Maigne’s Syndrome. Lumbo-Pelvic Pain Part 1. William E. Morgan. It is natural to associate the site of pain as the source of pain. If the pain is over the sacroiliac. PDF | Thoracolumbar junction syndrome is defined as a result of a minor intervertebral dysfunction at the thoracolumbar junction and referred pain in the low. PDF | Thoracolumbar junction syndrome is characterized by referred pain which may originate at the thoracolumbar junction, which extends.
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Patients diagnosed as thoracolumbar junction syndrome were divided into 3 treatment groups and the results of each modality were compared. The first maige received exercise therapy, the second group was treated with local steroid injections and the third group was the combination therapy group kaigne both injection and exercise.
Each group had 10 patients. The average age of the groups was detected to be While the average difference of the VAS values was 2. The results shown on the Oswestry scale of the first month difference Ssyndrome a result of this study, while in all three treatment groups in the Oswestry scale, VAS scores at rest or at movement during the regular controls before and after the treatment showed statistically significant difference; the best results were obtained in the group administered to the combined injection and exercise therapy.
TLS clinical findings showed that the affected movement segment includes sensitivity with palpation at the T12 and L3 point with the pain radiating throughout segmental nerve distribution originated by the thoracolumbar dorsal or ventral ramie sections.
The pain radiation and clinical results show that the distribution of the spinal nerve root T12 and L1; while the posterior branch of L1 innervates the lower lumbar subcutaneous sybdrome, the anterior branch innervates the groin region, and the lateral cutaneous branch innervates the lateral hip side [ 2 ] Fig. Maigne [ 3 ] characterized thoracolumbar junction syndrome by specific syndromme findings. The clinical diagnosis may be reaffirmed in one or more thoracolumbar region between TL3 vertebrae by the tenderness on palpation test; comparing the sensitivity difference on the iliac crest cluneal nervethe inguinal canal inguinal nerve or the greater trochanter lateral perforator nerve and by rolling and tightening the skin on the normal side.
Skin rolling test or German origin Kiblerfalte test procedure is: The patient lies prone with arms relaxed alongside the trunk. The examiner compares both sides and states where the skin is rolled more heavily [ 4 ]. The clinical findings show that the back pain is the most common complain.
Due to interference between the back pain and the waist pathologies, the hip pain and the hip pathologies, maine pubic pain and the hip adductor pathology, the TLS may be overlooked. Besides, since the lower abdomen synrdome affected while causing a pseudo visceral pain, the pain could be imitated with induced ayndrome causing gynecological, gastroenterological and urological pains.
A definitive diagnosis may be provided by the local anesthetic injection in the thoracolumbar region with cessation of the current pain after injection. The strength and stability should be improved jaigne muscle balance and stabilization exercises.
Posterior ramus syndrome
We aimed in our study to search the effectiveness of the exercise, and local steroid injection treatment as a TLS treatment modality [ maigns ]. The thoracic facet joint irritation is a common cause of pain at the lower lumbar and lumbosacral region [ 6 ]. The 12 th thoracic vertebra being a transition segment is located between the maihne facets at the sagittal plane with the thoracic facet in the coronal plane.
The 12 th thoracic vertebra continues to be the focus of the transitional stress during the spinal movements. This syndromd results as traumatic lesions at the T9-L2 facet joints and may cause unilateral radiating pain in the lower lumbar and upper gluteal region [ 7 ]. While standing on the floor of the lower extremities, the professional activities in the form of rotating the spine that can lead to repetitive loading of the spine such as hairdressing conglutinating etc.
Also, it has been reported that bending the head forward and back with hip flexion during sports activities of the thoracolumbar spine will be beneficial [ 8 synndrome. When the thoracolumbar region is overloaded, the adjacent lamina can be affected by the inferior articular process and as a result, the contralateral posterior joint capsule will be stretched and pain can occur [ 9 ]. The pain dissemination and clinical results are related to the T12 and L1 anatomical distribution of the spinal nerve root; while the posterior branch of the upper gluteal innervates lower lumbar subcutaneous tissues; it innervates the anterior region of the lower abdomen and the crotch maigme, and the lateral cutaneous innervates the outer side of the hip [ 2 ].
The musculoskeletal entities to consider for the cause of back pain include: It is important in patients subjected to significant trauma to rule out vertebral fracture [ 10 ] i. In the differential diagnosis, musculoskeletal diseases need to be paid attention which cause the back pain and are as follows: It is important to examine patients who may have been exposed to a major trauma in order to control this vertebral fracture [ 11 ] i. Patients found in the clinical application complain about the deteriorating hip pain and back synddrome from time to time while walking.
In such case, the diagnosis of the disease together with the difficulties, definition of the pain originated from the thoracolumbar region is possible in 5 steps.
On the other hand, spinous process of L4 is palpated and followed lateral till the crest is marked [ 13 ]. The specific findings of thoracolumbar region are the pain pathways radiating to upper gluteal, lower lumbar or inguinal region. Facet joint palpation is not an easy technique, because they are located cm below the skin.
For example, L4-L5 facet joint is located by first palpating L4 spinous process and following cm laterally on right and left side. The manual therapy applications, and the exercises and injection applications are most often preferred treatment methods during the treatment of disease. The corticosteroid injection in the treatment which has widespread use shows positive effects of early and late periods at the Facet joint pathology. The edema, the fibrin formation, the capillary dilatation and the leukocyte aggregation and phagocytosis occur from the effects of the Corticosteroids early inflammation; on the other hand, preventing the late effects collagen formation and scatrisation by capillaries and fibroblast proliferation plays an important role in controlling the inflammation.
The intermediate materials involved within the C fibers and nociception can be suppressed by corticosteroid injection while being effective in controlling the inflammation.
Thoracolumbar Junction Syndrome | Bone and Spine
Due to this aspect, the suppression of the corticosteroids for acute and chronic pain in the suppression of pain offers a segmental and clear solution while being an important tool [ 11 ].
The 4 steps functional restoration program for the TLS commonly seen in athletes can be defined as follows. The patient cannot pass to the next step without completing the previous step of doing the exercise smoothly, securely and distinctly considering the pain VAS from 0 to10 and 5 and above identifies considerable pain.
The manner in which the exercise is done is as follows: The most important thing is that the exercises should be done in the morning and, if possible, after waking up before getting out of bed.
However, the exercises are not suitable for all the patients, especially those of neurodegenerative diseases originated from coordination disorders depending on the extent of making counter-indications for coordination disorder. After that, the hip lifting exercises are given to patients. The patients who applied for the Physical Medicine and Rehabilitation clinic and who had complains regarding their mxigne, hips, flanks or in ayndrome groins, differential diagnoses were examined on them which resulted in low back pain and lumbar spinal magnetic resonance visualization.
Positive injection response to local anesthestics and exclusion of other lumbar diseases with MRI were the key point of the patient selection. The reasons for exclusion are mentioned in the next paragraph. According to the stories of the 6 month short-term patients complaining about the pain in the waist, hips and groin or the outer side region and according to maugne lumbar MRI results, the patients who were normal or having flattening in the lumbar lordosis only were excluded.
The patients who had precisely TLS diagnosed and whose ages ranged between years were examined by a local anesthetic injection and were provided with the thoracolumbar junction, being included in the study. Also, 2 of the 4 patients who still had unresolved complaints in the local anesthetic injection induced in the thoracolumbar region had chronic disease and 1 of the patients was excluded since he did not follow the exercise program.
The treatment given to the first group of patients of the 3 group patients was just exercise therapies. Only local steroid treatment was applied to the patients in the second group from the thoracolumbar junction region and exercise therapy was not provided. The third group patients were provided by the local steroid treatment and exercise therapy.
Thoracolumbar Junction Syndrome
At the beginning of the study, 37 patients were evaluated and 30 patients were suitable for the study. They were randomly allocated to the three groups and each group consisted of 10 patients Fig. The recommended exercises for patients include: Since the facet joint injection was applied to the patients during our study, the local steroid injection was induced to the patients receiving the injection therapy in the thoracolumbar junction region; shndrome the manual therapy applications have not been applied.
Besides exercise therapy, no manual therapy methods were used. The patients in the exercise group therapy conducted the exercises during their control visits and they were followed carefully regarding the exercises they could not do. The syndrom who were given the exercise programs were followed up regarding their frequency and regularity of doing the exercises. The lumbar range of motion ROMthe visual analogue scale at rest and during movement VAS values, the Beck Depression Scale, Oswestry scales and the SF results values of the patients were evaluated before and after injection, during the 1 st week, the 1 st month and 3 rd month control visits.
The highest values are used in the descriptive syndrlme of the data average, standard deviation and the lowest median. The distribution of the variable is measured by the Kolmogorov-Smirnov test. The most common levels TT12, TL1 which are usually considered as unilateral and sometimes as bilateral can be defined as the TLS involvement showing that according to the Maigne minor vertebral disorders, and according to chiropractic subluxation and osteopathy, they are somatic [ 12 ].
But if the TLS is a matter to be discussed by all the related methods, then the three perspectives would not be adequate for defining the disease. Although the examination syndrpme a certain area of the affected muscle is helpful in understanding it in a better way, and even though the compliance of the joint surfaces is corrupt, but there is not a disorder that can be defined in subluxation degree. Finally, although the somatic dysfunction could be seen within the context in which Chapmann was described but the disease is not just that.
The Corticosteroid injections common usage is one of the methods for controlling inflammation and pain at the early and late periods. Despite that, it is seen that it is not an adequate treatment alone according to the decrease in the long-term success of corticosteroid and considering their side effects.
This maignne because of the loss of spinal stabilization due to the muscular insufficiency which is considered as the main problem and due to other mechanical causes regarding the mechanical back and synrdome back pain. The application results of corticosteroid injection are summed up as the pain and inflammation reduction which enhances the effectiveness of exercise through strengthening of the muscles and the thoracolumbar region, so they have been considered as satisfactory treatment effects for corticosteroids [ 15 ].
In our study, the exercises given to the patients can primarily affect the facet joints found in the upper lumbar region with the multifidus, the quadratus lumbar, and the pelvic floor muscles. By judging from a much wider angle, the deterioration of sexual function in young adults regarding the weakness of these muscles up to the urinary incontinence development occurring in much older individuals has shown that the patients had various negative effects in the patients applying to the mentioned muscle clinics synddrome complaints of back pain.
On the other hand, these exercises provide the advantage of doing other exercises at the same time in order to face the growing differences in muscle length, the elimination of muscle strength imbalance maiyne the development of proprioception. There are some programs which require some exercise positions in some functional rehabilitation tools, which enable to prevent all kind of loss sjndrome balance during the exercises.
Therefore, applying the functional rehabilitation equipment hosted by the Software-based systems or maiigne mechanical systems hosted by the balance board assembly on these patients may lead to worsening of the symptoms. As a result of bone diseases such as the osteogenesis imperfecta and osteoporosis which have been reported in the literature, the developing T11 has been taken into consideration in cases such as the thoracolumbar junction syndrome due to the compression fractures.
Regarding the risk of the manipulative treatment applications in the developing thoracolumbar junction syndrome related to the compression fractures, it has been reported that the manipulative therapy did not show adequate effect when used by itself in the healthy mwigne [ 10 ].
On the other hand, the presence of muscular dystrophy results, the possible muscular weakness results and the syndrpme junction problems may occur again depending on the same disease and the changes in bone density.
It can be seen that the muscular dystrophy should be taken into consideration before the manipulation or exercise therapies in the treatment. A small number of case reports have been shown that it is successful in relation to the corticosteroid injection practices in the thoracolumbar junction syndrome in literature scan. Although insufficient sample group during the studies is required to be less than the needed studies number, the study results are such as to overlap the problems reported in the literature.
However, new studies must be conducted on different populations regarding this topic. The authors declare that they have no conflict of interest and no financial support either. National Center for Biotechnology InformationU. Journal List Open Orthop J v. Published online May Author information Article notes Copyright and License information Disclaimer. This is an open access article distributed under the terms of the Creative Commons Attribution 4.
This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Open in a separate window. In such case, the diagnosis of the disease together with the difficulties, definition of the pain originated from the thoracolumbar region is possible in 5 steps; 1- Iliac crest point finding.
The 4 steps functional restoration program for the TLS commonly seen in athletes can be defined as follows; 1- Elimination of pain and inflammation. Table 1 Baseline values of age and BMI of 3 groups.