Reports from spinal cord injury patients: Eight months after the 2003 earthquake in Bam, Iran

OBJECTIVE: The World Health Organization defines disaster as a sudden ecologic phenomenon of sufficient magnitude to require external assistance. On December 26, 2003, the Bam earthquake left more than 200 spinal cord injury (SCI) patients. Our study of these SCI patients and the rehabilitation of disabled persons in Bam may assist in the organization of rehabilitation programs during future disasters. DESIGN: Eight months after the disaster, we planned to visit the SCI patients in Bam. We visited 61 patients in Bam, Baravat, and surrounding villages. We completed a questionnaire during our visit. RESULTS: The patients' mean age was 31.9 ± 9.6 yrs. Twenty-nine (53.7) patients were female, and 25 (46.3) were male. Fifty-two (96.3) patients had pain syndromes, which had started from 3 days to 8 mos after injury. Thirty-three (61) patients used clean intermittent catheterization, and 29 (53.7) did not have bowel programs. Nineteen (35.2) patients had pressure sores. CONCLUSIONS: All aspects of disasters should be considered seriously by all countries. The special needs of people with disabilities during and long after any disaster are important. The impact of disasters on disabled people is magnified because of their condition, so special attention must be paid to this group. © 2007 Lippincott Williams & Wilkins, Inc

Study of the ulnar nerve compromise at the wrist of patients with carpal tunnel syndrome

Introduction: That the ulnar nerve compromise occurs concomitant with the carpal tunnel syndrome (CTS) has been cited by previous studies. It seems that the previously mentioned incidence is much higher than what we observe in our electrodiagnosis studies. Material and Method: A prospective study was designed to evaluate the incidence of ulnar nerve compromise in patients with electrodiagnostic evidence of CTS according to age and sex, and also to determine the site of ulnar nerve involvement. Results: One hundred and sixty five limbs with standard elestrodiagnostic criteria of CTS were evaluated. In 9.7 of the tested limbs, the ulnar nerve was involved. The site of the involvement was the wrist area in 43.75. The elbow region was involved in 43.75, and in 12.5, the forearm region was involved. The most prevalent age range of concomitant involvement was 45-54 years old. In patents who had sensory symptoms in the 4th and 5th fingers, the incidence of concomitant ulnar nerve compromise was significantly higher (p < 0.001) than the patients without these symptoms. Discussion: In patients with CTS, concomitant ulnar nerve compromise is much lower than the incidence mentioned in previous researches. Apparently the rate of involvement in wrist and elbow are equal. It is recommended that in evaluation of patients for CTS especially when the patient has sensory symptoms in the hand, special attention is paid to ulnar nerve involvement and two nerve comparison tests are interpreted with caution

Survey of general practitioners' attitudes toward physical medicine and rehabilitation

This study reports the attitudes of general practitioners towards physical medicine and rehabilitation after participating in a continued medical education course in this field. Given the high prevalence of musculoskeletal disorders and number of disabled persons in the country, along with the role of general practitioners in the primary and long-term management of such patients, basic competency in rehabilitation medicine must be considered in the educational curriculum of medical students. Nevertheless, rehabilitation medicine is not taught in most universities. This study was performed to evaluate the attitude of general practitioners towards physical medicine and rehabilitation as a baseline for developing educational programs in this field. In a simple descriptive study, at the end of a continued medical education program in low back pain management, 217 questionnaires, focusing on the field of physical medicine and rehabilitation, were distributed between participants. One-hundred-and-forty-three questionnaires were analyzed. Statistical analyses were performed with descriptive and Student's t-test. The results showed that of the participants, 69 (48.3) were female and that they graduated from 24 medical schools. Most respondents (92.2) believed that musculoskeletal education had not been sufficient in general practitioner training courses. Of the respondents, 56.8 had visited at least one disabled patient during the previous month, while 11 had visited more than 10 in the same period, but 84.3 had not studied disabilities. Musculoskeletal physical examination was the most needed educational field cited by general practitioners. In conclusion, this study clearly documents the inadequacy of basic rehabilitation training in medical schools. The findings reveal the most needed and preferred rehabilitation areas for general practitioners, and these should be considered in the establishment of rehabilitation training programs for Iranian medical students. © 2006 Lippincott Williams & Wilkins

Prevalence of ulnar-to-median nerve motor fiber anastomosis (Riché-Cannieu communicating branch) in hand: An electrophysiological study

Background: Two main muscles studied in the hand for evaluation of median nerve injuries are opponens pollicis (OP) and abductor pollicis brevis (APB). However, Riché-Cannieu communicating branch (RCCB) may limit the use of these muscles in electrodiagnosis. This condition is confusing in the case of median nerve injuries. This study was conducted to evaluate the prevalence of RCCB. Methods: Twenty-three consecutive cases of complete median nerve injury were studied. Evoked responses via stimulation of median and ulnar nerves in the wrist and recording with needle in the thenar area were studied. Results: Of the patients, 82.6 exhibited RCCB. In 14 (60.8) cases the OP and in 19(82.6) cases APB was supplied by the ulnar nerve. Conclusion: RCCB was detected to be 60.8 in OP and 82.6 in APB, so OP is preferable to APB in the study of median nerve

Integrating physical medicine and rehabilitation into the curriculum of Iranian medical students

Purpose. To evaluate the attitude of interns toward Physical Medicine and Rehabilitation (PM&R) and design a PM&R curriculum for medical students with continued medical education programmes and workshops based on the needs and interest of Iranian medical community. Method. Eighty questionnaires were distributed to the medical interns on the last day after attendance in the PM&R ward after participating in a one-month outpatient and inpatient course including 12 lectures. Results. Out of 80 participants, 34 (42.5) were female and 46 (57.5) were male. All the participants believed participating in a rehabilitation course was necessary; 52 (65) believed that participating in a separate course of PM&R was necessary, and 28 (35) believed that rehabilitation of each field of medicine should be presented in its course. A significant percentage (31.4) of the participants were interested in continuing their education in PM&R specialty. Conclusion. The enthusiasm of the medical students towards PM&R is a promising sign toward progress of PM&R in Iran which must be directed through a strong effort of physiatrists through setting up appropriate educational programmes for medical students and continued medical education programmes in the universities. © 2006 Taylor & Francis

Repeated sessions of transcranial direct current stimulation for treatment of chronic subjective tinnitus: a pilot randomized controlled trial

Subjective tinnitus is an auditory phantom sensation characterized by the perception of sound in the absence of an identifiable external source. This distressing audiological symptom can severely affect the quality of life. Transcranial direct current stimulation (tDCS) is a noninvasive technique that can induce short-term relief in tinnitus in some patients. The purpose of this pilot double-blind randomized controlled trial was to investigate whether repeated application of anodal tDCS over left temporoparietal area could induce long-lasting relief in patients with chronic tinnitus. Twenty-two patients with chronic tinnitus for at least 6 months were randomly allocated into two groups and received five sessions of anodal (N = 11) or sham (N = 11) stimulation in five consecutive days. A current intensity of 2 mA for 20 min was used for anodal stimulation. Outcomes were assessed using Persian version of tinnitus handicap inventory (THI), loudness and distress visual analog scale (VAS) scores and clinical global impression (CGI) scale. The trial is registered at the Iranian Registry of Clinical Trials (IRCT) with the reference ID of IRCT2014082018871N1. No statistically significant difference was found between anodal and sham stimulation regarding either immediate or long-lasting effects over the 2 weeks follow-up period. Deterioration of symptoms and alteration in tinnitus characteristics were reported by a few patients. There were no significant long-term beneficial effects following tDCS of the left temporoparietal area. © 2015, Springer-Verlag Italia

Randomized clinical trial comparing of transcranial direct current stimulation (tDCS) and transcutaneous electrical nerve stimulation (TENS) in knee osteoarthritis

Background: Due to the limitations of pharmacological and surgical management of knee osteoarthritis (OA), several non-pharmacologic approaches including transcutaneous electrical nerve stimulation (TENS) and transcranial direct current stimulation (tDCS) have been introduced, with promising results. Objective: We aimed to investigate and compare the therapeutic effects of TENS and tDCS for the treatment of patients with knee OA. Methods: In this double-blinded randomized controlled trial, a total of 40 adult patients with knee OA were randomly allocated to either the TENS or the tDCS group. Patients in either group received 6 sessions of the TENS or tDCS for 2 weeks. Knee strengthening exercises were performed twice daily for the entire treatment period. Patients were evaluated using the visual analogue scale (VAS) and Western Ontario and McMaster Universities (WOMAC). Results: Significant improvement was observed in all outcomes in both TENS and tDCS groups at each follow up compared to baseline although the early improvement (first follow-up) in the WOMAC index was not significant in the TENS group. Based on the within-subject analysis, the behavior of two treatment groups did not differ regarding the changes in the course of the VAS, WOMAC score and its subscales, i.e. stiffness, pain and function (p = 0.263, 0.051, 0.198, 0.075, and 0.146, respectively). Conclusions: Based on the results of this study, the effect of tDCS and TENS was not significantly different on pain and function of patients with knee OA. © 2020 Elsevier Masson SA

Is there an association between lumbosacral radiculopathy and painful gluteal trigger points? A cross-sectional study

Objective: The objective of this study was to compare the prevalence of gluteal trigger point in patients with lumbosacral radiculopathy with that in healthy volunteers. Design: In a cross-sectional, multistage sampling method, patients with clinical, electromyographic, and magnetic resonance imaging findings consistent with lumbosacral radiculopathy were examined for the presence of gluteal trigger point. Age- and sex-matched clusters of healthy volunteers were selected as the control group. The primary outcome of the study was the presence or absence of gluteal trigger point in the gluteal region of the patients and the control group. Results: Of 441 screened patients, 271 met all the inclusion criteria for lumbosacral radiculopathy and were included in the study. Gluteal trigger point was identified in 207 (76.4) of the 271 patients with radiculopathy, compared with 3 (1.9) of 152 healthy volunteers (P < 0.001). The location of gluteal trigger point matched the side of painful radiculopathy in 74.6 of patients with a unilateral radicular pain. There was a significant correlation between the side of the gluteal trigger point and the side of patients' radicular pain (P < 0.001). Conclusions: Although rare in the healthy volunteers, most of the patients with lumbosacral radiculopathy had gluteal trigger point, located at the painful side. Further studies are required to test the hypothesis that specific gluteal trigger point therapy could be beneficial in these patients. Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved

The diagnostic accuracy of gluteal trigger points to differentiate radicular from nonradicular low back pain

Objectives: Low back pain (LBP) is highly prevalent and costly to the society. Previous studies have shown an association between radicular LBP and trigger points (TrPs) in the superior-lateral quadrant of the gluteal area (GTrP). The objective of current study was to evaluate the diagnostic value of GTrP to predict nerve root involvement among patients with LBP. Materials and Methods: In a prospective, diagnostic accuracy study 325 consecutive patients with LBP were recruited. At first step, patients were evaluated for the presence or absence of the GTrP. A different investigator, blinded to the GTrP findings, then performed history taking and physical examination. Subsequently, all patients underwent a lumbar spine magnetic resonance imaging and, when indicated, electrodiagnostic tests. On the basis of the clinical and ancillary tests findings, a multidisciplinary panel of experts (the "reference standard"), blinded to the GTrP evaluation, allocated patients to radicular versus nonradicular LBP groups. The agreement between the GTrP findings, as a diagnostic test and the reference standard allocation was evaluated in a 2 by 2 contingency table. Results: The specificity of the GTrP test was 91.4 and its sensitivity was 74.1. The area under the receiver operating characteristic curve was 0.827 (0.781 to 0.874). Positive likelihood ratio was 8.62 and negative likelihood ratio was 0.28. Positive and negative predictive values were 91.9 and 72.7, respectively. Discussion: As a clinical finding, TrPs in superior-lateral quadrant of gluteal area are highly specific indicators for radicular LBP. Incorporating these TrPs evaluation in routine physical examination of patients with LBP could decrease the need for more costly, time-consuming, and invasive diagnostic tests. © 2015 Wolters Kluwer Health, Inc