Carpal tunnel syndrome is the most common compressive neuropathy of upper extremity affecting predominantly females of middle age group. Symptoms include pain, paracsthesia, numbness in median nerve distribution of hand.

Comparative type of interventional study.

Department of Physical Medicine and Rehabilitation, SMS Medical College and attached group of hospitals, Jaipur.

One and a half years April 2014-October 2015.

To compare the efficacy of local ultrasound therapy and local corticosteroid injection for carpal tunnel syndrome management.

A total of sixty patients with CTS (agep>18 years) were randomly assigned to the steroid treatment plus splinting(group A) or ultrasound treatment plus splinting(group B).

The mean age of study population was 45.47±12.24 years with males comprising 13.3% and females 86.6% of whole study. At baseline all outcome variables were comparable statistically in both the groups (p>0.05). In follow-up assessment at 8th week, statistically significant improvement was obtained in all clinical and electrophysiological parameters in group A: Grip strength, symptom severity score, functional status score, median DML, sensory nerve conduction velocity (p<0.001 for each). Also the group B showed improvement in all parameters except grip strength. At the end of 24th week all outcome variables showed decline in improvement as comparative to 8th week, but still they were better than baseline in both groups. There was no significant difference between the groups in outcome variables except for the grip strength.

Ultrasound treatment provided improvement comparable to steroid injection in all clinical and electrophysiological parameters in patients with CTS except grip strength. Overall steroid therapy is more effective than ultrasound therapy. Effectiveness of treatment persist for at least 6 months then it lessens, so long follow-up is required.

The benign joint hypermobility syndrome (BJHS) was first addressed by Kirk as a distinct pathology in 1967, as the presence of rheumatic symptoms with generalised joint laxity in the absence of any demonstrable systemic rheumatic disease.

In this prospective, longitudinal, analytical study, we tried to find out the response of rehabilitation therapy in patients presenting with locomotor symptoms of BJHS and selected 61 patients randomly. The rehabilitation protocol followed: Explanation and reassurance, teaching of joint protection techniques and work modification, isometric muscle strengthening exercise (both extensor and flexor muscles), endurance exercise. Clinically most of the patients showed significant overall response quantitatively, in all the parameters.

It can be concluded that the rehabilitation protocol prescribed here is very much suitable both quantitatively and qualitatively for the patients of BJHS.

Myofascial pain syndrome is one of the commonest pain syndromes now a days. Its pathophysiology is not fully documented or understood. Goal of treatment is to release the pain and discomfort of myofascial pain syndrome.

This was a multicentric prospective study comprising 70 patients who had been diagnosed clinically with myofascial pain syndrome in the neck, shoulder or back. Cases were randomly divided into two treatment groups. First group (36 cases) were treated with physiotherapy modalities (extracorporeal shock wave therapy and ultrasound therapy as combination therapy) and patients in second group (34 cases) were treated with trigger point injection. In both the groups patients were advised stretching exercises as soon as pain decreases.

Pain was substantially decreased in both the treatment groups but results were early and comparatively better in patients treated by trigger point injection group. Stretching exercises were helpful in regaining strength and also helpful in decreasing recurrence of pain.

Effect of neuromuscular electrical stimulation in acute stroke patients while stimulating only single muscle is not known. The purpose of the study is to find the influence of early neuromuscular electrical stimulation to the motor point of tibialis anterior muscle of the affected limb in achieving early motor control of the ankle with reduction in spasticity in poststroke patients.

One hundred and thirty-two subjects were selected between 45and 65 years of age and within 2 weeks of the first attack of stroke. They were randomly divided into study and control groups comprising 66 subjects in each group. Study group received neuromuscular electrical stimulation to tibialis anterior muscle of the affected limb, 15 minutes twice daily, 5 days a week up to 3 weeks along with conventional exercise therapy whereas control group received only exercise therapy for that period. Outcome measures include Modified Ashworth Scale for spasticity of ankle plantar flexors, motor power of ankle dorsiflexors and plantar flexors, motor control of ankle joint. They were recorded before starting treatment, after 3 weeks and at 7 weeks following starting the treatment.

Significant improvement of spasticity was noticed after 7 weeks follow-up (p=0.014). Significant improvement also noticed in ankle dorsiflexor motor power (p<0.001), ankle motor control (p=0.007).

Neuromuscular electrical stimulation along with traditional exercise programme is superior to exercise alone for early recovery of ankle motor control, plantar-flexor spasticity and ankle dorsiflexor motor strength.

Difficult ulcers have differing aetiologies calling for varying strategies. For long, physiatrists have been treating diabetic foot and decubitus ulcers with great success. The “vacuum assisted therapy” (VAC) technique is proven to alter the local milieu to facilitate wound healing. A known case of filariasis for last 14-15 years, presented with elephantiasis of left leg with a large ulcer. The financial status of the patient prevented usage of the commercial VAC machine and so “in-house” VAC technique innovations were used at a fractional cost. She was successfully treated using the VAC technique and spontaneous complete healing was achieved in 8 weeks and resulted in early rehabilitation. It was very cost-effective.