Conservative Rehabilitation of Partial Anterior Cruciate Ligament Tear - A Case Report

The anterior cruciate ligament is one of the most important ligaments in the knee joint (ACL). The ACL is necessary for appropriate knee joint mobility and mechanics. When the ACL is torn, patients may experience issues with their knee's function, as well as instability and the sensation of 'falling away' while walking. The anterior cruciate ligament acts as a main restraint on tibia-to-femur translation (anterior shear). Depending on the angle of knee flexion, this function is allocated to either anteromedial or posterolateral bundle. When the knee is fully extended, the posterolateral bundle is tense; however, when the knee flexes, the posterolateral bundle loosens and the anteromedial bundle tightens. We report the case of a 32-year-old man who twisted his leg while jogging, resulting in a partial thickness ACL rupture and mild joint effusion along the periarticular surface of the right knee, as revealed by radiological symptoms and MRI.Conservative rehabilitation in a patient aged 32 year shows good results and so the surgery was not performed. Initially 10 weeks protocol was managed in hospital under the guidance of a therapist including strengthening, stretching and conditioning of lower limb muscles, later on as pain reduced and patient achieved functional pain free range 12 week protocol was further set for home program.

FUNCTIONAL PAIN ABDOMEN IN CHILDREN: EPIDEMIOLOGY AND ETIOPATHOLOGY

Background: Chronic abdominal pain is one of the most common problem dealt in day to day practice by paediatricians. In most of these children, no cause can be identified. Although it is common but its definition, pathophysiological mechanisms and predisposing factors are not completely understood & there is need for large well performed clinical trials for evidence based treatment. Methods: Hospital based prospective case control study conducted on 100 children aged 5 to 15 years in routine OPD and indoor patient fulfilling the inclusion criteria. Conclusion: Female gender, school going children, psychological stress, traumatic life event and lower socioeconomic status increase the prevalence of pain abdomen in children. Keywords: Functional abdominal pain (FAP), Chronic abdominal pain. Children

The correlation between the angle of calcaneal eversion and gastrocnemius extensibility with nonspecific low back pain in obese women

Background: Individuals with obesity will experience an increase in the angle of calcaneal eversion which has an impact on increasing the workload of the muscles to maintain joint stability, so that tension occurs in the gastrocnemius muscle which affects its extensibility ability. Increasing the angle of calcaneal eversion will cause changes in lumbopelvic alignment so that it can cause low back pain. The aim of the study was to determine the correlation between the angle of calcaneal eversion and gastrocnemius extensibility with nonspecific low back pain in obese women.Methods: This research was a cross sectional analytic study with simple random sampling technique. The number of samples are 78 women aged 36-55 years old. The variables measured were functional pain reduction score in nonspecific low back pain with modified Oswestry disability questionnaire, the angle of calcaneal eversion and gastrocnemius extensibility with goniometer.Results: Our study showed that there was no significant correlation between the angle of calcaneal eversion and gastrocnemius extensibility. However, there was a significant correlation between gastrocnemius extensibility and low back pain at the level of 0.033. In addition, there was a significant correlation between the angle of calcaneal eversion and low back pain at the level of 0,000.Conclusions: There was a significant correlation between the angle of calcaneal eversion and gastrocnemius extensibility with low back pain. However, the angle of calcaneal eversion is not directly related to gastrocnemius extensibility.

O39 Unidimensional and functional pain assessment tools in postoperative adult patients: a systematic review of their development and utility

Introduction The Visual Analogue Scale (VAS), Numeric Rating Scale (NRS), Verbal descriptor scale, and faces pain scale are used to measure postoperative pain in adults. However, their utility in this population has not been reviewed systematically. We aimed to summarise and appraise the evidence relating to the measurement properties of unidimensional tools when used for this population and to identify available tools assessing the impact of pain on the restoration of function. Method Four databases (MEDLINE, EMBASE, CINAHL, PsycINFO) were searched up to August 2020 for relevant studies. Two reviewers independently screened articles and assessed risk of bias using the COensus-based Standards for the selection of health Measurement Instruments (COSMIN) checklist. Result Thirty-one studies were included. Only one study included an objective pain score; a tool assessing pain interference with function and reported low-quality evidence for construct validity. Studies looked at unidimensional tools were underpinned by low or very low-quality evidence for reliability, and all displayed a low quality of evidence of indeterminate responsiveness. Measurement error was only reported for VAS in one study of moderate quality. Interpretability results were available only for VAS and NRS. Feasibility results varied based on the included population. Conclusion Despite the extensive use of unidimensional tools, there is no evidence to suggest that any of these tools has superior measurement properties for postoperative pain. Therefore, future studies should be prioritised to assess their validity, measurement error and responsiveness. Validation studies of pain assessment tools that promote function are needed. Take-home Message Take home message: Functional pain scores should be assessed and validated for postoperative pain.

Inflammatory bowel disease, pancreatitis, and gut dysmotility disorders

Pain is a common complaint in children with gastrointestinal tract pathology. It has significant consequences for patients’ quality of life. A thorough evaluation should be performed to determine the cause and severity of pain. It is important to differentiate between organic and functional pain. Understanding the pathophysiology of pain in various conditions is useful in its management. This chapter outlines the causes and general principles in management of pain in gastrointestinal disorders. The specific management of common gastrointestinal conditions associated with pain, for example inflammatory bowel disease, gastroesophageal reflux disease, pancreatitis and gut dysmotility disorders, is discussed.

Chronic pain syndromes in childhood

Though this volume is replete with detailed discussions about specific pain problems, the focus of this chapter is on a discussion of the commonalities in etiology, associated symptoms, and treatment of many of the frequent chronic pain problems, primarily those categorized as Chronic Primary Pains in the International Classification of Diseases, 11th Revision, and traditionally known as “functional.” We will explore, in brief, the data that demonstrate the co-occurrence of many of the common chronic pain problems in children and the epidemiological similarities that exist between affected individuals. Then, we will review the concept of central sensitization and the physiological evidence that supports its presence in many of the functional pain problems. We will briefly review some of the symptoms associated with these entities (orthostatic intolerance, sleep disturbance, depression, anxiety, hypermobility, and family distress). Finally, we will discuss briefly a general approach to these problems, emphasizing the collection of specific information in the history and physical examination, the critically important presentation of the formulation to the family, and the treatment modalities that appear to be effective for many of these conditions. In-depth discussion of each of these pain problems is available in chapters specifically designated to review them in detail.