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We need to overcome limitations of present assessment and also integrate newer research in our work about sciatica. Inflammation induces changes in the DRG and nerve root. It sensitizes the axons. Nociceptor is a unique axon. It is pseudo unipolar: both its ends, central and peripheral, behave in similar fashion. The nerve in periphery which carries these axons may selectively become sensitive to mechanical pressure--“mechanosensitized,” as we coin the phrase. Many pain questionnaires are used and are effective in identifying neuropathic pain solely on basis of descriptors but they do not directly physically correlate nerve root and pain. A thorough neurological evaluation is always needed. Physical examination is not direct pain assessment but testing mobility of nerve root and its effect on pain generation. There is a dogmatic dominance of dermatomes in assessment of leg pain. They are unreliable. Images may not correlate with symptoms and pathology in about 28% of cases. Electrophysiology may be normal in purely inflamed nerve root. Palpation may help in such inflammatory setting to refine our assessment further.Confirmation of sciatica is done by selective nerve root block (SNRB) today but it is fraught with several complications and needs elaborate inpatient and operating room set up. We have used the unique property of the pseudo unipolar axon that both its ends have similar functional properties and so inject along its peripheral end sodium channel blockers to block the basic cause of the mechanosensitization namely upregulated sodium channels in the root or DRG.Thus using palpation we may be able to detect symptomatic nerve in stage of inflammation and with distal end injection, along same inflamed nerve we may be able to abolish and so confirm sciatica. Discussions of sciatica pain diagnosis tend to immediately shift and centre on the affected disc rather than the nerve. Theoretically it may be possible to detect the affected nerve by palpating the nerve and relieve pain moment we desensitize the nerve.

Introduction: India is a country where many religions coexist together. Prayer & meditation form an integral part of Indian lifestyle. Also 90% of India's population lives in the rural areas. Medial compartment osteoarthritis is the most common type of arthritis in India. Total knee replacement has longer rehabilitation time, morbidity and cost. In addition, it doesn't allow squatting and sitting cross legged. With rise in unicondylar knee replacements for medial compartment osteoarthritis, patient's satisfaction is much higher. Hypothesis of this paper was to investigate whether sitting cross-legged easily on floor for prayer and meditation, contributed to higher levels of patients satisfaction in unicondylar knee replacement significantly. Material & Methods: this retrospective study was done with study population of 36 patients of which, 33 knees of unicondylar knee replacement (mean age 61.7) and 25 knees of total knee replacement (mean age 63.5). We used modified Oxford knee score to compare the functional outcome and Likert scale for grading the patient's satisfaction level. Results: study outcome after unicondylar knee replacement was extremely satisfactory for all patients measured with modified Oxford knee score and is better than total knee replacement. The mean Oxford score for 33 knees with unicondylar knee replacement is 47.18 and for 25 knees with total knee replacements is 46.35. But viewing by satisfaction index point of view, patients are highly satisfied with unicondylar knee replacement because of ability to squat and sit cross-legged used for praying and meditation and other social habits.

Introduction: OA knee is most common form of arthritis in Asian population. The medial compartment of knee is most commonly involved. Most X-ray studies have been from the Western Caucasian patients with different genetic pool, habitus and lifestyle. The accepted norm for surgical intervention like unicondylar knee replacement or High Tibial Osteotomy is bone on bone Arthritis which has simultaneous affection of both medial Tibial & Femoral compartments. We however noted a different radiological pattern also causing severe pain on medial side of knee, without bone on bone arthritis. This was labeled DERVAN RIM SIGN. Materials and Method: This pilot Study describes a new radiological sign based on standard Anteroposterior Xray of knee joint, taken in standing weight bearing position with toes and patella pointing forwards in 15 degrees of flexion. The findings of this sign and correlation to selective medial condylar femoral cartilage loss in 25 patients are confirmed with 1 MRI of knee joint 17 patients 2 Arthroscopy of knee joint 3 patients 3 Open Arthrotomy during Unicondylar knee Arthroplasty 5 patients Results: 100 percent correlation is seen in all 25 cases between the Dervan RIM sign & Eburnation and loss of Medial femoral cartilage in the three modalities of visual confirmation viz MRI, Arthroscopy or Visual examination in open surgery. Mild involvement of the Tibial condyle was noted in all cases and this was the cause of absence of bone on bone Arthritis.

Introduction: Knee pain is among the commonest complaints in the outpatient orthopedic department. However the cause does not always originate from knee itself. and knee pain is used by the patient more as an umbrella term. In fact very few patients give the complete list of accompanying symptoms. They have more often than not to be coaxed out of the patient. To make matters more complex, Referred pain from the Spinal nerves, Hip and Ankle joints join the many structures around the knee to make knee pain an umbrella term for this Pandora's Box. Misdiagnosis or partial diagnosis leads to inadequate or wrong treatment and continued suffering for patient and treating doctors Materials & Methods: 78 patients with knee pain attended the OPD of Walawalkar hospital, Dervan. On x-ray, 28 were found to have different grades of osteoarthritis. Of these 25 agreed to be part of this pilot study. They underwent standing x rays & MRI of the lumbosacral spine. Results: This study found an unusually high rate of coexistent knee and spine pathologies. All patients had some degree of disc disease accompanying medial or tricompartmental osteoarthritis. It undermines the need for investigating this important contributor to the umbrella term of knee pain. The commonest affected disc segment was L4-5 i.e 92% with two patients having L5-S1 prolapse 8%. The purpose of this pilot study is only to alert the surgical and rehabilitation colleagues of the frequent coexistence of the spine and knee conditions for Counseling, consent, surgery & rehabilitation and thus improve patient satisfaction.