Factors Associated with Prosthetic Looseness in Lower Limb Amputees.

OBJECTIVE: To determine the factors associated with prosthetic looseness in lower limb amputees in Sisaket province. MATERIAL AND METHOD: The present was a cross-sectional descriptive study. Subjects were lower limb amputees who previously obtained prostheses and required prosthetic replacements at the mobile prosthetic laboratory unit under the Prostheses Foundation of H.R.H. the Princess Mother at Khun Han Hospital, Sisaket province, in February 2013. Data including participant characteristics, prosthetic looseness data, and various variables were collected by direct semi-structured interview. Energy expenditures in physical activities were measured using the Thai version of the short format international physical activity questionnaire. Data between participants with and without prosthetic looseness were compared to determine prosthetic loosening associated factors. RESULTS: Among 101 participants enrolled, 33 (32.7%) had prosthetic looseness with average onset of 1.76 ± 1.67 years. Diabetes mellitus was the only significant factor associated with prosthetic looseness from both univariate and multivariate analyses (HR = 7.05, p = 0.002 and HR = 5.93, p = 0.007 respectively). CONCLUSION: Among the lower limb amputees in Sisaket province, diabetes mellitus was the only factor associated with prosthetic looseness. Therefore, diabetic screening should be supplemented in lower limb amputee assessment protocol. In addition, we recommend that amputees with diabetes mellitus should receive prosthesis check out at approximately

Demographics and psychosocial impact on disabled soldiers and family members from southernmost Thailand's insurgency: a mixed method study.

OBJECTIVE: To find the incidence, demographics, socioeconomics and their association with mental health of disabled soldiers from antiterrorists operations in the southernmost part of Thailand between 2004 and 2008. MATERIAL AND METHOD: Investigators gathered the lists of disabled soldiers from four different database then performed physical examination and semistructured interviews. Mental health of the disabled Royal Thai Army (RTA) officers and close family members was assessed by General Health Questionnaire-12 (GHQ-12). RESULTS: Of the 1,078 traumatic cases, 940 were nonfatal with 33 disabled. Fifteen point sixty-three percent required assistance for activities of daily living (ADL). A positive score of 37.50% in the GHQ-12 was associated with difficulties in ADL and dept repayment (p = 0.004 and 0.029, respectively). In close family members, a score of 17.5% in the GHQ-12 was associated with low family income, ADL, and walking difficulty (p = 0.019, 0.001 and 0.008, respectively). The qualitative results supported the importance of physical and financial problems plus a significant role of the affiliations and family members. CONCLUSION: Disabled RTA officers appeared 6.6 cases/year. The most important problems were physical and financial difficulties. The medical-environmental-financial model is proposed as an effective rehabilitation for the disabled RTA officers from the southernmost Thailand.

Cross-sectional Area Ratio of Median-to-Ulnar and Median-to-Superficial Radial Nerve at the Wrist for Diagnosis of Carpal Tunnel Syndrome.

Objectives: This study aimed to evaluate the diagnostic properties for carpal tunnel syndrome (CTS) of the median-to-ulnar cross-sectional area ratio (MUR) and the median-to-superficial radial cross-sectional area ratio (MRR). Methods: A case-control study was conducted. A physiatrist, blinded to the CTS status of the subjects, assessed the cross-sectional area of the median nerve (CSA-m), MUR, and MRR at the distal wrist crease for the CTS and control groups. The relationship of CSA-m, MUR, and MRR with CTS severity was tested using Spearman's correlation. The overall diagnostic accuracy was determined using the area under the receiver operating characteristic curve (AUC). The cut-off values to diagnose CTS were chosen to achieve similar values for sensitivity and specificity. Results: There were 32 hands in the CTS group and 33 hands in the control group. The correlations of CSA-m, MUR, and MRR with CTS severity were 0.66, 0.56, and 0.34, respectively. The AUCs of CSA-m, MUR, and MRR were 0.86 (95%CI: 0.77-0.95), 0.79 (0.69-0.90), and 0.69 (0.56-0.82), respectively. The cut-off values of CSA-m, MUR, and MRR were 12 mm2 (sensitivity, 81.3%; specificity, 81.8%), 2.6 (sensitivity, 68.8%; specificity, 69.7%), and 10 (sensitivity, 65.6%; specificity, 63.6%), respectively. Conclusions: : MUR and MRR had acceptable diagnostic abilities but did not show superiority over CSA-m for CTS diagnosis.

Efficacy of acupuncture versus night splinting for carpal tunnel syndrome: a randomized clinical trial.

OBJECTIVE: To compare the efficacy of acupuncture with night splinting for carpal tunnel syndrome (CTS). MATERIAL AND METHOD: Sixty one mild-to-moderate degree CTS patients, aged 27-67 were randomly assigned to acupuncture (Acu) and night splinting (NS) groups. The Acu group received 10 sessions of electro-acupuncture twice a week. The NS group received prefabricated volar neutral wrist splint during the night for 5 weeks. Outcomes were assessed at baseline and the end of treatment protocol by Boston Carpal Tunnel Scale comprising symptom severity scale (SSS) and functional status scale (FSS). Pain was measured by 100 mm visual analog scale (VAS). RESULTS: VAS decreased more in Acu than in the NS group (p = 0.028) whereas improvements in SSS and FSS were not significant between both groups. CONCLUSION: Electro-acupuncture was as effective as night splinting in respect of overall symptoms and functions in mild-to-moderate degree CTS. However, pain was reduced more by electro-acupuncture than night splinting.

Effect of supraneural transforaminal epidural steroid injection combined with caudal epidural steroid injection with catheter in chronic radicular pain management: Double blinded randomized controlled trial.

Background: Epidural steroid injection (ESI) has been used in managing chronic radicular pain. Regarding various techniques of ESI, the synergistic effect of caudal ESI (CESI) on transforaminal ESI (TFESI) in chronic lumbosacral radicular pain in prospective randomized controlled trial has not been determined.  Methods:  A total of 54 eligible patients with lumbosacral radicular pain were randomly allocated to undergo TFESI plus CESI (TC group) or TFESI alone (T group).  The effective response to treatment was predefined by at least a 30% reduced verbal numerical rating scale (VNRS) from baseline between group comparison and the functional outcomes as measured by improved Oswestry Disability Index by least 15 points from baseline. All participants were evaluated using a single blinded outcome assessor before the  procedure and at 1, 3 and 6 months after the procedure. P <0.05 was considered as statistically significant.  Results:  Average VNRS reduced significantly from baseline after receiving procedure at 1, 3 and 6 months in both groups (P-value <0.05). The TC group exhibited more effective and showed significant pain relief compared with the T group at 3 months (P=0.01). However, no statistical difference was observed between sub group analysis in pain relief and insignificant difference between group comparisons of functional outcomes. Conclusions: A treatment combining TFESI and CESI showed significant pain relief over TFESI alone at 3 months. No effect was found concerning functional evaluation. Registration: Thai Clinical Trials Registry ID TCTR20171101002 01/11/2017F.

Effectiveness comparison between Thai traditional massage and Chinese acupuncture for myofascial back pain in Thai military personnel: a preliminary report.

The objective of this randomized comparative study was to provide preliminary data of comparative effectiveness of Thai traditional massage (TTM) and Chinese acupuncture for the treatment of myofascial back pain in young military personnel. Eighteen Thai military personnel, aged ranging from 20-40 years were randomly divided into TTM and acupuncture groups. Each group received 5 sessions of massage or acupuncture during a 10-day period. The Thai version McGill Pain Questionnaire, 100-mm, visual analog scale (VAS) and summation of pain threshold in each trigger point measured by pressure algometer were assessed at day 0, 3, 8 and 10. At the end of treatment protocols, McGill scores decreased significantly in TTM and acupuncture groups (p = 0.024 and 0.002, respectively). VAS also decreased significantly (p = 0.029 and 0.003, respectively). However, the pain pressure threshold increased significantly in the acupuncture group but not in the TTM group (p = 0.006 and 0.08, respectively). When outcomes were compared between the two groups, no significant difference was found in the VAS (p = 0.115) and pain pressure threshold (p = 0.116), whereas the acupuncture group showed significantly lower McGill scores than the TTM group (p = 0.039). In conclusion, five sessions of Thai traditional massage and Chinese acupuncture were effective for the treatment of myofascial back pain in young Thai military personnel. Significant effects in both groups begin after the first session. Acupuncture is more effective than Thai traditional massage when affective aspect is also evaluated.

Reliability of Thai version Boston questionnaire.

OBJECTIVE: To determine the reliability of the Thai version Boston questionnaire. SETTING: Hospital-based electrodiagnosis laboratory, Department of Physical Medicine and Rehabilitation. MATERIAL AND METHOD: The Boston questionnaire is the severity rating instrument for carpal tunnel syndrome (CTS). It consists of 11 items of symptom severity scores (SSS) and eight items of functional severity scores (FSS). CTS patients, confirmed by electrodiagnosis, were evaluated by the Thai version Boston questionnaire. The reliability was assessed by internal consistency using Chronbach's alpha coefficient. RESULTS: Thirty-one subjects (4 male and 27 female) enrolled in the present study. Among these, six were classified as mild, nine as moderate, and 16 as severe CTS. Chronbach's alpha coefficient was 0.86 and 0.84 in SSS and FSS, respectively. CONCLUSION: Thai version Boston questionnaire is reliable to measure hand symptoms and disabilities due to carpal tunnel syndrome.

Determination of Electrophysiologically Moderate and Severe Carpal Tunnel Syndrome: Ultrasonographic Measurement of Median Nerve at the Wrist.

OBJECTIVE: To establish the cutoff value of cross-sectional area (CSA) of the median nerve at the wrist, for determination of electrophysiologically moderate and severe carpal tunnel syndrome (CTS). METHODS: The prospective study was conducted among patients suspected of having CTS. A total of 106 patients (185 symptomatic wrists) received nerve conduction study (NCS) and ultrasonography. To establish a cutoff value, various diagnostic properties were calculated across a range of the CSA. RESULTS: A mean±standard deviation of CSA of the median nerve of normal and mild, moderate and severe CTS was 9.4±2.1, 12.0±2.7, 13.8±4.7, and 15.4±4.1 mm2, respectively. The positive relationship between CTS severities and CSA was observed (rs=0.56). A 14 mm2 CSA had sufficient power to rule in moderate and severe CTS, with a specificity of 91.4% and sensitivity of 42.3%. In addition, it showed a post-test probability (positive predictive value) of 86.3% as against a pre-test probability of 56.2%. CONCLUSION: Patients who had ≥14 mm2 of median nerve CSA had very high probability of moderate to severe CTS.

Common peroneal nerve palsy caused by compression stockings after surgery.

Peroneal nerve palsy is one of the more common entrapment neuropathies of the lower limb and can be a result of a multitude of causes. Compression stockings are commonly used for prophylaxis of deep venous thromboembolism after surgery. The entrapment on the head and the neck of the fibula caused by compression stockings is uncommon. In this article, the authors report a 46-yr-old male patient who was operated on for postauricular squamous cell carcinoma of the skin. On the third postoperative day, it was noticed that compression stockings had rolled down, and a linear impression mark was observed under its upper edge at the proximal part of the left cruris. He had left foot drop and difficulty in walking during gait assessment. The needle electromyography confirmed total axonal degeneration of the left peroneal nerve with denervation potentials. The aim of this report was to emphasize the importance of the size and length of the compression stockings and regular skin control in avoiding the risk for peroneal nerve palsy.

Efficacy of electro-acupuncture in chronic plantar fasciitis: a randomized controlled trial.

The aim of the study was to investigate the efficacy of electro-acupuncture coupled with conventional treatments and compare it with the efficacy of conventional treatments alone in patients with chronic plantar fasciitis. Thirty patients with chronic refractory plantar fasciitis were randomly assigned to two groups. Subjects in the control group received five weeks of conventional treatments, including stretching exercise, shoe modification and rescue analgesics. Subjects in the acupuncture group received the same treatments plus ten sessions of electro-acupuncture twice weekly. Endpoints included a success rate determined by a minimum of a 50% decrease in Visual Analog Scale (VAS) and Foot Function Index (FFI). At the end of treatment, VAS decreased significantly from 6.00 ± 1.69 to 1.89 ± 1.59 and from 6.27 ± 2.34 to 5.40 ± 2.26 in the acupuncture and control groups, respectively. FFI decreased significantly only in the acupuncture group (p < 0.05). Subjects in the acupuncture group obtained higher success rates than those in control group (80% and 13.3%, respectively). FFI in the acupuncture group was better than those in the control group (p < 0.001). At the sixth week follow-up, subjects in the acupuncture group showed a better FFI and success rate for pain during the day than those in the control group (p < 0.05). Electro-acupuncture coupled with conventional treatments provided a success rate of 80% in chronic planar fasciitis which was more effective than conventional treatments alone. The effects lasted for at least six weeks.