Considerable Pain Relief Research Articles

PROPOSE. Development and validation of a prediction model for shared decision making for patients with lumbar spinal stenosis

BackgroundDecompression for lumbar spinal stenosis (LSS) is the most frequently performed spine surgery in Denmark. According to the Danish spine registry DaneSpine, at 1 year after surgery, about 75% of patients experiences considerable pain relief and around 66% improvement in quality of life. However, 25% do not improve very much. We have developed a predictive decision support tool, PROPOSE. It is intended to be used in the clinical conversation between healthcare providers and LSS patients as a shared decision-making aid presenting pros and cons of surgical intervention. This study presents the development and evaluation of PROPOSE in a clinical setting. MethodsFor model development, 6.357 LSS patients enrolled in DaneSpine were identified. For model validation, predictor response and predicted outcome was collected via PROPOSE from 228 patients. Observed outcome at 1 year was retrieved from DaneSpine. All participants were treated at 3 Danish spine centers. The outcome measures presented are improvement in walking distance, the Oswestry Disability Index, EQ-5D-3L and leg/back pain on the Visual Analog Scale. Outcome variables were dichotomized into success (1) and failure (0). With the exception of walking distance, a success was defined as reaching minimal clinically important difference at 1-year follow-up. Models were trained using Multivariate Adaptive Regression Splines. Performance was assessed by inspecting confusion matrix, ROC curves and comparing GCV (generalized cross-validation) errors. Final performance of the models was evaluated on independent test data. ResultsThe walking distance model demonstrated excellent performance with an AUC of 0.88 and a Brier score of 0.14. The VAS leg pain model had the lowest discriminatory performance with an AUC of 0.67 and a Brier score of 0.22. ConclusionsPROPOSE works in a real-world clinical setting as a proof of concept and demonstrates acceptable performance. It may have the potential of aiding shared decision making.

The effect of Marma therapy in Student’s Elbow i.e., Olecranon Bursitis with special reference to Pain - A Single Case Study

Student's elbow, medically known as olecranon bursitis, is a common condition among students and individuals who frequently rest their elbows on hard surfaces while studying or working. This condition often leads to pain, swelling, and restricted joint movement, affecting daily activities and overall well-being. Traditional treatment approaches typically involve rest, anti-inflammatory medications, and physical therapy. However, complementary, and alternative therapies are gaining recognition for their potential in enhancing pain management and accelerating recovery. This study investigates the application of Marma therapy, an ancient Indian healing practice rooted in Ayurveda, in the management of student's elbow. Marma therapy involves stimulating vital energy points (Marma points) on the body to restore balance and promote healing. Marma therapy's holistic approach aligns well with the principles of integrative medicine, addressing not only the physical aspect of the condition but also the mental and emotional well-being of the individual. This study emphasizes the need for further research, including randomized controlled trials, to establish the effectiveness of Marma therapy in student's elbow. Additionally, practical guidelines for incorporating Marma therapy into conventional treatment plans are discussed. The integration of Marma therapy into clinical practice holds promise for providing students and individuals suffering from student's elbow with a holistic and personalized approach to pain management and rehabilitation. Hence in this study a clinically diagnosed OPD patient of Student’s Elbow is treated with Marma Chikista for 15 days provided considerable relief of pain.

Antimicrobial and Analgesic Effect of Dhoopana with Sriveshtakadi Choorna in Non-Healing Ulcer - A Case Study

A chronic ulcer may be defined as one that fails to heal in the expected time for a ulcer of that type, which is usually less than 3 weeks. Chronic ulcers usually respond slowly to conventional treatments. In Ayurveda classics, ulcers its types and management has been explained. Signs and symptoms of non-healing ulcers can be compared with features of Dushtavrana. In spite of the modern advances that have been made; the management of Chronic ulcer is still a challenge for the clinician. Sushruta was quite aware of the importance of ulcer management. 60 methods of treatment of Vrana have been explained in Susruta Samhita Chikitsa stana Dvivraneeya adhyaya and one among them is Dhoopana. Dhoopana is indicated in ulcers which have predominance of Vata, severe pain and exudation. In Susruta Samhitha suthrasthana Misraka adhyaya, Dhoopana with Sriveshtaka, Sarjarasa, Sarala, Devadaru and other Sara-vrikshas are explained. In the present case study, 60 year old male patient who visited OPD with non-healing ulcer over left side of left lower limb with pain and purulent discharge from the ulcer was subjected to Dhoopana for 7 days twice daily for 10 minutes with Sriveshtakadi dhoopa choorna. Assessment of pain was done with VAS and VRS scale, discharge was assessed with grading scale and microbial content was assessed with Pus culture. After the study period there was considerable relief of pain and discharge. The organism Staphylococcus aureus present in initial swab was absent after 7 days of Dhoopana.

Efficacy of Tramadol as Pre-emptive Analgesia in Mandibular Impacted Third Molar Surgery

Introduction: The pre-emptive analgesia is an alternative for treating postsurgical pain. It is given before the painful stimulus begins to prevent or reduce the development of any ‘’memory’’ of the pain stimulus in the nervous system. Objective: To investigate the existence of pre-emptive analgesic efficacy of Tramadol for impacted mandibular third molar surgery. Materials and methods: This was a prospective study carried out in Oral & Maxillofacial Surgery Department; Dhaka Dental College & Hospital.100 patients were included and were randomly divided into two groups. Study group received injection Tramadol 50mg, 20 minutes before surgery. Control group did not receive pre-emptive analgesic. Study parameters included (1) Pain intensity scores, (2) Time to 1st rescue analgesia and (3) Total number of analgesics consumed during the 5 post-operative days. Results: Study group reported considerable pain relief in the day of surgery at hours 1, 3 and 5 with significantly lower pain intensity scores. When the mean time to first rescue analgesic was assessed, study group reported a longer pain free interval with the mean time being 7.46±1.11 hours for study and 2.43±1.72 hours for control group. Patients in the control group consumed maximum number of rescue analgesics during the 5 post-operative days and Tramadol proved more efficient by consuming fewer rescue analgesics [p<0.001]. Conclusion: Tramadol has significant pre-emptive analgesic efficacy.

Progress in the treatment of lupus nephritis with Chinese medicine

By examining the recent domestic and international literature, we provide a breakdown of Chinese medicine in the treatment of lupus nephritis in recent years. It summarizes the etiology and pathogenesis of the disease, the historical theoretical sources of TCM evidence-based treatment and the composition of prescriptions and medicines, elaborates on TCM stage-based treatment, and outlines various TCM characteristic treatment methods including internal herbal tonics, acupuncture, medicinal baths, tui-na and enemas.The results showed that the above-mentioned TCM treatment methods not only have precise clinical efficacy, but also can appropriately reduce the frequency of hormone use, thus alleviating the physical harm caused by the related side effects, with considerable safety and effective relief of patients' pain.

Comparing preemptive injection of peri-articular-multimodal drug with oral celexocib for postoperative pain management in total knee arthroplasty: A randomized clinical trial.

Total knee arthroplasty (TKA) is associated with tremendous postoperative pain, and pain relief should concisely be considered. This study aims to compare the efficacy of preemptive periarticular multimodal drug injection versus placebo and oral celecoxib on postoperative pain control after TKA. This study is a randomized clinical trial on 146 patients candidate for TKA who were randomly allocated to three treatment groups, including (1) a cocktail consisting of bupivacaine, morphine, epinephrine, and ketorolac (n = 48), (2) only epinephrine (placebo group) (n = 49), and (3) 400 mg celecoxib orally (control group) (n = 49) using the Random Allocation software. The injections and oral therapy were performed within 15 min before the surgical procedure. The study's primary outcome was the Knee Society Score (KSS) calculated at baseline, within 6 weeks and 6 months postoperatively. Range of motion (ROM) and Visual Analog Scale (VAS) to assess pain intensity as the other primary outcomes were evaluated before the procedure, within 24 h, 48 h, and 6 weeks postoperatively. The three studied groups were similar regarding demographic characteristics, including age (P = 0.33), gender distribution (P = 0.65), and involved knee side (P = 0.94). Baseline comparison of KSS (P = 0.39), VAS (P = 0.24), and ROM (P = 0.37) among the groups revealed insignificant differences. All the studied groups showed a statistically significant trend of improvement in KSS, VAS, and ROM (P < 0.001), while the comparison of the three groups in terms of KSS (P = 0.001), VAS (P < 0.001), and ROM (P < 0.001) revealed remarkable superiority of multimodal injection to the other treatments. Preemptive periarticular multimodal drug injection, including bupivacaine, morphine, epinephrine, and ketorolac, can cause considerable postoperative pain relief and better ROM achievement in comparison to placebo or oral celecoxib.

Denervation of the thumb carpometacarpal joint for symptomatic osteoarthritis in 46 patients

We investigated the effect of an extended denervation procedure in the thumb carpometacarpal (CMC) joint in patients suffering from CMC osteoarthritis. Between 2006 and 2018, 46 patients underwent the procedure in our clinic and were included in this retrospective study. Pain, strength, range of motion, DASH score, complications and overall satisfaction were determined. Assessment showed a significant decrease in pain and excellent physical function at a median 5 years’ follow-up. Twelve patients needed secondary surgery due to persistent pain. Overall, 28 of the 46 patients were satisfied with the results of the denervation. Even though the results of CMC denervation are poorer than with simple trapeziectomy, considerable pain relief can be achieved in selected young, physically active patients by exclusively soft-tissue surgery, conserving the biomechanical properties of the joint. In case of failure of the procedure, all other options remain available.

An intraarticular injection to the elbow joint completely relieves pain in stenosing tenosynovitis of the wrist

Stenosing tenosynovitis of the first dorsal compartment of the wrist, de Quervain’s disease causes radial wrist pain and disability. Clinically, corticosteroids are most commonly used to treat de Quervain's disease. The injection of triamcinolone into the sheath of both the extensor pollicis brevis and abductor pollicis longus tendon is known to successfully relieve the symptoms of de Quervain’s disease. However, depigmentation of the skin and spontaneous rupture of extensor tendons have been frequently reported as side effects of injection of intra-sheath injection of triamcinolone. To bypass undesirous complications of triamcinolone for the treatment of de Quervain’s disease, we conducted an intra-articular injection of it into the elbow joint instead of an intra-sheath injection to the wrist. This retrospective study examines the results of 54 outpatients who presented with de Quervain’s disease from October 2018 through September 2021 and were treated with a combination of triamcinolone/ lidocaine injection. After single injection of triamcinolone, patients had a considerable pain relief with a dose-dependent manner and experienced an easier wrist mobility than prior to the treatment. With two times of injections, pain relief and movement flexibility were more consolidated. Adverse complications caused by the intra-articular triamcinolone were observed in none. These results indicate that the intra-articular triamcinolone in the elbow joint can provide an acceptable treatment option for de Quervain’s disease.

Surgical therapy in osteoarthritis

To provide an evidence-based overview of the different surgical procedures in osteoarthritis (OA). This narrative review reports on surgical therapies (1) for severe, end stage OA and (2) of surgical options aiming to possibly reduce OA development earlier in the course of the disease. Surgical practice guidelines provide evidence-based recommendations to assist in the clinical decision-making. Total joint arthroplasty represents the only valuable, established surgical option for severe, end stage OA. For hip and knee OA, it is by far the most common surgical procedure and provides considerable pain relief, functional restoration, and improved quality of life. Surgical therapy aiming to postpone OA essentially addresses extra- or intraarticular pre-osteoarthritic deformities, defined as congenital or acquired disturbances of the joint structure that adversely affect its function. Approaches in this category include osteotomies and different cartilage repair procedures such as osteochondral autograft and allograft transfer, marrow stimulation techniques, and autologous chondrocyte implantation. However, they are not only less commonly performed than arthroplasty, but the scientific clinical evidence in favour of this type of surgery to reduce the long-term risk of developing OA is considerably reduced. Total knee and hip arthroplasty are two of the most successful procedures in all of medicine. As the progression of this insidious disease is often asymptomatic and slow, it is imperative to judge reparative procedures at their potential to reduce OA development at long-term, besides their primary clinical outcomes. Evidence-based guidelines provide a valuable tool for high-quality surgical decision making in OA.

Study Design Characteristics and Endpoints for Enriched Enrollment Randomized Withdrawal Trials for Chronic Pain Patients: A Systematic Review.

Enriched enrollment randomized withdrawal (EERW) pain trials are designed to include only responders with considerable pain relief without unacceptable side effects into the randomized phase. There are no recommendations for primary endpoints in such trials. Our objective was to propose recommendations based on assessment of trial characteristics, endpoints and effect sizes in EERW pain trials. We conducted a systematic review by searching electronic databases up to June 2020 for EERW trials comparing an analgesic with a placebo in adults suffering from chronic pain. A total of 28 trials met our criteria, involving 13662 patients in the open or single-blind phase and 7937 patients in the double-blind phase. As primary endpoint 18 trials used pain intensity measured with the visual analogue scale (VAS) or the 11-point numerical rating scale (NRS); 1 trial used a 4-point NRS. Loss of therapeutic response (LTR) was used in 1 trial and time to LTR was used in 8 trials as primary endpoint. Definitions of time to LTR differed considerably between trials. Only 2 out of 8 trials using time to LTR as primary endpoint reported the percentage of patients experiencing a minimum pain relief of 50%, compared to 14 out of 18 trials using NRS or VAS. Due to the complexity and diversity of time to LTR in EERW pain trials, we propose to use the NRS as primary endpoint with conservative imputation methods, and to use time to LTR as secondary endpoint.

Scoliosis Secondary to Lumbar Spine Herniated Nucleus Pulposus in Adolescents: A Case Report

Introduction: Herniated nucleus pulposus (HNP) is infrequent among children and adolescents. The first case of surgical intervention for disc herniation was reported in a 12-year-old child. Since then, very few cases or series of cases have been published. The reactive scoliosis is frequently associated with lumbar HNPs, a compensatory effort to relieve nerve compression. Moreover, reactive scoliosis secondary to lumbar HNP is typically associated with children and usually resolves with effective management of lumbar HNP. Although the surgical intervention is frequently employed among adults, only 0.5% of discectomies are carried out in children &lt;16 years old. The current case report is of a 15-year-old girl, with no history of spinal ailment, who presented with a large disc herniation at L4–L5 region, associated with a reactive secondary scoliosis, which was resolved following a successful surgical intervention.&#x0D; Case Report: A 15-year-old female with known case of scoliosis and a history of lower back pain for nine months following a fall while playing football presented at outpatient clinic. She sought medical opinion after two months of persistent pain with radiculopathy to the right side toward big toe. Similarly, there was normal plantar reflex and no clonus or Hoffman sign. There was positive straight leg raise test as well as positive contralateral straight leg raise test. Scoliosis is idiopathic in majority of young patients. However, it might also arise as a part or complication of a triggering health state. Although scoliosis has been frequently associated with lumbar HNP among adolescents, most patients with lumbar disc ailment in this age group might be underdiagnosed initially. Similarly, in our case study the patient was not diagnosed when medical opinion was sought after two months of persistent pain with radiculopathy to the right side toward big toe. The clinical characteristics of pediatric lumbar HNP are usually comparable to those seen in adults; however, one distinguishing feature is that up to 90% have a positive straight-leg raising test. The most common symptom is lumbar pain; limitation of lumbar motility and lassegue are the most common signs. The etiology, pathophysiology, and patterns of the scoliotic posture in cases secondary to HNP remain debated. It is highly recommended to do CT scan in cases of adolescent lumbar HNP to rule out apophyseal ring fracture; accurate diagnosis helps surgeon in planning the appropriate surgical intervention needed. Scoliosis secondary to lumbar disc herniation is observed occasionally, therefore, its clinical significance and pathophysiology are not well-established. However, it is well-recognized that children’s spines have superior adaptive capacity, which shields nervous tissue. An example of this could be scoliosis in patients with root compression, when they bend to the side contrary to the compression, causing an enlargement of the affected foramen and root release. It has been reported that 80% of the patients with disc herniation and scoliosis had the convexity on the side of the root compression. The MRI findings revealed that the scoliosis widened the foramen. Similarly, in our case report the X-ray depicted scoliotic deformity with convexity toward the right side. MRI is the best imaging technique to indicate disc herniation and eliminate other likelihoods in both children and adolescents. Surgical interventions, such as micro-endoscopy discectomy and percutaneous endoscopic lumbar discectomy, could achieve considerable pain relief and function improvement. Our case finding revealed that microscopic discectomy relieved the pain and improved the scoliosis.&#x0D; Conclusion: Lumbar disc herniation is a rare entity among both children and adolescent and may also result in scoliosis and lumbar pain with or without sciatica. Therefore, lumbar disc herniation in association with scoliosis need vigilant evaluation of signs and symptoms in addition to appropriate diagnostic imaging. Imaging has a vital role in the diagnosis of underlying disease state and helps in clinical management along with surgical planning. The appropriate treatment is discectomy.

Role of Erector Spine Plane Block for Postoperative Analgesia in Patients Undergoing Percutaneous Nephrolithotomy

Background and objective: The objective of the present study was to determine the effectiveness of erector spinae plane block (ESPB) for pain relief in patients undergoing percutaneous nephrolithotomy. Methods: Sixty-four patients of either sex, American Society of Anaesthesiology (ASA) Grade I/II for surgery were enrolled. After informed consent, all participants received subarachnoid block with 3 ml of 0.5% injection heavy bupivacaine. Participants in the block group received ultrasound-guided ESPB with 30 ml of 0.5% ropivacaine, whereas participants in the control group received routine analgesia as per our hospital's protocol for percutaneous nephrolithotomy procedure which is tramadol 100 mg intravenously. This prospective, single-blind, randomized, controlled study was conducted after approval from the institutional ethics committee (SRHU/HIMS/RC/2019/291) and written informed consent was obtained for surgery under spinal anesthesia. Pain score (visual analog scale, VAS) was evaluated by the anesthesiologist who was not involved in the study at 30 minutes and 2, 4, 6, 8, 12, 18, and 24 hours postoperatively and patient was monitored with electrocardiogram, noninvasive blood pressure, heart rate, and pulse oximetry. Unpaired t test was used for comparison between the groups. Results: Both the groups were appropriately matched for age, ASA physical status, weight, and duration of surgery. The total dosing of rescue analgesia, that is, tramadol was considerably more in the control group in comparison with the ESPB group in the first postoperative day (P = 0.000; 218.75 ± 82.06 mg vs. 103.12 ± 47.41 mg, respectively). Similar results were obtained in the VAS pain score. Conclusion: ESPB helped in providing considerable postoperative pain relief in patients undergoing percutaneous nephrolithotomy.

Percutaneous Cryoablation of Lower Limb Soft-Tissue Venous Malformations: Preliminary Results of Long-Term Efficacy.

To retrospectively evaluate long-term efficacy of percutaneous cryoablation for lower limb soft-tissue venous malformations. Nine patients (mean age, 36.6years) with lower limb soft-tissue venous malformations were included. Cryoablation was performed percutaneously using an argon-based system. Adverse events (AE) using the Common Terminology Criteria for AEs version 4.0 were evaluated. The visual analog scale (VAS) scores and lesion volumes measured on magnetic resonance imaging were also evaluated at 12months and 5-6years. Technical success (i.e., complete coverage of the lesion by an iceball) was achieved in eight of the nine patients. All patients developed a total of 14 grade 1 or 2 adverse events. The mean (± standard deviation) VAS score was 6.0 (± 1.7) before therapy, whereas it was 0.14 (± 0.27) at 12months and 0.97 (± 1.3) at 5-6years (58-78months). Complete pain relief was obtained in 6 and 5 patients at 12months and 5-6years, respectively. The median lesion volume was 2.49mL before therapy, whereas it was 0.26mL at 12months and 0.35mL at 5-6years. Percutaneous cryoablation of lower limb soft-tissue venous malformations achieved considerable pain relief and lesion shrinkage for 5-6years in this small preliminary study. Level 4, Case Series.

Proteus\xa0mirabilis thoracic vertebral osteomyelitis: a case report

BackgroundProteus mirabilis is the second most common pathogen that causes urinary tract infections after Escherichia coli. In rare cases, it is associated with vertebral osteomyelitis. The underlying mechanism of this relationship may be related to the retrograde dissemination of bacteria through the paravertebral venous plexus.Case presentationWe report a case of an 80-year-old Taiwanese woman who had recurrent episodes of fever and chronic back pain for 1 year. All blood cultures were positive for P. mirabilis. Inflammation scans and magnetic resonance imaging revealed a previously undetected vertebral lesion between the seventh and eighth thoracic vertebra. She responded well to treatment with antibiotics, reporting considerable relief of back pain and no fever recurrence at the 4-month follow-up.ConclusionsChronic back pain is a common but often dismissed symptom among the older population; osteomyelitis should be considered in patients with recurrent fever or neurological symptoms. Old age, chronic renal failure, and diabetes mellitus are possible predisposing factors for osteomyelitis. Our findings suggest that long-term treatment with antibiotics is effective for osteomyelitis caused by P. mirabilis,, although surgery is required for abscess formation or serious vertebral destruction.

Thermographic follow-up of postherpetic neuralgia (PHN) subsequent to Ramsay Hunt syndrome with multicranial nerve (V, VII, VIII and IX) involvement: a case report

BackgroundRamsay Hunt syndrome (RHS) is caused by a reactivation of varicella-zoster virus (VZV) infection, and it is characterized by the symptoms of facial paralysis, otalgia, auricular rash, and/or an oral lesion. Elderly patients or immunocompromised patients, deep pain at the initial visit and no prompt treatment are significant predictors of postherpetic neuralgia (PHN). When PHN occurs, especially involved cranial polyneuropathy, multiple modalities should be administered for patients with the intractable PHN. The use of thermography in the follow-up of PHN secondary to RHS with multicranial nerve involvement has not yet been described yet in the literature.Case presentationThe patient was a 78-year-old man with the chief complaint of a 3-month history of PHN secondary to RHS with polycranial nerve (V, VII, VIII, and IX) involvement. Multimodality therapy with oral gabapentin, pulsed radiofrequency (PRF) application to the Gasserian ganglion for pain in the trigeminal nerve region, linear-polarized near-infrared light irradiation for pain in the facial nerve region, and 2% lidocaine spray for pain in the glossopharyngeal nerve region was used to the treat patient, and follow-up evaluations included thermography. This comprehensive treatment obviously improved the quality of life, resulting in considerable pain relief, as indicated by a decrease in the numerical rating scale (NRS) score from 9 to 3 and a decrease in thermal imaging temperature from higher to average temperature on the ipsilateral side compared with the contralateral side. Lidocaine spray on the tonsillar branches of the glossopharyngeal nerve resulted in an improvement in odynophagia, and the NRS score decreased from 9 to 0 for glossopharyngeal neuralgia after three applications.ConclusionAlthough the use of thermography in the follow-up of RHS with multiple cranial nerve (V, VII, VIII, and IX) involvement is very rare, in this patient, thermal imaging showed the efficacy of combination therapy (oral gabapentin, 2% lidocaine sprayed, PRF application and linear-polarized near-infrared light irradiation) and that is a good option for treatment.

Steroid Antibiotic Pack Versus 10% Ichthammol Glycerol Pack in Management of Acute Otitis Externa: A Comparative Study

Acute otitis externa is a common clinical condition that presents with rapid onset of otalgia, fullness, otorrhea and canal oedema. Moisture in-ear canal appears to be an important predisposing factor. The most common etiological agents include Pseudomonas aeruginosa and Staphylococcus aureus. Management includes control of otalgia and elimination of infection from the ear. Precipitating factors should be avoided. The main objective of this study is to compare the efficacy of 10% ichthammol glycerol ear pack with steroid antibiotic ear pack in the treatment of acute otitis externa. Institutional Review Board (IRB) clearance was obtained, and a prospective randomised clinical trial was conducted in the ENT outpatient department of Saveetha Medical College &amp; Hospital, Thandalam, from January 2020 to March 2020. Patients were explained about the study in detail, and consent was obtained. The patients were randomised, and 10% ichthammol glycerol pack and steroid antibiotic pack were used in alternate turns for aural packing. Pain rating was done using Numerical rating scale (NRS) before and 48 hours post-treatment and also in each subsequent hospital visit till complete subsidence of symptoms. Among the 85 patients included in the study, 42 (49.4%) were males, and 43 (50.6%) were females. Most of them belonged to the age group 31-40 years (41.2%). Tragal tenderness and external auditory canal oedema were the most common ear findings noted. In the patients treated with steroid antibiotic pack, only 2.3% of the patients had severe pain, whereas 14% had moderate pain and 83.7% had only mild pain. Whereas among those treated with 10% ichthammol glycerol pack, 9.5% of the patients had severe pain, whereas 35.7% had moderate pain and 54.8% had mild pain. On analysis, the results were statistically significant, and there was considerable pain relief with steroid antibiotic pack. Therefore, our study showed that steroid antibiotic pack is more effective in relieving the symptoms, thereby reducing the number of hospital visits when compared to 10% ichthammol glycerol pack.

Motor Recovery of the Suprascapular Nerve after Arthroscopic Decompression in the Scapular Notch – a Systematic Review

The suprascapular nerve can be compromised as a result of a compression syndrome in different locations. A (proximal) compression within the scapular notch can lead to dorsal shoulder pain and simultaneous weakness of the infraspinatus and supraspinatus muscles. By transection of the lig. transversum this compression syndrome can be treated. By means of a systematic review, the present work analyzes the motor recovery potential after arthroscopic decompression. A systematic review of the U. S. National Library of Medicine/National Institutes of Health (PubMed) database and the Cochrane Library was performed using the PRISMA checklist. The search words used were "suprascapular" and "arthroscopic"; "suprascapular" and "arthroscopy". Based on the evaluated literature, articles in English with at least a partial arthroscopic case series from 4 cases on and a compression syndrome of the suprascapular nerve treated with arthroscopic decompression in the scapular notch were identified. Motor recovery was described by means of EMG, clinical strength and MRI. Primarily 408 hits were generated. Six articles met the inclusion criteria and were further analyzed. The number of arthroscopic cases was between 4 and a maximum of 27. The level of evidence was between III and IV. The majority of the reported clinical results were good. Motor recovery as measured by EMG was observed, recovery of full strength was not achieved in the majority of reported cases (60%), neither was regression of structural (fatty) degeneration of the muscle bellies. Arthroscopic decompression of the suprascapular nerve in the scapular notch provides good clinical results and considerable pain relief. However, in the majority of cases it does not lead to a complete recovery of the strength of the supra- and infraspinatus muscles. Patients should be informed about this. An early decompression after diagnosis in the event of proximal compression within the suprascapular notch combined with beginning EMG or MRI changes appears reasonable. These beginning changes should be further defined. Future studies should develop prognostic criteria for motor recovery. Awareness regarding the diagnosis needs to be improved due to the probably time-dependent irreversibility of resulting muscular weakness.

Single-Cut Single-Screw Capitate-Shortening Osteotomy for Kienbock's Disease.

Background Kienbock's disease, in spite of an uncertain natural history, is known to cause lunate compromise, leading to central column collapse, carpal instability, and degenerative arthritis of the wrist. Joint leveling procedures are performed in the early stages of Kienbock's disease to "unload" the lunate. Capitate shortening is the preferred procedure in Kienbock's patients with positive ulnar variance. Description of Technique We describe the rationale and a simplified technique of capitate shortening in early Kienbock's disease. This is a single-cut osteotomy with single-screw stabilization. Patients and Methods We have performed this technique in three cases. We present a case of a 26-year-old male who presented with a 1-year history of pain in his right wrist. Radiology performed demonstrated lunate sclerosis. Diagnostic arthroscopy revealed healthy articular surfaces. Single osteotomy capitate shortening was performed with an oscillating saw and fixed with a single cannulated compression screw. A shortening of 1.5mm was obtained with this technique. Results At 1- to 2-year follow-up, all three patients had considerable pain relief but did not have a complete resolution of pain. There was a significant improvement in function and grip strength. There have been no cases with infection, nonunion, avascular necrosis or a need for a salvage procedure. Conclusion The simplified technique of capitate shortening is easy to perform, less traumatic to the capitate vascularity, and leads to good short-term functional results.

Navigation-Assisted Posterior Open Reduction and Internal Fixation in a C-CLAMP Fashion for an Isolated C1 Fracture.

C1 fractures with an intact transverse ligament are usually treated conservatively. Patients who present with a progressive diastasis of bone fragments and a progressive articular subluxation mainly attributed to progressive lengthening of the transverse ligament (TAL) fibers can be treated with a C1 “C-clamp” fusion.A 75-year-old male who sustained a motor vehicle accident was neurologically intact. A computed tomography (CT) imaging demonstrated a Jefferson's type-C1 fracture with a slight lateral displacement of the C1 left lateral mass (LM) and a rotatory subluxation on the right. MRI showed an intact TAL and demonstrated an isolated rupture of the left alar ligament. Conservative treatment was chosen. Radiographic follow-up showed, at 3 months, progressive lateral mass displacement, most likely due to elongation of the TAL fibers; this was also associated with a persistent mechanical neck pain. For this reason, we performed a posterior reduction and internal fixation in a C-clamp fashion by placement of C1 lateral mass screws and posterior compression sparing the C1–2 joint. Using navigation, a 3.5-mm screw was inserted into the LM bilaterally. The screw heads were then connected with a rod and compression was applied before tightening. Postoperative CT scan demonstrated a satisfying reduction and further imaging will be made during the follow-up. The patient had a considerable relief of neck pain. Simple lateral mass fixation with C-clamp technique is a reasonable option in case of isolated C1 fractures in patients who have failed conservative management while preserving the range of motion (ROM) at the atlanto–axial joint. The link to the video can be found at: https://youtu.be/x8bsVwzCt_M .

Effectiveness of distal tibial osteotomy with distraction arthroplasty in varus ankle osteoarthritis

BackgroundIn highly active older individuals, end-stage ankle osteoarthritis has traditionally been treated using tibiotalar arthrodesis, which provides considerable pain relief. However, there is a loss of ankle joint movement and a risk of future arthrosis in the adjacent joints. Distraction arthroplasty is a simple method that allows joint cartilage repair; however, the results are currently mixed, with some reports showing improved pain scores and others showing no improvement. Distal tibial osteotomy (DTO) without fibular osteotomy is a type of joint preservation surgery that has garnered attention in recent years. However, to our knowledge, there are no reports on DTO with joint distraction using a circular external fixator. Therefore, the purpose of this study was to examine the effect of DTO with joint distraction using a circular external fixator for treating ankle osteoarthritis.MethodsA total of 21 patients with medial ankle arthritis were examined. Arthroscopic synovectomy and a microfracture procedure were performed, followed by angled osteotomy and correction of the distal tibia; the ankle joint was then stabilized after its condition improved. An external fixator was used in all patients, and joint distraction of approximately 5.8 mm was performed. All patients were allowed full weight-bearing walking immediately after surgery.ResultsThe anteroposterior and lateral mortise angle during weight-bearing, talar tilt angle, and anterior translation of the talus on ankle stress radiography were improved significantly (P < 0.05). Signal changes on magnetic resonance imaging also improved in all patients. Visual analog scale and American Orthopedic Foot & Ankle Society scores improved significantly (P < 0.05), and no severe complications were observed.ConclusionDTO with joint distraction may be useful as a joint-preserving surgery for medial ankle osteoarthritis in older patients with high levels of physical activity.Level of evidenceLevel IV, retrospective case series.