Browsing by Author "Karunanayake, A.L."

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Anatomical variations of lumbar arteries and their clinical implications: a cadaveric study
(Hindawi Publishing Corporation, 2013) Karunanayake, A.L.; Pathmeswaran, A.
Lumbar arteries arise from the abdominal aorta. Some abdominal and spinal surgeries can damage these arteries, and that can lead to serious consequences. This study aimed at studying the types and frequencies of variations of lumbar vasculature. We dissected both sides of 109 adult human cadavers and studied the variations of lumbar vasculature. Age range was 43-90 years. Fifty-seven percent were males and 43% were females. The number of lumbar arteries arising from either side of the abdominal aorta varied between 3 and 5 pairs. The lumbar arteries arose from a common single stem in 12% of the cadavers. The third and fourth pairs of lumbar arteries arose from a common single stem in 3% and 11% of cadavers, respectively, and the first and second pairs of lumbar arteries arose from a common single stem in 1% and 2% of cadavers, respectively. The first and second lumbar arteries on the right side traveled anterior to the right crus of the diaphragm in 7% and 8% of cadavers, respectively. There were several variations with regard to the number, origin from the abdominal aorta, and pathway of lumbar arteries from what is described in the literature.
Anatomical variations of the common peroneal nerve (cpn) and the deep pereoneal nerve (dpn) in the lateral compartment of the leg: A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Salgado, L.S.S.; Karunanayake, A.L.; Hasan, R.; Salvin, K.A.; Fernando, E.D.P.S.; Ranaweera, M.S.L.; Padeniya, A.G.P.M.; Senevirathne, S.P.; Ranaweera, K.R.K.L.K.
INTRODUCTION: The aim of this study is to demonstrate anatomy of CPN and DPN in the lateral compartment and identify high risk area/s which is important in high tibial osteotomy, in total knee arthroplasty, in external fixation of leg and CPN decompression surgery. MATERIAL AND METHODS: Thirty cadaveric legs (female-14, male-16) were dissected to demonstrate the bifurcation of the CPN and the exit point of the DPN from the lateral compartment. The ethical clearance was obtained. RESULTS: None of the specimens showed bifurcation of the CPN proximal to the apex of the fibular head. Musculoaponeurotic fibular arch at the entrance to the fibular tunnel was confirmed in all specimens. The mean distance from the apex of the fibular head to the opening of the fibular tunnel was 28.4mm (SEM±1.4mm). Of 30 specimens respectively 21(70%), 7(23.33%) and 2(6.66%) had bifurcation vertically distal to, on and proximal to the entry point with the average of 8.0mm and 12.0mm from the entry point. Eleven legs had muscular branches of the DPN in the lateral compartment of the leg. The mean exit point of the DPN/its longest muscular branch was observed 66.5mm (SEM±2.6mm) distal to the apex of the fibular head. CONCLUSIONS: Variations of the CPN bifurcation in relation to the fibular tunnel and muscular branches of the DPN in the lateral compartment were observed. From the apex of the fibular head, distance of 25.6mm-71.6mm was identified as the high risk area for surgeries involving in the upper part of the lateral compartment.
Anatomical variations of the musculocutaneous nerve - A cadaveric study
(College of Surgeons of Sri Lanka, 2015) Padeniya, A.G.P.M.; Salgado, L.S.S.; Hasan, R.; Fernando, E.D.P.S.; Ranaweera, R.M.S.L.; Abeysuriya, V.; Karunanayake, A.L.; Salvin, K.A.; Siriwardana, S.A.S.R.; Balasooriya, B.M.C.M.; Alahakoon, A.M.D.K.
INTRODUCTION: The musculocutaneous (MC) nerve commences from the lateral cord of the brachial plexus, passes inferolaterally and pierces the coracobrachialis while innervating it. It then descends between biceps and brachialis muscles, innervating both and continues as the lateral cutaneous nerve of the forearm. Few studies have been done with regard to variations in origin, course, branching pattern, termination and communications of the MC nerve. These variations are important for anatomists, clinicians, anesthetists and surgeons to avoid unexpected complication as these variations have clinical significance during the surgical procedures and in diagnostic clinical neurophysiology. Therefore the aim of this paper was to study the anatomical variations of the MC nerve. MATERIAL AND METHODS: This descriptive cross sectional study was carried out in the Department of Anatomy, Faculty of Medicine, University of Kelaniya. Dissections were carried out on 50 upper limbs of 25 cadavers to record anatomical variations of the MC nerve. RESULTS: MC nerve was present only in 46(92%) upper limbs. Of the 46 upper limbs where the MC was present, one (2%) did not pierce the coracobrachialis. Communications were seen between MC and median nerve in 06(13%) samples of which 1(17%) was proximal and 5(83%) were distal to the point of entry of the MC into the coracobrachialis and in 4(9%) upper limbs MC nerve rejoins with the median nerve. CONCLUSIONS: It is evident that significant anatomical variations of the MC nerve exist in our study. These variations emphasize the complexities and irregularities of this anatomical structure with regard to surgical approaches.
Association between changes of lumbar spine and age, physical activity and body mass index in a sample of Sri Lankan population: A descriptive study
(University of Kelaniya, 2006) Karunanayake, A.L.; Pathmeswaran, A.
Introduction: Disc space narrowing, vertebral osteophytes, spondylolisthesis are features of degeneration of the spine and are recognized causes of low back pain and sciatica. However on some occasions they can be present in the spine without causing problems such as low back pain and sciatica. Objective: To describe the association between disc space narrowing, vertebral osteophytes and spondylolisthesis with body mass index (BMI), posture, physical exercise and age. Method: Descriptive cross sectional study was done with people who had antero posterior and lateral radiographs of the lumbar spine ordered due to problems such as abdominal pain. These people had no problems of backache. Structured interviewer administered questionnaire was used to assess their leisure time activities and other physical activities done at office and home. Their weight and heights were measured and BMI was calculated. Results were analysed using EPI6 statistical package. This study was done in North Colombo Teaching hospital Ragama. Results: Sample size 133. Age range 18-79yrs. Mean (SD) age 51.4 (16.3). There were 82 (62%) females. Age had a significant positive association with vertebral osteophytes (P<0.0001). Regular exercise had a significant positive association with spondylolisthesis (P=0.03). BMI had a significant positive association with vertebral osteophytes (P< 0.001). Posture did not have a significant association with disc space narrowing, vertebral osteophytes and spondylolisthesis. Conclusions: Ageing and high BMI are associated with vertebral osteophytes. Regular exercise is associated with spondylolisthesis.
Association between pain and disability in patients with chronic mechanical low back pain
(Sri Lanka Medical Association, 2015) Perera, G.L.R.S.; Wijayaratne, L.S.; Senarath, U.; Dissanayake, P.H.; Karunanayake, A.L.; Dissanayake, V.H.W.
INTRODUCTION AND OBJECTIVES: Low back pain is the leading cause of years lived with disability in developed countries as well as in South Asian countries. The aim of this study is to evaluate the association between the intensity of pain and disability in patients with chronic mechanical low back pain (CMLBP) who attended the rheumatology clinic, National Hospital of Sri Lanka (NHSL). METHOD: This is a descriptive study on 675 patients with CMLBP who attended the rheumatology clinic, NHSL, from May 2012 to May 2014, recruited according to inclusion and exclusion criteria. Intensity of pain was measured using the 101-point numerical pain rating scale (NRS) and the disability was measured using the modified Oswestry Disability Index (MODI). A multiple linear regression model adjusted for age, gender, level of education, duration and frequency of pain and duration of treatment was used to assess the association between the intensity of pain and disability. RESULTS: Majority (482, 71.4%) were females. Mean age was 49.19 ± 11.75 years. Mean score for NRS was 46.79 ± 20.38 and for MODI was 31.77 ± 14.16, while 84.3% had daily pain. Intensity of pain was positively associated with the disability (p<0.01) and the standardized regression coefficient was +0.627 after adjusting for confounders. Frequency of pain, female gender and aging were positively associated with disability (p<0.05) while level of education, and durations of pain and treatment did not reach significant level. Conclusion: Intensity of pain explains 63% of the disability associated with CMLBP. Frequency of pain, female gender and age were also associated with disability.
Association between the intima media thickness of lumbar arteries and the cell density of lumbar intervertebral discs: a postmortem study among Sri Lankan adults
(Sri Lanka Medical Association, 2005) Karunanayake, A.L.; Pathmeswaran, A.; Fonseka, M.M.D.; Wijayaratne, L.S.
BACKGROUND: Disc degeneration is an important cause of low backache. Cartilage cells help to maintain the structure of the disc. The lumbar arteries provide blood supply to the lumbar discs. The tunica media affects the mechanical properties of the vessel wall and thereby control the blood supply to the tissues. OBJECTIVES: To describe the association between the intima media thickness (expressed as a percentage of total thickness) of 4th lumbar artery and the mean cell density of the 4th lumbar disc. METHODS: Descriptive cross sectional study was done on 4th lumbar discs and 4th lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs and lumbar arteries. By using a graticule number of cells per 4mm2 were counted in each disc specimen in ten low power fields and the mean cell density was calculated. With a graticule measurement of intima media thickness (IMT) and total thickness of lumbar arteries were taken on each artery specimen in ten low power fields. Mean of IMT expressed as a percentage of TT was calculated. Correlation coefficient was calculated to find out the association between the IMT and the mean cell density. RESULTS: Postmortem specimens of 31 subjects aged between 21-96 years (mean age 46 years. SD 19 years) were examined. 24 were males. There was a significant association between the IMT and the cell density (r = 0-37, P< 0.05). CONCLUSIONS: IMT of lumbar arteries had a significant positive association with the cell density.
Association between the number of chondrocytes of lumbar intervertebral discs and age, abdominal aorta atherosclerosis and lumbar artery arteriosclerosis , a descriptive cross sectional study
(OMICS International, 2015) Karunanayake, A.L.; Gupta, A.
Background: The effect of age, atherosclerotic changes of abdominal aorta and arteriosclerotic changes of lumbar arteries on number of chondrocytes of lumbar intervertebral discs has not been studied. Methods: A descriptive cross sectional post mortem study was carried out in Faculty of Medicine, University of Kelaniya, Sri Lanka to determine the association between the mean number of chondrocytes in the fifth lumbar intervertebral disc and age, the level of atherosclerotic changes of the lumbar abdominal aorta and arteriosclerotic changes of right and left, fourth lumbar arteries. The presence or absence of atherosclerotic plaques in the abdominal aorta lumbar region was studied. To assess arteriosclerotic changes, the Intima Media thickness (IMT) and the total thickness (TT) of lumbar arteries were measured and the ratio IMT/TT was calculated. Bivariant analysis and a multi variant analysis were done. Results: There were 51 samples in total. Their ages ranged from 18 to 96 years. The mean age (SD) was 43 (± 17.1) years. The samples were obtained from 38 males and 13 females. There was no significant association between atherosclerotic changes of abdominal aorta and arteriosclerotic changes of lumbar arteries and the mean number of chondrocytes. Conclusion: Only the age had a significant negative association with the mean number of chondrocytes of the intervertebral disc
Associations between disc space narrowing, anterior osteophytes and disability in chronic mechanical low back pain: a cross sectional study
(BioMed Central, 2017) Perera, R.S.; Dissanayake, P.H.; Senarath, U.; Wijayaratne, L.S.; Karunanayake, A.L.; Dissanayake, V.H.W.
BACKGROUND: Radiographic features of lumbar disc degeneration (LDD) are common findings in patients with chronic mechanical low back pain; however, its role in disability and intensity of pain is debatable. This study aims to investigate the associations of the x-ray features of LDD and lumbar spondylolisthesis with severity of disability and intensity of pain. METHODS: A cross-sectional study was conducted on 439 patients with chronic mechanical low back pain who attended the rheumatology clinic, National Hospital of Sri Lanka, Colombo, from May 2012 to May 2014. Severity of disability was measured using Modified Oswestry Disability Index and intensity of pain was assessed using numeric rating scale (0-100). X-ray features of LDD (disc space narrowing, anterior osteophytes and overall LDD) and spondylolisthesis were assessed in lateral recumbent lumbar x-rays (L1/L2 to L5/S1) and graded by a consultant radiologist blinded to clinical data. Generalised linear model with linear response was used to assess the associations of x-ray features of LDD with severity of disability and intensity of pain adjusting for age, gender, body mass index and pain radiating into legs. RESULTS: Mean age was 48.99 ± 11.21 and 323 (73.58%) were females. 87 (19.82%) were obese. Mean severity of disability was 30.95 ± 13.67 and mean intensity of pain was 45.50 ± 20.37. 69 (15.72%), 26 (5.92%) and 85 (19.36%) patients had grade 2 disc space narrowing, anterior osteophytes and overall LDD, respectively. 51 (11.62%) patients had lumbar spondylolisthesis. Grade of disc space narrowing and overall LDD were not associated with severity of disability or intensity of pain. The presence of lumbar spondylolisthesis was associated with severity of disability. Female gender and pain radiating into legs were associated with severity of disability and intensity of pain. Advancing age was associated with x-ray features of LDD and lumbar spondylolisthesis. CONCLUSIONS: Lumbar spondylolisthesis is associated with severity of disability in patients with chronic mechanical low back pain. Associations of x-ray features of LDD with severity of disability and intensity of pain are inconclusive. Female gender and pain radiating into legs are significant confounders.
Chronic low back pain and its association with lumbar vertebrae and intervertebral disc changes in adults. A case control study
(Wiley, 2018) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.
AIM: This study was done to determine the association between chronic low back pain and vertebral fractures, intervertebral disc space (IDS) narrowing, vertebral osteophytes and spondylolisthesis among adults. METHOD: This case control study was done in Sri Lanka. Cases were patients with low back pain and controls were without low back pain. Postero-anterior and lateral radiographs of lumbar sacral spine of both groups were studied. To detect vertebral fractures in fourth and fifth lumbar vertebrae, anterior and posterior heights of vertebrae were measured using a Vernier caliper and antero-posterior ratio (A/P) was calculated. Having an A/P ratio value of < 0.89 was considered as a vertebral fracture. Presence of disc space narrowing, vertebral osteophytes and spondylolisthesis was assessed by two radiologists working independently. Bivariate and logistic regression analysis was done to find associations. RESULTS: There were 140 cases and 140 controls. Mean (SD) age for cases was 51.6 (17) years. Mean (SD) age for controls was 50 (15) years. Females made up 62% of cases and controls. Fifth lumbar vertebral fracture (odds ratio [OR] = 10.2; P = 0.001), fourth lumbar vertebral fracture (OR = 2.5; P = 0.017) and IDS narrowing (OR = 4.15, P = 0.009) had a significant association with low back pain and vertebral osteophytes and spondylolisthesis did not have a significant association with low back pain. CONCLUSION: Only vertebral fractures and IDS narrowing had a significant association with chronic low back pain.
Chronic musculoskeletal symptoms following COVID-19 in a cohort of Sri Lankan patients
(Ceylon College of Physicians, 2022) Kurukulasuriya, S.A.; Karunanayake, A.L.
INTRODUCTION AND OBJECTIVES: Musculoskeletal symptoms of myalgia and arthralgia after recovery of COVID-19 is a pressing issue. Objective of this study was to assess the prevalence of persistent myalgia and arthralgia and likelihood of developing rheumatoid arthritis (RA), six weeks following COVID-19. METHODS: A descriptive longitudinal study was conducted in selected private sector hospitals in Colombo, Sri Lanka. PCR positive COVID-19 patients were recruited by consecutive sampling until required sample size of 333 was fulfilled. They were contacted over the phone six weeks after the discharge. Interviewer administered questionnaire was used to evaluate the presence of symptoms of myalgia and arthralgia. Those with positive symptoms were invited for a consultation to conduct further investigations. RESULTS: Of the 333 patients, 96 (28.8%) had persistent arthralgia, myalgia or both, six weeks after recovery from COVID-19. Among them, 56.3% had only arthralgia, 10% had only myalgia and 33% had both myalgia and arthralgia. Two patients (4.8%; 95% CI: 0.6-16.2%) were confirmed of having RA. CONCLUTIONS: More than one fourth of patients, suffered with persistent symptoms of myalgia and arthralgia six weeks following COVID-19 and 2 patients (4.8%) were confirmed to have rheumatoid arthritis..
Comparison of undergraduate student performance in Anatomy practical examination after studying prosected anatomy specimens and after doing anatomy dissections
(University of Kelaniya, 2006) Karunanayake, A.L.; Salgado, L.S.S.; Pathmeswaran, A.
Introduction: In the subject of Anatomy, students are expected to identify parts of the human body and their relationships to each other. This could be studied by dissecting human cadavers by students themselves according to the manual or using the already dissected/ “prosected” specimens. Prosected anatomy specimens are prepared by the staff. Objective: To compare the performance in anatomy practical examination (OSPE) of students who had studied prosected specimens with the students who did dissections. Method: A batch of students was divided into two groups by using random numbers. One group was given prosected specimens (prosection group) to study the pelvic walls and pelvic organs. The other group was given cadavers to dissect (dissection group) and study the same areas. Two weeks time period was given to both groups. At the end of two weeks both groups had to face an OSPE. The OSPE involved identifying structures in prosected specimens. None of the students had access to these specimens prior to the OSPE. Results were analysed using EPI6 statistical package. Results: Prosection group had 80 students. Dissection group had 72 students. Age range was 20 -28 years. Mean ages for both groups were 21.6 years. There were 43 (55%) and 34 (47%) females in prosection and dissection groups respectively. In prosection group 30 (38%) passed the practical test. In dissection group 14 (19%) passed the practical test. There was a significant difference (based on X2 test, P= 0.02) in the performance of these two groups. Conclusion: Prosection group performed significantly better than the dissection group. It is probable that when prosected specimens are used time used for dissecting can be used to identify and study structures.
The effect of 6-week core stability training on core endurance and physical performance in professional rugby players: A randomized controlled pilot study
(Nepal Journal online, 2021) Senavirathna, C.S.; Mallawaarachchi, A.P.; Karunanayake, A.L.; Gunawardena, S.
BACKGROUND: Core stability training (CST) is used to enhance sports performance. The relationship between core endurance and physical performance in rugby players had not been evaluated before in Asia. AIMS AND OBJECTIVES: This study aims to determine the effects of a 6-week specific CST program on the core endurance and physical performances (speed, upper body power, lower body power, and agility) following a CST intervention in male rugby players. MATERIALS AND METHODS: Professional rugby players (n=8, intervention and n=8, control) were randomly selected. Mean (SD) age, height and weight of intervention group were 25.25 (2.4) years, 1.64 (0.03) m, and 69.6 (14.9) kg, respectively. In the control group, corresponding values were 29.75 (4) years, 1.66 (0.04) m, and 72.3 (19.1) kg, respectively. Intervention group was trained CST sessions complementary to the usual physical training, 3 times/week for 6 weeks. The control group followed the usual physical training. Subjects were tested for four physical performances (using 40 m sprint, vertical jump, 3 kg medicine ball put, and agility T tests) and four core endurance tests (back extension, abdominal fatigue [AF], and left and right bridges). RESULTS: AF, left bridge, right bridge, and total core endurance were significantly increased in the intervention group (P=0.028, P=0.006, P= 0.008, and P=0.001, respectively). Agility and AF were increased significantly in the control group (P=0.048, P=0.027). The right side bridge endurance (P=0.024) was significantly increased in the intervention group compared to the control group. CONCLUSION: The results suggest that the CST improves core endurance without improving physical performances in rugby players
Effect of atherosclerosis on lumbar intervertebral disc cells in a sample of Sri Lankan population: a postmortem study
(Sri Lanka Medical Association, 2004) Karunanayake, A.L.; Pathmeswaran, A.; Wijayaratne, L.S.; Fonseka, M.M.D.
BACKGROUND: Disc degeneration is an important cause of low backache. The cartilage cells of the disc are important to maintain the structure and function of intervertebral discs. Lumbar arteries provide blood supply to lumbar discs. OBJECTIVE: To describe the association between cell density of fourth lumbar intervertebral disc and atherosclerotic changes of fourth lumbar artery openings. METHODS: Descriptive study was done on 4th lumbar intervertebral disc and 4lh lumbar arteries of postmortem specimens. H&E sections were prepared on the annulus fibrosus of lumbar discs. Atherosclerotic changes of lumbar artery openings were studied. By using a graticule number of cells per 4mm" were counted in each disc specimen in ten low power fields and mean cell density was calculated. Cell density of less than three was categorized as low cell density. Atherosclerotic changes of lumbar arteries were graded into three groups according to severity. Grade 1 was the least severe and grade 3 was the most severe. The chi-square for trend was used to find the association between the atherosclerotic changes of lumbar arteries and the cell density. RESULTS: 31 postmortem specimens. Age range 21 - 96 years. Median age 43 years. There was a significant association (P = 0.005) between atherosclerotic changes of lumbar arteries and low cell density. OR for gradcl, grade 2 and grade 3 was I, 4.5 and 18 respectively. CONCLUSIONS: Atherosclerotic changes of lumbar arteries had a significant negative association with the cell density.
Effectiveness of anapana, body scan and metta meditation techniques on chronic neck and shoulder region pain and disability in adult patients in Sri Lanka: study protocol for a cluster clinic-level randomised controlled trial
(BioMed Central, 2022) Karunanayake, A.L.; Solomon-Moore, E.; Coghill, N.
Background: Chronic neck and shoulder region pain affects many people around the world. This study aims to compare the effectiveness of three 8-week meditation training programmes (each using a different meditation technique: Anapana, Body scan or Metta) on pain and disability in a patient population affected with chronic neck and shoulder region pain, with a usual care control group and with each other. Methods: This four-arm parallel clinic-level randomised controlled trial will be conducted with male and female patients aged 18-65 years, who are affected with chronic neck and shoulder region pain, and who attend one of four clinics held on four different days of the week in a single medical centre in the Colombo North region, Sri Lanka. Clinics will be considered as clusters and randomly allocated to intervention and control arms. Data will be collected using validated questionnaires, clinical examinations and focus groups. To compare primary (differences in changes in pain (Numeric Pain Rating Scale) at 8 weeks) and secondary (differences in changes in pain, physical disability, range of movement and quality of life (SF-36) at 4 and 12 weeks) outcomes between groups, a two-way ANOVA will be used if data are normally distributed. If data are not normally distributed, a nonparametric equivalent (Kruskal-Wallis) will be used. Focus group transcriptions will be thematically analysed using the Richie and Spencer model of qualitative data analysis. Discussion: This is a four-arm trial which describes how three different 8-week meditation technique (Anapana, Body Scan, Metta) interventions will be implemented with adult patients affected with chronic neck and shoulder region pain. The effectiveness of each meditation intervention on the pain, physical and psychosocial disabilities of patients will be compared between groups and with a usual care control group. The results of this study will contribute to recommendations for future meditation interventions for chronic neck and shoulder pain.
Effectiveness of early stretching exercises for range of motion in the shoulder joint and quality of functional recovery in patients with burns - a randomized control trial
(Tirupati: IJPHY publishers, 2017) Perera, A.D.; Perera, C.; Karunanayake, A.L.
BACKGROUND; This study evaluated the effects of an early stretching exercises programme on the range of motion of the shoulder joint and functional recovery in patients with burns. METHODS; A randomized controlled study was conducted. Patients from 15 to 55 years of age with a total burn injury surface area (TBSA) of 10% to 45% involving the shoulder joint including axilla were eligible. Participants were randomized into two groups&59; intervention and a usual care control group, with 110 patients in each group. A standardized protocol was used in the management of intervention group for 14 days. The control group was subjected to usual protocol currently used. The range of Motion (ROM) was measured, and Functional recovery (FR) was assessed with the Quick DASH questionnaire and the Abduction Ladder. Data were obtained before and after the intervention phase and at 3, 6 and 12 months of post-burn period. RESULTS; The mean (SD) age of intervention group and control group were 29.76 &91;9.81&93; and 30.31 &91;9.45&93; respectively. The mean (SD) TBSA% of intervention group and control group was 26.15&91;9.45&93; and 24.60&91;9.56&93; respectively. There is a significant beneficial difference (p&61;&60;0.0001) in ROM and FR between the intervention group and the control group. CONCLUSION; This study demonstrated that an early sustained stretching exercise regime significantly improved the ROM and functional recovery of the shoulder joint after a severe burn involving the axilla.
Effectiveness of early stretching exercises for range of motion of the shoulder joint, state of axillary scar and quality of recovery in burnt patients admitted to the Burns unit of the National Hospital of Sri Lanka
(Faculty of Graduate Studies, University of Kelaniya, 2015) Perera, G.A.D.; Perera, C.; Karunanayake, A.L.
Background: Burn injuries can result in long term impairment, limitation and activity participation restrictions in a patient‘s life. The majority of burns occur in low- and middleincome countries. In axillary or shoulder burns scar contracture is common and leads to loss of shoulder movements and function. Purpose: This study aim was to compare outcomes of an early stretching exercise programme on the range of motion of the shoulder joint, state of axillary scar and quality of recovery for patients with upper limb burn with a control group. This study has not been discussed in the previous literature. Methods: A randomized controlled study was conducted in National Hospital of Sri Lanka. Patients from 15 to 55 years of age with a total burn surface area (TBSA) of 10% to 45% involving the shoulder joint and axilla were eligible. Participants were randomized into intervention and a usual care (control) groups. There were 110 patihhents in each group. The study protocol lasted 14 days for each participant in the intervention group, whilst the controls had usual care. Range of Motion (ROM) was measured with a Universal Goniometer. Functional recovery (FR) and state of the axillary scar was assessed with the Quick DASH questionnaire and Vancouver Scar Scale (VSS). Data were obtained before and after the intervention phase and at 3, 6 and 12 months of post burn. Results: Age, intervention group mean [SD] 29.76[9.81] vs control group mean [SD] 30.31 [9.45] and TBSA%, intervention group mean [SD] 26.15[9.45] vs control group mean [SD] 24.60[9.56] were not significantly different. There were highly significant differences (p>0.0001) in ROM, FR and the state of the axillary scar in favour of the intervention group. Conclusion: This study demonstrated that early stretching exercise regime significantly improved the ROM and functional recovery of the shoulder joint and scar condition of the axilla for adults with burns involving the upper arm.
Factors associated with osteoporosis among a sub-urban Sri Lankan population
(Research Symposium 2009 - Faculty of Graduate Studies, University of Kelaniya, 2009) Karunanayake, A.L.; Pinidiyapathirage, J.; Salgado, L.S.S.
Introduction : Risk factors for osteoporosis can vary from country to country. Objective: To determine the association between osteoporosis and age, physical activity, body mass index (BMI), smoking, alcohol consumption, consumption of milk, level of education and income in a sample of sub-urban Sri Lankan adults. Methodology: A descriptive cross sectional study involving 22 grama niladari divisions of the Ragama MOH area was conducted from March to October 2007. A randomly selected sample of 700 adults, in the age group of 35-64 years, were invited to participate in the study. A structured interviewer administered questionnaire was used to collect demorgraphic data and details of risk factors. Bone mineral density (BMD) was measured with a peripheral Dexa scan. A BMD of < -2.5 was considered as having osteoporosis. Result: Of the 700 subjects studied, 60% (n=421) were females. Using logistic regression analysis, age >50 years (OR 3.5 95% CI 1.9-6.2), female sex (OR 12.2 95% CI 4.8-30.9), low level of education (OR 1.8 95% CI 1.1-2.8), low BMI (OR 3.5 95% CI 1.7-7.3) and smoking (OR 5.8 95% CI 1.9-17.2) had a significant association with osteoporosis. Conclusion: Age, sex, level of education, nutritional status and regular smoking showed a significant association with osteoporosis.
Gross anatomical variations of lumbar vasculature among Sri Lankan adults: a cadaveric study
(Sri Lanka Medical Association, 2003) Karunanayake, A.L.; Jayasinghe, J.A.P.; Wijayaratne, L.S.; Pathmeswaran, A.
BACKGROUND: Lumbar arteries supply intervertebral discs, vertebrae, muscles and ligaments in the lumbar region. Lumbar arteries can get damaged during urological and vascular surgery. According to textbooks of anatomy there are four pairs of lumbar arteries arising as individual stems from abdominal aorta and they travel posterior to crura of the diaphragm. There are no published studies in Sri Lanka either confirming this or describing the variations of lumbar arteries. OBJECTIVE: To describe the anatomy of lumbar arteries with regard to their numbers, origin and pathway. MATERIALS AND METHODS: This descriptive study was done on cadavers in anatomy departments of Kelaniya, Colombo and Sri Jayawardenepura Universities. Lumbar arteries were cleared from the origin of the abdominal aorta up to the point of passing deep to the Psoas major muscle. Their origin, number and pathway were noted. RESULTS: Dissected 109 cadavers. Ages ranged 43 -90 years. Mean age 70 years (SD 13.6). Males constituted 57% of the sample. The number of lumbar arteries varied from 3-5 pairs. In 12% of cadavers lumbar arteries originated as a common stem from the aorta and divided into two. These arteries traveled anterior to crura of the diaphragm in 17% of cadavers. CONCLUSIONS: There were variations with regard to the number, origin from abdominal aorta and pathway of lumbar arteries from what is described in textbooks. These findings will be useful for surgeons performing retroperitoneal surgery.
Hand book on examination of spine, upper limb joints and lower limb joints : book 1
(S. Godage & Brothers, 2011) Karunanayake, A.L.
No abstract available
Hand book on gross anatomy upper limb & lower limb : spots and viva for self evaluation
(S.Godage and Brothers (Pvt) Ltd., 2016) Karunanayake, A.L.