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Abstract

Background

‘Free From Pain’ is a drug-free, injection injection-free, lifestyle-based musculoskeletal pain management programme for seniors. The programme empowers Seniors with relevant information and inspirational metaphors whilst providing them with validated exercises. The programme is also available as a published book (ISBN-0995676941). This pilot study aimed to assess the suitability and safety of the programme's exercises and the usefulness of the book before considering a larger study.

Methods

Participants used 5-point Likert scales to evaluate the exercises. A rating of three or below on a Likert scale denoted non-agreement to a positive statement regarding the exercises. A rating of four or above denoted agreement. The Usefulness Scale for Patient Information Material (USE) was utilised to assess the book.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 41 - 41
1 Oct 2022
Kundu S Sims J Rhodes S Ampat G
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Background

BANDAIDE aka Back and Neck Discomfort relief with Altered behaviour, Intelligent Postures, Dynamic movement and Exercises (ISBN - 0995676933) is a concise self-help booklet containing strengthening exercises and illustrated information to enable patients self-manage their back and neck pain. The aim of this preliminary audit was to determine patient opinion on BANDAIDE. Institutional audit approval was obtained – No. 8429.

Methods and Results

BANDAIDE was distributed to 40 patients, who were asked to evaluate the booklet using the Usefulness Scale for Patient Information Material (USE). USE consists of nine positive statements which are subdivided into three sub-domains; cognition, emotional and behavioural. The cognition sub-domain assesses the knowledge obtained from the material, the emotional sub-domain evaluates the effects of the material on an individual's ability to cope with the illness and the behavioural sub-domain assesses ability to self-manage. Responders were required to rate the extent to which they agreed with each of the nine statements on a scale of 0 to 10, where 0 denotes ‘completely disagree’ and 10 denotes ‘completely agree’. Each subsection is on a scale of 0–30, with a higher score suggesting better usefulness. 23 participants provided their opinions of BANDAIDE through the USE. For the three sub-domains, the mean ratings for cognition, emotional and behavioural were 27.2, 24.7, and 26.4 respectively.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 40 - 40
1 Oct 2022
Howard J Rhodes S Sims J Ampat G
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Background

Free From Pain (aka Fear Reduction, Exercise Early with Food from plants, Rest and relaxation, Organisation and Motivation to decrease Pain from Arthritis and Increase Natural Strength) is a functional rehabilitation programme to combat sarcopenia and musculoskeletal pain in seniors. It is also published as a book (ISBN-0995676941). The aim of this audit was to evaluate the safety and suitability of the exercises and the usefulness of the exercise book.

Methods and Results

Participants were volunteers who paid to attend the Free From Pain Exercise programme. Participants evaluated the exercises using a 5-point Likert scale and the Exercise Book using the Usefulness Scale for Patient Information Material (USE). 30 participants attended the Free From Pain programme. 26 participants completed the questionnaire. This included 20 females and 6 males, with a mean age of 76 years. The mean scores on the 0 to 5 Likert scales were A) Exercises were suitable? 4.69; B) Exercises were safe? 4.58; C) Absence of any injury or medical event whilst exercising? 4.58; D) Covered all body parts? 4.38; E) Easy to do at home? 4.42; F) Encouraged to do more exercise? 4.42; G) Recommend to family and friends? 4.50. The mean scores of the cognitive, emotional, and behavioural sub domains of the USE scale, scored 0 to 30, were 25.23, 23.73 and 23.69, respectively.


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_4 | Pages 10 - 10
1 Jan 2013
Gandham S Thimmiah R Ampat G
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Aims

To capture the views of various members of the healthcare system with regards to whiplash injuries and in particular, the cumulative effects of whiplash on a patient seeking compensation.

Method

A questionnaire was set up on “Surveymonkey” which consisted of three scenarios outlining 1. single whiplash injury 2. Past history of neck pain with new whiplash injury 3. Chronic history of neck pain with a new whiplash injury seeking long term compensation and early retirement. The respondents were asked whether or not they agreed or disagreed with fictional expert opinions for each scenario. The questionnaire was distributed to orthopaedic surgeons, accident & emergency doctors, general practitioners and physiotherapists.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XVIII | Pages 91 - 91
1 May 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Background

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered.

Objectives

To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_X | Pages 18 - 18
1 Apr 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment, which can lead to devastating outcome on patients. The aim of this study was to assess health care professionals knowledge with regards to the urinary symptoms of CES and the timeframe in which treatment should be offered.

To assess health care professionals knowledge with regards to urinary symptoms of CES and when treatment should be offered.

A 4-part questionnaire established profession and number of cases seen per week. The participant was asked to rank 15 urinary symptoms, 7 of these symptoms were not related to CES. The participants were asked the ideal time to surgical intervention for Complete CES and Incomplete CES.

Primary and Secondary Care

60 questionnaires were complete. Participants had to successfully complete the first three parts of the questionnaire (n = 44). Any who failed to complete section four were excluded from analysis from that part only (n = 41).

A total of 44 questionnaires were analysed. Both doctors and physiotherapists ranked the CES symptoms on average significantly higher than then the non-CES symptoms. The physiotherapists rated the CES symptoms significantly higher than the doctors (P = 0.05) and on average rated the non-CES symptoms significantly lower than doctors (P < 0.05).

87.8% thought that complete CES should be treated < 24 hours and 9.76% thought that complete CES should be treated from 24-48 hours. 46.34% thought that CESI should be treated < 24 hours and 43.9% thought that CESI should be treated from 24-48 hours.

These results demonstrate that physiotherapists are better than Doctors at identifying the urinary symptoms in CES. The majority of health care professional who took part in this study stated that they would offer surgical intervention for both Complete and Incomplete CES within 24 hours. The gap in knowledge highlights the need for education to all medical professionals in the symptoms of CES and also the timing of treatment.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 41 - 41
1 Jan 2012
Hall S Ketheswaran J Walker J Studnicka K Ampat G
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Purpose of study

A recent audit in our institution showed that 40% of Lumbar spine X-rays ordered by General Practitioners were outside the Royal College of Radiology guidelines. Little in 1998 had commented that GPs requested Lumber Spine X-rays for psychosocial reasons.

Methods

An online survey was conducted on www.surveymonkey.com among the local GPs to determine their practice and preferences in investigating low back pain. The 5 questions in the survey were “rating scale questions” on a scale of 1 and 10, where 1 = DISAgree and 10 = Agree. A request to participate in the survey was sent to all the local General Practitioners by e-mail.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 22 - 22
1 Jan 2012
Walker J Studnicka K Vaghela D Ramachandran I Ampat G
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Purpose of study

The Royal College of Radiology (RCR) provides guideline criteria to order lumbar spine X-rays for back pain. An audit was undertaken in our hospital to see compliance with this guideline.

Methods

200 lumbar spine radiology requests received in the hospital radiology department from General Practitioners over a 12 month period were identified. These 200 requests and their corresponding radiology reports were retrospectively analyzed.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 44 - 44
1 Jan 2012
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Objectives

To assess health care professional's knowledge with regards to the urinary symptoms of CES and when treatment should be offered.

Background

Recent articles in the medical press highlight the potential dangers of Cauda Equina Syndrome (CES). CES has the highest rates of litigation due to its long-term neurological impairment.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_I | Pages 52 - 52
1 Jan 2012
Hindmarsh D Manickavasagar T Davenport J Ampat G
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Introduction:

“Spine Class” was organised at Southport Hospitals NHS Trust. The course was awarded 6 CPD (Continuing Professional Development) points. We propose a new method for assessing the effectiveness of educational courses by pre and post testing and participant satisfaction.

Materials and Methods

The course was attended by 64 delegates (49 Allied Health Professionals e.g. Physiotherapists and 15 Physicians). 21 lectures were planned for the day. The lecturers were asked to submit 2 True/False questions (TFQs), a total of 42 questions. Questions were answered prior to the course and immediately after. The lectures were evaluated on a scale of 1 to 5.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 491 - 491
1 Nov 2011
West M Palial V Jakaraddi C Prasad P Ampat G
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Aim: This study aims to quantify pain relief and quality-of-life benefit from a diagnostic SIJ injection.

Methods: 50 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, and no obvious source of pain in the lumbar spine. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls Ropivacaine hydrochloride.

Results: Onset of lower back pain symptoms ranged from 1962 to 2007. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual jobs. 18 patients (36%) had sustained previous back injury. A visual assessment score was carried out for low back pain and pain in both legs, both pre- and post-injection. Overall, 16 patients (32%) reported no change in their symptoms, 7 (14%) reported worsening, but in 27 (54%) improvement was recorded. When considering the Oswestry Disability Index score, 18% reported no symptom change, 24% worsened and 58% improved.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit.

Conflicts of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 492 - 492
1 Nov 2011
Webster BI Hindmarsh Ampat G
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Introduction: A survey was conducted among the personnel of Southport and Ormskirk Hospitals NHS Trust to determine the prevalence of spinal pain and the factors that could be related.

Materials and Methods: 200 questionnaires were distributed. Participation was voluntary. Details of sex, age, weight, smoking habits, previous accidents, compensation claims, details of work place, personal habits and presence of pain in the Neck, Thoracic spine, Lower Back and limbs were collected.

Results: Completed data was available only from 122 respondents (61%) who comprised of 16 HCAs, 42 Nurses, 5 OTs, 39 Physiotherapists 15 Theatre Practitioners and 5 others. The average age was 39.5 years. 92 (75.4%) had pain in at least one spinal region. 30 (24.6%) had no spinal pain. 35 (28.7%) had pain in the all the three regions of the spine. 83 of the respondents had Lower back followed by 53 having neck pain. 51 had of mid back pain. 15 of the 39 physiotherapists (38.5%) reported that they had no pain in any region of the spine. This contrasted with the Occupational Therapists in whom none of the 5 (0%) reported a pain free spine. There was no correlation between pain and Age, Sex or Weight. Twenty (16.4%) respondents smoked and the average spinal pain among smokers was 8.45 whilst that of non smokers was 5.03. (p< 0.05).

Conclusions: Among the groups tested the physiotherapists seemed to have healthy backs. Our results from a small survey show a clear correlation between smoking and back pain. These results seem to suggest that health promotion to decrease back pain should promote quitting smoking.

Conflicts of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 492 - 492
1 Nov 2011
West M Prasad P Ampat G
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We would like to present a rare case report describing a case in which new-onset tonic-clonic seizures occurred following an unintentional durotomy during lumbar discectomy and decompression. Unintentional durotomy is a frequent complication of spinal surgical procedures, with a rate as high as 17%. To our knowledge a case of new onset epilepsy has never been reported in the literature. Although dural rupture during surgery and CSF hypovolemia are thought to be the main contributing factors, one can postulate on the effects of anti-psychiatirc medication with epileptogenic properties. Amisulpride and Olanzapine can lower seizure threshold and therefore should be used with caution in patients previously diagnosed with epilepsy. However manufacturers do not state that in cases were the seizure threshold is already lowered by CSF hypotension, new onset epilepsy might be commoner. Finally, strong caution and aggressive post-operative monitoring is advised for patients with CSF hypotension in combination with possible eplieptogenic medication.

Conflict of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 491 - 491
1 Nov 2011
Gurbinder C Oni J Khan F Ampat G
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Introduction: An audit was undertaken to quantify patient satisfaction in the Orthopaedic Outpatient setting.

Materials and Methods: A 16 point questionnaire on a Likert scale of 1 to 5 was used. 216 consecutive questionnaires were distributed to patients attending the elective orthopaedic clinic during a three week period. The questionnaire collected details of sex, age, the grade of the health professional primarily assessing the patient in the clinic, administration of the appointment, welcome by reception staff, waiting room facilities, 7 questions pertaining to the care provided by the health professional primarily assessing the patient, 1 question regarding nurses and 2 regarding the overall service.

Results: Completed data was available only from 178 respondents (82.4%). There were 109 females and 69 males. 13 patients were under 20, 34 between 20 to 39, 61 between 40 to 60 and 70 over 60. 105 patients were seen by the Consultant, 49 by the Registrar, 14 by the Senior House Officer, 8 by a Physio Practitioner and 2 by an Associate Specialist. The mean score for questions 7 to 13 that pertained to the consultation with the health professional showed the following results. Associate Specialist 5.00, SHO 4.74, Consultant 4.70, Physio 4.68 and Registrar 4.63. The differences were not significant (P=0.017).

Conclusions: Our results show that patients are satisfied by being assessed even by Senior House Officers as long as normal NHS work practices are complied with.

Conflicts of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 196 - 196
1 May 2011
Hindmarsh D Davenport J Selvaratnam V Ampat G
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Introduction: Recent articles in the MPS Casebook (Cauda equina syndrome, Gardner and Morley) and BMJ (Cauda Equina Syndrome, Lavy) highlighted the potential dangers of Cauda equina syndrome (CES). CES has the highest rates of litigation due to the risk of symptoms not resolving and having a devastating impact on patients. This study aimed to assess clinician knowledge of the urinary symptoms of CES and the timeframe in which treatment should be offered.

Method: A 4 part questionnaire was constructed. The first part established the status and type of health care professional. The second part assesses how many musculoskel-etal patients are seen in an average week. In the third part the participant is asked to rank 15 urinary symptoms; with 1 being the least alarming and 15 being the most alarming. 7 of the symptoms were not related to CES and so should have been ranked in the bottom seven. Lastly, to highlight an issue raise in the BMJ article; the participants were asked the ideal time to surgical intervention for Complete CES and Incomplete CES, with the options being within 24 hours; 24–48 hours; and 48 hours to 2 weeks. The questionnaire was distributed to Health Care Professionals in Southport and Ormskirk Hospital.

Results: The questionnaire was completed by 23 participants (12 Doctors and 11 Physiotherapists). 90.91% of Physiotherapists and 10 Doctors (83.3%) managed to complete the questionnaire as specified. An average of 24 patients was seen by each professional (25 patients doctors; 31 patients Physiotherapist). The 7 false CES urinary symptoms were ranked in the bottom 7 in 76.40% of questionnaires (77.92% in Doctors; 81.82% in Physiotherapists). True CES urinary symptoms were ranked in the bottom 7 in 59.63% of cases (66.23% Doctors; 58.44% Physiotherapists). Finally 91.30% of those asked thought Complete CES should be treated within 24 hours (83.33% Doctors; 100% Physiotherapist); 56.52% thought Incomplete CES should be treated within 24 hours (66.67% Doctors; 45.45% Physiotherapists); 30.43% within 24 to 48 hours (8.33% Doctors; 54.55% Physiotherapists) and lastly 13.04% thought Incomplete CES should be treated within 2 weeks (25% Doctors and 0% of Physiotherapists).

Conclusion: The results show that there is a gap in knowledge of all professional with regards to CES urinary symptoms and the optimal timing of treatment. The results showed that Physiotherapists are more likely to recognise True CES than doctors. False symptoms were ranked lower by Physiotherapists than Medical Professionals. These results demonstrate that physiotherapists are better than Doctors at identifying urinary symptoms in CES. Finally the majority of those asked would treat Complete and Incomplete CES within 24 hours. The gap in knowledge highlights the need for education to all medical personnel in the symptoms of Cauda Equina Syndrome and also the timing of treatment.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_II | Pages 112 - 113
1 May 2011
AMPAT G WEST M PALIAL V
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Aim: This study was a sub group analysis of a larger study. The aim was to quantify pain relief and quality-of-life benefit from a single diagnostic SIJ (Sacro-Iliac joint) injection.

Methods: Between August 2008 and February 2009, 56 consecutive patients were retrospectively recruited with unilateral low back pain, pain mapping compatible with a sacroiliac origin, tenderness over the SIJ, no obvious source of pain in the lumbar spine and no neurological deficit. These were selected for a diagnostic SIJ injection. A structured questionnaire was completed both pre- and post-injection. Median patient age was 63. All patients were injected under fluoroscopic imaging with Triamcinolone 40mgs and 3mls of 0.5% Ropivacaine hydrochloride.

Results: 6 patients were excluded from the study on the basis of incomplete answers. 38 patients (76%) had some form of previous non-operative treatment. No patients had previous injection or surgery. 8 patients (16%) were smokers. 17 patients (34%) had a desk based job, 22 patients (44%) had a manual job, 7 patients (14%) had heavy manual job. 18 patients (36%) had sustained previous back injury including rear ended road traffic accidents. A numerical rating score was carried out for low back pain and pain in the affected and unaffected leg; both pre- and post-injection. In 27 patients (54%) significant improvement was recorded, 16 patients (32%) reported no change in their symptoms, and only 7 (14%) reported worsening. When considering the Oswestry Disability Index score, 58% improved, 18% reported no symptom change, and 24% worsened. The mean pre injection Numerical Rating Score of back pain in patients who had a previous injury to the back was 7.66 and that improved to 5.72 (P = 0.0287).

Discussion: Sacroiliac joint as a potential source of back pain has had less focus following the identification of the disc pathology by Mixter and Barr. The pain from the joint is real and needs to be addressed specifically with injection as a diagnostic measure. Blanket prescription of “low back - core stability exercises” without identification of other potential non red flag causes of back pain should be discouraged. The mechanism of sacroiliac joint syndrome following road traffic accidents occur due to one leg being on the brake pedal stabilizing one half of the pelvis, whilst the opposite hemipelvis twists forward following a rear end collision.

Conclusion: History and physical examination can enter SIJ syndrome into the differential diagnosis, but cannot make a definitive diagnosis. Fluoroscopically guided diagnostic SIJ injection is the gold standard test for making the diagnosis whilst also conferring substantial pain relieve and quality-of-life benefit. This benefit is also seen in back pain following traumatic injuries including rear end motor vehicle collisions.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 281 - 281
1 May 2009
Morgan S McGonagle L Defty C Kenyon J Rodd S Ampat G
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Multiple treatments of Sacro-iliac joint (SIJ) dysfunction have been adopted by various disciplines that treat low back pain. The aim of this audit is to evaluate the effect of steroids and Local anaesthetic injection (LA) in the management of SIJ dysfunction and to determine the relation between road traffic accident and low back pain (LBP).

We retrospectively reviewed 31 patients who were diagnosed as having SIJ dysfunction. All patients had steroids and LA injection under x-ray control. Based on previous history of road traffic accident patients were divided into RTA and non-RTA group. Through a postal questionnaire the severity of LBP and leg pain (pre and post injection) were assessed using visual analogue scale (VAS). Functional level was evaluated through the Oswestery disability Index (ODI).

All patients showed improvements in LBP and leg pain post injection with mean improvement in VAS of 2.95 (SD 3.0, p-value < .0001) for LBP and mean improvement of 3.3 (SD 3.3, p-value < 0.001) for leg pain. Similarly the ODI showed mean improvement of 15.0 (SD 17.0, p-value < 0.0001). Patients in the RTA group showed greater improvement than the non RTA group, however this did not reach statistical significance.

We conclude that steroids and LA injection is an effective method in management of SIJ dysfunction. Also our study suggests that RTA can be a potential cause of back pain by causing SIJ dysfunction. We accept that our sample size is small and needed to be confirmed through a prospective randomised controlled trial which is currently taking place in our institution.


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_II | Pages 284 - 284
1 May 2009
Morgan S Ampat G
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Sarcoidosis is a multisystem syndrome characterized by the development of non-caseating granulomata. The lesion disrupts the architecture and function of the tissue in which they reside.

Sarcoidosis in and around the spine is very rare affecting less than 1% of patients with the disease. It can affect various parts of the craniospinal axis: intramedullary, intradural, extramedullary, intraspinal epidural spaces and in vertebral bodies. In this report we present a rare case of sarcoidosis in the intervertebral disc causing diagnostic dilemma. To our knowledge this has never been reported before.

Our patient has had aggressive systemic sracoidosis, however the first presentation of the disease was in his spine in the form of intractable low back and leg pain resistant to treatment. X-ray and MRI showed Listhesis at L4/5. Posterior Fusion was performed. Pain became worse and accordingly anterior fusion was attempted, which was aborted because of excessive bleeding. Patient then developed subcutaneous nodules. Biopsy from the nodules showed features of non-caseating granulomatous lesion. In view of the persistence of his symptoms biopsy from L4/5 disc was performed and showed similar histological features. CT chest and abdomen confirmed the diagnosis of sarcoidosis. The patient was commenced on steroids and Methotrexate.

In this report we highlight the approach to diagnosis and management and present a review of the literature. Our main aim is to make the clinicians more aware of this rare condition and raise the index of suspicion, particularly if the first presentation of this multi-system granulomatous disorder is in the spine.


The Journal of Bone & Joint Surgery British Volume
Vol. 90-B, Issue 2 | Pages 240 - 242
1 Feb 2008
Morgan SS Aslam MB Mukkanna KS Ampat G

A 48-year old man presented with back pain that was resistant to treatment. An MR scan showed spondylolisthesis at L4-5 and narrowing of the exit foraminae. He had a posterior fusion which did not relieve his symptoms. He continued to have back pain and developed subcutaneous nodules in both forearms. Biopsy from the skin revealed cutaneous sarcoidosis, and one from the lumbar spine showed sarcoidosis granuloma between the bone trabeculae. A CT scan of the abdomen and chest revealed axillary lymphadenopathy, mediastinal enlarged nodes, apical nodular nodes and splenomegaly. The patient was started on large doses of methotrexate and steroids. His angiotensin-converting enzyme and calcium levels returned to normal and the back pain resolved.


Orthopaedic Proceedings
Vol. 86-B, Issue SUPP_III | Pages 271 - 271
1 Mar 2004
Aslam N Ampat G Nair S Willett K
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Aims: To evaluate the functional outcome following internal fixation of distal humerus intra-articular fractures (AO type C) with a minimum follow up of two years. Methods: Design: Retrospective evaluation and clinical review. Setting: Regional trauma centre Patients and Participants: Twenty six consecutive patients with fractures of the distal humerus were treated over a thirty one month period (June 1993 to December 1995). The mean age was 55years (range,18–82). Clinical review of twenty patients at a mean follow up of more than two years (range 19–48 months). Six patients were lost to follow up. Results: Clinical evaluation of twenty patients was carried out. Fourteen patients (70 percent) had an excellent or good outcome, five patients (25 percent) a fair outcome and one patient (5 percent) had a poor result. Three patients (15 percent) underwent a second procedure for symptomatic metalwork. The mean arc of flexion-extension was 112 degrees (range, 85 to 122 degrees). Fifteen patients (75 percent) were able to return to their pre injury level of occupation and activity. Seventeen patients (85 percent) were satisfied with the final outcome. Conclusion: nternal fixation of intra-articular distal humerus fractures is an effective procedure with an excellent/good functional outcome in most patient age groups. Patients have a high level of satisfaction and return to previous level of activity.