F-2-21-09
REDUCTION OF KNEE FIXED FLEXION CONTRACTURE IN A TRANS-TIBIAL AMPUTEE USING BOTULINUM TOXIN
Dr Scott A R Hannan, Dr Gregory T Bowring (St George Hospital, Sydney, Australia)
Fixed flexion contractures complicate the prosthetic programme, reducing mobility and efficiency of gait. In high tone patients the range of movement (ROM) of a joint can be improved using motor point block techniques or Botulinum Toxin. Our aim was to reduce an established fixed flexion contracture (FFC) of the knee, in a trans tibial amputee with normal tone.
The patient was a 71 year old man with a very short BKA and a fixed knee contracture of 44°, 6 months post-surgery. The hamstring muscles on the side of amputation were isolated using a stimulatory approach and collectively injected with 200 units of Botox-R. The patient's maximal knee extension both passive and active was measured serially using goniometry and plain lateral X-rays.
An increase range of movement (ROM) of 10｡?of the knee with the flexion contracture was noted at 4 weeks, with total increase of 15｡?to the present (8 months). This response is a minimum of 2-4 months past the pure physiological effect of the Botulinum Toxin.
Botulinum Toxin is useful in the reversal of recently acquired flexion contractures, which appear fixed. In our patient's case there was a marked reduction in the reports of pain, and he became an active, safe walker with a prosthesis.
F-2-22-01
RELATIONSHIPS BETWEEN LUMBAR DYNAMOMETRY PERFORMANCES AND PSYCHOLOGICAL FACTORS IN LOW BACK PAIN (LBP) PATIENTS.
D. Wever-2, M.M.R. Hutten-1, H.J. Hermens-1, M.G.B.G. Blokhorst-2, G. Zilvold-2
(1-Roessingh Research and Development, Enschede, The Netherlands; 2-Roessingh Rehabilitation Center, Enschede, The Netherlands)
The "definition" of deconditioning syndrome strongly suggests relationships between psychological aspects, pain experiences and low back muscle condition. The objective of this study was to investigate these possible relationships.
45 patients with chronic low back pain participated in this study. Low back muscle condition was assessed by means of lumbar dynamometry measurements using the Isostation B200. Torque, velocity and range of motion parameters were measured. Psychological complaints and pain experiences were assessed using the Symptom Checklist (SCL-90) and the Multidimensional Pain questionnaire (MPI-DV).
Results demonstrate significant relationships between somatisation, depression of the SCL-90, pain intensity of the MPI-DV and lumbar dynamometry performances. In general, patients with worse performance during lumbar dynamometry show more psychological complaints and they experience more pain. Patients with more inconsistencies during the test also show more somatic symptoms and they experience more pain than patients producing consistent tests. From this study, it can be concluded that lower lumbar dynamometry performances and increasing psychological complaints are acting together in the deconditioning syndrome.
