Wide-Awake Wrist Arthroscopy and Open TFCC Repair.

Wide-Awake Wrist Arthroscopy and Open TFCC Repair.

J Wrist Surg. 2012 Aug; 1(1): 55-60
Hagert E, Lalonde DH

The wide-awake approach to hand surgery entails the use of local infiltration anesthesia using lidocaine with epinephrine and no tourniquet. The technique provides practitioners with an option to perform advanced hand surgical care in an ambulatory setting, without the need for general or regional anesthetics. We present our results using wide-awake approach in wrist surgery, both open and arthroscopic. Between June and August 2011, the wide-awake approach was used in nine elective wrist surgery cases; three arthroscopic procedures, four open triangular fibrocartilage complex (TFCC) repairs, and two combined arthroscopy/open surgery (eight men/one woman). The arthroscopic patients were anesthetized using dorsal infiltration of lidocaine with epinephrine (20?mL) with an additional intra-articular 5?mL injection 30 minutes before surgery. The open surgery patients received 40?mL of lidocaine with epinephrine around the ulnar aspect of the forearm, from 8-cm proximal to 3-cm distal to the distal radioulnar joint. Standard diagnostic radio- and midcarpal arthroscopies were performed, where one patient had a loose body removed and two patients underwent TFCC debridements due to central TFCC tears. The six open cases were all due to TFCC foveal disruptions, which were reinserted using osteosutures in the distal ulna. Following placement of the ligament sutures, a preliminary knot allowed active and passive motion testing of pronosupination, to determine the adequate amount of tension in the ligaments. The wide-awake approach to wrist surgery is a plausible and reliable technique that eliminates the need for general anesthesia, removes the need of a tourniquet, and provides a cost-efficient and safe approach to wrist surgery. The ability to control ligament reconstructions using active motion may additionally enhance the rehabilitation of these patients, both through early proprioceptive awareness and adequate tensioning of soft tissues. HubMed – rehab

Anterior distal femoral hemiepiphysiodesis in the treatment of fixed knee flexion contracture in neuromuscular patients.

J Child Orthop. 2012 Aug; 6(4): 313-8
Al-Aubaidi Z, Lundgaard B, Pedersen NW

Patients with neuromuscular diseases such as cerebral palsy (CP) and meningomyelocele (MMC) are prone to develop fixed knee flexion contracture. Distal femoral extension osteotomy allows acute correction of the deformity, but it is an extensive surgical procedure, and the complication rate is rather high. Immobilization can prolong the rehabilitation period, and may even result in deteriorated walking ability. The aim of this retrospective study was to evaluate the results of using anterior hemiepiphysiodesis of the distal femur to treat fixed flexion contracture of the knee.We studied 21 patients in our department from 2003 to 2009. Mean age was 10 years (5-15). Twelve suffered from MMC, five from CP, two from arthrogryposis, one had an enzyme defect, and one had Down’s syndrome. Thirteen patients had a bilateral and eight a unilateral procedure. None of the patients underwent any other procedures. Two staples or 8-plates were inserted using two parapatellar incisions. Nine were operated on with staples and 12 with 8-plates. The plates or staples were removed when the desired effect of full knee extension was achieved or the patient reached skeletal maturity.Mean fixed flexion contracture was 20° (10°-40°). Staples or 8-plates were removed after a mean of 24 (6-42) months. Mean fixed flexion contracture at removal was 10° (0°-30°). Two complications were seen: one infection and one supracondylar fracture.Anterior distal femoral hemiepiphysiodesis using 8-plates or staples seems to be effective for correcting fixed knee flexion deformity in skeletally immature individuals. The complication rate is low (10 %). Our results are comparable to those of Kramer, Klatt, and Stevens. This procedure should be the primary treatment for fixed knee flexion contractures in neuromuscular patients with sufficient remaining growth. HubMed – rehab

Exercise and nutrition interventions in advanced lung cancer: a systematic review.

Curr Oncol. 2013 Aug; 20(4): e321-37
Payne C, Larkin PJ, McIlfatrick S, Dunwoody L, Gracey JH

In this systematic review, we sought to evaluate the effect of physical activity or nutrition interventions (or both) in adults with advanced non-small-cell lung cancer (nsclc).A systematic search for relevant clinical trials was conducted in 6 electronic databases, by hand searching, and by contacting key investigators. No limits were placed on study language. Information about recruitment rates, protocol adherence, patient-reported and clinical outcome measures, and study conclusions was extracted. Methodologic quality and risk of bias in each study was assessed using validated tools.Six papers detailing five studies involving 203 participants met the inclusion criteria. Two of the studies were single-cohort physical activity studies (54 participants), and three were controlled nutrition studies (149 participants). All were conducted in an outpatient setting. None of the included studies combined physical activity with nutrition interventions.Our systematic review suggests that exercise and nutrition interventions are not harmful and may have beneficial effects on unintentional weight loss, physical strength, and functional performance in patients with advanced nsclc. However, the observed improvements must be interpreted with caution, because findings were not consistent across the included studies. Moreover, the included studies were small and at significant risk of bias. More research is required to ascertain the optimal physical activity and nutrition interventions in advanced inoperable nsclc. Specifically, the potential benefits of combining physical activity with nutrition counselling have yet to be adequately explored in this population. HubMed – rehab

The use of the Patient-Specific Functional Scale to measure rehabilitative progress in a physiotherapy setting.

J Man Manip Ther. 2012 Aug; 20(3): 147-52
Nicholas P, Hefford C, Tumilty S

The Patient-Specific Functional Scale (PSFS) and the Numeric Pain Rating Scale (NPRS) are two measures which the Accident Compensation Corporation (ACC) of New Zealand have made compulsory for physiotherapists to record at a patients initial visit and discharge. Therefore, it is important to assess clinicians’ compliance to this reporting requirement, and whether research results regarding effectiveness of these measures are transferable to the clinic.A retrospective observational study that assessed compliance in recording these measures, and analyzed the changes in scores seen across 11 physiotherapy practices in New Zealand over a 12-month period.Overall compliance rates of 51·8% [95% confidence interval (CI): 50·7-52·9] for PSFS and 51·9% (95% CI: 50·7-53·0) for NPRS were reported. These figures increase to 85·3% (95% CI: 82·0-88·6) PSFS; and 85·1% (95% CI: 81·7-88·4) NPRS, when a full discharge for the patient was made. Mean change in PSFS scores were 5·1 (95% CI: 5·0-5·1) points representing an 85·2% (95% CI: 84·1-86·3) change in total score.The study has shown that when patients complete a prescribed course of rehabilitation, clinicians show good compliance in recording PSFS and NPRS. Change in PSFS score is, on average, above the minimal clinically important difference shown in previous studies. HubMed – rehab

The management of bilateral high hamstring tendinopathy with ASTYM® treatment and eccentric exercise: a case report.

J Man Manip Ther. 2012 Aug; 20(3): 142-6
McCormack JR

High hamstring tendinopathy (HHT) is an overuse injury that occurs most commonly in runners. The management of HHT is often challenging and the research supporting many interventions is limited. Eccentric exercise has been proven effective in the treatment of various tendinopathies but has not been thoroughly studied with HHT. Soft tissue mobilization, including ASTYM, is often utilized in the treatment of tendinopathies, though there is limited evidence supporting this approach. The purpose of this paper is to present the case of a patient referred to physical therapy with bilateral HHT. The patient was a 41-year-old recreational runner that had an insidious onset of right buttock pain 12 months prior to initiating therapy and left buttock pain 9 months prior. Her primary complaints included an inability to run, pain with prolonged or brisk walking, and pain with sitting on hard surfaces. The patient was treated in physical therapy two times per week for 16 visits with treatment focused on eccentric hamstring strengthening and ASTYM. By her eighth visit, the patient was able to walk 2·5 miles without pain and by her 12 visit, she was able to jog 1 mile before the onset of pain. After 16 visits, the patient reported that she was approximately 95% improved, was able to run 2·5 miles without pain, and had no pain with sitting on hard surfaces. This case suggests that eccentric exercise combined with ASTYM may be an effective treatment for HHT. HubMed – rehab