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: Stroke is the most common neurological condition causing long term disabilities in various ways. Post-stroke shoulder subluxation, mainly the Gleno-humeral Subluxation (GHS) of the affected side is often detected as a complication. Numerous theories exist to explain the pathomechanics of developing GHS,but studies regarding its relationship with the sensori-motor recovery of the affected limb is still controversial. Aim of Study:To ascertain the correlation between Gleno-humeral subluxation with sensori-motor recovery of the affected upper limb following stroke.Method: This correlation study was conducted on 30 patients of both sexes within the age group of 45-65 years with post-stroke (duration < 6weeks) Gleno-humeral subluxation( GHS). Screening of GHS was done by palpation and degree of GHS was quantified by High resolution USG by measuring the Acromion -Greater Tuberosity Distance difference (AGTDD) between two shoulders. Sensorimotor recovey of the affected limb was assessed by Fugl -Meyer Assessment Scale of Upper Extremity (FMA-UE). Data 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).

Background: Hemiplegic shoulder subluxation is one of the most common factor for post-stroke upper limb disability. There are various ways to assess its outcome during rehabilitation, but the assessment of patients’ satisfaction with the shoulder support is often missed. This study was done to compare those patients’ satisfaction with clinical outcome who were undergoing same rehabilitation programme for their hemiplegic shoulder subluxation with and without Bobath shoulder sling.Methods: This prospective controlled interventional study was conducted on 30 patients of both sexes within the age group of 45-65 years with hemiplegic (duration <6 weeks) gleno-humeral subluxation (GHS). Screening of GHS was done by palpation. They were randomly divided in two groups of same number (15 in each group) and put on rehabilitation protocol with group 1 receiving Bobath shoulder Sling as support for subluxed shoulder and group 2 continuing without it. Patients’ satisfaction on clinical outcome was measured with clinical global impression-improvement (CGI-I) scale. Data were collected at 6 weeks (first follow up-visit), 12 weeks (visit 2) and at the end of the study i.e. 24 weeks (visit 3).Results: Statistically significant difference (p=0.003) in mean score of CGI-I at visit 1 suggested significant improvement for group 1 but no statistically significant difference in improvement was noticed between the groups at visit 2 (p=1.000) and visit 3 (p=0.724).Conclusions: Use of support for hemiplegic shoulder is beneficial only during early days of rehabilitation, not on prolonged use.

Background: Tennis elbow or Lateral epicondylitis is now a days a well known condition with mixed etiopathogenesis of inammation and microtear resulting in decreased hand grip strength. Among the various treatment options, therapeutic ultrasound and local steroid injection are commonly used in managing these patients, but comparative effectiveness of these two treatment procedures are often debated. To compare the efcacy of local cortic Aim of Study: osteroid injection versus therapeutic ultrasound in terms of improvement in painfree grip strength(PFGS) of affected upper limb. This i Method: nterventional study was conducted on 56 patients of both sexes within the age group of 18-60 years with unilateral Tennis elbow. They were randomly divided in two groups of same number(28 in each group)- Group-1: managed with local injection of steroid (methylprednisolone-10mg, single dose) with 2% of 0.5 ml lignocaine and Group-2 : managed with Therapeutic Ultrasound. Improvement of PFGS was assessed by hand held Dynamometer. Data collected at 0 week (Visit-1 or Pre-initiation), 3weeks (Visit-2 ), 6 weeks (Visit-3), 12 weeks (Visit-4). For PFGS score, in both Group-1 and Group-2, there Result: was signicant increase in subsequent visits (p<0.05). The mean PFGS score of Group-1 was signicantly higher than that of Group-2 in visit2(p<0.01), but in visit-3(p>0.05) & visit-4(p>0.05) there was no statistically signicant difference noted. Local Steroid injection & Conclusion: therapeutic ultrasound both are effective in improving PFGS. Though Local steroid injection is more effective in initial period, but in subsequent followups, the difference was statistically insignicant.

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.

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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