Clinical and radiological effects of Corticosteroid injection combined with deep transverse friction massage and Mill's manipulation in lateral epicondylalgia-A prospective, randomized, single-blinded, sham controlled trial.

BACKGROUND: The knowledge about the effective implementation of corticosteroid injection (CS) with deep transverse friction massage (DTFM) and Mill's manipulation (MM) on clinical and radiological changes (Magnetic resonance imaging-MRI and Ultra sound) in lateral epicondylalgia (LE) is lacking. Therefore, the objective of this study is proposed to find and compare the effects of corticosteroid injection (CS) DTFM and Mill's manipulation on clinical and radiological changes in lateral epicondylalgia. DESIGN, SETTING, PARTICIPANTS: Randomized, single-blinded, controlled study was conducted on 60 LE participants at university hospital. The active MM group (n = 30) received corticosteroid injection with DTFM and active Mill's manipulation (MM) three sessions a week for 4 weeks and the sham MM group received corticosteroid injection with sham manipulation. The primary outcome was pain intensity, measured with the visual analog scale. The other outcome measures were percentage of injury measured by MRI and ultrasound, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life which were measured at 4 weeks, 8weeks and at 6 months follow up. RESULTS: The between-group difference in pain intensity at 4 weeks was 1.6 (CI 95% 0.97 to 2.22), which shows improvement in the active group than sham group. The similar effects have been noted after 8 weeks and at 6 months 2.0 (CI 95% 1.66 to 2.33) follow up in pain intensity. Similar improvements were also found on percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life (p = 0.001). CONCLUSION: Corticosteroid injection with DTFM and Mill's manipulation was superior to sham group for improving pain, percentage of injury, functional disability, handgrip strength, patient perception, kinesiophobia, depression status and quality of life in people with lateral epicondylalgia. TRIAL REGISTRATION: Clinical trial registration: CTRI/2020/05/025135 trial registered prospectively on 12/05/2020. https://trialsearch.who.int/Trial2.aspx?TrialID=CTRI/2020/05/025135.

Comparison of latissimus dorsi tendon transfer with subscapularis release versus sliding of internal rotation contracture in obstetrical brachial plexus paralysis sequela.

BACKGROUND: The purpose of this study was to compare the functional results of latissimus dorsi (LD) tendon transfer with those of subscapularis (SS) muscle release versus sliding. METHODS: Fifty-six patients with internal rotation contracture and external rotation (ER) weakness as sequelae of Erb's palsy were included in the study. Of the patients, 24 were included in group 1 (11 boys and 13 girls), with a mean age of 2 years 8 months (range 1.5-5 years) and a follow-up period of 62 months (range 38-68 months). The patients in group 1 underwent LD tendon transfer, with internal rotation contracture and SS release procedures. Thirty-two patients were included in group 2 (18 boys and 14 girls), with a mean age of 2 years 6 months (range 1.5-4.8 years) and a follow-up period of 58 months (range 38-68 months). The patients in group 2 underwent LD tendon transfer with SS sliding. RESULTS: A significant improvement in preoperative passive ER from - 3.6° to 67.3° after operation was observed in group 1. In group 2, preoperative passive ER in adduction improved from 0° to 72.3°. We found no significant difference (P = 0.1) in postoperative improvement in active ER in both groups (group 1 vs. group 2: 75° vs. 77.3°). Similarly, no significant difference (P = 0.7) in postoperative improvement in passive ER was found between the groups (group 1 vs. group 2: 71° vs. 72.3°). CONCLUSIONS: LD tendon transfer with SS release or sliding is an effective procedure to improve shoulder ER in patients with OBPP, with no inferiority of SS muscle release or sliding for internal rotation contractures and increased passive range of shoulder motion. LEVEL OF EVIDENCE: Level III; Retrospective Cohort Comparison; Treatment Study.

Effects of Virtual Reality Exercises versus Isokinetic Exercises in comparison with Conventional Exercises on the Imaging Findings and Inflammatory Biomarker Changes in Soccer Players with Non-Specific Low Back Pain: A Randomized Controlled Trial.

Chronic non-specific low back pain (CNLBP) is the most common musculoskeletal problem. The purpose of this study was to investigate the effects of advanced physiotherapeutic exercise programs on imaging findings and inflammatory biomarkers in soccer players with CNLBP. In total, 60 CNLBP participants were divided into virtual reality exercise (VRE; n = 20), isokinetic exercise (IKE; n = 20), and conventional exercise (n = 20) groups. Pain intensity, imaging findings (muscle cross-sectional area (CSA) and muscle thickness), and changes in inflammatory biomarkers (CRP, TNF-α, IL-2, IL-4, and IL-6) were measured at baseline and after four weeks. After four weeks of intervention, there was a significant improvement (p = 0.001) in pain intensity for the VRE vs. IKE (0.7; CI 95% 0.38 to 1.07) and VRE vs. conventional (3.0 CI 95% 2.68 to 3.31) groups. The IKE group showed a greater number of significant changes in muscle CSA and muscle thickness than the other two groups (p < 0.001). Moreover, the VRE group showed significant improvement in inflammatory biomarker measures compared with the other two groups (p < 0.001). In CNLBP, virtual and isokinetic exercises had equal effects on reducing pain intensity. Isokinetic exercise is beneficial in increasing the muscle CSA and thickness, and virtual exercises are helpful for attenuating the inflammation process in soccer players with CNLBP.

Scaphoid excision with lunatocapitate fusion for the treatment of scaphoid nonunion with advanced collapsed wrist.

PURPOSE: To investigate the union rate after lunatocapitate arthrodesis for the treatment of scaphoid nonunion advanced collapse (SNAC) wrists and to evaluate the clinical results of this technique. METHODS: We conducted a prospective study between January 2014 and July 2017. Fifteen males with painful stage III SNAC wrists (average age, 32 years, range, 20-37 years; average follow-up time, 25.2 months, range, 20-36 months) underwent scaphoid excision and lunatocapitate fusion. Lunatocapitate fusions were fixed with headless Herbert screws with K-wire fixation (retrograde direction). Radiographs, wrist range of motion, and Mayo wrist score were examined. RESULTS: All patients achieved radiographic and clinical union after lunatocapitate fusion during follow-up (average 10 months post-operatively). The flexion-extension arc was 70°, and the average Mayo wrist score was 74.3 points (eight with excellent, four with good, three with satisfactory, and one with poor result). Thirteen patients returned to work, whereas two with nonunion required surgical graft revision. Complete union was achieved at an average of 12 weeks after graft revision, with improved range of motion, and the patients returned to work with a change in their occupation. CONCLUSIONS: Lunatocapitate arthrodesis is a satisfactory therapeutic alternative to four-corner fusion for SNAC wrists.

Short-Segment Fixation of Thoracolumbar Fractures with Incorporated Screws at the Level of Fracture.

OBJECTIVE: To evaluate the effect of including the fractured vertebra in the short-segment fixation of thoracolumbar (TL) fractures. METHODS: A total of 32 patients with thoraco-lumbar fractures, selected between August 2013 and February 2016, were managed by short-segment fixation with screws at the level of the fracture, and decompression was performed only for patients with neurological deficits. The patients' functional outcome was assessed using the visual analogue scale (VAS) score for pain and the American Spinal Injury Association (ASIA) score for neurological condition. All patients were followed up with radiographs. RESULTS: Patients with complete neurologic deficits (n = 3) did not show any neurologic recovery. All ASIA B patients improved to ASIA C. Five ASIA C patients improved to ASIA E. The remaining five ASIA C patients improved to ASIA D. All ASIA D patients improved to ASIA B. At the final follow-up examination, the mean anterior vertebral height was 21 ± 5 mm, indicating no significant height loss during the follow-up period. CONCLUSION: Short-segment fixation of TL fractures with inclusion of the fracture level into the construct offers good correction of segmental kyphosis, vertebral wedging, and vertebral height loss.