[Sexual disorders among spinal cord injury patients]. / Troubles sexuels chez les patients atteints de lésions médullaires.

OBJECTIVE: Spinal cord injury (SCI) can alter to varying degrees patients' sexuality. The goals of this study were to evaluate sexual dysfunctions (SD) among a sample of Tunisian patients with SCI and to determine the associated factors. METHODS: A cross-sectional descriptive study was conducted on a sample of 30 patients with SCI. Sexuality was evaluated by : Male Sexual Quotient (MSQ) and Sexual Health Inventory for Men (SHIM). Other parameters were collected : sociodemographic, clinical, functional capacity, psychological profile and quality of life (QoL) (Short-Form 36 SF36). RESULTS: The mean age was 41±9.6 years (23-56). The frequency of SD in this study was 69.2 %. The most affected items in the MSQ (76 %) were erection, orgasm, seduction and performance. The SD were associated with alteration of SF36 domains. We noted positive correlations on the one hand between the MSQ score and the role physical (RP) and general health (GH) sub scores of SF36 and on the other hand between the SHIM and the sub scores RP, mental and physical component score (MCS and PCS). The MSQ score was negatively correlated with the HAD score. No other associations were noted. CONCLUSION: Our study showed a high frequency of SD in SCI patients including Tunisians. SD were mainly associated with impaired QOL and the anxio-depressive profile. The absence of other associations could be explained mainly by the peculiarity of our culture which still considers sexuality and SD as a taboo and secondary subject.

[Urinary disorders and metabolic syndrome: prospective study]. / Troubles vésicosphinctériens et syndrome métabolique: étude prospective.

OBJECTIVE: Metabolic syndrome (MS) risk factors are potentially implicated in the development of lower urinary tract symptoms (LUTS). The goals of this study were to analyze the prevalence of the LUTS in patients presenting with MS and to evaluate the correlation between the MS components and LUTS. METHODS: A prospective study was conducted on a group of 34 patients with MS according to the criteria of the NCEP ATP III. Urinary symptom profile (USP) questionnaire was used to evaluate LUTS. The physical examination included: weight, waist circumference, body mass index (BMI) and blood pressure looking for orthostatic hypotension. The following laboratory data were obtained: fasting blood sugar, postprandial glycemia, glycosylated hemoglobin (HbA1c), HDL-cholesterol, LDL-cholesterol, triglycerides and total cholesterol. RESULTS: The mean age was 56.2 years (±9.2). Twenty of the patients (58.8%) were females. All patients underwent diabetic and hypertension therapy. The mean BMI was 30.2±4.8 and waist circumference was 107.8±9.3 cm. USP total score was 8.3±6. Besides, 29 (85.2%) patients had overactive bladder symptom, and 13 (38.2%) patients presented with urinary stress incontinence. The overactive bladder USP score was significantly correlated with age, waist circumference, BMI and postprandial glycemia. The other parameters of MS were not correlated with urinary symptoms. CONCLUSION: The most frequent urinary symptom in the MS was overactive bladder symptoms and urinary incontinence. The components of MS that influenced the USP score were abdominal obesity and hyperglycemia. The hypothesis of a link between MS and overactive bladder in diabetic patients with MS is plausible.

Unusual clinical presentation of a partial tibialis anterior rupture.

Subcutaneous rupture of the tibialis anterior tendon is rare. Diagnosis is usually clear. The essential clinical symptoms are progressively: footdrop gait, loss of ankle flexion strength, ankle foot pain and claw toes. But the occurrence of an asymptomatic time period between the injury and the onset of clinical signs can make the diagnosis more difficult. MRI is the gold standard examination for tendons injuries and associated bone and joints damages. Surgical exploration confirms MRI findings. It constitutes the treatment of choice for tibialis anterior tendon rupture. Surgical or functional techniques used have an impact on the design of the rehabilitation program, essential step in the care management of these injuries. It avoids postoperative tendon adhesions and their functional consequences. We report here a case of a man presenting with footdrop gait as the only clinical symptom.

Isolated greater tuberosity fracture: Short-term functional outcome following a specific rehabilitation program.

BACKGROUND: Evaluate the functional outcome of a specific program of rehabilitation during conservative treatment of fracture of the greater tuberosity. METHODS: We retrospectively studied the records of 22 patients, with minimally displaced greater tuberosity fracture, according to inclusion criteria. All patients have received an early (one week after the injury) rehabilitation program based on physical analgesic therapy means, techniques for recovering range of motion, strengthening exercises, proprioceptive stabilization exercises and usability advices. The evaluation was done at baseline, one, two and three months of the end of physical treatment. RESULTS: Pain, perceived disability and range of motion were improved significantly since the end of rehabilitation. The improvement of function (Constant score) was significant at different evaluation times. The functional result seems to be poor when patients are aged and pain is severe at baseline. CONCLUSION: During conservative treatment of fracture of the greater tuberosity, earlier rehabilitation allows rapid range of motion and functional recovery limiting care duration. After fracture healing, the rehabilitation program becomes similar to that advocated in rotator cuff disease. Whatever the initial treatment choice, rehabilitation must be considered at the waning of the first week.

The value of intermittent cervical traction in recent cervical radiculopathy.

OBJECTIVE: Our objective is to assess the effect of mechanical and manual intermittent cervical traction on pain, use of analgesics and disability during the recent cervical radiculopathy (CR). METHODS: We made a prospective randomized study including patients sent for rehabilitation between April 2005 and October 2006. Thirty-nine patients were divided into three groups of 13 patients each. A group (A) treated by conventional rehabilitation with manual traction, a group (B) treated with conventional rehabilitation with intermittent mechanical traction and a third group (C) treated with conventional rehabilitation alone. We evaluated cervical pain, radicular pain, disability and the use of analgesics at baseline, at the end and at 1, 3 and 6 months after treatment. RESULTS: At the end of treatment improving of cervical pain, radicular pain and disability is significantly better in groups A and B compared to group C. The decrease in consumption of analgesics is comparable in the three groups. At 6 months improving of cervical and radicular pain and disability is still significant compared to baseline in both groups A and B. The gain in consumption of analgesics is significant in the three groups: A, B and C. CONCLUSION: Manual or mechanical cervical traction appears to be a major contribution in the rehabilitation of CR particularly if it is included in a multimodal approach of rehabilitation.

Osteoarthritis of the sacroiliac joint complicating resection of the pubic symphysis. Interest of a rehabilitation programme.

Sacroiliac joint (SIJ) is an uncommon localisation of osteoarthritis. Instability of this joint is one of rare aetiologies. It can occur after resection of the pubic symphysis for whatever the reason. The biomechanical consequences on the SIJ are increasing shear forces and vertical restrain. This leads to secondary progressive SIJ osteoarthritis. There is no specific rehabilitation programme for this pathology. Here, we report the case of a patient who presents SIJ osteoarthritis 20 years after surgical resection of the pubic symphysis for osteochondroma. We proposed a rehabilitation programme based on the pelvic biomechanical characteristics. It included specific exercises of muscular strengthening (the transversely oriented abdominal muscles and pelvic floor muscles) and muscular stretching (the psoas major muscle). We obtained an improvement of pain and functional capacity in our patient.

Efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain: a randomized, controlled study.

OBJECTIVE: To assess the efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain (CLBP). POPULATION: CLBP outpatients treated in a Physical Medicine Rehabilitation or Rheumatology unit within a university hospital. METHODS: We performed a prospective, comparative study. The participants were randomly assigned to either a home-based rehabilitation programme (Gp A) or a standard physical therapy (Gp B). The programme included four weekly sessions. In each group, we measured pain intensity (on a visual analogue scale, VAS), flexibility and muscle endurance (the Schöber MacRae test, finger-to-floor distance, thigh-leg angle, the Shirado and Sorensen test), functional and psychological repercussions (the Quebec functional index and the Hospital Anxiety and Depression scale) and handicap (on a VAS). Follow-up examinations took place at baseline and four weeks and three, six and 12 months later. RESULTS: One hundred and seven patients (82 women) with a mean+/-standard deviation (S.D.) age of 35.7+/-0.8 years were included (with 54 patients in Gp A). At four weeks, a significant improvement (relative to baseline) was observed for all parameters in both study groups but with a significantly greater difference in Gp A, which was maintained at one year (despite an observed regression of the improvement at six months). At one year, compliance with the home-based rehabilitation programme was good (68.1%) and 59.5% of the patients regarded the programme as useful. CONCLUSION: Our results suggest that a home-based rehabilitation programme is as effective as standard physical therapy. However, this type of programme requires patient motivation and regular follow-up.