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Sinha S.,St Georges Vascular Institute | Houghton J.,Defence Medical Rehabilitation Center | Holt P.J.,St Georges Vascular Institute | Thompson M.M.,St Georges Vascular Institute | And 2 more authors.
Journal of Vascular Surgery | Year: 2012

Popliteal entrapment syndrome (PES) is a rare but important cause of intermittent claudication in young people. Controversy exists about optimal strategies for diagnosis and management, particularly for variants such as functional popliteal entrapment. The aim of this review was to systematically catalog the published English-language literature on PES and to determine if evidence-based guidelines for management could be formulated. An electronic search using the MEDLINE, EMBASE, Cochrane Library, AMED, and CINAHL databases was performed to identify articles about PES published from 1947 to December 2010. The systematic review conformed to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement standards. Prospective studies and retrospective case series with more than five patients with arterial, venous, nerve, and combined neurovascular entrapment were analyzed on a study-by-study narrative basis. The search identified 291 articles, and 44 were included. Of these, 30 studies were on popliteal artery entrapment syndrome (PAES). No relationship was found between duration of symptoms and the presence of irreversible arterial injury. Each study used a median of three diagnostic tests (range, 1-6). Arteriography was used in 28 of 30 studies to diagnose PAES, with an estimated mean sensitivity of 97% (range, 85%-100%). Twenty-three studies described arterial reconstructive procedures, with a median failure rate of 27.5% (range, 0%-83%). The proportion of patients asymptomatic after surgery was reported in only 12 of 30 studies, with a median value of 77% (range, 70%-100%). A large volume of predominantly retrospective clinical data exists on PES. A subset of studies describe a significant failure rate after surgery, but study quality is insufficient to derive robust conclusions allowing recommendation of any one particular diagnostic modality or operative procedure over another. Improvements in management of this condition are unlikely to result from publication of further retrospective case series, and clinicians should concentrate on prospectively collected data with predefined inclusion criteria, outcome measures, follow-up protocols, and transparent standardized reporting criteria. © 2012 Society for Vascular Surgery.

House C.,Institute of Naval Medicine | Reece M.A.,Defence Medical Rehabilitation Center | De Sa D.R.,Institute of Naval Medicine
Military Medicine | Year: 2013

This study was undertaken to determine whether the incidence of lower limb overuse injuries (LLOIs) sustained during Royal Marine training could be reduced by issuing the recruits with shock-absorbing insoles (SAIs) to wear in their military boots. This was a retrospective longitudinal trial conducted in two phases. Injury data from 1, 416 recruits issued with standard Saran insoles and 1, 338 recruits issued with SAI were compared. The recruits in the two groups were of similar height, body mass, and aerobic fitness and followed the same training course. The incidence of LLOI sustained by the recruits was lower (p < 0.05) in the SAI Group (19.0%) compared to the Saran Insole Group (31.7%). The incidences of lower limb stress fractures, tibial periostitis, tenosynovitis of foot, achilles tendonopathy, other tendonopathy and anterior knee pain were lower (p < 0.05) in the SAI Group. Tibial stress fracture incidence was lower (p < 0.05) in the SAI Group but metatarsal and femoral stress fracture incidences were the same for the two insole groups. Thus, issuing SAIs to military recruits undertaking a sustained, arduous physical training program with a high incidence of LLOI would provide a beneficial reduction in the incidence of LLOI.

Camp S.J.,Peripheral Nerve Injury Unit | Birch R.,Peripheral Nerve Injury Unit | Birch R.,Defence Medical Rehabilitation Center
Journal of Bone and Joint Surgery - Series B | Year: 2011

The integrity of the spinal accessory nerve is fundamental to thoracoscapular function and essential for scapulohumeral rhythm. This nerve is vulnerable along its superficial course. This study assessed the delay in diagnosis and referral for management of damage to this nerve, clarified its anatomical course and function, and documented the results of repair. From examination of our records, 111 patients with lesions of the spinal accessory nerve were treated between 1984 and 2007. In 89 patients (80.2%) the damage was iatropathic. Recognition and referral were seldom made by the surgeon responsible for the injury, leading to a marked delay in instituting treatment. Most referrals were made for painful loss of shoulder function. The clinical diagnosis is straightforward. There is a characteristic downward and lateral displacement of the scapula, with narrowing of the inferior scapulohumeral angle and loss of function, with pain commonly present. In all, 80 nerves were explored and 65 were repaired. The course of the spinal accessory nerve in relation to the sternocleidomastoid muscle was constant, with branches from the cervical plexus rarely conveying motor fibres. Damage to the nerve was predominantly posterior to this muscle. Despite the delay, the results of repair were surprising, with early relief of pain, implying a neuropathic source, which preceded generally good recovery of muscle function. ©2011 British Editorial Society of Bone and Joint Surgery.

Bond S.J.,Defence Medical Rehabilitation Center | Soundy A.,University of Birmingham
Journal of the Royal Army Medical Corps | Year: 2012

Background: There is a high prevalence of Lower Back Pain (LBP) within military populations. Physiotherapeutic management has a primary role for patient care, but there is a need to establish the most effective management. Civilian physiotherapists provide the majority of clinical provision throughout the Defence Medical Rehabilitation Programme for British Armed Forces personnel. To date no study has been carried out looking at their perceptions and beliefs with regards to management of non-specific LBP and the potential impact this had on the delivery of rehabilitation across Defence. Methods: This mixed methods exploratory study aimed to explore the potential complexities surrounding the decision making process with regards to management of non-specific LBP using semi-structured interviews with 14 MOD civilian physiotherapists. All interviews were transcribed verbatim. The transcribed data was then subjected to a categorical content analysis. Results: The analysis of the interview data revealed four interrelated themes that influence civilian physiotherapists in their management of back pain in military personnel: the military environment, integration of military procedures, physiotherapist treatment approach and communication. Discussion: This paper highlights the value civilian physiotherapists place on experience when managing non-specific LBP. This experience however was gained through 'patient mileage' rather than integration of best evidence into practice. Several problems were identified in patient management including specific types of patients and their expectations and the importance of the right communication between Health Care Professionals, but also with patients.

Kristensen J.,Defence Medical Rehabilitation Center
Journal of the Royal Army Medical Corps | Year: 2013

Introduction Exercise-based rehabilitation programmes have formed the cornerstone of the treatment currently delivered at the Defence Medical Rehabilitation Centre (DMRC) based at Headley Court.Increased operational activity in recent years has meant a concomitant increase in the pressure on Defence rehabilitation resources and a greater need for effective rehabilitation strategies. The aim of this research was to assess the effects of exercisebased rehabilitation on energy expenditure and body composition. Methods A group of nine male volunteers (30±2.4 years) serving with the Armed Forces and suffering from a variety of musculoskeletal lower limb injuries underwent 17 days of exercise-based rehabilitation. Total daily energy expenditure (TEE) was assessed using a portable combined heart rate monitor/accelerometer (Actiheart).Changes in body composition were assessed using dual energy x-ray absorptiometry (DEXA). Results MeanTEE over the entire admission period was 2915±53 kcal/day with no significant difference in TEE observed between training week 1 (W1) and 2 (W2). However, a strong trend towards increased TEE in W1 was observed (p=0.06). No significant change was observed in fat mass (FM), lean body mass (LBM) or body-fat percentage despite the exercise-based rehabilitation programme. Conclusions These results suggest that 17 days of exercise- based rehabilitation is insufficient to observe significant changes in body composition, despite high energy expenditure.

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