Orthopaedic review
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The results of a retrospective 44-patient study of vocationally disabled patients who had undergone unsuccessful traditional lumbar spine surgical procedures for low back pain and/or lower extremity sciatic pain are presented. It was found that errors in patient selection and patient psychosocial pathology may have been contributory to the failures. If identified preoperatively, these conditions might have contraindicated one or more of the surgical procedures. The 24-month study required the completion of the Minnesota Multiphasic Personality Inventory by each patient; this test aids identification of patients who will be better served by treatment interventions other than surgery, or who may require psychological perioperative care.
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The McKenzie approach to evaluating and treating low back and neck pain is an exciting development in clinical medicine. A thorough mechanical assessment as described by McKenzie is informative and appropriate for all such patients and identifies an individualized self-treatment program that is often dramatically successful. ⋯ The assessment process and McKenzie's classification of low back pain syndromes--postural, dysfunctional, and derangement--are described. Therapeutic regimens emphasizing patient self-treatment for the current episode are presented, with the long-range goal of preventing recurrences.
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Review Case Reports
Acute anterior thigh compartment syndrome complicating quadriceps hematoma. Two case reports and review of the literature.
Acute compartment syndrome of the thigh has been reported infrequently. To date, only eight cases from isolated blunt trauma without fracture have been reported. ⋯ Morbidity can be avoided if a high level of suspicion is maintained, compartment pressures are measured, fasciotomies are performed, and hematomas are drained. Postoperatively, patients can expect a dramatic decrease in pain and a quick return of quadriceps function with aggressive physical rehabilitation.
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A retrospective review was performed of 109 patients who underwent arthroscopic debridement of the knee for degenerative osteoarthritis. The results were evaluated using a modification of the Hospital for Special Surgery (HSS) scoring system as well as a subjective scale that measured the patients' degree of satisfaction with the procedure. Follow-up was obtained in 111 knees for an overall follow-up of 92% of knees. ⋯ The overall results were 50 good, 20 fair, and 41 poor. Arthroscopic debridement offered measurable relief for 63% of the patients for a significant period of time. Although the results are equivocal by orthopaedic standards, 74% of the patients felt the procedure had been beneficial.
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Neuralgic amyotrophy is an infrequent neuromuscular anomaly involving the shoulder girdle and upper extremity. Its course is highlighted by the sudden onset of severe pain followed by sensory deficits, muscle weakness, and severe atrophy. ⋯ The prognosis is excellent. Treatment is supportive, using analgesics and physical therapy.