Assuta Medical Center, Haifa, Israel
Kfar Rosh Haniqra | Israel
Main Specialties: Adult Reconstructive Orthopaedics, Hand Surgery, Orthopaedic Sports Medicine, Orthopaedic Trauma, Orthopaedics, Pediatric Orthopaedics
Additional Specialties: Orthopaedic Surgeon, Hand Surgeon
J Healthc Technol 2018; 1 (1): 001-006
J Healthc Technol 2018; 1 (1): 001-006
Bell’s palsy (BP) is one of the most common causes of facial nerve neuropathy cause facial paralysis. Etiology of the BP is not known. Diagnosis made according to anamnestic data and clinical examination. Other pathology as CVA, Lyme disease, viral infection, brain tumors must be excluded. A degree of nerve damage graduate according to modified House-Brackmann score. Corticosteroids, antiviral therapy, symptomatic treatment, physiotherapy, alternative medicine and surgical intervention, in some severe cases with residual palsy, are the treatments of choice. About 70% of patients had a full recovery and in some cases without any treatment. However, 30% had residual damage to the facial nerve, and functional disability and 12% have a recurrence. In the article, authors present new treatment modality known as Pulsed Signal Therapy (PST®) that was applied as management for severe pain around the ear of the affected side and surprisingly cased for full recovery of two patients with BP between two to six weeks after treatment. Keywords: Bell’s palsy; Electromagnetic fields; Pulsed Signal Therapy
Gorelick L, Gorelick AR, Saab A, Ram E, Robinson D (2015) Lateral Epicondylitis Injection Therapy: A
Advanced Techniques in Biology & Medicine
Abstract Lateral epicondylitis or tennis elbow, is a common elbow malady the extensor carpi radialis brevis origin. It is commonly treated by local injections of steroids are often associated with severe side effects and limited long term efficacy. Recently, hyaluronate is being increasingly used for the treatment of different degenerative processes of joints and soft tissue. Hyaluronate significantly and dose-dependently inhibits cell proliferation and decreased the expression level of mRNA for adhesion-related pro-collagens and cytokines. It is possible that such hyaluronate injections might improve results of injection therapy in tennis elbow syndrome. We reviewed 157 patients with tennis elbow that were treated in general, orthopaedic and hand clinics between 2003 and 2011. All patients were followed for up to one year according to a standardized protocol. Patients with rheumatoid arthritis and other rheumatoid diseases, after fractures or avascular necrosis about elbow, radial tunnel syndrome, and moderate and severe osteoarthritis were excluded. Patients were divided into three groups: first group treated by corticosteroid injection, second group treated by combination corticosteroid and hyaluronate injection and third group treated by hyaluronate injections only. The Hyaluronate treated group was clearly superior to the steroid group in efficacy measures (VAS score and DASH score) as well as side effect frequency. The combination therapy group was similar efficacy-wise to hyaluronate but similar to the steroid group in the number of associated side effects. In conclusion it seems that hyaluronate injection therapy is superior to steroid therapy in lateral epicondylitis
Osteoarthritis of trapeziometacarpal joint (TM joint), typically presenting with pain, reproducible tenderness in the region of the TM joint, restricted the range of motion, deformation(shoulder sign) and grind test that causes repentance and pain, is relatively common and affects 50% of postmenopausal women and up to 25% of elderly men. The aim of this study was to evaluate author’s experience with arthroplasty as opposed to surgical treatment of degenerative disease of the TM joint. Authors have used Polylactic acid (PLA) braid rolled on itself AREX trapezium implant(Arex®615R) in Assuta Medical Center as part of surgical option together with trapeziectomy and arthrodesis in patients with Eaton type III-IV of TM joint osteoarthritis.Methods:12 patients (11female/1male) were operated in Assuta Medical Center between 2009and 2011.Pre-operation average DASH score were 80,4 (88-74).Following operation, the average degree of improvement in DASH score at six weeks was 32.8 (42-22), three months-20.7 (31-12) and one year-10.6(5-13). All patients significantly improved after operation as measured with the VAS scale and DASH score. At one year follow-up allpatients were free of pain. Two patients had complication as acute-on-chronic autoimmune reaction due to PLA degradation. It appears that trapezectomy and interposition arthroplasty using AREX trapezium implant is efficacious for treatingofosteo arthritis Eaton type III-IV of TM joint. Keywords: Trapeziometacarpal joint Osteoarthritis, Interposition Arthroplasty, Polylactic acid implant, Foreign body giant cells inflammatory response, Polylactic acid implant degradation
Abstract: The Achilles tendon is the strongest and thickest tendon in the body and plays an important role in the biomechanics of the lower extremity. It can withstand high forces during sporting exercises and excessive torsion and stretching. Achilles Tendinopathy (AT) has no pathophysiological theory and no clear understanding of the pathological process. Rest and specific exercises, NSAIDs, steroid injections and surgical treatments are currently used to treat AT. Not one of them has a dominant efficacy for any length of time. Lately, hyaluronate injections have increasingly been used for the treatment of different degenerative processes of joints and soft tissues. The authors reviewed 56 patients with insertional AT treated between 2007 and 2012. All patients were followed up for one year. Patients were divided into three groups: the first group treated by the corticosteroid injection, the second group treated by single hyaluronate injection and the third group treated by rest, splint, NSAIDs, and physiotherapy. Most patients that treated by a single hyaluronate injection showed good to excellent results for a long time in comparison with corticosteroids injections and the conservatively treated patients, according to FADI and VAS scores. In conclusion, it seems that hyaluronate injection therapy is superior to steroid therapy and non-invasive conservative treatment for insertional AT. Keywords: Achilles tendon, Achilles insertional tendinopathy, corticosteroid injection, hyaluronate injection
Gorelick et al. Journal of Rheumatology and Orthopedics 2015, http://www.hoajonline.com/journals/pdf
Journal of Rheumatology and Orthopedics
Background: In children supracondylar fracture of the humorous is one of the most common fractures in the first decade of life. This study was conducted to establish the efficacy and the accuracy of a new own method for measuring the Trochleocapitellar index (TCI) in the management of supracondylar humeral fracture in children versus Baumann’s angle. Methods: This study made on base AP elbow radiograms and clinical charts of 54 children that were treated due to supracondylar fracture of the elbow. Cases included were of either gender with age range from four to 13 years with a supracondylar fracture presenting within 72 hours of the reduction. Outcome measures: Two measure roentgen logic modalities studied for comparison: Baumann’s angle and TCI were taken into consideration when examining the AP roentgenograms (immediately after the reduction and during 1-3 months thereafter). Results: During 1-3 months after the reduction Baumann’s angle modality gave normal results in 51 (94.4%), valgus result in one (1.9%) and varus result in two (3.7%) patients. While TCI showed normal results in 31 (57.4%), valgus result in one (1.9%) and varus results in 22 (40.7%) patients. Correlation was found between the measurements of the normal Baumann’s angle and normal TCI immediately after fracture reduction (r=0.75, p<0.001) and on the period between one to three months follow-up (r=0.54, p<0.001). TCI was found as more accurate for detection of cubitus varus. Conclusions: Authors recommends post reduction measurement of the TCI in supracondylar fractures to determine the adequacy of reduction. Keywords: Children, supracondylar fracture of the humorous, cubitus varus, cubitus valgus, Baumann’s angle, trochleocapitellar index
J Diagnos Tech Biomed Anal 2015, 4:1 http://dx.doi.org/10.4172/jdtba.1000112
Journal of Diagnostic Techniques and Biomedical Analysis
Polylactic acid (PLA) braid rolled on itself AREX trapezium implant is a part of surgical treatment in patients with Eaton type III-IV of trapeziometacarpal joint (TM) osteoarthritis. The foreign body reaction composed of macrophages and foreign body giant cells is the end-stage of the inflammatory responses following implantation of the PLA prosthesis. Prolonged resorptive giant cells immune inflammatory response, leading the patients to undergo revision surgery for removal of the implant before the end of the third postoperative year. This article describes a patient after successful implantation of the PLA prosthesis and without record of any autoimmune disease. The patient developed onset acute-on-chronic autoimmune response due to a second-degree burn at site of implantation after physiotherapy. Discussion: On the base of this case, authors make assumption that the onset of the acute-onchronic immune inflammatory response in a previously normal responded patient to biocompatible implant is the results of local tissue damage by external factor like burn. It is possible that other unpredictable factors causes the changes in degradation rate as for example acidosis, infection, trauma and genetic differences.
International Journal of Humanities, Arts, Medicine and Sciences (BEST: IJHAMS)
Backgrounds: Typically presenting with pain and a reproducible tenderness in the region of the greater trochanter or lateral thigh, Greater Trochanteric Pain Syndrome (GTPS) is relatively common, reported to affect more than 10% of the general population. Previously, the etiology of GTPS was thought to be caused by inflammation. In that time the results of histologic study, along with recent MRI and ultrasound studies strongly suggest that there is no etiologic role of inflammation in the trochanteric pain syndrome. Treatment of GTPS includes physical therapy measures, activity modification, analgesics, NSAID, shock wave therapy and local glucocorticosteroid injection. The current study performed in order to assess the efficacy of single hyaluronic acid trochanteric injections in diabetic patients. Methods: 92 diabetic patients (74 female/18 male) treated for GTPS by single injection of hyaluronate. Results: Pre-injection average HOOS score were 23±3. Following injections, the HOOS score increased from 23 to 62 after six months and 72 after year. The average VAS score of patients treated by hyaluronate fall from 10 before the treatment to 2.25 at one year. This data are similar to results of treatment GTPS by hyaluronate injection in the general population. Discussion: It appears that hyaluronate injections are highly safe and efficacious for treating trochanteric bursitis in diabetic patients as in the general population.
doi:10.1186/1471-2474-15-60 Cite this article as: Gorelick et al.: Assessment of the normal and path
BMC Musculoskeletal Disorders
Background: The current research is a retrospective study that involves the description of a new trochleocapitellar index (TCI), on basis of anteroposterior (AP) radiographs of normal and fractured paediatric elbows. This index may be useful in assessing the alignment of the elbow with a supracondylar fracture. Methods: The index was evaluated to define its normal and pathological range in children between the ages of 1–13 years. A total of 212 elbows in 141 children were radiographically evaluated. 70 children without fracture elbows were evaluated by radiographs taken at the time of trauma. 35 children with unilateral fractures that healed in a normal alignment were compared to 33 patients that had a mal-union and three patients with bilateral elbow fractures. The patients were radiographically assessed at the time of fracture as well as after fracture healing as part of a routine clinical assessment. Treatment included observation, cast or internal fixation as needed. Results: The current study establishes that the normal range of the TCI was 0.25-0.8. The average TCI is 0.45. The lower range correlates with a valgus alignment of the elbow while the higher range indicates a neutral alignment. The TCI in fractured elbows that have healed in a clinically normal alignment is different than the contra-lateral elbow’s TCI. This might indicate a sub-clinical remaining deformity. Conclusions: In current practice, paediatric patients with elbow trauma, often undergo bilateral radiographs during emergency room visits. The TCI has high negative and positive predictive values and might be superior to direct angle measurement that is currently in use. The use of the TCI measurement is expected to reduce exposure to irradiation in elbow trauma patients as bilateral comparative films appear to be superfluous when this measurement is used. Keywords: Elbow, Children trauma, Distal Humerus, Physis, Supracondylar fractures
Open Journal of Rheumatology and Autoimmune Diseases, 2013, 3, 125-129
Trochanteric bursitis is a common cause of musculoskeletal pain and often requires medical intervention and should be distinguished from sciatica and irradiating pain of pelvic and spinal origin. Previously, the etiology of the trochanteric pain syndrome was thought to be caused by inflammation. The current study was performed in order to assess the effi- cacy of trochanteric injections. Methods: 158 patients were treated for trochanteric bursitis (132 females/26 males, range 22 - 88 years). 59b were treated with corticosteroid injection, 60 with hyaluronate and 39 were injected using a combination of both. Patients were followed by the HOOS score for a minimum of 12 months. Results: Pre-operative HOOS scores were similar in all groups. Following injection, the HOOS score increased from 27 ± 4 to 66 ± 2 after six months and 77 ± 4 after a year. At 12-month follow-up, the average score of patients treated by corticosteroids injection was 44 ± 7 compared with 62 ± 8 for the hyaluronate injected group and 64 ± 6 for the combination injection group. Discussion: It appears that injection therapy is highly efficacious for treating trochanteric bursitis. The effect of hyalu- ronate or hyaluronate and steroid combination appears to be longer lasting than that of steroid alone.
Archives of Radiology
Isolated interphalangeal joint dislocation is common in traumatology practice. However, simultaneous dislocation of the interphalangeal joints of the same finger is a rare injury. In the literature, only case reports are available. Authors present case report of a young patient with dislocations of the interphalangeal joints little finger of the dominant right hand. The diagnosis was made by specific clinical step-ladder deformity of the finger and roentgenographic “Stairway like sign” appearance of the joints dislocation. As in most cases, reduction was achieved by longitudinal traction. Finger splint fixation in slight flexion of the proximal interphalangeal joint was applied for nearly three weeks. Early exercise and rehabilitation program started by hand therapist to prevent joint contracture. Keywords: Finger Interphalangeal joint dislocation; Step-ladder deformity;”Stairway sign”.