Buttock Pain Research Articles

Effectiveness of Interferential Therapy with Hip Muscle Strengthening Exercises and Ultrasound Therapy with Hip Muscle Strengthening Exercises for Piriformis Syndrome

Background: Sciatic nerve irritation caused by the piriformis muscle ,which results in Buttock pain, sciatica, or bothis known as piriformis syndrome. The prevalence of PS with sciatic nerve piercing is 17% and 81% respectively,while it was present in 17.2% suffering from low back discomfort.Purpose: The purpose of this study is to find the effectiveness of interferential therapy with hip muscle strengtheningexercises and ultrasound therapy with hip muscle strengthening exercises for piriformis syndrome.Materials and Methods: About 220 participants were selected by using FAIR test and visual analogue scale oninclusion and exclusion criteria. Written informed consent was collected before the commencement of the study. The220 participants were allocated into 2 groups. Interferential therapy group (n=110) and ultrasound therapy group(n=110). Interferential therapy group were given interferential therapy with hip muscle strengthening exercisesand the ultrasound therapy group were given ultrasound therapy with hip muscle strengthening exercises. Theintervention was given 5 times a week for a total duration of 2 weeks. Study Period: October 2022-June 2023.Results: The collected data was statistically analyzed using paired and unpaired t test, when comparing theInterferential therapy group to the ultrasound therapy, the Interferential therapy group indicates significanteffects P<0.0001 in piriformis syndrome, as assessed by VAS.Conclusion: This study concluded that the Interferential therapy group was found to be more effective than theultrasound therapy group in patients with Piriformis Syndrome.

Chapter 13 - Piriformis syndrome

Piriformis syndrome is a condition that is proposed to result from compression of the sciatic nerve, either in whole or in part, in the deep gluteal space by the piriformis muscle. The prevalence of piriformis syndrome depends upon the diagnostic criteria being used and the population studied but is estimated by some to be 5%-6% in all cases of low back, buttock, and leg pain and up to 17% of patients with chronic low back pain. While the sciatic nerve may pierce the piriformis muscle in about 16% of healthy individuals, this frequency is no different in those with the syndrome; thus, the relationship to this anatomic finding is unclear. The most common symptoms are buttock pain, external tenderness over the greater sciatic notch, and aggravation of the pain through sitting. Many clinical signs are reported for piriformis syndrome, but the sensitivity and specificity are unclear, in part because of the lack of a uniformly accepted case definition. In the majority of cases in the literature, it appears that the diagnosis is more ascribed to a myofascial condition rather than a focal neuropathy. Electrodiagnostic studies can be useful to exclude other causes of symptoms, but there is no well-accepted test to confirm the presence of piriformis syndrome. Ultrasound imaging may show thickening of the piriformis muscle, but further research is required to confirm that this is correlated with the clinical diagnosis. Magnetic resonance imaging and neurography may hold promise in the future, but there are not yet sufficient data to support adopting these methods as a standard diagnostic tool. The initial treatment of piriformis syndrome is typically conservative management with the general rehabilitation principles similar to other soft tissue musculoskeletal conditions. Local anesthetic, botulinum toxin, and/or corticosteroid injections have been reported by some to be beneficial for diagnostic or treatment purposes. Surgical interventions have also been used with variable success.

Bilateral Sacroiliitis in a Patient with Rheumatoid Arthritis: Unraveling the Rope: A Case Report

Rheumatoid arthritis (RA) and spondyloarthritis(SpA) are chronic inflammatory disorders with unique symptoms and pathologies. Misclassification of these two entities is prevalent due to overlapping clinical features and the presence of typical symptoms for both disorders. Rheumatoid nodules are one of the most common extra articular manifestations in rheumatoid arthritis, usually associated with severe disease activity. Herein, we describe a case of rheumatoid arthritis with bilateral sacroiliitis, an uncommon joint involvement of rheumatoid arthritis, and accelerated subcutaneous nodulosis after treatment with adalimumab. Introduction RA is a chronic, autoimmune disorder that primarily affects peripheral synovial joints [1]. The axial skeleton is usually spared other than the cervical spine, particularly C1 to C2 [1]. Though sacroiliitis is a paramount sign of SpA, it can be rarely observed in RA [2]. The commonest extra-articular manifestation of RA is subcutaneous nodules, which can be accelerated with RA treatments [3]. Herein, we describe a patient presented with bilateral sacroiliitis, along with the diagnostic and therapeutic challenges we surmounted. Case presentation A-45-years-old female presented with a one-year history of inflammatory arthritis of bilateral metacarpophalangeal, wrist, and ankle joints. She also had inflammatory-type back pain with buttock pain and plantar fasciitis. The Left-sided Faber test was positive. The laboratory investigations revealed elevated inflammatory markers, negative RF and HLA-B27. MRI-SI joints revealed bilateral active sacroiliitis. She was treated as SpA with NSAIDS at first, followed by subcutaneous adalimumab due to inadequate response. Though arthritis improved following adalimumab, multiple firm subcutaneous nodules occurred in the extensor surface of the elbow and hands after six-doses of adalimumab. Biopsy was compatible with rheumatoid nodule and anti-cyclic citrullinated peptide was positive. Based on the presence of rheumatoid nodules and positive anti-CCP antibodies, the patient was diagnosed with seropositive RA and bilateral sacroiliitis, an unusual joint involvement in RA. Discussion Sacroiliitis is the paramount clinical sign in SpA [2]. However, it can be seen in a wide range of disease conditions [4]. Misclassification between SpA and RA can occur due to overlapping clinical manifestations [4]. The Rheumatoid nodule is the most common cutaneous manifestation of RA and often seen in seropositive RA and more severe disease [3]. There have been case reports of accelerated subcutaneous nodulosis in patient with RA, treated with MTX, leflunomide, azathioprine, TNF alfa inhibitors and tocilizumab [3]. Though Inflammatory back pain, active sacroiliitis, and plantar fasciitis mislead the diagnosis, rheumatoid nodules and positive anti-CCP antibodies aid the classification of RA.

Clinical Evaluation: An Essential Tool for Diagnosis

Low back pain is one of the commonest and leading causes of hospital visits, functional limitation and absence from work in the world.1 Low back pain can occur at any age, but its highest prevalence is in third decade of life. Avascular necrosis of Hip commonly presents at the age of 35-50 years with mean age being 36 years.3 Presenting complaints of both lumbar spine and hip pathologies are overlapping which include low back pain with associated buttock, groin, anterior thigh, and knee pain. Therefore, identifying the exact pain generator becomes crucial, where clinical evaluation plays a vital role.

Spinal manipulation and electrical dry needling as an adjunct to conventional physical therapy in patients with lumbar spinal stenosis: a multi-center randomized clinical trial

BACKGROUND CONTEXTNonoperative management of lumbar spinal stenosis (LSS) includes activity modification, medication, injections, and physical therapy. Conventional physical therapy includes a multimodal approach of exercise, manual therapy, and electro-thermal modalities. There is a paucity of evidence supporting the use of spinal manipulation and dry needling as an adjunct to conventional physical therapy in patients with LSS. PURPOSEThis study aimed to determine the effects of adding thrust spinal manipulation and electrical dry needling to conventional physical therapy in patients with LSS. STUDY DESIGN/SETTINGRandomized, single-blinded, multi-center, parallel-group clinical trial. PATIENT SAMPLEOne hundred twenty-eight (n=128) patients with LSS from 12 outpatient clinics in 8 states were recruited over a 34-month period. OUTCOME MEASURESThe primary outcomes included the Numeric Pain Rating Scale (NPRS) and the Oswestry Disability Index (ODI). Secondary outcomes included the Roland Morris Disability Index (RMDI), Global Rating of Change (GROC), and medication intake. Follow-up assessments were taken at 2 weeks, 6 weeks, and 3 months. METHODSPatients were randomized to receive either spinal manipulation, electrical dry needling, and conventional physical therapy (MEDNCPT group, n=65) or conventional physical therapy alone (CPT group, n=63). RESULTSAt 3 months, the MEDNCPT group experienced greater reductions in overall low back, buttock, and leg pain (NPRS: F=5.658; p=.002) and related-disability (ODI: F=9.921; p<.001; RMDI: F=7.263; p<.001) compared to the CPT group. Effect sizes were small at 2 and 6 weeks, and medium at 3 months for the NPRS, ODI, and RMDI. At 3 months, significantly (p=.003) more patients in the MEDNCPT group reported a successful outcome (GROC≥+5) than the CPT group. CONCLUSIONPatients with LSS who received electrical dry needling and spinal manipulation in addition to impairment-based exercise, manual therapy and electro-thermal modalities experienced greater improvements in low back, buttock and leg pain and related-disability than those receiving exercise, manual therapy, and electro-thermal modalities alone at 3 months, but not at the 2 or 6 week follow-up.

The Effects of Dry Needling and Physical Therapy on Improvement of Pain in Patients with Piriformis Syndrome

Background: Piriformis syndrome may be source of low back, buttock pain or sciatica. The purpose of this Study is to determine the effectiveness of dry needling (ND) and classical physiotherapy (PT) in the management of pain in patients with Piriformis Syndrome (PS). Methods: A cross-sectional study was conducted 58 patients with PS were divided to two groups classical PT (n=29) and DN (n=29). 6 sessions performed for both groups, the pain measured before the first session and after each session at the end of both program, both groups were compared to determine which of them is more effective. Results: The result showed that there was significant reduction of pain in both classical PT and dry needling groups. Paired-Sample T.Test indicated significantly difference mean ratings of pain affect from session 1 compare to session 6 for classical physical therapy T(28) = 14.065 , p = 0.000. in other group Paired-Sample T.Test also showed significantly difference mean ratings of pain affect from session 1 compare to session 6 for dry needling therapy T(28) = 11.119, p = 0.000. Conclusion: Based on the results of statistical data analysis, it is concluded that both classical physical therapy and dry needling therapy have significant effect in treating and managing the pain in patients with piriformis syndrome and no significant difference was observed between the results of both groups.

CORRELATION BETWEEN DURATION AND SITTING POSITION WITH THE INCIDENCE OF LOWER BACK PAIN DURING ONLINE LEARNING

Low back pain is a musculoskeletal disorder that is very common and has an impact on socioeconomic, individual, family, and community losses. Low back pain is choking between the 12th thoracic rib and the bottom of the gluteal fold, with or without pain radiating down the leg. Since the coronavirus disease 2019 (COVID-19) outbreak hit Indonesia, learning that has been carried out in schools and university has become online learning where learning uses laptops or cell phones with internet facilities and in a prolonged sitting position. The condition of sitting for a long time is the most common posture performed during online learning, so it can cause discomfort and pain in the lower back. This study aimed to determine the correlation between duration and sitting position with the incidence of back pain during online learning. This study used a descriptive correlational method with a cross-sectional design. The sample in this study was 203 students of the Faculty of Nursing at Syiah Kuala University. The data collection technique used a valid and reliable Sitting Position Duration (DPD) questionnaire with a Cronbach's Alpha value of 0.729 and the Nordic Body Map (NBM) questionnaire to see low back pain. This study showed no significant relationship between sitting duration and back pain (p-value = 0.625), sitting duration, and buttock pain (p-value = 0.616). A significant relationship exists between sitting position and back pain (p-value = 0.002) and sitting position and buttock pain (p-value = 0.001). It was concluded that an unergonomic sitting position for a long time could cause low back pain

Assessment of the Initial Diagnostic Accuracy of a Fragility Fracture of the Sacrum: A Study of 56 Patients.

Retrospective study. To investigate the clinical manifestations of a fragility fracture of the sacrum (FFS) and the factors that may contribute to a misdiagnosis. The number of patients diagnosed with FFS has increased because of extended life expectancy and osteoporosis. Patients with FFS may report nonspecific symptoms, such as back, buttock, groin, and/or leg pain, leading to a misdiagnosis and a delay in definitive diagnosis. Fifty-six patients (13 males and 43 females) with an average age of 80.2±9.2 years admitted to the hospital for FFS between 2006 and 2021 were analyzed retrospectively. The following patient data were collected using medical records: pain regions, a history of trauma, initial diagnoses, and rates of fracture detection using radiography, computed tomography (CT), and magnetic resonance imaging (MRI). Forty-one patients presented with low back and/or buttock pain, nine presented with groin pain, and 17 presented with thigh or leg pain. There was no history of trauma in 18 patients (32%). At the initial visit, 27 patients (48%) were diagnosed with sacral or pelvic fragility fractures. In contrast, 29 patients (52%) were initially misdiagnosed with lumbar spine disease (23 patients), hip joint diseases (three patients), and buttock bruises (three patients). Fracture detection rates for FFS were 2% using radiography, 71% using CT, and 93% using MRI. FFS was diagnosed definitively using an MRI with a coronal short tau inversion recovery (STIR) sequence. Some patients with FFS have leg pain with no history of trauma and are initially misdiagnosed as having lumbar spine disease, hip joint disease, or simple bruises. When these clinical symptoms are reported, we recommend considering FFS as one of the differential diagnoses and performing lumbar or pelvic MRIs, particularly coronal STIR images, to rule out FFS.

Complications during Vaginal Sacrospinous Fixation along with McCall Culdoplasty in Stage III and IV POP

In Bangladesh, about half a million women are suffering from stage III or IV pelvic organ prolapse (POP). With traditional surgical methods, there is a chance of recurrence, especially of apical prolapse. Sacrospinous fixation (SSF) along with MacCall Culdoplasty during vaginal hysterectomy can reduce this recurrence rate enormously. This study was designed to identify, manage as well as to prevent per-/post-operative complications during SSF. The study period was from August 2017 to December 2021 at Kumudini Women’s Medical College and Hospital, Bangladesh. Total 335 stage III and IV utero-vaginal prolapse cases were included in this study. The surgeries performed were vaginal hysterectomy followed by modified McCall Culdoplasty and right-sided vaginal sacrospinous ligament fixation (SSF) along with anterior and posterior fascial closure and perineorrhaphy. A standard data collection sheet was used to record the information. Per-operatively, main complications were hemorrhage (3.57%) due to vessel injury and rectal injury (0.90%). The immediate early postoperative complication was buttock pain (24%). Of these, in 97.53% cases, pain subsided within 6 weeks with analgesic and counselling. Only one patient had recurrence of apical prolapse within 1st week of operation. It should be concluded that with proper knowledge of anatomy and careful surgical technique, most of the complications can be avoided. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 90-97

An Overview of Inflammatory Spondylitis for Biomedical Imaging Using Deep Neural Networks

Ankylosing Spondylitis (AS) is an axial spine inflammatory illness and also chronic that might present with a range of clinical symptoms and indicators. The illness is most frequently characterized by increasing spinal stiffness and persistent back discomfort. The affect of the sacroiliac joints, spine, peripheral joints, entheses and digits are the main cause of the illness. AS symptoms include reduced spinal mobility, aberrant posture, hip and dactylitis, enthesitis, peripheral arthritis, and buttock pain. With their exceptional picture classification ability, the diagnosis of AS illness has been transformed by deep learning techniques in artificial intelligence (AI). Despite the excellent results, these processes are still being widely used in clinical practice at a moderate rate. Due to security and health concerns, medical imaging applications utilizing deep learning must be viewed with caution. False instances, whether good or negative, have far-reaching effects on the well-being of patients and these are to be considered. These are extracted from the fact of the state-of-the-art of deep learning (DL) algorithms lack internal workings comprehension and have complicated interconnected structure, huge millions of parameters, and also a "black box" aspect compared to conventional machine learning (ML) algorithms. XAI (Explainable AI) approaches make it easier to comprehend model predictions, which promotes system reliability, speeds up the diagnosis of the AS disease, and complies with legal requirements.

Unrepaired Trochanteric Bursae as a Risk Factor for Deep Gluteal Syndrome After Total Hip Arthroplasty: A Prospective Randomized Controlled Trial

BackgroundThe trochanteric bursae are often left unrepaired after total hip arthroplasty (THA) and they retract posteriorly over the muscle belly of the piriformis. Deep gluteal syndrome (DGS) is a multifactorial condition presenting as buttock pain and is attributed to nondiscogenic sciatic nerve irritation or impingement causes. The purpose of this study was to investigate the relationship between bursal repair and incidence of DGS in patients undergoing THA. MethodsThis prospective randomized trial included patients treated with a THA between January and December 2022 for a diagnosis of primary osteoarthritis. Patients were randomized into 2 groups: group 1 underwent a routine bursal repair, while group 2 did not, leaving the bursae unrepaired. Follow-up was performed on the 15th, 30th, and 90th day postoperatively with clinical scores, physical examinations, and laboratory tests. In this cohort of 104 patients, mean age was 55 years (range, 26 to 88). Demographic variables as well as range of motion and overall clinical results showed no significant difference between the groups. ResultsDGS rates were significantly more common in the patients who had an unrepaired bursa (group 2) both on the 30th and 90th postoperative days, while comparison of lateral trochanteric pain on palpation showed similar results between the groups. ConclusionsDGS is common in individuals who have unrepaired trochanteric bursal tissue following a THA. Despite its higher frequency, these symptoms did not have a substantial impact on the overall clinical scores, which remained consistent across the study groups.

A comparison between the vaginal patch plastron associated with the anterior sacrospinous fixation and the Uphold™ LITE vaginal support system for the treatment of advanced anterior vaginal wall prolapse

ObjectiveThe aim of the present study was to compare efficacy and safety of the vaginal patch plastron (VPP) associated to the anterior sacrospinous fixation (SSLF-A) with a TVM procedure (Uphold™ LITE support-system) for the treatment of the advanced anterior vaginal wall prolapse.Study design.Single-center retrospective study. Women with symptomatic anterior prolapse ≥ III stage according to the POP-quantification (POP-Q) system and submitted to the VPP associated with the SSLF-A or to the Uphold™ procedure were included. Primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at 6- and 12-month follow-up. Secondary outcome was to describe peri- and postoperative complications. Pearson chi-square test and exact Fisher test were adopted for categorical variables, while intergroup Mann-Whitney U test and intragroup Wilcoxon Rank Sum Test for continuous variables; the statistical analysis was conducted at 95 % confidence level. ResultsFifty-five women in VPP-group and 118 women in Uphold-group were included. At 6-month follow-up, objective anterior relapse in VPP-group (3/55, 5.4 %) was like Uphold-group (5/118, 4.2 %; p = 0.71), as well as objective apical relapse (0/55, 0 % vs 3/118, 2.5 %; p = 0.55); no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 5/118, 4.2 %; p = 0.67). At 12-month follow-up women were telephonically investigated; no significant difference emerged in bulge symptoms (1/55, 1.8 % vs 6/118, 5.1 %; p = 0.43). Reoperation rate for the composite outcome POP relapse, stress urinary incontinence (SUI) and remotion of the TVM resulted lower in the VPP group (1/55, 1.8 % vs 13/118, 11 %; p = 0.03). Post-operative buttock pain (32/55, 58.2 % vs 24/118, 20.3 %; p < 0.0001) and post-operative urinary retention (16/55, 29.1 % vs 6/118, 5.1 %; p < 0.0001) were higher in VPP-group, with a complete resolution between 2 and 3 weeks after treatment. ConclusionVPP associated with SSLF-A was as effective as Uphold™ LITE support-system for both anterior and central compartment prolapse treatment at 6- and 12-month follow-up. VPP-group presented a lower reoperation rate for the composite outcome prolapse relapse repair, SUI, and removal of the mesh.

Symptoms of sacral fractures after posterior spinal instrumented fusion: A case series

BackgroundImprovements in spinal fusion devices and techniques have enabled stronger spinal fusion, resulting in excellent clinical outcomes. Nevertheless, complications associated with implants, such as screw misalignment, screw lubrication, cage dislocation, and skin issues, might occur. This study aimed to investigate the characteristics and symptoms of sacral fractures after spinal instrumented fusion. MethodsThis case series retrospectively examined the medical records of eight patients (one man and seven women; mean age: 74 years) diagnosed with sacral fractures after undergoing posterior spinal instrumented fusion from February 2015 to March 2022. ResultsThe average number of fusion levels in all patients was 3.5 (range, 1–10). The lowest instrumented vertebrae (LIV) ranged from L5 to the ilium. Sacral fractures were diagnosed at 18.8 (range, 0.5–84) months postoperatively. The average time from consultation to diagnosis was nine days (range, 0–25 days). Two patients had subclinical fractures, two had H-shaped fractures with the LIV at L5, and four had U-shaped fractures, including screw holes. Buttock pain and lower extremity pain, the most commonly reported symptoms, were observed in seven patients each. There were also instances of leg numbness, muscle weakness, and unilateral leg pain that may be related to L5 or S1 radiculopathy. In all patients, leg and buttock pain were worse during movement and in the sitting position, and better while resting and in the supine position. Three patients were treated conservatively, and five were treated with extended fixation to the ilium. ConclusionsSacral fractures following posterior spinal fusion can cause radiculopathy and buttock pain. Symptoms are especially severe when instability occurs in the pelvic region, such as during movements or sitting. As atypical radiculopathy may lead to delays in diagnosis, spine surgeons should recognize the symptoms of this condition.

CLINICAL ASSESSMENT OF DASHAMOOL KWATH WITH HINGU AND PUSHKARMOOL CHURNA IN THE MANAGEMENT OF JHINJHINI VATA WITH SPECIAL REFERENCE TO SCIATIC NEURALGIA.

Introduction: Chakradatta has explained the use of Dashamool kwath, Pushkarmool, and Hingu in Jhinjhini Vata. The word Jhinjhini is the best example of onomatopoeia meaning the formation or use of words that indi-cate the sounds associated with the objects or actions they refer to. In Sanskrit, the word Jhinjhini is taken from the colloquial language that was in existence at the time of the writer. It is the influence of dialects which was commonly used at that time. This type of word is known as Prakrut (original) words without any specific Nirukti, which has been taken directly from colloquial language. Such words are being accepted in Sanskrit as they are. Therefore, we do not find its original root in any Sanskrit dictionary. So, we assumed that the word Jhinjhini resembled the tingling numbness in sciatic neuralgia. By this assumption, we have studied the effect of the said combination on Jhinjhini Vata w.r.t. tingling and numbness in Sciatic neuralgia. Sciatica is a set of symptoms that includes pain caused by general compression or irritation of one of five spinal nerve roots of each sciatic nerve or by compression or irritation of the left, right, or both sciatic nerves. There is often a history of trauma such as twisting of the spine, lifting heavy objects, or exposure to cold. Herniation or degenerative changes in the intervertebral disc is the most common cause. Symptoms include lower back pain, buttock pain, numbness or weakness, and pain in various parts of the leg and foot. Other symptoms include a “pins and Nee-dles” sensation or tingling and difficulty in moving the leg. Mostly, symptoms only manifest on one side of the body and pain may radiate below the knee, but not always. Sciatica is a set of symptoms where irritation of the root of the nerve is a cause of the pain. This disease is now becoming a major threat to the working population. Methodology: The study aimed to observe the effect of Dashamool kwath, Pushkarmool, and Hingu in Jhinjhini Vata with spe-cial reference to sciatic neuralgia. The subjective assessment of dependent variables such as Sphikshula (Buttock pain), Katishula (Low back pain), Urushula (Pain in the back of thigh), Jamgha shula (Pain in calf), Pada shula (Pain in the foot), Graha (Pulling pain), Spandan (Twitching), Stambha (Stiffness), Supti (Numbness), Toda (Pricking pain) was done. A total of 30 patients were studied. Appropriate statistical tests were applied to find out the significance of the treatment. Results: The Results showed that 2 patients got excellent results (&gt; 75%), 25 patients got good relief (&gt; 50%), and 3 pa-tients got moderate relief (&gt;25%) after treatment of 21 days. The percentage of relief on symptoms score of Sphikshula was 57.33%, Katishula 53%, Urushula 50%, Jamghashula 51.11%, Padashula 64.13%, Graha 67.36%, Stambha 64.8%, Supti 61.61% and Toda 64.42% re-spectively. An average relief of 59.3% was observed for the above-said symptoms. Conclusion: This study revealed that the treatment of Jhinjhini Vata with Dashamool kwath, Pushkarmool, and Hingu as ex-plained by Chakradatta is statistically significant, effective, and complication-free.

A Single-Institution Experience of Acute Neuropathic Lumbosacral Pain in Patients Treated with Short Course Hypofractionated Radiotherapy in Locally Advanced Rectal Cancer

There has been increased interest in the use of short course hypofractionated radiotherapy as part of a total neoadjuvant treatment (TNT) approach in the management of rectal cancer since publication of the RAPIDO trial. However, the literature on short course radiation for rectal cancer has not reported significant acute toxicities in the weeks immediately following the completion of treatment. Anecdotally, a subset of patients has experienced acute neuropathic pain characterized in a lumbosacral distribution. This study investigates acute lumbosacral toxicity for patients receiving hypofractionated short course radiation as part of their definitive treatment for rectal cancer. We retrospectively analyzed 75 patients with locally advanced rectal adenocarcinoma treated with hypofractionated short course radiation (25 Gy in 5 fractions) at our institution between 2016 and 2022. Acute toxicity caused by radiation was defined as that occurring from the start of radiation treatment to either 30 days post radiation completion, the start of chemotherapy, or date of surgery, whichever occurred first. Among 75 patients treated with hypofractionated short course preoperative radiation with definitive intent, we identified 10 patients (13.3%) who experienced significant lumbosacral neuropathic pain and initiated a report to their medical providers during the acute toxicity time frame. Commonly, this was described as an achy pain in the bilateral buttocks radiating down to the knees or posterior claves. Patients rated this pain between moderate to extreme and management included steroids after failure of improvement with conservative measures, gabapentin, and conservative treatment with NSAIDs and Tylenol. Average time to onset of acute lumbosacral neuropathic pain was 3.7 days (SD 2.05) from start of RT. We have identified a previously underappreciated acute toxicity of neuropathic lumbosacral pain in short course hypofractionated radiation therapy, which may be due to a lumbosacral plexus toxicity. Further analysis will seek to identify predictive factors such as comorbidities and dose to the lumbosacral plexus, and to determine whether there is a correlation between these observed acute toxicities and long-term outcomes.

Effect and safety of Lasso suture hook in transvaginal sacrospinous ligament fixation

To investigate the feasibility and safety of the Lasso suture hook in transvaginal sacrospinous ligament fixation, a total of 38 patients with vaginal vault prolapse at or above stage Ⅱ, and aged 46-75(62.7±12.5)years, who underwent transvaginal sacrospinous ligament fixation at the Second Affiliated Hospital of Soochow University from January 2018 to January 2021 were retrospectively analyzed. After complete exposure of the right sacrospinous ligament, the cervical/uterosacral ligament was sutured to the sacrospinous ligament using Lasso hook and polypropylene sutures. The completion rate of the operation, intraoperative complications, operation time, blood loss, and postoperative situations were observed, and the objective cure rate and subjective satisfaction were followed up. Transvaginal sacrospinous ligament fixation was successfully performed in all 38 patients using Lasso suture hooks. There were no bladder or rectum injuries during the operations, and no pelvic hematoma occurred. The operation time was 15-40 (24±9.5) min; the intraoperative bleeding was 20-60 (40±12.5) ml; the visual analogue scale(VAS)score was 3-5 (3.2±1.4) points on the first day of postoperative, and 2-4 (2.2±1.8) points on the third day of postoperative. No numbness or pain in buttocks and lower limbs after the operation. The 3-month follow-up results showed that the objective surgical success rate of the postoperative pelvic organ prolapse quantitation (POP-Q) score was 100% (38/38). The 1-year follow-up results showed that the objective surgical cure rate of postoperative POP-Q score was 92.1% (35/38). The score of Pelvic Floor Distress Inventory-Short Form 20 (PFDI-20)was 42-180(120.4±44.9)before operation and 8-75 (28.0±14.3) after operation(t=15.90, P<0.001); The score of Pelvic Floor Function Impact Questionnaire-Short Form7 (PFIQ-7) was 52-214(112.8±44.5)before operation and 5-29 (14.3±6.0) after operation (t=14.40, P<0.001), and the subjective satisfaction rate is 89.5% (34/38) conducted by Patient Global Impression of Improvement (PGI-I). Transvaginal sacrospinous ligament fixation with Lasso suture hook is simple, safe, and feasible.

261 Bilateral Femoral Neck Stress Fractures in an Active Adolescent Female: A Case Report

Abstract Bilateral femoral neck stress fractures are uncommon injuries in adolescents. We present such a case in a 15-year-old athletic female with no preceding trauma or underlying metabolic bone abnormality. The patient presented to Accident and Emergency with a three-week history of left buttock and lateral thigh pain and one-week history of right lateral thigh pain. The pain developed during physical activity and was relieved upon rest. Activities included running, dancing, and attendance at a six-week cadet marching course. Simple analgesia did not alleviate the pain. History revealed low caloric intake and previous secondary amenorrhea. The patient was previously managed by the General Practitioner and physiotherapist for suspected atypical sciatica. Physical examination showed a minimally antalgic gait and pain on palpation of the left groin. Both hips had full range of motion. Bone profile was normal. Radiographic films were initially interpreted as normal, however, formal reporting revealed sclerotic appearances to both femoral necks and a subtle break in the left femoral neck cortex. MRI confirmed the diagnosis of a complete displaced left femoral neck fracture and incomplete right inferomedial femoral neck fracture. Trace bilateral hip joint effusions were noted. The patient underwent bilateral fixation with cannulated screws. One-month post-operative, she engaged in walking and swimming without pain. Radiographic appearances were satisfactory. Early radiographic changes associated with stress fractures are subtle. This case highlights the importance of prompt formal radiological reporting and the early use of MRI as a diagnostic tool, particularly in patients with risk factors.

Buttock pain after blunt trauma.

Buttock pain after blunt trauma.

A Rare Case of Long TNS following Caesarean Section under Spinal Anaesthesia

The first regional anaesthetic technique performed was spinal anaesthesia, and the first operation under spinal anaesthesia was in 1898 in Germany by August Bier. Spinal anaesthesia (SPA) is in common use worldwide for surgical procedures involving the lower abdomen, pelvis, perineal and lower extremities. It is beneficial for procedures below the umbilicus. Currently more than 50% global surgical patients undergo spinal anaesthesia every year. It is estimated that in USA 50 million individual were given spinal anaesthesia in 2022 and in India 60% of surgeries were performed under RA in 2021 as per a recent survey. Benefits of Spinal anaesthesia include prompt recovery, early return of normal functions, low chances of a blood clot following surgery and has less incidence of sickness, vomiting, when compared to a general anaesthetic for similar procedure. While acknowledging the benefits of SPA, Anaesthetists should be aware of and must inform clients of common side effects like acute back pain after spinal injection, that resolves with simple measures, Nausea, vomiting, headache and hypotension and Low-frequency hearing loss. One of the rare complications called Transient Neurologic Symptoms (TNS) with symptoms of, exclusive pain in buttocks, thighs, legs, few hours to ~ 1 day, lasting up to 10 days. After initial pain patient may notice numbness usually in left buttock area and weakness in gluteal muscles involved, that may prolong for 6 months to a year. The incidence India is quoted as 10-12 cases per lakh spinal anaesthesia procedures mainly caesarean sections. This article is of one such case the author is managing since a month. A 26-year-old lady primigravida, underwent caesarean section for the delivery 2 months ago. She was more concerned about the premature baby’s feeding challenges, but coincidentally brought to author’s notice. She has been put on a few o lower limb and abdominal muscle strengthening exercises and supplemented Tablet Neurobion (vit B12) forte one tablet a day. As of 22 /08/23 she has improved muscle power (20%) able to sit up with the support of upper and Numbness has also improved a bit. Material &amp; Methods: One rare case of TNS, clinical diagnosis, management, Physiotherapy, Literature review and case report studies.

Evaluation of the Efficacy of Ultrasound-Guided Dry Needling Therapy and Exercise in Piriformis Muscle Syndrome.

Piriformis muscle syndrome (PMS) is characterized by symptoms of buttock pain and numbness radiating to the back of the thigh due to irritation of the sciatic nerve. This study aimed to evaluate the efficacy of dry needling (DN) therapy and exercise programs on pain, neuropathic pain, physical function, and disability in patients with PMS. Forty-four patients with PMS were included in the study. Patients were divided into two groups, those who were treated with DN three times once per week under ultrasound guidance and those who had an exercise program for three weeks. To identify the outcomes of the treatment modalities, pre-treatment and post-treatment first-month and third-month visual analog scale (VAS), Oswestry Disability Index (ODI) questionnaire, Lower Extremity Functional Scale (LEFS), and Douleur Neuropathique 4 (DN4) questionnaire scores were used. There was no statistically significant difference between the groups in baseline scores of VAS (p = 0.548), DN4 (p = 0.446), and LEFS (p = 0.880), but in the DN group, baseline ODI scores were significantly higher than in the exercise group (p = 0.001). The group comparisons showed no statistically significant differences in decreasing pain, reducing disability, and increasing functional status scores among the groups at post-treatment first-month and third-month assessments (p > 0.05). Both treatment modalities are beneficial in reducing pain and disability, and increasing the functional status of the patients with PMS in three months of follow-up. In patients who cannot adapt to exercise programs, DN treatment under ultrasound guidance should be kept in mind as a minimally invasive treatment modality with no adverse effects.