Dr Satyajit Mohanty blogs

Many ulnar wrist pains are obscure & according to Bottke both surgical exploration and nonoperative treatment have been less than satisfying. Most of the times specific physical examination and standard radiographs were unrevealing in these cases. Even with specific diagnostics test such as arthroscopy, treatment results could not be correlated with arthrographic findings (1). Ulnar wrist pain,Distal RUJ & TFCC: The distal radioulnar joint (DRUJ) acts in concert with the proximal radioulnar joint to control forearm rotation. The DRUJ is stabilized by the triangular fibrocartilage complex (TFCC). This complex of fibrocartilage and ligaments support the joint through its arc of rotation, as well as provide a smooth surface for the ulnar side of the carpus. TFCC and DRUJ injuries are part of the common pattern of injuries we see with distal radius fractures. While much attention has been paid to the treatment of the distal radius fractures, many of the poor outcomes are due t...

Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro...

  Key word: Carpal instability, Data base: Pubmed Wrist anatomy- extrinsic & and intrinsic ligaments The extrinsic (radiocarpal) and intrinsic (intercarpal) ligaments maintain carpal stability. The major extrinsic ligaments are the radioscaphocapitate, radiolunotriquetral, short radiolunate, and dorsal radiocarpal ligaments. The scapholunate and lunotriquetral ligaments are the most important intrinsic ligaments and the primary wrist stabilizers. The most common causes of carpal instability are unstable fracture of the scaphoid, scapholunate dissociation, and lunotriquetral dissociation (7). Let us discuss the causes of carpal instability. Classification of carpal instability is presented below is based on anatomic and kinematic characteristics of the wrist. A classification of the subtle patterns of carpal instability is presented below.   Navarro's concept of the carpus (1921): Carpals of wrist are arranged in 3 vertical longitudinal columns: late...

Synonyms:   •    Therapeutic Laser •    Low Level Laser Therapy •    Low Power Laser Therapy •    Low Level Laser •    Low Power Laser •    Low-energy Laser •    Soft Laser •    Low-reactive-level Laser •    Low-intensity-level Laser •    Photobiostimulation Laser •    Photobiomodulation Laser •    Mid-Laser •    Medical Laser •    Biostimulating Laser •    Bioregulating Laser 4 categories of lasers –    Crystal & Glass (solid - rod) •    Synthetic ruby & others (synthetic ensures purity) –    Gas (chamber) – 1961 •    HeNe, argon, CO2, & others –    Semiconductor (diode - channel) - 1962 •    Gallium Arsenide (GaAs under investigation) –    L...

Classification of spondyloarthritides (SpA) & USpA Definition: The spondyloarthritides (SpA) are an interrelated group of rheumatic diseases that are characterized by common clinical symptoms and genetic similarities. For clinical purposes, 5 subgroups are differentiated: 1.    AS (ankylosing spondylitis) 2.    Psoriatic SpA (PsSpA) 3.    Reactive SpA (ReSpA) 4.    SpA associated with inflammatory bowel disease (SpAIBD) and 5.    Undifferentiated SpA (uSpA) Features of SpA: Important clinical features of the SpA are 1.    inflammatory back pain (IBP) 2.    asymmetric peripheral oligoarthritis predominantly of the lower limbs 3.    enthesitis 4.    specific organ involvement such as anterior uveitis (eye) , psoriasis (skin) and chronic inflammatory bowel disease The most important subtype of SpA is ankylosing spondylitis (AS), which is now consi...

All people dealing with soft tissue pain & dysfunction "Eosinophilic Fascitis" is rearrest of the rare condition to encounter. Take a note of it. It is a matter of debate for all fascia researchers & people involved in "Fascia research congress" Pubmed link to "Eosinophilic Fascitis":   http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001483/

A retrolisthesis is a posterior displacement of one vertebral body with respect to the adjacent vertebrae to a degree less than a luxation (dislocation). Retrolisthesis is relatively rare but when present has been associated with increased back pain and impaired back function. Clinically speaking, retrolisthesis is the opposite of spondylolisthesis (anterior displacement of one vertebral body on the subjacent vertebral body). Retrolistheses are most easily diagnosed on lateral x-ray views of the spine. Views, where care has been taken to expose for a true lateral view without any rotation, offer the best diagnostic quality. Retrolisthesis may occur more commonly than initially believed. However retrolisthesis (backwards slippage of one vertebral body on another) has historically been regarded as an incidental finding, one which doesn’t cause any symptoms, and is considered to be of little or no clinical significance. But there is a possible association between retrolisthesis and...

Different varieties sitting postures: A. Common sitting postures: 1.    Chair sitting 2.    Crossed sitting 3.    Crossed sitting with arms wrapped around both knees & locked in front 4.    Half crossed sitting 5.    Crook sitting 6.    Inclined sitting (to back) 7.    Inclined sitting (to sides) 8.    Inclined long sitting 9.    Side sitting 10.    Stoop sitting 11.    Fall out sitting 12.    Ride sitting 13.    Kneel sitting 14.    Crouch sitting B. Activities in sitting: 1.    Twisting in sitting 2.    Bending & reaching in sitting (sidewise- office works & in front- driving) 3.    Hitching & Hiking (to relieve pressure on buttocks in prolonged sitting) C. Co-existing unavoidable stress f...

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 &...