Bone Mineral Density Among Individuals With Residual Lower Limb Weakness After Polio.

BACKGROUND: Literature indicates that individuals with long-term residual lower extremity (LE) weakness after polio have decreased bone mineral density (BMD) related to muscle weakness. Where weakness is asymmetrical, bone densitometry measured only on the stronger LE may misclassify BMD. OBJECTIVE: To determine (1) whether femoral neck BMD differed from side to side in individuals with asymmetrical LE muscle weakness, and (2) the proportion of individuals at risk for underdiagnosis of low bone density or osteoporosis given unilateral assessment of the femoral neck. DESIGN: Retrospective study. SETTING: Outpatient postpolio center. PARTICIPANTS: Patients >18 years old with complete relevant data. MAIN OUTCOME MEASURES: Bone densitometry T scores, BMD categories based on standard T-score ranges, and side of LE weakness determined by a strength score. RESULTS: Forty-three patients had at least 1 femoral neck T score and bilateral LE strength scores. Fourteen (32.5%) had bone densitometry only on their weaker LE and 14 (32.5%) had bone densitometry only on their stronger LE. Of the 15 patients with bone densitometry done on both femoral necks, T scores (mean [SD]) were lower in the weaker LE (-1.73 [1.09]) than the stronger LE (-0.88 [1.0]) (P = .001). Classification of low bone density or osteoporosis was more frequent based on T scores taken on a weaker LE (48.3% and 24.1%, respectively) than from T scores from a stronger LE (41.4% and 6.9%, respectively). CONCLUSIONS: In this small sample, using strong-limb T scores resulted in fewer individuals categorized as having low bone density or osteoporosis than when weak-limb T scores were used. Underestimating BMD loss may lead to undertreatment and increased risk of morbidity, mortality, and costs associated with femoral neck fractures in this high-fall-risk group. LEVEL OF EVIDENCE: III.

Prolotherapy versus corticosteroid injections for the treatment of lateral epicondylosis: a randomized controlled trial.

OBJECTIVE: To compare the efficacy of prolotherapy versus corticosteroid injection for the treatment of chronic lateral epicondylosis. DESIGN: A prospective, randomized controlled, double-blinded study. SETTING: Academic, tertiary, outpatient, rehabilitation hospital. PARTICIPANTS: Twenty-four subjects with clinically determined chronic (ie, lasting 3 months or longer) lateral epicondylosis were recruited. All subjects noted pain intensity levels significant enough to prevent the participation in activities, such as playing racquet sports or lifting heavy objects. METHODS: Subjects were assigned to receive either prolotherapy or corticosteroid injection for treatment of chronic lateral epicondylosis. Each subject underwent injection at baseline followed by a second injection 1 month later. OUTCOME MEASUREMENTS: Visual analog scale (VAS) self-rating of pain, quadruple visual analog scale (QVAS), and the Disabilities of the Arm, Shoulder, and Hand questionnaire (DASH) were measured at baseline and at 1, 3, and 6 months' follow-up. RESULTS: Within each group, the analysis demonstrated statistically significant improvements in both VAS and DASH within the prolotherapy group with significant changes noted from baseline to 3 months (VAS: Δ2.38; 95% confidence interval [95% CI] 1.04-3.71, P = .004 and DASH: Δ19.89; 95% CI 5.73-34.04, P = .01), and baseline to 6 months (VAS: Δ2.63; 95% CI 0.61-4.62, P = .017 and DASH: Δ21.76; 9% CI 7.43-36.09, P = .009) after initial treatment, as well as in the QVAS from baseline to 3 months. The steroid group demonstrated a clinically and statistically significant change for DASH only at both 3-month (Δ13.33; 95% CI 0.68-25.99, P = .04) and 6-month (Δ15.56; 95% CI 1.30-29.81, P = .04) follow-up. Comparison of the subjects completing the study revealed no significant differences between the prolotherapy and the corticosteroid group for change in VAS, QVAS, or DASH, although the study lacked sufficient power to draw conclusions from this finding. Eighty-three percent of the subjects were satisfied with their overall improvement during the course of the study, without significant differences revealed between groups. Aside from injection-associated pain, no adverse reactions were reported. Seventeen subjects completed study protocol. CONCLUSIONS: Both prolotherapy and corticosteroid therapy were generally well tolerated and appeared to provide benefit of long duration. Small sample size precludes determining whether one therapy is superior to the other. Larger, controlled trials appear feasible and warranted on the basis of these findings.

The lateral atlanto-axial joint as a source of headache in congenital atlanto-occipital fusion.

A 47-yr-old woman presented with severe right-sided neck pain and headache, predominantly in the right-occipital region, for 3 yrs. The symptoms persisted despite using nonsteroidal antiinflammatory medications and undergoing physical therapy. The patient's examination was unremarkable except for reduced neck motion and prominent right-occipital tenderness. Imaging showed congenital fusion of the atlanto-occipital joints bilaterally. A fluoroscopically guided diagnostic right-lateral atlanto-axial joint injection was positive. We are reporting the first case of clinically proven lateral atlanto-axial joint arthropathy with neck pain and headache in a patient with congenital atlanto-occipital joint fusion. Subsequently, the patient received a set of two therapeutic lateral atlanto-axial joint injections. She had remarkable improvement of her headache and neck pain. At 1-yr follow-up, the patient continued to have significant improvement of the right-sided neck pain and headache.