Effects of Cervical Spine Exercise Protocol on Neck Pain, Pericervical Muscle Endurance, and Range of Motion in Medical Students: A Prospective Study.

Introduction Neck pain is a common and debilitating ailment that places a significant burden on the healthcare system. No practical protocols have been published utilizing a portable, commercially available, and affordable device that significantly reduces acute and chronic neck pain. Methods Forty-six young adults with or without mild-to-moderate neck pain completed a six-week neck stretching and strengthening protocol with a portable cervical stretching and strengthening device. The primary outcome was changes to pericervical muscle endurance. Secondary outcomes were changes to cervical range of motion (ROM), neck length, circumference, and subjective pain, flexibility, and strength. Measurements were obtained on study days 0, 21, and 42. Results A significant increase in pericervical muscle endurance was demonstrated across all planes of cervical motion, ranging from 84% to 105%. Cervical ROM improved across all planes of motion but was only significant in right-side bending (5.3°), left rotation (6.2°), and right rotation (7.8°). Subjective pain evaluated via the Numeric Rating Scale (NRS) saw statistically significant improvement as well (1.33 to 0.51). Subjective assessment of participant cervical pain, strength, and flexibility improved 61.3%, 95.7%, and 97.8%, respectively. Conclusions A six-week pericervical muscle stretching and strengthening program increased pericervical endurance and ROM in young adults. Decreased cervical pain was seen using the NRS and modified pain scale across most participants.

Matrix-Induced Autologous Chondrocyte Implantation (MACI) is Largely Effective and Provides Significant Improvement in Patients With Symptomatic, Large Chondral Defects: A Systematic Review and Meta-Analysis.

INTRODUCTION: The purpose of this study was to perform a meta-analysis for long-term patient-reported outcome (PRO) measures in Matrix-induced Autologous Chondrocyte Implantation (MACI) patients using the Knee Injury and Osteoarthritis Outcome Score (KOOS) model. MATERIALS AND METHODS: A literature search under the PubMed/Medline and Embase databases was conducted. Statistical significance was determined between the mean pre- and postoperative scores at each time point (1-, 2-, and 5-years). Cohen's d analysis was used to measure the effect size (ES) in each group when compared to preoperative measurements to determine clinical responsiveness. RESULTS: KOOS subscales at all long-term postoperative follow ups measured in this study showed significant (p-value < 0.001) improvement when compared to preoperative scores. Furthermore, apart from KOOS sports and recreation (KOOS-SR) at 1-year postoperative follow up that showed a medium ES (ES, 0.761), all other KOOS subscales at long-term follow up periods showed a large (>0.8) ES on mean preoperative KOOS. CONCLUSION: Review of the literature demonstrate an absence of large meta-analyses for long-term PRO measures with the MACI procedure. It was found that all subscales were largely responsive when evaluated at >2 years after surgery. Based on these results, MACI is an effective treatment option for patients with symptomatic, full-thickness cartilage defects about the knee.

A Case of Recurrent Compartment Syndrome with Concomitant Use of Eliquis.

Introduction. Acute compartment syndrome (ACS) occurs secondary to increasing pressure within a fascial compartment that exceeds perfusion pressure. This can be caused by spontaneous hematomas, which can be secondary to prolonged anticoagulation therapy. Eliquis® has not been associated with ACS of the thigh in any of the currently published literature. Identifying ACS early is important because it can reduce the risk of permanent structural damage, limb amputations, and mortality rates. Case Report. A 43-year-old male with past medical history of unprovoked Deep Vein Thrombosis (DVT) eight months prior to presentation on Eliquis® presented to the emergency department for significant right thigh pain after riding a roller coaster. There was increased tone/firmness of the anterior compartment and tenderness on palpation of the proximal two-thirds of the anterior thigh. Imaging, clinical findings, and Stryker needle measurements confirmed ACS secondary to hematoma, which required fasciotomy and evacuation of the hematoma. The patient was temporarily switched to aspirin for DVT prophylaxis postoperatively to prevent new hematoma formation. Six weeks later, the patient arrived at the ED with a DVT that was treated with Eliquis®. Eight months later, the same patient presented with acute right thigh pain that started while lying in bed. A diagnosis of recurrent ACS in the right anterior thigh was made, requiring a fasciotomy. Surgery was successful without any complications. Discussion. Eliquis® is associated with an increased risk of hematoma formation, which can lead to ACS. This is a rare adverse effect that providers should be aware of because it requires early management to prevent ACS-associated complications. This is significant because no currently published literature has identified an association of Eliquis® with ACS in the thigh. In cases of atraumatic ACS, we were unable to find any protocols advocating for or against the use of DVT prophylaxis postfasciotomy in the literature.

Femoral Nerve Palsy With Concomitant Patellar Dislocation in a Ballet Dancer.

Femoral nerve palsy with concomitant patellar dislocation is a rare clinical entity that has not previously been well documented. The authors present the case of a 16-year-old female ballet dancer who sustained a patellar dislocation with concomitant femoral nerve palsy. She experienced muscle weakness after the initial injury and developed neuropathic symptoms through the anterior left thigh. The patient exhibited muscle atrophy in her left lower extremity verified by circumferential thigh measurements as well as magnetic resonance imaging showing clear atrophy of the anterior compartment. Electromyography of the left lower extremity verified femoral neuropathy. Gross improvements in muscle strength were noted during the year following initial injury, but circumferential thigh differences persisted. Two years after initial injury, repeat electrodiagnostic studies had normal findings, but subjective left quadriceps weakness persisted and the patient was unable to return to competitive dance. [Orthopedics. 2019; 42(2):e273-e275.].