Mean Visual Analog Scale Research Articles

Treatment of Kienböck's Disease Using Fourth and Fifth Extensor Compartmental Artery Vascularized Bone Grafts.

This study evaluated the radiological and clinical outcomes of bone grafts using fourth and fifth extensor compartmental arteries (4+5 ECAs) for the treatment of Kienböck's disease. In total, 21 patients (12 men and 9 women; mean age, 41 years; range, 19-59 years) were followed for a mean of 33 months. Radiological images were analyzed for the Lichtman stage, carpal height ratio, radioscaphoid angle, and Stahl's index. Clinical evaluation included range of motion, visual analog scale (VAS) score, grip strength, modified Mayo wrist score (MMWS), Lichtman outcome score, and Disabilities of the Arm, Shoulder and Hand (DASH) score. At the time of surgery, 6, 14, and 1 patients had Lichtman stages II, IIIA, and IIIB, respectively. At the final follow-up visit, grip strength had improved from 65.4% to 79.7%, wrist extension had improved from 43° to 57°, and flexion had improved from 42° to 50°. There were no significant changes in the carpal height ratio, Stahl's index, or radioscaphoid angle. The mean VAS score was 1.7, and the mean DASH score was 6.9. The mean MMWS was 87.9, with excellent and good outcomes in 6 and 11 patients, respectively. Satisfactory Lichtman outcome scores were observed in 81%. Body mass index had a strong correlation and age had a weak correlation with MMWS (coefficient=-0.534, P=.013, and coefficient=-0.393, P=.078, respectively). The 4+5 ECA bone graft is effective for the treatment of Kienböck's disease in young patients with low body mass index. [Orthopedics. 202x;4x(x)xx-xx.].

Rigid iatrogenic hallux varus: a decades’ worth experience with arthrodesis of the metatarsophalangeal joint

PurposeArthrodesis of the first ray metatarsophalangeal joint (MPJ) is the gold standard in iatrogenic hallux varus (IHV) in the presence of stiffness and osteoarthritis. The purpose of this study is to collect clinical and radiographic results and complications of MPJ arthrodesis in rigid iatrogenic HV.MethodsA retrospective evaluation of rigid iatrogenic HV undergoing arthrodesis with a minimum follow-up (FU) of two years was performed. The clinical parameters assessed were visual analog scale (VAS), the AOFAS Hallux Metatarsophalangeal-Interphalangeal Scale score and the satisfaction scale. The radiological parameters evaluated the first to second metatarsal angle (IMA) and the angle of hallux valgus (HVA). Complications were also analysed.ResultA total of 18 patients (19 procedures) with a mean FU of 5.5 ± 2.5 years were included. The mean VAS improved from 7.3 ± 1.6 to 1.3 ± 1.2 (p < 0.05) at the last FU. Similarly, the AOFAS Hallux Metatarsophalangeal-Interphalangeal scale score significantly improved to 82 ± 9.2 (p < 0.05). Radiological evaluation demonstrated a 1–2 IMA improvement from 4.4 ± 2.2° preoperatively to 8.9 ± 2.4° at 3 months post-operatively. Similarly, there was a significant (p < 0.05) improvement of the HVA from − 22.7 ± 4.1° to 13.1 ± 4.1° at three months post-operative (p < 0.05). No signification loss of correction was noted at the last follow-up (p > 0.05). In one case, a delayed fusion at the arthrodesis site required surgical revision to promote fusion. No patient experienced pain with stress from the first MTP joint arthrodesis site or identified the arthrodesis site as a source of pain. No patient required implant removal. Re-operation and revision rates were 5.3%. The overall complications rate was 15.8%.ConclusionsMPJ fusion effectively corrects Iatrogenic Hallux Varus in cases of rigid and fixed deformities in the medium- to long-term follow-up, with lasting improvements in AOFAS and VAS scores. The procedure is characterised by a non-negligible risk of complications, reoperations and revisions.Level of evidenceLevel IV, case series.

A Patient-Centered Perspective on Changes in Personal Characteristics After Deep Brain Stimulation

Deep brain stimulation (DBS) results in improvements in motor function and quality of life in patients with Parkinson disease (PD), which might impact a patient's perception of valued personal characteristics. Prior studies investigating whether DBS causes unwanted changes to oneself or one's personality have methodological limitations that should be addressed. To determine whether DBS is associated with changes in characteristics that patients with PD identify as personally meaningful. This cohort study assessed changes in visual analog scale (VAS) ratings reflecting the extent to which patients with PD manifested individually identified personal characteristics before and 6 and 12 months after DBS at a large academic medical center from February 21, 2018, to December 9, 2021. The VAS findings were tailored to reflect the top 3 individually identified personal characteristics the patient most feared losing. The VASs were scored from 0 to 10, with 0 representing the least and 10 the most extreme manifestation of the trait. Change scores were examined at the individual level. Content analysis was used to code the qualitative data. Qualitative and quantitative analyses were performed from January 12, 2019 (initial qualitative coding), to December 15, 2023. Deep brain stimulation. The primary outcome variable was the mean VAS score for the top 3 personal characteristics. The secondary outcome was the incidence of meaningful changes on the patients' top 3 characteristics at the individual level. Fifty-two of 54 dyads of patients with PD and their care partners (96.3%) were recruited from a consecutive series approved for DBS (36 patients [69.2%] were male and 45 care partners [86.5%] were female; mean [SD] age of patients, 61.98 [8.55] years). Two patients and 1 care partner were lost to follow-up. Increases in the mean VAS score (indicative of greater manifestation of [ie, positive changes in] specific characteristics) were apparent following DBS for ratings of both the patients (Wald χ2 = 16.104; P < .001) and care partners (Wald χ2 = 6.746; P < .001) over time. The slopes of the changes for both the patient and care partners were correlated, indicating agreement in observed changes over time. The individual level analyses indicated that scores for most patients and care partners remained the same or increased. In this cohort study, participants reported greater (more positive) manifestations of individually identified, valued characteristics after DBS. These findings may be relevant to informing decision-making for patients with advanced PD who are considering DBS.

Mid-Term Clinical and Radiographic Results of Complex Hip Revision Arthroplasty Based on 3D Life-Sized Model: A Prospective Case Series.

Background: The pre-operative three-dimensional (3D) assessment of acetabular bone defects may not be evaluated properly with conventional radiographic and computed tomography images. This paper reports mid-term clinical and radiographic outcomes of complex revision total hip arthroplasty (r-THA) based on a 3D life-sized printed model. Methods: Patients who underwent r-THA for septic or aseptic acetabular loosening with acetabular defects Paprosky types IIc, IIIa, and IIIb between 2019 and 2021 were included. The outcomes of the study were to determine clinical and radiographic assessment outcomes at the time of the last follow-up. Results: 25 patients with mean age of 62.9 ± 10.8 (18-83) years old were included. The mean Harris hip score improved from 34.8 ± 8.1 pre-operative to 81.6 ± 10.4 points (p < 0.001). The mean visual analog scale decreased from 6.7 ± 1.4 points pre-operative to 2.4 ± 1.0 points (p < 0.001). The mean limb length discrepancy improved from -2.0 ± 1.2 cm pre-operative to -0.6 ± 0.6 cm (p < 0.001). The mean vertical position of the center of rotation (COR) changed from 3.5 ± 1.7 cm pre-operative to 2.0 ± 0.7 cm (p < 0.05). The mean horizontal COR changed from 3.9 ± 1.5 cm pre-operative to 3.2 ± 0.5 cm (p < 0.05). The mean acetabular component abduction angle changed from 59.7° ± 29.6° pre-operative to 46° ± 3.9 (p < 0.05). Conclusions: A three-dimensional-printed model provides an effective connection between the pre-operative bone defects' evaluation and the intraoperative findings, enabling surgeons to select optimal surgical strategies.

Peri-operative outcomes of IlluminOss fixation for pelvic metastatic bone disease

BackgroundPelvic metastatic bone disease (MBD) leads to significant pain and functional impairment. Managing these lesions through an open approach involves invasive procedures linked to potential morbidity and complications. The IlluminOss system, a UV light-activated polymer implant, has shown efficacy and safety in managing various fractures. This study evaluates the effectiveness of IlluminOss photodynamic bone stabilization system (PBSS) in pelvic MBD. MethodsA retrospective cohort review was conducted, including all patients treated with the PBSS system for MBD of the pelvis and acetabulum. ResultsFifteen patients were included with a mean follow-up of 4.97 months (SD 3.05). In the thirteen patients treated with the IlluminOss without concurrent total hip arthroplasty, the mean operative time was 170.4 min (SD 90.6). The mean estimated blood loss was 52.3 mL (SD 73.7). No patients required transfusions. The mean visual analog scale (VAS) pain score at the latest follow-up was 2.29, significantly lower than the preoperative score of 9.07 (p < 0.001). Thirteen patients (92.9 %) had improved functional status at the latest follow-up. ConclusionPBSS offers similar operative times, reduced blood loss, and decreased need for transfusions compared to open pelvic fixation methods. It also demonstrates significant pain reduction and improved functional outcomes without increased complications.

Internal Nasal Valve Collapse Treatment by Endonasal Hyaluronic Acid Injection.

Internal nasal valve collapse (IVC) is a common functional complication of rhinoplasty and injecting hyaluronic acid is one of the treatment options available, but its effectiveness has never been evaluated. The objective of this study was to assess the evolution of IVC after injection of hyaluronic acid using objective and subjective measures of nasal obstruction. A prospective interventional study was conducted. Adult patients consulting for nasal obstruction after (septo)rhinoplasty and diagnosed with IVC were included. Patients underwent 4-phase rhinomanometry, completed nasal obstruction symptoms evaluation (NOSE) and visual analog scale (VAS) questionnaires and received hyaluronic acid injections. Measurements were repeated immediately, one month and one year later. The primary outcome measure was the proportion of patients below the rhinomanometric diagnostic threshold for IVC at one month. Among the 22 patients included, 20 (91%) had rhinomanometry measurements below the diagnostic threshold for IVC one month after injection. It decreased to 53% (8/15 patients) at one year post injection. The mean NOSE score decreased from 74.5 (± 18.0) before injection to 35.2 (± 23.3) after injection (p < 0.0001). The mean VAS score decreased from 7.0 (± 1.4) before injection to 3.4 (± 1.9) after injection (p < 0.0001). In these patients with post-(septo)rhinoplasty IVC, hyaluronic acid injection into the internal nasal valve substantially improved subjective and objective measures of nasal obstruction. These results suggest hyaluronic acid injection (performed as described) is an effective treatment for IVC and is an excellent alternative to surgical treatment. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors https://www.springer.com/00266 .

Perioperative Complications of Oblique Lumbar Interbody Fusion (OLIF): 5 Years of Experience with OLIF

Abstract Objective The objective of this study was to share our early experience with oblique lumbar interbody fusion (OLIF), with emphasis on the perioperative complications and determine clinical outcomes following OLIF. Materials and Methods It was a retrospective prospective study performed at a single institute from March 2019 to August 2023. A total of 56 consecutive patients who had undergone OLIF for degenerative spine disorders were enrolled in the study. Pre-, intra-, and postoperative data on these patients were collected. All the patients were followed up at regular intervals with an evaluation of Visual Analog Scale (VAS), Oswestry Disability Index (ODI), neurological parameters, and X-rays to look for fusion, screw loosening, pseudoarthrosis, and cage slippage. Statistical analysis was done with the odds ratio, chi-square test, and Student's t-test. A p-value of &lt; 0.05 was considered significant. Results The overall incidence of complications was 25%, with no mortality. Intraoperative complications were noted in 10.7% of cases. This included endplate fractures (n = 3), peritoneal lacerations (n = 2), and ureteric injury (n = 1). The most common early postoperative complications were postoperative ileus (n = 6), followed by anterior thigh or groin numbness (n = 3), ipsilateral psoas weakness (n = 2), and superficial surgical site infection (n = 2). Of the late postoperative complications, cage subsidence was the most common, which occurred in 4 patients, followed by adjacent segment degeneration (n = 2) and loss of indirect decompression (n = 1). The mean ODI and VAS scores showed significant improvement (p &lt; 0.05) at the final follow-up. Conclusion OLIF is a promising surgical technique with the potential to treat a variety of degenerative conditions of the lumbar spine with a good clinical outcome. Despite its various benefits, OLIF can lead to complications in rare instances, which every spine surgeon should be aware of.

The impact of stroke and bleeding on mortality and quality of life during the first year after TAVI: A POPular TAVI subanalysis.

Bleeding and stroke are frequent complications after transcatheter aortic valve implantation (TAVI). The mortality risk associated with these events has been reported before, but data regarding their impact on health-related quality of life (QoL) is limited. To evaluate the impact of bleeding and stroke occurring within 30 days after TAVI, on mortality and QoL during the first year after TAVI. POPular TAVI was a randomized clinical trial that evaluated the addition of clopidogrel to aspirin or oral anticoagulation in patients undergoing TAVI. Besides clinical outcomes, QoL was assessed using the Short Form-12 and EuroQoL Five Dimensions questionnaires before, and at 3, 6, and 12 months after TAVI. Major or life-threatening bleeding occurred in 81 patients (8.3%) and was associated with an increased risk of death (hazard ratio [HR] 1.95 [95% confidence interval (CI) 1.00-3.79]); minor bleeding occurred in 104 patients (10.6%) and was not associated with mortality (HR 0.75 [95% CI 0.30-1.89]). Stroke occurred in 35 patients (3.6%) and was associated with an increased risk of death (HR 2.90 [95% CI 1.23-6.83]). Mean mental component summary (MCS-12) scores over time were lower in patients with major or life-threatening bleeding (p = 0.01), and similar in patients with minor bleeding, compared to patients without bleeding; mean physical component summary (PCS-12) scores, EQ-5D index, and visual analog scale (VAS) were similar between those patients. Mean MCS-12 scores were lower in patients with stroke (p = 0.01), mean PCS-12, EQ-5D index, and VAS were similar compared to patients without stroke. Major or life-threatening bleeding and stroke were associated with an increased risk of death and decreased mental QoL in the first year after TAVI.

Effectiveness of combining greater occipital nerve block and pulsed radiofrequency treatment in patients with chronic migraine: a double-blind, randomized controlled trial

BackgroundPulsed radiofrequency (PRF) treatment targeting the greater occipital nerve (GON) has shown efficacy in treating various conditions. This double-blind, randomized controlled study aimed to evaluate the effects of combining PRF therapy with GON block (GONB) therapy in patients with chronic migraine.MethodsThe study consisted of two groups: GONB and GONB + PRF, each comprising 16 patients with chronic migraine. Using 0.5-Hz sensorial stimulation, a 5-cm-long radiofrequency needle was inserted under ultrasound guidance in both groups. Subsequently, all patients received a GONB by administering 2 mL of 0.25% bupivacaine. In the GONB + PRF group, patients underwent 4 min of PRF at 42℃, whereas the GONB group did not receive any PRF treatment. Follow-up examinations were performed at 1, 2, 3 and 6 months after the procedure to evaluate the frequency and severity of migraine attacks, number of headache days, and analgesic consumption.ResultsIn the GONB + PRF group, the visual analog scale (VAS) score, number of migraine attacks, number of headache days, and analgesic consumption were significantly lower compared to the GONB group (P < 0.05). Significant decreases (60%) in mean VAS scores, number of migraine attacks, number of headache days, and consumption of analgesic medications were observed in the GONB + PRF group at the 1-, 2-, 3-, and 6-month follow-ups compared with the pre-treatment period (P < 0.05).ConclusionsThe combination of GONB and PRF presents a promising new treatment option for patients with chronic migraine. This approach has demonstrated efficacy in minimizing analgesic use, decreasing the frequency of migraine attacks, reducing the number of headache days and decreasing the severity of migraine attacks.Trial RegistrationNCT05464212.

Comparing the effects of neck stabilization exercises versus dynamic exercises among patients having nonspecific neck pain with forward head posture: a randomized clinical trial

BackgroundNonspecific neck pain (NSNP) is a well-established global burden affecting. It is also a common problem in Pakistan. The burden of neck pain is also increasing day by day due to poor work ergonomics, and increased use of computers and mobiles after the pandemic. An individual’s poor posture is often associated with forward head posture (FHP). Limited evidence is available about the effects of neck stabilization (NSE) and dynamic exercises (NDE) for nonspecific neck pain particularly in patients with FHP. This aimed to compare the effects of NSE versus NDE among patients having NSNP with FHP in reducing pain, disability, forward head posture and improving neck range of motion.MethodsIt is a single-blinded randomized clinical trial with 60 patients aged 18–40 years, with moderate intensity NSNP for > 3 weeks and < 6 months along with FHP with a moderate disability on neck disability index (NDI) randomly assigned to the treatment groups. Group 1 was doing NSE and group 2 was doing NDE. Transcutaneous Electical Nerve Stimulation, cold packs, and stretching exercises were given to both groups. A total of 9 sessions (3 sessions/ week) were given to participants. NDI questionnaire, Visual analogue scale (VAS), goniometry, and plumb line measurement tool were used as baseline and assessment at the end of 3rd week. The data was analyzed on SPSS version 21. Descriptive analysis was performed. Independent t-test was used for between group comparison and paired t-test used for within group comparison. A p-value less than 0.05 was considered statistically significant.ResultsAfter treatment within-group analysis of both NSE and NDE showed significant (p < 0.001) improvement in pain on VAS, all ROMs of the neck including flexion, extension, left and right lateral flexion and left rotation, plumb line and NDI score with very large effect size. However, between-group analysis showed non-significant differences (p > 0.05) for post-treatment mean VAS, neck ROM, NDI and plumb line measurement.ConclusionBetween NSE and NDE, no one is more beneficial than another. Both are equally effective in alleviating pain, increasing ROM, decreasing functional disability, and improving forward head posture in patients with NSNP.Trial RegistrationRegistered trial at ClinicalTrials.gov Identifier: NCT05298631, 28/03/2022, prospectively registered.

Effects of Lavender Oil Aromatherapy on Pain, Anxiety, and Comfort after Cesarean Section: A Randomized Controlled Trial

Objective: This study aims to determine the effects of lavender oil aromatherapy on pain, anxiety, and comfort after cesarean section. Methods: This study was conducted as a three-group randomized and controlled trial conducted in a city hospital in Adana, Türkiye between August and December 2020.The study included 93 women who had cesarean section, with 30 women in the experimental group, 31 women in the placebo group, and 32 women in the control group. The study was conducted in four phases including before the cesarean and 1st, 4th, and 8th hours post-cesarean section. Data were collected through the “Personal Information Form”, the “Visual Analogue Scale (VAS)”, the “Trait Anxiety Inventory (TAI)”, the “State Anxiety Inventory (SAI)”, and the “Postpartum Comfort Scale (PCS)”. Results: The women in the experimental, control and placebo groups were found to demonstrate statistically significant differences in terms of their VAS mean scores according to the processes (P

Low back pain and kinesiophobia in pregnant women.

During pregnancy, many pregnant women experience lumbopelvic pain due to mechanical, systemic, and hormonal reasons and this pain and fear of movement (kinesiophobia) causes daily life limitations. To examine low back pain (LBP), kinesiophobia, disability, and related conditions that develop together during pregnancy. The was a cross-sectional and analytical study. The presence, severity, and duration of pain in the lumbopelvic region were questioned. Postpartum LBP was evaluated using a self-administered questionnaire, disability using the Oswestry Disability Index (ODI), pain intensity using a visual analog scale (VAS), physical activity levels using the physical activity level during pregnancy questionnaire and the international physical activity questionnaire short form, and kinesiophobia was evaluated using the Tampa Scale for Kinesiophobia. The study comprised 120 pregnant women with a mean age of 27.4 ± 6.1 years. It was observed that 42.3% of the pregnant had LBP (n= 69). The mean body mass index (BMI) was 73.6 ± 16.2 kg/m2, and the mean VAS score was 5.5 ± 2 cm. When we divided the group according to the presence of LBP, age (p= 0.49), gestational week (p= 0.75), and gravida (p= 0.81) were similar. BMI (p= 0.038) and ODI scores (p< 0.001) were higher in the group with LBP. LBP in pregnant women has a higher frequency than in the normal population, regardless of age, gestational week, and gravida. Obesity appears to be a risk factor for LBP and increases disability. Kinesiophobia in pregnant women is significantly associated with obesity and disability. Unless there are contraindications, a physically active pregnancy process and regular exercise should be recommend.

A Retrospective Analysis of Medical Management Strategies for Trigeminal Neuralgia: An Institutional Review.

Background Neuropathic pain results from nervous system damage, and trigeminal neuralgia (TN), also called tic douloureux, is a chronic disorder affecting the trigeminal nerve. TN causes sudden, severe, recurring facial pain that can be highly disabling. Treatment usually involves medications like carbamazepine, oxcarbazepine, gabapentin, or baclofen to manage nerve pain. If medications are ineffective, surgical interventions like microvascular decompression or gamma knife radiosurgery may be explored for symptom relief. Aim and objectives This study aims to assess the demographic characteristics and clinical features of patients with TN treated at a private institution. The objective was to assess key demographic factors, including age, gender, and the affected trigeminal nerve divisions, with a focus on identifying the most frequently involved nerve divisions in TN cases. Methodology This five-year retrospective study (January 2019-April 2023) in the Oral Medicine and Radiology Department analyzed 483 TN cases, including 300 patients with confirmed primary TN and complete records. Dental Information Archive System (DIAS) data covered demographics, clinical features, treatments, and outcomes. Pain levels were assessed using the visual analog scale (VAS). LFTs monitor the long-term effects of medications like carbamazepine. Statistical analysis employed descriptive statistics, chi-square tests, and t-tests, with p < 0.05 considered significant. Results Of 7,500 outpatients in the Oral Medicine Department, 483 were diagnosed with TN, and 300 met the diagnostic criteria for inclusion in a five-year study (January 2019-April 2023). The average age was 60 years for men and 58.5 years for women. TN primarily affected the right side in 158 patients (56%), while the left side was involved in 114 (43%) of the cases (p = 0.04) and most commonly involved the maxillary nerve (V2) in 159 patients (53%) and the mandibular nerve (V3) in 141 patients (47%), with a slight female predominance (p = 0.02). One hundred thirty-five patients (45%) used carbamazepine alone, while 84 were treated with carbamazepine and gabapentin, and 81 were treated with carbamazepine and baclofen. The combination of carbamazepine and gabapentin was the most effective, achieving pain control in 123 patients (75%) compared to 94 patients (70%) with carbamazepine alone and 119 patients (72%) with carbamazepine and baclofen (p = 0.06). VAS scores showed better pain relief with carbamazepine and gabapentin (VAS: 3.8 ± 1.0), carbamazepine alone (mean VAS: 4.5 ± 1.2) and carbamazepine with baclofen (mean VAS: 4.2 ± 1.1). In long-term management, 45 patients (15%) discontinued due to side effects, while 105 patients (35%) continued on carbamazepine alone, 90 patients (30%) on carbamazepine with gabapentin, and 60 patients (20%) on carbamazepine with baclofen (p = 0.04). LFTs were performed on 240 patients (80%), while 60 patients (20%) did not undergo LFTs. Conclusions This study underscores the treatment of TN, with anticonvulsants as the primary therapy and alternative options available for refractory cases. However, limitations like small sample size and lack of long-term follow-up affect the findings' generalizability. The results highlight the importance of treatment plans and the potential advantages of combination therapies in clinical practice.

A hypertrophic distal fascicle of the anterior tibiofibular ligament is associated with a high rate of osteochondral lesions of the talus.

The purpose of this retrospective review was to determine the prevalence of osteochondral lesions (OCLs) of the lateral talar dome in patients with anterior ankle impingement with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament. Retrospective chart review identified 40 patients who underwent anterior ankle arthroscopy for the management of anterior ankle impingement. Clinical outcomes assessed includedpre- and postoperative foot and ankle outcome score (FAOS), visual analogue scale (VAS), complications, failures, secondary surgical procedures, return-to-work data and return-to-sport data. Thirty-two patients with a mean follow-up time of 29.3 ± 10.4 months were included. The hypertrophic distal fascicle of the anterior tibio-fibular ligament was hypertrophic in 29 patients (90.6%), with a mean thickness of 2.5 ± 0.4 mm on MRI. There were 22 OCLs of the lateral talar dome (75.9%) with an associated hypertrophic distal fascicle of the anterior tibio-fibular ligament visualized during arthroscopy. The international cartilage repair society gradings of the lesions included3 (13.6%) grade I lesions, 15 (68.1%) grade II lesions, 3 (13.6%) grade III lesions, and 1 (4.6%) grade IV lesion. There was a statistically significant improvement in mean FAOS and VAS scores from preoperative to postoperative (p < 0.001). No cases of syndesmotic instability were observed following resection of hypertrophic distal fascicle of the anterior tibio-fibular ligament. This retrospective case series demonstrated that a hypertrophic distal fascicle of the anterior tibio-fibular ligament was associated with an OCL of the lateral talar dome identified during arthroscopic evaluation. In addition, preoperative MRI demonstrated poor sensitivity for the detection of these OCLs. Heightened awareness is warranted for potential lateral talar dome OCLs in patients presenting with anterolateral ankle impingement with a hypertrophic ATiFLdf identified on preoperative MRI in the absence of an associated OCLs. Level IV, Retrospective case series.

Effect of transcutaneous electrical nerve stimulation on neuro-sensory disturbance after orthognathic surgery: a randomized clinical trial.

The present study aims to determine the effect of Transcutaneous Electrical Nerve Stimulation (TENS) on neuro-sensory disturbance after orthognathic surgery. In a randomized clinical trial, the participants via split-mouth sampling were randomly divided into two intervention (n=27) and control (n=27) groups. In the intervention group, participants received TENS physiotherapy. TENS physiotherapy was performed on the day after surgery, 1, 2, 3, and 4 weeks after surgery, along with prescriptions for the use of painkillers. On the control group, no physical therapy was performed and the patients only used painkillers (immediately after the operation). Paresthesia was evaluated using the 2-point discrimination (TPD) test and the semi-quantitative sensory-neural disorders test called brush stroke 6 months after the surgical procedures. Self-reported sensory-neural disorders were measured and reported for each patient before and 6 months after surgery using the visual analog scale (VAS). A total of 54 patients participated in this study. The mean TPD score in the TENS group and the control group 6 months after the operation were 5.76 (SD=0.73) and 6.14 (SD=0.54), respectively (P=0.003). The mean VAS score in the TENS group and the control group 6 months after the operation was 6.48 (SD=0.50) and 5.80 (SD=0.63), respectively (P=0.005). Also, 66.7 and 38.9% in the TENS and control groups, respectively, performed the brush stroke test correctly (P=0.007). In sum, the benefits of TENS physiotherapy can be effective in reducing complications such as pain in dental surgery treatments or orthognathic surgeries.

Clinical results of carpal tunnel Re-release revision surgery and synovial wrap for recurrent carpal tunnel syndrome

IntroductionCarpal tunnel syndrome is a challenging condition when conventional carpal tunnel revision surgery fails to alleviate symptoms. This study aims to assess the outcomes of combining carpal tunnel revision surgery with a synovial wrap for cases of recurrent carpal tunnel syndrome in patients who had adhered median nerve, with a minimum 1-year follow-up. Patients and methodsA retrospective analysis was conducted on 10 patients (mean age: 73.7 years, nine females and one male) who underwent treatment for recurrent carpal tunnel syndrome. The approach involved carpal tunnel revision surgery coupled with a median nerve synovial wrap. Patients were followed up for a minimum of 1 year. The procedure involved harvesting a 3.5 cm × 4 cm section of the flexor synovial membrane with a distal ulnar pedicle, which was then wrapped around the adherent site of the median nerve. Physical assessments included the pain visual analogue scale (VAS), Tinel sign in the carpal tunnel, thenar muscle atrophy, the Semmes-Weinstein monofilament test (SW test), manual muscle test (MMT) as assessed on the 5-point British Medical Research Council Scale (5/5, normal; 0/5, absent), and the Disabilities of the Arm, Shoulder, and Hand (Quick DASH) questionnaire. The physical variables were compared before surgery and at final follow-up. ResultsAll patients showed some improvement in SW test. The MMT for the abductor pollicis brevis showed significant improvement at final follow-up (3 for four patients, 4 for four patients, and 5 for two patients) compared to pre-surgery assessments (2 for six patients, 3 for two patients, and 4 for two patients). The mean VAS score and DASH score at final follow-up (13.0 ± 10.3, 19.3 ± 12.7, respectively) were significantly lower than those recorded before surgery (76.5 ± 11.1, 52.4 ± 17.1, respectively). The Tinel sign and the thenar muscle atrophy significantly improved from before surgery to final follow-up. ConclusionCarpal tunnel release with a synovial wrap demonstrated significant improvements in muscle strength, pain relief and function. The synovial wrap method is an effective procedure for treating recurrent carpal tunnel syndrome.

Outcomes After Percutaneous Zadek Osteotomy for Insertional Achilles Tendinopathy.

Surgical treatment of insertional Achilles tendinopathy (IAT) historically consists of Achilles tendon debridement with reattachment and excision of the posterosuperior calcaneal prominence with or without a gastrocnemius recession. Zadek osteotomy (ZO) is an alternative to an open midline splitting approach. The purpose of this study was to analyze patient-reported outcomes and complications after percutaneously performed ZO with minimum 2 years' follow-up. One hundred eight cases treated with percutaneous ZO with a minimum 2-year follow-up were retrospectively reviewed. Postoperative complications and patient satisfaction were evaluated. Foot Function Index (FFI) and visual analog scale (VAS) scores were recorded at preoperative and follow-up appointments to measure patients' functional outcomes and pain, respectively. Mean follow-up was 41.2 months (range, 24-65). Mean age was 51.8 years (range, 28-81). The mean FFI score improved from 56.1 (range, 47-88) to 11.0 (range, 7-59) postoperatively (P < .001). The mean VAS score improved from 7.7 (range, 5-10) to 0.4 (range, 0-7) postoperatively (P < .001). The overall complication rate was 3.8% (n = 4). Of 104 cases, 98.1% of patients said they were satisfied with their procedure (n = 102) when asked if they were satisfied with their ZO and recovery. We found the percutaneous ZO to be a safe and effective intervention for treatment of IAT. At a minimum of 2-year follow-up, this intervention is associated with minimal complications, improved function, reduced pain, and a high rate of patient satisfaction.

Comparing Mental Strain and Subjective Sensations With and Without a Wearable Chair While Performing Simulated Suturing Tasks.

Introduction Prolonged standing during surgery is a cause of musculoskeletal disorders in surgeons. Wearable chairs have reportedly reduced musculoskeletal strain effectively when used in industry. However, discomfort and instability issues may remain. This study examines whether using a wearable chair for surgical procedures imposes negative effects, such as mental or physical strain on surgeons prior to its clinical implementation. Methods This prospective cross-over study compared mental strain and subjective sensations in simulated suturing tasks with and without using Archelis®, a wearable chair (Archelis Inc, Yokohama, Japan). Six surgeons participated in the study. Mental strain was examined using heart rate variations calculated during tasks. Four subjective sensations (fatigue, comfort, balance, and workability) after each task and differences in body localized pain pre- and post-task were compared using a 10 centimetres (cm)-visual analog scale (VAS) score questionnaire. Results Results showed no significant differences in mental strain nor subjective sensations with or without the wearable chair. The mean VAS scores for all four subjective sensations with the wearable chair were relatively positive. There was a slight yet insignificant post-task increase in VAS mean scores for body-localized pain in the lower legs. Conclusions Significant negative effects on surgeons from the wearable chair were not observed during simulated suturing procedures. This demonstrates no major barriers in the initial phases of wearable chairs integration into the surgery environment.

Patients Undergoing Revision Hip Arthroscopy With Labral Reconstruction or Labral Repair and Patient-Reported Outcomes: A Systematic Review.

Compromise of the acetabular labrum can lead to pain and loss of critical intra-articular fluid pressure. Revision labral preservation poses unique challenges due to adhesions and compromised tissue quality. The purpose of the study was to evaluate patient-reported outcome (PRO) measures (PROMs) in patients undergoing revision hip arthroscopy with either labral reconstruction or labral repair after primary hip arthroscopy for labral tear. It was hypothesized that both procedures would lead to improved PROs. Systematic review; Level of evidence, 4. A systematic review of the literature was conducted with the following keywords: (revision) AND (hip OR femoroacetabular impingement) AND (arthroscop*) AND (reconstruction OR repair) in PubMed, Cochrane, and Scopus in August 2023 using the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) criteria, yielding 2002 initial records. Only studies comparing PROMs between revision labral reconstruction or revision labral repair after primary hip arthroscopy for labral tear were included. Background article information was recorded, including article title, author, study design, level of evidence, patient demographics, radiographic information, intraoperative data, PROMs, psychometric thresholds, and secondary surgeries. Secondary surgery in our study was defined as any open or arthroscopic hip surgery secondary to the initial revision surgery. Forest plots were created for pre- and postoperative outcomes present in ≥3 studies. Heterogeneity was calculated using I 2 values. Four studies, including 215 revision labral reconstructions and 115 revision labral repairs of the hips, were included in this systematic review. All studies were level 3 evidence, and study periods ranged between 2009 and 2019. Mean follow-up for the reconstruction and repair groups ranged from 26.3 to 36.6 months and 30.7 to 56.4 months, respectively. The mean age for the reconstruction and repair groups varied between 27 to 34.6 years and 27.5 to 30 years, respectively. Mean postoperative modified Harris Hip Scores for the reconstruction and repair cohorts ranged from 72.0 to 81.2 and 70.8 to 84.1, respectively (I 2 = 0%). Mean visual analog scale for pain scores for the reconstruction and repair cohorts ranged from 3 to 3.5 and 2.3 to 3.9 (I 2 = 33%). Overall secondary surgery rates ranged from 10.0% to 26.7% in the labral reconstruction cohort, compared with 10.0% to 50.0% in the labral repair cohort. One study reported superior outcomes in the revision labral repair group, with 3 studies finding no statistically significant difference in outcomes between the groups. Our systematic review showed that patients undergoing revision hip arthroscopy with labral reconstruction demonstrated significant improvement in postoperative outcome measures. Postoperative outcomes were similar to those of a benchmark control group of patients undergoing revision hip arthroscopy and labral repair. Labral reconstruction in the revision setting appears to be an effective treatment in clinically indicated patients.

De Quervain Tendinopathy: Anatomical Prognostic Indicators of Corticosteroid Injection Success.

Anatomical variations of the first extensor compartment can affect de Quervain tendinopathy outcomes. Our study aimed to identify the anatomical prognostic indicators of symptom recurrence following a corticosteroid (CS) injection and to assess the efficacy of CS injections. Fifty consecutive patients received a single CS injection for de Quervain tendinopathy. Ultrasound imaging was used to assess anatomical factors of the first extensor tendon compartment of the wrist. The primary outcome was recurrence after six weeks and six months and the identification of the anatomical prognostic indicators of the recurrence. The Disabilities of the Arm, Shoulder, and Hand (DASH) score and the Visual Analogue Scale (VAS) for pain were evaluated as secondary outcomes. Fifteen patients (30%) experienced symptom recurrence within six weeks. The intracompartmental septum and the number of tendon slips were associated with higher recurrence rates (adjusted odds ratio for the septum: 18.39, p = 0.045; adjusted odds ratio for each additional tendon slip: 24.68, p < 0.01). The mean DASH score improved from 74.1 ± 5 to 19.3 ± 25.3, and the mean VAS for pain from 8.5 ± 0.8 to 2 ± 2.7 (p < 0.01 for both scores). Five patients experienced minor adverse events with spontaneous improvement. CS injections are a viable treatment for de Quervain tendinopathy. Anatomical variations can predict treatment success. Counseling patients based on these factors can help guide treatment decisions, including surgical options.