Groin pain in athletes is a common problem in sports medicine, accounting for 10% of all visits to sports medicine centers. Furthermore, groin injuries have been estimated to account for up to 6% of all athletic injuries, with the prevalence in sports such as football as high as 12-16%. However, despite the prevalence of this condition, its diagnosis and treatment remain a challenging problem for the sports medicine physician, and the injury is a frustrating one for the athlete. Chronic groin pain in particular can be difficult to diagnose, treat, and rehabilitate, and is responsible for a large proportion of time lost from sport and work for the athlete. A complicating component in the treatment of this condition is an extensive differential diagnosis and overlap in symptoms between possible diagnoses. Typically, groin pain develops in male and female athletes who participate in sports involving kicking, rapid accelerations and decelerations, and sudden changes of direction. The aim of this article is to briefly review the most common musculoskeletal conditions that cause groin pain in athletes and to discuss their diagnosis and management.

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Patients with conditions like tennis elbow are frequently referred to physiotherapy. Patients with this condition suffer from pain and tenderness over lateral epicondyle, which hampers their activities of daily living. Lateral epicondylitis (tennis elbow) is the most frequent type of myotendinosis and can be responsible for substantial pain and loss of function of the affected limb. Muscular biomechanics characteristics and equipment are important in preventing the conditions. This article presents on overview of the current knowledge on lateral epicondylitis and focuses on, conservative treatment and recent surgical techniques are outlined. This information should assist health care practitioners to manage symptoms, improve activity and reduce relapse who treat patients with this disorder.

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The purpose of this study was to evaluate the efficacy of resisted exercise in a patient with a painful straightened cervical lordosis. A 35-year-old male patient was referred by an orthopedist with a complaint of neck ache; he had difficulty in bending backward to see the roof and forward (chin poke) since one and half months. He experienced pain severity of 9 on a visual analog scale (VAS). Neck's active range of motions in all six directions were measured using a universal goniometer; flexion was 20΀, extension 10΀, left and right lateral flexion were 20΀ each side, and rotation was 35΀ each side. The patient was given mild resisted exercise in phoenix position twice a day for two alternative weeks along with initial short wave diathermy for one week for pain relief. At the end of the fifth week, pain was nearly normal on the numeric scale. Hence, an attempt was made to explore the efficacy of resisted exercise in straightened cervical lordosis to correct and prevent painful living and irreversible cervical lordotic deformity.

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Plyometric is a type exercise training to produce fast, powerful movements and improves performance in sports. It is used to increase speed or force of muscular contractions, providing explosiveness in sport-specific activities. Plyometric is a type of explosive exercise which is used in soccer, basketball, boxing, parkour, American football and rugby, gymnastics, volleyball, racket sports, martial arts, professional cycling, athletics (including track and field events). It contains the prerequisites consisting of the biomechanical examination, which is helpful in finding out stable base of support and normal force transmission, stability testing, which is divided into two parts-static stability and dynamic movement testing, and flexibility that start with general flexibility exercises. Plyometric program design contains the four variables-intensity, volume, frequency, recovery which are interlinked with each other in training the sportsperson in each session. Phases of plyometric are divided into three parts, which consist of the loading phase, the coupling phase and the unloading phase. And finally when specifying the soccer specific plyometric training the physiotherapist should keep in mind that the sportsperson being trained should go for warm-up producing mild sweating. Later approaching toward the specific types of jumps, including traffic cones of defined height and jumps excluding the cones. The jumps that are included within the programme would be double leg side jump, single-leg side jump, turning cone jump, squat jump, rocket jump, power skipping, lateral bound, knee tuck jump, multiple jumps with a sprint.

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Background: Hypertension is one of the leading causes of cardiovascular death and is primarily silent as there is hardly any symptom before target organ damage. Heredity and autonomic nervous system play pivotal roles in pathogenesis of essential hypertension. Aims: To detect early cardiovascular autonomic changes by heart rate variability (HRV) before overt hypertension, among the offspring having family history of essential hypertension. Materials and Methods: 34 normotensive offspring aged 19-24 years with parental history of essential hypertension were included as study group and the control group included 32 age, sex, and body mass index (BMI) matched normotensive offspring having normotensive parents. Resting pulse, blood pressure, and short-term supine HRV was recorded initially followed by standing HRV. Results: A statistically significant increase in resting diastolic blood pressure in study group indicated increased sympathetic tone. Postural stress in the study group revealed a greater increase (P < 0.0001) in low frequency (LF) spectrum and simultaneous greater decrease (P < 0.0001) in high frequency (HF) band as compared to control group (P < 0.05). These findings indicate greater dysfunction in both autonomic branches associated with alterations in baroreflex function in the study group. Conclusions: Current study provides an evidence of early impairments in autonomic cardiovascular regulation in young adults having hereditary history of hypertension. Early lifestyle modification with sports activity may help in improving autonomic functions and thus decrease morbidity and mortality due to cardiovascular diseases.

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Background: Surya namaskara (SN) training is a part of yoga; it consists of a sequence of postures done with breath regulation, relaxation and awareness of energy centers. The selective attention (SA) is a vital function mediated by the right frontal-parietal cortex. The cancellation tests require visual selectivity and a repetitive motor response. The six letter cancellation task (SLCT) is useful to assess functions such as SA, focused attention, visual scanning, and the activation and inhibition of rapid responses. Assessing SA in orphan boys (OB) is a part of the neuropsychological evaluation to know their academic performance (AP). Objective: To assess the effect of SN training on SA in OB using SLCT. Subjects and Methods: Sixty OB with 11.3 ΁ 2 years of mean age were divided randomly, using computerized random number table into two groups (n = 30 in SN training group and n = 30 in control group). The SLCT data were collected before (pre) and after (post) the SN training and control of 1 month duration. Results: The Shapiro-Wilk Test and Paired Samples Test using Statistical Package for the Social Sciences 16 (IBM Corporation, USA) showed that there was 50.75% increase (P < 0.001) in total attempted (TA) and 52.99% increase (P < 0.001) in net score (NS) after SN training, whereas there was decrease in TA and NS in control group. Furthermore, there was no significant change observed in the wrong cancellation scores in both SN training and control group. Thus, it was revealed that SN training can increase TA and NS, and decrease wrongly attempted scores that is associated with an increase in SA. Conclusion: The present study suggests that SN training may enhance SA among OB, thus, may prove useful for their AP. Additional well-designed studies are needed before a strong recommendation can be made on the efficacy of SN training for enhancing SA, and thereby improving AP.

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Background: Clavicle fractures are common injuries in active individuals, and it is becoming increasingly apparent that clavicular malunion is a distinct clinical entity with radiographic, orthopedic, neurologic, and cosmetic features. Aims: To analyze the outcome of managements of nonoperative and operative procedures in fracture clavicle in an urban population of eastern India. Materials and Methods: This prospective observational study of 30 cases with fracture of the clavicle was conducted in a tertiary care hospital of eastern India in a time span of 1 year after taking institutional ethical clearance and informed consent of the patients. Injuries were classified according to the AO classification scheme. Patients were treated either conservatively or operatively and followed-up at 6 weeks and 3, 6, and 12 months, then every 6 months. Results: The mean time for fracture healing was significantly shorter in the operative group (15.73 ± 0.70 weeks) than nonoperative group (27.47 ± 0.74 weeks). The difference is statistically highly significant (P < 0.000). Patients in the operative group were more satisfied with the appearance of the shoulder (P < 0.05*). There was no statistically significant difference between two groups with respect to flexion, extension, abduction, internal rotation and external rotation movements with P = 0.532, 1.00, 0.344, 0.052 and 0.056 respectively. Patients in the operative group had better range of Shoulder adduction movement than nonoperative group (P = 0.015). Conclusion: Operative fixation of the clavicle fracture results in improved functional outcome, shorter time for union compared with nonoperative treatment at 1 year of follow-up and primary operative intervention in clavicle fracture in active adults may be of immense importance.

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Lateral meniscus root (LMR) injuries associated with anterior cruciate ligament (ACL) tears are less frequent than medial meniscus root (MMR) injuries. Among the reported cases of lateral meniscus injuries associated with an ACL tear, those involving the posterior horn are most frequent, followed by LMR tear; however, LMR avulsion is a very rare condition, and its incidence is still unknown. Injuries that involve detachment of the meniscus root attachments profoundly affect the meniscal biomechanics and kinematics and can accelerate degenerative changes within the knee joint. Thus, it is imperative to accurately and concisely identify such lesions to guide treatment and surgical decision-making and help determine prognosis. We report a rare case of a male athlete with an LMR avulsion associated with an ACL tear; this condition was surgically treated with ACL reconstruction and in situ pull-out suture repair.

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Aims and Objective of the Study: To study the effectiveness of exercises using Swiss ball in lowering waist circumference, fasting blood sugar (FBS), post-prandial blood sugar (PPBS), and glycosylated Hemoglobin (HbA1c) among Type II diabetic patients. Scope of the Study: The outcome of this research study can be used for comprehensive diabetic management and preventive means by adopting at schools and colleges. Materials and Methods: Eighty Type II diabetic patients were divided in two groups. While both groups were treated with medication, group II were treated with set of exercises using Swiss ball. FBS, PPBS, HbA1c, and waist circumference were measured before and 12 weeks after the test, which was recorded and statistically analyzed. Results and Discussion: Reduction in waist circumference decreased with a probability level of 0.1%, reduction in fasting blood sugar at 5% level of probability, lowering of HbA1c at 0.1% of probability, and PPBS remained unaffected with P > 0.05. Conclusion: Hence, exercises using Swiss ball are effective in the management of diabetic patients and can be used as preventive means of diabetes among schools and colleges where Juvenile Diabetes, physical inactivity, life style changes, etc., predisposing to various medical ailments can better be utilized as part of physical education and fitness promotions.

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Background: Open reduction internal fixation (ORIF) of distal humerus fracture is the gold standard treatment but controversies exists regarding surgical approaches, type of implants, operative techniques, need for transposition of ulnar nerve, and type of rehabilitation after surgical treatment. Aims: To analyze the functional outcome of open reduction and internal fixation of distal humerus fracture using three different posterior approaches namely: olecranon osteotomy, Campbell's approach, Bryan Moorey approach. Materials and Methods: This prospective randomized observational study of 60 cases of intercondylar fracture of humerus was conducted in the Department of Orthopedic Surgery in a tertiary care hospital in West Bengal over a time span of two years after taking Institutional ethical clearance and informed consent of the patients. Out of 60 cases, olecranon osteotomy approach was used in 20 cases; Campbell's approach in 20 cases; and Bryan Moorey approach in 20 cases. Results: At final follow up, all patients were assessed by Mayo Elbow Performance Index (MEPI) scoring system. We found best results in patients operated by olecranon osteotomy approach (18 patients had excellent result) whereas only eight cases in Bryan Moore group and six cases in patients operated by Campbell's approach had excellent result. However, when statistically analyzed the mean results of three groups the results were statistically insignificant (P = 0.09). Conclusion: It can be concluded that among that three approaches being studied for intercondylar fracture humerus, the olecranon osteotomy approach provides adequate exposure to distal humerus facilitates accurate articular reduction even in complex type of fractures and early mobilization can be instituted, which is the crux for the final outcome.

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Introduction: Acromioclavicular (AC) joint reconstruction using a tendon graft with clavicular tunnels and with/without coracoid tunnels is a treatment of choice for injuries more severe than Grade III. We are reporting a modified technique of AC joint reconstruction using tendon graft and endobutton loop in nine patients at mean follow-up of 18 months. Materials and Methods: Nine patients with an average age of 36 years (25-55 years) underwent this procedure between October 2011 and June 2013 at this hospital for Grade III or more AC joint injury. In all the patients, the semitendinosus graft was used to recreate coracoclavicular and AC ligaments with the added fixation with fiberwire tied over an endobutton over the clavicle. Results : At the mean follow-up of 18 months the average American Shoulder and Elbow Surgeons score was 89.06 (Range 69.99-96.66) and constant score was 89.77 (Range 75-97). According to constant score four patients had excellent, four had good, and one had satisfactory post-operative function according to constant score. One patient had minimal (0.5 cm) loss of reduction and one had a superficial infection. Both this complication did not affect the final outcome. Conclusion: This technique is near anatomic with added advantage of protecting the repair with fiber wire suture and also reducing the risk of clavicular fracture with endobuttion placed on the superior surface of clavicle. It also avoids the risk of coracoid fracture.

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Background: Various cardio-respiratory parameters are markedly better in youths who undertake couple of hours of exercise. This better cardio-respiratory fitness is known to translate into a lower cardiac disease risk in future. Aims: To study the effects of physical exercise on cardiovascular profile in young undergraduate males in health sector. Materials and Methods: This pilot study was undertaken in a tertiary care hospital of eastern India after taking Institutional ethical clearance and informed consent of the subjects in a time span of 2 years. One hundred male subjects in the age group of 18-25 years with no regular exercise habit, were selected as study group and 100 males otherwise comparable anthropometrically with a physically active lifestyle were selected as control. Blood pressure, pulse rate, and spirometric parameters were measured. Then, the subjects were made to exercise with bicycle ergometer. After cessation of exercise, the previous parameters were again recorded. Data obtained was analyzed using SPSS software. Results: Pre- (71.16 ± 1.98 vs 77.76 ± 4.59) and post-exercise (114.52 ± 5.55 vs 120.05 ± 4.79) heart rate and systolic BP (119.8 ± 7.05 vs 125.3 ± 5.72 and 140.80 ± 7.60 vs 147.84 ± 6.07) were significantly less in control as compared to study group. Post-exercise FEV1% was significantly less in study group. Pre- (4.1 ± 0.56 vs 4.05 ± 0.54) and post-exercise values of FVC (3.94 ± 0.55 vs. 3.77 ± 0.47) was significantly less (P value: 0.037*) in study group as compared to controls. Conclusions: Early lifestyle modification by regular exercises may improve not only quality of life in general but patient care in particular in students of healthcare services.

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Low back pain (LBP) is a common occurrence among young athletes. Although most back pain is managed non-operatively, a careful assessment is required as some serious pathologies can masquerade as LBP. Both acute and chronic LBP occur in the athlete. Avulsion injuries to the posterior elements and apophysial ring fractures are top on the list of causes of acute LBP. Spondylolysis and spondylolisthesis are common diagnoses which are more frequently implicated as causes of chronic LBP. Extra-spinal causes of LBP should always be ruled out as delayed treatment may result in unacceptable outcomes.

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Background: Regular exercise in athletes is associated with cardiac acclimation in the form of functional and structural changes. Its effect on the cardiac functions still debated. Objective: The objective was to detect the impact of long-term regular physical exercise on the cardiac systolic and diastolic function of soccer players. Materials and Methods: Thirty professional soccer players were examined twice, the first examination was made during the passive resting period before the beginning of the season (measurement I) and the second during the peak of the season (measurement II). At both examinations, players underwent electrocardiogram (ECG), conventional Echo-Doppler, pulsed tissue Doppler imaging on both septal and lateral sides of the mitral annulus and lateral tricuspid annulus. The (propagation velocity [Vp]) values were measured. Paired t-test was used for comparison. Results: The following changes between measurement I and measurement II were found: ECG Changes; 80% of the entire group showed early repolarization, 93% had left ventricular hypertrophy (LVH) by voltage criteria, 20% showed right atrial abnormalities, 20% left atrial abnormalities, 40% showed inverted T-wave in leads V1-V4, 5% showed mobitz type I second degree heart block, and 5% showed incomplete right bundle branch block. Echo changes; The mitral E/E` ratio increased from 6.18 ± 1.27 to 6.91 ± 1.18; the Vp decreased from 56.3 ± 9.23 to 50.67 ± 8.6; the tricuspid valve Ratio between the early and late peak pulsed Doppler velocities on tricuspid valve decreased from 1.67 ± 0.23 to 1.54 ± 0.23 while the E`/A` ratio decreased from 1.67 ± 0.53 to 1.28 ± 0.49; the (isovolumetric relaxation time) of the right ventricle increased from 52.4 ± 11.33 to 58.17 ± 10.73; the (isovolumetric contraction time) decreased from 70.47 ± 9.9 to 65.2 ± 7.9. All changes were statistically significant at P < 0.001. Conclusions: Long-term regular exercise in soccer players is associated with cardiac alterations in the form of bradycardia, early repolarization, inverted T-wave, concentric LVH, and a tendency toward diastolic impairment of both ventricles.

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Background: Fibrous dysplasia is a benign bony lesion managed surgically with curettage, bone grafting, and, in some cases, internal fixation. Aims: Study result of cortical bone grafting with fibular strut graft in patient of symptomatic dysplastic lesion without varus deformity of proximal femur. Case Report: A 25-year-old female presented with pain in left hip for 3 months which increased in intensity during walking. Clinically there was no swelling or deformity and tenderness. Range of hip joint movement was normal. The patients had no endocrine disturbances. X-rays of left proximal femur showed radiolucent cystic area involving trochanter, neck, and 30% head at postero-inferior aspect. No pathological fracture was seen. Image showed homogeneous loss of the normal trabecular pattern, with a ground-glass appearance caused by fibrous dysplasia. Patient underwent dual autogenous non-vascularized fibular strut grafts. The dual fibular graft was used as a bridge in the dysplastic lesion in femoral neck and it was securely anchored to the head of femur as well as lateral femoral cortex. The fibular graft was providing excellent structural support without any need for any form of internal fixation. At routine follow-up at 8 months, patient was found ambulating at her own without any substantial pain at the hip joint. Conclusion: For carefully selected patients (symptomatic dysplastic lesion without varus deformity of proximal femur) cortical bone grafting with fibular strut graft is an excellent procedure which provide strong structural support to biomechanically weakened bone.

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We present an unusual case of chronic diffuse calcifying tendonitis involving the subscapularis tendon with a clinical presentation similar to frozen shoulder in a 58-year-old right hand dominant female. The patient was treated with arthroscopic removal of the calcific deposits. Patient had drastic improvement in the pain score postoperatively; range of movement was near normal with weakness in internal rotation. Now at one year follow up all the movements of shoulder are in good range and of same power as the opposite shoulder except for weak internal rotation.

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Background: Proprioception encompasses the senses of joint position and joint motion. With the use of proprioceptive information the human body can better maintain joint stability during static posture and produce coordinated and precise motions during mobile tasks. It is learnt that proprioceptive acuity decreases not only due to injury and degenerative diseases but also as a result of aging. Most of the previous studies have focused on recipients of joint replacements or those with ligament injuries. This study was conducted to check the effectiveness of elastic tubing exercises (ETEX) and step-up exercises (STEX) on knee proprioception in normal healthy subjects. Materials and Methods: 30 college-going healthy females between 20-30 years of age were randomly assigned to be trained with either STEX or elastic-tubing exercises (ETEX). Outcomes of the interest were captured at baseline and at the end of 6 weeks training. Results: There was significant difference in both groups. However, ETEX are better than STEX at 20^°; and STEX are better than ETEX at 30^°. Conclusion: Both exercises are effective in improving knee joint proprioception in young and physically active females. These are simple exercises which can be carried out as a part of home protocol and require minimum supervision. It will be interesting to see if the same results can be replicated in all age-groups, especially the elderly. Regular training in elders can reduce likelihood fall and hence improve the overall quality of life.

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The purpose of this study was to evaluate the efficacy of resisted exercise in a patient with pain and instability of bicipital tendon. A 45-year-old male patient was referred by an orthopedist, with a complaint of anterior shoulder pain and apprehension of mechanical symptoms such as a "clunk" when rotating the arm inward or outward since three-and-half months. He experienced pain severity of 7 on a visual analog scale (VAS). Many provocative tests such as Yergason, Neer and Speed were positive. The patient was given resisted exercise to biceps muscle twice a day for six weeks along with initial ultrasound therapy for pain relief. At the end of the sixth week, pain was normal on the numeric scale, and all provocative tests were also normal without apprehension of instability in forward shoulder movement during daily activities. Hence, an attempt was made to explore the efficacy of resisted exercise in a case of bicipital tendon instability.

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Background: Pulmonary involvement in rheumatoid arthritis (RA) is frequent although not always clinically recognized. Objectives: The present study was conducted to measure the alterations of lung function parameters with the help of pulmonary function tests in patients of RA in a semi-urban population of a developing country. Materials and Methods: This pilot study was conducted in a time span of 1 year on 156 subjects in Burdwan Medical College after taking Institutional Ethical Clearance and informed consent of the subjects. A total of 106 diagnosed cases of RA was taken as cases, and 50 normal individuals were selected as a control. Different parameters studied were forced vital capacity (FVC), FVC%, forced expiratory volume in 1 s (FEV1), FEV1%, FEV1/FVC, forced expiratory flow (FEF25-75), FEF25-75%, peak expiratory flow rate (PEFR), PEFR%. Results: FVC, FEV1, FEV1/FVC, FEF25-75, PEFR, and PEFR% were significantly decreased (P < 0.05) in cases. But there was no significant difference in FVC%, FEV1%, and FEF25-75%. Among RA patients, 56.6% were normal, 15.09% had obstructive lung diseases (OLD), and 28.3% had restrictive lung diseases (RLDs). Conclusions: RA was found to be of significant importance in the development of restrictive, as well as OLD. RLD was significantly higher in patients positive for rheumatoid factor and anticyclic citrullinated peptides antibody. Since RA, affects general population with a prevalence of 0.5-1% and lung function gets affected in 30-40% of cases, the patients might be screened for respiratory abnormalities from the time of diagnosis using spirometry.

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Background: Shoulder joint instability results in great disability and it is possible to get good results of treatment in selected patients in whom intraarticular pathologies are diagnosed and treated appropriately. Aims: To investigate the pathology of unstable shoulder joint and study the effect of arthroscopic stabilization for the management of traumatic anterior glenohumeral instability and success rate of all arthroscopic Bankart repair. Materials and Methods: This prospective study was conducted in a tertiary care hospital of West Bengal in a time span of 1 year, after getting the approval of the Institutional Ethical Committee and informed consent of the patients. Patients aged between 20 and 40 years with post-traumatic recurrent anterior dislocation of the shoulder were included. Patients were operated arthroscopically and followed up. Results were analyzed per the assessment criteria of Rowe scale. Results: Ten percent had fair and 90% had poor Rowe score during preoperative period. Bankart lesion was present in 16 patients out of 20 patients in whom we performed arthroscopic Bankart repair with suture anchors. At last follow up, 13 patients were able to work above shoulder level normally; two patients had mild limitation of work. One patient had moderate type of restriction of activities. This patient had a history of trauma 3 months after operation. Conclusions: Overall 93.75% patients had excellent to good result in the present study. Based on this short series and minimum follow-up we recommended, this method of management for shoulder instability due to Bankart lesion.

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The purpose of this study was to evaluate the efficacy of resisted exercises on quality of life (QOL) in knee osteoarthritis (OA) patient using disease-specific Urdu version of the knee injury and osteoarthritis outcome score (KOOS) questionnaire. A 60-year-old male patient with bilateral grade-2 primary knee OA was referred by an Orthopedist, with a complaint of bilateral knee pain with poor QOL. He experienced pain severity as seven on visual analog scale, difficulty climbing stairs and on observation patient had left and right swaying, while walking. Pain and QOL were assessed using self-rated questionnaire such as KOOS. On functional assessment prior to the intervention using KOOS questionnaire, the pain subscale was 27% means severe pain and QOL subscale was 13% means poor QOL. The patient was given bilateral resisted exercises using quadriceps table twice daily for 4 weeks along with initial short wave diathermy for pain relief. At the end of 6 ^th week pain was nearly normal 2 on the numeric scale and KOOS subscales pain and QOL were 84%, 82.25% indicating substantial pain relief and good QOL along with improved gait. It is concluded that bilateral resisted exercises for both hamstring and quadriceps can be used as a prime intervention for relief of pain and improved QOL and to prevent knee flexion deformity.

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