Ozana Katarina Tot

Background/Objectives: Severe traumatic injuries of the upper extremity present a major therapeutic challenge because of extensive tissue damage, severe pain, loss of function, and substantial psychosocial consequences. Continuous multidisciplinary rehabilitation that adapts to the patient’s evolving clinical condition may optimize functional outcomes across the entire continuum of care. Methods: A 42-year-old man with no prior comorbidities sustained a severe work-related traumatic injury to his left hand. Despite reconstructive surgery and prolonged multidisciplinary treatment, he developed CRPS with persistent neuropathic pain, progressive functional deterioration, and psychological distress. Fourteen months after injury, the affected limb became completely nonfunctional, and elective transradial amputation was recommended after multidisciplinary evaluation. Results: Rehabilitation was delivered as a continuous, phase-adapted multidisciplinary program. Before amputation, treatment focused on pain control, reduction of edema and inflammation, preservation of joint mobility and muscle function, and management of CRPS using multimodal physical therapy combined with pharmacological treatment and psychological support. As amputation became inevitable, rehabilitation goals shifted toward pre-amputation preparation, promotion of adaptive neuroplasticity, and prevention of phantom limb pain. After transradial amputation, pain intensity markedly decreased, functional adaptation improved, and the patient successfully completed prosthetic rehabilitation. Conclusions: This case highlights the importance of a continuous, individualized multidisciplinary rehabilitation strategy extending from limb salvage through post-amputation recovery. Integrating multimodal physical therapy, neuroplasticity based interventions, psychological support, and prosthetic rehabilitation may improve pain control, facilitate functional recovery, and enhance long-term adaptation after severe traumatic upper extremity injury.

Background/Objectives Severe traumatic injuries of the upper extremity present a major therapeutic challenge because of extensive tissue damage, severe pain, loss of function, and substantial psychosocial consequences. Continuous multidisciplinary re-habilitation that adapts to the patient's evolving clinical condition may optimize functional outcomes across the entire continuum of care. Methods A 42-year-old man with no prior comorbidities sustained a severe work-related traumatic injury to his left hand. Despite reconstructive surgery and prolonged multidisciplinary treatment, he developed CRPS with persistent neuropathic pain, progressive functional deterioration, and psychological distress. Fourteen months after injury, the affected limb became completely nonfunctional, and elective transradial amputation was recommended after multidisciplinary evaluation. Results Rehabilitation was delivered as a continuous, phase-adapted multidisciplinary program. Before amputation, treatment focused on pain control, reduction of edema and inflam-mation, preservation of joint mobility and muscle function, and management of CRPS using multimodal physical therapy combined with pharmacological treatment and psychological support. As amputation became inevitable, rehabilitation goals shifted toward pre-amputation preparation, promotion of adaptive neuroplasticity, and preven-tion of phantom limb pain. After transradial amputation, pain intensity markedly decreased, functional adaptation improved, and the patient successfully completed prosthetic rehabilitation. Conclusions This case highlights the importance of a continuous, individualized multidisciplinary rehabilitation strategy extending from limb salvage through post-amputation recovery. Integrating multimodal physical therapy, neuroplasticity based interventions, psycho-logical support, and prosthetic rehabilitation may improve pain control, facilitate func-tional recovery, and enhance long-term adaptation after severe traumatic upper extremity injury.

Anesthetics are essential agents that are frequently used in clinical practice to induce a reversible loss of consciousness and sensation by depressing the central nervous system. The inhalational anesthetics isoflurane and sevoflurane are preferred due to their rapid induction and recovery times and ease of administration. Despite their widespread use, the exact molecular mechanisms by which these anesthetics induce anesthesia are not yet fully understood. In this study, the age-dependent effects of inhalational anesthetics on two demyelination models were investigated: congenital (B4galnt1-null) and chemically induced (cuprizone). Various motor and cognitive tests were used to determine sensitivity to isoflurane and sevoflurane anesthesia. B4galnt1-null mice, which exhibit severe motor deficits due to defects in ganglioside synthesis, showed significant impairments in motor coordination and balance in all motor tests, which were exacerbated by both anesthetics. Cuprizone-treated mice, which mimic the demyelination in B4galnt1-null mice, also showed altered, age-dependent sensitivity to anesthesia. The study showed that older mice exhibited more pronounced deficits, with B4galnt1-null mice showing the greatest susceptibility to sevoflurane. These differential responses to anesthetics suggest that age and underlying myelin pathology significantly influence anesthetic effects.

Lumbar radicular pain is a major public health and economic problem. It is among the most common reasons for professional disability. The most common cause of lumbar radicular pain is intervertebral disc herniation, which results from degenerative disc changes. The dominant pain mechanisms are direct pressure of the hernia on the nerve root and the local inflammatory process triggered by intervertebral disc herniation. Treatment of lumbar radicular pain includes conservative, minimally invasive, and surgical treatment. The number of minimally invasive procedures is constantly increasing, and among these methods is epidural administration of steroids and local anesthetic through a transforaminal approach (ESI TF). The aim of this research was to examine the effectiveness of ESI TF as measured by a visual analog scale (VAS) and the Oswestry Disability Index (ODI), depending on whether there is contact between the herniated intervertebral disc and the nerve root. In both groups of participants, there was a significant reduction in pain intensity, but there was no significant difference between the groups. In the group with disc herniation and nerve root contact, the only significant reduction was in pain intensity (p < 0.001). There were no significant differences in measurements in other domains of the ODI. In the group without disc herniation and nerve contact, there was a significant difference in all domains except weight lifting. In the group without contact, there was significant improvement after 1 month (p = 0.001) and 3 months (p < 0.001) according to the ODI, while there was no significant improvement in the group with contact. In addition, there were no significant differences in the distribution of participants based on the ODI and whether disc herniation and nerve contact was present. The results suggest that transforaminal epidural administration of steroids is a clinically effective method for treating lumbar radicular pain caused by intervertebral disc herniation in people with and without nerve root contact, without significant differences.

Lumbar radicular pain is defined as pain in the lumbar spine with propagation to the lower extremities. It is a major public health, social and economic problem in the modern society, and is one of the most common reasons for visits to the doctor. Lumbar radicular pain is often the reason for absenteeism and occupational disabilities. It is estimated that about 70-85% of the world’s population have experienced lumbar spine pain once in their lifetime. There are numerous modalities for the treatment of lumbar radicular pain, ranging from pharmacotherapy to surgery. In order to avoid systemic side effects of analgesics, anaesthesia and long-term and extensive surgery, minimally invasive procedures are increasingly used for treating lumbar radicular pain. Percutaneous laser disc decompression (PLDD) is one such procedure, first performed by Dr Choy and Dr Ascher in 1986. PLDD is an outpatient surgery performed under local anaesthesia, its success rate is high and the complication rate is low. This method therefore certainly attracts the attention of clinicians dealing with this issue.