Indian Journal of Physical Medicine and Rehabilitation

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2019 | January-March | Volume 30 | Issue 1

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Dr U Singh

Interventional Remedies: Are We On The Right Path?

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:1] [Pages No:0 - 0]

   DOI: 10.5005/ijpmr-30-1-iv  |  Open Access |  How to cite  | 


Original Article

Aniketa Banerjee, A Basak

A Comparative Study on the Use of Lateral Heel Wedge and Lateral Wedge Insole in the Treatment of Medial Compartment Osteoarthritis of Knee with Varus Deformity

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:6] [Pages No:1 - 6]

Keywords: Comparative study, Lateral heel wedge, Lateral wedge insole, Medial compartment narrowing

   DOI: 10.5005/jp-journals-10066-0043  |  Open Access |  How to cite  | 


Background: Osteoarthritis (OA), a degenerative joint disease, has a strong predilection for weight-bearing joints, the most common being the knee. It commonly affects the elderly obese female population. In a world of modern medical marvels, the percentage of elderly population is increasing. The problem of OA especially involving knee joint has become rampant, leading to greater physical, financial, and emotional burden on the patient, family, and society at large. Hence, extensive research has gone into various facets in the treatment of OA, viz., nonpharmacological, pharmacological, and surgical methods, with varying results. This study was concerned with a particular aspect of nonpharmacological therapy, viz., the use of two lateral wedge orthotics, i.e., lateral heel wedge and lateral wedge insole in OA of medial compartment of knee joint with varus deformity. It has been proved through prior research that patients have benefited from each of the above type of lateral wedge orthotics, but there is a paucity of studies that compares them. This study is an attempt toward addressing this gap using various relevant outcome measures. Standard statistical tests were performed and conclusion drawn based on the research findings. Materials and methods: This is a single-blind randomized parallel group trial conducted in the Department of Physical Medicine and Rehabilitation in Institute of Postgraduate Medical Education and Research and Seth Sukhlal Karnani Memorial Hospital, Kolkata, for a period of 18 months, considering a minimum of 28 subjects in each group. Symptomatic patients having grade II or higher Kellgren–Lawrence radiological grading of tibiofemoral OA along with medial compartment narrowing and varus deformity in standing anteroposterior (AP) view were included. Patients excluded had history of knee trauma or surgery in the past 6 months. Parameters studied were Western Ontario and McMaster (WOMAC) scale, visual analog scale (VAS) score, and 50 ft walk time. Selected patients were divided into two groups randomly and written informed consent was taken from all. One group was given lateral heel wedge of 1/6th inch and the other group was given lateral wedge insole of the same dimension. Selected patients were examined at baseline using the parameters mentioned above and were further examined after intervals of 4 and 8 weeks. The results have been analyzed according to the standard statistical methods to fulfill the aim and objectives of the study. Discussion: Majority of the patients were elderly, overweight females with grade III OA on the Kellgren–Lawrence scale. Outcome measures showed significant difference in both groups, with slightly greater significance in lateral wedge insole group but compliance was higher in lateral heel wedge because of greater comfort level.


Original Article

Ajit S Naorem, Jugindro S Ningthoujam, Kunjabasi Wangjam, Rajkumar Rajesh Singh

Role of Nonreal-time Imaging in Improving Success of Blind Interlaminar Epidural Injection for Treatment of Symptomatic Prolapsed Lumbar Intervertebral Disk

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:5] [Pages No:7 - 11]

Keywords: Lumbar interlaminar epidural injection, Nonreal-time imaging, Prolapse intervertebral disk

   DOI: 10.5005/jp-journals-10066-0048  |  Open Access |  How to cite  | 


Objective: To see effectiveness of measurements in plain roentgenograms of lumbosacral (LS) spine to guide needle placement into the epidural space. Setting: Department of Physical Medicine and Rehabilitation. Design: Cross-sectional study. Materials and methods: A total of 56 consecutive diagnosed prolapsed intervertebral disk (PIVD) patients attending PMR OPD were enrolled. Length of the spinous process and skin thickness were measured using a caliper, which were converted to centimeter by using a calibration bar in a digital X-ray of the LS spine. A 22G Quincke needle was advanced to the expected depth given by digital X-ray measurement. One milliliter of Iohexol dye was injected, and the position of the needle was checked by C-arm X-ray. Two milliliters of methyl prednisolone acetate were injected into the space. Main outcome measures: Depth measured by using digital X-ray and length of the spinal needle from the epidural space to the skin by C-arm X-ray in centimeters. Results: Out of 56 subjects, 46 (73.1%) completed the treatment program. A needle was placed at proper depth in 36 cases by using X-ray measurement, giving success rate of 87.8%. Depth of the epidural space from the skin (mean 3.82 ±0.74 cm) as measured from X-ray and actual measurement confirmed by fluoroscopy (mean 3.96 ± 0.81 cm) were compared using the Pearson's correlation coefficient (=0.86). Conclusion: Measurement of depth of the epidural space using plain X-ray of the LS spine improves the success rate of blind midline interlaminar epidural steroid injection (MILESI) from around 50–87.8%. This method of nonreal-time imaging is cost-effective in developing countries where C-arm X-ray facilities are not available.



Ratul Das, Keshav Dev, Aruna Vyas

Occurrence of Urinary Tract Infection in Reference to Bladder-emptying Method and Etiological Agents among Spinal Cord Injury Patients: A Cross-sectional Study

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:5] [Pages No:12 - 16]

Keywords: Asymptomatic bacteriuria, Multidrug-resistant organism, Symptomatic urinary tract infection

   DOI: 10.5005/jp-journals-10066-0046  |  Open Access |  How to cite  | 


Spinal cord injury (SCI) patients who develop neurogenic bladder can not have normal physiological voiding and require catheterization for bladder drainage. The method of bladder drainage influences risk of urinary tract infection (UTI) and most people on the indwelling catheter or intermittent catheterization develop urinary tract infection. A cross-sectional study among 138 SCI patients admitted in the Department of Physical Medicine and Rehabilitation, Sawai Man Singh Medical College, and Jaipur was done. Urine samples were sent to Microbiology department for culture and antibiotic sensitivity test. Bacteria found resistant to three or more of the envisaged antibiotics were considered multidrug-resistant. The study revealed that 87.68% patients had significant bacteriuria. Asymptomatic and symptomatic UTI developed in 65.94% and 21.74% respectively. Symptomatic UTI was significantly associated with indwelling catheter user (p value < 0.05). The most common organism isolated was E. coli (49.30%) followed by Enterobacter aerogenes (14%). About 50.70% isolated organisms were multidrug-resistant and 4.22% organisms were extensively drug resistant. Development of multidrug-resistant organism was highest who were using an indwelling catheter (p value < 0.05). Clean intermittent catheterization (CIC) should be preferred the option to manage the neurogenic bladder in spinal cord injury patients. Not urine culture with significant bacteriuria but symptomatic UTI should be treated.



Nitin A Menon, Dwarkadas K Baheti, A Menon Nitin

Management of Primary Hyperhidrosis with Sympathetic Block: A Case Report

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:2] [Pages No:17 - 18]

Keywords: Epidural catheter, Hyperhidrosis, Sympathetic block

   DOI: 10.5005/jp-journals-10066-0047  |  Open Access |  How to cite  | 


Hyperhidrosis is an unusual condition characterized by excessive sweating, which results in social embarrassment and workplace impairment. Although several treatment options are available, the use of sympathetic block in certain patients is an important tool as a part of multimodal approach in the management of this condition.



Samantak Sahu, Abhimanyu Vasudeva, Gita Handa

Ultrasound-guided Intercostal Nerve Block in Chronic Musculoskeletal Chest Pain: A Case Report

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:3] [Pages No:19 - 21]

Keywords: Chest wall, Nerve block, Pain

   DOI: 10.5005/jp-journals-10066-0041  |  Open Access |  How to cite  | 


Introduction: Chronic musculoskeletal chest pain, though not life-threatening, is a disabling condition and is often left untreated or improperly managed. Case description: A 45-year-old male presented with pain in the lower part of the left lateral chest wall (visual analog scale (VAS) for pain = 6) for the last 4 months aggravating with deep inspiration (VAS = 7). On examination, there was grade III tenderness over anterior end of the 10th rib but no swelling. Examination of both upper limbs (including shoulder joints), spine, and abdomen was unremarkable. Cardiac and respiratory systems were within normal limits. We investigated the patient to exclude various differential diagnoses. Ultrasound evaluation of the 10th rib at the most tender point was suggestive of costochondritis. Three weeks of conservative management yielded inadequate relief (VAS = 6, both at rest and deep inspiration). As a case of recalcitrant costochondritis, ultrasound-guided intercostal nerve block was performed for the left 9th and 10th intercostal nerves. The patient achieved immediate reduction in pain at rest (VAS = 2) and deep inspiration (VAS = 3). At 2 weeks of follow-up, pain reduced further (VAS = 1) both at rest and deep inspiration. At 4 weeks of follow-up, pain reduced completely (VAS = 0) both at rest and deep inspiration. Conclusion: The ultrasound-guided intercostal nerve block is a relatively simple day-care procedure that can prove effective in a properly selected patient. Despite perceived simplicity of the procedure, there are risks involved that should be carefully considered while planning and performing the procedure.



Firdaus Kamal

Pictorial Continuing Medical Education

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:1] [Pages No:22 - 22]

   DOI: 10.5005/ijpmr-30-1-22  |  Open Access |  How to cite  | 



Medical Philately

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:1] [Pages No:23 - 23]

   DOI: 10.5005/ijpmr-30-1-23  |  Open Access |  How to cite  | 



Postgraduate Forum

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:1] [Pages No:24 - 24]

   DOI: 10.5005/ijpmr-30-1-24  |  Open Access |  How to cite  | 



Rehab Quiz

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:1] [Pages No:25 - 25]

   DOI: 10.5005/ijpmr-30-1-25  |  Open Access |  How to cite  | 



Rehab Challenge

[Year:2019] [Month:January-March] [Volume:30] [Number:1] [Pages:2] [Pages No:26 - 27]

   DOI: 10.5005/ijpmr-30-1-26  |  Open Access |  How to cite  | 


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