Indian Journal of Physical Medicine and Rehabilitation

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2012 | September | Volume 23 | Issue 3

RESEARCH ARTICLE

ARTICLE NEWS

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijopmr-23-3-129a  |  Open Access |  How to cite  | 

EDITORIAL

R. N. Haldar

Post Graduate Medical Education in Physical Medicine and Rehabilitation

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:100 - 100]

   DOI: 10.5005/ijopmr-23-3-100  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

Yogendra Jagatsinh, Jim George

Audit of Safety of Intramuscular Botulinum Toxin Injections among Patients Receiving Warfarin Anticoagulation Therapy

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:4] [Pages No:101 - 104]

   DOI: 10.5005/ijopmr-23-3-101  |  Open Access |  How to cite  | 

Abstract

Background

Botulinum toxin (BTX) intramuscular injections are an effective treatment for spasticity in acquired brain injury. Despite use since the 1980s, issues concerning technique, dose and long-term side-effects remain unresolved. For example, the safety of BTX in warfarinised patients is unclear. There are two studies reporting the risk of intramuscular injections in patients receiving anticoagulant therapy with regard to possible local haematoma formation. There is no advice on this subject in the manufacturers’ summary of product characteristics for the original brand of warfarin, Dysport, BOTOX, Xeomin or in the British National Formulary.

Aim

To assess the safety of BTX injections in patients receiving oral anticoagulation.

Design

Prospective audit of safe practice.

Setting

Outpatient setting in a rehabilitation centre.

Population

Adult population affected with spasticity with acquired brain injury and receiving concurrent warfarin anticoagulant therapy.

Methods

Fourteen patients who were receiving anticoagulant therapy were given regular BTX (number of injection cycles or total mean no of injections each). Patients gave written informed consent before the injections. Injection technique did not differ from that used for un-anticoagulated patients. Patients were assessed by the injector for obvious haemorrhage in the first 15 minutes after the injection resulting in swelling, bruising, tenderness or haematoma. Patients were asked to watch for appearance of local reactions like swelling, bruising or haematoma and pain in the first week.

Results

There were no clinically detectable local complications after intramuscular injections and no major or minor bleeding episodes after BTX injections.

Conclusion

In our group, BTX injections were administered intramuscularly to patients who were receiving anticoagulant therapy without significant risk of local bleeding. However, injections must be used with caution in patients with an INR above the therapeutic range.

Clinical rehabilitation impact

BTX can be safely given in patients on anticoagulation therapy with safety checks in place.

RESEARCH ARTICLE

Chauhan Sonal, S.Y. Kothari, Laisram Nonica

Comparison of Ultrasonic Therapy, Sodium Hyaluronate Injection and Steroid Injection in the Treatment of Peri-arthritis Shoulder

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:6] [Pages No:105 - 110]

   DOI: 10.5005/ijopmr-23-3-105  |  Open Access |  How to cite  | 

Abstract

Peri-arthritis (PA) shoulder is a common cause of shoulder pain and disability. The optimum management of periarthritis shoulder has been the subject of great debate, particularly since the condition tends to resolve spontaneously over months to years leaving behind stiff shoulder.

Objectives of this study was to prospectively evaluate the comparative efficacy of intra-articular steroid (methylprednisolone) injection, intra-articular sodium hyaluronate injection and deep heat in patients with peri-arthritis shoulder who were also taught a simple home exercise programme.

Objectives of this study was to prospectively evaluate the comparative efficacy of intra-articular steroid (methylprednisolone) injection, intra-articular sodium hyaluronate injection and deep heat in patients with peri-arthritis shoulder who were also taught a simple home exercise programme.

Outcomes were determined by the assessment of subjective and objective parameters viz. shoulder pain and disability index (SPADI), range of motion. All three groups showed improvement with respect to time. Steroid group and sodium hyaluronate group showed significant improvement as compared to other ultrasonic group (p=0.02) with respect to shoulder pain and disability index and range of motion. Improvement in pain was equal with all three types of treatment‥

RESEARCH ARTICLE

M Joshi, Mahima Agrawal

Traumatic Cervical Spine Injury Pattern– A Snapshot

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:6] [Pages No:111 - 116]

   DOI: 10.5005/ijopmr-23-3-111  |  Open Access |  How to cite  | 

Abstract

Study design and subjects

Cross-sectional descriptive study of pattern of cervical spine injury at a tertiary care rehabilitation centre in Rajasthan.

Objectives

To observe the socio demographic profile and injury pattern in cervical spinal cordinjury.

Methods

One hundred and forty-one clients of traumatic cervical spine injury (CSI) were admitted from 1st December 2010 to 15th October 2011 at the Department of Physical Medicine and Rehabilitation, S.M.S. Medical College and Hospital, Jaipur. Detailed clinical, neurological evaluation as per American Spinal Injury Association Classification (ASIA) and radiological assessment were done along with identification of mechanism of injury, mode of evacuation and presence of associated injuries. Data analysis was done in October 2011 and results were compiled and analysed.

Results

Mean age in our sample was 35.87 ± 14.38 years that comprised 11 females (7.8%) and 130 males (92.2%) of whom 78 (55.3%) fell in the age group of 25 to 55 years. Majority 64 (45.4%) were illiterate, 80 (56.8%) being farmers and labourers. Greater fraction had road traffic accidents i.e., 66 (46.81%) and fall from height 56 (39.72%) as the mechanism of trauma. Only 69 (49.8%) could arrange an ambulance for transport. Majority of the injured i.e., 84 (59.57%) presented with neurologically complete picture as per ASIA classification and the most common involvement being of 5th and 6th cervical segments i.e., 103 (73.15%).

Conclusion

This study evaluated the demographic variables of cervical spine injury for better understanding of impact that it has and further for better allocation of our health resources, distribution and planning

CASE REPORT

A.K. Agarwal, A.K Gupta, V.P. Sharma, Dileep Kumar

Pentazocine Induced Contractures: A Case Report of Drug Abuse

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:3] [Pages No:117 - 119]

   DOI: 10.5005/ijopmr-23-3-117  |  Open Access |  How to cite  | 

Abstract

Contractures around the joints are seen due to multiple causes in our day to day practice where pathology can be superficial or deep. Further it can involve one joint or multiple joints. We are presenting a rare case of drug abuse due to pentazocine (fortwin) here in a 32 years old male, who had generalised and severe contractures of his hips, knees and ankles. In all such cases of myogenic generalised contractures around multiples joints, we must exclude the possibility of drug abuse.

CASE REPORT

S.N Mansoor, F.A Rathore, Fahim Muhammad

Back Pack Palsy as an Unusual Cause of Shoulder Pain and Weakness–A Case Report

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:3] [Pages No:120 - 122]

   DOI: 10.5005/ijopmr-23-3-120  |  Open Access |  How to cite  | 

Abstract

Heavy back packs carried for prolonged durations can cause different musculoskeletal and neurological problems especially in the untrained and physically vulnerable individuals. They can cause postural disorders, gait abnormalities, muscular strains, pains and injuries to the brachial plexus and nerves resulting in significant morbidity and at times permanent disability. We report a case of brachial plexus injury in a young soldier wearing back pack for prolonged period. He developed weakness and pain in right shoulder which was not relieved with rest and analgesics. On examination he had weakness in deltoid, biceps and scapular muscles along with numbness in axillary nerve area. Brachial plexus injury (upper trunk) was suspected and confirmed by electrodiagnostic evaluation. His baseline investigations were normal. He was advised rest and avoidance to lift heavy weight. He was managed with electrical muscle stimulation for weak muscles, strengthening exercises and analgesics. He responded well to the treatment and had minimal residual weakness at the end of the six weeks’ treatment

Back pack palsy should be suspected in people carrying back packs and presenting with pain, weakness and numbness in the upper limbs. It can be prevented by education in the use of back packs, its weight limits, physical fitness and frequent breaks with changing positions.

CASE REPORT

I.N Krishnaprasad, V Soumya, S Abdulgafoor

Arnold Chiari Malformation with Holocord Syringomyelia Presenting as Unilateral Foot Drop: A Case Report

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:4] [Pages No:123 - 126]

   DOI: 10.5005/ijopmr-23-3-123  |  Open Access |  How to cite  | 

Abstract

Foot drop is a common problem encountered in the clinical practice of a medical rehabilitation specialist. The aetiology of foot drop is usually lower motor neuron, either by the affection of peripheral nerve or the lower lumbar roots. However other rare differential diagnosis of foot drop should be borne in mind while evaluating such a patient. A detailed neurological evaluation along with supportive investigations like electrodiagnosis and magnetic resonance imaging often helps in differentiating such a cause. Here we report a case of holocord syringomyelia, secondary to Arnold Chiari malformation type 1, presented as unilateral foot drop.

RESEARCH ARTICLE

P Das, R Pramanik

Chondroblastoma Presented as ACL Injury in a Young Boy

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:127 - 127]

   DOI: 10.5005/ijopmr-23-3-127  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

REHAB CHALLENGE

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:128 - 128]

   DOI: 10.5005/ijopmr-23-3-128  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

BOOK NEWS

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:129 - 129]

   DOI: 10.5005/ijopmr-23-3-129  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

REHAB QUIZ

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:2] [Pages No:130 - 131]

   DOI: 10.5005/ijopmr-23-3-130  |  Open Access |  How to cite  | 

RESEARCH ARTICLE

B K Chowdhury

Obituary

[Year:2012] [Month:September] [Volume:23] [Number:3] [Pages:1] [Pages No:133 - 133]

   DOI: 10.5005/ijopmr-23-3-133  |  Open Access |  How to cite  | 

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