To study the bladder behaviour in response to rehabilitation intervention in traumatic spinal cord injury (SCI) patients using urodynamic study (UDS) and to compare the nature of the bladder in a rehabilitated and nonrehabilitated neurogenic bladder of traumatic SCI.

Prospective follow-up study.

Rehabilitation ward of National Institute for the Orthopaedically Handicapped.

Thirty traumatic SCI patients mean age 31.4±7.9 years, 26 males and 4 females, admitted for rehabilitation were done UDS to see the bladder behaviour in response to rehabilitation intervention and compare the nature of bladder of the rehabilitated and that of the non-rehabilitated neurogenic bladder. Rehabilitation of the bladder was done at least for three months. The study lasted for 2 years with a minimum of one year follow-up.

In upper motor neuron (UMN) neurogenic bladders there were significant changes in the max. cystometric capacity (p=0.018) after rehab intervention. The compliance, Pdet. at first desire to void and Pdet. at max. cystometric capacity of these patients were also found to have significant correlations (p=0.012, 0.010 and 0.014 respectively). But the volume at the first desire to void does not show must significant changes after rehab intervention (p=0.45). Significant reduction of amplitude and frequency was found in involuntary contractions (detrusor hyper-reflexia). In similar comparison of the lower motor neuron (LMN) neurogenic bladder significant changes after rehab intervention, could be found only in the max. cystometric capacity (p=0.018). Other variables like compliance, volume at first desire to void, Pdet. at first desire to void, and Pdet. at max. cystometric capacity were found to have no significant changes after rehab intervention (p=0.168, 0.194, 0.324, 0.302 respectively).

The change in the nature of the rehabilitated neurogenic bladder is different with the type of bladder.

Osteo-arthritis, the most common joint disease of human being, presents with pain and stiffness of the affected joints, feeling of instabilities, deformities and severe loss of function of the involved joint affecting activities of daily livings as well as economic burden.

The present study evaluates the efficacy and adverse effects of diacerein, an anti-inflammatory drug now being considered as a disease modifying drug in osteo-arthritis on 38 patients. After 6 weeks of intervention, diacerein showed statistically significant superiority versus aceclofenac as assessed with WOMAC A (P<0.0001), WOMAC B (P< 0.0001), WOMAC C (P<0.0001) and secondary efficacy variable like NSAIDs (aceclofenac) intake from the baseline and at the efficacy time point at 6 weeks and 12 weeks(P<0.0001), demonstrating the better efficacy of diacerein over aceclofenac. This superiority was already evident from 6th week for all the parameters. It was more significant after completion of the study.

To compare the anterior and posterior blind intra-articular steroid injections approaches in the management of adhesive capsulitis of shoulder

Randomised control trial

Department of PMR, Regional Institute of Medical Sciences (RIMS), Imphal, Manipur.

The patients having adhesive capsulitis of shoulder (n=60) attending PMR department, RIMS during the study period.

One year (August 2011 to July 2012).

After randomisation, 60 patients were allocated in three groups (A, B and C). Group C (n=20) received physical therapy practice in the department of PMR, RIMS, Imphal. Group A (n=18) and B (n=22) received intraarticular steroid (methylprednisolone 80mg each) by anterior and posterior approaches without imaging guidance respectively in addition to physical therapy. Outcome measures: 1) Visual analogue scale (VAS) for pain, 2) Shoulder pain and disability index (SPADI) and 3) Passive range of motion of affected shoulder using goniometer.

All the three groups showed improvement with statistically significant (p<0.005) findings in all the outcome variables except in shoulder flexion range (p=0.085). Improvement in outcomes namely VAS, SPADI, shoulder rotation and abduction range were more marked in group A when compared with group B which was found statistically significant (p<0.05).

The intra-articular steroid injection when combined with physical therapy is effective in the management of adhesive capsulitis of shoulder. The blind anterior approach intra-articular steroid injection is more effective than posterior approach in improving shoulder rotation and abduction range of movements, reducing shoulder pain and disability in patient having less than 3 months duration adhesive capsulitis of shoulder.

Quadrilateral space syndrome is a rare occurrence of compression of the axillary nerve within the quadrilateral space. It presents as shoulder pain with weakness due to teres minor atrophy. It can often times be overlooked and undertreated. MRI and electrodiagnostic studies are used to confirm the diagnosis. We present a case of a patient with quadrilateral space syndrome confirmed using both MRI and electrodiagnosis.

A 61 year-old male was referred from neurology to PMR department RML hospital, New Delhi, with difficulty in writing for 2 years prior to consultation. Initially difficulty in writing which is accompanied with pain after prolonged writing. Also he noticed tremor and stiffness while writing. Disability progressed and he was unable to write even a few words legibly and cannot hold object (spoon) which leads to anxiety and dependency.

When the patient was examined at PMR OPD, EMG/NCV study was advised, which showed normal sensory and motor nerve functions.

The present treatment involved the use of a multidisciplinary therapeutic approach with Physical Medicine and Rehabilitation Specialist, Clinical psychologist and Occupational Therapist which gave us satisfactory results within 6- 8 months. The findings in this case is very encouraging and studies with large sample sizes can be considered for further conclusive evidence on the treatment of writer's cramp.

Plexiform neurofibromatosis, also known as pachydermatocele, is a rare type of neurofibromatosis, caused by excessive growth of the neural tissue in the subcutaneous fat. This condition is rare in Indian subcontinent but when it occurs, it causes cosmetic as well as functional disability. The optimal management of plexiform neurofibroma is not well defined and surgery is often delayed. We report a rare case of neurofibromatosis with pachydermatocele involving the nerves of the left thigh and leg with disfigurement and associated disability.