Thigh Pain Research Articles

Effect of Adding Ankle-Joint-Pumping Exercise to Gluteal-Muscle-Strengthening Exercise on Thigh Swelling, Gait ability and Pain level in Patients With Total Hip Arthroplasty

Effect of Adding Ankle-Joint-Pumping Exercise to Gluteal-Muscle-Strengthening Exercise on Thigh Swelling, Gait ability and Pain level in Patients With Total Hip Arthroplasty

Optimizing Tourniquet Pressure in Primary Total Knee Arthroplasty: Limb Occlusion Pressure vs Systolic Blood Pressure Method: A Randomised Controlled Study.

This study aims to systematically compare the efficacy of two distinct approaches that is limb occlusion pressure (LOP) and systolic blood pressure (SBP) in determining the optimal tourniquet pressure for primary total knee arthroplasty. The overarching goal is to identify the method that yields superior outcomes in minimizing post-operative thigh pain while simultaneously reducing complications in our patient population. 311 patients scheduled for primary total knee replacement (TKR) were randomized in two groups. Group A (LOP) had 154 patients and group B had 157 patients. In group A, LOP was determined for all patients. After adding the safety margin, the tourniquet pressure was determined which was kept during the procedure. By adding 150mm Hg to SBP in group B, the tourniquet inflation pressure was ascertained. Postoperatively, thigh pain was evaluated from day 1 to day 3 and at 6weeks. The average tourniquet pressure in group A patients having thigh circumference between 40 and 50cm was 223.8mm + -19.8mm Hg and in group B it was 262.1 + -15.9mm Hg (P < .01). Patients having thigh circumference between 51 and 60cm had average tourniquet pressure of 240.07 + -20.1mm Hg in group A and 264.5 + -17.4mm Hg in group B (P < .01). The average tourniquet pressure for patients with thigh circumference more than 60cm was 296 + /15.3mm Hg in group A and 267.3 + /19.2mm Hg in group B (P < 0.01). Tourniquet pressure determination based on the limb occlusion pressure (LOP) method provide less postoperative thigh pain and better range of motion. Optimizing Tourniquet Pressure in Primary Total Knee Replacement: Limb Occlusion Pressure vs Systolic blood pressure method to minimize thigh pain.

Exposure of Undergraduate Nursing Students to Standing Environments: A Longitudinal Study on Plantar Force and Pressure Distribution.

Understanding the link between plantar force, pressure, and foot discomfort is important for nursing students' well-being, given the prevalence of foot and ankle musculoskeletal disorders among nurses. Assessing these factors can inform tailored self-care interventions, supporting holistic nursing education. To assess the plantar force and pressure distribution of third-year nursing students at baseline and after 5months of exposure to a clinical setting. A prospective cohort study in a Portuguese nursing school measured changes in podiatric profile at 5months, including peak pressure, maximum force, and contact area. Elevated mean peak pressure in the heel correlated positively with maximum force and contact area. Negative correlations were found between the contact area and edema. Peak pressure correlated positively with thigh pain, indicating pressure transfer to metatarsal heads. The findings underscore the importance of integrating ergonomic education into nursing curricula and raising awareness of self-care interventions.

A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF FRACTURE NECK OF FEMUR IN ADULTS WITH CEMENTED BIPOLAR HEMIARTHROPLASTY

Objectives: Displaced femoral neck fractures are frequently treated with bipolar hemiarthroplasties. There is little long-term data regarding bipolar hemiarthroplasty. This study aims to know the clinical efficacy of bipolar hemiarthroplasty in fractured neck femur in old age people. Patients are assessed postoperatively for pain, limp, and functional activities, and a Harris hip score is used to evaluate the results. Methods: This is a prospective study that included patients who underwent bipolar hemi replacement arthroplasty. A total 40 number of patients treated with bipolar prosthesis were assessed during our study. Both males and females were included in the study. We obtained all proper consent from patients during the study from a tertiary care hospital. Results: In this study, a sample of 20 patients with fractures of the neck of the femur with displacement, communication, and neck resorption above 50 years old were surgically treated with hemiarthroplasty using a bipolar endoprosthesis. Postoperatively, bipolar hemiarthroplasty allows for early mobilization, pain alleviation, and a high degree of activity while posing little risks. Conclusion: When compared to Austin Moore’s prosthesis, bipolar hemiarthroplasty had fewer complications, such as acetabular erosion and anterior thigh pain. As a result of these findings, we believe that bipolar hemiarthroplasty is the best treatment for intracapsular fracture neck femur.

Effects of Neurodynamics Along With Conventional Exercises on Sciatica Patients: A Single-Blinded Randomized Clinical Trial.

Introduction Sciatica refers to a pain that travels along the course of the sciatic nerve. Patients also often experience paresthesia along with the pain in thighs, which may further radiate to the legs. Most commonly, compression of the lumbosacral nerve root is the cause of this syndrome. Neurodynamics and conventional exercises are considered effective treatment procedures for sciatica. This study aims to find out the efficacy of neurodynamics along with conventional exercises and conventional exercises alone. Methods A total of 58 patients with sciatica aged between 30 and 60 years of both genders were included in the study and randomly divided into a neurodynamic group (n=29) and a conventional group (n=29). Pre-test data were collected before the interventions, and post-test data were collected on the 14th day. The 101 numeric pain rating scale (NPRS) was used to measure data of sciatic pain, the patient-specific functional scale (PSFS) was used to measure the health-related quality of life (HRQL), and a surface electromyography (EMG) biofeedback instrument was used to measure the peak and average muscle activation of the biceps femoris muscle. Results The pre-post data analysis of the neurodynamics and conventional group showed significant (p<0.05) improvement in 101 NPRS, PSFS, and peak EMG values. Insignificant (p>0.05) improvements were seen in average EMG values in the conventional group, and significant (p<0.05) improvement were seen in the neurodynamic group. Between-group analysis showed insignificant (p>0.05) differences in 101 NPRS as well as peak and average EMG values and showed significant (p<0.05) differences in PSFS values. Conclusion Neurodynamics with conventional exercises can help in reducing pain, improving muscle activation of the biceps femoris, and elevating the HRQL of the patient.

An effective Ayurveda management of Sarvangavata W.S.R. to Guillain–Barre syndrome: A case report

Abstract Guillain–Barré syndrome (GBS) is a rare but potentially serious autoimmune disorder affecting the peripheral nervous system, leading to muscle weakness, paralysis, and in severe cases, respiratory failure. Therapies, such as immunoglobulin therapy and plasmapheresis, are considered mainstays of GBS treatment. Ayurveda treatment can potentially offer therapeutic support to GBS patients in enhancing recovery. A 43-year-old male presented to the in-patient department of an Ayurvedic hospital with bilateral weakness in both upper and lower limbs, accompanied by pain in the left thigh and lower back region, as well as tingling sensations in the ring and middle fingers of the right hand. Following a comprehensive evaluation, including clinical assessment, neurological examination, magnetic resonance imaging, and nerve conduction study, a conclusive diagnosis of GBS was established. Based on the detailed Ayurveda assessment, an Ayurveda diagnosis of Sarvangavata was also made. Upon admission, the patient underwent a comprehensive in-patient treatment regimen spanning 44 days, which included Udwarthana (dry powder massage), Ksharavasti (enema), Sneha Pana (internal administration of medicated oils), Abhyanga (oil massage) and Sweda (sudation therapy), Virechana (therapeutic purgation), Samsarjana Karma (diet for restoring Agni)), Vasti (medicated enema), Shirobasti (medicated oil retention in the head), Pizhichil (oil bath therapy), and Nasya (nasal administration of medicine). Following these intensive therapies, the patient was discharged and continued on Samana Ousadha (palliative medication) for ongoing management of symptoms. The patient was routinely followed up for 6 months with routine clinical assessments and the symptoms gradually improved and consistent recovery was noticed. This case study underscores the promising prospects of integrating Ayurvedic principles and treatments into the management of GBS. However, to substantiate these findings and elucidate the mechanisms through which Ayurvedic therapies operate, further investigation and rigorous clinical trials are warranted.

A case of primary skeletal muscle lymphoma mimicking cellulitis

Primary skeletal muscle lymphoma is a rare entity. Their presentation can be easily confused with a wide variety of inflammatory conditions, neoplasia as well as infectious diseases. We came across a 65-year-old lady who presented to us with complains of pain and swelling in the right thigh, leg and foot and fever-on and off for 20 days. She was initially managed elsewhere on the line of cellulitis with incision and drainage of right leg 15 days back but there had been no clinical improvement. We took her detailed history and examined her thoroughly. Relevant blood investigations were sent. However, the clinical examination findings and history were suggestive of an infective cause, blood investigations were suggestive of an acute inflammatory pathology, whereas radiological investigations (NCCT and X-ray) and cytological investigations (FNAC) which were performed at the previous place of treatment were inconclusive. We then did a CE-MRI of the right lower limb which showed centrally necrotic, enhancing mass lesion involving peroneal muscles with multiple enlarged inguinal and popliteal lymph nodes. Based on this finding, biopsy was performed and specimen was sent for histopathological examination which revealed “malignant small round cell tumor”. Immunohistochemistry was then done and tumor cells were found to be positive for vimentin, LCA, CD20 and negative for PANCK and CD3. Based on the above findings it was diagnosed as “non-hodgkin’s lymphoma (NHL) B-cell type” of right leg. Considering the confusing clinical presentation of this entity and inconclusiveness of blood and basic radiological investigations, lesions of extremities presenting with features of cellulitis must be carefully assessed.

Necrotising fasciitis with extensive necrosis caused by Lactobacillus: a case report

BackgroundNecrotising fasciitis (NF) is a life-threatening soft-tissue infection that rapidly destroys the epidermis, subcutaneous tissue, and fascia. Despite their low virulence, Lactobacillus spp. can cause NF, and because of its rare incidence, there is limited information about its molecular and clinicopathological characteristics. We report a rare case of NF in a patient with type 2 diabetes mellitus diagnosed on admission and severe obesity due to infection with two types of Lactobacillus spp. that manifested in extensive necrosis.Case presentationA 48-year-old woman was referred to our hospital with a complaint of difficulty walking due to severe bilateral thigh pain. She presented with mild erythema, swelling, and severe skin pain extending from the pubic region to the groin. The patient was morbidly obese, had renal dysfunction, and had diabetes mellitus diagnosed on admission.; her LRINEC (Laboratory Risk Indicator for Necrotising Fasciitis) score was 9, indicating a high risk of NF. An exploratory surgical incision was made, and NF was diagnosed based on fascial necrosis. Emergent surgical debridement was performed, and cultures of the tissue culture and aspirated fluid/pus revealed two types of Lactobacillus spp.: Lactobacillus salivarius and L. iners. The patient was admitted to the intensive care unit (ICU), where antibiotics were administered and respiratory and circulatory management was performed. Diabetic ketoacidosis was detected, which was treated by controlling the blood glucose level stringently via intravenous insulin infusion. The patient underwent a second debridement on day 11 and a skin suture and skin grafting on day 36. The patient progressed well, was transferred from the ICU to the general ward on day 41, and was discharged unassisted on day 73.ConclusionsLactobacillus spp. are rarely pathogenic to healthy individuals and can scarcely trigger NF. However, these bacteria can cause rare infections such as NF in immunocompromised individuals, such as those with diabetes and obesity, and an early diagnosis of NF is imperative; surgical intervention may be required for the prevention of extensive necrosis. The LRINEC score may be useful for the early diagnosis of NF, even for less pathogenic bacteria such as Lactobacillus.

A novel design of hip-stem with reduced strain-shielding.

The use of uncemented stems in hip arthroplasty has been increasing, even in osteoporotic patients. The major concerns of uncemented hip-stems, however, are peri-prosthetic fracture, thigh pain, and proximal femoral stress-/strain-shielding. In this study, a novel design of uncemented hip-stem is proposed that will reduce such concerns, improve osseointegration, and benefit both osteoporotic and arthritic patients. The stem has a central titanium alloy core surrounded by a set of radial buttresses that are partly porous titanium, as is the stem tip. The aim of the study was to investigate the mechanical behaviour of the proposed partly-porous design, examining load transfer in the short-term, and comparing its strain-shielding behaviour with a solid metal implant. The long-term effect of implant-induced bone remodelling was also simulated. Computed tomography based three-dimensional finite element models of an intact proximal femur, and the same femur implanted with the proposed design, were developed. Peak hip contact and major muscle forces corresponding to level-walking and stair climbing were applied. The proposed partly-porous design had approximately 50% lower strain-shielding than the solid-metal counterpart. Results of bone remodelling simulation indicated that only 16% of the total bone volume is subjected to reduction of bone density. Strain concentrations were observed in the bone around the stem-tip for both solid and porous implants; however, it was less prominent for the porous design. Lower strain-shielding and reduced bone resorption are advantageous for long-term fixation, and the reduced strain concentration around the stem-tip indicates a lower risk of peri-prosthetic fracture.

Aortic Angiosarcoma Manifesting as Multiple Musculoskeletal Metastases: A Case Report.

Aortic angiosarcomas are rare. Due to its rarity and metastatic presentation, it is difficult to diagnose metastatic aortic angiosarcoma. We describe the clinicopathological and radiologic features of a metastatic aortic angiosarcoma presenting as musculoskeletal metastases. A 59-year-old male patient presented with left thigh pain. Plain radiographs revealed multifocal osteolytic lesions in the left femur shaft. Abdominopelvic computed tomography showed a lobulated osteolytic lesion in the left iliac bone. Magnetic resonance images revealed multifocal soft tissue lesions in the thigh musculature. A positron emission tomography/computed tomography (PET/CT) scan demonstrated multiple foci of increased uptake in the left femur bone, pelvis, left thigh, and calf musculature. Focal increased uptake in the lower abdominal aorta was newly detected. Pelvis biopsy showed tumor cell nests of epithelioid cells. The tumor cells showed vasoformative features. Immunohistochemically, the tumor cells showed positivity for vimentin, CD31, and ERG. The pathologic diagnosis of epithelioid angiosarcoma was established. The origin of the tumor was presumed to be the aorta. This case underscores the importance of PET scans in identifying primary lesions. In terms of the histopathologic diagnosis of biopsy samples with tumor cells exhibiting epithelioid neoplastic morphology, employing appropriate ancillary techniques such as immunocytochemistry with vascular markers may assist in accurately diagnosing metastatic angiosarcoma.

Migratory schwannoma of the cauda equina with a change in radicular pattern: illustrative case.

Intradural spinal tumors are an uncommon entity with a variety of pathologies and symptom patterns. Few cases reports in the literature have described tumor migration within the spinal canal. A 38-year-old male presented with bilateral upper lumbar radicular symptoms of anterior thigh pain, with an enhancing tumor of the cauda equina initially located at L1-2. He declined surgery initially, and at a follow-up 3 years later, his symptoms were unchanged but the tumor was now located at T12-L1. He again declined surgery, but 3 months later, he had a significant change in his pain distribution, which was now along his posterolateral right leg to his foot with associated dorsiflexion and extensor hallicus longus weakness. At this time, the tumor had migrated to L2-3. He underwent laminectomy and tumor resection with resolution of his radicular symptoms and improvement in his strength back to baseline by the 1-month follow-up. Pathology was consistent with a World Health Organization grade I schwannoma. Migratory schwannoma is a rare entity but should be considered when radicular symptoms acutely change in the setting of a known intradural tumor. Repeat imaging should be performed to avoid wrong-level surgery. Intraoperative imaging can also be used for tumor localization.

Analysis on association between sagittal stem alignment and early functional and radiological outcome following primary cementless total hip replacement.

Accurate reconstruction of hip anatomy and biomechanics is mandatory for achieving good clinical outcomes following total hip replacement (THR). Optimal stem alignment is essential to avoid impingement or loosening. This study aimed to evaluate sagittal stem position following cementless THR and its relationship with patient's functional outcome and post-operative radiological parameters. We performed analytical observational study with cross-sectional design on 71 hips (67 patients, ranged 18-85years old) that underwent primary cementless THR in two orthopedic centers in Jakarta, Indonesia. All hips were operated through either anterolateral or posterior approach using either extended/full-coating wedge-tapered stem or proximal-coated wedge-tapered stem. Clinical outcomes were evaluated at follow-up time using mHHS questionnaire, VAS level of thigh pain, and hip ROM. Stem sagittal alignment and other radiological parameters, including combined anteversion and offset, were measured from conventional radiograph. There were no significant differences on mHHS score, VAS level on thigh pain, and ROM between stem alignment groups. Post-operative anteversion and offset of the implant were not affected by the stem sagittal position. All influencing factors have significant effect on sagittal stem alignment. Linear regression test on femur morphology showed 0.69° increase in stem posterior tilt for every 1° increase in the anterior bowing (coeff. = 0.502). Stem tilting in sagittal plane did not affect patient's functional outcome or post-operative radiological parameters. In addition, for every degree of increased anterior femoral bowing, 0.69° increase in posterior stem tilting can be expected.

Comparison of functional outcome in uncemented and cemented bipolar hemiarthroplasty in displaced fracture neck of femur in elderly age group

Some studies recommends uncemented prothesis in treating femoral neck fractures as the blood loss, operative time, and incidence of embolism are lower. On the other hand, others recommend using a cemented prosthesis for fracture neck of femur treatment as there is reduced thigh pain, facilitates early mobilization and a decreased incidence of prosthetic loosening. Uncertainty exists regarding whether a uncemented bipolar hemiarthroplasty for the treatment of displaced femoral neck fractures could have the same clinical outcomes as a cemented bipolar hemiarthroplasty. This study compared a using uncemented and cemented bipolar prosthesis in the treatment of fracture neck of femur

Sonification of plantar pressure in runners with and without pain after running practice

PurposeHumans interact with the environment using sensory channels. Although vision is the main sensory channel, the auditory channel is excellent for learning when trained. Movement learning via auditory inputs requires sound analysis, such as sonification.MethodsData on peak plantar pressure from 43 recreational runners were collected using Flexinfit resistive insoles. Participants wore Run Falcon 1.0 (Adidas) running shoes and were categorised into four groups: without pain; spine or hip pain; thigh or knee pain; and leg, ankle, or foot pain. Participants responded to whether they presented pain and whether it was related to running (training or races). Sonification data were collected using the TwoTone software. We used the C note in the first octave to transform numerical data into sounds according to the pressure magnitude. The sound file was decomposed using the Audacity software into a spectrogram illustrating the main frequency components and their amplitudes.ResultsThe spectrogram made it possible to identify qualitative differences between the runners with and without pain after running. The frequency spectrum showed that some frequencies had greater sound intensity in runners without pain.ConclusionsOur results indicated differences between runners with and without pain after running using sonification. The frequency spectrum also indicated a difference in the sound intensity produced between the groups at specific frequencies.

Comparison of Cylindrical and Tapered Stem Designs for Femoral Revision Hip Arthroplasty.

Background: Cylindrical fully-coated cobalt-chromium stems (CCS) have been widely used in femoral revisions. However, monoblock fluted conical tapered stems (FCTS) are growing in popularity. The present study seeks to determine whether there are any long-term differences between the two designs. Material and methods: A retrospective study of 38 CCS versus 40 FCTS was carried out. Demographic data, clinical variables and radiographic parameters were recorded. Results: Demographic data were comparable. A greater proportion of septic revisions, periprosthetic fractures and previous osteosynthesis failures was observed with FCTS versus CCS (p = 0.012). A greater use of FCTS was recorded in cases with bone defects of type IIIA and higher (p = 0.025). There were no significant differences in terms of in-hospital complications (p = 0.815), postoperative surgical complications or need for reoperation (p = 0.156). The CCS group presented a higher percentage of clinical thigh pain at the end of follow-up (p = 0.006). Additionally, a greater presence of radiolucencies was observed with CCS, especially in proximal zones (1, 7, 10 and 14). More subsidence, tip cortical hypertrophy and stress shielding were recorded in the CCS group. The overall survival at 120 months was 84.2% in the CCS group and 85% in the FCTS group (p = 0.520). When analyzing isolated aseptic loosening as the cause of failure, the survival rate was 94.7% in the CCS group and 95% in the FCTS group (p = 0.506). Conclusions: Both FCTS and CCS with diaphyseal anchorage afford excellent long-term survival rates, with no differences between the two designs. However, a higher incidence of stress shielding, radiolucencies and thigh pain with CCS seems to favor the use of FCTS.

Anatomical cup implantation assisted with dynamic 3D planning improves functional outcomes in primary total hip arthroplasty: A retrospective study.

Anatomical cup implantation is a promising approach in primary total hip arthroplasty (THA) and improves functional outcomes. We aimed to evaluate the cup position and functional outcomes in primary THA with preoperative dynamic 3D planning. We retrospectively reviewed 54 hips in 48 patients who underwent primary THA with anatomical cup implantation (mean follow-up time: 52months). Cup positions were evaluated based on patient-specific morphology, the acetabular fossa and the combined anteversion test. Functional outcomes were assessed after THA. The paired-sample t-test was performed for surgical and contralateral native hips among 42 patients who underwent unilateral THA. Two hips suffered intraoperative trochanteric fracture, but no hip dislocations occurred. No patients reported groin or thigh pain, and all patients were capable of deep squatting and one-leg standing. The mean Harris hip score, WOMAC score, and physical SF-36 score were 94.46 ± 6.16, 10.41 ± 3.62, and 95.19 ± 8.74, respectively. Except for acetabular offset, THA restored biomechanics to those of contralateral native hip, including cup anteversion, abduction, femoral offset and acetabular height (P> 0.05). This study provided evidence for the application of anatomical cup implantation assisted with dynamic 3D planning in primary THA, which restored morphology and improved functional outcomes.

Laterally Protruded Cephalomedullary Nail Lag Screws are a Source of Consistent Thigh Pain After Pertrochanteric Fracture.

To assess the correlation between the amount of proximal screw lateralization and clinical symptoms in patients treated with a cephalomedullary nail (CMN) after a pertrochanteric fracture. Retrospective study. Level 1 trauma center. Patients operated for a pertrochanteric fracture (OTA/AO A1, A2, A3) between 2019 and 2022 and treated with a CMN were included. Three measurements were evaluated: D1 distance between the most laterally prominent point of the lag screw and the line tangent to the greater trochanter, D2 distance between the lateral femoral cortex and the most laterally prominent point of the lag screw, and D3 distance between the point where the lag screw emerges at the lateral edge of the femur shaft and the skin's surface. Clinical scores and information regarding lateral thigh pain were obtained, and a correlation analysis was performed. Mean age of the study cohort (n = 134) was 77.9 ± 12.3 years. Patients with categorical protrusion (considered present in cases where the distance between the lateral tip of the lag screw and the lateral border of the greater trochanter was ≥0.2 mm) had significantly higher rates of lateral thigh pain ( P = 0.007) and discomfort while lying on the side ( P = 0.032) compared with those without protrusion. Correlation analyses showed a positive correlation between measurements D1 and D2 and lateral thigh pain (r = 0.324 and r = 0.334, respectively, P < 0.001) and a negative correlation between D3 and lateral thigh pain (r = -0.286, P = 0.001). Regression analysis showed that higher D1 and D2 distances and shorter D3 distances are risk factors for lateral thigh pain ( P = 0.001, 0.001, and 0.002, respectively). Increasing lateral protrusion of the lag screw leads to significantly greater clinical complaints and lateral hip pain in patients treated with a CMN. Patients with lower distance between the lateral femoral wall and the skin are at higher risk of lateral pain. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Acute compartment syndrome of the thigh after total knee arthroplasty: a case report

IntroductionAcute compartment syndrome of the thigh after total knee arthroplasty is a rarely described complication. After the assessment of the diagnosis, immediate surgical intervention is necessary to prevent further tissue damage. Since only a few cases have been described and because of the high complication rate, early detection is essential for ensuring patient outcomes.Case presentationAfter total knee arthroplasty in a high-volume university hospital, a 57-year-old Caucasian female patient experienced strong, disproportional pain in the ventromedial thigh of the affected leg, which did not respond to an adequate adjustment in pain medication. Imaging revealed a distinct swelling of the vastus intermedius muscle. This resulted in acute compartment syndrome of the thigh, which was immediately surgically treated. Apart from receiving surgery distal from the affected compartment and continuous intake of acetylsalicylic acid, the patient had no risk factors for developing compartment syndrome. The patient’s recovery was uneventful, with timely wound closure and discharge to outpatient care without significant functional limitations.ConclusionAcute compartment syndrome of the thigh represents a rare, but severe complication that can occur after orthopedic surgery. In our case, no triggering factors for the development of acute compartment syndrome, such as the use of a tourniquet, were detected. Even in unusual locations, compartment syndrome should be considered as a differential diagnosis. With sufficient evidence, immediate fasciotomy should be indicated.

More With Less: Single-Incision Sling Insertion Techniques

To demonstrate reproducible procedures for efficient single-incision sling insertion and troubleshooting. Narrated video footage with stepwise demonstration of single-incision sling insertion technique with anchor system. The mesh midurethral sling is a highly effective and safe procedure that is considered the gold standard for surgical treatment of stress urinary incontinence. Retropubic and transobturator approaches for midurethral slings have similar subjective cure rates with differing surgical risk profiles [1,2]. The retropubic route has a higher risk of injury to the bladder, nerves, and vascular structures, whereas the obturator approach carries a risk of groin or thigh pain [3-5]. Use of a single-incision sling decreases these risks and allows flexibility to perform the procedure without sedation or general anesthesia. Recent literature demonstrates similar subjective and objective success and safety of single-incision slings compared with both retropubic and transobturator approaches, although long-term data are forthcoming [5]. We demonstrate a stepwise approach for the insertion of a single-incision sling using a helical trocar. Easily reproducible procedures for setup and sling anchor management allow for efficient placement without assistance. In addition, we outline hand positioning, trocar management, and anchor deployment with troubleshooting techniques for potential placement difficulties. Finally, we review methods for sling tensioning to prevent complications such as voiding dysfunction and mesh or suture exposures. Given that single-incision slings are more likely to be performed under local anesthesia and are less invasive with decreased recovery time, it has the potential to become the preferred approach in the future. This video demonstrates clear and detailed steps to facilitate successful placement of the single-incision mesh midurethral sling.

An Anterior Femoral Nerve Glomus Tumor Causing Twenty Years of Neuropathic Pain: A Case Report

BACKGROUND: Glomus tumors are a rare, yet painful, neoplasm commonly occurring in the subungual area of the digits. While uncommon, a glomus tumor can present in extradigital locations, leading to delays in diagnosis. CASE REPORT: We present a case of a 53-year-old man with a 20-year history of right thigh pain. Previous diagnostic workup and treatment with spinal cord stimulation and peripheral nerve stimulation did not yield resolution. Exam with ultrasound revealed a hypoechoic lesion. Upon targeted surgical exploration, a mass near the right anterior femoral cutaneous nerve was identified and resected. Pathology was consistent with a glomus tumor. Since the operation, the patient has experienced complete relief after a 1.2-year follow-up. CONCLUSION: Glomus tumors are treated surgically. Ultrasound may be useful in well-localized, neuropathic pain of the extremity, highlighting the importance of clinicians becoming familiar with employing this modality. While rare, a glomus tumor should be included in the differential diagnosis. KEY WORDS: Glomus tumor, chronic neuropathic pain, case report