W. Kessomtini

AB1076 Complex regional pain syndrome type 1: which treatment?

Background The treatment of Complex Regional Pain Syndrome Type 1 (CRPS-I) is multidisciplinary.1 It aims to minimise symptoms, pain, preserve functional ability and professional activity. Unfortunately, therapeutic possibilities are still very limited and there is no Gold standard. Objectives The purpose of our work is to evaluate the efficiency of four therapeutic modalities in the management of CRPS-I. Methods Retrospective study of 60 patients (21 men and 39 women) treated for CRPS-I. Four groups were identified according to therapeutic modalities used: rehabilitation alone (16 patients), Calcitonin associated with rehabilitation (15 patients), Bisphosphonates (BP) (Sodium Risedronate, 1 tablet per week, over an average duration of 1 month) associated with rehabilitation (20 patients) and Calcitonin in combination with BP and rehabilitation (9 patients). Results The mean age of the patients was 51±16.5 years. The average time of treatment was 2 months and the average duration of follow-ups was 7 months. Traumatic origin was found in 88.3% of cases. Distal radius fractures (DRF) were the most incriminated (40% of cases). The evolution was judged on pain reduction, vasomotor signs and on functional improvement. For all etiologies combined, no statistically significant difference was found between the different groups (p=0.462). For patients with a DRF, a favourable outcome was noted in the BP group associated with rehabilitation in 85.7% of cases while it was only 42.9% for rehabilitation alone. Conclusions Our study concludes that the different therapeutic modalities evaluated for the treatment of CRPS-I had an efficiency close to each other with a superiority of BP. Oral Sodium Risedronate could therefore be proposed as a treatment for CRPS-I without marketing authorisation (MA). Reference [1] Hernández-Porras BC, Plancarte-Sánchez R, Alarcón-Barrios S, Sámano-García M. Complex regional pain syndrome: A review. Cirugía y Cirujanos (English Edition). 1 juill 2017;85(4):366–74. Disclosure of Interest None declared

Rehabilitation's importance in cervico brachial neuralgia management

Objective Physical treatment is an integral part in the management of cervico brachial neuralgia (CBN). But it is rarely touched on in literature. The aim of this study is to evaluate the contribution of rehabilitation in the management of CBN and its effect on pain, function and psychology of patients. Material/patients and methods A prospective study including patients with CBN referred to the department of physical medicine and rehabilitation (PRM) of Mahdia from October 2016 to March 2017. All of the patients underwent physical rehabilitation and the evaluation was performed before and at the end of the protocol. Measures outcomes were: pain via the Visual Analog Scale (VAS), functional outcome using the neck disability index (NDI) and the psychological profile with HAD scale. Results Forty patients were enrolled in this study; 12 men (30%) and 28 women (70%). The average age was 51 years old and the mean duration of symptoms was 2.4 years. In most of the cases, CBN was unilateral (87%) and C6 root was concerned (52%). On physical examination, we found limited and painful spinal motion mobility in 95% of the cases associated with contracture of the neck muscles in 87.5% of the cases. The cervical spine X-rays showed osteoarthritis, pinching discs or osteophytosis in 90% of the cases. At the end of the protocol, all parameters improved. Patients had significantly improvement of VAS pain and NDI but the improvement of HAD scale was not significant. Discussion–conclusion This study concludes that rehabilitation reduces the perception of pain and improves function in patients with CBN.

Contribution of therapeutic education in the treatment of knee osteoarthritis: Preliminary results

Objective Therapeutic education is an integral part of the management of knee osteoarthritis to acquire or to maintain skills allowing patients to manage their lives better. The aim of our study is to assess the contribution of therapeutic education in the management of knee osteoarthritis. Material/Patients and methods This is a randomized prospective study on patients with knee OA referred to the department of Physical Therapy of Mahdia since January 2016. Patients were divided into 3 groups. The first group G1 (10 patients) underwent physical rehabilitation, the second group G2 (10 patients) underwent therapeutic education and the third group G3 (10 patients) underwent therapeutic education and physical rehabilitation. The education program included definition of the disease, possible therapeutic means, hygieno-dietetic advices and self-rehabilitation exercises. Educational means used were an audiovisual system and an Arabic brochure distributed late in the session. The evaluation was performed at the beginning and at the end of the protocol. It had been about pain via the Visual Analog Scale (VAS), overall physical function with WOMAC, disability via the Lequesne index, mobility of the knee joint, and the psychological profile with HADscale. Results Thirty patients diagnosed with knee osteoarthritis (OA) were enrolled in this study; 5 men and 25 women whose age average was 58 years old. At the beginning of the protocol, the 3 groups were homogeneous in terms of all the parameters studied. At the end of the protocol, all parameters improved for all the groups. However, improvement was more important in G1 and G3. G3 had significantly greater values for VAS pain and Lequesne index than G3. There were no significant differences in WOMAC index, joint gain and HAD score between G1 and G3. Discussion/Conclusion Our study showed the short-term interests of therapeutic education associated with rehabilitation in the treatment of knee osteoarthritis. Our results should be confirmed in the long-term.

Club foot revealing a hypoplasia of the navicular bone: the first case report.

Congenital orthopaedic disorders are not infrequent. Even though some orthopaedic disorders are immediately obvious at birth (such as congenital talipes equinovarus [CTEV]), others are not apparent or may even be hidden (such as congenital bone hypoplasia). This means that a comprehensive orthopaedic examination is of great value when screening for congenital orthopaedic disorders [7]. Congenital talipes equinovarus is one of the most frequent congenital orthopaedic disorders. It may occur alone or in combination with other malformations. However, an association with hypoplasia of the navicular bone has never previously been described. Here, we report on a case of unilateral hypoplasia of the navicular bone discovered during the treatment of CTEV.