Consultation for a third opinion on bone health Case Was it really another case of "tennis elbow"?
Bisphosphonates and peri-prosthetic osteolysis Case A young engineer with disabling sciatic pain Case The "wonder drug" glucosamine Case Hyaluronan for knee OA, facts vs. High heels woes Case Silent bone loss and Vitamin D insufficiency Case A professor suffering from OA knee pain Case New physical sign in carpal tunnel syndrome Case Kinesiophobia Case Breakthrough fracture while on bisphosphonates Case Can back pain be predicted?
Enthusiasm for "non-fusion technology" for discogenic back pain Case Extra busy banker troubled by subacute back pain, yet no time for physiotherapy Case Metal-on-metal hip surface replacement Case An athlete going for anterior cruciate ligament reconstruction with little time for rehabilitation Case The office lady with neck, shoulder, arm, and back pain Case Bone health and space travel Case Crouch gait Case Non-healing diabetes mellitus heel ulcer Case Cervical disc replacement Case Intractable lateral epicondylitis Case Chronic LBP in a laborer whose job requires repeated lifting Case Stiffness after flexor tendon repair Case Postpartum sacroiliac joint pain Case In this case, emphasis was put on first regaining full ROM, then stressing the proprioceptive stimulation at the very end of motion ranges that help stimulate the firing of proprioceptive receptors, followed by isokinetics machine re-training for the shoulder.
The occupational therapist of our team meanwhile reinforced the importance of good posture as well as provision of ergonomic advice concerning the use of a visual-display unit. Sensorimotor rehabilitation and serial assessment by a physiotherapist, with monitoring of therapy by graphical representation on the shoulder isokinetic machine were arranged. Vestibular symptoms was present in this patient and were dealt with by ENT surgeons, and rehabilitation here involved exercises challenging and improving her balance function, head-eye coordination exer- 26 Case 4 Fig.
A SOT sensory organization test is often ordered as well Fig. Jaw-neck dysfunction was present in Sharon and she was referred for assessment and management by combined consultation of dentists as well as maxillo-facial unit staff. Our dentist performed a functional examination of the stomato-gnathic system, and the other unit arranged therapeutic jaw exercises for Sharon.
Whiplash-associated Neck Disabilities 27 Changes were also detected in muscle activation patterns in this whiplash patient and arrangement was made for ambulant myofeedback training and forms the rationale of adding bio-feedback to our program Voerman et al. We followed the strategy as suggested by Voerman, where feedback was provided whenever muscle relaxation was insufficient as the author does not use botox for this condition, although this has been reported recently in the literature. Trigger point injections sometimes do help ,however, and are done with the help of physiotherapist who helped the author to map out the points beforehand.
In more difficult cases, muscle activation patterns were compared during rest, typing, and stress tasks by surface electromyography before commencement of therapy. Rehabilitation of the deep longus capitus, longus colli, semispinalis cervicus, and segmental multifidus was stressed by recent researchers, but most cases already responded pretty well to the afore-mentioned programs Conley et al.
J Neurosurg Spine, would have been prescribed. Although a recent meta-analysis Conlin et al. These complex symptoms may involve jaw-neck motor control dysfunction, oculomotor and vestibular dysfunction, altered sensorimotor processing and muscle activation patterns, and even dysphagia. Since the above symptoms need dedicated specialists across different specialties, a multi-disciplinary team is frequently needed, especially for those patients who present late, despite the fact that some recent papers have challenged the use of multi-disciplinary teams.
As for physical therapy, emphasis on the training of deep longus capitus, longus colli, semispinalis cervicus, and segmental multifidus is recommended Conley et al. Techniques like PEMF and even radiofrequency neurotomy may be considered as a last resort.
An occasional case may have the rehabilitation process hampered by on-going law suits and secondary gain issues that may affect prognosis. Whiplash-associated Neck Disabilities 29 References 1. Adams H, Ellis T, et al. You got a call from your old friend Paul who is the athletics trainer of the football club to which John belongs because Paul is worried about the right knee of his top player.
In the latest soccer match, John had persistent pain and on and off swelling of his right knee after a tackle from behind during the match.
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A radiograph was taken as arranged by the team physician and was passed as normal. The clinical notes of the team physician recorded no signs of cruciate, meniscal or collaterals injury. However, you did notice a subtle abnormality in the lateral radiograph of the right knee Fig. How would you proceed assuming that subsequent arthroscopy confirmed a 6-cm, full-thickness, cartilaginous defect at the trochlea of the right knee with no kissing lesion, no tibio-femoral mal-alignment, no evidence of arthrosis elsewhere and no sign of meniscal or cruciate ligament injury?
John, in addition, asked about the likelihood of generalized arthrosis as a sequela of the lesion — what are your views? Autologous chondrocyte implantation ACI should be considered when larger defects are presented in the younger patient. If there is already existing osteoarthritis, ACI is not recommended. Up till now, there has been no significant difference in outcomes comparing ACI and mosaicplasty or microfracture in the literature.
The membrane is of porcine origin with a bi-layered structure, an outer flat layer with low friction and closely aggregated fibers, and an inner surface that is rough with a loose arrangement of collagen fibers presenting a larger surface area for chondrocyte adhesion. Electron Sizable Cartilage Defect in a Professional Footballer 33 microscopy done previously confirmed chondrocyte migration to this membranous scaffolding. Following matching to the chondral defect, the chondrocyte seeded membrane will be secured by fibrin glue. Mechanical injury induces damage to the tissue matrix directly or mediated by chondrocytes via expression of matrixdegrading enzymes and reduction of biosynthetic activity.
This is because the natural history of many chondral lesions has not been proven beyond doubt. Later in the course of rehabilitation, muscle strengthening commences and we also place stress on patient education. Newer techniques including the use of Atomic Force Microscopy, which can assess in detail the topography of bio-engineered cartilage.
Thus, for the first time, atomic force microscopy was used to characterize surface topography of tissue-engineered cartilage Romito et al. The natural history of the full-thickness chondral defect has not been completely elucidated. However, the most popular techniques like microfractures, etc. Steinwachs M, Kreuz PC, et al.
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Arthroscopy, 23 4 —7 Romito L, et al. The mother told you that Mary nearly tripped over twice in the past month. Subsequent kinematics profile Fig. Elective right distal rectus transfer was performed with re-attachment of the tendon ends to semitendinosus. Postoperatively, there was marked improvement in slope and magnitude of knee flexion in both late stance and early swing as reviewed by the kinematics profile.
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What benefits, if any, do you think preoperative gait analysis may help in the decision-making process regarding this child with a functional knee problem? Discussion Spasticity, muscle contracture formation, impairments of motor control, weakness, balance deficits, and extrapyramidal motions can all contrib- Functional Knee Complaints in a Child with Cerebral Palsy 39 ute to the functional limitations imposed at the knee.
Careful clinical evaluation of the child and their gait must be performed in order to determine the best individual course of treatment. Often, three-dimensional motion analysis with assessment of muscle activity and force is necessary to completely assess the complexities of gait. Commonly seen compensation strategies include circumduction, external rotation of the affected side, as well as contralateral vaulting. The etiology is frequently spasticity of the rectus femoris — often unmasked by previous distal hamstring lengthening. The Ely test was shown to have a good positive predictive value i.
As for the role of gait analysis, it is most useful to have the preoperative EMG during gait analysis to confirm a spastic and overactive rectus femoris co-spasticity in swing before proceeding to surgery.
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Most units perform rectus transfer medially to the medial hamstring — commonly semitendinosus — while at the same time lengthening the medial hamstring. Sewing the end of the rectus to the cut end of the semitendinosus gives greatest arm movement, and is preferred to simple distal release. Dynamic EMG in gait analysis is most useful in confirming an abnormal rectus femoris muscle firing pattern in swing before we embark on surgery.
Distal rectus transfer with re-attachment to the semitendinosus gives greatest arm movement, and is preferred against simple distal release or proximal release and represents the treatment of choice in most cases. Chambers HG Treatment of functional limitations at the knee in ambulatory children with cerebral palsy. Eur J Neurol.
go to site Six days ago, Elizabeth noticed sudden onset of pain and weakness during the explosive action of sprinting and heard an audible pop at the time of injury. There followed posterior right thigh pain near the beginning of the sporting event making her unable to continue to play. Besides pain, Elizabeth experiences a feeling of inadequate leg control and reports pain while sitting or walking up and down stairs, and she also noticed that her posterior thigh was bruised.
Elizabeth attributed her right leg injury to lack of adequate warm-up. On examination, Elizabeth had pain with active knee flexion against resistance, performed with the hip in a neutral position and the knee in an extended starting position. A subsequent radiograph did not reveal any bony avulsion, but a subsequent MRI showed an incomplete hamstring tear at the proximal myotendinous junction of the right leg.
Discussion Hamstring injuries are the most prevalent muscle injury in sports that involve rapid acceleration, sprinting, and short putts. Injury typically 42 Case 7 occurs in an acute manner through an eccentric mechanism at the terminal stages of the swing phase of gait.