The effectiveness of a multimodal approach in the treatment of patients with upper crossed syndrome: A randomized controlled trial.

OBJECTIVES: Considering the multitude of contributing factors to upper crossed syndrome (UCS), a multimodal treatment may be an effective therapeutic option. This study aimed to examine the effectiveness of the multimodal approach, including muscle energy technique (MET), cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice, in the treatment of patients with UCS. METHODS: This randomized controlled trial randomly assigned 40 patients with UCS aged 30-55 years to either group A (intervention group, n = 20) who received the multimodal approach or group B (control group, n = 20) who received MET only. The trial evaluated the craniovertebral angle (CVA) and sagittal shoulder angle (SSA) measured by photogrammetry, pain intensity estimated using the visual analog scale (VAS), and functional disability evaluated using the Arabic version of the neck disability index (ANDI) pretreatment and four weeks after intervention. RESULTS: The within-group analysis demonstrated a substantial decrease in VAS and ANDI and an increase in CVA post-intervention (P < 0.001). Only the multimodal group exhibited a significant change in SSA (P < 0.0001). Between-group differences were noteworthy, favoring the multimodal intervention (P < 0.0001). CONCLUSIONS: A 4-week multimodal approach that comprises MET, cervical and scapulothoracic stabilization exercises, and postural correction training with ergonomic advice has remarkable improvements in CVA, SSA, pain intensity, and functional disability in patients with UCS, highlighting it as a superior choice.

Combined open reduction and Dega transiliac osteotomy for developmental dysplasia of the hip in walking children.

The iliac osteotomy described by Dega in Poland, in 1969, is an acetabuloplasty that changes the acetabular configuration and its inclination. The aim of this work is to analyze a group of patients with DDH treated by combined open reduction and Dega transiliac osteotomy ,to evaluate the results and determine the advantages and disadvantages, as well as, assess the factors affecting the final outcome of such procedure. A prospective study was conducted during the period, from November 2010 to October 2014, on 39 hips, in 29 children, with neglected DDH after walking age, either diagnosed late or after failure to respond to previous non operative treatment. The mean age at the time of surgery was 27.6 months ranging from 18 to 48 months. All hips were followed up clinically and radiologically for a mean period of 33.6 months (range from 18 to 48 months). No patient was lost to follow up. At the end of follow up, satisfactory final clinical results were obtained in 34 hips (87.2%) and unsatisfactory in 5 (12.8%) according to McKay's criteria. Radiologically, satisfactory results were obtained in 32 hips (82.1%) and unsatisfactory in seven (17.9%), according to Severin's criteria. In conclusion, the results of our series show open reduction combined with Dega transiliac osteotomy to be a safe and efficient method for the surgical treatment of DDH in selected patients, and can easily and safely be combined with associated procedures for single stage correction of acetabular dysplasia.