A. Jellad

Complex Regional Pain Syndrome Type I: Incidence and Risk Factors in Patients With Fracture of the Distal Radius

OBJECTIVE To examine the incidence and predictors of complex regional pain syndrome type I (CRPS I) after fracture of the distal radius. DESIGN Prospective study. SETTING University hospital. PARTICIPANTS A consecutive sample of patients (N=90) with fracture of the distal radius treated by closed reduction and casting. INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Occurrence of CRPS I, occurrence of pain, wrist and hand range of motion, radiographic measures, Patient-Rated Wrist Evaluation, Hospital Anxiety and Depression Scale, and Medical Outcomes Study 36-Item Short-Form Health Survey at baseline and 1, 3, 6, and 9 months follow-up. RESULTS CRPS I occurred in 29 patients (32.2%) with a mean delay ± SD of 21.7±23.7 days from cast removal. Univariate analyses found significant differences between patients with CRPS I and patients without CRPS I at baseline for sex (P=.021), socioeconomic level (P=.023), type of trauma (P=.05), pain at rest and activity (P=.006 and P<.001, respectively), wrist dorsiflexion and pronation (P=.002 and P=.001, respectively), finger flexion (P=.047), thumb opposition (P=.002), function of the hand (P<.001), and physical quality of life (QOL) (P=.013). Logistic regression showed that risk for CRPS I was higher in cases of women (odds ratio [OR]=5.774; 95% confidence interval [CI], 1.391-23.966), medium and low energy trauma patients (OR=7.718; 95% CI, 1.136-52.44), patients with a Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning score <40 (OR=4.931; 95% CI, 1.428-17.025), and patients with Patient-Rated Wrist Evaluation pain subscale score >16 (OR=12.192; 95% CI, 4.484-43.478). CONCLUSIONS CRPS I occurs frequently during the third and fourth week after cast removal, especially in women who report severe pain and impairment of physical QOL. Additional prospective studies are required to verify these findings in comminuted and operated fractures of the distal radius.

Efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain: a randomized, controlled study.

OBJECTIVE To assess the efficacy and treatment compliance of a home-based rehabilitation programme for chronic low back pain (CLBP). POPULATION CLBP outpatients treated in a Physical Medicine Rehabilitation or Rheumatology unit within a university hospital. METHODS We performed a prospective, comparative study. The participants were randomly assigned to either a home-based rehabilitation programme (Gp A) or a standard physical therapy (Gp B). The programme included four weekly sessions. In each group, we measured pain intensity (on a visual analogue scale, VAS), flexibility and muscle endurance (the Schöber MacRae test, finger-to-floor distance, thigh-leg angle, the Shirado and Sorensen test), functional and psychological repercussions (the Quebec functional index and the Hospital Anxiety and Depression scale) and handicap (on a VAS). Follow-up examinations took place at baseline and four weeks and three, six and 12 months later. RESULTS One hundred and seven patients (82 women) with a mean+/-standard deviation (S.D.) age of 35.7+/-0.8 years were included (with 54 patients in Gp A). At four weeks, a significant improvement (relative to baseline) was observed for all parameters in both study groups but with a significantly greater difference in Gp A, which was maintained at one year (despite an observed regression of the improvement at six months). At one year, compliance with the home-based rehabilitation programme was good (68.1%) and 59.5% of the patients regarded the programme as useful. CONCLUSION Our results suggest that a home-based rehabilitation programme is as effective as standard physical therapy. However, this type of programme requires patient motivation and regular follow-up.

Unusual clinical presentation of a partial tibialis anterior rupture.

Subcutaneous rupture of the tibialis anterior tendon is rare. Diagnosis is usually clear. The essential clinical symptoms are progressively: footdrop gait, loss of ankle flexion strength, ankle foot pain and claw toes. But the occurrence of an asymptomatic time period between the injury and the onset of clinical signs can make the diagnosis more difficult. MRI is the gold standard examination for tendons injuries and associated bone and joints damages. Surgical exploration confirms MRI findings. It constitutes the treatment of choice for tibialis anterior tendon rupture. Surgical or functional techniques used have an impact on the design of the rehabilitation program, essential step in the care management of these injuries. It avoids postoperative tendon adhesions and their functional consequences. We report here a case of a man presenting with footdrop gait as the only clinical symptom.

Isolated greater tuberosity fracture: Short-term functional outcome following a specific rehabilitation program.

BACKGROUND Evaluate the functional outcome of a specific program of rehabilitation during conservative treatment of fracture of the greater tuberosity. METHODS We retrospectively studied the records of 22 patients, with minimally displaced greater tuberosity fracture, according to inclusion criteria. All patients have received an early (one week after the injury) rehabilitation program based on physical analgesic therapy means, techniques for recovering range of motion, strengthening exercises, proprioceptive stabilization exercises and usability advices. The evaluation was done at baseline, one, two and three months of the end of physical treatment. RESULTS Pain, perceived disability and range of motion were improved significantly since the end of rehabilitation. The improvement of function (Constant score) was significant at different evaluation times. The functional result seems to be poor when patients are aged and pain is severe at baseline. CONCLUSION During conservative treatment of fracture of the greater tuberosity, earlier rehabilitation allows rapid range of motion and functional recovery limiting care duration. After fracture healing, the rehabilitation program becomes similar to that advocated in rotator cuff disease. Whatever the initial treatment choice, rehabilitation must be considered at the waning of the first week.

Osteoarthritis of the sacroiliac joint complicating resection of the pubic symphysis. Interest of a rehabilitation programme

Sacroiliac joint (SIJ) is an uncommon localisation of osteoarthritis. Instability of this joint is one of rare aetiologies. It can occur after resection of the pubic symphysis for whatever the reason. The biomechanical consequences on the SIJ are increasing shear forces and vertical restrain. This leads to secondary progressive SIJ osteoarthritis. There is no specific rehabilitation programme for this pathology. Here, we report the case of a patient who presents SIJ osteoarthritis 20 years after surgical resection of the pubic symphysis for osteochondroma. We proposed a rehabilitation programme based on the pelvic biomechanical characteristics. It included specific exercises of muscular strengthening (the transversely oriented abdominal muscles and pelvic floor muscles) and muscular stretching (the psoas major muscle). We obtained an improvement of pain and functional capacity in our patient.

Interest of visual biofeedback rehabilitation on balance in the lower limb amputee

Objective The aim of our study was to evaluate the role of the visual biofeedback in balance disorders in lower limb amputees. Material/Patients and methods A prospective study performed in lower limb amputees followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The first group received visual biofeedback on the balance platform combined with conventional rehabilitation of balance disorders. The second group of patients was treated only by conventional rehabilitation. Patients were evaluated clinically before and after each program. The total duration of the protocol was 24 sessions. Results Ten patients participated in our study. Five patients received only conventional rehabilitation and the five others were treated also using visual biofeedback. Both groups were clinically improved. Patients benefiting from visual biofeedback rehabilitation had a statistically greater improvement in the gain on the functional scores (L Test, monopodal support) as well as an improvement in the area and length of the center of pressure in the stabilogram with closed eyes. Discussion/Conclusion Visual biofeedback rehabilitation seems to improve the integration of proprioceptive information with a functional gain.

Functional and socio-professional outcome of lower limb amputees: About 101 cases

Objective The objective of this study was to assess the functional and socio-professional future of lower limb-amputated patients. Patients and methods This is a 3-year-prospective study of lower limb-amputated patients, followed at the Physical Medicine and Rehabilitation department of the University Hospital of Monastir. The data analyzed were epidemiological, clinical, functional [the index of locomotion (ICL), the score “Special interest group of the amputee physician” (SIGAM)] and socio-professionals. Results We collected 101 patients with a mean age of 61.3 years with a male predominance (75.2%). Sixteen patients (15.8%) were initially braced and 58 (57.4%) had their device during the study period with an average delay of 10.08 months compared to surgery. Seventy-two patients had a job and only 8 amputees initially had a driving license. Forty-nine patients (48.5%) were initially able to do their own toilet against by 52 (51.5%) needing a third person to help them. After fitting, the rates have improved from 74.13% to 82.75 as well as the walking ability. For the device-fitted patients, ICL averaged 28.09. The average value of the non-ICL fitted patients initially increased from 25.89 to 31.25 (at least 6 months after being fitted). The SIGAM score assessment for all fitted patients showed that the most represented clinical grade was grade B for 20 patients (27.02%), followed by the degree F for 18 patients (24.32%). Forty-five patients (44.5%) had a professional outplacement and one remained able to drive after fitting. Discussion/Conclusion The device acquisition is a significant change for patients on the functional and professional levels. It allows a significant improvement in various activities of daily life with greater autonomy.

Prise en charge rééducative d’une neuromyopathie de réanimation suite à un tétanos généralisé : à propos d’un cas

P061-f Paraosteo-arthropathie neurogene secondaire a une neuromyopathie de reanimation : a propos de deux cas W. Kessomtini a, N. Gader a, H. Ben Brahim a, S. Younes b, W. Said a, A. Jellad c a Unite de medecine physique et readaptation, CHU Tahar Sfar, Mahdia, Tunisie b Service de neurologie, CHU Tahar Sfar, Mahdia, Tunisie c Service de medecine physique et readaptation, CHU Fattouma Bourguiba, Tunisie

Neuropathies périphériques : épidémiologie et prise en charge en rééducation

P045-f Pied plat valgus secondaire à une rupture isolée du spring ligament (calcanéo-naviculaire plantaire). À propos d’un cas, état de l’art en échographie M. Cohen a,∗, X. Demondion b, B. Piclet-Legre c, M. Helix-Giordanino c, J.-M. Coudreuse d a Clinique Juge, service de radiologie, Marseille, France b Laboratoire d’anatomie, faculté de médecine de Lille, Lille, France c Clinique Juge, Marseille, France d Hôpital Salvator, CHU de Marseille, Marseille, France ∗Auteur correspondant.

Profil épidémiologique des patients atteints de neuropathies diabétiques en consultation de médecine physique

P045-f Pied plat valgus secondaire a une rupture isolee du spring ligament (calcaneo-naviculaire plantaire). A propos d’un cas, etat de l’art en echographie M. Cohen a,∗, X. Demondion b, B. Piclet-Legre c, M. Helix-Giordanino c, J.-M. Coudreuse d a Clinique Juge, service de radiologie, Marseille, France b Laboratoire d’anatomie, faculte de medecine de Lille, Lille, France c Clinique Juge, Marseille, France d Hopital Salvator, CHU de Marseille, Marseille, France ∗Auteur correspondant.