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Women with pelvic floor complaints experience restrictions and distress in their daily, social, and sexual functioning, and their intimate relationships. We interviewed forty-eight women to unravel differences between women receiving and not receiving pelvic physical therapy and between pregnant, parous, and nulliparous women in preparation for theory development. We analyzed data in a mixed-method design using NVivo and Leximancer. sexual dysfunction, relationship dynamics, the nature and severity of restrictions and distress, and coping strategies appear to vary between women receiving and not receiving therapy. specific combinations of restrictions and distress are present in pregnant, parous, and nulliparous women, and might influence women’s decision to seek help.

Objective. To develop a conceptual model of patho- and sanogene­sis of the sacroiliac joint (SIJ) osteoarthritis on base of the known data about the SIJ, the results of our own biomechanical studies of this joint, its ligaments and stabilizing muscles by finite element modelling, data of clinical verification of these results. Methods. The object of the model is the SIJ as a link, which connects thespine and pelvis. The proposed conceptual model is based on the M.Panjabi hypothesis of chronic lumbar pain in the case of partial dama­ge to ligaments, which leads to muscle dysfunction. Results. Anew conceptual model of SIJ osteoarthritis was developed. In this model we tried to take into account the limitations of the existing SIJ stability hypotheses and models of the appearance ofthepelvic girdle pain, SIJ dysfunction and SIJ arthrosis. Themodel is based on theresults of our own research. It was proved, that patients with SIJ osteoarthritis have an asymmetry of the width ofthejoint slits, theinclination of the sacrum and pelvis, sacral rotation, hyperlordosis in the LV–SI segment. These factors lead toa shift ofthehorizontal axis of sacral rotational mobility relative tothe pelvic bones. This horizontal axis shift leads to the instabili­ty oftheSIJ on one side of the joint, and to the functional block on another side. Theresults of these functional changes were damage ofthe SIJ ligaments-stabilizers, dysfunction of the SIJ muscles-stabilizers, degenerative changes ofSIJ elements and pain. The deve­loped model allows toexplain the distortion of muscular response pattern in patients with improper SIJ biomechanics in conditions ofSIJ osteoarthritis. The increase of the SIJ biomechanics changes enlarges thethemuscle response pattern distortion. Conclusions. The developed conceptual model explains many clinical manifestations oftheSIJ osteoarthritis and will help to understand better themechanics ofthepelvic girdle pain in such conditions, will improve theresults ofdiagnosis and treatment., Мета. На підставі відомих уявлень про крижово-клубовий суглоб (ККС), результатів власних біомеханічних досліджень методом скінченних елементів особливостей цього суглоба, його зв’язок і м’язів-стабілізаторів, їхньої клінічної верифікації розробити концептуальну модель пато- ісаногенезу артрозу ККС. Методи. Об’єктом моделювання була система ККС як ланка, що з’єднує хребет ітаз. За основу передбачуваної концептуальної моделі взято модель М. Panjabi виникнення хронічного поперекового болю в разі часткового ушкодження зв’язок, що призводить до порушення функції м’язів. Результати. Розроблено нову концептуальну модель розвитку артрозу ККС, в якій ми намагалися врахувати обмеження наявних моделей стабільності ККС і появу хребтово-тазового болю, виникнення дисфункції та розвитку артрозу ККС. Модель побудована за результатами власних досліджень. Доведено, що у хворих на артроз ККС є асиметрія ширини суглобових щілин, нахил крижів і таза, ротація крижів, гіперлордоз ухребтовому руховому сегменті LV–SІ. Це призводить до зсуву горизонтальної осі ротаційної рухомості крижів щодо тазових кісток і, відповідно, виникнення, з одного боку, нестабільності ККС, а з іншого, — функціонального блока. Унаслідок цього виникають ушкодження зв’язок-стабілізаторів ККС, біль іпорушення функції м’язів-стабілізаторів суглоба і дегенеративні зміні в його елементах. Розроблена модель дає змогу пояснити зміну патерна м’язової відповіді в пацієнтів із порушенням біомеханіки ККС за умов артрозу. Чим більше змінюється біомеханіка ККС, тим більше спотворюється патерн м’язової відповіді. Висновки. Розроблена концептуальна модель пояснює багато клінічних проявів артрозу ККС і допоможе кращому розумінню механізму виникнення хребтово-тазового болю за таких умов, дозволить поліпшити результати діагностики та лікування.

Introduction: Thoracic myelopathy is relatively uncommon because few degenerative changes occur as a result of the restricted range of motion surrounding the rib cage. Methods: A retrospective study was performed in 300 consecutive surgical cases of thoracic disorders with myelopathy treated in our department from 2000 to 2015. Girdle pain, back pain, low back pain, leg numbness, leg pain, gait disturbance, leg paresis, and bowel bladder disturbance as initial and preoperative symptoms; patellar tendon reflex, ankle tendon reflex, and ankle clonus as preoperative neurologic findings; MRI and CT findings; and surgical procedure, intraoperative findings, and postoperative recovery were investigated. Results: The disease distribution included ossification of the ligamentum flavum (OLF) (n = 48), ossification of the posterior longitudinal ligament (OPLL) (n = 30), OPLL with OLF (n = 27), intradural extramedullary tumor (n = 98), intramedullary spinal cord tumor (n = 64), vertebral tumor (n = 17), spinal cord herniation (n = 7), vertebral fracture (n = 4), and thoracic disk herniation (n = 5). There were notable associations of gait disturbance with OPLL and OPLL + OLF; back pain at initial diagnosis with disease at upper levels; and low back pain with disease at a lower level. Conclusion: These findings suggest that patients with gait disturbance, back pain, and low back pain on physical examination may have thoracic disease that results in myelopathy.

The possibility that polymyalgia rheumatica (PMR) can be diagnosed when both ESR and CRP are normal at the time of diagnosis and before therapy with glucocorticoids, has been often discussed in the literature. We present a case report of a 100-year-old Caucasian man referred to our outpatient clinic, complaining of chronic pain in the shoulder and hip girdle associated with normal values of both ESR (21 mm/1st hour) and CRP (4 mg/dL). In the previous four months, several anti-inflammatory drugs and painkillers associated with physiotherapy treatments gave no significant improvement in pain and self-care. After an ultrasound (US) and an 18-fluorodeoxyglucose positron emission tomography associated with total body computed tomography (18-FDG PET/CT) examination, PMR was diagnosed and he started therapy with 17.5 mg prednisone, obtaining a fast improvement in pain and self-care. After 10 months of tapering, he stopped prednisone without relapse. During a 3-year follow-up, no alternative diagnosis was done. When a patient complains of chronic bilateral shoulder and hip girdle pain associated with normal inflammatory indices, it is reasonable to think in the first instance that this person is not suffering from PMR. Moreover, the possibility that PMR may onset in a centenarian person, is exceptional. In our patient, when we piece the puzzle together, the diagnosis of PMR was the most possible one.

Capillary hemangiomas are benign tumors found in the skin and soft tissues in younger people. They occur in the central nervous system only rarely, and intradural occurrence is extremely rare. We report here a 60-year-old man presenting with thoracic girdle pain and progressive gait disturbance. Magnetic resonance images of the thoracic spine showed a12×8×20 mm, well-defined intradural mass at the T2 level, compressing the spinal cord laterally. Relative to the spinal cord, the mass was hypo- to isointense on T1-weighted images and relatively hyperintense on T2-weighted images, with strong enhancement on contrast-enhanced T1-weighted images. The patient underwent T1-2 hemilaminectomy with resection of the intradural extramedullary tumor, which showed characteristics of a capillary hemangioma on histologic examination. The patient’s symptoms improved following the surgery and no clinical or radiological evidence of recurrence was noted at the 2-year follow-up. We present this case with a review of the literature, highlighting features for differential diagnosis.

Data on the severity of signs and symptoms of lumbopelvic pain (LPP) during pregnancy are scarce. Therefore, this cross-sectional study examines the severity of LPP and pain-related signs and symptoms. Women with an uncomplicated pregnancy of 20-30 weeks were invited to participate. They rated their pain and fatigue on a numerical rating scale, and pain location was indicated on a drawing. Disability was scored on the Quebec Back Pain Disability Scale (QBPDS) and urine incontinence on a Likert scale. Physical examination consisted of the Active Straight Leg Raise (ASLR) test, the Posterior Pelvic Pain Provocation (PPPP) test and pain score, and force during isometric bilateral hip adduction. Of all 182 participants, 60.4% reported LPP. Mean pain level was 3.6 (SD 2.2); in 20.0% of the women the score was >5. The mean score on the QBPDS was 27 (SD 16); in 20.9% the score was >40. Compared to women without LPP, women with LPP more frequently suffered back pain in the past (p

Background: Discogenic, facet joint, and sacroiliac joint mediated axial low back pain may be associated with overlapping pain referral patterns into the lower limb. Differences between pain referral patterns for these three structures have not been systematically investigated. Objective: To examine the individual and combined relationship of age, hip/girdle pain, leg pain, and thigh pain and the source of internal disc disruption (IDD), facet joint pain (FJP), or sacroiliac joint pain (SIJP) in consecutive chronic low back pain (CLBP) patients. Design: Retrospective chart review. Setting: Community based interventional spine practice. Patients: 378 cases from 358 consecutive patients were reviewed and 157 independent cases from 153 patients who underwent definitive diagnostic injections were analyzed. Methods: Charts of consecutive low back pain patients who underwent definitive diagnostic spinal procedures were retrospectively reviewed. Patients underwent provocation lumbar discography, dual diagnostic medial branch blocks, or intra-articular diagnostic sacroiliac joint injections based on clinical presentation. Some subjects underwent multiple diagnostic injections until the source of their chronic low back pain (CLBP) was identified. Main Outcome Measurements: Based on the results of diagnostic injections, subjects were classified as having IDD, FJP, SIJP, or other. The mean age/standard deviation and the count/percentage of patients reporting hip girdle pain, leg pain, or thigh pain were estimated for each diagnostic group and compared statistically among the IDD, FJP, SIJP, and other source groups. Next, the 4 predictor variables were simultaneously modeled with a single multinomial logistic regression model to explore the adjusted relationship between the predictors and the source of CLBP. Results: The mean age was significantly different among the source groups. IDD cases were significantly younger than FJP, SIJP, and other source groups and FJP cases were significantly younger than other sources. The age by thigh pain interaction effect was statistically significant (P = 0.021), indicating that the effect of age on the source of CLBP depends on thigh pain, and similarly, that the effect of thigh pain on the source of CLBP depends on age. Limitations: Retrospective study design. Conclusions: The presence or absence of thigh pain possesses a significant correlation on the source of CLBP for varying ages, whereas the presence of hip/girdle pain or leg pain did not significantly discriminate among IDD, FJP, or SIJP as the etiology of CLBP. Younger age was predictive of IDD regardless of the presence or absence of thigh pain. Key words: low back pain, intervertebral disc, zygapophyseal joint, sacroiliac joint, pain referral patterns

Erasmus syndrome is defined as the association of silica exposure and subsequent development of systemic sclerosis. The limited number of cases reported in the literature mainly involves miners and only sporadically other professionals. We describe a case of Erasmus syndrome in a marble worker. A 68 year old man came to our observation complaining pelvic and scapular girdle pain, evening fever, intense weakness and emaciation for about 1 month. He also reported to have had Raynaud’s phenomenon in his hands for the last 13 years. Also, his occupational history revealed a chronic exposure to silica dust. The patient presented pain in his shoulders and hips, moderate skin thickening and sclerosis in his hands and fingers extending proximally to his wrists. The diagnosis of systemic sclerosis was determined according to his clinical and medical history, the positivity of anti-Scl 70 antibodies, the nailfold capillaroscopy suggestive of an active scleroderma pattern and the detection of a mild restrictive pulmonary syndrome. The evaluation of the organbased complications excluded a gastroenterological and cardiovascular involvement, while the chest computed tomography (CT) detected multiple small nodules with a mantle distribution and enlarged lymph nodes with no signs of interstitial lung disease and fibrosis. Additional tests (positron emission tomography-CT, flexible bronchoscopy and broncho-alveolar lavage) excluded infectious diseases and cancer. However, given the pulmonary involvement, we performed a histological examination of the parenchyma and lymph nodes, which revealed a picture of pneumoconiosis. In the end, the occupational history and the findings from the diagnostic procedures led to the diagnosis of pulmonary silicosis. The precise definition of the pulmonary involvement was essential to the therapeutic approach to this patient.

Operative cases in thoraco-lumbar fracture-dislocations were investigated. Nine males underwent surgical reduction, decompression and posterior instrumentations using ISOLA in 7 patients and VSP in 2 from June 1993 to July 1998. The age at the surgery ranged from 24 to 49 years old (average 33 years old) and follow-up period from 4 months to 65 months (average 17 months). The dislocated vertebrae ranged from T9 to L2 and 3.4 vertebrae on average were included into fusion area. Four patients underwent urgent operations and 5 patients elected operations.The duration of bed rest averaged 2 weeks. Six patients represented complete paraplesia preoperatively and no one improved postoperatively. Three patients with incomplete paraparesis improved completely (2 patients D→E, 1 patient B→E). After surgery the mean kyphotic angle before, justafter, at follow-up were 12°, 0°, and 4° respectively. Therefore good reduction was achieved and the correction loss was small. Three patients complained of persistent girdle pain of the torso but there was no relation with the correction loss of the kyphosis after surgery.

A 46-year-old female was admitted complaining of progressive, severe girdle pain consistent with the left Th3 dermatome. Neurological examination on admission revealed dysesthesia and radiating pain in the left Th3 territory. Plain X-rays and tomograms of the thoracic spine revealed a beak-like bony excrescence arising from the lamina and projecting moderately to the Th3/4 intervertebral foramen, suggesting ossification of the thoracic ligamentum flavum (OYL). Myelography showed the dural sac compressed from laterally just below the left Th3 pedicle, which suggested that the Th3 nerve root was compressed by the OYL. After Th3 nerve root decompression through hemilaminectomy and foraminotomy, the girdle pain disappeared. OYL is known to cause thoracic radiculomyelopathy, but presentation with intercostal neuralgia only is very rare. The authors review the literature and stress the importance of myelography for diagnosis.

Object The author describes a technique of thoracic discectomy that has evolved from the posterolateral transfacet and the transpedicular approaches but that spares the pedicle and most of the facet joint. Methods This approach was used to remove a total of 11 discs (T6–12) in seven patients. The follow-up period ranged from 8 months to 3 years. In four patients with axial and/or girdle pain significant improvement was demonstrated. The paraparesis in one patient with myelopathy improved postoperatively; that in another patient improved but recurred 8 months postoperatively. In one patient who experienced preoperative leg weakness, the weakness was slightly increased postoperatively, but this sequela was only transient. There were no other complications, and there were no deaths. Conclusions This technique appears safe and effective. It can be adapted to the conventional laminectomy known to spine surgeons and requires no specialized instruments. Further trials appear warranted.

This report deals with a case with a myelopathy of Brown-Sequard type due to ossification of the posterior longitudinal ligament (OPLL) in the cervico-thoracic spine. The patient, 59-year-old male was admitted on February 1, 1977, with complaints of disturbance of gait, girdle pain in the chest, cold dysesthesia of the left half of trunk below papilla, with progressive aggravation for the last two years. Neurological examination revealed weakness of the right leg with pyramidal tract signs, hypesthesia to pin-prick, and temperature on the left leg below Li with cold dysesthesia and impaired vibration sense on both legs. X-ray examinations showed the OPLL from C6 down to Th4 vertebral bodies and myelographic block at the level of C6-7; blocked mainly on the right side of the spinal cannal. (Fig. 1, 2). Decompressive laminectomy from Th 1 upto CS and bilateral facetectomy at C6-7 disclosed an extradural osseous bulge on the right side of the spinal canal most marked at level of Th 1 to C7, compressing the dural tube from right lateral to the midline with distortion of the tube away from the right. The exposed cord at this level showed marked atrophy; almost 1/2 of normal diameter. No intradural pathology noted. Dentatotomy was added. Following closure of the dura, the osseous bulge was drilled away. Postoperatively, the girdle chest pain disappeared on the next morning, cold dysesthesia improved for 50%, hypesthesia to pain and temperature for 80%. With 11 months' follow-up, the patient showed good recovery of muscle strength of legs; walking by himself and running by bicycle. The clinical course, X-ray examinations and surgical exploration revealed the OPLL as the sole cause of this syndrome in this case.

A case of spinal cord compression from an intradural arachnoid cyst in the thoracic region is reported. The patient was a 59-year-old female. She had noted thoracic girdle pain and urinary trouble for 2 years. Neurologically, she showed muscle atrophy and weakness of the right leg, and loss of all sensory modalities below the 7th thoracic cord (Th7) level bilaterally. Metrizamide myelography showed no abnormal findings, but computed tomography (CT) following the metrizamide myelography demonstrated marked enlargement of the subarachnoid space and remarkable rightward and ventral displacement of the spinal cord. During surgery it was noted that the spinal cord was severely compressed by an arachnoid cyst from Th4 through Th6. After this operation, neurological deficits disappeared completely. Most spinal intradural arachnoid cysts arise in the region of the septum posticum in the thoracic portion. Various etiologies have been postulated. Although conventional myelogram has been the most important form of examination, intradural arachnoid cysts may be filled incompletely or not at all in the myelography performed in a prone position, because they mostly locate on the dorsal aspect of the spinal cord. There are some reported cases in which intradural arachnoid cysts were found a few hours after myelography. Therefore it is not so easy to diagnose intradural arachnoid cysts with conventional myelography. With metrizamide CT myelography, intradural arachnoid cysts can be visualized more easily.

Brucellosis in Britain is usually caused by Bruceila abortus and mainly affects those in direct contact with cattle or their un pasteurised milk products.1 2 Bone and joint brucellosis consti? tutes about 9% of brucellosis infections and the spine is the commonest site of skeletal infection.1 3 Brucellar spondylitis most often presents with back pain and leg pain, resembling an inter vertebral disc protrusion. Girdle pain has been reported.1 2 4 Para vertebral abscesses are uncommon in brucellosis.4 It is most unusual for brucellar spondylitis to present as right upper quadrant pain. A paravertebral abscess could produce nerve root and diaphragmatic irritation, resulting in right hypochondrial pain with radiation to the right shoulder tip. In skeletal brucel? losis the cultures are frequently negative in keeping with the late stage of the disease.3 4 Early serological studies may be crucial to the diagnosis. Treatment with tetracylines and streptomycin is successful in most cases.1-4 Surgery is indicated for spinal brucellosis only if there is instability, vertebral collapse with cord compression, or failure of a thick walled paravertebral abscess to respond to medical treatment.4