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Aim To evaluate low back pain (LBP) incidence and impact throughout pregnancy in terms of women’s well-being and delivery outcomes. Material and methods Cross-sectional prospective study conducted on singleton pregnancies at ≥37th gestational age admitted for delivery. Localization of LBP, intensity and frequency as well as derived functional disability status were assessed with a self-reported questionnaire. Main delivery outcomes including mode of delivery, and maternal or neonatal complications were recorded. Results A total of 229 women participated in the study. LBP prevalence amounted to 55.9%, with the pain already present before pregnancy in 14.0% of the cases. The pain was mostly localized in the lower back (40.6%), symphysis (23.3%), and coccyx (20.5%). Both the frequency and intensity of pain gradually increased significantly during pregnancy, reaching 20 days/month (IQR=10–30) and 6/10 points (IQR=5–8) on a visual analog scale in the 3rd trimester (p Conclusions LBP is a common issue in pregnant women, accounting for increasing morbidity and invalidity, and leading to an increased cesarean section risk during labor.

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

Women with pregnancy-related pelvic girdle pain (PPP), or athletes with groin pain, may have trouble with the active straight leg raise (ASLR), for which a pelvic belt can be beneficial. How the problems emerge, or how the belt works, remains insufficiently understood. We assessed muscle activity during ASLR, and how it changes with a pelvic belt. Healthy nulligravidae (N=17) performed the ASLR, and walked on a treadmill at increasing speeds, without and with a belt. Fine-wire electromyography (EMG) was used to record activity of the mm. psoas, iliacus and transversus abdominis, while other hip and trunk muscles were recorded with surface EMG. In ASLR, all muscles were active. In both tasks, transverse and oblique abdominal muscles were less active with the belt. In ASLR, there was more activity of the contralateral m. biceps femoris, and in treadmill walking of the m. gluteus maximus in conditions with a belt. For our interpretation, we take our starting point in the fact that hip flexors exert a forward rotating torque on the ilium. Apparently, the abdominal wall was active to prevent such forward rotation. If transverse and oblique abdominal muscles press the ilia against the sacrum (Snijders' "force closure"), the pelvis may move as one unit in the sagittal plane, and also contralateral hip extensor activity will stabilize the ipsilateral ilium. The fact that transverse and oblique abdominal muscles were less active in conditions with a pelvic belt suggests that the belt provides such "force closure", thus confirming Snijders' theory. © 2009 Elsevier Ltd. All rights reserved.

Evaluation of an athlete's report of "hip pain" is challenging. Many conditions involving the pelvic girdle can present with overlapping pain distributions, and athletes often may have coexisting disorders. Appropriate evaluation requires thorough, systematic consideration of intra-articular hip disease, extra-articular local causes of hip pain, and referred pain from other musculoskeletal or even visceral sources. Although our understanding of intra-articular hip disorders has been greatly enhanced in recent decades through advances in hip arthroscopy, gaps still exist in our understanding of appropriate treatment, including effective nonsurgical protocols and when to consider surgical intervention. For instance, we have a better understanding of hip dysfunction related to structural changes that occur prior to the onset of arthritis, but we are also learning that correction of the structural changes does not always guarantee a correction of dysfunction and pain. Furthermore, athletes need instruction and guidance in retraining appropriate movement patterns after a surgical intervention. Risk stratification regarding which athletes need surgical intervention and what their needs are after specific surgical procedures remain undefined. In this review we will describe the differential diagnosis of hip and pelvic girdle pain in the athlete and then discuss how to use a history, physical examination, and appropriate imaging and diagnostic injections to arrive at a proper diagnosis. Lastly, a brief discussion is included of key concepts and controversies involved in treating some of the most common hip disorders experienced by athletes.

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.

Supraclavicular nerve entrapment syndrome, although rare, should be considered among the causes of anterior shoulder girdle pain. This syndrome is usually related to anatomic variants (involving the bone structures, fibrous bands, or muscles and tendons). Computed tomography is the most useful investigation. Medications used to treat neuropathic pain may provide relief. Otherwise, a local glucocorticoid injection or even surgical decompression should be considered.

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.

We describe a case of dumbbell hydatid cyst of the T(10) pedicle. This cyst had both extradural and retroperitoneal components,leading to spinal cord compression and abdominal pain. Following surgical excision and irrigation with hypertonic saline the patient made a full recovery, and is recurrence-free after 18 months follow-up.

Tumours arising from the paraganglia (paragangliomas) are characteristically of low malignant potential, with only 10% developing distant metastases (North et al, 1990). Malignancy in paragangliomas is defined either by local invasion or spread to distant sites normally devoid of paraganglia (Irons et al, 1977; Jackson et al, 1982). We present a case with several unusual features: (1) the primary site of the tumour is in the extradural space at D7 and L3 levels (lesion at L3 not biopsied), (2) multiple skeletal metastases at a short interval after primary diagnosis, and (3) absence of mitoses both in the original specimen and the metastatic deposit. A 29-year-old man presented in December 1989 with girdle pain in the upper abdomen for 3 months, descending numbness and paraparesis for 3 weeks and incontinence for 1 week.

Calcified psoas abscesses are a characteristic feature of tuberculosis of the thoraco-lumbar spine. We present a case in which well established calcification has almost completely disappeared, several years after any antituberculous treatment. A review of the English literature has revealed no previous report of this finding. The patient, now a 48-year-old woman, first presented at the age of 6 with back pain and radiographic features of spinal tuberculosis at T12/L1. Bilateral calcined psoas abscesses developed over thenext few months. Management was first by bed rest and later, at the age of 12, by postero-lateral drainage with spinal fusion. By this time abscess calcification was well established. The patient then remained relatively well until the age of 33, when she developed girdle pain due to further vertebral destruction at a higher level (T8–T12).

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.

Summary 1. We are reporting here a case of spinal lues, which showed clinically an attack of gastric crisis (peristaltic unrest and abdominal distress) accompanied simultaneously with hypersensibility (girdle pain sensation). 2. The autopsy findings revealed that the pathological changes are found in the spinal cord, meninges and spinal root fibers extending between the 5.-10. thoracic segments. Nerve fibers in the sglanchnic nerve are also found partly degenerated. These findings correspond exactly to the clinical symptoms of motor and sensory disturbances. 3. There is no change in the vagus nerve, so the cause of the gastric crisis can not be attributed to lesion of the vagus nerve. We would rather ascribe the crisis symptom to the lesin of the posterior root of the spinal cord. We believe that the lesion of the Fosterior roots causes simultaneous appearance of sensory irritation (girdle pain) and peristaltic unrest of the stomach.

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