Zacharia Isaac

Strength post-spinal cord injury: myometer vs manual muscle test

This study was designed to compare changes in strength after spinal cord injury (SCI) with the use of a hand held myometer to the manual muscle test (MMT). Eighty-eight C4-C8 Frankel A-D tetraplegie subjects were tested at various times up to 2 years post-SCI. Elbow flexor strength on successive examinations were grouped according to their early and later MMT scores (3.5 with no change in MMT, 3.5 to 4.0, and 3.5 to 4.5; 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0; 4.5 with no change in MMT, and 4.5 to 5.0). For each group, later myometric measurements (MYO) were expressed as percents of their earlier MYO and were anlayzed using paired Students t-tests. Later MYO were 116, 205, 232% (P>0.05, P<0.002, P<0.05) of their earlier MYO for groups 3.5 with no change in the MMT, 3.5 to 4.0, and 3.5 to 4.5 respectively. Later MYO were 140, 139, 191% (P<0.05, P<0.02, P<0.0001) of their earlier MYO for groups 4.0 with no change in MMT, 4.0 to 4.5, and 4.0 to 5.0 respectively. Later MYO were 127 and 126% (P<0.01, P<0.02) of their earlier MYO for groups 4.5 with no change in MMT and 4.5 to 5.0 respectively. In conclusion the hand held myometer detected changes in muscle strength not detected by the MMT.

Side effects and complications after percutaneous disc decompression using coblation technology.

Bhagia SM, Slipman CW, Nirschl M, Isaac Z, El-Abd O, Sharps LS, Garvin C: Side effects and complications after percutaneous disc decompression using coblation technology. Am J Phys Med Rehabil 2006;85:6–13. Objective:To report the short-term side effects and complications after percutaneous disc decompression utilizing coblation technology. Design:Following institutional review board approval, consecutive patients who were to undergo percutaneous disc decompression using coblation technology (nucleoplasty) were prospectively enrolled. Patients were questioned preoperatively, postoperatively, and 24 hrs, 72 hrs, 1 wk, and 2 wks postprocedure by an independent reviewer regarding 17 possible symptom complications, which included bowel or bladder symptoms, muscle spasm, new pain, numbness/tingling or weakness, fevers/chills, rash/pruritus, headaches, nausea/vomiting, bleeding, and needle insertion site soreness. Statistical analysis was performed using Wilcoxon’s signed-rank test. Results:A total of 53 patients enrolled, of whom four patients dropped out. Two patients had increased symptoms and opted for surgery. Two patients could not be contacted. The most common side effects at 24 hrs postprocedure was soreness at the needle insertion site (76%), new numbness and tingling (26%), increased intensity of preprocedure back pain (15%), and new areas of back pain (15%). At 2 wks, no patient had soreness at the needle insertion site or new areas of back pain; however, new numbness and tingling was present in 15% of patients. Two patients (4%) had increased intensity of preprocedure back pain. There were statistically significant reductions in visual analog scale score for back pain and leg pain (P < 0.05). Conclusions:Based on this preliminary data, nucleoplasty seems to be associated with short-term increased pain at the needle insertion site and increased preprocedure back pain and tingling numbness but without other side effects.

Discography in practice: a clinical and historical review

Chronic low back pain is the most common cause of disability in individuals between the ages of 45 and 65. Given the variety of anatomic and pathophysiologic causes of persistent low back pain, it is a difficult diagnosis for clinicians to treat. Discography is a diagnostic option that may link a patient’s subjective complaints of spinal pain to symptomatic disk disease when non-invasive imaging, such as magnetic resonance imaging (MRI), does not find structural abnormalities. A controversial procedure, discography is only necessary to assess painful discs prior to surgical interventions. For accurate discogram interpretation an experienced spine interventionalist must be careful to exclude false positive results and be aware of the patient’s underlying psychological state. This literature review will discuss the following: anatomy and function of the spine and intervertebral disc, intervertebral disc degeneration and discogenic pain, history of discography, indications and contraindications, a description of the procedure, complications, and the current debate regarding its outcomes.

Clean versus sterile technique for common joint injections: a review from the physiatry perspective

Preparation of the skin prior to joint injection varies widely among disciplines and across regional borders. This is likely due to the paucity of literature on the most effective and efficient methods of preparation. There is no standard definition of clean technique prior to joint injection. Review of the available literature suggests that alcohol is effective preparation for the skin prior to most procedures. Surveys of current clinical practice demonstrate that the use of gloves may be favored, but no conclusions can be drawn in regards to whether sterile gloves are required. Clean technique should be defined as use of non-sterile gloves and agents such as alcohol or soap prior to injection. Significant cost savings may be achieved with the consistent use of clean technique for preparation of the skin prior to joint injection. Further study should address the incidence of iatrogenic bacterial arthritis following clean technique versus sterile technique for joint injection.

Sacral stress fracture in a female field hockey player

Slipman CW, Gilchrist RV, Isaac Z, Lenrow DA, Chou LH: Sacral stress fracture in a female field hockey player. Am J Phys Med Rehabil 2003;82:893–896. We report a collegiate field hockey player who sustained a sacral fatigue-type stress fracture that manifested as persistent low back and leg pain. The diagnosis of sacral stress fracture was suggested by history and physical examination and confirmed by magnetic resonance imaging. Our patient experienced complete resolution of symptoms after a 3-mo interval of activity restriction. This article describes the first reported case of a sacral stress fracture in a field hockey player.

When should a cervical collar be used to treat neck pain

Neck pain is one of the most prevalent and costly health problems in the United States. It remains a complex, subjective experience with a variety of musculoskeletal causes. Although, cervical collars are a seemingly benign intervention, they can have adverse effects, especially when used for longer periods of time. It is feared that a long period of immobilization, can result in atrophy-related secondary damage. Many physicians cite anecdotal evidence of their clinical utility and soft cervical collars are often prescribed by convention for patients complaining of neck pain. The use of cervical collars to treat neck pain is an area of controversy. This review article examines the current evidence and studies related to recommending cervical collars for neck pain of a variety of etiologies.

Are Facet Joint Bone Marrow Lesions and Other Facet Joint Features Associated With Low Back Pain? A Pilot Study

To determine the frequency of facet joint (FJ) bone marrow lesions, high FJ periarticular signal intensity, and FJ effusions in a convenience sample of patients with axial low back pain (LBP).

The role of intradiscal steroids in the treatment of discogenic low back pain

LBP is one of the most common reasons for visiting a doctor and is the most common cause of disability under age 45.Amongst a variety of etiologies, internal disc disruption (IDD) has been postulated as an important cause of low back pain. Treating discogenic low back pain continues to be a challenge to physicians. Inflammation, either from direct chemical irritation or secondary to an autoimmune response to the nucleus pulposus has been implicated as the primary pain source. Both steroids and non-steroidal anti-inflammatory drugs have partial effectiveness in treating pain associated with inflammation. Therefore, the rationale for using intradiscal steroids is to suppress the inflammation within the disc, thereby alleviating the patient’s symptoms. The goal of this article is to review the literature regarding the efficacy of intradiscal steroids to treat low back pain of discogenic origin.

The lateral atlanto-axial joint as a source of headache in congenital atlanto-occipital fusion.

El Abd OH, Rosenberg D, Gomba L, Isaac Z: The lateral atlanto–axial joint as a source of headache in congenital atlanto–occipital fusion. Am J Phys Med Rehabil 2008;87:232–237.A 47-yr-old woman presented with severe right-sided neck pain and headache, predominantly in the right-occipital region, for 3 yrs. The symptoms persisted despite using nonsteroidal antiinflammatory medications and undergoing physical therapy. The patients examination was unremarkable except for reduced neck motion and prominent right-occipital tenderness. Imaging showed congenital fusion of the atlanto–occipital joints bilaterally. A fluoroscopically guided diagnostic right-lateral atlanto–axial joint injection was positive. We are reporting the first case of clinically proven lateral atlanto–axial joint arthropathy with neck pain and headache in a patient with congenital atlanto–occipital joint fusion. Subsequently, the patient received a set of two therapeutic lateral atlanto–axial joint injections. She had remarkable improvement of her headache and neck pain. At 1-yr follow-up, the patient continued to have significant improvement of the right-sided neck pain and headache.

Osteoid Osteoma of the Spinoglenoid Notch Mimicking Cervical Radiculopathy

Osteoid osteomas are benign skeletal neoplasms that are most commonly seen in persons who are in their 20s and 30s [1]. Characteristically, patients report having severe focal pain that worsens at night and with activity and that is relieved by nonsteroidal anti-inflammatory drugs (NSAIDs). Osteoid osteomas can occur in any bone. However, they typically involve the cortex of long bones and, in more than 50% of cases, they are localized to the lower limbs. Rarely osteoid osteomas may occur in the scapula, where they have been reported in the glenoid, acromion, and coracoid process [2-5]. The diagnosis is based on clinical and radiologic evaluation. However, plain radiographs and even magnetic resonance imaging (MRI) are not always diagnostic, which may lead to a delay in diagnosis [6]. We report the case of a young, healthy man in whom progressive and debilitating right shoulder pain developed. The initial clinical impression pointed to subacromial impingement as the most likely pain generator, followed by cervical radiculopathy. Computed tomography (CT) showed the presence of a right spinoglenoid notch osteoid osteoma. The patient had excellent functional results after CT-guided radiofrequency ablation.