Abstract Context: There is a severe shortage of assistive technology (AT) in low- and middle-income countries, where access is limited to only 3% of individuals, compared to 90% in high-income countries. Despite this disparity, there remains a critical lack of data on the prevalence of paediatric disability and the associated need for mobility devices. Aims: This study aims to estimate the prevalence of children living with mobility-related disabilities in India and the proportion of them who would benefit from a mobility device. Subjects and Methods: An environmental scan was carried out using scoping review methodology to synthesise available peer-reviewed and grey literature on paediatric disability in India. Data from the 2011 Indian Census and from the World Health Organization as of 2023 were used to derive population estimates. The current paediatric population with mobility-related disabilities was projected using prevalence estimates from cerebral palsy and other mobility-related disabilities. Finally, published distributions of the Gross Motor Function Classification System levels were used to determine the proportion of children likely to benefit from mobility devices. Results: As of 2023, an estimated 3.28 million children in India were projected to be living with a mobility-related disability. Approximately 37.3% of them would likely benefit from a mobility device. Conclusions: These findings reflect the need for mobility devices and improved access to paediatric AT among children with mobility-related disabilities in India. In addition, they inform rehabilitation professionals and AT vendors about the potential market size and unmet needs in this region.
Abstract Context: Spasticity is a common complication of upper motor neuron syndrome and, if left untreated, can lead to contracture. In this study, patients with lower limb spastic stiff muscles were injected with hyaluronidase, and the response was assessed compared to similar peers. Aims: The aim of this study was to analyse the differences in Modified Ashworth Score and passive range of movement between groups. Settings and Design: This was a prospective nonrandomized study conducted at a tertiary-level rehabilitation centre. Methods: Patients with lower extremity spastic muscle stiffness due to acquired brain injuries were included. Spasticity was quantified with the Modified Ashworth Score (MAS), popliteal angle and overall passive range of movement. Intervention patients received hyaluronidase in the affected lower extremity muscle groups. After this, patients’ bystanders were taught passive stretching of spastic muscles. The control group received home exercises. Follow-up was done in 2 and 4 weeks. Results: At baseline, there was no significant difference between the groups for the outcome variables. At 2 weeks, MAS (0.4, 95% CI = 2.98–3.63, P = 0.03) and passive range of movement (PRoM) knee (14.0, 95% CI = 49.46–86.59, P = 0.01) and ankle (5.34, 95% CI = 10.05–27.7, P = 0.05) showed significant differences favouring the intervention group. At 4 weeks, knee PRoM (15.33, 95% CI = 53.48–93.23, P < 0.01) and ankle (14.67, 95% CI = 10.14–37.60, P = 0.03) showed significant differences favouring the intervention group. At 50 weeks, ankle PRoM (20.67, 95% CI = 47.62–18.28, P = 0.02) showed significant differences favouring the intervention group. Conclusions: Patients who received intramuscular hyaluronidase had a better range of motion at joints affected by spastic muscle stiffness both early and late.
Abstract Painful digital neuromas are an uncommon but debilitating cause of chronic neuropathic hand pain. Symptoms often persist despite conservative management, and surgical revision is associated with variable outcomes and a significant risk of recurrence. Minimally invasive, nerve-targeted interventions may offer effective pain relief while avoiding additional surgical morbidity. Reporting successful alternative approaches is important to inform clinical decision-making in selected refractory cases. We report the case of a 49-year-old Indian woman with severe, refractory neuropathic pain of the right index finger following prior surgery for a presumed glomus tumour. Clinical features and high-resolution ultrasonography confirmed a symptomatic digital neuroma. Given persistent symptoms and the unpredictable outcomes of repeat surgery, landmark-guided micro-volume phenol neurolysis was performed using a 26-gauge needle and 0.2 mL of 6% phenol. The patient experienced rapid and marked pain relief, with sustained functional improvement and no complications. This case demonstrates that micro-volume phenol neurolysis may offer a minimally invasive option for pain relief in carefully selected patients with painful digital neuromas. As a low-morbidity technique, it may represent a valuable therapeutic option when conservative measures fail, and surgical revision is undesirable. However, larger studies are required to establish its effectiveness, define appropriate patient selection and determine long-term outcomes.
Abstract Background: Clinical remission in rheumatoid arthritis (RA), defined by conventional measures, may not reflect the complete absence of synovial inflammation. This study aimed to investigate the correlation between musculoskeletal ultrasound (MSK US) findings and Disease Activity Score 28 (DAS28) in RA patients who achieved clinical remission. Materials and Methods: This cross-sectional study included 45 RA patients fulfilling the 2010 American College of Rheumatology criteria who achieved clinical remission (DAS28 <2.6). Patients underwent a comprehensive clinical assessment and MSK US examination of 22 joints, including bilateral wrists, metacarpophalangeal and proximal interphalangeal joints. Synovial hypertrophy (SH) was assessed using Grey-scale ultrasound (B-mode), and synovial vascularity was evaluated using power Doppler (PD). The OMERACT semi-quantitative Szkudlarek scale was used for ultrasound grading. Spearman’s rank correlation coefficient ( r s ) was used to analyse the relationship between DAS28 scores and ultrasound findings. Results: Despite clinical remission, MSK US detected subclinical synovitis in 26.67% of patients. Among patients in DAS28-erythrocyte sedimentation rate (ESR) remission ( n = 28), 17.9% showed SH on B-mode and 10.7% demonstrated positive PD signals. In the DAS28-C-reactive protein (CRP) remission group ( n = 42), 19.0% had SH and 16.7% showed PD positivity. A weak but statistically significant positive correlation was found between DAS28-ESR and combined ultrasound scores ( r s = 0.31, P = 0.039), while the correlation between DAS28-CRP and ultrasound findings was weak and not statistically significant ( r s = 0.26, P = 0.085). Conclusion: MSK US can detect subclinical synovitis in a substantial proportion of RA patients who have achieved clinical remission according to DAS28 criteria. The weak correlation between clinical disease activity measures and ultrasound findings suggests that conventional assessment tools may not fully capture ongoing inflammatory processes. Incorporating MSK US into the routine assessment of RA patients in clinical remission may provide valuable information for treatment decisions and potentially prevent disease progression. It may serve as an adjunct tool for remission assessment by identifying subclinical synovitis in RA patients classified as being in clinical remission.
Abstract Introduction: Knee osteoarthritis (OA) stands as the most prevalent chronic joint ailment, with more than 50% of people reporting a fall during the previous year. Neuromuscular changes associated with OA alter dynamic postural control, compromising the ability to evade falling. Few studies show how the severity of knee OA relates to the risk of fall (RoF) and impaired balance. Materials and Methods: In this observational cross-sectional study, the participants had primary OA knee, fulfilled inclusion and exclusion criteria and were classified into early (Kellgren–Lawrence Grade 1 and Grade 2; n = 55) and advanced (Grade 3 and Grade 4; n = 35) OA groups. Outcome measures were static balance, dynamic balance and RoF assessed using the Biodex Balance System and Timed Up and Go (TUG) test. Correlation was studied between these indices. Results: Dynamic balance, RoF and TUG scores showed statistically significant differences worse for the late OA group. On correlating with the TUG test, the dynamic balance measures correlated positively for early OA, whereas RoF measures correlated positively for late OA. Conclusion: Balance impairment and RoF were higher in those with advanced knee OA. Mobility showed deterioration in the same group. The device outputs correlated positively with the clinical scale, indicating that TUG has predictive value in detecting falls.
Abstract Background: Physical medicine and rehabilitation (PMR) is a relatively untapped speciality in India even though it was initiated in 1955. With the approach of biopsychosocial, the field treats chronic conditions, pain, musculoskeletal disorders and neurological disorders, in contrast to disease-oriented medical fields. Objectives: The research was intended to determine the distribution of the number of practicing physiatrists in India and their concentration; to record the subspeciality domains that have developed during the last 7 decades. Methodology: A cross-sectional survey was developed among the practicing physiatrist in India using the network of the Indian Association of Physical Medicine and Rehabilitation. The information was gathered through a four-question survey on a Google Forms questionnaire and distributed through WhatsApp groups and direct contacts. The survey measured practice location, work setting as well as subspeciality domains of practice. Results: Twenty three states and union territories have provided 345 responses, that is about 35% of registered physiatrists in India. The maximum number of respondents was exhibited in Kerala ( n = 123, 35.7%), Tamil Nadu ( n = 41, 11.9%) and Karnataka ( n = 39, 11.3%). Most of them worked in government (53%), and 47% worked in a private/independent arrangement. The most common areas of practice were pain and musculoskeletal rehabilitation, then neurorehabilitation, spinal cord injury rehabilitation, rheumatology and paediatric rehabilitation. The new areas were cancer rehabilitation, burn care, hyperbaric oxygen therapy, applications of the virtual reality and the clinics of diabetic foot. Conclusion: It is a groundbreaking study that presents the first nationwide mapping of PMR practice in India and shows that there are notable geographical inequalities and concentration within domains. There is a critical shortage of workforce in the field, which has 40 PMR residency programmes in the whole country, and a population of more than 1.4 billion, with an estimated 789 registered physiatrists. The results reveal the critical necessity of raising awareness, developing training opportunities and institutionalising the use of PMR in the regular medical education.
Abstract Background: Diabetic foot ulcers (DFUs) are a major complication of diabetes mellitus, contributing substantially to morbidity, amputation risk and mortality. Orthotic interventions focusing on pressure redistribution and offloading are central to DFU prevention and treatment. Objective: To systematically review evidence on the effectiveness of orthotic interventions in DFU management, including ulcer healing, recurrence prevention, patient adherence and clinical outcomes. Methods: A systematic search of PubMed/MEDLINE, EMBASE, Cochrane Central Register of Controlled Trials, Scopus, Web of Science and CINAHL databases was conducted from January 2013 to October 2025. Studies evaluating total contact casting (TCC), removable and non-removable offloading devices, custom-made orthotics, therapeutic footwear and emerging technologies were included. Two independent reviewers performed study selection, data extraction and quality assessment. Results: Strong evidence supports orthotic management in DFU care. TCC demonstrated the highest healing rates (75%–90%) and remains the gold standard for plantar ulcer offloading. Non-removable knee-high devices achieved superior healing (82%–89%) compared with removable devices. Custom-made orthotics reduced ulcer incidence and recurrence more effectively than prefabricated insoles. Therapeutic footwear with pressure-redistributing insoles and rocker soles reduced ulcer recurrence from approximately 50% to 20%. Overall, orthotic interventions reduced recurrent ulceration from 79% to 15% and significantly lowered amputation rates. Patient adherence emerged as a critical determinant of outcomes, particularly with removable devices. Conclusions: Orthotic management is fundamental to DFU treatment and prevention. Non-removable offloading devices, especially TCC, should be first-line therapy when appropriate, while custom orthotics and therapeutic footwear are essential for long-term ulcer prevention.
Abstract Background: Neurogenic overactive bladder in patients with suprasacral spinal cord injury (SCI) often responds poorly to the available conservative treatment. Although the cystoscopy-guided intravesical onabotulinum toxin Type A injection can help in this situation, data in the Indian population are still lacking. Aim and Objective: To observe the improvement following intravesical onabotulinum toxin (Type A) injection in neurogenic overactive bladder due to traumatic SCI. Materials and Methods: This single-arm prospective interventional study was conducted initially on 51 cases after taking institutional ethics committee clearance on patients of traumatic SCI with neurogenic overactive bladder assessed by urodynamic study (UDS). Cystoscopy-guided intravesical injection of onabotulinum toxin Type A: 200 units were given under strict aseptic conditions. Maximum cystometric capacity (MCC), first desire to void (FDV) and frequency of incontinence per week (Freq/W) were assessed as outcome parameters and noted at the baseline, 2 nd week, 6 th week and 12 th week post-procedure. Data of 47 patients were analysed as there were 4 dropouts. Results: Both the UDS parameters, i.e. MCC and FDV, along with the clinical parameter, i.e. Freq/W, showed post-procedure significant improvements ( P < 0.001), and those were sustained during subsequent follow-ups. Conclusion: For patients who are poorly responding to conservative management, intravesical onabotulinum toxin Type A injection can help them to improve their bladder function as a whole.
Abstract Artificial intelligence (AI) is the ability of computer systems to perform tasks such as learning, reasoning and solving problems that require human intelligence. Natural intelligence (NI) in their turn encompasses ethical, emotional and cognitive competencies of human clinicians, particularly their flexibility, empathy and contextual judgement. AI and NI have emerged as a significant, complementary factor in patient outcome in Physical Medicine and Rehabilitation (PMR). The applications of AI are found in many different fields, including: Real-time treatment optimisation and adaptive therapy protocols Tele-rehabilitation and monitoring of remotely to enhance accessibility Documentation and clinical decision support automation to minimise clinical burnout Individual measurement using imaging, wearable sensors and clinical data The process of medical history taking, triage, patient education and scientific research is supported by AI-based systems such as ChatGPT/GPT-4. However, there are still major obstacles, such as algorithm bias, information privacy issues, a lack of empathy and the danger of over-depending on technology. On the other hand, NI provides essential benefits in moral reasoning, innovation, socialisation and integrative goal-setting. Rehabilitation is indeed patient-centred by treating the patient in a manner that is sensitive to the slight, yet silent signals, dynamic modification of treatments and developing trusting therapeutic relationships. The present opinion paper is of the view that AI and NI will shape the future of PMR instead of replacing each other. Using NI empathy and clinical judgement and AI analytical powers and scalability, it is possible to provide personalised, ethically correct and clinically effective rehabilitation care. Strong ethical approaches, clear algorithms, multidisciplinary teamwork and continuous learning of the rehabilitation professionals are needed in this synthesis.
Abstract Nemaline myopathy (NM) is a rare congenital neuromuscular disorder characterised by muscle weakness and the presence of nemaline bodies in muscle fibres. We present a case of an 11-year-old male with mild, non-progressive lower limb muscle weakness, incidentally detected during a routine check-up. Whole exome sequencing identified compound heterozygous pathogenic variants in the nebulin gene (c.9046C>T, p.Arg3016* and c.21417+3A>G), confirming the diagnosis of autosomal recessive NM Type 2. A positive family history in his sister with a milder phenotype was noted. This report highlights the diagnostic approach, genetic considerations and implications for physical activity and rehabilitation in a paediatric patient with a mild phenotype of NM.
Abstract Median nerve schwannomas occurring above the elbow are rare. Although surgical enucleation is usually curative, persistent post-operative motor deficits are uncommon and can significantly affect hand function, creating rehabilitation challenges. We describe the recovery of median nerve palsy following schwannoma enucleation with a tailored rehabilitation approach. A 48-year-old male presented 1 month after surgical enucleation of a right supracondylar median nerve schwannoma with hand weakness and paraesthesia in the palmar aspect of the lateral three and a half fingers. Clinical examination showed sensory impairment in the median nerve distribution and motor weakness involving the thenar muscles, flexor pollicis longus and first and second lumbricals, which was confirmed by nerve conduction studies. The patient underwent a comprehensive rehabilitation programme including pharmacological management of neuropathic pain, sensory care, neuromuscular electrical stimulation and activity of daily living modifications. After 6 months, significant functional recovery was achieved with improved grasp, fine motor function and Rosen score.
Abstract Introduction: Low back pain (LBP) is one of the leading causes of disability. In addition to specific organic causes, environmental, socioeconomic, cultural and psychological influences and peripheral and central sensitisation (CS) also play a role in its development and chronicity. The impact of CS on physical capacity in individuals with chronic pain remains unclear. Aims and Objectives: To study the effect of CS on physical capacity and disability in patients with chronic LBP. Methodology: It was a cross-sectional study, with 100 patients divided into two groups according to their risk of CS using CS inventory (CSI) scores. The patient’s physical capacity was assessed using a 6-min walking test (6MWT), timed up-and-go test, sit-to-stand test (STS), trunk flexor extensor and side bridge endurance tests. Roland Morrison disability questionnaire was also used to assess disability. The association of physical capacity and disability with the risk of CS was evaluated. Results: The results suggest that a high risk of CS is associated with prolonged pain duration, increased pain intensity, greater disability and decreased physical capacity. A negative correlation was observed between CSI scores and several physical performance measures, including the 6MWT (m), STS (s), flexor endurance test (s) and side bridge tests (both right and left, in seconds), with correlation coefficients of −0.46, −0.538, −0.556, −0.546 and − 0.534, respectively. Conclusion: These outcomes highlight the importance of assessing and managing CS in patients with chronic LBP to alleviate disability and improve functional capabilities.
Abstract Lateral elbow tendinopathy, or tennis elbow, is a common musculoskeletal condition linked to repetitive wrist extension and gripping. Although standard treatments are often effective, recurrence may result from overlooked behavioural or mechanical factors. This report describes the two cases of recurrent lateral elbow tendinopathy in young women, where symptom persistence stemmed from atypical causes. One patient exhibited compulsive utensil-cleaning behaviour due to undiagnosed obsessive–compulsive disorder, while the other experienced mechanical strain from a faulty scooter throttle. Both had previously received standard conservative care with limited success. Symptoms resolved only after identifying and addressing the underlying perpetuating factors – psychological in one case and mechanical in the other. Targeted interventions, including behavioural therapy and ergonomic correction, led to complete recovery. These cases highlight the value of a biopsychosocial approach in musculoskeletal care. Thorough clinical history is essential to uncover hidden contributors and guide effective and personalised management.
Abstract Background: Rehabilitation is a key strategy for enhancing the quality of life, yet the magnitude of unmet needs and the factors influencing the demand for these services remain under-researched in many settings. This study aimed to assess the perceived need for rehabilitation services, their determinants and perceived barriers amongst patients attending a tertiary care hospital in the National Capital Region, India. Materials and Methods: A cross-sectional study was conducted amongst 400 participants. Data were collected through a pretested structured interview schedule covering socio-demographics, functional limitations and a qualitative assessment of barriers and service preferences. Statistical analysis was performed using the Chi-square test to determine the associations. P ≤0.05 was considered statistically significant. Results: Of 400 participants, 40.8% ( n = 163) reported a perceived need for rehabilitation services. Older age ( P = 0.011), female sex ( P = 0.021) and lower educational status ( P < 0.001) were significantly associated with higher perceived need. Functional difficulty in performing daily activities showed the strongest association ( P < 0.001). Amongst identified barriers, ‘lack of information’ was most frequently reported (58.8%), far exceeding financial constraints (6.5%). Most participants preferred hospital-based rehabilitation services (74.8%) and favoured public awareness campaigns (52.0%) as their preferred mode of receiving information. Conclusion: The study highlights a substantial demand for rehabilitation services, particularly amongst vulnerable populations such as the elderly, women and those with lower socioeconomic status. The findings suggest that perceived need is driven more by functional impairment and service awareness than by clinical diagnosis alone. Strengthening awareness campaigns and ensuring equitable access for marginalised groups are critical strategies to address this issue.
Abstract Rotator cuff tears are frequently overlooked when imaging is not performed soon after trauma, allowing chronic changes to develop and secondary conditions to dominate the clinical picture. A 52-year-old right-handed female presented with severe right shoulder pain of 1-month duration that was initially attributed to isolated bicipital tendinitis. Detailed history revealed a remote motor vehicle accident evaluated only with plain radiographs. Magnetic resonance imaging (MRI) performed several years later demonstrated a complete full-thickness tear of the supraspinatus tendon with approximately 3.7 cm retraction of its fibres, Grade 3 Goutallier fatty atrophy, partial-thickness tear of the subscapularis tendon, tendinosis of infraspinatus and teres minor, acromioclavicular joint arthropathy with bursitis and mild capsular thickening suggestive of early adhesive capsulitis. A focused 3-week physiotherapy program combining pain-modulating modalities and progressive strengthening achieved complete pain relief (Visual Analogue Scale 8 → 0–1) and restored functional range of motion without surgery. Undiagnosed post-traumatic rotator cuff tears can remain quiescent for years and later present primarily as biceps tendon inflammation due to compensatory overload. This case reinforces the value of early MRI after significant shoulder injury and demonstrates that intensive, short-duration conservative treatment can yield excellent outcomes even when substantial retraction and fatty infiltration are present.
Abstract Spasticity is a common manifestation of upper motor neuron syndrome due to central nervous system dysfunction and occurs in conditions such as traumatic brain injury, spinal cord injury, cerebral palsy and stroke. Excessive spasticity can interfere with posture, mobility and activities of daily living, requiring intervention. The first-line management typically includes physiotherapy, oral antispastic medications and botulinum toxin injections; however, surgical neurotomy remains a valuable option for localised spasticity unresponsive to conservative measures. We report the case of a 40-year-old male with post-traumatic paraplegia following a D12 compression fracture who developed equinus deformity due to poor adherence to home rehabilitation. Despite tendo-Achilles Z-plasty, he developed intractable right ankle clonus. He underwent selective tibial neurotomy combined with bilateral Baker’s procedure, resulting in the resolution of clonus and improved ankle mobility. Post-operative follow-up at 3 and 6 months demonstrated sustained functional improvement, enabling independent ambulation with walker support and no recurrence of clonus. Selective neurotomy should be considered in patients with refractory focal spasticity after failure of conservative therapies, providing durable functional improvement and enhancing the quality of life.
Abstract Limb-girdle muscular dystrophy (LGMD) is a progressive neuromuscular disorder characterised by proximal muscle weakness, often exacerbated by obesity-related deconditioning. We report the outcomes of an intensive, individualised inpatient rehabilitation programme in a 23-year-old male with genetically confirmed LGMD and Class II obesity (body mass index 37.58 kg/m 2 ) who presented with severe functional decline. The multidisciplinary intervention included tailored physiotherapy, ambulation training, respiratory exercises, occupational therapy, nutritional optimisation, psychological counselling and adaptive equipment training. Over 45 days, significant functional improvement was observed: The functional independence measure motor subscore increased from 78 to 91, 6-min walk distance improved from 120 m to 850 m and the Fatigue Severity Scale score decreased from 53 to 18. Muscle strength and endurance also improved, accompanied by a 13 kg weight reduction. This case highlights that intensive, individualised rehabilitation incorporating weight management can yield meaningful functional recovery in LGMD complicated by obesity, emphasising the value of early multidisciplinary intervention.
Abstract Background: Hyperbaric oxygen therapy (HBOT) has shown use in the treatment of traumatic brain injury (TBI). Clear, context-specific guidelines are absent, particularly in resource-limited settings like India. There are over 1.6 million TBIs annually in India. There is growing interest in HBOT. This study aimed to develop the first India-specific consensus-based guidelines for its clinical use in TBI. Methods: A modified Delphi technique was employed, following the Conducting and Reporting Delphi Studies checklist, engaging expert members of the Hyperbaric Society of India across four structured rounds. Participants reviewed literature, rated proposed statements and refined items through both anonymous and open discussions over four rounds. Results: From 238 initial responses, the panel distilled 42 items, ultimately reaching consensus on 15 core guideline statements. These address critical gaps left by global recommendations, including treatment pressure, duration, timing and patient selection. Results highlight the feasibility and value of HBOT across TBI severity levels, with demonstrated benefits in cognition, intracranial pressure reduction and survival. Conclusion: This initiative represents a vital step towards standardised HBOT use for TBI in India, providing actionable guidance for clinicians and supporting further integration of this evidence-based modality into neurorehabilitation practice.
Background: Partial tears of the supraspinatus tendon are a common cause of shoulder pain and functional impairment. This randomised controlled trial aimed to compare the effects of platelet-rich plasma (PRP) injections combined with an exercise programme versus an exercise programme alone in managing partial supraspinatus tears. Methodology: This open-label, parallel-group study was conducted in the Department of Physical Medicine and Rehabilitation at AIIMS, Rishikesh. A total of 60 participants aged 18–65 years with clinically and radiologically confirmed supraspinatus tears were randomised into two groups: Group A received PRP injections with a structured exercise programme, while Group B followed the exercise programme alone. Outcome measures included pain reduction (Numeric Rating Scale [NRS]), functional improvement (Shoulder Pain and Disability Index [SPADI]) and radiological healing (ultrasonographic tear thickness). Assessments were conducted at baseline, 1 month and 3 months. The analysis included parametric tests such as repeated measures ANOVA, along with logistic regression to calculate odds ratios and the number needed to treat (NNT). Results: Both the groups demonstrated improvements over time in NRS, SPADI and tear thickness, with Group A showing significantly greater benefits. At 3 months, the mean NRS scores decreased to 1.75 ± 1.37 in Group A versus 3.95 ± 2.66 in Group B (P = 0.003), while SPADI scores reduced to 9.95 ± 9.44 in Group A compared to 25.90 ± 31.44 in Group B (P < 0.001). Ultrasonographic measures revealed significant tear healing in Group A compared to Group B for both transverse and longitudinal tear dimensions (P < 0.005). Logistic regression analysis showed Group A participants were more likely to achieve >50% improvement (odds ratio = 3.76, NNT = 3.33). Conclusion: PRP injections combined with an exercise programme offer superior pain relief, functional recovery and radiological healing compared to exercise alone in the management of partial supraspinatus tears. These findings highlight the potential of PRP as an effective adjunctive therapy.
Piriformis syndrome is characterized by buttock pain, low back pain and when it’s severe it can lead to sensory abnormalities in the lower limbs causing difficulty in walking and thus it has significant impairment of the activities of daily living. Thus, a correct diagnosis and treatment is required to reduce the consequences. The usual treatment is conservative and injections are reserved for refractory cases. The role of piriformis block with ultrasound guidance plus physical therapy needs further enlightenment. We encountered 12 cases who had no improvement in the pain with 6 weeks of oral pharmacological management, so they were given injection triamcinolone 40 mg with lignocaine under ultrasound guidance. Improvement was assessed at immediate post injection period and after 3 months with numerical pain rating scale. 11 of them showed improvement during subsequent follow ups. 1 patient had very little response and was diagnosed with prolapsed intervertebral disc at lumbar level on detailed evaluation. Corticosteroid along with local anesthetic is an effective way of reducing refractory piriformis syndrome pain and ultrasound guidance is more preferred than landmark guidance for its precision and accuracy. Physical therapy further added to recovery by reducing the compressive symptoms.
