Dr Satyajit Mohanty blogs

The sacrum weight transmission factors: The direction of the trabecular bone indicates the route of load transmission in the sacrum. From the various parts of the sacrum (body, facets, alae and laminae) distinct sets of trabeculae extend towards the auricular surface. L5-S1 weight transmission Weight transmitted from the fifth lumbar vertebrae to the sacrum is distributed in 3 separate components i.e. (a) Anteriorly- through vertebral bodies (b) Intermediately- through transverse elements (c) Posteriorly- through lumbosacral facet joints The posterior components of the fifth lumbar vertebra share greater proportion of load in comparison with the posterior elements of the upper lumbar vertebral levels. The forces acting on the body and articular facets, at the upper end of the sacrum, are ultimately transmitted through the two auricular surfaces with an appreciable part of the load passing directly from the transverse process of the fifth lumbar vertebra to the ala of the sacrum through

I. Recent findings in DISH The diagnosis of DISH or Forestier's disease is based solely on radiographic abnormalities defined using the Resnick criteria. DISH is a condition characterized by calcification and/or ossification of soft tissues, mainly entheses, ligaments and joint capsules. Its prevalence increases with age and, therefore, DISH is a relatively common entity in the elderly. Witnessing the present increase in lifespan, obesity, DM and metabolic syndrome in the Western population, the prevalence of DISH should be expected to rise. Recent findings: Recent studies confirm that patients with DISH have a. Strong association with obesity: DISH patients have a greater body mass index, increased waist circumference b. Strong association with metabolic disturbances: DISH patients have disturbed lipid profile (dyslipidaemia), hypertension, , diabetes mellitus (DM), hyperuricaemia, metabolic syndrome and an increased risk for cardiovascular diseases. c. In addition, DISH

2 misconceptions about subacromial impingement & adhesive capsulitis Subacromial impingement (SI) syndrome is a painful condition that occurs during overhead activities as the rotator cuff is compressed in the subacromial space. Unrecognized secondary causes of subacromial impingement may lead to treatment failure. Posterior capsular tightness, believed to alter glenohumeral joint kinematics, is often cited as a secondary cause of SI. Karduna et al examined the effects of scapular orientation on clearance in the subacromial space in a cadaver study. Results from this study demonstrated no significant effect of posterior tilting and external rotation of the scapula but subacromial clearance was found to decrease with an increase in upward rotation, which is contrary to what was expected. These results suggest that changes in upward rotation observed in patients with impingement syndrome may serve to open the subacromial space. In adhesive capsulitis there is tightening of posterior

According to Lin et al in persons with stiff shoulder a. A strong co-relationship is found between functional disabilities in a stiff shoulder and posterior shoulder tightness. The study also revealed significant relationship between functional disabilities and cross-chest adduction. b. There exists a significant relationship between internal rotation and posterior shoulder tightness. Similarly there is also a significant relationship of external rotation and anterior shoulder tightness. c. Further significant correlations between shoulder internal rotation and cross-chest adduction, shoulder external rotation and below-chest abduction are observed, indicating that internal and external rotations might be related to posterior and anterior shoulder stiffness. d. Below-chest abduction and cross-chest adduction were found to provide reliable data in shoulder stiffness & disbility. Reference: Lin JJ et al; Man Ther. 2006 May;11(2):146-52. Epub 2005 Aug 10. (Reliability and validity of

Isolated shoulder internal rotation restrictions are rare clinical entities for physiotherapist to encounter in OPD set ups. According to cyriax J in a pan-capsular involvement there is more external rotation restriction than abduction restriction than internal rotation. This restriction pattern is called capsular pattern. So only limitation of internal rotation is attributed to involvement of structures other than capsule i.e. muscles & IDK (labrum problems) etc. A case in my clinic: A 42 year male reported with lateral arm pain. The patient has cervical spine involvement with Rt side rotation, side bend & back ward bending limited terminally but no ULTT tests ware positive. Both side levator scapulae ware tight. First 10 sitting ware spend to improve ROM & myofascial work to improve length of elevators of scapula without much avail. During the second 10 sitting it was found that shoulder IR/hand behind back is limited could reach maximum up to L3. No other shoulder tests