Dr Satyajit Mohanty blogs

Lumbar facet pain (1): Lumbar facet joints are a well recognized source of low back pain and referred pain in the lower extremity in patients with chronic low back pain. Conventional clinical features and other non-invasive diagnostic modalities are unreliable in diagnosing lumbar zygapophysial joint pain. However with invasive diagnostic technique the chance of false positive result may be up to 47% but these controlled diagnostic studies have shown the prevalence of lumbar facet joint pain in 27% to 40% of the patients with chronic low back pain without disc displacement or radiculitis. Facet joint surface area in LBA (2): Facet joint surface area is an important parameter for understanding facet joint function and pathology. Otsuka et al investigated lumbar facet joint surface area in relation to age and the presence of chronic low back pain. In this invivo study the following things are found: 1. The lumbar facet area was significantly greater at the inferior lumbar levels and a...

How facet joint pain manifests? Facet or zygapophysial joints are considered to be common sources of chronic spinal pain. In addition to causing localized spinal pain, facet joints may refer pain to adjacent structures. Cervical facet joint pain may radiate to the head, neck, and shoulders. Thoracic facets may produce paraspinous mid-back pain with neuralgic characteristics; and lumbar facet joints may refer pain to the back, buttocks, and proximal lower extremities. Referred pain may assume a pseudoradicular pattern, making the underlying diagnosis difficult to confirm, without the use of diagnostic blocks. Joint innervation: Facet joints are well innervated by the medial branches of the dorsal rami. Neuroanatomic, neurophysiologic, and biomechanical studies have demonstrated free and encapsulated nerve endings in facet joints, as well as nerves containing substance P calcitonin gene-related peptide; facet joint capsules contain low-threshold mechanoreceptors, mechanically sensitive n...

Clinical examination is not an efficient method of diagnosis of spine pain!!! Pain emanating from various structures of the spine is a major cause of chronic pain problems. Linton et al estimated the prevalence of spinal pain in the general population as 66%, with 44% of patients reporting pain in the cervical region, 56% in the lumbar region, and 15% in the thoracic region. Manchikanti et al reported similar results. Despite the high prevalence of spinal pain, it has been suggested that a specific etiology of back pain can be diagnosed in only about 15% of patients with certainty based on clinical examination alone (2). Prevalence of facet joint pain & Z joint pain: In the 1990s precision diagnostic blocks were developed, including facet joint blocks, provocative discography, and sacroiliac joint blocks. Facet joints have been implicated as a cause of chronic spinal pain in 15% to 45% of patients with chronic low back pain, 48% of patients with thoracic pain, and 54% to 67% of pat...

I. Introduction o other causes of anterior knee pain, besides primary PF pain o differential diagnosis may be more difficult than anticipated owing to interrelationships o realize that more than one problem may exist concurrently o a small acute injury may stir up an underlying mechanical anomaly that had previously been painfree; daily activity with a malalignment may be enough to perpetuate symptoms II. Plica o embryologically the knee is formed by the fusion of three synovial compartments and the intervening synovial tissues resorbed. The plicae are synovial remnants of these synovial tissues o intrapatellar plica (ligamentus mucosum) most common and runs parallel to the ACL; it has no clincial significance o suprapatellar second most common: acts as a tethering band in the superior portion of the quadriceps bursa and may separate it into two separate segments o medial plica least common, but probably produces the most symptoms; runs distally along the ...

Progressively Accelerating Cardiopulmonary Exertion (PACE) – A More Effective Alternative to Modern Exercise Prescriptions This following is an article from a news letter from Dr. Al Sears (USA) Ask a personal trainer, pick up a fitness magazine, or consult a medical organization and you will see the same fitness-training concepts. These modern exercise prescriptions will be cardiovascular endurance training (CVE) or “cardio” for short, “aerobic” exercises often given in hour-long group classes, and weight training on machines or with free-weights. These forms of exercise, while promoted by a majority of physicians and fitness professionals, fail to bring about the physiological adaptations necessary for a healthy and vital cardiopulmonary system and may leave patients at a heightened risk of mortality. The key failing of both cardiovascular endurance training and aerobics classes is the focus on exercise duration at the expense of intensity. In order to achieve the recommended duratio...