Case Report: Rehabilitation for Lower Extremity Pain Due to Venous Stasis in a Patient With Multisystem Inflammatory Syndrome in Children

Recently, it was reported that children recovering from coronavirus disease (COVID-19) developed multisystem inflammatory syndrome in children (MIS-C), which causes severe inflammation in multiple organs of the body. Because MIS-C is a new disease, the pathophysiology and prognosis are unknown. Owing to a lack of studies on this subject, we herein provide information on rehabilitation for children with MIS-C. A 12-year-old male patient presented with systemic inflammatory symptoms after approximately 2 months since recovery from COVID-19. He was treated with cyclosporine and steroid pulse therapy after admission to our hospital. His general condition improved significantly within approximately 1 week. Thereafter, his lower legs turned dark purple and he experienced intense pain whenever the lower limbs hung below the heart, such as in the sitting position. The patient was referred to the rehabilitation department, as he had difficulties during standing and walking. Because the symptoms improved with elevation of the lower extremities, we considered that the pain was related to venous stasis. The pain reduced when an elastic bandage was applied for the prevention of venous stasis; therefore, exercise therapy was implemented while the patient wore the elastic bandage. The patient's lower extremity symptoms improved in 10 days. He was discharged after 16 days and could independently perform activities of daily living (ADL). The mechanism underlying the patient's pain could not be determined; however, rehabilitation was effective when combined with compression therapy using an elastic bandage.

Comparison of the Efficacy of Two Elastic Bandages for Forearm Hematoma After Transradial Coronary Intervention

Background: This study compares the efficacy of two elastic bandages in treating forearm hematoma after transradial coronary intervention.Methods: A total of 60 patients with moderate or severe forearm hematoma following transradial coronary intervention were enrolled in this study. They were randomly divided into two groups, as follows: an Idealast-haft elastic bandage group (the observation group) and a control group. The patients in the Idealast-haft elastic bandage group received compression bandaging with Idealast-haft elastic bandages and the patients in the control group received compression bandaging with Nylexorgrip elastic bandages. Observation indexes related to, for example, forearm pain, arterial pulsation, blistering, skin color, and hemostasis time were compared between the two groups.Results: The results revealed that the times taken for pain disappearance, arterial pulse recovery, blister disappearance, skin color recovery, and compression hemostasis were significantly shorter in the Idealast-haft elastic bandage group than in the control group, and the differences were statistically significant (P < 0.05). The hematoma range and the arm circumference at the severest part of the hematoma decreased faster in the observation group than in the control group, and the differences were statistically significant (P < 0.05).Conclusion: The Idealast-haft elastic bandage is more effective than the Nylexorgrip elastic bandage in patients with forearm hematoma following transradial coronary intervention and should therefore be used in such cases.

What’s new for the clinician? - Excerpts from and summaries of recently published papers

Extraction of third molars is one of the most common procedures performed by oral surgeons. Generally, these surgeries do not encounter difficulties but at times can result in complications. Postoperative complications may include swelling, pain, trismus, prolonged bleeding, dry socket, infection and sensory alterations of the inferior alveolar nerve or lingual nerve. For the swelling, the most common therapies include corticosteroids, non-steroid anti-inflammatory drugs (NSAIDs), or a combination of these agents. Elastic bandage application (Kinesio taping) is a technique that originates from sports sciences. Studies have reported its beneficial effects on swelling and trismus symptoms after oral and maxillofacial surgeries.1It has been claimed that elastic tapes reduce postoperative swelling by creating space between the dermis and fascia layers and thus increasing lymphatic and blood flow.1 Their alleviating effect on postoperative pain is due to dermal stimulation.1 Erdil and colleagues (2021)1 reported on a trail that sought to compare the effectiveness of submucosal dexamethasone injection, a therapeutic elastic bandage (Kinesio tape), and an NSAID (dexketoprofen trometamol) on postoperative swelling, trismus, pain following third molar surgery and alterations in the quality of life in the first postoperative week.

Prospective Multicenter Randomized Controlled Trial Comparing Early Protected Movement and Splinting for Fifth Metacarpal Neck Fracture

Background: Fifth metacarpal neck fractures account for 20% of all hand fractures, yet there remains debate with respect to management, particularly when conservative treatment is initiated. The objective of this study is to compare functional and patient-reported outcomes (PROs) in patients treated with early protected movement or splint immobilization. Methods: This national multicenter prospective randomized controlled trial compared 2 groups; elastic bandage with early protected movement versus immobilization with splinting. Demographic characteristics were collected at baseline. Functional outcomes (grip strength testing) and PROs (Brief Michigan Hand Questionnaire [bMHQ]) were collected at 4, 8, and 12 weeks post-intervention. Grip strength values of the injured hand were normalized to both the non-injured hand (at baseline), and the Canadian reference values. Results: Thirty-seven participants from 5 Canadian centers were randomized into the splint (n = 21) or elastic bandage group (n = 16). There were no significant differences in the bMHQ score between the splint (52.1 ± 27.2) or the elastic bandage (46.6 ± 20.4) groups ( P = .51). There were no differences in baseline grip strength between the splint (15.3 ± 8.9 kg) and elastic bandage (19.9 ± 7.5 kg) groups. At 8 weeks, the elastic bandage group had a significantly higher grip strength than the splint group (93% vs 64%, respectively: P < .05), when standardized as a percentage of the Canadian reference values. Conclusion: Patients with Boxer’s fractures treated with early protected movement had better functional outcomes by 8 weeks post-treatment as compared to the Canadian reference values of those treated with immobilization and splinting. Providers should manage Boxer’s fractures with early protected movement.

Lymphaticovenular Anastomosis for Patients with Lymphedema of the Upper Extremity at Siriraj Hospital: A Quantitative Analysis Study

Background: Lymphedema occurrence in patients that underwent breast cancer-related lymphedema (BCRL) treatment can become a major problem. Over the past decade, lymphaticovenular anastomosis (LVA) has become widely utilized. This surgery replicates the body’s system by creating a connection between the lymphatic tracts and the venous system and replaces a damaged lymphatic system caused by the consequences from BCRL. Objective: To analyze the results of LVA surgery targeting particularly the upper extremity areas from BCRL patients at Siriraj Hospital, Thailand. Materials and Methods: This retrospective study was based on the medical records of patients that underwent LVA surgery between January 2010 and August 2018. Lymphoscintigraphy examination (⁹⁹ᵐTc-dextran lymphoscintigraphy) or ICG lymphography was performed to confirm the physician’s diagnosis. The present study aimed to compare the arm circumference size and the rate of infection of patients between the pre-surgery and post-surgery of LVA. Results: One hundred eighteen patients underwent the LVA operation and were included in the study. They had an average of 3.2±1.3 anastomoses. The average duration for the follow-up after surgery was 32 weeks. The different sizes in both arms were 5.8±1.6 cm and 5.5±1.4 cm, which were measured from 10 centimeters above and below the elbows, respectively. Comparing the sizes of the arms based on pre-surgery and post-surgery measurements, the arm circumference decreased by 0.9±0.6 centimeters (15.5%) and 0.9±0.4 centimeters (16.4%) post-surgery for the position above and below the elbow, respectively. The number of infections decreased from 1.9±0.8 times per year to 0.8±0.1 times per year. However, it was found that the rate of applying skin-care treatments in patients was relatively low at 3.4%. Conclusion: The authors’ revealed that LVA surgery of the upper extremity is one of the most effective treatments for lymphedema patients. According to the authors experience in Siriraj Hospital, this treatment is not only decreasing the size of the limb, but it can also minimize the infection rate. However, most patients note that other additional treatments, such as elastic bandage, elastic stocking, or skin-care treatment, are still necessary. Keywords: Lymphedema, Lymphatic obstruction, Breast Cancer Related Lymphedema (BCRL), Lymphaticovenular anastomosis (LVA)