Abdulaziz Al-Ahaideb

Treatment of knee osteoarthritis in relation to hamstring and quadriceps strength.

[Purpose] To assess the effect of hamstring and quadriceps strengthening exercises on pain intensity, gait velocity, maximum isometric strength, and activities of daily living of patients with knee osteoarthritis (OA). [Subjects and Methods] A total of 20 patients with knee OA, 50 to 65 years of age (57.65 ± 4.78 years), received hot packs, strengthening exercises for the quadriceps and the hamstring muscles and stretching exercises for hamstring muscles. Outcome measures included: the Western Ontario and McMaster Universities OA index questionnaire (WOMAC) scores for assessing health status and health outcomes of knee OA; self-reported pain intensity scores, measured using a visual analogue scale; the 50 ft walk test (a measure of gait velocity and function); and handheld dynamometry (a tool used to measure maximum isometric strength of knee extension and flexion). [Results] There was a significant difference between pre- and post-intervention measures of pain intensity, 50 ft walk times, hamstring strength, and quadriceps strength. Significant differences in WOMAC measures were also observed in the subscales of pain, stiffness and physical function, as well as WOMAC total scores. [Conclusion] Strengthening the hamstring muscles in addition to strengthening the quadriceps muscles proved to be beneficial for perceived knee pain, range of motion, and decreasing the limitation of functional performance of patients with knee OA.

High-resolution ultrasound accurately identifies the medial antebrachial cutaneous nerve at the midarm level: a clinical anatomic study.

Objectives: The present prospective volunteer study was designed to describe a technique for ultrasound identification of the medial antebrachial cutaneous nerve (MACN) and a technique for ultrasound-guided blockade of this sensory nerve of the upper limb. Methods: Twenty male volunteers were included in this study. After cross-sectional ultrasound identification of the MACN at the upper arm, where it is closely adjacent to the basilic vein, a selective blockade via an in-plane needle guidance technique was performed with 0.3 mL of mepivacaine 1.5% under direct ultrasound visualization. Sensory loss to pinprick at the upper extremity was evaluated and compared with the contralateral side. Results: Constant ultrasound visualization of the MACN adjacent to the basilic vein at the upper arm level was possible in all cases. Blockade of the MACN under direct visualization was associated with a 100% success rate. Conclusions: The results of this investigation enable selective blockade of the MACN via ultrasound. Moreover, our data provide insight regarding the specific anatomic course and the integrity of this sensory nerve, which could be used for plastic and reconstructive surgical indications and for diagnosis of nerve injury.

Septic arthritis in patients with rheumatoid arthritis

There is an increasing number of rheumatoid patients who get septic arthritis. Chronic use of steroids is one of the important predisposing factors. The clinical picture of septic arthritis is different in immunocompromised patients like patients with rheumatoid arthritis. The diagnosis and management are discussed in this review article.

Comparative Study of Hamstring and Quadriceps Strengthening Treatments in the Management of Knee Osteoarthritis

[Purpose] Osteoarthritis (OA) of the knee is the most common form of joint disease. It is one of the major causes of impaired function that reduces quality of life (QOL) worldwide. The purpose of this study was to compare exercise treatments for hamstring and quadriceps strength in the management of knee osteoarthritis. [Subjects and Methods] Forty patients with OA knee, aged 50–65 years were divided into 2 groups. The first group (57.65±4.78 years) received hot packs and performed strengthening exercises for the quadriceps and hamstring, and stretching exercises for the hamstring. The second group (58.15±5.11 years) received hot packs and performed strengthening exercises for only the quadriceps, and stretching exercise for the hamstring. Outcome measures were the WOMAC (Western Ontario and McMaster Universities OA index questionnaire), Visual Analogue Scale (VAS) assessment of pain, the Fifty-Foot Walk Test (FWS), and Handheld dynamometry. [Results] There was a significant difference between the groups. The first group showed a more significant result than the second group. [Conclusion] Strengthening of the hamstrings in addition to strengthening of the quadriceps was shown to be beneficial for improving subjective knee pain, range of motion and decreasing the limitation of functional performance of patients with knee osteoarthritis.

Posterior cruciate ligament avulsion fracture in children: a case report with long-term follow-up and comprehensive literature review

Isolated posterior cruciate ligament (PCL) avulsion fracture from the tibial attachment in children is extremely rare. The initial diagnosis is often missed in clinical practice. The present report describes the outcome in a long-term follow-up case of an 11-year-old boy involved in a motorcycle accident. The lesion was fixed through an open posterior approach with anatomic reduction. The patient has been followed for 4 years, and his final assessment revealed stable painless knee with an excellent functional outcome. The procedure is described and a surgical video outlines the pre-operative clinical examination. The particularity of this case is the long-term follow-up and the excellent outcome. We reviewed similarly reported cases in the literature and the different methods used in current practice.

Impact of knee osteoarthritis on the quality of life among Saudi elders: A comparative study

Background: The population sector of elders is progressively increasing, and it is estimated that it will reach almost one third of the total population in 2025. Large number of elders is suffering from knee osteoarthritis (OA) as the most prevalent rheumatic diseases worldwide. Recently there is a growing concern among researchers and health professionals regarding the impact of knee OA on elders and their quality of life (QOL). Objectives: To explore the impact of knee OA on QOL among Saudi elders aged between 60-70 years and to define which of the Short from survey (SF-36) domain (s) and which component, physical or mental, are mostly affected by this knee OA. In addition to study the presence of correlation between scores of SF-36 domains and components and the following factors; patient′s age, gender, weight, height, body mass index (BMI), disease duration and severity, educational level, stability of the income source, income, housing type, housing ownership, and care giver. Subjects and Methods: This study was carried out during (December/ 2010 - March/ 2011). One hundred and twenty Saudi elders, (58, 48.3% male), aged between 60-70 years with mean± SD (64.5 ± 3.03) participated in this comparative study. Half of them had severe knee OA, as defined by knee society score (KSS), they were recruited from King Saud Medical City. The other half were without knee OA, were recruited from Prince Salman Social Center and the Saudi association for the Cooperative Retirees. Arabic version of Short Form -36 questionnaire was used to measure participants QOL domains scores as well as the overall scores of the physical and mental components of the questionnaire. Data collected were statistically treated and presented in tables. Results: Current study showed a better significant scores for Saudi elders without knee OA on all SF-36 domains (p = 0.0001). Calculating the patients′ domain′s scores as percentage from the maximum domain′s scores which showed that, the mental health component of elders patients was more affected than physical health component and that role limitation due to emotional problems domain (RLEP) was the most affected domain (22.7%). Physical component showed positive correlation with income (r= 0.320, P= 0.013). While mental component showed negative correlation with disease duration (r = -0.341, P=0.008). Conclusion: Knee OA has negative impact on Saudi elders′ QOL. Mental health component was more affected than physical health component. Consequently RLEP domain was the most affected domain. Patients′ QOL was positively correlated to income and negatively correlated to disease duration.

Anterior sternoclavicular dislocation associated with clavicular fracture: a case report and review of the literature

Although clavicle fractures are common, fracture dislocations of the medial end are rare. We report on a case of a 17-year-old patient who presented with a fracture of the medial clavicle with an associated anterior dislocation of the sternoclavicular joint. The patient underwent successful surgical management resulting in fracture union, restoration of shoulder stability and full functional range of motion at latest follow-up.

The early detection and management of unstable concentric closed reduction of DDH with percutaneous K-wire fixation in infants 6 to 12 months of age.

Background: In some infants with developmental dysplasia of the hip, concentric closed reduction, although initially achievable, cannot be maintained even by casting because of a deficient posterior acetabular wall. Usually, these hips will redislocate in the cast and a rereduction will be necessary, often requiring an open reduction subsequently. Methods: A 3-year retrospective review of 88 infants, (M/F; 14/74) 6 to 12 months of age with 124 dislocated hips, was conducted to assess the efficacy of percutaneous Kirschner wire fixation in achieving permanent hip stability. A “hip-at-risk” instability test was developed to detect potentially unstable hips at the time of closed reduction that might redislocate in the hip spica cast, and these hips were stabilized with a percutaneous K-wire through the greater trochanter into the pelvic bone. Results: The hip instability test was positive in 27 hips and negative in 97. Percutaneous K-wire fixation was used to stabilize 21 hips with a positive hip instability test. All 21 unstable hips that were stabilized with the K-wire technique maintained their concentric reduction and went on to stable development. No K-wire breakage was encountered and only 1 superficial pin tract infection occurred. Conclusions: K-wire stabilization of unstable closed reductions is a safe, reliable technique for maintaining concentric hip reduction in infants 6 to 12 months of age with developmental dislocation of the hips. Level of Evidence: Level II retrospective study.

Delayed Horner's syndrome following ultrasound- guided interscalene brachial plexus block

We describe a case of Horners syndrome that occurred shortly after post-operative bolus administration of interscalene brachial plexus analgesia.

Synovial osteochondroma originating from the synovium of the anterior cruciate ligament

Primary synovial osteochondromatosis is a rarely seen disorder of the synovium in any joints. Among reported cases of knee osteochondromatosis, those originating from the anterior cruciate ligament (ACL) are very rare. We report an unusual case of primary synovial osteochondromatosis. A 27-year-old woman complained of a restricted range of right-knee motion and pain when walking. With locking symptoms similar to those associated with a meniscus bucket handle tear. Although plain radiograph and MRI showed normal appearance, diagnostic arthroscopy revealed the curious appearance of a huge mass seated on ACL. In addition, the sign of proliferation of synovium and cartilaginous tissues were apparent. The ACL mass has been removed while preserving the ACL fibres. Histological examination confirmed a diagnosis of osteochondromatosis. To the best of our knowledge, this is the first report to describe synovial osteochondromatosis originating from ACL fibres and has been resected while preserving the ACL.