Measurement Properties and Minimal Important Change of the World Health Organization Disability Assessment Schedule 2.0 in Persons With Low Back Pain: A Systematic Review.

OBJECTIVE: To determine the measurement properties and minimal important change (MIC) of the World Health Organization Disability Assessment Schedule 2.0 (WHODAS 2.0) short (12 questions) and full (36 questions) versions in persons with nonspecific low back pain (LBP). DATA SOURCES: MEDLINE, Embase, Cumulative Index to Nursing and Allied Health Literature, APA PsycInfo, and Cochrane Central Register of Controlled Trials (inception to May 2021). STUDY SELECTION: Eligible studies assessed measurement properties or MIC of WHODAS 2.0 in persons with LBP. DATA EXTRACTION: Paired reviewers screened articles, extracted data, and assessed risk of bias using Consensus-Based Standards for Selection of Health Measurement Instruments (COSMIN) and COSMIN-Outcome Measures in Rheumatology checklists. DATA SYNTHESIS: We descriptively synthesized results stratified by measurement property and LBP duration (subacute: 6 weeks to 3 months; chronic: ≥3 months). RESULTS: We screened 297 citations and included 14 studies (reported in 15 articles). Methodological quality of studies was very good for internal consistency and varied between very good and doubtful for construct validity, doubtful for responsiveness, and adequate for all other properties assessed. Evidence suggests that WHODAS 2.0 full version has adequate content validity (2 studies); WHODAS 2.0 short and full versions have adequate structural validity (3 studies), but construct validity is indeterminate (9 studies). WHODAS 2.0 short and full versions have adequate internal consistency (10 studies), and the full version has adequate test-retest and interrater reliability (3 studies) in persons with LBP. Minimal detectable change (MDC) was 10.45-13.99 of 100 for the full version and 8.6 of 48 for the short version in persons with LBP (4 studies). WHODAS 2.0 full version has no floor or ceiling effects, but the short version has potential floor effects in persons with chronic LBP (3 studies). One study estimated MIC for the full version as 4.87 of 100 or 9.74 of 100 (corresponding to 1- and 2-point change on 0- to 10-cm visual analog scale for pain, respectively), and 1 study estimated 3.09-4.68 of 48 for the short version. CONCLUSIONS: In persons with LBP, WHODAS 2.0 full version has adequate content validity, structural validity, internal consistency, and reliability. WHODAS 2.0 short version has adequate structural validity and internal consistency. Construct validity of the short and full versions is indeterminate. Since MDC is estimated to be larger than MIC, users may consider both MIC and MDC thresholds to measure change in functioning for LBP.

Pre-rehabilitation scores of functioning measured using the World Health Organization Disability Assessment Schedule in persons with nonspecific low back pain: a scoping review.

Knowledge of the pre-rehabilitation generic status of functioning in individuals with low back pain is necessary to understand the clinical utility of rehabilitation care. We conducted a scoping review to describe the pre-rehabilitation functioning status of persons with nonspecific low back pain using the World Health Organization Disability Assessment Schedule (WHODAS)-36 or WHODAS-12. We searched multiple databases from 2010 to 2021 for studies reporting pre-rehabilitation scores using WHODAS in persons with low back pain. Reviewers independently screened articles and extracted data, and we descriptively summarized results by the duration of low back pain (acute/subacute <3 months; chronic ≥3 months), and the WHODAS version. Of 1770 citations screened, eight citations were relevant. Five studies were conducted in Europe, two in America, and one in the African Region (mostly high-income countries). In persons with acute low back pain, the mean WHODAS-36 pre-rehabilitation summary score (complex scoring) was 22.8/100 (SD = 15.4) (one study). In persons with chronic low back pain, the mean WHODAS-36 summary score (complex scoring) ranged from 22.8/100 (SD = 5.7) to 41.5/100 (SD = 13.8) (two studies). For WHODAS-12 in persons with chronic low back pain, the mean summary score was 11.4/48 (SD = 8.7) or 14.4/48 (SD = 9.4) using simple scoring (two studies), and 25.8/100 (SD = 2.2) using complex scoring (one study). No floor or ceiling effects were observed in WHODAS-36 summary scores for chronic low back pain. Our scoping review comprehensively summarizes available studies reporting pre-rehabilitation levels of functioning using WHODAS in persons with low back pain. Persons with low back pain seeking rehabilitation have moderate limitations in functioning, and limitations level tends to be worse with chronic low back pain.

Incidence and risk factors for musculoskeletal disorders of the elbow in baseball pitchers: a systematic review of the literature.

OBJECTIVE: To determine the incidence and risk factors of musculoskeletal disorders of the elbow in baseball pitchers. DESIGN: Systematic review. DATA SOURCES: Medline, CINAHL, Cochrane, PubMed and SportDiscus from onset to July 7, 2018. ELIGIBILITY CRITERIA: Eligible studies included randomized controlled trials, cohort studies and case-control studies. Independent pairs of reviewers screened titles and abstracts for eligibility. Relevant articles were critically appraised for internal validity using the SIGN criteria. We included low risk of bias studies in our best evidence synthesis. RESULTS: We retrieved 4502 articles, 39 were critically appraised and nine had a low risk of bias. These were included in the evidence synthesis. The incidence of musculoskeletal disorders of the elbow ranges from 2.3% in adolescent pitchers to 40.6% in youth pitchers. Evidence suggests that pitch characteristics, inadequate rest, biomechanical and anthropometric factors may be risk factors of UCL tears. SUMMARY/CONCLUSION: Baseball pitchers develop musculoskeletal disorders of the elbow. There is little high-quality evidence to understand the etiology. Preliminary evidence suggests the risk factors are multifactorial.PROSPERO Trial Registration Number: CRD42018092081.

OBJECTIF: Établir l'incidence et facteurs de risque de troubles musculosquelettiques du coude chez le lanceur de baseball. MÉTHODOLOGIE: Revue exhaustive. SOURCES DES DONNÉES: Medline, CINAHL, Cochrane, PubMed et SportDiscus depuis le début jusqu'au 7 juillet 2018. CRITÈRES D'ADMISSIBILITÉ: Les études admissibles étaient des essais comparatifs à répartition aléatoire, des études de cohortes et des études de cas-témoins. Des pairs examinateurs indépendants ont trié des titres et des résumés satisfaisant les critères d'admissibilité. On a évalué la validité interne des articles pertinents en utilisant les critères SIGN. On a tenu compte d'un faible risque d'études faussées dans notre meilleure synthèse de preuves. RÉSULTATS: Sur les 4 502 articles retenus, 39 ont été évalués d'une façon critique; neuf présentaient un risque de parti pris. Ceux-ci ont été inclus dans la synthèse de preuves. L'incidence des troubles musculosquelettiques du coude variait de 2,3 % chez les lanceurs adolescents à 40,6 % chez les jeunes lanceurs. Les données semblent indiquer que les caractéristiques du lancer, un repos insuffisant, des facteurs biomécaniques et anthropométriques pourraient être des facteurs de risque de déchirure du ligament collatéral de l'ulna (LCU). RÉSUMÉ/CONCLUSION: Les lanceurs de baseball développent des troubles musculosquelettiques au coude. Il existe peu de preuves de grande qualité permettant de comprendre l'étiologie de ces troubles. Les données préliminaires semblent indiquer que les causes sont multifactorielles.Numéro d'enregistrement d'essai PROSPERO : CRD42018092081.

The association between psychological and social factors and spinal pain in adolescents.

Spinal pain, back pain, and/or neck pain begins early in life and is strongly associated with spinal pain in adulthood. Understanding the relationship between psychological and social factors and adolescent spinal pain may be important in both the prevention and treatment of spinal pain in this age group. We aimed to determine if psychological and social factors were associated with spinal pain in a cross-sectional study of a school-based cohort of 1279 Danish adolescents aged 11-13, who were categorized into "any" and "substantial" spinal pain. "Substantial spinal pain" was defined as a lifetime frequency of "sometimes" or "often" and a pain intensity of at least two on the revised Faces Pain Scale. Logistic regression analyses, stratified by sex, were conducted for single and all variables together. Eighty-six percent of participants reported "any spinal pain" and 28% reported "substantial spinal pain". Frequency of psychological and social factors was significantly higher in those with spinal pain compared to those without. As the frequency of psychological and social factors increased, the odds of both "any spinal pain" and "substantial spinal pain" also increased.Conclusion: Psychological and social factors may be important determinants in adolescent spinal pain. What is Known: • Spinal pain begins early in life to reach adult levels by age 18. Spinal pain in adolescence is strongly associated with spinal pain in adulthood. • In adults, psychological and social factors and spinal pain are strongly related; however, this relationship in adolescence is poorly understood. What is New: • Adolescents with spinal pain reported a significantly higher frequency of psychological factors and loneliness and lower levels of pupil acceptance. • Adolescents reporting higher levels of loneliness, lower levels of pupil acceptance, and increased frequency of psychological factors had increased odds of reporting "substantial spinal pain".

Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVE: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS: We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. DISCUSSION: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.

The Effectiveness of Exercise on Recovery and Clinical Outcomes in Patients With Soft Tissue Injuries of the Hip, Thigh, or Knee: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVE: The purpose of this systematic review was to determine the effectiveness of exercise for the management of soft tissue injuries of the hip, thigh, and knee. METHODS: We conducted a systematic review and searched MEDLINE, EMBASE, PsycINFO, the Cochrane Central Register of Controlled Trials, and CINAHL Plus with Full Text from January 1, 1990, to April 8, 2015, for randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effect of exercise on pain intensity, self-rated recovery, functional recovery, health-related quality of life, psychological outcomes, and adverse events. Random pairs of independent reviewers screened titles and abstracts and assessed risk of bias using the Scottish Intercollegiate Guidelines Network criteria. Best evidence synthesis methodology was used. RESULTS: We screened 9494 citations. Eight RCTs were critically appraised, and 3 had low risk of bias and were included in our synthesis. One RCT found statistically significant improvements in pain and function favoring clinic-based progressive combined exercises over a "wait and see" approach for patellofemoral pain syndrome. A second RCT suggests that supervised closed kinetic chain exercises may lead to greater symptom improvement than open chain exercises for patellofemoral pain syndrome. One RCT suggests that clinic-based group exercises may be more effective than multimodal physiotherapy in male athletes with persistent groin pain. CONCLUSION: We found limited high-quality evidence to support the use of exercise for the management of soft tissue injuries of the lower extremity. The evidence suggests that clinic-based exercise programs may benefit patients with patellofemoral pain syndrome and persistent groin pain. Further high-quality research is needed.

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

BACKGROUND: Musculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity. METHODS: Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best-evidence synthesis principles. Where available, we computed mean changes between groups, relative risks and 95 % CI. RESULTS: We screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults. CONCLUSIONS: The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014009899.

The effectiveness of exercise on recovery and clinical outcomes of soft tissue injuries of the leg, ankle, and foot: A systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

INTRODUCTION: Soft tissue injuries of the leg, ankle, or foot are common and often treated by exercise. The purpose of this study was to determine the effectiveness of exercise for the management of soft tissue injuries of the leg, ankle, or foot. METHODS: A systematic review of the literature was conducted. We searched five databases from 1990 to 2015. Relevant articles were critically appraised using Scottish Intercollegiate Guidelines Network (SIGN) criteria. The evidence from studies with low risk of bias was synthesized using the best-evidence synthesis methodology. RESULTS: We screened 7946 articles. We critically appraised ten randomized trials and six had a low risk of bias. The evidence suggests that for recent lateral ankle sprain: 1) rehabilitation exercises initiated immediately post-injury are as effective as a similar program initiated one week post-injury; and 2) supervised progressive exercise plus education/advice and home exercise lead to similar outcomes as education/advice and home exercise. Eccentric exercises may be more effective than an AirHeel brace but less effective than acupuncture for Achilles tendinopathy of more than two months duration. Finally, for plantar heel pain, static stretching of the calf muscles and sham ultrasound lead to similar outcomes, while static plantar fascia stretching provides short-term benefits compared to shockwave therapy. CONCLUSIONS: We found little evidence to support the use of early or supervised exercise interventions for lateral ankle sprains. Eccentric exercises may provide short-term benefits over a brace for persistent Achilles tendinopathy and plantar fascia stretching provides short-term benefits for plantar heel pain.

Varied clinical presentation of os odontoideum: a case report.

OBJECTIVE: To present a case of an os odontoideum and to provide insight into the varied clinical presentations. CLINICAL FEATURES: A 54 year old man presented with chronic neck pain without headache. A clinical examination was performed and the chiropractor viewed his AP and lateral radiographs. Previous flexion/ extension radiographs and MRI imaging from 2009 were requested for review. The patient was diagnosed with grade II mechanical neck pain. Treatment was rendered that day which included spinal manipulation/ mobilization. Several days later the requested imaging reports were received and described the presence of an os odontoideum. CONCLUSION: In the presence of os odontoideum, familiarity with the signs and symptoms of potential cervical instability is imperative. Health care providers must remain diligent in their patient histories, physical exams, and imaging. This case highlights the importance of following up on imaging studies to rule out diagnoses that would involve treatment contraindications thus ensuring safe and effective treatment.

OBJECTIF: Présenter un cas d'os odontoïde, et donner un aperçu des différents tableaux cliniques. CARACTÉRISTIQUES CLINIQUES: Un homme de 54 ans qui souffre de douleurs cervicales chroniques, sans maux de tête. Un examen clinique a eu lieu et le chiropraticien a vérifié sa pression artérielle et ses radiographies latérales. Des radiographies et images IRM antérieures de la flexion et l'extension, datant de 2009, ont aussi été requises pour examen. On avait diagnostiqué sur ce patient une cervicalgie mécanique de stade II. Un traitement avait été administré ce même jour, dont une manipulation / mobilisation vertébrale. Quelques jours plus tard, les rapports demandés d'imagerie sont reçus, qui font état d'un os odontoïde. CONCLUSION: Il est impératif de reconnaître les signes et les symptômes d'une instabilité cervicale potentielle, en la présence d'un os odontoïde. Les fournisseurs de soins de santé doivent faire preuve de vigilance à l'égard des antécédents de leurs patients, des examens physiques, et de l'imagerie médicale. Ce cas souligne l'importance de faire le suivi des examens d'imagerie pour écarter tout mauvais diagnostic qui engendrerait un traitement contre-indiqué, pour assurer une prise en charge sûre et efficace du patient.

The course and prognostic factors of symptomatic cervical disc herniation with radiculopathy: a systematic review of the literature.

BACKGROUND CONTEXT: Cervical spine disc herniation is a disabling source of cervical radiculopathy. However, little is known about its course and prognosis. Understanding the course and prognosis of symptomatic cervical disc herniation is necessary to guide patients' expectations and assist clinicians in managing patients. PURPOSE: To describe the natural history, clinical course, and prognostic factors of symptomatic cervical disc herniations with radiculopathy. STUDY DESIGN: Systematic review of the literature and best evidence synthesis. METHODS: A systematic search of MEDLINE, EMBASE, CINAHL, SportsDiscus, and the Cochrane Central Register of Controlled Trials from inception to 2013 was conducted to retrieve eligible articles. Eligible articles were critically appraised using the Scottish Intercollegiate Guidelines Network criteria. The results from articles with low risk of bias were analyzed using best evidence synthesis principles. RESULTS: We identified 1,221 articles. Of those, eight articles were eligible and three were accepted as having a low risk of bias. Two studies pertained to course and one study pertained to prognosis. Most patients with symptomatic cervical disc herniations with radiculopathy initially present with intense pain and moderate levels of disability. However, substantial improvements tend to occur within the first 4 to 6 months post-onset. Time to complete recovery ranged from 24 to 36 months in, approximately, 83% of patients. Patients with a workers' compensation claim appeared to have a poorer prognosis. CONCLUSIONS: Our best evidence synthesis describes the best available evidence on the course and prognosis of cervical disc herniations with radiculopathy. Most patients with symptomatic cervical spine disc herniation with radiculopathy recover. Possible recurrences and time to complete recovery need to be further studied. More studies are also needed to understand the prognostic factors for this condition.

Detection of syringomyelia in a pediatric patient with mild scoliosis: a case report.

It can be challenging to detect syringomyelia in patients with scoliosis, as some cases are mildly symptomatic with little to no neurological deficits. However, a timely diagnosis of syringomyelia is needed to facilitate important treatment considerations. This case report details an 11-year-old female with mild scoliosis and a two-year history of spinal pain that had short-term symptomatic relief from chiropractic treatment. Subtle neurological signs were detected only at re-evaluation, which prompted further investigation with radiographs and subsequent magnetic resonance imaging (MRI). MRI revealed a non-expansile syrinx measuring 3 mm at its widest diameter that extended from C5 to the conus medullaris. The aim of this case is to heighten awareness of the potential diagnostic challenges in patients with syringomyelia and scoliosis. The incidence, pathogenesis, clinical presentation, and management of syringomyelia will be presented to help primary contact providers with appropriate referral and co-management of these patients.

La détection de la syringomyélie peut être difficile chez les patients atteints de scoliose, car certains cas sont légèrement symptomatiques, avec peu ou pas de déficits neurologiques. Toutefois, il faut effectuer un diagnostic rapide de la syringomyélie pour faciliter les aspects importants de traitement. Cette étude de cas présente une jeune de 11 ans atteinte de scoliose légère, avec des douleurs vertébrales depuis deux ans qui ont bénéficié d'un soulagement symptomatique à court terme à la suite d'un traitement chiropratique. Des signes neurologiques subtils ont été détectés seulement pendant un nouvel examen, ce qui a incité un examen plus approfondi à l'aide de radiographies et l'imagerie par résonance magnétique (IRM). L'IRM a révélé une syrinx non extensible mesurant au plus 3 mm de diamètre et s'étendant de C5 jusqu'au cône médullaire. Le but de cette étude est d'accroître la sensibilisation aux difficultés potentielles du diagnostic chez les patients atteints de syringomyélie et de scoliose. L'incidence, la pathogenèse, la présentation clinique et la gestion de la syringomyélie seront présentées en vue d'offrir aux fournisseurs des soins primaires des outils pour l'orientation et la cogestion appropriées de ces patients.

A delayed diagnosis of bilateral facet dislocation of the cervical spine: a case report.

OBJECTIVE: To review the case of a patient suffering from bilateral facet dislocation of the cervical spine. CLINICAL FEATURES: A 53-year-old male was involved in a car accident and was transported to the hospital. Cervical radiographs were taken at the emergency department and interpreted as normal. Four days later, he consulted a chiropractor where radiographs of the cervical spine were repeated. The examination revealed bilateral cervical facet joint dislocation at C5-C6 as well as a fracture involving the spinous process and laminae of C6. INTERVENTION AND OUTCOME: The patient was referred to the hospital and underwent surgery. CONCLUSION: Patients involved in motor vehicle accidents often consult chiropractors for neck pain treatment. A high index of suspicion due to significant history and physical examination findings should guide the clinician in determining the need for reviewing the initial radiographs (if taken and available) or request repeat studies, regardless of the initial imaging status.

OBJECTIF: Examiner le cas d'un patient souffrant d'une dislocation facettaire bilatérale de la colonne cervicale. CARACTÉRISTIQUES CLINIQUES: Un homme de 53 ans a été transporté à l'hôpital à la suite d'un accident de voiture. Les radiographies cervicales prises à l'urgence ont été jugés normales. Quatre jours plus tard, les radiographies de la colonne cervicale ont été répétées chez un chiropraticien. L'examen a révélé une dislocation facettaire bilatérale à C5­C6, ainsi qu'une fracture impliquant l'apophyse épineuse et les lames de C6. INTERVENTION ET RÉSULTAT: Le patient a été envoyé à l'hôpital où il a subi une intervention chirurgicale. CONCLUSION: Les patients impliqués dans des accidents de véhicules automobiles consultent souvent les chiropraticiens pour le traitement des douleurs cervicales. Un indice élevé de suspicion dû à l'histoire importante et aux résultats de l'examen physique doit pousser le clinicien à déterminer la nécessité de réviser les radiographies initiales (si disponibles) ou à demander la répétition des examens, peu importe l'interprétation initiale de l'imagerie.

A case of early sports specialization in an adolescent athlete.

Early sport specialization (ESS) refers to intense year round training in a specific sport with the exclusion of other sports at a young age. This approach to training is heavily debated and there are claims both in support and against ESS. ESS is considered to be more common in the modern day youth athlete and could be a source of overuse injuries and burnout. This case describes a 16 year old elite level baseball pitcher who engaged in high volume, intense training at a young age which lead to several significant throwing related injuries. The case highlights the historical context of ESS, the potential risk and benefits as well as the evidence for its effectiveness. It is important for health care professionals to be informed on the topic of ESS in order to educate athletes, parents, coaches and organizations of the potential risks and benefits.

La spécialisation précoce dans un sport (SPS) se réfère à l'entraînement intensif toute au long de l'année dans un sport particulier à l'exclusion des autres formes de sport dès le jeune âge. Cette approche de l'entraînement est fortement débattue et la SPS a ses détracteurs tout comme ses défenseurs. La SPS est considérée comme plus fréquente chez les jeunes athlètes de nos jours et pourrait être une source d'épuisement et de blessures dues à un surentraînement. Ce cas décrit un lanceur de baseball de 16 ans au niveau provincial qui a suivi un entraînement intense à un jeune âge qui lui a causé plusieurs blessures importantes liées au lancement. Le cas met en lumière le contexte historique de la SPS, les risques et les avantages potentiels, ainsi que les preuves de son efficacité. Il est important que les professionnels de la santé soient renseignés au sujet de la SPS afin de sensibiliser les athlètes, parents, entraîneurs et organisations aux risques et avantages potentiels.

Myxopapillary ependymoma as a cause of back pain in a young male - A case report.

OBJECTIVE: Primary spinal cord tumours are rare causes of low back pain but can be a significant cause of morbidity if undiagnosed and untreated. The following is a case of a young male patient presenting with low back pain and radicular symptoms caused by myxopapillary ependymoma. CLINICAL FEATURES: A nineteen year old male presented to an orthopaedic surgeon with a long history of back pain. He was initially diagnosed with soft tissue injuries and discharged. He began to experience erectile and bowel dysfunction two years later and was re-referred to the orthopaedic surgeon by his family physician but was lost to follow-up. The patient did not present to the surgeon until two years after his symptom profile changed. At that point, MRI examinations revealed a large myxopapillary ependymoma extending from T12 to L4 that was confirmed by a pathologist. INTERVENTION AND OUTCOME: The tumour was surgically resected with subsequent adjuvant radiotherapy. After one year, the patient required continued catheterization and had poor anal tone. His back and leg complaints were almost normal. Follow-up MRI examinations revealed no disease progression or new spinal lesions at 4 years after the initial diagnosis. CONCLUSION: The clinical presentation of primary spinal cord tumours is non-specific and can easily be missed. In cases of chronic back pain, signs and symptoms should be regularly monitored for changes indicative of progressive neurological compromise such as sensory, motor and bowel/bladder dysfunction. If there is deterioration of clinical signs and symptoms, a spinal tumour should be considered in the list of differential diagnoses. Delayed diagnosis and treatment of these rare causes of back pain could lead to poor outcomes; therefore, a referral to a surgeon should be done immediately with proper follow up to ensure continuity of care.

OBJECTIF: Les tumeurs primaires de la moelle épinière sont des causes rares de lombalgies, mais peuvent être une importante cause de morbidité si elles sont pas diagnostiquées ni traitées. Le cas suivant concerne un jeune homme qui présente une lombalgie et des symptômes radiculaires causés par un épendymome myxopapillaire. CARACTÉRISTIQUES CLINIQUES: Un homme de dix-neuf ans s'est présenté chez un chirurgien orthopédique avec de longs antécédents de douleur dorsale. Il lui a d'abord diagnostiqué des blessures des tissus mous et il a été libéré par la suite. Deux ans après, il a commencé à souffrir de dysfonctionnement érectile et intestinal et a été renvoyé vers le chirurgien orthopédique par le médecin de famille mais a été perdu au suivi. Le patient s'est présenté au chirurgien deux ans après que son profil de symptôme a changé. À ce moment-là, les examens par IRM ont révélés un épendymome myxopapillaire se prolongeant de T12 à L4, confirmé par un pathologiste. INTERVENTION ET RÉSULTAT: La tumeur a été prélevée chirurgicalement à l'aide d'une radiothérapie adjuvante subséquente. Après un an, le patient avait besoin d'un cathétérisme continu et présentait un tonus anal faible Il ne se plaignait presque plus de douleurs au dos et aux jambes. Les examens de suivi par IRM n'ont pas révélé de progression de la maladie ou de nouvelles lésions de la moelle épinière, quatre ans après le diagnostic initial. CONCLUSION: La présentation clinique de tumeurs primaires de la moelle épinière n'est pas spécifique et peut facilement ne pas être repérée. Dans les cas de douleurs dorsales chroniques, les signes et symptômes devraient être contrôlés régulièrement dans le cas de changements indiquant des troubles neurologiques progressifs tels que les dysfonctionnements sensoriels, moteurs, intestinaux et érectiles. Dans le cas de dégradation des signes et symptômes cliniques, une tumeur de la moelle épinière devrait être considérée parmi les diagnostics différentiels. Un diagnostic tardif et un traitement de ces causes rares de douleur dorsale peut mener à de pauvres résultats; et un renvoi chez un chirurgien devrait par conséquent être effectué dans les plus brefs délais avec un suivi approprié pour assurer la continuité des soins.

Urolithiasis presenting as right flank pain: a case report.

BACKGROUND: Urolithiasis refers to renal or ureteral calculi referred to in lay terminology as a kidney stone. Utolithiasis is a potential emergency often resulting in acute abdominal, low back, flank or groin pain. Chiropractors may encounter patients when they are in acute pain or after they have recovered from the acute phase and should be knowledgeable about the signs, symptoms, potential complications and appropriate recommendations for management. CASE PRESENTATION: A 52 year old male with acute right flank pain presented to the emergency department. A ureteric calculus with associated hydronephrosis was identified and he was prescribed pain medications and discharged to pass the stone naturally. One day later, he returned to the emergency department with severe pain and was referred to urology. He was managed with a temporary ureteric stent and antibiotics. CONCLUSION: This case describes a patient with acute right flank and lower quadrant pain which was diagnosed as an obstructing ureteric calculus. Acute management and preventive strategies in patients with visceral pathology such as renal calculi must be considered in patients with severe back and flank pain as it can progress to hydronephrosis and kidney failure.

CONTEXTE: La lithiase urinaire se réfère à des calculs rénaux ou urétéraux connus plus communément comme des calculs rénaux. La lithiase urinaire présente une urgence potentielle qui entraîne souvent des douleurs aiguës à l'abdomen, au dos, à la colonne lombaire, au flanc ou à l'aine. Les chiropraticiens peuvent rencontrer les patients quand ceux-ci éprouvent des douleurs aiguës ou après s'être remis de la phase aiguë et devraient donc connaître les signes, les symptômes, les complications possibles et les recommandations appropriées de gestion. EXPOSÉ DE CAS: Un homme de 52 ans éprouvant des douleurs aiguës au flanc droit s'est présenté à l'urgence. Un calcul urétéral avec hydronéphrose associée a été décelé et on lui a prescrit des analgésiques et on l'a renvoyé chez lui pour passer les calculs rénaux sans intervention. Le lendemain il est retourné aux urgences avec une douleur intense et a été renvoyé à l'urologie, où on lui a posé une endoprothèse urétérale temporaire et prescrit des antibiotiques. CONCLUSION: Ce cas décrit un patient souffrant d'une douleur aiguë au flanc et au quadrant inférieur droits. Le diagnostic posé indiquait des calculs urétéraux obstructifs. Il faut envisager des stratégies de prévention et de gestion à court terme pour les patients atteints de pathologies viscérales telles que des calculs rénaux avec des douleurs sévères au dos et au flanc, sinon cela peut mener à une hydronéphrose et une insuffisance rénale.

An unusual case of gout in the wrist: the importance of monitoring medication dosage and interaction. A case report.

BACKGROUND: Gouty arthritis of the wrist is uncommon although gout itself is the most common inflammatory arthritis in older patients. Some known risk factors for the development of gout include trauma, alcohol use, obesity, hyperuricaemia, hypertension and diabetes mellitus. As well, certain medications have been shown to promote the development of gout. These include thiazide diuretics, low dose salicylates and cyclosporine. We present a case of gouty wrist pain possibly precipitated by a medication dosage increase as well as medication interactions. CASE PRESENTATION: A 77 year old male presented with right wrist pain. Redness and swelling was present at the dorsal aspect of his wrist and range of motion was full with pain at end range upon examination. One week prior, his anti-hypertensive medication dosage had been increased. The patient's situation continued to worsen. Radiographic examination revealed changes consistent with gouty arthritis. CONCLUSION: It is important for clinicians treating joint conditions to be aware of patients' comorbidities, medication usage and changes in dosages. Education of patients with gout is of prime importance. Clinicians should educate patients that gout may occur at any joint in the body not only the lower limb. Patients should be aware of the signs and symptoms of an acute gouty attack and be made aware that changes in certain medication dosages may precipitate an attack. Awareness of radiographic changes associated with gout is still of importance although these changes are not seen as frequently as they have been in the past due to better control of the disease.