Apofizealne avulzijske ozljede prednje donje šiljaste izbočine: rehabilitacija sine qua non – prikaz slučaja

Apophyseal injuries of the anterior superior iliac spine and pubic bone are common, whereas injuries to the anterior inferior iliac spine are only rarely encountered. When it occurs in children, it may be difficult to diagnose and is easily mistaken for slipped capital femoral epiphysis. To make timely and correct diagnosis, the physician must have thorough understanding of the basic anatomical relationships and awareness of the existence of this injury. In this case report treatment and follow-up period in a 12-year-old patient with apophyseal avulsion of anterior inferior iliac spine is described and the differential diagnosis is discussed.Apofizealne ozljede prednje gornje šiljaste izbočine bočne kosti i stidne kosti su česte, dok su ozljede prednje donje šiljaste izbočine bočne kosti rijetke. Kada se dogodi u djece ponekad je teško postaviti dijagnozu i lako se zamijeni s poskliznućem epifize glave femura. Da bi se postavila točna i pravovremena dijagnoza liječnik mora temeljito razumijeti osnovne anatomske odnose i biti svjestan mogućnosti pojave ove ozljede. U ovom prikazu slučaja iznosi se liječenje i praćenje tijekom dvije godine 12-godišnjeg bolesnika s apofizealnom avulzijom prednje donje šiljaste izbočine bočne kosti, a raspravljeno je o diferencijalnoj dijagnozi

Rehabilitacijski protokol kod stres frakture talusa niskog stupnja

Bone stress injuries are common overuse injuries seen in active people. The pathogenesis is multifactorial and usually involves repetitive submaximal stresses. No comprehensive studies describing rehabilitation protocol of low grade bone stress injury of the talus have been published. The aim of this case series was to describe a conservative treatment protocol for low grade bone stress injury of the talus.The rehabilitation and pain features in 15 patients with low grade bone stress injury of the talus, as confirmed by magnetic resonance imaging (MRI), were reviewed retrospectively. Of 15 patients (8 female and 7 male; age range 16-50 years; median age 29.1 years; mean duration of symptoms 2.5 (range, 1 to 12) weeks, MRI studies showed low grade bone marrow edema of the talus in six cases, whereas in other nine cases (5/15 calcaneus, 3/15 navicular and 1/15 cuboideum) adjacent osseous structures were affected as well. In four cases, the entire talus was involved and in eleven cases, only a portion of the bone was affected. The mean visual analogue scale for pain before treatment was 53.5 mm. The median duration of walking boot usage was 16.2 (7 to 70) days. Patients became symptom free in a mean of 23.2 (12-40) days. Ten patients returned to daily life and sportive activities without difficulty. Early diagnosis and appropriate conservative treatment of low grade bone stress injury of the talus allow favorable outcome in most cases.Stres ozljede kosti su uobičajene ozljede prenaprezanja u aktivnih osoba. Njihova patogeneza je multifaktorijalna i obično uključuju ponavljajući submaksimalni stres. Do sada nisu objavljene sveobuhvatne studije koje bi opisale rehabilitacijski protokol stres ozljeda talusa niskog stupnja. Cilj ove serije slučajeva je bio opisati konzervativni terapijski protokol za stres ozljede talusa niskog stupnja. Osobine rehabilitacije i boli u 15 pacijenata sa stres ozljedom talusa niskog stupnja, potvrđeno magnetskom rezonancijom (MR), su retrospektivno pregledani. Od 15 pacijenata (8 žena i 7 muškaraca; raspon dobi 16-50 godina; medijan dobi 29,1 godina; srednje trajanje simptoma 2,5 tjedana (raspon 1 do 12 tjedana), MR je pokazala edem koštane srži niskog stupnja talusa u šest slučajeva, dok je u preostalih devet slučajeva (5 petnih kostiju, 3 navikularne kosti I 1 kuboidne kosti) obližnje koštane strukture su bile također zahvaćene. U četiri slučaja bio je zahvaćen cijeli talus a u jedanaest slučajeva samo dio kosti. Srednja vrijednost jačine boli na vizualnoj analognoj ljestvici (VAS) je prije liječenja bila 53,5 mm. Srednje trajanje primjene imobilizacije (čizma) je bilo 16,2 dana (raspon 7 do 70). Pacijenti su postali bez simptoma za prosječno 23,2 dana (raspon 12-40). Deset pacijenata se vratilo aktivnostima svakodnevnog života i sportskim aktivnostima bez da imaju bilo kakve poteškoće. Rana dijagnoza i odgovarajuće konzervativno liječenje stres ozljede talusa niskog stupnja omogućuje povoljan ishod u većini slučajeva

Apofizealne avulzijske ozljede prednje donje šiljaste izbočine: rehabilitacija sine qua non – prikaz slučaja

Apophyseal injuries of the anterior superior iliac spine and pubic bone are common, whereas injuries to the anterior inferior iliac spine are only rarely encountered. When it occurs in children, it may be difficult to diagnose and is easily mistaken for slipped capital femoral epiphysis. To make timely and correct diagnosis, the physician must have thorough understanding of the basic anatomical relationships and awareness of the existence of this injury. In this case report treatment and follow-up period in a 12-year-old patient with apophyseal avulsion of anterior inferior iliac spine is described and the differential diagnosis is discussed.Apofizealne ozljede prednje gornje šiljaste izbočine bočne kosti i stidne kosti su česte, dok su ozljede prednje donje šiljaste izbočine bočne kosti rijetke. Kada se dogodi u djece ponekad je teško postaviti dijagnozu i lako se zamijeni s poskliznućem epifize glave femura. Da bi se postavila točna i pravovremena dijagnoza liječnik mora temeljito razumijeti osnovne anatomske odnose i biti svjestan mogućnosti pojave ove ozljede. U ovom prikazu slučaja iznosi se liječenje i praćenje tijekom dvije godine 12-godišnjeg bolesnika s apofizealnom avulzijom prednje donje šiljaste izbočine bočne kosti, a raspravljeno je o diferencijalnoj dijagnozi

The efficacy of balneotherapy and physical modalities on the pulmonary system of patients with fibromyalgia

Effects of balneotherapy on Primary Fibromyalgia Syndrome (FMS) have been studied well, except for its effect on the respiratory symptoms of FMS. In this study we allocated 56 patients with FMS into three groups who matched according to age, gender and duration of illness. All three groups received the same three physical therapy modalities (PTM): transcutaneous electrical nerve stimulation (TENS), ultrasound (US) and infrared (IR). The first group received PTM plus balneotherapy (PTM+BT), the second group received PTM alone (PTM), whilst the third group received PTM plus hydrotherapy (PTM+HT). All groups were treated for three weeks and in the same season. All patients were assessed at four time points: (a) at baseline, (b) on the 7th day of therapy, (c) at the end of therapy (after 3 weeks) and (d) at 6 months after the end of therapy. The effectiveness of treatments in all groups were evaluated in three main categories (pain, depressive and respiratory symptoms). Tender point count, total algometric measurements and pain with visual analog scale for pain; Beck Depression Inventory (BDI) and Hamilton Depression Rating Scale (HDRS) for depression; dyspnea scale, and spirometric measurements for respiratory symptoms; plus quality of life with visual analog scale as a general measurement of effectiveness were taken at all four assessment time points. Both at the end of therapy and at the 6 months follow up significant improvements in dyspnea scale, and spirometric measurements, as well as in other measured parameters were observed in group PTM+BT. All groups achieved significant improvements in BDI and HDRS but scores of PTM and PTM+HT groups had overturned at 6 months follow up. Except second group which receieved PTM alone, pain evaluation assessments were improved at 6 month follow up in PTM+HT and PTM+BT groups. But PTM+BT group had more significant improvements at the end of therapy. PTM group had no significant change for dyspnea scale and spirometric measurements. PTM combined BT and HT groups achieved significant improvements at the end of therapies for dyspnea scale and spirometric measurements, but only PTM+BT group had significant improvements for dyspnea scale and spirometric measurements at six month follow up. The group of PTM+BT was significantly better than other groups. Our results suggest that supplementation of PTM with balneotherapy is effective on the respiratory and other symptoms of FMS and these effects were better than other protocols at 6 month follow up