Research

Global Journal For Research Analysis (GJRA) volume - 10, issue - 06, june- 2021 • print issn no. 2277 - 8160 • doi :10.36106/gjra

Background: Back pain with or without lumbosacral radicular pain is the most common pain condition.
seen by doctors. Aim: To evaluate results of multidisciplinary treatment for low back pain and lumbosacral radicular pain. Material and Methods: This prospective follow study was carried out at private in Pune city of India. Follow up of the patients, who underwent multidisciplinary treatment for low back pain and lumbosacral radicular pain done for over the period after obtaining written informed consent of the patients. Patients underwent Transforaminal epidural injection with Fluoroscopy guidance at level of disc herniation causing nerve compression followed by 12 days' rest. After 12 days, patient underwent multidisciplinary therapy as per protocol which included, physiotherapy, ergonomics, nutritional guidance, psychological counselling and complementary therapy. Statistical analysis: Data was analysed by using statistical software Primer of Biostatistics. Measurements were expressed as means and standard deviations for continuous variables and percentages for categorical variables and was analysed. Pre- and postoperative interventional values were compared using the one way Analysis of Variance (ANOVA) test. A p value less than 0.001 was considered statistically significant. Results: Total 520 patients were included in the study. Mean follow up of the patient was 4.7 years (SD=3.6 years). Total female patients were 288 (55.38%) and male patients were 232 (44.62%). Straight leg raise (SLR) for right and left leg was significant for all patients (p<0.001). The improvement in neurodeficit for L3L4 (right and left leg) was significant among those having neurodeficit (p<0.001). Neurodeficit involving L4L5 had statistically significant improvement (p<0.001). Patients with neurodeficit involving L5S1 also showed statistically significant improvement (p<0.001). Patients with neurodeficit affecting S1S2 showed statistically significant improvement (p<0.001). Patients had significant improvement in pain scores (Numerical rating scale) (p<0.001). Lumbar spine movements, namely, Flexion, Extension, Lateral rotation improved significantly post treatment. Oswestry Disability Index (ODI) scores improved after treatment (p<0.001). Conclusion: Innovative multidisciplinary approach was found to be effective in for low back pain and lumbosacral radicular pain.

Shete, K.M., Pandve, H.T. and Joshi, T., 2017. Adductor magnus tear a rare cause of sciatica: a case report. EC Orthop, 7, pp.197-201.

Adductor magnus is the largest muscle in the groin and is one of the two long adductors of the hip joint. Working to adduct, flex and medially rotate the hip joint, it is a rear phenomenon for it to be torn independently, without any trauma. The main symptom of adductor strain is a sharp pain in the groin which might radiate in the inner thigh. The rarity in our case was that the patient presented with left sided low back and hip pain radiating posteriorly throughout the left lower limb, which aggravated on prolonged sitting. Herniated disc being the commonest cause of sciatica, and patient’s symptoms paralleling sciatica, the patient was clinically diagnosed as discogenic sciatica. However, with a normal Lumbo-sacral X-Ray and MRI, some other factors causing sciatica should be thought off, which often delays the diagnosis and treatment.

Shete KM, Suryawanshi P, Gandhi N. Management of low back pain in computer users: A multidisciplinary approach. J Craniovertebr Junction Spine. 2012 Jan;3(1):7-10. doi: 10.4103/0974-8237.110117. PMID: 23741122; PMCID: PMC3669474.

Background: Low back pain is a very common phenomenon in computer users. More than 80% people using computers for more than 4 h complain of back pain. Objective: To compare the effectiveness of multidisciplinary treatment approach and conventional treatment approach amongst computer users. Materials and Methods: A prospective interventional study was carried out at a private spine clinic amongst the computer users with the complaint of low back pain. The study participants were randomly distributed in two groups. The first group comprised the study participants treated by conventional approach and the second group was treated by multidisciplinary approach. Primary outcomes analysed were pain intensity, sick leave availed, and quality of life. Statistical analysis was done using proportions, unpaired “t” test, and Wilcoxon signed-rank test. Results: Totally 44 study participants were randomly assigned to groups I and II, and each group had 22 study participants. Intensity of pain was reduced significantly in the group treated by multidisciplinary approach (t = 5.718; P = 0.0001). Similarly, only 4 (19.19%) of the study participants of the group treated by multidisciplinary approach availed sick leave due to low back pain, while 14 (63.63%) study participants availed sick leave in the other group (P = 0.02). The quality of life amongst the study participants treated by multidisciplinary approach was significantly improved compared to the group treated by conventional approach (t = 7.037; P = 0.0001). Conclusion and Recommendation: The multidisciplinary treatment approach was better than the conventional treatment approach in low back pain cases when some factors like pain and quality of life were assessed. The multidisciplinary approach for treatment of low back pain should be promoted over conventional approach. Larger studies are required to confirm the findings in different settings.

Shete, Kiran. (2018). Is Medial Arch Support Effective in Reducing Foot Pain, Heel Pain, Low Back Pain and Pressure Symptom in Knee Joint? Ergonomics International Journal. 2. 10.23880/EOIJ-16000151.

Introduction: Many individuals experience pain in foot, heel, low back as well as pressure symptoms in knee joint due to fallen arch. Objective: To determine effectiveness of medial arch support on footwear to reduce pain in foot & heel and pressure in knee joint. Material & Methods: The randomly selected patients who were reported either with foot pain, heel pain, and low back pain or with pressure symptoms along with fallen arch, which was based on the foot evaluation irrespective of gender, were included in the study. Medial arch support on footwear was provided and follow up was taken after one month and then after six months by using Foot and Ankle Ability Measure of Activities of Daily Living Sub-scale. Statistical analysis: Mean, standard deviation was used for descriptive data. Repeated measure ANOVA was used as test of significance. Results: Total 30 patients were included in the study out of which 16 (53.33%) were males and 14 were females (46.67%). There was statistically significant improvement in the reduction of foot pain, heel pain, low back pain and pressure symptoms in knee joint on follow up measurements taken on repeated occasions that before intervention, one months after the intervention and six months after the intervention (F=60.862; p= 0.0001). Conclusion: This study concluded that use of medial arch support is effective in reducing foot pain, heel pain, low back pain and pressure symptoms knee joint.

Shete, Kiran & Pandve, Harshal & Puntambekar, Tanmayee. (2015). Role of Ergonomics in Kitchen Related Back Problems. Journal of Ergonomics. 5. 1000e141.

The kitchen is an important area in the home serving many purposes, both functional and social. The kitchen environment needs to be both usable as well as comfortable [1]. The favorite place of all women in their house is kitchen. Kitchens are the highest function room. Indian women spend about 5-6 hours a day in kitchen which may amount to approximately one fourth of her life span and this also is a reason for (causes) various health problems. One of the most important health problem women working in kitchen is pain observed maximally at upper and lower back region. Posture and mode of work had a great effect on the development of musculoskeletal disorders among women engaged in different kitchen activities [2]. In the kitchen the need to have everything on hand and to move freely and tirelessly is often the goal which is not achieved satisfactorily by women. Repetitive movements like chopping and dicing vegetables, awkward positions like holding the head downward to cook food or bending while arranging utensils, overreaching like reaching for supplies on platform or reaching for higher cabinet's, lifting like moving pots and pans are the most commonly done while working in kitchen. Postures and its maintenance play a major role in reducing muscles stress. Ergonomics takes into account the user's capabilities and finds methods that make tasks easier utilizing equipment and the surrounding environment. Ergonomics principles are not frequently considered in preparation kitchens especially in developing countries like India. Study conducted by Spinalogy Clinic in Kitchen Ergonomics and Back pain and found that simple changes in kitchen ergonomics have far lasting and very good effects on spine and joint pain of women. Total 104 patients participated in the study. The Oswestry Disability Index (ODI) was taken before the treatment and then , after 1 week, after 1 month, 6 months and 1 yr of the session. The questioner has been designed to give information as to how the low back pain and the upper back pain have affected the ability to manage the daily routine activities. Changes like taking foot stool while standing, arranging cabinets and postural modifications were done. A common goal of these changes was to reduce the unnecessary loading of muscles, improve the posture, and reduce the fatigue level. Excessive stress on the body can lead to disability resulting in pain in daily routine activities. The decrease in the disability index of 104 patients over a period of 1 year is from an average of 35% (before session) to 2% (after 1 year). The study concluded that, these changes reduce the low back pain, upper back pain, discomfort and even they increase the functional abilities.(did not understand this sentence) Ergonomic solutions can help in reducing some of the fatigue level of women while optimizing their sense of overall well-being. Maximum work in the kitchen is done in standing; due to this women always feel fatigue after kitchen work especially in the morning time [3]. To conclude with use of certain ergonomics principles as well as proper interior of the kitchen plays an important role in reducing back related problems.

Goyal, Satish & Sancheti, KH & Shete, Kiran. (2006). Poly Trauma in Rural India-Changing Trends. Indian Journal of Orthopaedics. 40. 10.4103/0019-5413.34508.

Poly trauma is a major killer. Team work is essential for better management. Method : Survey was undertaken to collect baseline data in polytrauma patient. Result : Two thousand patients were studied. Cause was fall in 904, vehicular accident in 776 and assault in 320 patients. Conclusion : There should be good prehospital emergency service and quick transport to equipped hospital.

Shete, Kiran & Sancheti, Parag & Kamdar, Rutuj. (2006). The role of Esmarch bandage and percutaneous cannulated cancellous screws in tibial condylar fracture. Indian Journal of Orthopaedics. 40. 10.4103/0019-5413.34486.

Proximal tibial fractures involving the condyles are often a matter of debate with regards to surgical management. The purpose of this study was to evaluate the efficacy of using closed reduction with an eschmarch bandage, gentle hammering, and use of percutaneous cannulated cancellous screws for fixation and buttressing the fracture, as a treatment modality for specific tibial condyle fractures. Methods : We evaluated 90 closed upper end tibia fractures, Schatzker types I, III, and IV, treated with closed reduction using an esmarch bandage and minimally invasive percutaneus fixation with cannulated cancellous screws. Results : We achieved excellent results in 33.3% of the cases, good result in 50%, a fair result in 13.3 %, and a poor result in 3.3 % cases. Conclusion : This minimally invasive modality of treatment of upper end tibia fractures gives satisfactory results. The use of esmarch bandage and gentle hammering to help achieve acceptable reduction has the advantage of being relatively simple and easily reproducible, without the use of any expensive extra medical equipment. The percutaneous fixation with cancellous screws has minimal morbidity. Thus, this is a good modality of treatment of tibial condlyle fractures of Schatzker types I, III and IV.