BACKGROUND Chronic low back pain (CLBP) is one of the common debilitating condition in middle-age population. Often the pain is "non-specific" or related to mechanical origin; so, often it is termed as chronic mechanical low back pain. Among the various predisposing factors, abnormal lumber lordosis is more often seen. Radiographic assessment of lumbar lordosis can be done by measuring lumbosacral angle (LSA). Therefore, study of variations in LSA among these patients can give important clues in both pathogenesis and management. The aim of the study is to determine different factors leading to the variations of lumbosacral angle amongst the middle-aged patients presenting with chronic mechanical low back pain. METHODS This retrospective study was conducted by analysing records of 105 CLBP patients of both sex (male = 32, female = 73) in the age group of 45 - 65 years. LSA was directly measured digitally by Ferguson technique from the selected patients’ lateral lumbosacral radiographs. Data was collected in Microsoft Excel 2016 and analysis was done with International Business Machines Statistical Package for the Social Sciences (IBM SPSS) Statistics version 23. RESULTS The difference in median of LSA of male [Median (IQR) = 37.00 (10.00)] and female [Median (IQR) = 45.00 (8.50)] patients was statistically significant (p-value 0.000). Significant positive correlation was also found between LSA and BMI for both sexes, but more in case of female (Spearman’s rho 0.806 p = 0.000) than male (Spearman’s rho 0.680 p-value 0.000). CONCLUSIONS Variation of LSA was found to have significant relations with sex and body mass index (BMI), but not with the age. Statistically significant positive correlation between LSA and BMI alongside higher BMI of the females in the study group suggested that they are more prone to develop CLBP. To formulate proper rehabilitation protocol for middle aged CLBP patients, LSA variations and related factors can be kept in mind. KEYWORDS Chronic Low Back Pain (CLBP), Lumbosacral Angle (LSA), Lordosis, Rehabilitation, Body Mass Index, Lordosis, Spine, Radiography, Rehabilitation

BACKGROUND Epidural steroid injections (ESIs) have been widely used for over 50 years in the treatment of back pain with or without radiculopathy. In this study, we intended to evaluate the effect of single caudal epidural steroid injection (CESI) in patients suffering from chronic lumbago-sciatica syndrome, resistant to conservative medical therapy. METHODS This was a retrospective study. CESI was performed on thirty-four patients suffering from chronic lumbago-sciatica syndrome, from April 2019 to March 2020. Single injection of caudal epidural steroid (40 mg Triamcinolone Acetonide) diluted with 10 ml. of sterile water was given guided by anatomic landmark, confirmed by “Whoosh” test and radiologically with dye. Patients were followed for 12 weeks using Numeric Rating Scale (NRS) for pain, Oswestry disability index (ODI) and North American spine society patient satisfaction index (NASS). Values were recorded before the injection and after the injection at 1 week, 3 week, 6 week and 12 week during follow-up. RESULTS Significant improvement in patient’s status was observed after CESI, as measured with NRS, ODI and NASS at one, three, six and twelve weeks as compared to pre injection (zero week) but no significant difference was observed at successive follow ups at first to third and third to six weeks. There was significant reversal of NRS and ODI Score from 6 week to 12 week follow-up. Sixty seven percent of patients were satisfied at the end of the follow-up and mild side-effects were reported in a few patients. CONCLUSIONS CESI is a safe, simple and cost-effective intervention procedure for the treatment of chronic lumbago-sciatica syndrome. It provides rapid pain relief and physical function improvement of the patient starting within a week. KEYWORDS Injections, Epidural, Sciatica, Low Back Pain

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Heterotopic Ossification (HO) is formation of atypical, lamellar bone within a soft tissue surrounding major joints. It is well documented as a complication following spinal cord injury and traumatic brain injury; however, it is quite rarely seen in lower motor neuron conditions like Guillain-Barre Syndrome (GBS). Here, we present two cases of GBS (both young males) with Bilateral hip pain who were diagnosed HO on the basis of radiological study while still admitted in the Intensive Care Unit (ICU). Both of them had history of mechanical ventilation, tetraparesis and prolonged immobilisation. There are very few reports of HO in GBS and if detected early, it improves the functional outcome.

Facet joints or zygapophyseal joints are paired synovial joints in the vertebrae that are commonly affected by degenerative changes that cause pain and disability. It is one of the most prevalent causes of low back pain and is more commonly seen in older population. Facet joint interventions may involve an intra-articular joint injection and medial branch block. Both of them are relatively simple and straightforward procedures best performed under fluoroscopy for guidance to properly target and place the needle.

Elbow Arthritis is a rare condition characterized by loss of articular cartilage in the ulnotrochlear and radiocapitellar articulations. The symptoms include pain, stiffness and loss of motion while radiographic manifestations may include osteophytes, loss of joint space and subchondral cysts. Recently it has been suggested that there is chronic low grade systemic inflammation in osteoarthritis occurring as a part of greater inflammatory metabolic syndrome. Primary OA mainly affects weight bearing joints of the lower extremity. The common assertion that the elbow is not a weight-bearing joint should not suggest that the elbow does not bear load. Elbow osteoarthritis commonly affects middle aged men who indulge in strenuous activity. We present a case report of a middle aged Indian Woman having primary elbow osteoarthritis with metabolic syndrome.

Background: The prevalence of pain in affected shoulder among post-stroke patients ranges from 34% to 84%. Numerous theories exist to explain the patho-mechanics behind development of Post-stroke shoulder pain, but its relationship with the sensori-motor recovery of the affected limb is still controversial. This study was conducted to detect the correlation, if any, between post-stroke shoulder pain and sensori-motor recovery of the affected upper limb.  Methods: This observational longitudinal study was conducted on 73 patients of both sexes within the age group of 45-65 years having presentation of post-stroke (duration<6weeks) shoulder pain. Pain intensity was recorded in numerical rating scale (NRS). Sensorimotor recovery of the affected limb was assessed by Fugl- Meyer assessment scale of upper extremity (FMA-UE). Data were collected at the baseline (visit1), at 6 weeks (visit 2), 12 weeks (visit 3) and at the end of the study i.e., 24 weeks (visit 4).  Results: Statistically significant negative correlations were found between severity of pain (assessed with NRS) and sensory-motor recovery (assessed with FMA-UE) on each visit with correlation coefficients (Spearman rho, r) being r=-0.890, p=0.000 on visit1, r=-0.685, p=0.000 on visit2, r=-0.629, p=0.000 on visit3 and r=-0.458, p=0.000 on visit 4.Conclusions: Post-stroke shoulder pain plays a significant negative role in sensori-motor recovery of the affected upper limb requiring early intervention.

Introduction: Lumbar zygopophyseal joint arthropathy is one of the most common causes of low back pain in adults. Historically, C-arm/Fluoroscopy has served as an image guidance tool in intra-articular facet joint injections, however, now ultrasound guidance is also a viable option. Aim: To compare ultrasonography (USG) and fluoroscopy as therapeutic imaging modalities on the basis of time taken for intervention, Visual Analogue Score (VAS) for pain and Oswestry Disability Index (ODI) at 2, 4 and 12 weeks. Materials and Methods: It was a prospective interventional study done with 62 patients who satisfied the inclusion and exclusion criteria and randomly allocated into two groups. Groups were compared on the basis of time taken for intervention, VAS for pain and ODI at 2, 4 and 12 weeks. Independent sample student t-test/Mann-Whitney U test was applied. Confidence Interval (CI) was taken as 95% and p-value <0.05 was considered as statistically significant. Results: Ultrasound group had mean age of 37.75 years (range, 23-55 years) while that of Fluoroscopy group was 40.05 years (range, 20-54 years). Ultrasonography group was quicker by about 135 seconds (2 minutes and 15 seconds) which was statistically significant but there was statistically no difference between the two groups in terms of VAS and ODI at 2 weeks (p=0.107 and 0.893, respectively), 4 weeks (p=0.383 and 0.408, respectively) and 12 weeks (p=0.343 and 0.777, respectively) at 95% CI. Conclusion: Both groups showed significant improvement in pain and disability after 2, 4 and 12 weeks however there were no significant differences in pain and functional improvement between USG guided transverse view and fluoroscopy guided intra-articular lumbar facet joint injection. Therefore, USG guided transverse approach is quicker, feasible and minimises exposure of radiation to patient as well as interventionist