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Background: Although life-threatening complications of extracorporeal membrane oxygenation (ECMO) are well described, non-life threatening complications are less known. Herein, we report a case of femoral neuropathy (FN) due to nerve compression caused by cannula compression and deep vein thrombosis (DVT) after successful ECMO therapy, which seriously undermined one's quality of life., Case Presentation: A 70-year old male presented to the emergency department for chest pain. The patient had cardiac arrest before percutaneous coronary intervention (PCI) and was inserted with ECMO. Although he was successfully weaned from ECMO 4 days after PCI, he consistently complained swelling, abnormal sensation, and weakness in his right lower extremity, where the cannulas were inserted. Imaging studies showed deep vein thrombosis (DVT) in his right leg, which was further treated with anticoagulants. Symptoms, however, remained after the regression of DVT. Nerve conduction study revealed femoral neuropathy, which may have been caused by ECMO cannula compression and tissue swelling., Conclusion: The current case proposes that non-life threatening complications of ECMO therapy can seriously affect quality of life. Venous drainage distant from the arterial cannula may prevent such complications.

Objective: This retrospective cohort study aimed to investigate the change of spinal cord displacements and the occurrence of C5 palsy between anterior controllable antedisplacement and fusion (ACAF) (group A) and single open-door laminoplasty (group L)., Methods: From January 2016 to December 2017, a total of 80 patients with cervical ossification of the posterior longitudinal ligament (OPLL) were enrolled. All patients underwent computed tomography and magnetic resonance imaging. The types and extent of OPLL, spinal cord rotation, deviation angle, and distance between the vertebral arteries line and spinal cord (DVS) were measured. Patients with postoperative C5 palsy were recorded. Neurologic function was evaluated by Japanese Orthopaedic Association (JOA) score., Results: Three days after surgery, patients in group A had better recovery (6.7° ± 2.4°) of spinal cord rotation than group L (3.1° ± 0.8°; P < 0.05). Deviation angle showed similar changes to spinal cord rotation. At the final follow-up, patients in group A had decreased DVS (11.0 ± 0.7 mm), whereas patients in group L had increased DVS (15.1 ± 0.8 mm) compared with preoperation (P < 0.05). Five patients (1 in group A and 4 in group L) developed postoperative C5 palsy (P > 0.05). Patients in group A had a higher JOA score at the final follow-up than those in group L (P < 0.05)., Conclusions: ACAF could achieve in situ decompression in terms of spinal cord rotation, deviation angle, and spinal cord shift with better clinical outcomes and relatively lower incidence of C5 palsy compared with single open-door laminoplasty., (Copyright © 2019 Elsevier Inc. All rights reserved.)

We report the case of a 71-year-old man complaining of swollen left limb and progressively worsening pain. He underwent surgery 12 years ago for popliteal artery aneurysm with proximal and distal ligation and venous bypass grafting. The patient was diagnosed as having left peroneal neuropathy caused by a 10.5 cm expanded aneurysmal sac compressing the peroneal nerve in the popliteal fossa. The patient underwent open repair with opening of the aneurysmal sac, removal of the thrombus, and sewing of the left genicular artery responsible for back-bleeding. Postoperative range of motion exercises and physical therapy allowed resolving foot drop 1 year after surgery., (Copyright © 2017 Elsevier Inc. All rights reserved.)

The article discusses such a common pathology as pain syndrome in the lower back and limbs. A variety of etiological causes, anatomical features leading to the formation of this persistent algic disorder lead to therapeutic failures in clinical practice. The authors consider in detail the most common types of compression-ischemic neuropathy accompanying back pain, suggest diagnostic algorithms and practical recommendations. Results of foreign, Russian and own research are presented.

Study Design Resident's case problem. Background Entrapment neuropathies represent a diagnostic challenge and require a comprehensive understanding of the nerve's path and the anatomical structures that may cause compression of the nerve. This resident's case problem details the evaluation and differential diagnosis process for median nerve entrapment resulting from forceful and repetitive pronation/supination motions. Diagnosis Median nerve compression syndromes include pronator syndrome, anterior interosseous nerve syndrome, and carpal tunnel syndrome. A cluster of clinical special tests were performed to determine the anatomical site of median nerve entrapment. Based on the patient's history and clinical test results, a diagnosis of pronator syndrome was determined. Provocation testing specific to pronator syndrome assisted with further localizing the site of entrapment to the pronator teres muscle, which guided effective management strategies. Discussion This resident's case problem illustrates the importance of detailed anatomical knowledge and a differential diagnostic process when evaluating a patient with signs and symptoms of an entrapment neuropathy of the median nerve. Electrodiagnostic studies are useful in ruling out carpal tunnel and anterior interosseous nerve syndromes, but are often inconclusive in cases of pronator syndrome. Therefore, a diagnosis of pronator syndrome in this case problem was based on a detailed understanding of median nerve anatomy, potential sites of compression, and unique clinical features associated with this condition. Level of Evidence Differential diagnosis, level 4. J Orthop Sports Phys Ther 2016;46(9):800-808. Epub 5 Aug 2016. doi:10.2519/jospt.2016.6723.

Purpose: Repeated back extension exercises (RBEEs) have been reported to cause changes in the distribution and intensity of radicular symptoms. Therefore, the objective of this study was to investigate the effects of RBEEs on the neurophysiology of the compromised nerve root and on standing mobility and pain intensity in patients with sub-acute and chronic lumbosacral radiculopathy (LSR)., Subjects and Methods: A total of 40 patients with unilateral sub-acute/chronic LSR voluntarily participated in the study; the patients performed three sets of 10 RBEEs in the prone position with 1 min of rest between the sets. The soleus H-reflex, standing mobility, and pain intensity were recorded before and after the RBEEs., Results: The results of the study showed that the RBEEs significantly improved the H-reflex, standing mobility, and pain intensity in patients with sub-acute LSR (p < .01); there was not a significant improvement in the patients with chronic LSR (p < .61)., Conclusion: RBEEs in the prone position are recommended for improving the neurophysiological function of the compromised nerve root and standing mobility in patients with sub-acute LSR.

Meralgia paresthetica is a chronic pain syndrome that is extremely rare in the pediatric population. It is manifested by hypesthesia or pain in the distribution of the lateral femoral cutaneous nerve (LFCN) and is typically caused by entrapment as the nerve passes deep to the inguinal ligament. This sensory mononeuropathy is rare in children and diagnosis is typically delayed, often leading to prolonged functional impairment and unnecessary medical testing. A 9-year-old girl presented to the pain clinic with a 6-week history of right anterolateral thigh pain first noticed after a nontraumatic cheerleading practice. Comprehensive laboratory and radiographic evaluation by multiple prior specialists revealed no clear nociceptive source of pain. History and examination were consistent with a diagnosis of idiopathic, compressive meralgia paresthetica. Conservative management including physical therapy was followed for 2 weeks with only mild improvement noted. To facilitate physical therapy, an ultrasound-guided LFCN block was performed which confirmed the diagnosis by providing complete analgesia. The patient reported overall 25% improvement from multimodal therapy at another 2 weeks. A second LFCN block was performed with complete resolution of symptoms and restoration of function. The patient remains pain-free and has returned to walking, running, and competitive sports. The primary goal of pediatric chronic pain management, regardless of pain etiology, is early restoration of function to avoid prolonged absence from school, sports, or other productive activities and limit the psychological burden of chronic disease., (Copyright © 2016 Elsevier Inc. All rights reserved.)

We report a case of entrapment of the deep peroneal nerve as well as the anterior tibial artery and vein by a spiral distal tibial shaft fracture, causing partial non-union. The authors describe the utility of MRI in making the diagnosis of this post-traumatic complication, which may potentially result in a permanent neurovascular deficit and adverse functional outcome if left undetected. The importance of recognizing the distinct possibility of entrapment and injury to the deep peroneal nerve as well as the anterior tibial vessels, when managing a fracture involving the distal third of the tibial shaft is emphasized. Absence of clinical symptoms or signs of neurovascular entrapment should not deter one from performing the relevant investigations to exclude this complication, in particular when surgical fixation is being contemplated, or in the presence of a non-healing fracture.

Objectives: We, herein, analyzed the effect of swimming on nociception threshold and peripheral nerve regeneration in lean and obese rats submitted to median nerve compression., Methods: To induce obesity, newborn male Wistar rats received injections of monosodium glutamate (MSG), whereas the control (CTL) group received saline. The animals were separated into 6 groups; control and obese (CTL and MSG), control and obese with lesion (CTL LES and MSG LES), and control and obese with lesion submitted to physical exercise (CTL LES PE and MSG LES PE)., Results: Median nerve compression reduced nociception threshold in CTL LES and MSG LES rats. Swimming effectively altered nociception only in CTL LES PE animals. Lean and obese animals displayed histological differences, when compared to sedentary animals, and exercise improved axon regeneration in both groups. The brain-derived neurotrophic factor and GAP 43 protein expression was greater in animals submitted to nervous compression without alteration by exercise., Discussion: In conclusion, swimming, a conservative treatment for peripheral nerve lesions, was not able to improve the nociception threshold in obese rats.

A 36-year-old woman presented with right shoulder weakness after a left parotid tumor resection. The overall clinical presentation included severe paralysis and atrophy of the right sternocleidomastoid and upper trapezius, an absent right gag reflex, and diminished right posterior tongue pinprick sensation. A diagnosis of right-sided Vernet syndrome (cranial nerve IX, X, XI lesions) was made, presumably from compression of cranial nerves by internal jugular vein phlebectasia. To our knowledge, this is the first case report of spontaneous Vernet syndrome associated with internal jugular vein phlebectasia in the absence of other lesions of the jugular foramen., (Copyright © 2014 American Academy of Physical Medicine and Rehabilitation. Published by Elsevier Inc. All rights reserved.)

Patellar tendinopathy which is a cause of pain in the inferior patellar region is a relatively common pathology among sports enthusiasts. This paper describes a new pain syndrome identified from clinical observations which is a differential diagnosis to patellar tendinopathy. The pattern is specific and recognizable among many individuals, and it should be considered as its own entity. The new syndrome is discussed in terms of the pain experienced, the diagnostic criteria, treatment and the rationale to explain it. As it is a differential diagnosis to patellar tendinopathy, many sports enthusiasts might benefit from this diagnosis. If identified correctly, treatment might be directed to the correct structures and with the appropriate modalities, ensuring the patients a fast return to their past occupations without pain and without unwarranted treatments., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Entrapment of the saphenous nerve is a frequently overlooked cause of medial knee pain. Delayed or misdiagnosis is a result of a lack of detailed reporting of the vastoadductor membrane, and by direct visualization of the entrapment only being accomplished at the time of surgical decompression. To date there are no documented conservative interventions discussed in the literature. This is a case of diagnosis and conservative resolution of a spontaneous saphenous nerve entrapment in a competitive female ultra-marathon runner. In-office Active Release Technique(®) combined with an at-home rehabilitative exercise program relieved the patient's subjective pain and paresthesia with two treatments provided over a one week period of time., (Copyright © 2012 Elsevier Ltd. All rights reserved.)

Nerve compression syndromes of the upper extremity, including carpal tunnel syndrome, cubital tunnel syndrome, posterior interosseous syndrome and radial tunnel syndrome, are common in the general population. Diagnosis is made based on patient complaint and history as well as specific exam and study findings. Treatment options include various operative and nonoperative modalities, both of which include aspects of hand therapy and rehabilitation.

Background Context: Activity avoidance and fear of movement/(re)injury are increasingly being recognized as important factors in the rehabilitation of persons suffering from chronic low back pain, yet these factors have not been thoroughly explored in persons suffering from neurogenic claudication resulting from lumbar spinal stenosis., Purpose: To determine, compare, and explain differences in the degree of fear of movement/(re)injury and activity avoidance in persons with neurogenic claudication, vascular claudication, and asymptomatic volunteers., Study Design: Prospective controlled cohort study at an academic medical center., Patient Sample: Eighty-two adults aged between 55 and 90 years with neurogenic claudication, vascular claudication, or no back and leg symptoms., Methods: Subjects completed a visual analog scale for pain, the Center for Epidemiological Studies Depression Scale, the Quebec Back Pain Disability Scale, Short Form 36 (SF-36), and the 13-item version of the Tampa Scale for Kinesiophobia (Tampa). They were also asked to estimate their maximum walking distance., Outcome Measures: The difference in the level of fear of movement/(re)injury and activity avoidance in the two symptomatic populations, as well as the predictive validity of self-reported measures such as pain level, functional impairment, and depression in determining fear avoidance., Results: The total Tampa score was significantly higher in individuals with neurogenic claudication (M=31.68; standard deviation [SD]=7.56; N=39) than vascular claudication (M=24.07; SD=6.57; N=15) (p=.002), whereas both symptomatic groups were significantly different from controls (M=18.71; SD=6.3; N=28) (p<.001 vs. neurogenic; p<.05 vs. vascular). Tampa scores were strongly correlated to the Center for Epidemiological Studies Depression Scale score (r=0.515; p<.001), SF-36 Physical Functioning score (r=-0.632; p<.001), and the visual analog scale average level of pain in a week (r=0.461; p<.001). Using a standard multiple regression model (R²=0.406; F(3,62)=13.47; p<.001), the amount of functional impairment, that is, the SF-36 Physical Functioning score, was the strongest contributor to the variance in the Tampa total score (β=-0.371; p=.014). The average level of pain did not make a significant or unique contribution in predicting the Tampa total score. Functional impairment as measured by the SF-36 Physical Functioning was strongly correlated with both pain (r=-0.740; p<.001) and depression (r=-0.488; p<.001)., Conclusions: Persons with neurogenic claudication have important elevations in fear and avoidance, higher than those with claudication from another source (vascular insufficiency). The impact of fear and avoidance along with other factors such as depression on pain, disability, and quality of life for persons with claudication and spinal stenosis need to be explored., (Copyright © 2012 Elsevier Inc. All rights reserved.)

Background: Carpal tunnel syndrome is a serious therapeutic problem and it considerably impairs the patients' quality of life. Despite many studies, the effectiveness of conservative treatment is still debatable. This study aimed to evaluate the immediate and long-term effects of conservative treatment involving ultrasound therapy combined with massage and kinesiotherapy for carpal tunnel syndrome., Material and Methods: A total of 61 patients with carpal tunnel syndrome were assessed with regard to such symptoms as pain, numbness, tingling sensation, morning stiffness, and self-care difficulties. We used provocation tests and investigated sensory impairments, autonomic disturbances, and Lüthy's sign. Conduction in the median nerve fibres was assessed during a nerve conduction study. We performed computer-aided measurement of the hand joint range of motion and global grip strength. The tests were conducted before and on completion of a rehabilitation programme. The hands were re-examined one year later. The treatment involved ultrasound therapy, massage, and kinesiotherapy., Results: The treatment outcomes confirmed the effectiveness of the therapeutic programme. Significant improvements concerning the majority of the symptoms were observed between the first and second examination as well for the entire follow-up period. We observed significant improvement in the quality of sensation, the hand range of motion and muscle strength., Conclusions: Ultrasound therapy combined with massage and kinesiotherapy brings the expected, long-term effects in patients with carpal tunnel syndrome.

Purpose: Facial nerve palsy after sagittal split ramus osteotomy of the mandible (SSRO) is a rare, but serious, complication. The aim of the present study was to evaluate the incidence of this complication, the possible causative mechanisms, its subsequent management, and eventual outcomes., Patients and Methods: All patients who underwent SSRO of the mandible at the Craniofacial Center, Chang Gung Memorial Hospital, Taiwan, from 1981 to 2008 were included in the present study. The patients reported as having postoperative facial nerve paralysis were identified and reviewed., Results: A total of 3,105 patients had undergone bilateral SSRO (6,210 sagittal splits). Of these 3,105 patients, 6 were reported as having unilateral facial nerve palsy postoperatively, for an incidence of 0.1%. One case was diagnosed as Bell's palsy. None of the patients with postoperative facial nerve palsy required surgical intervention, but all received physical therapy and medications. Complete recovery was obtained without sequela in all but 1 patient, who had incomplete frontal branch recovery., Conclusions: Most facial nerve palsies that occur after SSRO of the mandible result from neurapraxia or axonotmesis, possibly from nerve compression or traction. Complete recovery can be expected in most cases, and conservative management without surgical exploration is recommended., (Copyright 2010 American Association of Oral and Maxillofacial Surgeons. Published by Elsevier Inc. All rights reserved.)

A client with hypochondroplasia dwarfism and a medical diagnosis of spinal stenosis had found that her ability to walk had decreased over the past 7 years from easily walking 6 miles (10 K) to now needing to rest every half block (171 ft/52 m) due to muscle fatigue. Such weakness is consistent with nerve impingement due to spinal stenosis, which would not be improved by massage. However, during a preliminary assessment, it was found that both lower legs had severe fascial adhesions, possibly compressing lower leg blood vessels and nerves. It was hoped that by using myofascial massage techniques to relieve the adhesions, her mobility would improve over the course of 8 sessions. Myofascial massage techniques showed positive results in reducing adhesions, improving circulation, and increasing the distance the client could walk before resting to 2 blocks (686 ft/209 m). Working with this client showed that Licensed Massage Practitioners (LMPs) can easily accommodate clients of very short height., (Copyright 2010 Elsevier Ltd. All rights reserved.)

Objective: To assess the effect of patient education, the simplest conservative treatment of ulnar neuropathy at the elbow, and establish its indication., Design: Patients with ulnar neuropathy at the elbow were treated by education. Its effects and factors affecting outcome were investigated. The length of the treatment was at least 3 months. If the symptoms were improving, the follow-up was lengthened. All of the improved patients were followed up at least for 1 year after they reached a plateau of improvement to check recurrence., Setting: Patients were selected from an outpatient clinic of a general hospital., Participants: Patients (N=77; 80 nerves) with ulnar neuropathy at the elbow diagnosed clinically and electrophysiologically., Interventions: Patient education on the pathophysiology and activity modification to unload the ulnar nerve from mechanical stress., Main Outcome Measures: Outcomes were graded as excellent, good, fair, or poor with use of the modified Akahori's classification system. Patient satisfaction was graded as 1 (low) to 5 (high). Repeat nerve conduction studies were performed in those who gave consent, and results were graded as excellent, good, fair, or poor., Results: Fifty-three nerves (66%) had excellent or good outcomes. Multivariate logistic regression analysis revealed that degenerative change (graded as normal, mild, moderate, or severe) was associated with the outcome, while age, sex, side, duration and severity of the disease, diabetes, dislocation of the nerve, and smoking were not. Excellent or good outcomes were obtained in 43 (80%) of 54 nerves with no or mild degeneration and 10 (38%) of 26 nerves with moderate or severe degeneration. Recurrence was less frequent in the former (2 of 43 nerves, 5%) than the latter (4 of 10, 40%). The outcomes strongly correlated with the satisfaction scores and repeat nerve conduction study results., Conclusions: Patient education is effective for a considerable number of patients with ulnar neuropathy at the elbow. Whether this is indicated depends on the grade of elbow degeneration. Those who have no or mild degeneration respond better to this treatment with a lower rate of recurrence than those with more severe degeneration regardless of age, sex, side, duration and severity of the disease, presence or absence of diabetes and dislocation of the nerve, and smoking status.

A description of soft tissue injuries to the shoulder and elbow, together with assessment, imaging and treatment considerations.

Purpose: We report our case series of patients undergoing surgical treatment (femoral osteoplasty) for symptomatic cam femoroacetabular impingement (FAI). Clinical results using a modified Heuter anterior approach combined with adjunctive hip arthroscopy are presented., Methods: A chart review of 16 hips (14 consecutive patients) was conducted. Radiographic parameters (alpha angle, head-neck offset, and Tönnis grade) were compared preoperatively and postoperatively. Clinical features (range of motion, provocative testing, and Harris hip score) were assessed., Results: At 2.0 years, mean hip flexion improved from 94.1 degrees to 110.0 degrees (P < .01) and internal rotation from 7.1 degrees to 12.3 degrees (P = .02). The mean alpha angle improved from 64.5 degrees to 43.3 degrees (P < .01), whereas the mean femoral head-neck offset improved from 1.9 to 9.6 mm (P < .01). The mean Harris hip score improved from 63.8 to 76.1 (P = .01). No deterioration in overall radiographic Tönnis grades was present at last follow-up., Conclusions: The combination of hip arthroscopy with a limited anterior approach (Heuter) is a useful technique for patients with cam or cam-dominant FAI lesions. We believe the limited anterior approach with open osteoplasty presents a reasonable alternative to arthroscopic methods of osteoplasty with minimal drawbacks in the event that total hip arthroplasty is indicated in the future., Level of Evidence: Level IV, therapeutic case series.

Purpose: The purpose of this study was to compare the outcomes of arthroscopic labral debridement with those of labral refixation., Methods: We reviewed patients who underwent labral debridement during a period before the development of labral repair techniques. Patients with labral tears deemed repairable with our current arthroscopic technique were compared with patients who underwent labral refixation with a minimum 1 of year of follow-up. To better match the 2 groups, only patients with labral pathology caused by pincer-type or combined pincer- and cam-type femoroacetabular impingement were included. In the first 36 hips the labrum was debrided (group 1); in the next 39 hips the labrum underwent refixation (group 2). Outcomes were measured preoperatively and postoperatively with the modified Harris Hip Score (HHS), Short Form 12, and visual analog scale for pain. Preoperative and postoperative radiographs were obtained to evaluate bony resection (alpha angle) and osteoarthritis (Tönnis grade)., Results: The mean age was 31 years in group 1, with a mean follow-up of 21.4 months, and 27 years in group 2, with a mean follow-up of 16.5 months. Preoperative subjective outcomes scores were not significantly different between groups. At the 1-year follow-up visit, subjective outcomes were significantly improved (P < .01) in both groups. HHSs were significantly better for the refixation group (94.3) compared with the debridement group (88.9) at 1 year (P = .029). At most recent follow-up, good to excellent results were noted in 66.7% of hips in the debridement group compared with 89.7% of hips in the refixation group (P < .01)., Conclusions: Although other variables could have influenced these outcomes, these preliminary results indicate that labral refixation resulted in better HHS outcomes and a greater percentage of good to excellent results compared with the results of labral debridement in an earlier cohort., Level of Evidence: Level III, retrospective comparative study.

Dorsal scapular nerve lesions are quite rare. A case of a 51-year-old man who had right shoulder pain, weakness of right arm elevation, and prominence of right scapula for 6 months is presented. The condition had been abruptly developed after lifting a heavy box overhead on which he felt a sharp pain in the right shoulder. On clinical examination, there was a prominence of the lower medial border and inferior angle of the right scapula compared with the left. In addition, the right scapula was located more lateral. Magnetic resonance imaging of the thorax revealed the presence of a thinner rhomboid major muscle with a pathologic signal compared with the other side. Needle electromyography of the right rhomboid muscle revealed a long duration, polyphasic motor unit potential with reinnervation potentials, and spontaneous activity. According to these findings, the patient was diagnosed as having a winged scapula because of dorsal scapular nerve lesion.

Objective: The primary aim was to report on the recovery of radial nerve function in patients with acute closed humeral shaft fractures and associated primary radial nerve palsy. The secondary aim was to report on the long-term functional outcome and health-related quality of life (HRQoL) in patients with this specific injury., Setting: Six major hospitals in Stockholm County., Design: Descriptive study. Retrospective assessment of radial nerve recovery and fracture healing. Prospective assessment of functional outcome and HRQoL., Patients: Thirty-three patients with acute radial nerve palsy and a closed humeral shaft fracture in a population of 358 patients with 361 humeral shaft fractures., Intervention: Nonoperative or operative treatment as per decision of the attending orthopedic surgeon., Main Outcome Measurements: Recovery of the radial nerve, fracture healing, functional outcome according to the Short Musculoskeletal Function Assessment (SMFA) and the Disabilities of the Arm, Shoulder and Hand (DASH). HRQoL according to Short Form 36 (SF-36)., Results: Among the 18 patients treated nonoperatively, 16 (89%) displayed a complete recovery from their radial nerve palsy while 2 (11%) presented minor sequelae. In 11 (73%) of the 15 patients treated primarily operatively, the nerve function recovered completely while 2 patients (13%) had minor sequelae and 2 (13%) had major sequelae, i.e. 1 partial nerve palsy and 1 total radial nerve palsy. Sixteen patients (48%) were available for assessment of the long-term functional outcome and HRQoL at a mean of 7 years (range, 6 to 8 years). The range of motion and the muscular strength of the injured arm, the functional outcome according to the SMFA, and HRQoL according to the SF-36 showed results comparable to those previously reported for patients with healed humeral shaft fractures without associated radial nerve palsy., Conclusion: This study confirms the high spontaneous recovery rate of primary radial nerve palsies in patients with closed humeral shaft fractures. Primary radial nerve palsy should not be regarded as an isolated indication for primary surgical intervention.

We report a rare case of femoral nerve palsy secondary to hematoma compression of the iliacus. The patient presented with pain 2 days after performing a double kick in karate. The femoral nerve symptoms (numbness and weakness) did not begin until 3 to 4 days after the initial trauma. Magnetic resonance imaging (MRI) confirmed that there was a hematoma compressing the iliacus (and femoral nerve). This hematoma was subperiosteal, within the iliac fossa. This case is rare because the femoral nerve palsy resolved without surgical intervention, the mechanism of injury, the imaging used to diagnose the iliacus hematoma, and the hematoma was subperiosteal and not within the actual iliacus muscle. A review of the literature regarding femoral nerve palsy secondary to traumatic iliacus hematoma is presented. If the diagnosis of femoral nerve palsy secondary to iliacus hematoma is suspected after history and physical examination, MRI is the imaging study of choice. If MRI does not depict a discreet hematoma mass, nonoperative management should be considered. Electromyography has not been shown to offer information that was not provided by history, physical examination, and other imaging. Surgery should be considered if there is progression of the femoral nerve symptoms, or if MRI depicts a discreet collection of blood impinging on the femoral nerve.

More efforts are needed to help stakeholders who are geographically isolated from one another become more collaborative in their approach to return-to-work (RTW). A review of the literature on team processes, and insights from the experiences of a federally funded Round Table Project on Safe and Timely Return to Function and Return to Work were used to inform strategies that might enhance collaboration among health professionals and stakeholders in injury and illness management and return-to-work. A case study serves to highlight the individual, identifies the problem and provides a potential solution at the broader service and system levels. It becomes evident that there is a need for a common language as well as policies that emphasize the importance of fostering awareness of interprofessional potentials and contributions of all stakeholders. Establishing shared goals, and building capacity for sustaining collaboration when multi-stakeholders do not function in the same physical location, but work virtually, might maximize effectiveness, efficiency and productivity.

Background: Lumbar disk prolapses are among the most common neurological conditions. In this open study, we asked whether repeated end-range spinal movements (McKenzie method) as physiotherapy in patients with lumbar disk prolapse induce early changes in location, size and signal intensity of lumbar disc material detectable by magnetic resonance imaging (MRI). We compared clinical with radiographic changes. The clinical efficacy of mechanical physiotherapy according to the McKenzie method within 5 days was documented., Methods: Eleven consecutive patients with lumbar disk prolapse were included. Patients were treated with repeated end-range spinal movements and MRI was performed before and after 2-5 treatments., Results: All patients achieved a reduction in symptoms and signs of disk prolapse during and after these procedures but none showed any change in the MRI features of the prolapses., Conclusions: Beneficial effects of specific mechanical physiotherapy in patients with radicular syndromes from lumbar disk prolapse are not paralleled by changes in the MRI appearance of the prolapses. Alternative explanations for the early clinical responses in some patients with lumbar disc prolapse treated according to the McKenzie method must be sought.

The purpose of this report was to determine a detailed description of a rehabilitation programme of a volleyball player who had a decompression surgery for suprascapular nerve entrapment and to expose the long-term functional outcomes which lead to successful results.

Stress fractures of the proximal fibula are uncommon and usually result from axial loading, which is mostly described in runners. We report an unusual mechanism of such a fracture in a circus performer resulting from repetitive direct horizontal loading from a trapeze bar. In addition, the bony injury resulted in a secondary injury to the common peroneal nerve with corresponding weakness. Both injuries responded well to nonoperative treatment and the athlete had an excellent recovery with no residual symptoms. He was able to resume his training with the use of protective padding applied to the proximal legs. Fracture of the proximal fibula caused by direct repetitive stress to the bone with a secondary compression injury to the common peroneal nerve is a previously undescribed injury. We report a patient who presented with this injury, the possible mechanisms of such injury, its management, and outcome.

Gender-specific care of musculoskeletal impairments is increasingly important in women's health. This is most relevant and of paramount importance as it relates to identification and management of musculoskeletal and peripheral neurologic disorders of pregnancy, delivery, and postpartum. The specific anatomic and physiologic changes of pregnancy predispose to a specific set of diagnoses. Virtually all women experience some degree of musculoskeletal discomfort during pregnancy. This article provides an overview of the more common pregnancy-related musculoskeletal conditions and includes a discussion of epidemiology, risk factors, diagnosis, prognosis, and management.

Two of the most common diagnoses assigned to patients presenting with lateral elbow and proximal forearm pain are lateral tendinosis and radial tunnel syndrome. Traditionally, these 2 conditions have been treated as distinct and separate entities with most patients being diagnosed with either one or the other, but not both. The extensor carpi radialis brevis (ECRB) and, to a lesser the degree, a portion of the extensor digitorum communis that form the conjoined lateral extensor tendon are thought to be primarily responsible for the excessive traction that induces lateral tendinosis (a degenerative process of microtears in the tendon with impaired healing), but the supinator blends with these same fibers and shares a role in the pathology. The supinator, primarily the arcade of Frohse, has been thought to play the majority role in compressing the posterior interosseous nerve in radial tunnel syndrome, but the undersurface thick tendon of the ECRB may also cause substantial nerve compression. Reduction of the linear tension transmitted by the ECRB is the common element in the various surgical treatments for lateral tendinosis, performed anywhere from directly at the lateral epicondyle to the distal myotendinous junction. Nerve decompression by division of fascial bands is the goal in surgery for radial tunnel syndrome. These 2 surgical approaches need not be mutually exclusive. In fact, this separation of the 2 clinical entities may play a role in the unpredictable results reported in the literature. This article presents a unified approach to treating both pathologies simultaneously including short-term clinical results.

Entrapment neuropathy of the suprascapular nerve (SNE), although a recognised clinical entity, is a relatively rare cause of shoulder pain and subjective weakness in the athlete involved in overhead sports like volleyball and badminton. This study deals with the presentation and management of four unusual cases of suprascapular nerve entrapment in volleyball players. Four male volleyball players presented to our department with intractable shoulder pain and subjective sensation of shoulder weakness. They all had visible wasting of both supraspinatus and infraspinatus muscles, together with weakness of abduction and external rotation of the arm. They all responded temporarily to a diagnostic injection of local anaesthetic. MR imaging was useful in diagnosing space occupying lesions in three cases and the presence of a hypertrophic suprascapular ligament in one case. Due to failure of non- operative treatment, which included activity modification, rest, analgesics and rehabilitation programme over 6 months, surgery was then required to decompress the suprascapular nerve. All patients were symptom free at 6 months postoperatively and after an intensive rehabilitation programme, they were able to return to their normal level of activity including sport.

Sex-specific care of musculoskeletal impairments is an increasingly important topic in women's health. This is clinically relevant and of paramount importance as it pertains to diagnosis and treatment of musculoskeletal and peripheral neurologic disorders of pregnancy and the puerperium. It is estimated that virtually all women experience some degree of musculoskeletal discomfort during pregnancy, and 25% have at least temporarily disabling symptoms. This review provides information on common pregnancy-related musculoskeletal conditions, including a discussion of anatomy and physiology, diagnosis, prognosis, and treatment of these disorders.

Quadrilateral space syndrome is an uncommon injury. The true prevalence is unknown because of a lack of literature and possible misdiagnosis. Prevalence may increase as knowledge of the syndrome increases. The case is presented of a recreational triathlete who had a spontaneous onset of quadrilateral space syndrome. The diagnosis was made by physical examination and confirmed with magnetic resonance imaging. A conservative, yet aggressive rehabilitation programme resulted in functional improvement within six weeks. Results have been maintained for eight weeks.

Varieties of injuries have been reported as a result of the deployment of the airbag/s following road traffic accidents. The purpose of this case-report is to present a physiotherapist's perspective of a patient who was diagnosed as having temporomandibular pain and dysfunction following the deployment of the airbag on the face and its implications for the dental profession. The patient was assessed using a modified Maitland assessment procedure to establish the diagnosis and the treatment consisted of Maitland mobilisation techniques, pulsed short wave diathermy and ultrasound as and when indicated directed to the upper cervical spine. The outcome of this case-report suggests that the temporomandibular symptoms presented by this patient were of cervical origin. Therefore, it is suggested that the cervical spine should be routinely examined in patients presenting with temporomandibular pain and dysfunction following trauma and early referral to physiotherapy may facilitate early recovery.

Study Design: Lumbar spine stenosis is a common cause of lower back pain and lower extremity pain especially in people over 60-years-old. Treatment can be surgical or non-surgical. The efficacy of these treatments remains unclear. The purpose of this study was to assess the result of a medical management in a prospective study. Preliminary results are presented., Patients and Methods: Patients following the clinical and the radiological criteria of inclusion were included in the study. Pain was assessed by visual analogic scale (VAS) and Oswestry scale. Sixty patients meeting inclusion criteria underwent non-surgical intervention including therapeutic exercises and 2 epidural injections. Patients were followed up at 3 and 6 months., Results: The main score on VAS was 5.2 for lumbar pain, 5.8 for radicular pain and 21/50 on the Oswestry scale. Three months later an improvement was noticed in 12 cases. Thirty-seven patients remained unchanged and surgery was decided for 11 patients. At 6 months an improvement was reported by 47% of the patients who have been managed by conservative treatment. No predictive factor except VAS was noticed., Discussion: Our results are inferior to those previously reported. Most of previous studies are retrospective and criteria of assessment are not based on functional scale as we done. The fact that the treatment management was ambulatory without supervision is probably the main explanation., Conclusion: Conservative treatment for spinal lumbar stenosis remains a reasonable option.

Nerve entrapment occurs when a nerve is "trapped" by pathologic changes in the tissues through which the nerve passes. Nerve entrapments occur more frequently in the upper than in the lower extremities and are characterized by pain and paresthesias, with or without sensory and/or motor nerve loss. The major pathologies related to upper extremity nerve entrapment involving the cervical, thoracic, shoulder, elbow, and wrist areas are discussed in this article.

Postpolio syndrome (PPS) is generally defined as a clinical syndrome of new weakness, fatigue, and pain in individuals who have previously recovered from acute paralytic poliomyelitis. These new problems may lead to loss of employment as well as new deficits in instrumental activities in daily living (cleaning, washing, shopping, transportation, etc.), walking, climbing stairs, and personal assistance. We presented three cases of PPS with working disabilities in Japan, and stated the issues confronted with. Particularly at the workplace, PPS individuals need special supports from both rehabilitation medicine and occupational health services, including improved nutrition, achieving ideal body weight, regular and sensible exercise, frequent checkups, and modifying working conditions.

We describe a 19-year-old man who underwent emergency laparotomy for perforated peptic ulcer. He was otherwise healthy before this admission with no history of diabetes mellitus or neuropathy. A standard-size adult blood pressure cuff connected to a Dinamap monitor, set to cycle automatically every 3 minutes was affixed to his left upper extremity during surgery. One day after the operation he complained of numbness over the dorsum of the left hand and wrist drop. Physical examination revealed 0/5 muscle power of the left wrist and finger extensor muscles with reduced sensation on the radial aspect of the dorsum of the same hand. A diagnosis of acute radial nerve injury was made and rehabilitation was started. The wrist numbness and sensation improved with physical therapy, and he was discharged 9 days after the operation with an active wrist splint. He continued with rehabilitation on an out-patient basis. The muscle power of the wrist extensors gradually improved after three months of physical therapy and reverted to completely normal one month later. Locating the cuff higher on the arm, away from the elbow joint, to avoid the most superficial portion of radial nerve, may prevent this type of compression injury especially in asthenic patients.

Objective: To assess whether a difference exists in restoration of strength between patients with a recent paresis of the dorsiflexors of the ankle using an ankle-foot orthosis (AFO) and patients without an AFO., Design: Prospective case-control study., Setting: Patients from regional hospitals, tested in a rehabilitation research center., Participants: Twenty-nine patients with a recent (6wk-1yr) peripheral paresis, alternately assigned to a group using an AFO or a control group. There was no significant difference in duration of the paresis and in torque at entering the study (T0) between the 2 groups., Interventions: The use of an ankle-foot orthosis., Main Outcome Measures: Isometric torque production of ankle dorsiflexors, expressed as ratio of paretic and healthy side, in 2 measurement sessions, over a period of 6 weeks (T0-T6) with the ankle in 0 degrees and 30 degrees plantarflexion., Results: Both groups had significant restoration of strength +/- standard deviation between T0 and T6 in 30 degrees flexion: non-AFO group 17% +/- 15%, AFO group 9% +/- 12%. No significant difference existed between the 2 groups (30 degrees p = .56). No significant shift in strength ratio 0 degrees :30 degrees occurred (AFO group p = .82)., Conclusion: The use of an orthosis does not influence restoration of strength in patients with a recent peripheral paresis of the ankle dorsiflexors.

Objective: To investigate neurourologic involvement in injuries to the thoracolumbar vertebra junction with magnetic resonance imaging (MRI) and electrophysiologic and urodynamic measurements and to characterize the neurogenic mechanisms of voiding dysfunctions., Design: Baseline comparisons among 3 anatomic groups before neural repair., Setting: Tertiary care center., Patients: Thirty-five T11 to L2 spinal cord injury patients consecutively admitted to a rehabilitation unit. Eight patients (Group 1) had above-conus lesions without denervation and polyphasic waves revealed in the anal sphincter electromyography; 13 patients (Group 2) had conal and/or above-conus lesions and anal sphincter electromyographic abnormalities; and 14 patients (Group 3) had below-conus lesions and anal sphincter electromyographic abnormalities., Main Outcome Measures: Comparison of features identified on pudendal nerve terminal motor latency, urethral pressure profiles, and multichannel voiding pressure-flow study., Results: The pudendal nerve terminal motor latency in Group 3, showing a significantly higher abnormal ratio (100%; p =.011, Fisher's exact test), indicated that cauda equina lesions might be the cause. Urodynamic data from Group 3 showed a significant decrease in maximal urethral closure pressure (48 +/- 17cm H2O, p =.0022, analysis of variance [ANOVA], repeated measure) and an increase in bladder capacity (429 +/- 194mL, p =.037, ANOVA, repeated measure). There were no significant changes in the other groups., Conclusion: Neurourologic abnormalities are less predictable with injuries to thoracolumbar junction, except in patients with cauda equina lesions.

Cryomassage in combined treatment of 100 patients operated for discogenic neuropathy produced a pronounced vasotropic effect. The authors have determined optimal zones for cryomassage application and order of its usage with some physical factors.

The most frequent consequence of chronic alcohol intake is a toxic polyneuropathy. It results from inadequate nutrition, mainly deficiency of thiamine and other B vitamins. Additionally there is a direct neurotoxic effect of ethanol. Signs and symptoms are 1. distal sensory disturbances with pain, paresthesia, and numbness in a glove and stockings-pattern, 2. weakness and atrophy of distal muscles, pronounced in the lower limbs, 3. loss of tendon jerks, 4. affection of autonomic fibers. Therapy consists in absolute alcohol abstinence, high-caloric nutrition, parenteral thiamine and other vitamins. Against paresthesia and pain, carbamazepine, salicylates, amitryptiline are effective. Parenteral tioctacid may be tried. The prognosis of alcoholic polyneuropathy is favorable, with alcohol abstinence, within several months up to a few years. In chronic alcoholic patients peripheral nerves frequently are injured by compression during alcohol intoxication. Peroneal nerve lesions result from compression in the region of the neck of the fibula during a prolonged lying position, the radial nerve is injured during sitting with the upper arm placed on the backrest of a bench. Usually pressure palsies resolve spontaneously. Rhabdomyolysis is a rare but life-threatening complication of alcoholic delirium. Symptoms are severe muscle pain, swelling of extremities, pigmenturia. The major complications of rhabdomyolysis are renal and respiratory failure, and cardiac arrhythmias due to electrolyte imbalance. Intensive care is needed with control of hyperkalemia, hydration, alkalinization of urine, hemodialysis if indicated.