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Effect of playing football (soccer) on balance, strength, and quality of life in unilateral below-knee amputees

Yazicioglu K, Taskaynatan MA, Guzelkucuk U, Tugcu I: Effect of playing football (soccer) on balance, strength, and quality of life in unilateral below-knee amputees. Am J Phys Med Rehabil 2007;86:800–805. Objective:To investigate the effect of playing football (soccer) on balance, muscle strength, locomotor capabilities, and health-related quality of life in subjects with unilateral below-knee amputation. Design:Cross-sectional controlled study. Results:Difference in KAT dynamic balance scores obtained 3 days after was statistically significant in the study group (P < 0.05) but not in the control group (P > 0.05). Differences in static balance test scores was statistically significant between the groups (P < 0.05) in favor of the study group. In isokinetic evaluation, differences in flexion and extension peak torque measures of the lower extremities were not statistically significant between the groups (P > 0.05). Differences in Houghton and Berg balance scales were not found statistically significant between the groups (P > 0.05). Differences in Locomotor Capabilities Index and in the SF-36 in physical functioning, physical role, pain, and emotional role between the groups were statistically significant (P < 0.05) in favor of the study group. Conclusions:Our results show that playing football may have positive effects on balance and health-related quality of life in unilateral below-knee amputees.

Assessment of Spasticity With Sonoelastography Following Stroke: A Feasibility Study

To investigate the feasibility of sonoelastography to show muscle stiffness in poststroke spasticity, as well as the relationship between sonoelastography findings and muscle architecture features and clinical spasticity scores in the spastic gastrocnemius.

Comparison of Intact Knee Cartilage Thickness in Patients with Traumatic Lower Extremity Amputation and Nonimpaired Individuals.

ObjectiveThe aim of this study was to assess the femoral articular cartilage thickness of the intact knee in patients with traumatic lower extremity amputation compared with nonimpaired individuals. DesignA total of 30 male patients with traumatic lower extremity amputation (mean [SD] age, 31.2 [6.3] yrs) and a random sample of 53 age-matched and body mass index–matched male nonimpaired individuals (mean [SD] age, 29.8 [6.3] yrs) participated in the study. Exclusion criteria were age younger than 18 yrs, history of significant knee injury, previous knee surgery, or rheumatic disease. The femoral articular cartilage thickness was measured using ultrasound at the midpoints of the medial condyle, the intercondylar notch, and the lateral condyle. Ultrasonographic cartilage measurement was performed on the intact side of the patients with amputation and on both sides of the nonimpaired individuals. ResultsThe femoral articular cartilage thickness of the intact knees of the patients with amputation was significantly decreased at the lateral and medial condyles compared with the nonimpaired individuals (P < 0.05). There was no significant difference in the measurements at the intercondylar notch between the patients with amputation and the nonimpaired individuals (P > 0.05). ConclusionsThere was a premature cartilage loss in the intact limb knee of the patients with traumatic amputation. This result supports the view that patients with traumatic lower extremity amputation are at increased risk for developing knee osteoarthritis in the intact limb.

Common peroneal nerve palsy caused by compression stockings after surgery

Peroneal nerve palsy is one of the more common entrapment neuropathies of the lower limb and can be a result of a multitude of causes. Compression stockings are commonly used for prophylaxis of deep venous thromboembolism after surgery. The entrapment on the head and the neck of the fibula caused by compression stockings is uncommon. In this article, the authors report a 46-yr-old male patient who was operated on for postauricular squamous cell carcinoma of the skin. On the third postoperative day, it was noticed that compression stockings had rolled down, and a linear impression mark was observed under its upper edge at the proximal part of the left cruris. He had left foot drop and difficulty in walking during gait assessment. The needle electromyography confirmed total axonal degeneration of the left peroneal nerve with denervation potentials. The aim of this report was to emphasize the importance of the size and length of the compression stockings and regular skin control in avoiding the risk for peroneal nerve palsy.

A Different Approach to the Management of Osteoarthritis in the Knee: Ultrasound Guided Genicular Nerve Block

Dear Editor, A 61-year-old female was referred to our tertiary physical medicine and rehabilitation outpatient clinic with a 7-year history of severe left knee pain. The patient was a nonsmoker and obese, with no comorbidities, and reported that the left knee pain worsened when walking and descending stairs and particularly when climbing stairs. Radiography of the left knee revealed Kellgren-Lawrence grade 3 osteoarthritis (OA) with multiple osteophytes and definite joint space narrowing. The pain and functional disability were nonresponsive to conservative treatment methods including weight loss, exercise, analgesics (paracetamol or diclofenac sodium once or twice a day), intra-articular steroid and hyaluronic acid injections, and physical therapy. The patient was finally offered knee replacement surgery by an orthopedic surgeon, but she did not accept surgery. The sensory and motor nerves supplying all the structures around the knee are the saphenous, tibial, and common peroneal nerves together with the subsartorial, peripatellar, and popliteal plexuses [1,2]. Vas et al. [2] targeted both the sensory and motor nerves supplying all the structures around the knee and succeeded in relieving the pain. Choi et al. [3] reported successful pain relief by ablation of the three branches of the genicular nerve [superior lateral (SL), superior medial (SM), and inferior medial (IM) genicular nerves]. These three nerves were selected because they pass the periosteal areas connecting the shaft of the femur to the bilateral epicondyles and the shaft of …

Post-laminectomy rotokyphoscoliosis causing paraplegia in long term: case report.

Abstract Context Childhood laminectomy can lead to spinal deformity. This is a report of a case of paraplegia caused by rotokyphoscoliosis, a late complication of laminectomy. Findings A 55-year-old woman developed paraplegia due to post-laminectomy kyphoscoliosis. She had surgery for a spinal tumor at age 13 years. She developed kyphosis 2 years after the laminectomy, which has been gradually progressing over the years. She experienced weakness of lower limbs that progressed to paraplegia. There was no evidence for tumor recurrence. To our knowledge, this is the first reported case of post-laminectomy kyphoscoliosis causing late-onset paraplegia. Conclusions/clinical relevance This case highlights a possible long-term complication of laminectomy without stabilization or untreated kyphoscoliosis. Children should be followed closely after laminectomy because development of spinal deformity is very common. Without intervention, the kyphosis might progress and in the long term, serious neurological complications may result, including paraplegia.

Ultrasound Findings of Young and Traumatic Amputees With Lower Extremity Residual Limb Pain in Turkey.

Objective The current study was designed to document clinical and ultrasound (US) findings of patients with residual limb pain (RLP) after amputation and to investigate the relationship between these findings. Materials and Methods A chart review was performed to identify demographic and clinical data including the age (current and at the time of injury), time since amputation, gender, reason for amputation, affected limb number, side and level of limb loss, and ultrasonographic findings of young and traumatic amputees with RLP. Results The study included a total of 147 patients. Inflammation and neuroma were the leading pathologies in 20–29 years and 30–39 years age groups, respectively. Inflammation/edema were detected significantly more in patients with <1 year since amputation (P = 0.001). Neuroma was found at a significantly high rate in patients at 1–5 years (P = 0.029) and infection/abscess was more common in patients at >5 years since amputation (P = 0.051). The percentage of neuromas in below-the-knee amputees was significantly higher than in non–below-the-knee amputees (45.8% vs. 28.6%). Neuroma formation was detected in 50% of the patients with land mine–related amputation and at 27% in patients with amputation secondary to other traumatic reasons. Regression analysis showed below-the-knee-level amputation to be an associated factor for US abnormality. Conclusion The leading US findings were inflammation/edema, neuroma, and infection/abscess in traumatic amputees with RLP. The US findings might be different in patients according to the time since amputation. Patient with land mine–related amputations may have different US findings.

Poster 457-B Complex Regional Pain Syndrome Type 1 in Young Male Adults

Disclosures: Lynne Turner-Stokes: no disclosure on file Objective: To describe the methodology for the Upper Limb International Spasticity study (ULIS) III, and describe an initial evaluation of goal-setting. Design: Non-interventional 2-year longitudinal cohort study. Setting: International, multicenter. Participants: Patients with upper limb spasticity (ULS) receiving botulinum toxin A (BoNT-A). Interventions: Repeated botulinum toxin A injections as part of integrated upper limb spasticity management in real-life clinical practice. Main Outcome Measures: ULS Index and Goal Attainment Scaling— Evaluation of Outcome for ULS (GAS eous) tool will be utilized to evaluate functional changes following BoNT A treatments. GAS eous provides a structured framework for application alongside standardized outcome measures in a clinical setting. Economic, quality of life data, and concomitant therapy use will also be recorded. Results: Recruitment began in January 2015; by 01 November 2015, initial goal-settingdata hadbeen collected for 242patients across 29 sites in 8 countries. Centers were awarded a rating based on the quality of goal statements set. Overall, 20/28 centers achieved the highest rating (A++) (one site was not accessible). One primary goal and 1 secondary goals were set for eachpatient. 236patientshad setprimarygoals anda total of 201 secondary goals were also set; 88 patients had only the primary goal set, 95 patients had set two goals (oneofwhichwasa primary goal) and 53 patients had set three goals (one of which was the primary goal). The commonest primary goal areas identified were passive function (40 patients) and active function (25 patients) followed by pain and range of movements/prevention of contractures (17 patients each). Conclusions: ULIS-III will implement novel approaches for evaluating patient centered goal attainment and a structured and consistent method of recording data. High-quality goal-setting was demonstrated in the majority of centers. Study results will be reported in peerreviewed journals and at international meetings. Level of Evidence: Level II

Poster 326 Synovial Chondromatosis of the Knee: A Case Report

Disclosures: W. Sussman: I Have No Relevant Financial Relationships To Disclose. Design: Case Report Case Description: The patient sustained a concussion during a helmet-to-helmet hit. At three-weeks after the concussion, the patient continued to be symptomatic. The patient had an Immediate PostConcussion Assessment and Cognitive Testing (ImPACT) symptom score of 15. By week-six, the ImPACT symptom score had decreased to 2, however, the patient continued to have daily headaches. After failing acetaminophen, the patient was started on topiramate 50mg twice daily for symptomatic management. Setting: Sports medicine clinic. Results or Clinical Course: At twelve-weeks, the patient continued to have headaches interfering with school and preventing a full return to sport. The decision was made to treat the patient with an intranasal SPG block. After the SPG block, the patient was symptom free and able to return to school and football. At the 6-month follow-up, the patient remained symptom free. Discussion: Post-traumatic headaches (PTHs) are headaches that develop within 7 days of a head injury, and in cases that persists for more than 3 months the headache is classified as chronic. Therapeutic options for PTHs are often the same as for their non-traumatic counterparts. In cases refractory to standard treatment, the SPG has been described as a therapeutic target in various headache disorders, including cluster headaches, migraine headaches, and tension-type headaches. Here we present the first report of successful treatment of PTHs after a sport-related concussion. Conclusion: Intranasal SPG block is a safe and effective treatment for refractory chronic PTHs after a sport-related concussion.