Osteoarthritis (OA) Knee is a common health problem affecting almost 29 % of India’s Population1. Gold standard treatment for high grade Arthritis is Total Knee Replacement2. However this procedure carries its risk to benefit ratio and complications3 like DVT, persistent pain. High tibial osteotomy and uni-compartmental replacement are other modalities for high grade knee which needs surgical skills and has its risk to benefit ratio and complications 4 like fracture, implant failure and others. Incidental findings Of High Fibular Osteotomy a Simple Surgical Procedure seems to be boon for those patients who have excruciating pain and waiting for total knee replacement but cannot go for it due to its prohibitive cost.  Evidence of its efficacy has been piling up fast and seems to buy time for patient with medial compartment arthritis for total knee replacement and gives short to medium term relief. For Indian subcontinent where > 50 % have varus deformity with medial compartment arthritis seems to be best interim surgery with minimal blood loss, small surgical scar, ability of full weight bearing walk and squat on the same day and cost effective with no age limits5. A total follow up of 20 patient shows increase in medial joint space of > 2mm and decrease Tibiofemoral angle around 2° with improved Visual Analogue Score (VAS) score from 2 To 8. Thus HFO can be considered as a choice of treatment for medial compartment knee with varus deformity as a joint preserving procedure for a span of 2-10 years.

Acetabular malposition in total hip arthroplasty can lead to instability, impingement, and edge loading resulting in eccentric loading and increased wear that can lead to bearing failure. Eccentric wear in metal on metal bearings used in Birmingham Hip Resurfacings (BHR) produces metal debris. Mounting body of evidence suggesting that one generic zone such as Lewennik’s “safe zone” is unreliable. Functional positioning of acetabular component relative to patient specific dynamic pelvic tilt throughout a range of activities is crucial. The aim use OPS to analyze pre-operative acetabular position, determine patient specific functional “safe-zone” and employ customized alignment guides to implant BHR acetabular components resulting in improved functional and radiographical outcomes. OPS performed pre-operatively in 13 patients to create customized implant alignment guides. Data collected pre and post-operatively at 6, 12 and 52 weeks. Primary outcome measures of functionality including Oxford Hip Scores, dislocation and revision rates. OPS post-operatively to evaluate positioning. Secondary outcome measure of serum metals ions monitoring for metallosis. Improved Oxford Hip Scores post-operatively. Currently no revision surgeries or dislocations have occurred. Preliminary results from post-operative OPS indicate no edge loading. Use of OPS results in improved precision and accuracy in achieving patient specific functional acetabular “safe-zone” thus improving functional outcomes and reducing edge loading in BHR.

Background: Dentist sits in a chair and leans forward towards the patient, lumbar curve flattens and the bony infrastructure provides very little support to the spine. Sitting in chair forces the hamstrings to become inactive and places them in a shortened position. Repetitive, prolonged sitting eventually leads to hamstring muscles that adapt to a new shortened length, and the result is Hamstring tightness which induces posterior pelvic tilt and decreased lumbar lordosis, which can result in low back pain

Objective: We investigated effects of hamstring stretch with pelvic control on pain, disability and work ability in Dentist with mechanical low back pain.

Methods: Thirty Dentist from Dental professional were randomly assigned to pelvic control hamstring stretching (Group A) (n = 15) and Supine hamstring stretching (Group B) (n = 15). All interventions were conducted 3 days per week for 6 weeks, and included in the hamstring stretching and lumbopelvic muscle strengthening.

Outcomes: Outcomes were evaluated through Numeric pain rating scale (NPRS) for Pain, Oswestry disability index (ODI) for Disability, and Work ability index (WAI) for Work ability.

Results: The paired t-test was used to compare within group differences and unpaired t-test was used to compare the between group differences. All statistical analyses were performed using SPSS statistical software version 21.Significant differences found between Group A and  group B in all three variables.(p<0.05).between pre and posttest of subjects. According to the results of the present research, it could be concluded that for reducing pain, disability and work ability in dentists pelvic control hamstring stretch and lumbopelvic strengthening exercises are recommended.

Conclusions: The pelvic control hamstring stretch exercise would be more helpful in back pain reduction and improvement of work ability in Dentist with mechanical low back pain. 

Introduction: Hallux valgus is a prevalent condition and affects a reported 30% of adults aged more than 40 years. There are several methods of conservative and surgical procedure (150 procedures) for treatment of that. The aim of this review is evaluation of advantages and disadvantages of these procedures.

Materials and Method: We recognize the studies utilizing data base of PubMed and Google scholar, with the keywords hallux valgus, osteotomy, minimally invasive, percutaneous, Conservative treatment, pain, quality of life and surgery.

Results: Percutaneous as a minimally invasive surgery is one of the major progresses in the operating field of orthopedic. Twenty-four studies compared the effectiveness of various kinds of surgeries. The results showed there is no difference in rate of pain between chevron-type osteotomy and other surgical procedures. One study revealed that chevron osteotomy is more beneficial than Lindgren osteotomy in terms of walking speed. A medium quality study evaluated the efficient of hallux valgus surgery compared to conservative or no treatment. This study revealed that surgery, specifically chevron osteotomy, is a more effective procedure for pain compared to conservative treatment   and also no treatment in the first year.

Conclusion: This review showed that differences between various types of surgical procedures are minimal; however there is evidence that surgery methods, are a more effective procedure than conservative or no treatment in decreasing pain in the first year following surgery. However, this review has showed that there is a loss of high-quality studies comparing equivalent types of Hallux valgus treatments that evaluate the same outcomes.

Background: Forward head posture is one of the most common abnormalities associated with chronic neck pain. In FHP the altered rib cage mechanics leads to decrease in thoraco abdominal mobility, impaired diaphragm muscle mobility and reduced the ventilator efficacy of diaphragm, reduced the effectiveness of abdominals and intercostals muscles.

Methods: Total of 20 subjects were taken, based on inclusion & exclusion criteria the experimental group (n=10) & control group (n=10) were randomized.  Experimental group received Cervical Stabilization Exercise with the conventional Physiotherapy and Control group received only Conventional Physiotherapy for 6 weeks. 

Outcome measures: Perceived recovery was assessed with Numeric Pain rating Scale (NRPS), Neck Disability Index (NDI), Forward head posture which was assesses by the digital camera by measuring the Craniovertebral Angle (CVA), Respiratory strengths (MIP & MEP) was assessed by Respiratory Pressure meter.

Results: Significant increase in Craniovertebral angle and respiratory strength with decrease in NRPS and NDI scores were found in the group which received the cervical stabilization exercises along with the conventional Physiotherapy (p< 0.05).

Conclusion: Cervical stabilization exercise is an effective approach to reduce the forward head posture and thus helps to regain the respiratory muscle strength by improving the biomechanics of respiratory muscles.

Latissimus Dorsi is a large pectoral girdle muscle and powerful arm adductor (1, 2). Avulsion injuries of its tendinous insertion into the humerus are incredibly rare. Surgical repair has rarely been reported, literature showing fewer than 15 cases, most with tendon augmentation (1, 3-8). This unique and complex case of a delayed Latissimus Dorsi avulsion injury in a power-lifting athlete cycling anabolic steroids. Using an intracortical button technique, we proposed that this robust repair would enable restoration of full function, strength and cosmetic defects. 28-year-old competitive powerlifter cycling anabolic androgenic steroids and testosterone presented 15 weeks post injury. Clinical examination revealed obvious asymmetry, tenderness and posterior axillary fold defect. Profound weakness of resisted arm adduction. MRI revealed absent Latissimus Dorsi insertion, tendon stump in axilla. Surgical repair was undertaken via dual axillary approach. Retracted tendon mobilised and two titanium buttons with integrated Fibrewire Sutures (Arthrex Inc) created a modified Krakow suture, a novel technique. A dual fixation point at its anatomical insertion was created using an intracortical button. We described a successful delayed repair of this chronic injury without the need for tendon augmentation. Dual approach assists with tendon mobilization and preparation, along with restoration of anatomy and strong fixation at bicipital groove. Clinical and radiological evidence of recovery without pain, correction of cosmetic defects and full return to competitive powerlifting. This robust intracortical button technique produces a successful Latissimus Dorsi tendon avulsion repair with incredible results leading to restoration of full function, even in the most challenging competitive athletes

Background: Patellofemoral pain syndrome is a relatively common diagnosis in outpatients presenting with anterior knee pain. Patellofemoral pain syndrome can be defined as retro patellar or peripatellar pain resulting from physical and biochemical changes in the patellofemoral joint.

Aim: This study was undertaken to investigate the efficacy of functional mobilization approach in terms of pain and function in young adults with patellofemoral pain syndrome and the clinical efficacy   of foot orthoses with functional mobilization in individuals with patellofemoral pain syndrome.

Methodology: 60 adults with patellofemoral joint pain. Each participant was randomly allocated to one of the two groups (a or b) using block randomization method. The two groups were as follows:  group a: functional mobilization of foot and ankle + exercises and group b: full length medial wedge insoles + exercises. A 12 week treatment program was prescribed for each patient, and each patient was assessed at baseline and after 12 weeks (pre- and post- intervention) for primary outcomes using lefs (lower extremity function test), nprs(numeric pain rating scale)and fpi(foot posture index).

Results: Patients from both groups demonstrated clinically significant improvement in primary outcomes with regard to self-reported pain and function upon completion of the study. A significant difference was also seen in foot posture. Post hoc analysis determined that post-intervention follow-up measures significantly improved (p < 0.05 for all) as compared to baseline values in terms of pain and function .Functional mobilization was more effective in reducing pain (mean difference 0.1) and orthoses were more effective in improving foot posture. Group b showed no immediate change in pain and function initially, indicating that improvement occurred at a slower rate in this group. Pain and function improved faster in group a.  However, the magnitude of change in foot posture was seen more in group b.

Conclusion: Therefore, incorporating functional mobilization of foot and ankle in addition to conventional therapy in physical therapy clinical practice in future may improve short term beneficial effects with regard to pain and function in patients with patellofemoral pain syndrome.

Introduction: The tendinitis is commonly defined as an inflammation of the tendon, which is what connects bones to muscle. On the major literature, tendinitis is usually caused by repetition of movements and lack of stretching. However, the cause was never before associated to a disease in the liver, such as Autoimmune Hepatitis. According to Traditional Chinese Medicine (TCM), tendons are governed by the energy of the Gallbladder meridian, which is attached to the Liver energy.  Purpose: The aim of this study is to demonstrate that tendinitis may be an early manifestation of Autoimmune Hepatitis. Methods:  Through a clinical case report of a female patient, M.C., 42 years old, with chronic pain in shoulder and elbow, resistant to conventional treatments with anti-inflammatories and physiotherapy. She sought acupuncture treatment, and even so, the improvement presented was scarce. In her physical examination, a bulging was detected in the right ear, on the area that corresponds to the Liver, according to Auricular Medicine. Laboratory tests were requested to see if there could be any undiagnosed liver disease until then. The only exam that was initially altered was the prothrombin time of 89%. More tests were ordered to see whether anti-bodies were present. Anti-nuclear, anti-smooth muscle, anti-microsomal. Results: To the physician's surprise, the patient had a 1:160 anti-nucleus reagent. Conclusion: The conclusion of this study is that tendinitis may be the initial manifestation of an Autoimmune Hepatitis.