Avital Fast

Low-back pain in pregnancy

Two hundred women were interviewed within 24–36 hours after giving birth. The patients were not examined. It was found that 56% of the patients suffered from low-back pain during pregnancy. The percentage of Caucasians was statistically higher in the back pain group. The percentage of Hispanics was statistically higher in the no pain group. Among the variables that were compared in both groups were the age, the weight gained by the mothers during pregnancy, the babys weight, the number of previous pregnancies, number of prior children. None of the variables reached a statistically significant level. The pain group complained of pain in the low-back area, which radiated in 45.5% of cases to the lower extremities. In about one-third of the patients the pain increased as the day wore on, whereas in another one-third the pain increased during the night and disturbed sleep. Standing, sitting, forward bending, lifting, and walking tended to increase the pain. Most of the patients started suffering from back pain between the fifth and seventh months of pregnancy. Several theories to explain the occurrence of backache during pregnancy are discussed.

Exercise for the dialyzed: Aerobic and strength training during hemodialysis

Oh-Park M, Fast A, Gopal S, Lynn R, Frei G, Drenth R, Zohman L: Exercise for the dialyzed: Aerobic and strength training during hemodialysis. Am J Phys Med Rehabil 2002;81:814–821. Objective To investigate the safety and feasibility of aerobic and strength training during hemodialysis for end-stage renal disease patients and to evaluate its impact on their cardiac fitness, muscle strength, and functional status. Design A total of 22 patients undergoing hemodialysis for end-stage renal disease had assessment of their cardiac fitness with stress tests and walk tests, assessment of their muscle strength by one repetition maximum of knee extension, and assessment of their functional status by Medical Outcomes Study Short Form-36 before and after exercise training. Training, consisting of cycle ergometer exercise and strengthening of the knee extensors two to three times a week for 3 mo, was done during dialysis. Results Eighteen of 22 patients completed 3 mo of training and four dropped out due to knee pain or medical complications unrelated to exercise. No patient developed major complications from the program. After training, there was a significant improvement in the mental and physical components of the Short Form-36 and one repetition maximum of knee extension. Among 14 of 18 patients who agreed and completed a follow-up fitness testing, five showed improvement on the stress tests and eight on the walk tests. Conclusions A well designed exercise program during hemodialysis can be performed safely with proper supervision and patient education, improving muscle strength, mental and physical function, and possibly cardiac fitness.

Radial Nerve Damage as a Complication of Elbow Arthroscopy

Posterior interosseous nerve damage following elbow arthroscopy occurred in a 20-year-old athlete. The course of the radial nerve brings it in proximity to the puncture site when the dorsoradial approach is selected. This case emphasizes the importance of careful attention to vital structures if the complication of a posterior interosseous nerve syndrome is to be avoided.

Low-back pain in pregnancy : abdominal muscles, sit-up performance, and back pain

An attempt was made to determine the effect of pregnancy on the abdominal muscles and to correlate changes in abdominal muscles strength with low-back pain during pregnancy. The study included 328 women. Group A consisted of 164 pregnant women; group B consisted of 164 non-pregnant women. The race, age, height, weight, parity, profession, time devoted to physical fitness per week, abdominal length, and relation between the abdominal length to height were recorded. A detailed history relating to backache prior to and during pregnancy was obtained. Each woman was asked to perform a single sit-up. The results of the study indicate that about 10% of pregnant women develop severe low-back pain that interferes with daily life activities. About 49% of the non-pregnant women complained of LBP. The pain did not interfere with activities of daily living. During pregnancy, due to overstretching of the abdominal muscles, the ability to perform a sit-up is significantly decreased. Whereas all non-pregnant women could perform a sit-up, 16.6% of pregnant women could not perform a single sit-up. There was no statistically significant correlation between the sit-up performance and backache. It may be concluded that during pregnancy the abdominal muscles become insufficient.

Obesity. A risk factor for knee dislocation.

Complete dislocation of the knee joint is a severe injury that is commonly the result of high-velocity injuries and often associated with disruption of the popliteal artery. We report two cases in which obesity appeared to be the principal cause of knee dislocation with vascular compromise. Preventive measures in extremely obese patients are recommended

Vertebral artery damage complicating cervical manipulation

Cervical manipulation may result in serious neurologic injury arising specifically from trauma to the vertebrobasilar system. The vertebral arteries are susceptible to trauma at three locations: in the transverse foraminae, at the atlantoaxial joint, and at the occipitoatlantal joint. Because of frequent inequality in the size of the two vertebral arteries, damage to the larger artery may lead to ischemia of the brain stem. Vertebral artery obstruction may be produced by extension with rotation, even within normal ranges of motion. Neurologic injury following manipulation requires accurate diagnosis and prompt manipulation requires accurate diagnosis and prompt anticoagulant therapy.

Diabetic lumbar radiculopathy: sciatica without disc herniation.

Three patients with diabetic radiculopathy (DR) are presented. The clinical aspects of DR, its management, and differential diagnosis are reviewed. Diabetic radiculopathy commonly presents with severe unilateral pain of sudden onset that is usually located in the lower extremity, frequently in the proximal segments. Occasionally, bilateral asymmetric pain may be observed. The pain is severe and may require narcotic medications. Sphincteric involvement is rare. Weakness of hip or thigh muscles, decreased sensation and hypo- or areflexia are commonly observed. The clinical picture can resemble that of high lumbar disc herniation. Electrodiagnostic and radiological studies may help differentiate between the two conditions.

Lumbar Spinal Strains Associated with Whiplash Injury: A Cadaveric Study

Fast A, Sosner J, Begeman P, Thomas MA, Chiu T: Lumbar spinal strains associated with whiplash injury: A cadaveric study. Am J Phys Med Rehabil 2002;81:645–650. Objectives To study and quantify the effects of rear-end collision on the lumbar spine. Design The lumbar spine of a cadaver was instrumented with rosette strain gauges applied on the lateral and anterior surfaces of T12, L2, and L4. Biaxial accelerometers were mounted on L1, L3, and L5. The cadaver was seated, restrained, and subjected to rear impacts of 5 g and 8 g. Results The anterior shear strains had a biphasic shape. Spinal strains peaked at the T12 at approximately 120 and 370 msec, whereas in the L4 vertebra, it peaked at 200 and 380 msec. The anterior strain pattern of the L4 and T12 vertebrae were in diametrically opposite directions. In the second set of tests (8 g experiment), the acceleration forces and strains pattern were similar to the 5 g test but of higher magnitude. The principal anterior strain was 480 &mgr;m/m for 5 g and 530 &mgr;m/m for 8 g; the lateral shear strain was 680 &mgr;m/m and 1500 &mgr;m/m in the 5 g and 8 g experiments, respectively. Conclusions Forces generated during simulated whiplash collision induce biphasic lumbar spinal motions (increased-decreased lordosis) of insufficient magnitude to cause bony injuries, but they may be sufficient to cause soft-tissue injuries.

One step forward and two steps back: the dangers of walking backwards in therapy.

Walking backwards has been used in therapy to improve balance and gait. There has not been any systematic investigation into the effectiveness or safety of walking backwards. We present two cases in which walking backwards during physical therapy resulted in a fall and considerable morbidity. The only clear indication for treatment by walking backwards should be a task-specific need to do so, and only then if adequate safety can be assured.

Odontoid Fracture and C1-C2 Subluxation in Psoriatic Cervical Spondyloarthropathy: A Case Report

Study Design Case presentation and review of pertinent literature. Objectives To present an unusual case and alert other physicians to possible missed diagnoses. Summary of Background Data An unusual case is presented of a young man with severe psoriatic spondyloarthropathy and fusion of C2‐C7 (Type II cervical psoriatic ankylosing disease) who fell at home, sustaining an unrecognized fracture of the odontoid process leading to subluxation of C1‐C2 and transitory tetraplegia. The patient presented with torticollis, and the fracture was unrecognized for a long period of time. Methods Case presentation. Results This patient became independent in all activities of daily living after surgery and rehabilitation despite persistence of torticollis. Conclusions A patient who presents clinically with traumatic torticollis after minor trauma and who also has psoriasis and ankylosis of the cervical spine should be suspected of having a fracture‐subluxation until definitely proven otherwise. In the present case, the late diagnosis delayed surgical stabilization.