Lateral Aspect Of Thigh Research Articles

Multiple hole drilling in osteonecrosis of femoral head- promising and better method of core decompression in Asian population

Introduction: Core decompression of femoral head has been one of the best option for delaying the need for Total Hip Replacement in cases of osteonecrosis of femoral head. It is also the best treatment option in earliest pre-collapse stages of disease. Techniques have been combined with several other adjunctive treatment modalities such as bone grafting and the addition of growth and differentiation factors [7]. Our case series describes the multiple hole drilling in osteonecrosis of femoral head.Materials and Methods: Our series include 46 patients (64 hips), who were diagnosed with osteonecrosis of femoral head of various aetiology. We improvised the conventional decompression technique which usually requires 8mm Michele trephine and DHS reamer with patient in fracture table. In our method, the patient was positioned in supine without need of any fracture table and small incision of less than 1cm was made in lateral aspect of thigh. We used only a single 3.5 mm drill bit and 3-4 holes were drilled into the femoral head under C-arm guidance. We didn’t use any adjunctive. Patients were allowed for partial weight bearing mobilisation with walker assistance for the first month and without any support thereafter.Results: Our case series includes totally 46 patients (64 hips) of Ficat stage I, II and III of osteonecrosis of femoral head. We had a follow up of two years. Patients who were symptomatic and showing oedema in femoral head had better results. Harris hip score was used for assessment. Post operatively patients showed improvement clinically. Only one patient required Total Hip Replacement later. None of the cases reported any perioperative fracture. Conclusion: Core decompression has been evolved the most reliable treatment for osteonecrosis of femoral head, especially for the early stages of necrosis. We have improvised the technique and made it quite simpler, less invasive, safer, and time saving and resulted in less morbidity, comparing to the conventional method of single coring, with better outcome and promising results. Also, considering the narrow width of Asian necks, multiple drill hole technique is more ideal option, as it eliminates the risk of fracture and other risks of single coring technique, and being cost effective too. Thus, multiple hole drilling is the best method of core decompression of femoral head, especially in Asian population.

Idiopathic Calcinosis Cutis Masquerading as Malignancy - The Mystery of Two Cases Revealed on Cytology

Calcinosis cutis also commonly called as Calciphylaxis is one of the uncommon conditions characterized by precipitation and deposition of phosphate and calcium salts in the dermis and subcutaneous tissues. We report two different cases clinical diagnosed as malignancy and final diagnosis was made on FNAC which correlated with the histopathology. A 45-year-old women came with a compliant of swelling over lateral aspect of thigh on left side since 6 months. Provisional diagnosis of liposarcoma was made clinically and on FNAC given as Calcinosis cutis which correlated with histopathology. A 62-year-old women came with compliant of swelling over lateral aspect of thigh on right side since 10 months associated with pain. Provisional diagnosis of soft tissue sarcoma was made clinically and advised for FNAC clinically and on FNAC given as Calcinosis cutis which correlated with histopathology. Calcinosis cutis is a condition in which there is organized and localized deposition of calcium in the skin. The evolution of the lesions depends on the aetiology of the calcification. The pathogenesis still remains unclear, but several theories have been suggested for this. Calcinosis cutis is a potential mimic of a neoplastic lesion. FNAC is a simple, rapid and reliable technique and which helps in diagnosis of such lesions. Keywords: Mimicker, Fine needle aspiration cytology, Diagnosis

Ultrasound-guided radio frequency ablation of lateral femoral cutaneous nerve in intractable meralgia paresthetica

Meralgia paresthetica characterised by pain, tingling and numbness in lateral aspect of thigh. A 48 year-old male with 2 years history of left lateral thigh paresthesias and burning pain consistent with meralgia paresthetica was referred to our clinic after failing trials of physical therapy, nonsteroidal anti-inflammatories and neuropathic medications. We performed lateral femoral cutaneous nerve block with corticosteroid, after that patient had good relief for 2 months; however, block provided only temporary relief and patient again started feeling same pain. As this pain was limiting the patient's ability to perform his functions as truck driver, we planned to perform a pulsed radiofrequency treatment of the lateral femoral cutaneous nerve left side under ultrasound guidance. After locating the lateral femoral cutaneous nerve with ultrasound and reproducing the patient's dysesthesia with stimulation, pulsed radiofrequency treatment was performed at 42°C for 120 seconds. The needle was then rotated 180° and an additional cycle of pulsed radiofrequency treatment was performed followed by injection of 0.125 % bupivacaine with 20 mg triamcinolone. At 2 and 4 month follow-up visits, the patient reported excellent pain relief with activity and improved ability to perform his duties. We have also described various aetiologies for meralgia paresthetica and multiple modalities available for the treatment of meralgia paresthetica.

A Comparative Clinical Study on the effect of Ajmodadi Churna and Kati Basti in the management of Gridhrasi w.s.r. to Sciatica

In Ayurveda, Gridhrasi is considered as one of the Vataja Nanatmaja Vyadhi having vitiation of Vata and sometimes Vata Kapha Dosha. The cardinal signs and symptoms of Gridhrasi are Ruk (pain), Toda (pricking sensation), Stambha (stiffness) and Muhurspandan in the Sphika, Kati, Uruh, Janu, Jangha and Pada in order and Sakthiuthkshepanigraha (hinderence in lifting of the legs). In Kaphanubandha -Tandra, Gaurav, Arochaka are present. The signs and symptoms of ‘Gridhrasi’ can be correlated with that of ‘Sciatica’ in modern terminology. Sciatica is a very painful condition in which pain begins in lumbar region and radiates along the posterior lateral aspects of thigh and leg along with difficulty in walking. SLR test, sitting test, Lasegues sign are helpful not only to diagnose the sciatica but also to assess the progress of the therapy. With reference to the management of Sciatica, in modern medicine, various modalities are available. These modern therapies have their own limitations and these management tools are not affordable for the poor, especially in the developing countries. Therefore, the choice of treatment commonly opens to reveal some effective, simple, safe and economic modalities. Total 30 patients were registered in this study. 15 patients were assigned to group A (Ajmodadi Churna) and 15 to group B (Ajmodadi Churna and Sahacharadi Taila Kati Basti). Each patient was examined thoroughly before treatment and observed keenly during the procedure and follow up.

Three-dimensional motion analysis for validation of shoulder internal rotation.

10% of the points for the Constant-Murley score (CMS) are allocated for the capacity for internal rotation (IR), measured as unassisted active movement of the dorsum of the hand or the thumb to reach different anatomical landmarks. However, there is little information about the validity of this method and no three-dimensional measurement of the degree of IR that is necessary to reach these landmarks. Sixteen volunteers with healthy shoulders were recruited. The degree of IR was defined using the following landmarks as described in the CMS: (1) lateral aspect of thigh, (2) buttock, (3) sacroiliac joint, (4) level of waist, (5) vertebra T12, (6) interscapular. The validity of IR measurement was assessed by simultaneous 3D motion analysis. Using the thumb as pointer, there were significant increases in IR from 39.3° at position 1 to 80.4° at position 2, followed by 105.1°, 108.6°, 110.1°, and 125.3° at position 3-6. Taking the dorsum of the hand as pointer, there were significant increases in IR between all positions, starting from 71.2° (position 1) and followed by 99.3°, 104.1°, 110.3°, 115.2°, and 119.7° at positions 2 to 6. Comparing the two measurement methods, a significant difference was found for the amount of IR between positions 1 and 2. Measurement of IR as described in the CMS is a suitable method. However, there was an increase of only 10° in IR between positions 3 and 5, which may be hard to measure with a standard goniometer in clinical practice.

Soft tissue neuroendocrine carcinoma of thigh: A case report with literature review

A rare case of advanced neuroendocrine carcinoma of thigh in a young adult female, diagnosed with the aid of immunohistochemistry and electron microscopic examinations together with a review of the literature are reported. The primary tumor involved the lateral aspect of thigh without bone involvement. Patient showed significant response with adjuvant chemoradiotherapy following incomplete surgery.

An automatic device to measure time spent upright

Objective measurements of time spent standing or walking would be of benefit in assessing response to therapy. We have tested a device consisting of a mercury tilt switch attached to an electronic counter to measure time spent upright. Eleven subjects, six male and five female age 67-88 years (mean 76 years) undergoing rehabilitation were studied. Diagnoses included: Parkinson's disease, dementia, stroke and femoral fracture. The device was fitted with the tilt switch on the lateral aspect of thigh. Measurements compared stopwatch readings made by an observer and the device. Study periods were of one to three hours. There was excellent correlation between stopwatch and device measurements of time spent standing (t = 0.994; p < 0.001). The device functioned well during physiotherapy and ward activities although measurements were inaccurate when subjects used an exercise bicycle or climbed steps greater than 20 cm in height. The device should prove useful for monitoring activity and response to mobilization therapy.