Pub Date : 2013-07-01DOI: 10.1179/1753614613Z.00000000044
M. Hutson
Abstract Increasing use of image-guided injections for musculoskeletal conditions has not been accompanied by any substantial evidence base of change in safety or efficacy. The possible implications of increasing dependence on image-guidance for treatments are discussed, including diminishing interest and skill in manual diagnostic techniques, and whether patients will be better served with these current trends.
{"title":"Ultrasound-guided soft tissue injections: Safety and effectiveness","authors":"M. Hutson","doi":"10.1179/1753614613Z.00000000044","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000044","url":null,"abstract":"Abstract Increasing use of image-guided injections for musculoskeletal conditions has not been accompanied by any substantial evidence base of change in safety or efficacy. The possible implications of increasing dependence on image-guidance for treatments are discussed, including diminishing interest and skill in manual diagnostic techniques, and whether patients will be better served with these current trends.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"49 - 51"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000044","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715658","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1179/1753614613Z.00000000046
M. O’Reilly, J. Tanner
A novel approach to traditional clinical radiology presentations took place recently in Oxford. The British Institute of Musculoskeletal Medicine (BIMM) hosted a Spring Symposium attended by sports physicians, rheumatologists, general practitioners with a special interest (GPSIs), and radiologists with a special interest in musculoskeletal (MSK) problems. Given the enthusiasm of sports medicine physicians and other non-radiology trained physicians in the use of imaging to complement their diagnostic abilities and administer therapeutic agents, with an ever likely potential for ‘turf battles’, a lively interaction between radiologists and non-radiologists was assured. Speakers included distinguished consultants in the fields of radiology, MSK medicine, orthopaedics, and sports medicine from London, Salisbury, Birmingham, and Oxford. The perennial problem for clinicians, outlined by Dr Grahame Brown (MSK physician) is the problem of making a diagnosis. He chose to put diagnosis in the widest context. Listening to the patient’s story without interrogation, building a rapport to enable elicitation of all the thoughts, fears, and attitudes of the patient in the context of their own individual lives being the only real way of getting to the roots of the presenting symptoms. A thorough examination using palpation to identify tender tissues and dysfunction complements the history and builds a complete picture. Without this complete picture interpretation of normal and abnormal imaging findings remains a two dimensional approach. This led on to a talk by Dr Philip Bell, consultant in sports and exercise medicine (SEM), outlining the essentials of sports medicine practice. Injury is often related to ‘what they do and how they do it’. High volume and repetitive training can result in abnormal imaging that simply reflects normal physiological changes, (a good example being the endurance athlete’s heart which used to be interpreted as ventricular hypertrophy). Diagnosis should be made clinically, imaging usually confirming what you know clinically. He pointed out the danger of uncertain clinical diagnosis and then going on an ‘imaging fishing trip’ which might throw up irrelevant findings and lead to unnecessary operations. Examples are asymptomatic soccer players with femoro-acetabular impingement (cam or pincer femoral heads) and small labral tears, and asymptomatic shoulders in tennis players with rotator cuff tears.
{"title":"The interface between MSK radiology and musculoskeletal and sports medicine practice: Who takes clinical responsibility for the patient?","authors":"M. O’Reilly, J. Tanner","doi":"10.1179/1753614613Z.00000000046","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000046","url":null,"abstract":"A novel approach to traditional clinical radiology presentations took place recently in Oxford. The British Institute of Musculoskeletal Medicine (BIMM) hosted a Spring Symposium attended by sports physicians, rheumatologists, general practitioners with a special interest (GPSIs), and radiologists with a special interest in musculoskeletal (MSK) problems. Given the enthusiasm of sports medicine physicians and other non-radiology trained physicians in the use of imaging to complement their diagnostic abilities and administer therapeutic agents, with an ever likely potential for ‘turf battles’, a lively interaction between radiologists and non-radiologists was assured. Speakers included distinguished consultants in the fields of radiology, MSK medicine, orthopaedics, and sports medicine from London, Salisbury, Birmingham, and Oxford. The perennial problem for clinicians, outlined by Dr Grahame Brown (MSK physician) is the problem of making a diagnosis. He chose to put diagnosis in the widest context. Listening to the patient’s story without interrogation, building a rapport to enable elicitation of all the thoughts, fears, and attitudes of the patient in the context of their own individual lives being the only real way of getting to the roots of the presenting symptoms. A thorough examination using palpation to identify tender tissues and dysfunction complements the history and builds a complete picture. Without this complete picture interpretation of normal and abnormal imaging findings remains a two dimensional approach. This led on to a talk by Dr Philip Bell, consultant in sports and exercise medicine (SEM), outlining the essentials of sports medicine practice. Injury is often related to ‘what they do and how they do it’. High volume and repetitive training can result in abnormal imaging that simply reflects normal physiological changes, (a good example being the endurance athlete’s heart which used to be interpreted as ventricular hypertrophy). Diagnosis should be made clinically, imaging usually confirming what you know clinically. He pointed out the danger of uncertain clinical diagnosis and then going on an ‘imaging fishing trip’ which might throw up irrelevant findings and lead to unnecessary operations. Examples are asymptomatic soccer players with femoro-acetabular impingement (cam or pincer femoral heads) and small labral tears, and asymptomatic shoulders in tennis players with rotator cuff tears.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"47 - 48"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000046","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715768","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1179/1753615413Y.0000000017
Jennifer Hall, A. Clough, M. Traynor
Abstract Objective A pilot trial to compare a ‘Society of Musculoskeletal Medicine (SOMM) approach’ to mobilization with a ‘Maitland approach’ in neck pain patients. Method Participants were adults with neck pain (central, bilateral, or unilateral neck or scapula pain, without neurology). Five participants were randomly assigned to a SOMM approach or a Maitland approach of manual therapy. All received four weekly treatments and proven adjunct therapies. Pain (visual analogue scale) and function (neck disability index) were assessed before each treatment and after the fourth. Results Irrespective of approach all subjects demonstrated a reduction in pain (to a clinically important level) and an increase in function. The low power of this pilot did not permit differences between groups to be tested. Discussion It would be feasible to investigate these promising trends with a future trial, providing two main limitations are addressed; firstly, recruitment and secondly, the consent process.
{"title":"Therapeutic effectiveness of a ‘Society of Musculoskeletal Medicine (SOMM) approach’ to mobilization versus a ‘Maitland approach’ in the treatment of neck pain: A comparative pilot study","authors":"Jennifer Hall, A. Clough, M. Traynor","doi":"10.1179/1753615413Y.0000000017","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000017","url":null,"abstract":"Abstract Objective A pilot trial to compare a ‘Society of Musculoskeletal Medicine (SOMM) approach’ to mobilization with a ‘Maitland approach’ in neck pain patients. Method Participants were adults with neck pain (central, bilateral, or unilateral neck or scapula pain, without neurology). Five participants were randomly assigned to a SOMM approach or a Maitland approach of manual therapy. All received four weekly treatments and proven adjunct therapies. Pain (visual analogue scale) and function (neck disability index) were assessed before each treatment and after the fourth. Results Irrespective of approach all subjects demonstrated a reduction in pain (to a clinically important level) and an increase in function. The low power of this pilot did not permit differences between groups to be tested. Discussion It would be feasible to investigate these promising trends with a future trial, providing two main limitations are addressed; firstly, recruitment and secondly, the consent process.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"52 - 57"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000017","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722417","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-07-01DOI: 10.1179/1753615413Y.0000000018
R. Hill, Sharon Chan
Abstract Objectives To provide a comprehensive review of flexor tendon injuries in the hand, their management, and subsequent recovery. Methods A review of the current literature surrounding flexor tendon anatomy, injury, surgical repair, and healing was performed. Results This review examines the flexor tendons of the hand and describes their anatomy, different zones of injury, surgical repair, and their regeneration and rehabilitation following injury. Adhesions, produced as part of the normal inflammatory process and their inhibitory effect on tendon function are studied. In order to address the issue of adhesions, numerous studies have examined surgical techniques, rehabilitation protocols, and the use of pharmacological and biosynthetic agents to reduce adhesions and therefore improve patient outcomes. Discussion The different zones of injury influence the likelihood of a good recovery following surgical repair. In particular, the presence of digital tendon sheaths in ‘Zone 2’ means that the formation of adhesions between tendons and sheath is a frequent complication that restricts the normal functioning of the tendon. Following surgery, an early active mobilization protocol produces good outcomes on the whole.
{"title":"Flexor tendon injuries: a review","authors":"R. Hill, Sharon Chan","doi":"10.1179/1753615413Y.0000000018","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000018","url":null,"abstract":"Abstract Objectives To provide a comprehensive review of flexor tendon injuries in the hand, their management, and subsequent recovery. Methods A review of the current literature surrounding flexor tendon anatomy, injury, surgical repair, and healing was performed. Results This review examines the flexor tendons of the hand and describes their anatomy, different zones of injury, surgical repair, and their regeneration and rehabilitation following injury. Adhesions, produced as part of the normal inflammatory process and their inhibitory effect on tendon function are studied. In order to address the issue of adhesions, numerous studies have examined surgical techniques, rehabilitation protocols, and the use of pharmacological and biosynthetic agents to reduce adhesions and therefore improve patient outcomes. Discussion The different zones of injury influence the likelihood of a good recovery following surgical repair. In particular, the presence of digital tendon sheaths in ‘Zone 2’ means that the formation of adhesions between tendons and sheath is a frequent complication that restricts the normal functioning of the tendon. Following surgery, an early active mobilization protocol produces good outcomes on the whole.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"72 - 79"},"PeriodicalIF":0.0,"publicationDate":"2013-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000018","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722512","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753615413Y.0000000015
P. Wheeler
Abstract Objectives Plantar fasciitis is a common condition with a small number of people having symptoms that are challenging to treat. This prospective case series pilot study paper reports the patient outcomes following ultrasound-guided autologous blood injections (ABI) for the treatment of chronic plantar fasciitis symptoms. Methods and patients Prospective case-series study of 35 consecutive patients who have undergone ultrasound-guided ABI for recalcitrant plantar fasciitis symptoms in a National Health Service Sports Medicine Clinic in Leicester, UK. Patients treated had suffered with symptoms of plantar fasciitis for an average of more than 4 years pre-ABI. Patients had an average follow-up of 6 months and with a maximum of over 800 days. The outcome measures include visual analogue scale (VAS) for pain, and 7-part patient satisfaction outcome scale. Results There was an average reduction of VAS of more than 85% post-ABI for all enrolled patients, increasing to nearly 90% in patients with at least 2 months follow-up data. At the latest follow-up appointment 53% of all patients were pain-free following the ABI procedure, increasing to 71% of patients with at least 2 months of follow-up data. Discussion While causality is not proved in this study design, ultrasound-guided ABI appear to be successful in the treatment of recalcitrant plantar fasciitis. Further studies with greater methodological rigour using a control group or alternative interventions should be conducted.
{"title":"Autologous blood injections for chronic plantar fasciitis – a pilot case-series study shows promising results","authors":"P. Wheeler","doi":"10.1179/1753615413Y.0000000015","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000015","url":null,"abstract":"Abstract Objectives Plantar fasciitis is a common condition with a small number of people having symptoms that are challenging to treat. This prospective case series pilot study paper reports the patient outcomes following ultrasound-guided autologous blood injections (ABI) for the treatment of chronic plantar fasciitis symptoms. Methods and patients Prospective case-series study of 35 consecutive patients who have undergone ultrasound-guided ABI for recalcitrant plantar fasciitis symptoms in a National Health Service Sports Medicine Clinic in Leicester, UK. Patients treated had suffered with symptoms of plantar fasciitis for an average of more than 4 years pre-ABI. Patients had an average follow-up of 6 months and with a maximum of over 800 days. The outcome measures include visual analogue scale (VAS) for pain, and 7-part patient satisfaction outcome scale. Results There was an average reduction of VAS of more than 85% post-ABI for all enrolled patients, increasing to nearly 90% in patients with at least 2 months follow-up data. At the latest follow-up appointment 53% of all patients were pain-free following the ABI procedure, increasing to 71% of patients with at least 2 months of follow-up data. Discussion While causality is not proved in this study design, ultrasound-guided ABI appear to be successful in the treatment of recalcitrant plantar fasciitis. Further studies with greater methodological rigour using a control group or alternative interventions should be conducted.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"3 - 7"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000015","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722696","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753614612Z.00000000033
J. Foell
Out of touch with the contemporary landscape of healthcare? Is manual medicine an activity of ‘grumpy old men’? And how can this branch of medical practice adapt to changing healthcare arenas? One speaker at the International Academy of Manual/ Musculoskeletal Medicine meeting at Bratislava, 2012, suggested that the difference between manual medicine and manual therapy was the number of treatments – one or two in the former, unlimited in the latter; and that this was enabled by the holistic approach in the former, together with an understanding of psychosocial issues and co-morbidities. But if the former has usually less time in consultation, and much of the ‘extras’ can be covered by advanced training, we question why some consider that one approach is specific to one health discipline. Theme of the first session was manual therapy in infants. The spectrum of treated disorders changed from torticollis to feeding and behavioural problems. The speaker, Heiner Biedermann, theorized that functional disturbances of the atlanto-occipital region associated with birth trauma generate a nociceptive barrage which affects feeding and makes the infant irritable as awhole. Someaspects of hismanagement generated controversy, for example, routine use of X-rays in infants. Other aspects are linked to the activity of manual therapists: it is impossible to unpick in a complex intervention what the active treatment components are and how they interact. What one believes the dominant method of action is, may not be what actually works. These uncertainties, the tension between externally validated knowledge and how knowledge is locally enacted, remained a theme throughout the conference. As much as musculoskeletal medicine strives to position itself in the positivist paradigm of evidencebased medicine it also is clear that there are phenomena which remain unexplained and possibly difficult to pinpoint, measure, and control. Aristotle’s distinction between craftsmanship, theoretical skills, and applied wisdom provided a framework to compartmentalize what therapists do and how it gets taught. It is about distinguishing subtle differences in tissue texture. How reproducible is this? This is one of the core questions of hands-on medicine. How can it be measured? And do skilled practitioners agree on their observations? One experiment consisted of comparing palpation of the painful side in a blinded situation. Two experienced therapists in France compared their accuracy in detecting the painful side in patients who complained of unilateral neck pain and back pain. The sad outcome was that there was very little accuracy in detecting the ‘correct’ side. The success rate ranged between 53 and 70% and none of the therapists was happy with the results. Is this something one should expect, as individuals differ in their judgment? Is this something to expect because a dialogue is needed to negotiate differing sources of information? A group in Germany used different textures of
{"title":"Manual medicine: Out of touch with contemporary medicine?","authors":"J. Foell","doi":"10.1179/1753614612Z.00000000033","DOIUrl":"https://doi.org/10.1179/1753614612Z.00000000033","url":null,"abstract":"Out of touch with the contemporary landscape of healthcare? Is manual medicine an activity of ‘grumpy old men’? And how can this branch of medical practice adapt to changing healthcare arenas? One speaker at the International Academy of Manual/ Musculoskeletal Medicine meeting at Bratislava, 2012, suggested that the difference between manual medicine and manual therapy was the number of treatments – one or two in the former, unlimited in the latter; and that this was enabled by the holistic approach in the former, together with an understanding of psychosocial issues and co-morbidities. But if the former has usually less time in consultation, and much of the ‘extras’ can be covered by advanced training, we question why some consider that one approach is specific to one health discipline. Theme of the first session was manual therapy in infants. The spectrum of treated disorders changed from torticollis to feeding and behavioural problems. The speaker, Heiner Biedermann, theorized that functional disturbances of the atlanto-occipital region associated with birth trauma generate a nociceptive barrage which affects feeding and makes the infant irritable as awhole. Someaspects of hismanagement generated controversy, for example, routine use of X-rays in infants. Other aspects are linked to the activity of manual therapists: it is impossible to unpick in a complex intervention what the active treatment components are and how they interact. What one believes the dominant method of action is, may not be what actually works. These uncertainties, the tension between externally validated knowledge and how knowledge is locally enacted, remained a theme throughout the conference. As much as musculoskeletal medicine strives to position itself in the positivist paradigm of evidencebased medicine it also is clear that there are phenomena which remain unexplained and possibly difficult to pinpoint, measure, and control. Aristotle’s distinction between craftsmanship, theoretical skills, and applied wisdom provided a framework to compartmentalize what therapists do and how it gets taught. It is about distinguishing subtle differences in tissue texture. How reproducible is this? This is one of the core questions of hands-on medicine. How can it be measured? And do skilled practitioners agree on their observations? One experiment consisted of comparing palpation of the painful side in a blinded situation. Two experienced therapists in France compared their accuracy in detecting the painful side in patients who complained of unilateral neck pain and back pain. The sad outcome was that there was very little accuracy in detecting the ‘correct’ side. The success rate ranged between 53 and 70% and none of the therapists was happy with the results. Is this something one should expect, as individuals differ in their judgment? Is this something to expect because a dialogue is needed to negotiate differing sources of information? A group in Germany used different textures of","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"1 - 2"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614612Z.00000000033","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715755","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753614613Z.00000000040
Helen B. Millson
Mark Piper Osteopathic maintenance of a football team Bryan English Lower limb disorders in sportsmen Helen Millson Contentious issues in management of groin/hips – EBM Simon Petrides Prolotherapy in elite rowers; video fluoroscopy; evidence of effectiveness of prolotherapy for low back pain. David Lewis Ultrasound in diagnosis of acute sporting injury Mark Bowditch Surgical treatment of the sporting knee
Mark Piper足球队的整骨疗法维护Bryan English运动员下肢疾病Helen Millson腹股沟/髋关节管理的争议问题- EBM Simon Petrides精英赛艇运动员的Prolotherapy;视频透视;前驱治疗腰痛有效性的证据。超声诊断急性运动损伤马克鲍迪奇手术治疗运动膝关节
{"title":"The British Institute of Musculoskeletal Medicine Our Sporting Life – Osteopathy and Sports Injuries in Practice Winter Symposium, 1 December 2012, Ipswich","authors":"Helen B. Millson","doi":"10.1179/1753614613Z.00000000040","DOIUrl":"https://doi.org/10.1179/1753614613Z.00000000040","url":null,"abstract":"Mark Piper Osteopathic maintenance of a football team Bryan English Lower limb disorders in sportsmen Helen Millson Contentious issues in management of groin/hips – EBM Simon Petrides Prolotherapy in elite rowers; video fluoroscopy; evidence of effectiveness of prolotherapy for low back pain. David Lewis Ultrasound in diagnosis of acute sporting injury Mark Bowditch Surgical treatment of the sporting knee","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"41 - 43"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613Z.00000000040","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753614613z.00000000039
A. Jacks, T. Barling
In Yelland’s comments on our paper in Int Musculoskelet Med 2012; 34:7–12, he makes a number of excellent points with which we generally agree; however, we wish to clarify some points and to build on others. We accept the uncertainty of the exact definition of instability but this should not prevent us from agreeing a reasonably uniform client base on whom to try to refine the efficacy of a treatment that seems to work well. Our subjects with lumbar or pelvic pain who had a diminishing response to manipulation were just one subgroup of several described, indeed some had no discernible dysfunction to manipulate. Our patients were all treated on three occasions rather than up to seven times as in Yelland’s cases and whereas he treated only tender entheses, we treat bilateral ligament attachments across affected segments even if there is only unilateral tenderness. We feel as does Yelland that both studies compare favourably with spinal fusion and that our group was also ‘from the difficult end of the spectrum’ – constituting only 5 and 9%, respectively, of our clinics’ patients. With regard to future research we support Yelland’s proposal that an extended series analysed carefully for subgroups is a practical way forward. Both of us have continued to collect the same data since publication and will be able to analyse subgroups further by factors such as ligament group treated (e.g. sacroiliac, iliolumbar, or lumbosacral) sex, age, and length of initial history. Further subgroups would require a considerable amount of work. We favour this approach since we already have the data collection process in place but as Yelland states so clearly in conclusion there is plenty of room for more research in this area.
{"title":"Lumbosacral prolotherapy","authors":"A. Jacks, T. Barling","doi":"10.1179/1753614613z.00000000039","DOIUrl":"https://doi.org/10.1179/1753614613z.00000000039","url":null,"abstract":"In Yelland’s comments on our paper in Int Musculoskelet Med 2012; 34:7–12, he makes a number of excellent points with which we generally agree; however, we wish to clarify some points and to build on others. We accept the uncertainty of the exact definition of instability but this should not prevent us from agreeing a reasonably uniform client base on whom to try to refine the efficacy of a treatment that seems to work well. Our subjects with lumbar or pelvic pain who had a diminishing response to manipulation were just one subgroup of several described, indeed some had no discernible dysfunction to manipulate. Our patients were all treated on three occasions rather than up to seven times as in Yelland’s cases and whereas he treated only tender entheses, we treat bilateral ligament attachments across affected segments even if there is only unilateral tenderness. We feel as does Yelland that both studies compare favourably with spinal fusion and that our group was also ‘from the difficult end of the spectrum’ – constituting only 5 and 9%, respectively, of our clinics’ patients. With regard to future research we support Yelland’s proposal that an extended series analysed carefully for subgroups is a practical way forward. Both of us have continued to collect the same data since publication and will be able to analyse subgroups further by factors such as ligament group treated (e.g. sacroiliac, iliolumbar, or lumbosacral) sex, age, and length of initial history. Further subgroups would require a considerable amount of work. We favour this approach since we already have the data collection process in place but as Yelland states so clearly in conclusion there is plenty of room for more research in this area.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"44 - 44"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614613z.00000000039","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715949","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753615413Y.0000000016
Chinmay De, B. Mondal, R. Sinha, S. Dasgupta, D. Ghosh, A. Majhi
Abstract Background Tuberculosis (TB) is a common disease in a tropical country like India. The commonest mode of presentation is pulmonary, followed by lymphatic, genitourinary, and osteoarticular. An even less common presentation is non-osteoarticular TB in a limb, and this may be bizarre when it involves a bursa or muscle tendon sheath. In such situations there is often a diagnostic problem. We present a consecutive case series of non-osteoarticular TB in the limbs. We look at the various clinical and laboratory aspects that would help to diagnose this uncommon but important presentation. Materials and methods All cases of chronic swelling in a limb with possible features of TB, presenting to a busy orthopaedic service, were assessed for history of contact with TB patients, clinical manifestations, radiological findings, Mantoux test, blood erythrocyte sedimentation rate (ESR), fine-needle aspiration cytology (FNAC), core biopsy of swelling, and bacteriological and histopathological examination (HPE) of biopsy material. After confirmation, patients were treated by anti-tuberculous drugs (ATDs) under directly observed treatment, short-course. Results Twenty-one suspected cases of non-osteoarticular TB of limb were studied in 3 years. There was an average delay of 8 months in diagnosis after onset of symptoms. Adults of all ages were affected (range 16–62 years) with a male:female ratio of 1:1.6. Diagnosis was confirmed by mycobacterial culture in 5 cases, HPE in 10 cases, and FNAC in 6 cases. All patients responded to ATD. The mean follow-up period was 15 months. Conclusion Non-osteoarticular TB in a limb is a diagnostic dilemma and is often not considered in differential diagnosis of any soft tissue swelling in limb. This leads to delay in diagnosis, with further increase in morbidity. Failure to isolate the mycobacterium in culture and sometimes negative histopathological findings make the task more difficult. However, a strong clinical suspicion aided by investigations like FNAC, core biopsy, culture, blood ESR, and Mantoux test can lead to early diagnosis.
{"title":"A case series of 21 patients with non-osteo-articular tuberculosis of limbs","authors":"Chinmay De, B. Mondal, R. Sinha, S. Dasgupta, D. Ghosh, A. Majhi","doi":"10.1179/1753615413Y.0000000016","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000016","url":null,"abstract":"Abstract Background Tuberculosis (TB) is a common disease in a tropical country like India. The commonest mode of presentation is pulmonary, followed by lymphatic, genitourinary, and osteoarticular. An even less common presentation is non-osteoarticular TB in a limb, and this may be bizarre when it involves a bursa or muscle tendon sheath. In such situations there is often a diagnostic problem. We present a consecutive case series of non-osteoarticular TB in the limbs. We look at the various clinical and laboratory aspects that would help to diagnose this uncommon but important presentation. Materials and methods All cases of chronic swelling in a limb with possible features of TB, presenting to a busy orthopaedic service, were assessed for history of contact with TB patients, clinical manifestations, radiological findings, Mantoux test, blood erythrocyte sedimentation rate (ESR), fine-needle aspiration cytology (FNAC), core biopsy of swelling, and bacteriological and histopathological examination (HPE) of biopsy material. After confirmation, patients were treated by anti-tuberculous drugs (ATDs) under directly observed treatment, short-course. Results Twenty-one suspected cases of non-osteoarticular TB of limb were studied in 3 years. There was an average delay of 8 months in diagnosis after onset of symptoms. Adults of all ages were affected (range 16–62 years) with a male:female ratio of 1:1.6. Diagnosis was confirmed by mycobacterial culture in 5 cases, HPE in 10 cases, and FNAC in 6 cases. All patients responded to ATD. The mean follow-up period was 15 months. Conclusion Non-osteoarticular TB in a limb is a diagnostic dilemma and is often not considered in differential diagnosis of any soft tissue swelling in limb. This leads to delay in diagnosis, with further increase in morbidity. Failure to isolate the mycobacterium in culture and sometimes negative histopathological findings make the task more difficult. However, a strong clinical suspicion aided by investigations like FNAC, core biopsy, culture, blood ESR, and Mantoux test can lead to early diagnosis.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"12 - 8"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000016","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722797","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2013-04-01DOI: 10.1179/1753614612Z.00000000032
J. Patijn, L. Beyer, O. Airaksinen, J. Kouri, Vesa Lehtola, M. Eerd
s International Academy of Manual / Musculoskeletal Medicine Bratislava, October 2012
国际手工/肌肉骨骼医学学会，布拉迪斯拉发，2012年10月
{"title":"International Academy of Manual / Musculoskeletal Medicine Bratislava, October 2012","authors":"J. Patijn, L. Beyer, O. Airaksinen, J. Kouri, Vesa Lehtola, M. Eerd","doi":"10.1179/1753614612Z.00000000032","DOIUrl":"https://doi.org/10.1179/1753614612Z.00000000032","url":null,"abstract":"s International Academy of Manual / Musculoskeletal Medicine Bratislava, October 2012","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"35 1","pages":"29 - 40"},"PeriodicalIF":0.0,"publicationDate":"2013-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614612Z.00000000032","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65715694","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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