Peri-arthritis (PA) shoulder is a common cause of shoulder pain and disability. The optimum management of periarthritis shoulder has been the subject of great debate, particularly since the condition tends to resolve spontaneously over months to years leaving behind stiff shoulder. Objectives of this study was to prospectively evaluate the comparative efficacy of intra-articular steroid (methylprednisolone) injection, intra-articular sodium hyaluronate injection and deep heat in patients with peri-arthritis shoulder who were also taught a simple home exercise programme. A total of 75 subjects were enrolled in the study. Patients of peri-arthritis of shoulder joint were randomly assigned to three groups: Inj. sodium hyaluronate 20mg (group1), inj. methylprednisolone 40mg (group2), ultrasonic therapy (group3). Evaluation was done at 3 weeks, 6weeks and 12 weeks and 24 weeks after starting the treatment. Outcomes were determined by the assessment of subjective and objective parameters viz. shoulder pain and disability index (SPADI), range of motion. All three groups showed improvement with respect to time. Steroid group and sodium hyaluronate group showed significant improvement as compared to other ultrasonic group (p=0.02) with respect to shoulder pain and disability index and range of motion. Improvement in pain was equal with all three types of treatment..

In this study 30 patients with osteo-arthritis (OA) knee (total 55 knees) were given weekly injections of high molecular weight (HMW) hyaluronic acid (HA) for 3 weeks. The subjective parameter was Western Ontario and McMaster Universities Index of Osteoarthritis (WOMAC) score which improved from 97.67±21.4 at baseline to 61.03±24.8 at six months follow-up (p=0.0001). Also the mean range of motion (ROM) of the involved knees was 125.73± 10.8 degrees at baseline and it increased to 132.64±5.2 degrees after six months (p=0.0001) of injection treatment. The objective parameter of disease modification was MRI based semi-quantitive Whole-organ Magnetic Resonence Imaging Score (WORMS) score. The mean of total WORMS score in medial femorotibial joint (MFTJ) and patellofemoral joint (PFJ) improved from baseline (28.382±10.446; 22.64±5.969) to final follow up (27.46±10.32; 21.76± 6.182) which was quite significant (p=0.0321; p=0.0294) and implies a reduced rate of cartilage destruction after injection HA though there is no regrowth of cartilage as such.

Trials have shown modest clinical improvement in disabilities after stroke with the use of different techniques; however most of the treatment protocols for the paretic upper extremity are either expensive or labour intensive, which makes the provision of intensive treatment for many patients difficult. It has been suggested that mirror therapy is a simple, inexpensive and, most importantly patient-directed treatment that may improve upper extremity function. A prospective randomised case control study was done on 60 patients of both the sexes in the age group of 19 to 82 years having stroke for the first time. This study was conducted in the Department of Physical Medicine and Rehabilitation of a tertiary care hospital. All the patients who fulfilled the criteria were enrolled for study; patients were randomly allotted to the study or control group. Study group was given mirror therapy in addition to the conventional stroke rehabilitation programme. Patients were assessed in terms of motor recovery (Brunnstrom stages), spasticity (modified Ashworth Scale), and the self-care items of the Barthel index. These indices were measured at 0 month (pretreatment), 1 month (post-treatment), and 6 months (follow-up). There was a statistically significant difference in spasticity improvement between the study and control groups; however no significant difference was seen in motor recovery and self care items between the groups. The patients had significant improvements within the groups after the therapy for one month. Mirror therapy can be a useful intervention supplement in rehabilitation of patients; it provides a simple and cost effective therapy for recovery of hand function. Original Article

Background: Low back pain (LBP) due to disc herniation is a frequent cause of back pain. It is a debilitating condition having enormous medical and socio-economic effects. Epidural injection of steroids has been used to treat LBP for many decades. Despite widespread use and numerous publications there is significant controversy with regards to the medical necessity and indications for epidural injections, hence we planned this study. Materials and methods: This was a prospective follow-up study. Forty-one patients of confirmed diagnosis of prolapse intervertebral disc (PIVD) were included. Caudal epidural steroid injection (CESI) of 80 mg methylprednisolone acetate diluted in 20 ml of 0.9% saline was given. Outcome was assessed by Numeric Pain Rating Scale (NRS), Oswestry Disability Index (ODI), Straight Leg Raise (SLR) and Modified Schober Test (MST) at baseline, one, three, six and twelve weeks follow-up. Results: Thirty-seven patients completed the study. Significant improvement in patient's status was observed after CESI, as measured with MST, SLR, NRS and ODI at one and three weeks post injection and the improvement were maintained till 12th week. Eighty-three per cent of patients were satisfied at the end of the study and side-effects reported were mild. Conclusion: CESI is a simple, safe and cost effective intervention procedure for the treatment of chronic LBP due to PIVD. It provides rapid pain relief and improvement of physical function starting within a week of injection.

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