PM & R : the journal of injury, function, and rehabilitation
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The prone trunk extension (PTE) exercise is often used to strengthen the back extensors. Although altered trunk posture is associated with movement impairment, the influences of a slouched thoracic posture on muscle activity of the thoracic erector spinae and thoracic movement during the PTE exercise were overlooked in previous studies. ⋯ Although the PTE exercise has historically been a key component of correction of hyperkyphosis, the increased spinal curvature inhibits muscle activation of the erector spinae pars thoracis in these individuals, thus limiting effective strength gains. Therefore, modified methods to maintain a neutral posture of the spine and facilitate muscle activation of the erector spinae pars thoracis are needed in these individuals.
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To determine the relationship between sacroiliac joint (SIJ) contrast dispersal patterns during SIJ corticosteroid injection and pain relief at 2 and 8 weeks after the procedure. The association between the number of positive provocative SIJ physical examination maneuvers (minimum of one in all patients undergoing SIJ injection) and the patient's response to the intervention was also assessed. ⋯ Fluoroscopically guided corticosteroid injections into the SIJ joint are effective in decreasing NPRS values in patients with SIJ-mediated pain. Delivery of corticosteroid to the superior portion of the SIJ leads to a greater reduction in pain at 2 weeks, but not at 8 weeks. Patients with at least one positive provocative maneuver should benefit from an intra-articular corticosteroid injection.
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Case Reports
Treatment of postherpetic neuralgia using a thoracic transforaminal epidural steroid injection.
A 64-year-old male patient with a history of herpes zoster exposure presented with severe, constant, burning pain in the left T10 dermatome consistent with postherpetic neuralgia. Previous treatment included oral and topical medications as well as an intercostal nerve block; however, these treatment options did not provide significant relief. ⋯ He reported complete resolution of his symptoms at 2- and 12-week follow-ups. This case illustrates transforaminal epidural steroid injections may be a successful treatment option for postherpetic neuralgia.
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Case Reports
Generalized pruritus as an unusual side effect after epidural injection with dexamethasone.
A 51-year-old man with lumbar radiculopathy underwent a right L5 transforaminal epidural steroid injection with dexamethasone. One minute after the injection, the patient experienced severe pruritus and burning, which began in the groin and then spread throughout his body. The symptoms resolved completely after 1 minute, and the patient was discharged without any complications. Although there are a small number of publications reporting perineal pruritus after intravenous administration of dexamethasone, to our knowledge there is no report of a generalized reaction to an epidural dexamethasone injection such as the one described here.
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Multicenter Study Observational Study
Prosthesis use and satisfaction among persons with dysvascular lower limb amputations across postacute care discharge settings.
To test the hypotheses that patients undergoing major lower limb amputations who received postacute care at an inpatient rehabilitation facility (IRF) would experience higher prosthesis use and satisfaction and lower prosthesis-related adverse effects than those treated at a skilled nursing facility (SNF) or at home. ⋯ These results add to the growing body of literature suggesting a general pattern of better outcomes for persons with vascular-related amputations who receive postacute care at IRFs relative to SNFs.