the intensive care unit. An endovascular procedure could not be proposed because of the juxta-aortic localization.

Prescription Dispensing Patterns Before and After a Workers' Compensation Claim: An Historical Cohort Study of Workers With Low Back Pain Injuries in British Columbia.

OBJECTIVE: Compare prescription dispensing before and after a work-related low back injury. METHODS: Descriptive analyses were used to describe opioid, nonsteroidal anti-inflammatory drug (NSAID), and skeletal muscle relaxant (SMR) dispensing 1 year pre- and post-injury among 97,124 workers in British Columbia with new workers' compensation low back claims from 1998 to 2009. RESULTS: Before injury, 19.7%, 21.2%, and 6.3% were dispensed opioids, NSAIDs, and SMRs, respectively, increasing to 39.0%, 50.2%, and 28.4% after. Median time to first post-injury prescription was less than a week. Dispensing was stable pre-injury, followed by a sharp increase within 8 weeks post-injury. Dispensing dropped thereafter, but remained elevated nearly a year post-injury, an increase attributable to less than 2% of claimants. CONCLUSION: These drug classes are commonly dispensed, particularly shortly after injury and dispensing is of short duration for most, though a small subgroup receives prolonged courses.

The association between a lifetime history of low back injury in a motor vehicle collision and future low back pain: a population-based cohort study.

PURPOSE: This population-based cohort study investigated the association between a lifetime history of a low back injury in a motor vehicle collision (MVC) and future troublesome low back pain. Participants with a history of a low back injury in a motor vehicle collision who had recovered (no or mild low back pain) were compared to those without a history of injury. Current evidence from two cross-sectional and one prospective study suggests that individuals with a history of a low back injury in a MVC are more likely to experience future LBP. There is a need to test this association prospectively in population-based cohorts with adequate control of known confounders. METHODS: We formed a cohort of 789 randomly sampled Saskatchewan adults with no or mild LBP. At baseline, participants were asked if they had ever injured their low back in a MVC. Six and 12 months later, participants were asked about the presence of troublesome LBP (grade II-IV) on the Chronic Pain Grade Questionnaire. Multivariable Cox proportional hazards regression analysis was used to estimate the association while controlling for known confounders. RESULTS: The follow-up rate was 74.8% (590/789) at 6 months and 64.5% (509/789) at 12 months. There was a positive crude association between a history of low back injury in a MVC and the development of troublesome LBP over a 12-month period (HRR = 2.76; 95% CI 1.42-5.39). Controlling for arthritis reduced this association (HRR = 2.25; 95% CI 1.11-4.56). Adding confounders that may be on the casual pathway (baseline LBP, depression and HRQoL) to the multivariable model further reduced the association (HRR = 2.20; 95% CI 1.04-4.68). CONCLUSION: Our analysis suggests that a history of low back injury in a MVC is a risk factor for developing future troublesome LBP. The consequences of a low back injury in a MVC can predispose individuals to experience recurrent episodes of low back pain.

Immediate postpartum neurological deficits in the lower extremity: a prospective observational study.

BACKGROUND: Neurological deficits noted immediately after childbirth are usually various obstetric neuropathies, but prospective studies are limited. The main study aim was to quantify and describe immediate postpartum neurological deficits of the lower extremity, including the buttocks. METHODS: A prospective observational study of postpartum women delivering in a single maternity hospital during three months of 2016. Among 1147 eligible women, 1019 were screened for symptoms of lower extremity numbness or weakness within eight to 32hours of delivery. Consent to undergo a detailed neurological evaluation was sought from those reporting symptoms. Risk factors were identified using logistic regression. RESULTS: Thirty five women (3.4%) reported symptoms, 27 entered the study and 23 (2.0%) had objective signs of a neurological deficit. The most common injuries were mild lumbosacral plexopathies and cluneal nerve compression. Most deficits were sensory, half of these also having a motor deficit that did not impact functionally. Based on analysis of 22 cases involving a likely intrapartum deficit, no association was found with parity, body weight, duration of labour, mode of delivery or neuraxial block. A past history of a neurological condition or a back injury was associated with odds ratios of 7.98 and 4.82 respectively. There were no neurological deficits that were clinically concerning or that were likely a complication of a neuraxial block. CONCLUSION: Transient neurological complications after labour and delivery are infrequent, mainly sensory involving multiple lumbosacral nerve roots or specific sacral cutaneous nerves, and they typically resolve within a short time.

Morel-Lavallee seroma (post-traumatic pseudocyst) of back: a rarity with management conundrum.

Morel-Lavallee seroma (MLS) or post-traumatic pseudocyst is a soft tissue seroma developing due to closed degloving injury by a shearing force that causes separation of subcutaneous fatty layer from the deeper muscular fascia resulting in collection of fluid in the created space. Presentation is usually fluctuant swelling following history of injury. More frequently described in orthopaedic literature, it occurs more commonly over gluteal and trochanteric regions, knee and flanks with occurrence over back, thorax being a rare entity. Despite mimicking several other similar presenting conditions, diagnosis of MLS can be made by meticulous history and physical examination with classical findings on ultrasonography, CT scan and MRI. Treatment modality may vary from conservative management to open surgical debridement of the wound with percutaneous aspiration and sclerodhesis forming useful adjuncts to conservative management.

Hepatotórax por rotura diafragmática postraumática tardía / Hepatothorax caused by a late post-traumatic diaphragmatic rupture

No disponible

An unusual case of a patient who presented with haemorrhagic shock following massive subcutaneous haematomas of the lower back due to blunt trauma.

An 83-year-old woman with no significant medical history was transferred to our tertiary hospital after being hit by a car and presenting with haemorrhagic shock. Immediate fluid resuscitation was performed; physical, chest/pelvic X-ray and echographic examinations did not detect any major sources of bleeding. However, a contrast-enhanced CT scan revealed multiple regions of significant contrast extravasation in an extensive part of the subcutaneous tissue of the patient's lower back, which is an unusual source of bleeding. Transcatheter arterial embolisation of the lumbar and internal iliac arteries and their branches was carried out. In addition, haemostatic resuscitation was performed for damage control resuscitation, which successfully resolved the patient's haemorrhagic shock.

A novel technique of anesthesia induction in supine position with impaled knife in the back.

Current technique of airway management for impaled knife in the back includes putting the patient in lateral position and intubation. We present here a novel technique of anesthesia induction (intubation and central line insertion) in a patient with impaled knife in the back which is simple and easily reproducible. This technique can be used for single lung ventilation using double lumen tube or bronchial blocker also if desired.

A population-based, incidence cohort study of mid-back pain after traffic collisions: Factors associated with global recovery.

BACKGROUND: Traffic collisions often result in a wide range of symptoms included in the umbrella term whiplash-associated disorders. Mid-back pain (MBP) is one of these symptoms. The incidence and prognosis of different traffic injuries and their related conditions (e.g. neck pain, low back pain, depression or others) has been investigated previously; however, knowledge about traffic collision-related MBP is lacking. The study objectives were to describe the incidence, course of recovery and prognosis of MBP after traffic collisions, in terms of global self-reported recovery. METHODS: Longitudinal data from a population-based inception cohort of all traffic injuries occurring in Saskatchewan, Canada, during a 2-year period were used. Annual overall and age-sex-specific incidence rates were calculated, the course of recovery was described using the Kaplan-Meier technique, and associations between participant characteristics and time-to-self-reported recovery were explored in 3496 MBP cases using Cox proportional hazards models. RESULTS: The yearly incidence rate was 236 per 100,000 population during the study period, and was highest in women and in young persons. The median time-to-first reported recovery was 101 days (95% CI: 99-104) and about 23% were still not recovered after 1 year. Participant's expectation for recovery, general health, extent of severely affecting comorbidities and having experienced a previous traffic injury were some of the prognostic factors identified. CONCLUSIONS: These findings show that MBP is common after traffic collisions, may result in a long recovery process and that a range of biopsychosocial factors are associated with recovery.

Sex differences in predicting chronicity of low-back pain after acute trauma using lumbar muscle area.

OBJECTIVE: The aim of this study was to investigate sex differences in predicting chronicity of low-back pain after acute trauma using cross-sectional areas of paraspinal (multifidus and erector spinae) and psoas muscles. DESIGN: Between January 2006 and December 2010, a total of 54 patients were interviewed at least 6 mos after the trauma event. The subjects were classified into chronic low-back pain group and improved low-back pain group according to the presence of low-back pain for more than 6 mos. The cross-sectional area of the multifidus, erector spinae, and psoas muscles was measured at the level of the lower margin of the L3 and L5 vertebrae using magnetic resonance imaging. RESULTS: The cross-sectional area of the multifidus and erector spinae muscles at L5 in the chronic low-back pain group was significantly smaller than that of the improved low-back pain group (P < 0.05) in the men. There were no significant differences in the other parameters between the groups in the men. There were no significant differences in any parameters in the women. CONCLUSIONS: In the men, the cross-sectional area of the multifidus and erector spinae muscles at the lower lumbar level can be considered to be prognostic factors for the chronic low-back pain after acute trauma. The authors thus suggest that strengthening of lumbar paraspinal muscles could be helpful for preventing chronicity of low-back pain.

Tratamiento de síndrome de espalda fallida con nucleolisis percutánea más bloqueo peridural y foraminal con ozonoterapia / Treatment of failed back syndrome with percutaneous nucleolisis and Epidural, foraminal Block with oxygen-ozone

Se realiza estudio prospectivo para demostrar que la nucleolisis percutánea, más el bloqueo peridural y foraminal con ozonoterapia es efectiva y muy segura para disminuir el dolor producido por síndrome de espalda fallida. Material y método: previo consentimiento informado, a 45 pacientes con síndrome de espalda fallida, se les realizó un total de 45 nucleolisis percutáneas, más bloqueo peridural y foraminal con ozonoterapia, durante un periodo comprendido entre mayo 2012 a mayo del 2013. Todas las nucleolisis se realizaron bajo control fluoroscopio con medidas de asepsia y antisepsia estrictas, y sedación consciente. A todos los pacientes, se les administró ozono en disco, peridural y foraminal (5-10 ml) a 10ug/ml, más procaina al 2% y 1cc de 40mg de cristales esteroideos; en todos los casos se administró 1gr. de cefacidal como profilaxis. Discusión: La eficacia del tratamiento, se basa en el control del dolor según la escala visual analógica basal (EVA 0), a los 30 días (EVA 1), a los seis meses (EVA 3) y a los 12 meses (EVA 6). Se aplicó el test de oswestry, antes del tratamiento y al final del estudio; a todos los pacientes se les realizo encuesta en la primera consulta, y luego al final del tratamiento con una respuesta satisfactoria(AU)

This prospective study is to demonstrate that percutaneous nucleolisys and epidural, foraminal block with oxygen-ozone is effective and very safe to decrease the pain from failed back syndrome. Materials and Methods: previous reported 45 patients with failed back syndrome consent to a total of 45 percutaneous nucleolisys more and foraminal Epidural blockade with ozone therapy was conducted over a period from May 2012 to May 2013 all nucleolisys were performed under fluoroscopic control measures strict asepsis and antisepsis, conscious sedation. All patients were administered ozone in disk, epidural and foraminal (5-10 ml) at 10 ug / ml over 2% procaine more steroidal 1cc 40mg of crystals, in all cases of cefaolin sodium 1grs administered prophylactically. Discution: The effectiveness of treatment is based on pain control by baseline visual analog scale (EVA 0), 30 days (EVA 1), six (EVA 3) and 12 months (EVA 6). By oswestry test evaluated before treatment and at study end; all patients were conducted survey in the first query and then at the end of treatment with satisfactory response

Absceso del músculo obturador interno: presentación de 2 casos / Internus obturator muscle abscess: Presentation of 2 cases

No disponible