Intrathecal baclofen (ITB) administration is a common method in managing spasticity. The location of the reservoir fill port (RFP) is identified manually in most cases. However, it can be difficult due to a variety of factors, such as the formation of excess subcutaneous cellular tissue and scar formation overlying the RFP and rotation or inversion of the pump. Consequently, multiple failed attempts accessing the reservoir increases pain and risk of fatal complications (e.g., infection and withdrawal syndrome from pocket filling). We describe a successful ultrasound-guided pump refilling case after multiple failed attempts by the conventional method. This groundbreaking instrument assists this minimally invasive procedure while limiting iatrogenic injury in the treatment of spasticity. The presentation of this case shows the utility of ultrasound as an important tool to guide the procedure and prevent adverse events in a spasticity management consult.
Platelet-rich plasma injections have been a therapeutic option with exponential growth in several pathologies in the last decades, particularly musculoskeletal for their effect on improving pain and functionality. Rheumatoid arthritis is a chronic joint disease, which involves inflammation of the synovial membrane with cartilage and juxta-articular bone destruction. Conventional and biological diseasemodifying anti-rheumatoid drugs are the cornerstone of the treatment of this disease. However, the use of intra-articular glucocorticoids is often necessary and the role of platelet-rich plasma injections in these patients remains uncertain.A literature review was carried out through the PubMed database, Cochrane and Google Scholar for the search terms "rheumatoid arthritis" and "platelet-rich plasma". Eleven studies have been included in this review: two of these are in vitro studies, five are animal studies, one case report, two case series and one randomized controlled trial. Most of the studies demonstrated a decrease in pain and inflammatory mediators and improvement of functional outcomes, with no severe adverse effects reported.However, the quantity and quality of literature about the effects and safety of plasma-rich plasma injections in rheumatoid arthritis patients are still scarce. It is essential that well-designed randomized controlled trials are made on this topic to understand if platelet-rich plasma may be useful as a coadjuvant therapy in rheumatoid arthritis.
Dermatomyositis (DM) is an idiopathic inflammatory myopathy most commonly characterized by proximal, progressive, symmetrical muscle weakness, as well as specific dermatological manifestations. The presence of nuclear matrix protein 2 (NXP-2) autoantibodies is predominantly associated with joint contractures and calcinosis. A 19-year-old female was diagnosed with DM with positive anti-NXP-2 autoantibodies. She had severe joint involvement of the shoulders, elbows, wrists, and ankles, and the presence of calcinosis was documented on radiographs. Concomitantly, she presented with heliotrope erythema on the eyelids and Grotton's papules on the interphalangeal joints of the hands. After performing a diagnostic investigation and beginning targeted therapy, the patient was transferred to an inpatient Physical Medicine and Rehabilitation Department to carry out a rehabilitation program. The patient had a favorable outcome, with improved range of motion and muscle strength, with a Manual Muscle Testing 8 at the time of admission of 73/150, and at discharge from the hospital of 94/150. Regarding the functional scales, she had a Functional Independence Measure at the time of admission of 87/126 and a Barthel Index of 50/100, with an objective improvement at the time of discharge to 118/126 and 90/100, respectively.DM is an insidious chronic disease with multisystemic involvement and can lead to a great loss of independence. Most patients with DM do not recover their previous muscle function, which leads to a negative impact on their quality of life. The institution of an early rehabilitation program seems to have beneficial effects on the functionality and independence of these patients. Its treatment is based on a multidisciplinary approach, and the established rehabilitation program must be individualized and directed to the deficits and limitations of each patient.
Foot drop is a pathology with a significant functional impact on athletes and can be caused by multiple etiologies, including common peroneal nerve palsy. As risk factors, we highlight the presence of polyneuropathies, recent weight loss and nerve compression. The prognosis of this injury depends essentially on the etiology and severity of the nerve injury, which can range from relatively benign to irreversible injuries. The authors describe a clinical case of an athlete with foot drop due to common peroneal nerve palsy who completed a rehabilitation program with complete resolution of this condition.
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