Therapeutic exercise in the treatment of patients with lumbar spinal stenosis.

Lumbar spinal stenosis is a condition that may cause significant pain and associated disability, especially in older patients. It is being recognized with increasing frequency as the population continues to age, and is the most common diagnosis associated with lumbar spine surgery in patients older than 65 years of age. The natural history of lumbar spinal stenosis is not necessarily one of progressive deterioration. Conservative treatment is advocated in patients with mild to moderate symptoms of lumbar spinal stenosis, and may include therapeutic exercise. The therapeutic exercise program must be prescribed with a thorough understanding of the contributing pathoanatomic and pathophysiologic factors, and should be tailored to each patient based on his or her history and physical examination. Components of the program are described in detail and include specific stretching and strengthening exercises, general conditioning exercises, and education in proper posture and body mechanics. Randomized controlled studies are needed to help clarify the indications for conservative versus surgical treatment, to determine which components of the therapeutic exercise program are the most beneficial, and to compare outcomes after conservative or surgical measures.

Sciatic neuropathy secondary to a uterine fibroid: a case report.

Lesions of the sciatic nerve outside the pelvis have been well described. Lesions within the pelvis, however, are far less common. We report the case of a 55-yr-old woman with a history of chronic low back pain who presented with progressive right buttock and posterolateral right lower limb pain associated with right foot numbness and tingling. She denied any associated low back or left lower limb pain. The patient was initially treated for a probable right lumbosacral radiculopathy, without improvement. A subsequent magnetic resonance image of the lumbosacral spine revealed multilevel disc degeneration at L3-4 through L5-S1, without disc herniation or canal stenosis. A magnetic resonance image of the pelvis revealed a markedly enlarged uterus, with a large pedunculated myoma impinging on the right sciatic foramen. The patient underwent a subtotal abdominal hysterectomy, with resolution of her right lower limb pain. This case illustrates the importance of considering intrapelvic causes of sciatic neuropathy. To our knowledge, this is the first reported case of sciatic neuropathy secondary to a uterine fibroid.

Pectoralis major rupture during gait training: case report.

Rupture of the pectoralis major muscle is rare. The majority of cases have been reported in young, healthy athletes during strenuous activities such as weight-lifting, wind surfing, and football. The injury is thought to result from either a forceful contraction of the muscle applied to an immovable object or a sudden stretching force applied to the contracting muscle. This report describes a case of a 79-year-old man with a history of severe degenerative joint disease of the right hip and a recent left transtibial amputation secondary to a failed arterial bypass procedure. During prosthetic training the patient developed acute pain in the left shoulder and left axilla, which prevented him from further ambulation. Physical examination was consistent with a partial rupture of the pectoralis major. The causative factors of pectoralis major rupture in this patient are reviewed. To our knowledge, this is the first such case reported.

Spinal accessory nerve palsy as a cause of pain after whiplash injury: case report.

Spinal accessory nerve injury is most commonly reported following surgery in and around the posterior cervical triangle. Pain, impaired ability to raise the ipsilateral shoulder, and scapular winging on abduction of the arm are the most frequently noted clinical manifestations. We report the case of a collegiate swimmer who developed left-sided neck and shoulder pain secondary to a spinal accessory nerve palsy (SANP) after a "whiplash injury," which we believe to be the first such reported case in the English language literature. We review the clinical manifestations, diagnostic pitfalls, and therapeutic approaches to SANP. A high index of suspicion for SANP following whiplash-type injury will ensure its earlier detection and treatment and improve the chances of a better functional outcome.

Common peroneal neuropathy secondary to squatting during childbirth.

BACKGROUND: Common peroneal neuropathy occurs fairly frequently in the adult population; however, very few cases of peroneal neuropathy after prolonged squatting have been reported. CASE: A 29-year-old woman noted right foot numbness and weakness immediately after childbirth, which involved 15-30 minutes of pushing in a squatting position. Physical examination and an electrodiagnostic study confirmed a common peroneal neuropathy. The patient was referred for rehabilitation, including bracing and gait training, which improved substantially her mobility and function. CONCLUSION: Prolonged squatting should be minimized or avoided. A high index of suspicion for peroneal neuropathy after prolonged squatting must be present. Early diagnosis and treatment may limit the number of complications in these patients, particularly falls.

Bilateral femoral neuropathy complicating a combined laparoscopic-vaginal procedure.

Excision of a longitudinal vaginal septum combined with operative laparoscopy for treatment of pelvic adhesions was complicated postoperatively by a profound bilateral femoral neuropathy. Prolonged operating time and excessive abduction and lateral rotation of the hip joints may have been contributory factors.