Piriformis Syndrome in Pre-monsoon, Monsoon, and Winter: An Observational Pilot Study.

INTRODUCTION:  Piriformis syndrome (PS) is a rare focal soft tissue rheumatic disease. Due to heavy rural work, we questioned whether PS was more prevalent in the rainy monsoon than in other seasons. In this pilot research, we studied the pattern of PS, the frequency of PS over the seasons, and whether there were typical preceding events.  Methods: In this time-series descriptive study, PS cases diagnosed in a community-based clinic between January 2018 and December 2019 were enrolled. PS was diagnosed by clinical features and a 50% immediate pain relief from ultrasonogram-guided lidocaine (2%) injection in the piriformis muscle (PM). PS mimics were excluded. RESULTS:  A total of 38 PS cases (11 males) were enrolled consecutively. In 2018, during dry winter (November-February), pre-monsoon (March-May), and rainy monsoon (June-October), nine, seven, and one PS cases were diagnosed, respectively; in 2019, the numbers were three, eight, and seven, respectively. Thus, over two years, 12 PS patients were diagnosed in dry winter, 15 in pre-monsoon, and eight in rainy monsoon. There was no correlation with the type of preceding events. There were no differences in the pattern of PS between the seasons. CONCLUSIONS:  In this pilot study, over two years more new PS cases were observed in the pre-monsoon and dry winter than in the rainy season; this was not supporting our research question. There was no association with specific preceding events.

Outcome of Intra-articular Injection of Total Stromal Cells and Platelet-Rich Plasma in Primary Knee Osteoarthritis: A Randomized Clinical Trial.

INTRODUCTION:  Mesenchymal stem cell (MSC) therapy appeared promising in knee osteoarthritis (OA). We examined if a single intra-articular (IA) autologous total stromal cells (TSC) and platelet-rich plasma (PRP) injection improved knee pain, physical function, and articular cartilage thickness in knee OA. METHODS:  The study was performed in the physical medicine and rehabilitation department of Bangabandhu Shaikh Mujib Medical University, Dhaka, Bangladesh. Knee OA was diagnosed according to the American College of Rheumatology criteria and randomly assigned to treatment (received TSC and PRP) and control groups. Kallgreen-Lawrance (KL) scoring system was used to grade primary knee OA. The Visual Analogue Scale (VAS, 0-10 cm) for pain, WOMAC (Western Ontario and McMaster Universities Arthritis Index) for physical function, and medial femoral condylar cartilage (MFC) thickness (millimeters) under ultrasonogram (US) were documented and compared between groups before and after treatment. Statistical Package analyzed data for Social Scientists (SPSS 22.0; IBM Corp, Armonk, NY) was used for data analysis. Pre- and post-intervention outcomes were measured using the Wilcoxon-sign test, whereas Mann-Whitney U-test calculated the difference between groups; a p-value <0.05 was considered statistically significant.  Result: In the treatment group, 15 received IA-TSC and PRP preparation, and in the control group, 15 patients received no injection, but quadricep muscle-strengthening exercise. There was no significant difference between groups regarding VAS for pain, WOMAC physical function, and cartilage thickness before starting the treatment and two weeks after intervention. VAS for pain and WOMAC physical function scores improved profoundly in the treatment group after 12 and 24 weeks of intervention; the pain and physical function scores difference between groups was also significant. However, significant mean femoral cartilage thickness was not changed until the end of 24 weeks (U=175.00, p=0.009 two-tailed and U= 130.00, p=0.016 two-tailed, respectively, for right and left knee). CONCLUSION:  Single TSC and PRP injection reduces knee pain and improves physical function and cartilage thickness in knee OA. While pain and physical function improvement happen earlier, cartilage thickness change takes more time.

Incidental Trifid Median Nerve Unveiled in a Lactating Mother.

Several anatomical variations concerning the median nerve have surfaced in the medical literature. Among them, bifid median nerve or median nerve bifurcation with or without persistent median artery has been widely reported. Sporadic case reports describe median nerve trifurcation (trifid median nerve) as well. In the present report, we describe carpal tunnel syndrome manifestations in association with trifid median nerve unveiled incidentally under high-frequency musculoskeletal ultrasonogram in a lactating mother-a first in the medical literature.

Lumbar Ligament Sprain-degeneration and Prolapsed Lumbar Intervertebral Disc: A Frequent Missed Combination.

Low back pain (LBP) is a frequent complaint in the working milieu of pain physicians. Common LBP generators are the lumbar spine, soft tissues around the spine, and intra-abdominal viscera; however, in recent times, lumbar spine ligament (LL) degeneration is increasingly getting more coverage as an important LBP source. Among various LLs, interspinous and supraspinatus ligaments' sprain-degeneration can perpetuate localized central LBP as described in the present case study. Localized LL sprain-degeneration in association with radiating LBP from prolapsed lumbar intervertebral disc (PLID) compressing adjacent nerve roots might further impair a patient's quality of life. In the present report, we describe both LL sprain-degeneration and PLID (a dual source of LBP) in a 26-year-old Bangladeshi woman; physicians often fail to notice this combination in their regular clinical practice.

Piriformis Syndrome and Wallet Neuritis: Are They the Same?

Piriformis syndrome (PS) involves the piriformis muscle and adjacent sciatic nerve, producing features similar to true sciatica of lumbar spine origin, for example, lumbar disc prolapse, thereby confusing pain physicians about the diagnosis. Synonyms that are used frequently for PS are deep gluteal syndrome, extra-spinal sciatica, wallet neuritis, etc. Commonly presenting symptoms of PS include gluteal pain which increases with affected side sitting/per-rectal manoeuvre, and improves with ambulation/intra-lesional steroid, etc. Among various PS associations, wallet neuritis is one of them. However, the latter condition can present with even without the typical features for PS, such as positive flexion adduction internal rotation (FAIR) test, pace sign, etc. In a situation like this, mere discontinuation with fatty buttock wallet is often sufficient for relieving patients' discomfort, making other approaches unnecessary for the patient (though these approaches are warranted for many PS manifestations). Thus, it would not be wise to use piriformis syndrome and wallet neuritis terminology interchangeably as depicted in many published papers.

Osgood-Schlatter Disease Unveiled Under High-frequency Ultrasonogram.

Osgood-Schlatter disease is a painful condition, affecting the tibial tuberosity of physically active children with a painful bump that aggravates with repetitive impacts over the affected area during exercise, sports, or even usual daily activities. The condition is usually unilateral; however, bilateral presentation is not unlikely. In addition to clinical features, a unique radiological finding appears worthy in terms of accurate diagnosis. Moreover, ultrasonogram-based pathological changes could appear not only in the tibial tuberosity but also in the patellar tendon. In this study subject, I approached the condition with a high-frequency musculoskeletal ultrasonogram in order to add further information about the ailment in medical literature. The conservative approach was found effective to relieve the patient's problems.