Dr Satyajit Mohanty blogs

Review of the literature and of recommendations from CRD manufacturers suggests that TENS, Diathermy, and Interferential Electrical Current Therapy are best avoided in patients with CRDs. But several case reports have demonstrated there are no interactions between various physiotherapy modalities and cardiac rhythm devices (CRD). However, in my graduation days it was criminal not to ask the patient whether he was having a CRD or not. I have seen students fail in practical examinations if they omitted this query while interviewing the patients. Till date I have also maintained the same precautionary measure in my set up. Here is a recent paper I am discussing which investigated on the fact that “Is there really an interaction various physiotherapy modalities with CRD that contraindicates or cautions it’s application”. This review will help many to 1. Reduce fear of potential interactions. This may lead to not implementing a treatment strategy that would be helpful to the patients’ ai...

A rare cause of upper limb exercise intolerance- Atherosclerosis !!! Atherosclerotic occlusive disease of the subclavian artery is seen and occasionally will cause pain in the upper extremities. This pain is typically brought on by exercise and especially with repetitive movements of the upper extremity such as brushing one's hair. It is relatively rare for atherosclerosis to affect the upper extremities and cause symptoms. For reasons that again are unclear, it is more common for the atherosclerotic plaque to accumulate on the left side than it is on the right side. Other associated features may be: 1. Difference in the quality of the pulse between the left wrist and the right wrist. The pulse on the left side may appear weaker. 2. Arm to arm blood pressure differences in upper extremities. There have been reports of surprising variation in arm-to-arm blood pressure differences. But these variations were no more than 10- 15% and were in the elderly. The hypertension expert ...

Peripheral arterial insufficiency is a product of progressive arterial degenerative disease. Further arterial insufficiency is associated with an increased morbidity and mortality in the suffering population. Usually this condition presents with decreases exercise tolerance and intermittent claudication. Enhanced physical activity is one of the most effective means of improving the life of affected patients. Researchers tried to answer how enhanced physical activity helps in this regards? They found following answer to that: Exercise training-induce vascular adaptations to ischemic muscle. Vascular remodeling assumes an important means for improved oxygen exchange and blood flow delivery. Relevant exercise-induced signals stimulate angiogenesis, within the active muscle (e.g. hypoxia), and arteriogenesis (enlargement of pre-existing vessels via increased shear stress) to increase oxygen exchange and blood flow capacity, respectively. This above statement is supported by following evide...

I treat about 8-10 frozen shoulder (FS) cases a day. My impression from what ever I know as a specialist physiotherapist is as follows: 1. We take frozen shoulder as an easy diagnosis because the movement restrictions & end feel are characteristics of diagnosis. I take capsular pattern as the hall mark sign of diagnosing a frozen shoulder. Further the capsular (lethery) end feel confirms my diagnosis. As patients present to us at various duration after the onset & even after various treatments, they show different grades of pain, stiffness & psychological impacts on over all shoulder function. I find clearly defined clinical subgroups among the presenting population of frozen shoulders. 2. After the realization of the entity (FS) we remain so much pre-occupied with the technique administration among myriad of physiotherapeutic probabilities that we many time forget to notice the postural attitude of the patients. In majority cases I find UCS (upper crossed syndrome) &...

Introduction: Two intermediate joints i.e. the elbow and the knee are the most affected by myositis ossificans. Stretching to regain ROM in the post immobilization period is not out of danger of acquiring myositis. Contracted elbow poses difficulty to both operative and non-operative treatment (7). In my more than a decade of carrier as a graduate & specialist physiotherapist I have hardly seen case non-responding to physiotherapy for stiff elbow except cases associated with bony block. The part of world where I live in orthopedic surgery is not common for elbow stiffness. Recently I saw a case presenting with post operative stiff elbow. To my assessment stiffness was due to capsule as the stiffness was bi-directional and characteristic end-feel. Despite 15 days of oscillatory mobilization, stretching & other rehabilitation exercises, there was o remarkable change. I have no provision of serial casting in my set up. So I tried to get in to reviewing operative interventions in e...

Elbow is a highly constrained synovial hinge joint (3). A 50% reduction of elbow motion can reduce the upper extremity function by almost 80% (1). Elbow motion is essential for upper extremity function to position the hand in space (2). Stiffness of the elbow impairs hand function, because this is highly dependent on elbow extension and flexion and forearm rotation (1). Elbow joint is prone to stiffness following a multitude of traumatic and atraumatic etiologies. Diagnosis depends on a complete history and physical exam, supplemented with appropriate imaging studies (2). Søjbjerg JO defined stiff elbow as reduction in extension greater than 30 degrees, and/or a flexion less than 120 degrees. According to him supination and pronation are also often reduced as well but this author says contracture of the elbow is not related to forearm rotation. However, it seems this description matches the capsular restriction. General guideline of treatment (1, 2 & 3): 1. Elbow contracture is ...

Microneurography is a method using metal microelectrodes to investigate directly identified neural traffic in myelinated as well as unmyelinated efferent and afferent nerves leading to and coming from muscle and skin in human peripheral nerves in situ. 1. Microneurography is particularly important to investigate efferent and afferent neural traffic in unmyelinated C fibers, in particular, recording of efferent discharges in postganglionic sympathetic C efferent fibers innervating muscle and skin (muscle sympathetic nerve activity; MSNA and skin sympathetic nerve activity; SSNA). 2. It provides direct information about neural control of autonomic effector organs including blood vessels and sweat glands. 3. Sympathetic microneurography has become a potent tool to reveal neural functions and dysfunctions concerning blood pressure control and thermoregulation. 4. This recording has been used not only in wake conditions but also in sleep to investigate changes in sympathetic neu...

Form 1997 onwards various researchers have started investigating keenly on vestibule-sympathetic reflex’s interaction with cardiovascular reflexes. Ray CA has studied regulation of MSNA activity by vestibular system in humans by using head-down rotation (HDR) in the prone position. These studies have clearly demonstrated increases in muscle sympathetic nerve activity (MSNA) and calf vascular resistance during HDR. These responses are mediated by engagement of the otolith organs and not the semicircular canals.

this following is a part of my review i am going to send for a renowned journal. Comparison of impacts of activation of SNA via metaboreflex & chemoreflex (21) Bothdynamic and static exercise are associated with a metaboreflex activation of sympathetic activity. Both dynamic and static exercises are associated with a metaboreflex activation of sympathetic activity. Arterial hypoxemia is associated with a peripheral chemoreflex-mediated increase in sympathetic activity. Symathoexcitation manifests by increases in heart rate, blood pressure, and ventilation. Characteristics of metaboreflex induced SNA: Increases in ventilation and heart rate being most prominent during dynamic exercise and blood pressure most prominent during static exercise. Characteristics of chemoreflex induced SNA: Increases in ventilation and heart rate, but no change in blood pressure. Although an increase in systolic blood pressure has been reported in subjects who performed dynamic exercise in hypoxic conditi...

Brain injury is one of the most common types of traumatic injury. In critical care units, patients with moderate to severe brain injury are often intubated and sedated in an effort to diminish the workload of the brain. Agitation or restlessness is common in these patients and can be associated with fever, posturing, tachycardia, hypertension, and diaphoresis. This exaggerated stress response, known as sympathetic storming, occurs in 15% to 33% of patients with severe traumatic brain injury who are comatose (score on Glasgow coma scale [GCS] ≤ 8). Signs and symptoms of sympathetic storming: Posturing, dystonia, hypertension, tachycardia, pupillary dilatation, diaphoresis, hyperthermia, and tachypnea. The episodes appear unprovoked and can last for hours or end abruptly. Sympathetic storming often occurs after discontinuation of administration of sedatives and narcotics in the intensive care unit (ICU). Sympathetic storming can occur within the first 24 hours after injury or up to weeks...

Both disc & vertebral abnormalities commonly presents with clinical symptoms affecting the lower extremities. Patients commonly present with pain, numbness and sensory disturbance in lower extremities. Some times these symptoms are suggested to be related to sympathetic nerve disturbance. Akihiko N & colleagues examined whether these patients experience a difference in sympathetic nerve flow in terms of muscle sympathetic nerve activity (MSA) compared to healthy subjects. Salient points from the study are as follows: 1. Basic MSAs (muscle sympathetic activities) for IDH (inter-vertebral disc Hernia) and SCS (spinal canal stenosis) patients that were introduced from a common peroneal nerve. 2. MSA behavior and muscle blood flow introduced from the tibialis anterior muscle over 30 seconds while performing the Valsalva maneuver are examined. NB: 1. Valsalva Maneuver is a well known technique that artificially facilitate MSA 2. Sympathetic activity in muscle has a vaso-...

Shinomiya K reported dissociated motor loss due to cervical spondylosis and disc herniation presenting with deltoid paresis in the absence of sensory deficits or myelopathy (5). The clinical entity is recognized as CSA or Cervical spondylotic amyotrophy. Cervical spondylotic amyotrophy is the clinical syndrome in cervical spondylosis characterized by severe muscular atrophy in the upper extremities, with an absent or insignificant sensory deficit. Pathophysiology of this particular syndrome has not been well understood. However, pathophysiology of this syndrome may be multisegmental damage to the anterior horns caused by dynamic cord compression, possibly through circulatory insufficiency (2). Abnormal venous circulation within the cord may cause the selective involvement of the gray matter (3). Signs/symptoms: 1. Unilateral muscle weakness and atrophy in the deltoid and biceps muscles (1). 2. Very little/insignificant or no significant sensory deficit (2). 3. Age of onset 30-...