Madelung Deformity: Diagnosis and Treatment Options

Madelung deformity (MD) comprises an increased volar and ulnar tilt of the joint facet of the distal radius, secondary to an idiopathic physeal dysplasia. Such change causes radial shortening and consequent distal ulnar prominence, along with wrist pain and loss of motion. Surgery becomes an option in patients with severe deformity that do not respond to conservative treatment.The classic surgical techniques are problematic for adults, as they are specific for children and adolescents, whose radial physis is still open. Very few papers discuss the treatment of adult patients; furthermore, most are focused on the distal radioulnar joint, and thus do not approach the origin of the pathology.When analyzing computed tomography scans with tridimensional reconstruction, a feature of MD, growth arrest of the volar and ulnar portions of the distal radius, is noted, causing the typical distal radius deformity that leads to lack of coverage of the lunate bone. That leads to palmar subluxation of the lunate bone and consequent radiocarpal instability.We herein describe the possibilities of treatment in different stages of evolution, summarizing the authors' view on MD.

Metacarpal chondrosarcoma, from negligence to rareness : a case report and review of the literature

Chondrosarcoma is rarely found in the extremities but it remains the most common primary malignant bone tumor of the hand. We report an unusual case of a 46-year-old man with a huge chondrosarcoma on his left hand that has been evolving for more than 30 years. The mass has always been painless, the symptoms were only the deformation and a slight loss of motion. We did a subtotal resection since the patient refused the amputation. The investigation, which in- cluded thoracoabdominal tomography, scintigraphy and blood analysis, turned out to be negative. In the literature, CS are usually associated with a locally destructive growth but metastasis hasn’t been often described. CS seems to be an aggressive tumor locally but, unlike in other sites, it seems to rarely metastasize when in the hands.

Diaphyseal Proximal Phalangeal Shortening Osteotomy for Correction of Hammertoe Deformity: Operative Technique and Radiological Outcomes

Background Correction of hammertoe deformities at the proximal interphalangeal (PIP) joint results in an inherent loss of motion that can be a concern for active patients who want to maintain toe function and grip strength. Diaphyseal proximal phalangeal shortening osteotomy (DPPSO) is a joint-sparing procedure resecting a cylindrical portion of the proximal phalanx on the middiaphysis. Patients/Methods This was a retrospective review including patients treated using DPPSO with at least a 1-year follow-up. Demographic, comorbidity, and Visual Analogue Scale (VAS) scores and complication data were obtained. Radiological assessment included union status and alignment. Medial frontal anatomical (mFAA), frontal proximal interphalangeal (mFIA), plantar lateral anatomical (pLAA), and medial and plantar lateral interphalangeal angles (pLIA) were measured. Results A total of 31 patients (45 toes) were included, with a mean age of 59 years (range: 24-72) and follow-up of 35 months (range: 12-60; mean preoperative VAS score was 4.9 ± 1.72 improving to 1.62 ± 2.28; P < .01). Union occurred in all patients at an average of 11.2 weeks. Complications were present on 4 toes (8.8%), with no recurrences. The pLIA significantly changed from 44.9° to 17.9°. There were no significant differences in the preoperative and postoperative values of the mFAA, pLAA, and mFIA. Conclusions DPPSO provides adequate pain relief and corrects the PIP joint in the lateral plane without significantly affecting the coronal plane or the anatomical axis of the phalanx in the frontal and lateral views, nor producing secondary deformities. DPPSO is a safe, effective, and reproducible technique with a low complication rate. Levels of Evidence: Level IV: Retrospective case series

Mental-Health Impact of Quarantine Measures during the Coronavirus Disease 2019 (COVID-19) Outbreak in Eastern Province, Saudi Arabia

Objectives: To explore, among residents of Dammam and Al-Khobar, Saudi Arabia, the impact of quarantining as a result of coronavirus disease 2019 (COVID-19) infection on depression, anxiety, and stress levels. Methods: A cross-sectional study of all patients with COVID-19 in Dammam and Al-Khobar was conducted in July 5–18, 2020. Of the 395 patients targeted, 283 responded (response rate: 72%). Results: The participants’ mean age (± standard deviation) was 31.3 (± 10.7) years; 46% were women. Loss of smell (26.5%), headache (25.4%), cough (25.1%), loss of taste (22.6%), and loss of motion (22.6%) were common symptoms. The main source of COVID-19 infection was family gatherings (38.2% of cases). Overall, 47% of the sample showed depression, 37% showed anxiety, and 29% showed depression and anxiety. Approximately 50% of those with depression, anxiety, and/or stress developed symptoms after infection; of these, 90% experienced stress. For 75% of those with depression, anxiety, and/or stress, quarantining did not exacerbate these symptoms. Depression was high among women, with diabetes mellitus, headache, loss of motion, body aches, lack of appetite, fatigue, shortness of breath, and loss of smell and taste showing significant associations in this regard. Anxiety was only significantly associated with fatigue. Conclusion: Loss of smell and taste, fatigue, and headache indicate a risk of developing depression, anxiety, and/or stress. Early mental-health interventions are necessary to prevent patients entering COVID-19 quarantine from experiencing long-term symptoms.

A CLINICAL STUDY TO EVALUATE EFFECT OF KSHEERBALA TAILA NASYA IN THE MANAGEMENT OF AVABAHUK w.s.r. FROZEN SHOULDER

Avabahuk is the disease that usually affect Amsa sandhi (shoulder joint).. Even though the term Avabahuk is not mentioned in the nanatmaj Vatavyadhi. Acharya Sushrut and others have considered Avabahuk as a Vatajvikar. Avabahuk is one such disease which hampers the day to day activity of an individual.. In Avabahuk, vitiated vata dosha localizes in amsa pradesh and does the sankoch of siras leading to the manifestation1. Sira sankoch and bahupraspanditharam can be correlated with painful stiffness and loss of motion of the shoulder. Hence it can be correlated with frozen shoulder as described in the modern system of medicine.Frozen shoulder is more common in diabetics. The general line of treatment mentioned for vatavyadhi in ayurvedic classics include snehan (both internal and external), swedan, mrudusamshodhan, basti, shirobasti, Nasya . Acharya Charak further states that, depending on the location and dushya (tissue element vitiated by vata) each patient should be given specific therapies. Acharya Vagbhata has mentioned Nasya karma in the jatruurdhwavatavikaras. Present study was conducted to assess the efficacy of Nasya with Ksheerbala taila in Avbahuka 15 patients of avabahuka were taken in an open label single group clinical study for nasya with ksheerbalataila.Results of this study showed that Nasya with Ksheerbala taila was effective in relieving the symptoms of Avabahuka and found statistically significant.

Range of Motion after the Sauvé–Kapandji and Darrach Procedures without Extensor Tendon Rupture

Background Previous study demonstrated that distal radioulnar joint (DRUJ) plays a biomechanical role in extension and flexion of the wrist and suggested that fixation of the DRUJ could lead to loss of motion of the wrist. Little is known about the pre- and postoperative range of motion (ROM) after the Sauvé–Kapandji (S-K) and Darrach procedures without tendon rupture. To understand the accurate ROM of the wrist after the S-K and Darrach procedures, enrollment of patients without subcutaneous extensor tendon rupture is needed. Purpose This study aimed to investigate the pre- and postoperative ROM after the S-K and Darrach procedures without subcutaneous extensor tendon rupture in patients with rheumatoid arthritis (RA) and osteoarthritis (OA). Methods This retrospective study included 36 patients who underwent the S-K procedure and 10 patients who underwent the Darrach procedure for distal radioulnar joint disorders without extensor tendon rupture. Pre- and postoperative ROMs after the S-K and Darrach procedures were assessed 1 year after the surgery. Results In the S-K procedure, the mean postoperative ROM of the wrist flexion (40 degrees) was significantly lower than the mean preoperative ROM (49 degrees). In wrist extension, there were no significant differences between the mean preoperative ROM (51 degrees) and postoperative ROM (51 degrees). In the Darrach procedure, the mean postoperative ROM of the wrist flexion and extension increased compared with the mean preoperative ROM; however, there were no significant differences. Conclusion In the S-K procedure, preoperative ROM of the wrist flexion decreased postoperatively. This study provides information about the accurate ROM after the S-K and Darrach procedures. Level of Evidence This is a Level IV, therapeutic study.

Incidence and Predictors of Subsequent Surgery After Anterior Cruciate Ligament Reconstruction: A 6-Year Follow-up Study

Background: The cause of subsequent surgery after anterior cruciate ligament (ACL) reconstruction varies, but if risk factors for specific subsequent surgical procedures can be identified, we can better understand which patients are at greatest risk. Purpose: To report the incidence and types of subsequent surgery that occurred in a cohort of patients 6 years after their index ACL reconstruction and to identify which variables were associated with the incidence of patients undergoing subsequent surgery after their index ACL reconstruction. Study Design: Cohort study; Level of evidence, 2. Methods: Patients completed a questionnaire before their index ACL surgery and were followed up at 2 and 6 years. Patients were contacted to determine whether any underwent additional surgery since baseline. Operative reports were obtained, and all surgical procedures were categorized and recorded. Logistic regression models were constructed to predict which patient demographic and surgical variables were associated with the incidence of undergoing subsequent surgery after their index ACL reconstruction. Results: The cohort consisted of 3276 patients (56.3% male) with a median age of 23 years. A 6-year follow-up was obtained on 91.5% (2999/3276) with regard to information on the incidence and frequency of subsequent surgery. Overall, 20.4% (612/2999) of the cohort was documented to have undergone at least 1 subsequent surgery on the ipsilateral knee 6 years after their index ACL reconstruction. The most common subsequent surgical procedures were related to the meniscus (11.9%), revision ACL reconstruction (7.5%), loss of motion (7.8%), and articular cartilage (6.7%). Significant risk factors for incurring subsequent meniscus-related surgery were having a medial meniscal repair at the time of index surgery, reconstruction with a hamstring autograft or allograft, higher baseline Marx activity level, younger age, and cessation of smoking. Significant predictors of undergoing subsequent surgery involving articular cartilage were higher body mass index, higher Marx activity level, reconstruction with a hamstring autograft or allograft, meniscal repair at the time of index surgery, or a grade 3/4 articular cartilage abnormality classified at the time of index ACL reconstruction. Risk factors for incurring subsequent surgery for loss of motion were younger age, female sex, low baseline Knee injury and Osteoarthritis Outcome Score symptom subscore, and reconstruction with a soft tissue allograft. Conclusion: These findings can be used to identify patients who are at the greatest risk of incurring subsequent surgery after ACL reconstruction.

Pseudo-grammaticalization: The anatomy of "come" in Modern Hebrew pseudo-coordination constructions

The paper examines the pseudo-coordination construction featuring the verb come preceding a lexical verb in Modern Hebrew, and shows that this is a mono-clausal mono-eventive construction, which did not emerge via a process of grammaticalization. That is, there is no tightening of internal dependencies between parts of the construction (Haspelmath 2004), nor evidence of a lexical unit starting to assume grammatical functions (Heine, Claudi & Hünnemeyer 1991). I go on to argue that, in this particular construction, the verb come is a “lexical restructuring verb” (Wurmbrand 2004, 2014), whose lexical properties do not differ from those of ‘simple’ change-of-location uses of come in that both feature a deictic meaning component. Particular attention will be paid to what looks like the absence of a motion component, suggesting that even if simple come selects for a prepositional complement, it does not necessarily encode a motion component, and therefore the absence of the PP, in a complex verb construction is not tied to loss of motion, but merely to a change in the type of complement. The current account provides substance to claims stressing a metaphorical relation between the two occurrences of come, since it points to the close similarities in the lexical-pragmatic properties of this lexeme in its two environments of use, and locates the difference between them in the choice of complement that produces the effect of transfer from the location realm to a more abstract one characteristic of metaphoric meanings.

A NEVER-ENDING STORY OF RHEUMATOID ARTHRITIS

There are distinct Rheumatic disorders, still Rheumatoid arthritis (RA) is believed to be very prevailing. RA is an empathic disorder described over integral redness, constant inflammation, and the existence of auto-antibodies. In RA, inflammation in joints, loss of motion of joint stiffness, joint tenderness are most common in patients. Deformity of joints can be prevented by early diagnosis and treatment. The extremity of the disease can be reduced by combining the drugs and improved weight more profiled than single medication. Treat-to-target progress results in a superior-conclusion in RA, and the ACR, EULAR, and other specialized systems have supported treat-to-target as a basic curative strategy for RA. The novel methods used in RA have upgraded the development of the disorder and maximum people helpful in cancellation of clinical manifestations if the identification of disorder takes place before time. This review article is written after studying most of the journal’s articles, which were published between 1997-2019.

Effectiveness of dysphagia exercises on swallowing ability among patients with Cerebrovascular Accidents

Cerebrovascular accident (CVA) is one of the foremost reasons leading to mortality and morbidity throughout the world. It is the third biggest killer in India after a heart attack and cancer. It is like a chronic health condition which negatively impacts on quality of life. Dysphagia is one of the most successive side effects in patients with a stroke which is a loss of motion of throat muscles. This condition can disturb the gulping procedure and make eating, drinking, taking prescription and breathing trouble. Dysphagiaexercises are designed toenhancing muscles and coordinatingthe nervesandmuscles involved in swallowing.The pre-experimental design was used with 60 samples who matched the inclusion criteria who were selected by purposive sampling technique.The study aims is to assess the swallowing ability before and after dysphagia exercisesamong patients with cerebrovascular accidents. Demographical variables were collected by using self- structured questionnaires and Modified Mann Assessment of Swallowing Ability Scale.The study uncovered that the pre-test mean swallowing ability score was 42.45 with a standard deviation of 8.63 among the cerebrovascular accident patients. The post-test swallowing ability mean score of 50.54% with a standard deviation of 8.23 among the cerebrovascular accident patients. The study findings concluded thatDysphagia practices which was an effective, inexpensive, simple measure for improving swallowing ability among patients with cerebrovascular accident.