Dr Satyajit Mohanty blogs

This disease is named after Danish radiologist (1855 - 1950) Christian Ingerslev Baastrup. Introduction & Epidemiology: It is claimed that Baastrup disease is responsible for intractable LBA (1). Though it is reported in mostly lumbar spine it’s cervical spine variant is also reported (2). Gardella called Baastrup disease as spinous process syndrome (3). It is reported in many occupational areas such as miners (4) & heavy vehicle drivers (8). Among of much debate now it is considered mostly a case of aging related problem. Let us discuss in little more detail: The Baastrup disease is characterized by the development of abnormal contact between adjacent spinous processes of the lumbar spine that results in rubbing against each other producing a bursitis which further result in focal midline pain and tenderness relieved by flexion and aggravated by extension. Epidemiology: It tends to be more common in the elderly. According to Maes et al (5) the prevalence of Baas...

Clinicians have long used a clinical scale to grade severity of neurological loss in SCI. First devised at Stokes Manville before World War II and popularized by Frankel in the 1970's, the original scoring approach segregated patients into five categories. Frankel classification: Grade A:  no function Grade B: sensory only Grade C: some sensory and motor preservation Grade D: useful motor function Grade E: normal function ASIA classification: Grade A:  Complete. No motor or sensory function preserved in the sacral segments (S4-S5) Grade B: Incomplete. Sensory function is preserved but motor function is affected below the neurological level & includes the sacral segments (S4-S5) Grade C: Incomplete. Motor function is preserved below the neurological level, and more than half of the key muscles below the neurological level have a muscle grade less than 3. Grade D: Incomplete. Motor function is preserved below the neurological level, and more than half of the key muscles...

Bankart surgery: Bankart lesion is an injury of the anterior (inferior) glenoid labrum due to repeated (anterior) shoulder dislocation. Repeated dislocation forms a pocket at the front of the glenoid that allows the humeral head to dislocate into it. It is often accompanied by a Hill-Sachs lesion (damage to the posterior humeral head seen as a depression on X-ray). A bony bankart is a Bankart lesion that includes a fracture in of the anterior-inferior glenoid cavity. Bankart lesion warrants surgery. In Bankart surgery the anterior (inferior) glenoid labrum is reattached to the glenoid. Generally there is a anterior approach to this shoulder operation. Rehabilitation is the key to successful reinstitution of functional activities. As it is a very common injury in sports like javelin throwing return to sports is heavily dependant on post operation physiotherapy. The following is an sample schema of physiotherapy & rehabilitation approach to the Bankart surgery.  ...

According to Rossi et al, for knee; clinicians should have own series of exams with whom he is more confident and on whom he relies on for diagnosis. Usually, three sets of series are used: 1. One for patello-femoral/extensor mechanism pathologies 2. Another for meniscal and chondral (articular) lesions 3. The other one for instability evaluation Among the above said to assess the 3rd category is difficult to diagnose. Often the diagnosis becomes more difficult because there are more than one tissue involved. Following are clues to diagnose them: 1. Anerior medial instability (AMI): AMI occurs due to: ACL + MCL + medial meniscus injury. Test series to diagnose it are: valgus stress, anterior drawer, Lachman tests 2. Anterior lateral instability (ALI): ALI occurs due to: ACL + lateral capsule + lateral meniscus injury. Test series to diagnose it are: valgus stress, anterior drawer, Lachman, pivot shift tests 3. Posterior lateral instability (PLI): PLI occurs due to: Injury to posteri...

The SLAP lesions: Superior labrum tears were first described by Andrews. Further SLAP lesions as described by Snyder are subdivided into 4 types (I-IV) & this classification is according to their severity of tear. For best diagrams of the SLAP lesions refer to the following site: http://www.shoulderdoc.co.uk/article.asp?article=1027 Type I SLAP lesion: This is a partial tear and degeneration to the superior labrum, where the edges are rough and fray along the free margin, but the labrum is not completely detached. Type II lesion: Type II is the comonest type of SLAP tear. The superior labrum is completely torn off the glenoid, due to an injury (often a shoulder dislocation). This type leaves a gap between the articular cartilage and the labral attachment to the bone. Type 2 SLAP tears can be further subdivided into (a) anterior (b) posterior, and (c) combined anterior-posterior lesions. Type III lesion: A Type III tear is a 'bucket-handle' tear of ...

In previous years, fitness was commonly defined as the capacity to carry out the day’s activities without undue fatigue. These days, physical fitness (PF) is considered a measure of the body’s ability to function efficiently and effectively in work and leisure activities, to be healthy, to resist hypokinetic diseases, and to meet emergency situations. Physical fitness comprises two related concepts: general fitness (for the purpose of health), and specific fitness (a task-oriented definition based on the ability to perform specific aspects of sports or occupations). Physical fitness is generally achieved through correct nutrition, exercise, and enough rest. PF can be measured as an out come of physical activity and also as a moderator on morbidity and mortality. Physical fitness for purposes of health, is best defined by the specific components that relate to improved health or reduced disease. The components of Health-Related Fitness are: –    Morphological ...

Narakas classified babies with obstetric palsy into four groups I. Upper Erb's palsy (C5, C6 injury) II. Extended Erb's (C5, C6, C7 injury) III. Total palsy (C5, C6, C7, C8 & T1 injury) IV. Total palsy with Horner’s syndrome (C5, C6, C7,C8 & T1 injury) Clinically however Narakas Group II can be sub-classified into two groups according to this 'early recovery of wrist extension.' II a. recovery of Gr 3 wrist extension before 2 months of age. II.b. recovery of Gr 3 wrist extension after 2 months of age. II a recovers the UL function much faster than the II b group. Muscles paralysed in Group I are: Biceps, Deltoid, Brachialis, Brachioradialis, partly supraspinatus, infraspinatus, Supinator. Extended erbs palsy involves the elbow & wrist Intrinsic muscles of hand & ulnar flexors are paalysed in total palsy Horner’s syndrome comprise of: Ptosis, Miosis, Anhydrosis, Enopthalmus, Loss of ciliospinal reflex. Sensory loss in Gr I &...

Hi all physiotherapists. Time is changing rapidly for us. Our services at different areas of medicine has brought credit to us. As a result of that In USA: We are trying to get into 1st hand practice where clinical entry level DPT and many such advancements are noted. Link:  In UK: Recently in BBC news it was flashed that "Physiotherapists may get independent medicine prescription rites". Already physios have injection rights in UK. Link: http://www.bbc.co.uk/news/health-15037491 http://www.somed.org/ In AUS: Physiotherapists are trying to persuade legislators to allow physiotherapists for minor surgeries "wound suturing", injection rights, independent prescription writes.      Link: 9thnrhc.ruralhealth.org.au/program/docs/papers/moore_D3.pdf  (Download) 2008 WHO classification of "Health workers"  Please refer to the WHO (World health organization) classification (2008) of health workers which is an international standard classi...

Lachman's vs. Anterior Draw Test •    Lachman's test may be more difficult for clinicians to perform but tends to be more sensitive •    In the anterior draw test knee is positioned so that the hamstrings have a mechanical advantage. Increased hamstring activity can inhibit tibial translation, causing a false negative test •    A torn meniscus can act as a block to tibial motion, again causing a false negative while doing the anterior draw test Anterior drawer test with tibia external rotation: Anterior drawer test with tibia in neutral rotation demonstrates equal displacement of both condyles & this displacement is eliminated by internal rotation of the tibia, then both anteromedial and anterolateral rotary instability may be present. Similarly positive anterior drawer test in neutral tibial rotation, that is accentuated when the test is repeated in 30 deg of external rotation and reduced when performed with the tibia in...

Many confuse marked tenderness at the coracoid tip, lateral pectoral and medial elbow sites to be a variant of fibromyalgia however usually it comes along with tenderness at the C6-7 level in the cervical spine. A close look in to the history reveals in this group of patients lose tenderness at C5-6 and standard upper body sites with proper neck support during sleep, but remained symptomatic at coracoid tip, lateral pectoral, medial elbow and C6-C7. Smythe HA (1994) have supported that mechanical factors determine patterns of symptoms and tenderness in this group. This implies that we are talking of segmental referred pain or referred tenderness rather than a pathologically ill-defined spectrum called “fibromyalgia”. If we differ on this front our treatment strategy is mislead. That’s why centrally acting medications or behavioral modifications are equally disappointing outcomes. To add to that tricyclic medications, stretch and spray or trigger point injections may be simply ...

Synonyms: stiff man syndrome (SMS), stiff person syndrome (SPS), stiff leg syndrome (a focal SMS) etc Introduction & definition: Moerch and Woltman reported the first 14 cases with this syndrome for more than 50 years since 2010. Stiff man syndrome (SMS) is an uncommon (rare) neurological disease that manifests with disorder of motor function which is characterized by rigidity of axial musculature and fluctuating painful spasms, which are often induced by startle or emotional stimuli. Clinical and immunological findings indicate that SMS is a heterogeneous disease, suggesting the need to define its diagnostic criteria. But it has basic 2 forms either it can be generalized or focal. Criteria for the diagnosis of SPS were proposed but there are several variants of this syndrome described. These variants include focal variants of SMS. Variants include stiff limb syndrome (SLS), jerking SMS and progressive encephalomyelitis with rigidity and myoclonus (PERM). Recognition of the clini...

To spare the treating hands of the clinicians & more to increase the precision of treatment in musculoskeletal therapy, clinicians now days are more and more inclined to use instruments for soft tissue mobilization. None the less these equipments can also be used to diagnose the soft tissue lesions more accurately enhancing the palpation capacity of the clnician. However, the objectives of this form of treatment are as follows: • Break down scar within the tissues • Promote blood flow into the sore area • Establish healing in damaged tissues • Release adhesions within the layers of tissue • Improve lymphatic circulation David Grastron is the pioneer in developing the new area instruments for soft tissue mobilization. However stylus massage was reported to be used in trigger point deactivation by Russian in Olympic game. Spa professionals use various types of massage equipments during spa sessions. Three common treatments always come into mind when soft tissue mobiliz...

Definition of GIRD: GIRD is a 20° or greater loss of internal rotation of the dominant shoulder compared with the non-dominant shoulder. Introduction: Glenohumeral internal rotation deficit, often diagnosed in players of overhead sports, has been associated with the development of secondary shoulder lesions. Conditions such as labral and rotator cuff injuries have been linked with decreases in glenohumeral internal-rotation and increases in external-rotation motion. This group also shows a loss of horizontal or cross-body adduction in the throwing shoulder when compared with the non-throwing shoulder. GIRD is also strongly associated with scapular dyskinesis. Tennis players, swimmers & athletes in throwing sports are commonly affected by GIRD. Deficit in dominant shoulder of tennis players is about twice the deficit found in swimmers. Data suggest that GIRD and scapular position change worsens as the level of competition increases in overhead sports. Pathologic conditions in the sh...

Grade 0 = Normal Grade 1 = Doubtful narrowing of the joint space & possible osteophytic lipping Grade 2 = Definite Osteophytes & definite narrowing of joint space Grade 3 = Moderate multiple Osteophytes, definite narrowing of joint space, some sclerosis & possible deformity of bone contour Grade 4 = Large Osteophytes, marked narrowing of joint space, severe sclerosis & definite deformity of bone contour

The impingement in shoulder can clearly be classified into internal & external varieties. Internal impingement: The internal impingement syndromes result from the impingement of the soft tissues of the rotator cuff and/or joint capsule on the glenoid or between the glenoid and the humerus. External impingement: The external impingement syndromes result from the impingement of the soft tissues of rotator cuff and bursa on the structures of the coracoacromial arch. External shoulder impingement and rotator cuff disease has been corroborative despite of research arguments. Attempts have been made to identify objective imaging criteria that confirm the diagnosis of impingement, but at present external impingement remains primarily a clinical diagnosis. Mainly shoulder impingement is caused by compression of the supraspinatus tendon underneath the coracoacromial arch, mostly in forward flexion of the arm. Stages of external impingement: Different stages of impingement syndrome are descr...

A claw toe is a toe that is contracted at the PIP and DIP joints and can lead to severe pressure and pain. Ligaments and tendons that have tightened cause the toe's joints to curl downwards. Claw toes may occur in any toe, except the big toe. There is often discomfort at the top part of the toe that is rubbing against the shoe and at the end of the toe that is pressed against the bottom of the shoe. Causes: Claw toe deformity results from altered anatomy and/or neurologic deficit, resulting in an imbalance between the intrinsic and extrinsic musculature to the toes. 1. Claw toe deformity can develop as a complication of fracture of the tibia. The deformity develops following a tibia fracture is basically due to adhesions of the flexor hallucis longus (FHL) and flexor digitorum longus (FDL) muscles to the surrounding structures under or just proximal to the flexor retinaculum. According to Fitoussi et al it may be related to a subclinical compartment syndrome localized in the distal...

Asian physios please see the following web site to appreciate the job APTA is doing uplifting the physical therapy profession. American board of physical therapy specialists (APTA certifying the physical therapy specialists) http://www.abpts.org/home.aspx

Introduction: Occupations & occupational demands have changed in the recent era. Modernization & Industrialization has changed the face of occupational activities & need of work related physical performances. We have slowly crawled in to mostly a sedentary era. On the other side passive leisure time pursuits are taking over active leisure time pursuits. The situation is such that the average office going adult hardly moves his or her axial & apendicular joints in it’s full range of motion. Mean temporal classification of ADL (activity of daily living) closely equates 7-8 hours of sleeping; 8-10 hours of working and rest of hours are spent in house hold activities like washing, watching TV, purchasing grocery, rarely gardening or a sports etc. Office hour activities span more than one third of the day. Except in blue collar jobs (manual labor class) office hours consists of at least 2-4 hours sitting to full office hour invested in sitting like in banking, IT sector job...

Introduction: Sociocultural, economic, and manufacturing factors are 3 different major factors that influence sitting. "Correct" seated posture is associated with spine health was known to people possibly from Hippocratic era. But the debate has not dampened yet whether the sitting is directly a cause of LBA or it predisposes or precipitates LBA. From 1980s much of research has been put into ergonomically correct sitting & providing a work environment for correct sitting posture. However there is a question; is there any medically correct sitting posture? The correct sitting posture refers to maintenance of a correct lumbar spine lordosis actively (muscle contraction) or passively (chair or sitting back support) (described below elaborately in neutral spine position). Passive maintenance is sought because it is noticed that within minutes of sitting lordosis is reversed or lost. According to Ernst even the correct sitting is not out of danger because of the repetitive nat...