Low Back Pain Triggering Cubital Tunnel Syndrome? An Unexpected Clinical Twist.

Pregnancy and low back pain: physical therapy can reduce back and pelvic pain during and after pregnancy.

Permanent paraparesis and cauda equina syndrome after epidural blood patch for postdural puncture headache.

Introduction: Development of at a younger age is a potential risk of developing chronic low back pain in adulthood. The study was planned with the purpose to know the extent of the less studied musculoskeletal disorders as a health problem among Indian medical students. The study was conducted to assess the prevalence of low back and neck pain among medical students, find the associations of low back and neck pain with quality-of-life issues, self-perceived stress and lifestyle. Methods: A cross-sectional study was conducted at the Bhopal, India from May to July 2019, total 220 medical students were randomly selected. A questionnaire including the pre-validated instruments viz. Oswestry Disability Index, Visual Analog Scale and Perceived Stress Scale-10 were used to collect the data. Data entry was done in Microsoft Excel and was analyzed on statistical package SPSS version 23. Results: The overall prevalence of Low Back and Neck Pain were 49.1% and 56.4% respectively. A significant association of female gender was found with Neck and Low Back Pain. A significant negative correlation was found between body mass index and Visual Analogue Scale neck & back (p=0.003). Conclusion: There was a high prevalence of low back pain and neck pain in medical students at Bhopal. Females were affected more than males. Complaint of lower back pain was more than neck pain. Playing outdoor sports and weightlifting was found to be having protective effect on low back pain and neck pain.

High-Dose Spinal Cord Stimulation for Treatment of Chronic Low Back Pain and Leg Pain in Patients With FBSS, 12-Month Results: A Prospective Pilot Study

ObjectiveBack pain and poor sleep quality are public health issues. Relating to adolescents particularly, the way in which this relationship can occur is still unclear. The aim of this study was to investigate whether low back and neck pain are associated with sleep quality among adolescents.Material and MethodsIn total, 1011 randomly selected adolescents participated in this study. Neck and back pain were assessed using the Nordic questionnaire, while sleep quality was assessed through the Mini-Sleep Questionnaire. The confounding variables used in the statistical analysis were age, socioeconomic status, physical activity, and body mass index. To analyze the associations between sleep quality and low back and neck pain, multivariate models and binary logistic regression were used.Results19.9% of the girls reported low back pain while 18.9% reported neck pain. 15.6% of the boys reported low back or neck pain. Regarding low sleep quality, the prevalence was 46.0% for girls and 49.6% for boys. An association was observed between low back pain and sleep quality among girls (OR=1.98 [1.25 - 3.12]) and boys (OR=2.58 [1.48 - 4.50]). An association between neck pain and sleep quality was also observed among girls (OR=2.27 [1.41 - 3.64]) and boys (OR=2.80 [1.59 - 4.91]).ConclusionLow back pain and neck pain were associated with poor sleep quality among adolescents even after the insertion of confounding variables.

Managing Nontraumatic Acute Back Pain

Neck and back pain pathologies are currently the main cause of absenteeism from work in Spain and in the European Union, and represent a high socio-labor, economic and health cost for the Health Systems. To assess the effectiveness of a Back School Program of a Spanish mutual insurance company (risk factors, pain and disability scales) in women workers with low back or neck pain. We combined a descriptive study of first-session data collected in the total sample and a prospective multicenter intervention study in those participants who completed the second and third check-up at 6 and 9 months. Women workers with low back or neck pain, from different sectors and occupations, who participated in a Back School Program of Ibermutua, a Spanish mutual insurance company, during the period from April 1st, 2009, to March 28th, 2019. Overall, 1452 women workers participated in the first session, 150 in the second session (6-month review) and 133 in the third session (9-month review). Different questionnaires and scales were used for data collection, Visual Analog Scale, Neck Disability Index, Oswestry Disability Index, Concept Check Questionnaire and Back School Program Effectiveness Questionnaires. A total of 1095 (75.4%) had low back pain and 742 (51.1%) had neck pain (497 of them had pain in both locations); 42.8% (622) related the pain to their work activity. One in four women workers (390, 26.9%) performed a high-risk work activity (handling, weight transport, mechanical vibrations), 27.4% were prolonged standing and 22.8% were prolonged sitting. The workers participated in the Back School Program for two purposes: therapeutic (1150 women, 79.2%) and preventive (302 women, 20.8%). The Back School is an effective intervention to manage pain and reduce disability in women workers. This study provided evidence that the Back School Program can be suitable for preventing and improving low back and neck pain and functional disability among women workers. The success of the Back Schools depends on women workers becoming aware of the importance of preventive measures aimed at strengthening the back muscles and collaborating actively, thus significantly reducing the incidence of low back and cervical pain in the workplace.

Subcutaneous Stimulation as an Additional Therapy to Spinal Cord Stimulation for the Treatment of Lower Limb Pain and/or Back Pain: A Feasibility Study

When performed alone, endoscopic carpal tunnel release and endoscopic cubital tunnel release are safe and effective surgical options for the treatment of carpal and cubital tunnel syndromes, respectively. However, there is currently no literature that describes the performance of both procedures concomitantly. We describe the results of 17 cases in which dual endoscopic carpal and cubital tunnel releases were performed for the treatment of concurrent carpal and cubital tunnel syndromes. A retrospective review of all patients in a single surgeon practice that presented with concomitant ipsilateral carpal and cubital tunnel syndromes was performed. Within an 8-month period, 17 patients had undergone 19 concomitant ipsilateral endoscopic carpal and cubital tunnel releases after failing conservative treatment. Pre- and postoperative measurements included subjective numbness/tingling; subjective pain; manual muscle testing of the abductor pollicis brevis (APB), intrinsics, and flexor digitorum profundus (FDP); static two-point discrimination; quick-DASH (Disabilities of the Arm, Shoulder and Hand) scores; grip strength; chuck pinch strength; and key pinch strength. Complete data are available for 15 patients and 17 total procedures. Thirteen male and four female patients (average age of 50.5) underwent dual endoscopic cubital and carpal tunnel release. Two patients were lost to follow-up and eliminated from data analysis. Pre- and postoperative comparisons were completed for median DASH scores, grip strength, chuck pinch strength, and key pinch strength at their preoperative visit and at 12weeks. DASH scores improved significantly from a median of 67.5 to 16 (p = 0.002), grip strengths improved from 42 to 55.0lbs (p = 0.30), chuck pinch strengths improved significantly from 11 to 15.5lbs (p = 0.02), and key pinch strengths increased significantly from 13 to 18lbs (p = 0.003). Average static two-point discrimination decreased from 5.9 to 4.8mm. In terms of pain, 82% of patients had complete resolution of pain, and the remaining 18% experienced pain only with strenuous activity. In terms of numbness/tingling, 100% of patients had complete resolution of median nerve symptoms; 88% of patients had substantial improvement of numbness and tingling symptoms, and 12% had residual ulnar nerve symptoms. In terms of muscle strength, 92% of patients had improvement to 5/5 APB strength, while 100% of patients had improvement to 5/5 intrinsic and FDP strengths. Two minor complications occurred, including one superficial hematoma and one superficial cellulitis. Preliminary data demonstrate that dual endoscopic carpal and cubital tunnel release is a safe and effective treatment option for patients who present with concurrent cubital and carpal tunnel syndromes recalcitrant to non-surgical management. Postoperative results and complications are comparable to endoscopic carpal and cubital tunnel releases performed alone.

THERE have been several publications of transient neurologic toxicity or transient radicular irritation attributed to intrathecal local anesthetics. Most described cases involved the use of hyperbaric lidocaine, 2 - 5%. Sumi et al. recently reported a case in which tetracaine, 0.5%, was used. Reported cases present with low back or buttock pain radiating to the thighs or lower legs. The pain is usually moderate to severe, appearing 1-24 h postoperatively after recovery from an otherwise uneventful spinal anesthetic. In all reported cases, the symptoms disappeared within 1 week. We report two cases of similar symptoms and circumstances that have the appearance of simple musculoskeletal pain.

To study whether work in a cold environment increased the risk of musculoskeletal symptoms in the neck and low back among construction workers. This cross-sectional study is based on a cohort of male workers in the Swedish construction industry that participated in regular health examinations through a nationwide occupational health service. The analysis is based on workers examined from 1971 to 1974, who answered a questionnaire including questions about neck and back pain. The cohort consists of 134,754 male workers, including 16,496 office workers and foremen. The health examinations of the workers were conducted in provinces covering Sweden from the south to the north, and temperature data were collected for the provinces. In the analyses, the results were adjusted for age, BMI and use of nicotine. The prevalence's of neck and low back pain were higher among manual construction workers than among foremen and office workers (24.3 vs. 8.6 % and 16.5 vs. 6.2 %, respectively); the corresponding adjusted ORs for low back and neck pain were 1.59 (95 % CI 1.52-1.66) and 1.39 (95 % CI 1.30-1.49), respectively. Workers in the northern and central provinces had higher ORs for low back and neck pain compared to workers in the southern province. The test for trends showed an increased risk of developing low back and neck pain with decreased outdoor temperature. Outdoor work in a cold environment may increase the risk of low back and neck pain.

The effects of stabilization exercise on low back pain and pelvic girdle pain in pregnant women

The impact of hand dominance and ulnar and median nerve impairment on strength and basic daily activities

BackgroundFew studies have explored the impact of low back or lower limb pain severity on recurrent (≥2) falls in older adults.ObjectivesInvestigate the association between the severity of low back or lower limb pain, and ≥2 falls or falls‐related injuries.MethodsCommunity‐dwelling Australian males and females in the ASPREE Longitudinal Study of Older Persons (ALSOP), aged ≥70 years. Self‐reported, cross‐sectional questionnaire data regarding number of falls and falls‐related injuries in the last 12 months; and sites and severity of pain experienced on most days. Adjusted relative risks (RR) were estimated from multivariable Poisson regression models, for males and females separately.ResultsOf 14,892 ALSOP participants, 13% (n = 1983) reported ≥2 falls (‘recurrent fallers’) in the last 12 months. Males and females who reported severe low back, or severe lower limb pain on most days were more likely to report ≥2 falls in the last 12 months compared to those with mild pain (lower back: males RR = 1.70 and females RR = 1.5, p = 0.001; lower limb: males RR = 2.0, p < 0.001 and females RR = 1.4, p = 0.003). Female recurrent fallers who reported severe low back (RR = 1.3, p = 0.029) or lower limb (RR = 1.2, p = 0.024) pain on most days were more likely to report a falls‐related injury in the last 12 months compared to females with mild pain.ConclusionSevere low back or lower limb pain was associated with an increased likelihood of recurrent falls (males/females) or falls‐related injuries (females only). Assessment of severe low back and lower limb pain should be considered as a priority when undertaking falls‐risk evaluation.SignificanceSevere low back pain, or severe lower limb pain is associated with an increased likelihood of recurrent falls in older males and females, and an increased likelihood of falls‐related injuries in older female recurrent fallers. Assessment and management of severe low back and lower limb pain should be prioritized when undertaking falls‐risk assessment. Future longitudinal research is required to further interrogate this relationship and its underlying mechanisms.

Editorial I: A (pain free) step in the right direction