Orthopaedic Clinic Research Articles

Mindfulness in the Clinic Waiting Room May Decrease Pain: Results from Three Pilot Randomized Controlled Trials.

Introduction: Mindfulness interventions can improve a broad range of patient outcomes, but traditional mindfulness-based interventions are time and resource intensive. Emerging evidence indicates brief, single-session mindfulness interventions can also improve patient outcomes, and brief mindfulness interventions can be embedded into medical care pathways with minimal disruption. However, the direct impact of a brief mindfulness intervention on patients' pain while waiting in the clinic waiting room remains unexamined. Objective: A series of three, pilot, randomized controlled trials (RCTs) were conducted to examine the impact of a brief, audio-recorded, mindfulness intervention on patients' pain in the clinic waiting room. Method: Study 1 examined an 8-min mindfulness recording delivered before a provider visit; Study 2 examined a 5-min mindfulness recording after a provider visit; and Study 3 examined a 4-min mindfulness recording before a provider visit. Time- and attention-matched control conditions were used in each study. Studies 1 and 2 were conducted in an academic cancer hospital. Study 3 was conducted at a walk-in orthopedic clinic. Pain intensity was measured in each of the three studies. Anxiety and depression symptoms were measured in Studies 2 and 3. Pain unpleasantness was measured in Study 3. Results: A brief (i.e., 4- to 8-min), audio-recorded mindfulness intervention decreased patients' pain intensity in the clinic waiting room, whether delivered before (Study 1 Cohen's d=1.01, Study 3 Cohen's d=0.39) or after (Study 2 Cohen's d=0.89) a provider visit. Mindfulness had a significant effect on anxiety symptoms in both studies in which it was measured. No effect on depression symptoms was observed. Conclusions: Results from these three pilot RCTs indicate brief, audio-recorded, mindfulness interventions may be capable of quickly decreasing clinical symptoms. As such, embedding brief, audio-recorded, mindfulness interventions in clinic waiting rooms may have the potential to improve patient outcomes. The continued investigation of this intervention approach is needed. Clinical Trial Registrations: NCT04477278 and NCT06099964.

Intramedullary stabilization of dislocated clavicle fractures with a compression rod

Despite the favorable prognosis of conservative treatment for clavicle fractures, unsatisfactory consequences reach 10–30 % cases. Surgical methods of treatment for dislocated clavicle fractures, such as osteosynthesis with a plate or an elastic titanium rod, are mostly used in practice. The disadvantage of the latter is the possible migration of the implant with perforation of the skin. The purpose was to study the effectiveness of an intramedullary rod, improved by us, for osteosynthesis of dislocated clavicle fractures type OTA 15A and OTA 15B according to the AO/ASIF classification. The essence of the improvement was the possibility of closed minimally invasive intramedullary osteosynthesis of the clavicle body, with a simplified technique of the surgical intervention itself, prevention of implant migration. The latter was achieved by the fact that one of the ends of the rod had a drill, which eliminated the need for predrilling the medullary cavity of the clavicle to insert the rod, and its opposite end had a thread onto which a nut is screwed to achieve compression between the clavicular fragments. Forty-two patients with closed dislocated clavicle fractures were under supervision in the clinic of traumatology and orthopedics of Kyiv City Clinical Hospital 6. They underwent intramedullary osteosynthesis for clavicle fractures with an improved compressing rod (closed in 28 cases, open in 14) under regional anesthesia. In dyna-mics of the postoperative period, a clinical and radiological examination was performed, the severity of the pain syndrome and the function of the upper limb were assessed according to the visual analog scale (VAS), Disability of Arm, Shoulder and Hand (DASH). As shown by the results of X-ray examinations, the average period of clavicle fracture union was 10.1 ± 1.4 weeks (range 8–12 weeks). During the observation of the patients, favorable dynamics on the VAS and DASH were noted; by the end of the study (12 months after the operation), the functional capabilities of the upper limb on the DASH corresponded to 1.54 ± 0.84 points, VAS score was 9.60 ± 2.11 points. The improved construction of the intramedullary rod for osteosynthesis of dislocated clavicle fractures of the OTA 15A and OTA 15B type can be recommended for use in practice, as it has demonstrated favorable clinical, radiological, and functional outcomes.

Cross-cultural adaption, validity, and reliability of the Japanese version of the Central Aspects of Pain in the Knee (CAP-Knee-J) questionnaire in patients with knee pain: a validation study

BackgroundKnee pain is a prominent concern among older individuals, influenced by the central nervous system. This study aimed to translate the Central Aspects of Pain in the Knee (CAP-Knee) questionnaire into Japanese and investigate its reliability and validity in older Japanese individuals with knee pain.MethodsUsing a forward–backward method, CAP-Knee was translated into Japanese, and data from 110 patients at an orthopedic clinic were analyzed. The Japanese version (CAP-Knee-J) was evaluated regarding pain intensity during walking, central sensitization inventory, and pain catastrophizing scale. Statistical analyses confirmed internal validity and test–retest reliability. Concurrent validity was assessed through a single correlation analysis between CAP-Knee-J and the aforementioned measures. Exploratory factor analysis was employed on each CAP-Knee-J item to examine structural validity.ResultsCAP-Knee-J showed good internal consistency (Cronbach’s α = 0.86) and excellent test–retest reliability (intraclass correlation coefficient = 0.77). It correlated significantly with pain intensity while walking, central sensitization inventory scores, and pain catastrophizing scale scores. Exploratory factor analysis produced a three-factor model.ConclusionsCAP-Knee-J is a reliable and valid questionnaire for assessing central pain mechanisms specific to knee pain in older Japanese individuals, with moderate correlations with the CSI and weak with the PCS, thus indicating construct validity. This study supports the development of effective knee pain treatments and prognosis predictions.

Evaluation of musculoskeletal system injuries after the 2023 Kahramanmaraş Turkey earthquakes: Our single-center experience.

This study aimed to retrospectively analyze patients who presented to the orthopedic and traumatology clinic following the 2023 Kahramanmaraş earthquakes. Over a week after the earthquakes, two hundred and sixty patients were consulted at our clinic. Demographic data of the patients, duration of being under the rubble, fracture locations, types of surgeries performed, number of surgical sessions attended by individuals, and early mortality rate within one month were determined. The mean age of the patients was 40.2 ± 22.4 years. One hundred thirty-eight (53.1%) were female, and 122 (46.9%) were male. The average duration of being under the rubble was determined as 27.1 ± 28.0 hours. Sixteen patients died within one month after the earthquake. The one-month mortality rate among patients with orthopedic injuries was 6.15%. Forty-seven fasciotomies were performed in 35 patients, and 22 amputations were performed in 19 patients. The most injured region was the lower extremity (78 cases, 40%). The ratio of external and internal fixation in extremity fractures was 22%. The management of musculoskeletal injuries can be successful with proper triage and treatment plans. Decisions regarding fasciotomy and amputation in patients with crush syndrome following an earthquake should be individualized. Implant sets should be planned accordingly, especially considering the higher occurrence of lower extremity injuries.

Implementing a shared decision-making intervention to support treatment decisions for patients following an anterior cruciate ligament rupture — a protocol for the POP-ACLR feasibility study

BackgroundTreatment for anterior cruciate ligament (ACL) rupture may follow a surgical or nonsurgical pathway. At present, there is uncertainty around treatment choice. Two shared decision-making tools have been codesigned to support patients to make a decision about treatment following an ACL rupture. The shared decision-making tools include a patient information leaflet and an option grid. We report the protocol for a mixed-methods feasibility study, with nested qualitative interviews, to understand feasibility, acceptability, indicators of effectiveness and implementation factors of these shared decision-making tools (combined to form one shared decision-making intervention).MethodsA single-centre non-randomised feasibility study will be conducted with 20 patients. Patients diagnosed with an ACL rupture following magnetic resonance imaging will be identified from an orthopaedic clinic. The shared decision-making intervention will be delivered during a clinical consultation with a physiotherapist. The primary feasibility outcomes include the following: recruitment rate, fidelity, acceptability and follow-up questionnaire completion. The secondary outcome is the satisfaction with decision scale. The nested qualitative interview will explore experience of using the shared decision-making intervention to understand acceptability, implementation factors and areas for further refinement.DiscussionThis study will determine the feasibility of using a newly developed shared decision-making intervention designed to support patients to make a decision about treatment of their ACL rupture. The acceptability and indicators of effectiveness will also be explored. In the long term, the shared decision-making intervention may improve service and patient outcomes and ensure cost-effectiveness for the NHS; ensuring those most likely to benefit from surgical treatment proceed along this pathway.Trial registrationPending registration on ISRCTN.

EFFICACY AND TOLERABILITY OF FLUPIRTINE MALEATE VERSUS DICLOFENAC IN MECHANICAL LOW BACK PAIN – A PROSPECTIVE COMPARATIVE STUDY

Objective: Low back pain (LBW) is one of the most common reasons for adults visiting orthopedic outpatient clinics in our country. The objective of the study was to compare the safety and efficacy of flupirtine, a selective neuronal potassium channel opener, with diclofenac, a widely used NSAIDs analgesic, in patients with mechanical LBW (MLBP). Methods: This prospective, open-labeled, and randomized comparative clinical study included 100 patients with MLBP for more than 6 weeks. Fifty patients received flupirtine 100 mg, and 50 patients received diclofenac 100 mg for 7 days. Follow-up was done on day 8 and day 30. Assessments of functional improvement by the Oswestry Disability Index (ODI), pain relief by the Visual Analog Scale (VAS), Numerical Rating Scale (NRS), and Pain Relief Rate (PRR) were recorded. Safety and tolerability were also assessed. Data were analyzed using the Chi-square and Paired student t-tests. Results: VAS, NRS, and ODI scores were assessed for each visit (0, 1, and 2), and PRR was assessed on visits 1 and 2. VAS (p<0.05), NRS (p<0.05) scores, and sustained effect after stoppage of the drug were found to be better in the flupirtine group compared to the diclofenac group. Flupirtine was well tolerated. More patients reported adverse events in diclofenac than in the flupirtine group. Conclusion: Flupirtine may have a superior sustained effect compared to diclofenac in MLBP.

Applying Bloom’s Taxonomy in Orthopedic Clinical Education: Examples for Daily Practice

Applying Bloom’s Taxonomy in Orthopedic Clinical Education: Examples for Daily Practice

Preoperative handgrip strength can predict early postoperative shoulder function in patients undergoing arthroscopic rotator cuff repair

BackgroundRotator cuff tears (RCTs) are a common musculoskeletal disorder, and arthroscopic rotator cuff repair (ARCR) is widely performed for tendon repair. Handgrip strength correlates with rotator cuff function; however, whether preoperative grip strength can predict functional outcomes in patients undergoing ARCR remains unknown. This study aimed to investigate the correlation between preoperative grip strength and postoperative shoulder function following ARCR.MethodsA total of 52 patients with full-thickness repairable RCTs were prospectively enrolled. Baseline parameters, namely patient characteristics and intraoperative findings, were included for analysis. Postoperative shoulder functional outcomes were assessed using the Quick Disabilities of the Arm, Shoulder, and Hand (QDASH) questionnaire and Constant–Murley scores (CMSs). Patients were followed up and evaluated at three and six months after ARCR. The effects of baseline parameters on postoperative outcomes were measured using generalized estimating equations.ResultsAt three and six months postoperatively, all clinical outcomes evaluated exhibited significant improvement from baseline following ARCR. Within 6 months postoperatively, higher preoperative grip strength was significantly correlated with higher CMSs (β = 0.470, p = 0.022), whereas increased numbers of total suture anchors were significantly correlated with decreased CMSs (β = − 4.361, p = 0.03). Higher body mass index was significantly correlated with higher postoperative QDASH scores (β = 1.561, p = 0.03) during follow-up.ConclusionsHigher baseline grip strength predicts more favorable postoperative shoulder function following ARCR. A preoperative grip strength test in orthopedic clinics may serve as a predictor for postoperative shoulder functional recovery in patients undergoing ARCR.

The establishment of orthopedics in Croatia : The role of Božidar Špišić (1879-1957) and his professional networks.

Božidar Špišić was apioneer of Croatian orthopedics. In 1908 he founded the first private orthopedic clinic in the entire South Slav region. During the First World War he organized and headed the first orthopedic hospital for the rehabilitation and resocialization of wounded soldiers. In the interwar period, Špišić was tasked with establishing the orthopedic clinic within the auspices of the School of Medicine, University of Zagreb. This effort in shaping and developing orthopedics in Croatia would not have been possible without his participation in awide network of internationally renowned orthopedists. After graduating from the University of Graz in 1904, Špišić spent the next 4years specializing in orthopedics with Hans Spitzy, Arnold Wittek, Fritz Lange and, most importantly, Adolf Lorenz. In this paper, we have reconstructed the transfer of knowledge and experiences between these prominent Austrian and German orthopedists and Božidar Špišić. We have paid special attention to the identification of those elements in Špišić's work that can be traced back to his mentor, teacher and lifelong colleague Adolf Lorenz, such as his treatment for congenital hip dislocation. We believe that the analysis of professional networks can shed additional light on the historiography of orthopedics, given that these influences did not manifest solely through the acquisition of specialized clinical knowledge but also through aprofound influence on the core tenets of orthopedics as adiscipline-its institutional organization and overall conservative approach.

Outcomes of a Novel Spine Virtual Fracture Clinic in an Australian Tertiary Hospital.

This was a retrospective cohort study. To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management. The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population. A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications. Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs . 2.4, P <0.001), appointments not attended (5% vs . 13%, P <0.001), referrals lost to follow-up (0% vs . 10.7%, P <0.001), and a shorter duration of care (median 48 vs . 58d, P <0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified. This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.

Reproducibility and Validity of the Kerlan-Jobe Orthopedic Clinic Shoulder and Elbow Score (Japanese Version).

The Kerlan-Jobe Orthopedic Clinic (KJOC) questionnaire is a self-reported performance and functional assessment tool with good reliability and validity for overhead athletes with shoulder and elbow injuries. This study aimed to develop a Japanese version of the KJOC (J-KJOC) to clarify its reproducibility and validity for use by Japanese university baseball players. The J-KJOC was translated according to the guidelines for cross-cultural adaptation. A total of 88 university baseball players completed the J-KJOC and the Quick-Disabilities of the Arm, Shoulder, and Hand (Q-DASH) questionnaires. Thirty players completed the J-KJOC two times after a median interval of two weeks. We assessed the absolute reliability, construct validity, internal consistency, and test-retest reliability. Cronbach's alpha coefficients ranged from 0.88 and the intraclass correlation coefficient for the total score was 0.91. A fixed bias was absent in the J-KJOC scores (mean difference: -2.2, 95% CI: -4.8 to 0.5). Furthermore, the J-KJOC score was correlated with the Q-DASH-disability/symptom (r = -0.60, p<0.01) and Q-DASH-sports/music (r = -0.63, p<0.01) scores but not correlated with the Q-DASH-work score (r = -0.11, p = 0.316). The J-KJOC questionnaire demonstrated good reproducibility and validity for assessing upper arm performance in Japanese university baseball players. The results of this study support the use of the J-KJOC for Japanese-speaking baseball players. Further research using this instrument on other types of overhead athletes is needed to determine its wider utility in sports medicine applications.

Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability

ObjectiveAims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient’s first consultation at orthopaedic department.Materials and methodsThis cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland–Altman plots, or intraclass coefficients.ResultsA total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81).ConclusionCalcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.

A Comparison of the short-term effects of steroid injection, prolotherapy and home-based physiotherapy in patients with chronic lateral elbow tendinopathy

Aim: This study aims to compare the effects of steroid injection (SI), prolotherapy, and home-based physiotherapy on pain and function in short-term in chronic lateral elbow tendinopathy (LET) patients. Materials and Methods: Patients with chronic LET admitted to the orthopedic clinic between 2022 and 2023 were divided into SI (n=17), prolotherapy (n=17) and home-based physiotherapy (n=17) groups. Visual Analogue Scale (VAS), Quick Disability Assessment of Arm, Shoulder and Hand Problems (QuickDASH), and Health Assessment Questionnaire (HAQ) for pain and function before, two, and six weeks after treatment were compared. Results: Second and sixth-week VAS, QuickDASH and HAQ were significantly lower in SI and prolotherapy than home-based physiotherapy group (p=0.001). In the sixth week, sufficient improvement was achieved in VAS, QuickDASH and HAQ in SI compared to prolotherapy and home-based physiotherapy (p=0.001, η2=0.30-0.42). Conclusion: SI, prolotherapy, and home-based physiotherapy improved elbow pain and function in short-term, but SI was greater effective. SI may be effective for short-term improvement in chronic LET patients.

A Child with Severe Bilateral Tibia Vara: Treatment with Computer-Assisted Gradual Correction Utilizing Hexapod External Fixator

A 7-year-old obese boy presented to the Paediatric Orthopaedic clinic with a complaint of worsening bilateral knee bowing. He was initially seen for the same problem in another hospital at the age of 3. The bowing of the leg was associated with pain over the lateral aspect of both knees. He was able to walk but unable to run or participate in sports due to the deformity and knee pain. On examination, the child had a waddling gait and lateral thrust due to severe bilateral genu varus. The range of motion of bilateral knee joints was 0 to 110 degrees. The knee intercondylar distance was markedly increased and there was bilateral tibial torsion. No limb length discrepancy and neurovascular examination was normal. The radiograph revealed features of infantile tibia vara (Blount disease). Bilateral proximal tibia temporary hemiepiphysiodesis was attempted but no correction of the deformity was achieved due to implant failure. His parents were then counseled to let him undergo gradual deformity correction surgery using a ring external fixator (hexapod system). The bilateral varus deformity was corrected after 4 months, and the patient was able to walk normally.

A Multi-centered Retrospective Study on the Efficacy of Pulsed Radiofrequency Nerve Ablation in the Treatment of Recalcitrant Plantar Fasciitis: A Mid-term Outcome.

Background Plantar fasciitis, a condition marked by persistent and often excruciating heel pain, frequently poses a formidable hurdle when conservative treatment approaches fall short. This multi-centered retrospective study embarks on a journey to explore the potential effectiveness of pulsed radiofrequency nerve ablation (RFNA), an innovative and less invasive procedure, as a novel avenue for treating recalcitrant plantar fasciitis. This investigation centers around a group of 24 patients who have faced the persistence of this challenging ailment. By meticulously scrutinizing patient outcomes and conducting a comprehensive analysis of safety aspects, this study aspires to offer enlightening revelations regarding the promise and practicality of pulsed RFNA as a therapeutic solution for tackling this intricate and tenacious condition. Methods This retrospective study included 24 patients who had undergone pulsed RFNA for recalcitrant plantar fasciitis between June 1, 2020, and June 1, 2022, at Hospital Pengajar Universiti Putra Malaysia (HPUPM), Hospital Universiti Teknologi Mara (UiTM), and Hospital Serdang. Patients were selected from the Orthopedic Clinics at HPUPM, Hospital UiTM, and Hospital Serdang and were screened according to the inclusion and exclusion criteria. Patient data was extracted from the hospital information systemand electronic medical records. Pre-procedure and post-procedure assessments were conducted at one, three, and six months on the selected patients using the visual analog scaleand American Orthopaedic Foot and Ankle SocietyAnkle-Hindfoot Scoring systems. All selected patient data was traced and tabulated accordingly. Results This study evaluates the effectiveness of pulsed RFNA in treating recalcitrant plantar fasciitis in 24 participants (39 feet). Results show a significant reduction in pain and improvement in functionality at one, three, and six months post-RFNA. Demographic factors (age, gender, and specific diagnosis) did not significantly impact outcomes. The study supports pulsed RFNA as an effective treatment for recalcitrant plantar fasciitis, emphasizing consistent benefits across various patient characteristics. Conclusion In conclusion, the study demonstrates the notable effectiveness of pulsedRFNAin improving pain reduction and functional outcomes for individuals with recalcitrant plantar fasciitis. The findings, consistent across various demographic factors, support pulsed RFNA as a promising and uniform treatment option for those who do not respond to conservative measures.

Dispositional mindfulness: Is it related to knee osteoarthritis population's common health problems?

A growing body of research supports dispositional mindfulness as important in influencing physical and mental health as well as physical activities in patients with chronic illnesses. Knee osteoarthritis (OA), which often causes health problems, is one of the most common chronic illnesses, but less is known about dispositional mindfulness in relation to this condition. To explore possible associations between dispositional mindfulness and physical and mental health as well as physical activity in knee OA patients. For this cross-sectional study, we recruited a purposive sample of orthopedic clinic patients in hospitals in Southern Taiwan. Instruments included the Mindful Attention Awareness Scale (MAAS) and the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Health-related characteristics were also measured. Demographic statistics, bivariate correlations, and multiple linear regression informed our exploration of potentially related factors for dispositional mindfulness. Participants with knee OA (N = 250) were mostly elderly (88%), female (70.5%), and married (84%). Marital status, perceived health status, depression, and physical activity were associated with dispositional mindfulness. Better perceived health, lower depression, and greater physical activity were significantly associated with greater dispositional mindfulness. However, the severity of symptoms, fear of falling, and exercise self-efficacy did not reach statistical significance in relation to dispositional mindfulness. Greater emphasis should be placed on the cultivation of mindfulness to enhance individuals' perceived health, decrease their depressive mood, and promote their engagement in physical activity, which could indirectly alleviate their experience of pain and improve their physical function, yielding better quality of life and well-being. Future research should focus on interventions to apply dispositional mindfulness in order to determine whether dispositional mindfulness can effectively improve physical and mental health as well as physical activity in those with knee OA.

Effectiveness of Sub-occipital Release In Cervicogenic Vertigo

Background: Cervicogenic vertigo is defined as a sensation of rotation, resulting from an alteration of the neck proprioceptive afferents of the upper cervical spine. Sub-occipital Release, a type of Myofascial Release (MFR) is a form of manual therapy technique which can be used for the treatment of cervicogenic vertigo. Purpose: The purpose of this study is to minimize the use of equipment and patient positioning, thus making it easy for providers to treat by using the suboccipital myofascial release technique and find the effects of this technique on cervicogenic vertigo. Objective: To determine whether sub-occipital myofascial release technique in upper cervical region is more effective than the use of conventional exercises in improvement of the symptoms of cervicogenic vertigo. Setting: Otolaryngology(ENT) and orthopaedic clinics of Pune city. Method: We carried out a prospective, randomized controlled, in 60 subjects with cervicogenic vertigo who were assigned randomly to an Exercise group (N = 17) and Sub-occipital Release group (N = 17). Subjects received treatment three times a week, for 2 weeks. By the end of session, pre‑ and post‑comparison was done for the signs and symptoms of cervicogenic vertigo. Participants: Age group 20-40 years were taken for the study. Patients with other types or causes of vertigo, acute cervical fractures or atlanto-axial joint instability were excluded from the study. Outcome measure: The primary outcome measure of this study was to find the intensity of the signs and symptoms of cervicogenic vertigo by using a Dizziness Handicap Inventory-NDI Questionnaire[6] . Results: Statistical significance was found between and within the groups with respect to the signs and symptoms of cervicogenic vertigo. The results showed a statistically significant difference (P&lt;0.05) between the pre-treatment and post-treatment values for both the groups. Also, a significant improvement of signs and symptoms of cervicogenic vertigo was found in the sub-occipital group as compared to the exercise group. Conclusion: This study concluded that sub-occipital release technique is significantly effective for the treatment of cervicogenic vertigo.

Acupotomy combined with Korean medicine treatment in a patient with acute sacroiliac pain unresponsive to conventional therapy: A case report

RationaleAcute injury to the sacroiliac joint (SIJ) can result from high-energy external forces that cause a combination of axial loading and sudden rotational movements, resulting in severe pain that cannot be relieved by regular nonsteroidal anti-inflammatory drugs. The treatment includes injections of steroids and local anesthetics to reduce pain and promote healing. Here, we report the case of a patient with acute sacroiliac pain who did not respond to conventional injection therapy. Patient concernsA 58-year-old male patient who did not exercise regularly experienced pain in his left groin and difficulty walking while kicking on his right leg. He received two injections and manual therapy at a local orthopedic clinic; however, his symptoms did not improve despite taking painkillers. DiagnosesRadiographic images showed no abnormalities. After confirming the cause of onset, pain pattern, physical examination, and tenderness, the patient was diagnosed with an acute SIJ sprain (static blood). InterventionsAt the first visit, a single acupotomy was performed on the seven treatment points identified during the physical examination, and immediate improvement in symptoms was confirmed. From then on, Korean medicine (KM) treatments, such as acupuncture, cupping, chuna, and bee venom pharmacopuncture, were performed. OutcomesImmediately after acupotomy, groin pain improved by 80 %, gait immediately normalized, and the patient showed no symptoms at the 9th visit. LessonsFor SIJ-type groin pain that does not respond to existing treatments, immediate relief is achieved after a single acupotomy at the exact treatment point. Therefore, in the future, the importance of identifying a precise treatment point for SIJ pain should be recognized, and the use of Korean medicine treatment techniques, including acupotomy, should be considered.

Preoperative spinal education for lumbar spinal stenosis: A feasibility study.

Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positive surgical outcomes and promote patient self-efficacy, while attempting to mitigate postoperative complications. No efforts have investigated the prehabilitation strategies specifically for patients undergoing LSS surgery. To determine the feasibility of delivery and acceptability by participants of a novel prehabilitation intervention for patients undergoing LSS surgery. Feasibility study. Outpatient orthopedic clinic at an academic medical center. Patients at least 50 years of age, who were scheduled for LSS surgery between October 2020 and October 2021. PreOperative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS), is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) Educational booklet and video; (2) In-person physical therapy (PT) session; and (3) Telemedicine visit with a physiatrist. The primary outcomes of interest were feasibility and acceptability of intervention by participants. Key potential surgical outcomes were length of stay and discharge disposition. POSE-LSS was completed by all eligible participants enrolled (n = 15) indicating feasibility and acceptability. Potential effectiveness measures including length of stay and discharge disposition were positively associated with the POSE-LSS intervention. This study demonstrates that a novel prehabilitation intervention is feasible, acceptable, and appears positively associated with important short-term measures of postoperative recovery that may impact the trajectory of patient care following LSS surgery.

Fast-track knee pathway – A cost effective, quality improvement initiative for knee osteoarthritis

BACKGROUND: The prevalence of knee osteoarthritis is increasing due to population growth, ageing and other risk factors. However, the majority of patients can successfully manage their symptoms using conservative management strategies with only a minority requiring surgery. In 2019, a patient waited four years to be seen if deemed routine for an elective orthopaedic out-patient appointment in a large acute hospital in Ireland. OBJECTIVE: To establish a Fast-Track Knee Pathway in an Irish healthcare setting, creating a more efficient channel into elective orthopaedics for patients requiring surgical intervention whilst providing community-based care for those with non-surgical needs. METHODS: – Establishment of a dedicated community-based physiotherapy and dietetic service for knee osteoarthritis. – Implementation of a Rapid Access Knee Clinic in elective orthopaedic clinics. – Economic evaluation of the Fast-Track Knee Pathway’s cost effectiveness compared with the traditional pathway. RESULTS: 403 patients with knee osteoarthritis were removed from physiotherapy waiting lists with 9 patients requiring referral onwards to the Rapid Access Knee Clinic. On average there was a 64% reduction in wait time to access an orthopaedic consultant across 4 pilot sites. An incremental cost-effectiveness ratio of € 22,535.03 per QALY was estimated. Comparing this to the national accepted threshold of € 45,000 per QALY the Fast-Track Knee Pathway can be considered cost-effective. CONCLUSION: The Fast-Track Knee Pathway provides a fully integrated pathway of care for patients with knee osteoarthritis, facilitating earlier access to orthopaedic intervention. An economic evaluation concluded that this model of care is more cost-effective than the traditional pathway.