Indian Journal of Physical Medicine and Rehabilitation

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2018 | October-December | Volume 29 | Issue 4

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[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijpmr-29-4-iv  |  Open Access |  How to cite  | 


Original Article

Amalesh Basak, Aniketa Banerjee

A Comparative Study on Effectiveness of Intra-articular Injection of Steroid and Steroid Plus High Molecular Weight Hyaluronate in Primary Osteoarthritis Knee

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:6] [Pages No:91 - 96]

Keywords: Comparative study, High molecular weight hyaluronate, Intra-articular injection, Osteoarthritis knee, Steroid, Viscosupplementation

   DOI: 10.5005/jp-journals-10066-0034  |  Open Access |  How to cite  | 


Background: Primary osteoarthritis knee is a degenerative joint disease which is becoming a burden on the society as the aging population is increasing day by day due to increased healthcare facilities. Often, patients need nonsteroidal antiinflammatory drugs (NSAIDs) for pain reduction along with disease-modifying osteoarthritic drugs, and NSAID use in aged population is itself a risk factor for developing gastrointestinal, renal, and cardiovascular side effects. Many patients need intra-articular injection of steroid or high molecular weight (HMW) hyaluronate to reduce pain specially in those who do not respond to NSAID and are in high-risk group for developing side effects of NSAIDs. This study is an attempt to compare the effectiveness of intra-articular injection of steroid (i.e., depot-methylprednisolone) and steroid plus HMW hyaluronate in primary osteoarthritis knee, as literature survey revealed that there is a scarcity of study which compared the effectiveness of intra-articular injection of steroid and steroid plus HMW hyaluronate in primary osteoarthritis knee. Materials and methods: This is a single-blind randomized parallel group study conducted in the Department of Physical Medicine and Rehabilitation, Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, for a period of 18 months taking 30 subjects in each group. Patients with Kellgren–Lawrence radiological grading II and III of primary osteoarthritis knee were taken in the study group. Patients who did not cooperate to receive intervention, patients with secondary osteoarthritis knee, who had history of allergy to any component of viscosupplementation, patients with grade I and IV osteoarthritis knee, with gross knee instability, patients who received intra-articular injection in the last one year, and patients having contraindications of intra-articular injection were excluded from the study. Visual analogue scale pain and fifty feet walk time were the primary outcome measures. After taking clearance from the institutional ethical committee, patients were selected based on the inclusion and exclusion criteria, and the baseline assessment was done on the parameters. The selected patients were divided into two groups randomly. Written informed consent was taken from all patients before interventions. One group received intra-articular injection of steroid (depot methylprednisolone 40 mg) and another group received intra-articular injection of steroid plus HMW hyaluronate in a single sitting. Injections were administered under strict aseptic condition. After administering injections, the patients assessed at an interval of 6 weeks (visit-2) and 12 weeks (visit-3) using the parameters mentioned above. The results have been analyzed according to the standard statistical methods to fulfill the aims and objectives of the study. Discussion: A majority of patients were females with a mean age of 56.26 years with standard deviation 10.364. Most of the patients had K–L grade III osteoarthritis knee with mean body mass index (BMI) 22.60 and with standard deviation 1.708. Visual analogue scale pain and fifty feet walk time improved in both groups in all visits, but the difference of improvement between groups was not statistically significant.


Original Article

Roy R Chandran, Santhosh K Raghavan, Charvakan Suthan, Harsha P Sasidharan

Etiological Profile of Musculoskeletal Disorders of Lower Extremities

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:4] [Pages No:97 - 100]

Keywords: Etiological profile, Musculoskeletal disorders of lower extremities, Osteoarthritis of knee, Plantar fasciitis

   DOI: 10.5005/jp-journals-10066-0035  |  Open Access |  How to cite  | 


Background: Lower extremity musculoskeletal disorders are common rheumatological conditions seeking medical advice. The diagnosis of these disorders is based primarily upon results of specific clinical tests. There are not many studies regarding the etiological profile of these conditions. The aim of this study was to assess the etiological profile of various musculoskeletal disorders of lower extremities among patients reporting to the Physical Medicine and Rehabilitation (PMR) Department of a tertiary care hospital in Kerala, India. Materials and methods: This study was carried out in the Department of Physical Medicine and Rehabilitation, Government T D Medical College, Alappuzha, during a period of one year from January 2017 to December 2017 to assess the etiological profile of various musculoskeletal disorders of upper extremities. This was a descriptive study conducted by evaluating the final diagnosis from the OP records of patients who were fully evaluated in the musculoskeletal pain clinic, which is functioning in the department. Results: There were 262 patients in the study. Age of patients ranged between 11 years and 79 years (mean age 46 years). 59.5% were females. 24.4% were manual labors. The most common etiology of lower limb musculoskeletal problems was osteoarthritis of knee (43.9%) followed by plantar fasciitis (12.6%) and post-traumatic stiffness of lower limb joints (11.8%). Other main causes were internal derangement of knee (6.1%), retrocalcaneal bursitis (4.2%), Achilles tendinitis and meralgia paresthetica (3.8% each), ankle sprain and osteoarthritis of hip (3.1% each). A few cases of osteoarthritis of ankle joints (1.9%), anserine bursitis (1.9%) and Osgood–Schlatter disease (1.1%) were also seen. More than half of the females in this study (51.2%) and one-third of males (33%) were suffering from osteoarthritis of knee. 19.2% of females in the study had plantar fasciitis, and only one male had plantar fasciitis. 68.6% of patients with osteoarthritis of knee were in the above 50 year age category. An important observation is that 31.3% with osteoarthritis of knee belonged to the less than 50-year age category. Plantar fasciitis was exclusively seen in less than 50-year age group. 96.8% with plantar fasciitis were in this category. A quarter of male patients presented with post-traumatic stiffness of lower limb joints (25.5%). Only 3.4% of females were having this problem. Conclusion: Osteoarthritis of knee, plantar fasciitis and post-traumatic stiffness of lower limb joints were the most common diagnoses reporting to PMR department of this tertiary care center with lower limb musculoskeletal problem. Osteoarthritis of knee was more common in females (p value 0.002). A statistically significant association also exist in plantar fasciitis among females (p value 0.000). Post-traumatic stiffness of lower limb joints was significantly more in males.


Original Article

Ameya D Joshi, Anil K Gaur, Amit S Mhambre, Vivek S Chawathe, Deepak Sharma

Effect of Lateral Single Bar Knee Orthoses in Correction of Genu Varum in Nutritional Rickets: A Randomized Trial

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:5] [Pages No:101 - 105]

Keywords: Genu varum, Intercondylar distance, Lateral single bar knee orthosis, Nutritional rickets, Stoss therapy, Tibiofemoral angle

   DOI: 10.5005/jp-journals-10066-0036  |  Open Access |  How to cite  | 


Introduction: Genu varum is a common pediatric knee deformity and seen as a physiological variation in the growth pattern. Rickets causes more pathological bowing if occurs during the phase of physiological bowing. Apart from vitamin D restoration, the role of orthosis in the correction of the genu varum due to rickets is not clear. This study is done to compare the effect of vitamin D restoration with and without orthosis in correction of the genu varum in nutritional rickets. Materials and methods: Sixty children with a bilateral genu varum were enrolled as per inclusion and exclusion criteria and divided into two equal groups. Group I received the Stoss therapy for vitamin D restoration with bilateral lateral single bar knee orthoses, and group II received the Stoss therapy only. The intercondylar distance and radiographic tibiofemoral angle were measured at the beginning and for three follow-up visits at 2 monthly intervals. Results: The intercondylar distance and tibiofemoral angle decreased significantly (p ≤0.001) at subsequent follow-ups in each group. The percentage change in the intercondylar distance and the tibiofemoral angle at the subsequent follow-up on comparison in both groups was statistically insignificant. Conclusion: Lateral single bar knee orthoses do not provide any additional benefit over vitamin D restoration by the Stoss therapy for the treatment of the genu varum in nutritional rickets.



Priya Gajendiran, Bobeena Rachel Chandy, Joyce Isaac, Rajdeep Ojha

Energy Expenditure and Gait Parameters in Bilateral Transtibial Prostheses Users with and without Sleeve Suspension: A Pilot Study

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:4] [Pages No:106 - 109]

Keywords: Bilateral transtibial amputee, Energy expenditure, Gait parameters, Sleeve suspension

   DOI: 10.5005/jp-journals-10066-0032  |  Open Access |  How to cite  | 


Objective: To compare the energy expenditure and gait parameters of bilateral transtibial prostheses user with and without sleeve suspension. Materials and methods: Five (4 male, 1 female) bilateral transtibial, patellar tendon bearing supracondylar (PTB-SC) prostheses users, 2 years postamputation, having good residual limbs and muscle power, were recruited in the study. Instrumented gait analysis, physiological cost index (PCI), timed up and go test (TUG), cadence and subjective feedback questionnaire were recorded on day 1 (without sleeve suspension) and day 15 (with sleeve suspension). Sleeve suspension was added with the prostheses on day 1. Adequate gait training for two weeks was provided to the participants. Wilcoxon signed-rank test was performed in SPSS 25.0 to compare the data recorded on days 1 and 15. p value less than 0.05 was considered as significant. Results: The p values of various gait parameters walking speed, percentage of stance, swing, single limb support and normalized stride length, cadence and TUG test were found to be not significant while p value of step width and physiological cost index was considered significant. All the five subjects have reported comfort in ambulation after wearing sleeve suspension. Conclusion: The study reports the effect of PTB-SC sleeve suspension in improving gait parameters and energy expenditure in five bilateral below knee amputee. Statistically significant improvement was reported in the cost of energy consumption and step width, suggesting that good prosthetic fitment is essential. However, the change in other gait parameters such as walking speed, percentage of stance, swing, single limb support, and stride length remained within normative data range. There is a need to conduct the study in a larger cohort with bilateral amputation where the essential component in prosthesis fitment, like sleeve suspension, can be varied, which in turn can give better stability and comfort resulting in improvement in walking efficiency.



Anuradha D Shenoy, Mahesh Choudhary, Shefali Gupta, Anil K Gaur

Spondylocostal Dysostosis with Sprengel Deformity: A Case Report

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:2] [Pages No:110 - 111]

Keywords: Jarcho–Levin syndrome, Spondylocostal dysostosis, Sprengel deformity

   DOI: 10.5005/jp-journals-10066-0033  |  Open Access |  How to cite  | 


Spondylocostal dysostosis is a term given to a heterogeneous group of disorders characterized by abnormal vertebral segmentation, mal alignment of ribs with variable points of intercostal fusion, and often a reduction in rib number. Sprengel deformity is characterized by abnormal development and elevation of scapula.



Pictorial Continuing Medical Education

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:1] [Pages No:112 - 112]

   DOI: 10.5005/ijopmr-29-4-112  |  Open Access |  How to cite  | 



Rehab Challenge

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:1] [Pages No:113 - 113]

   DOI: 10.5005/ijopmr-29-4-113  |  Open Access |  How to cite  | 



Postgraduate Forum

[Year:2018] [Month:October-December] [Volume:29] [Number:4] [Pages:1] [Pages No:114 - 114]

   DOI: 10.5005/ijopmr-29-4-114  |  Open Access |  How to cite  | 


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