Pub Date : 2014-07-01DOI: 10.1179/1753614614Z.00000000072
F. Naim, Khamis Elessi
Abstract The pelvic bones and especially the ischium are rare sites for osteomyelitis. The case of a 30-year-old man with osteomyelitis in the ischium is presented, where persistent pain was not accompanied by markers of acute inflammation. Details of further investigation and treatment are described. Osteomyelitis must be kept in mind as a possible differential diagnosis of persisting pain around the pelvis, and appropriate investigations carried out.
{"title":"Osteomyelitis of the ischium: An often missed diagnosis, case study report","authors":"F. Naim, Khamis Elessi","doi":"10.1179/1753614614Z.00000000072","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000072","url":null,"abstract":"Abstract The pelvic bones and especially the ischium are rare sites for osteomyelitis. The case of a 30-year-old man with osteomyelitis in the ischium is presented, where persistent pain was not accompanied by markers of acute inflammation. Details of further investigation and treatment are described. Osteomyelitis must be kept in mind as a possible differential diagnosis of persisting pain around the pelvis, and appropriate investigations carried out.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"79 - 81"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716605","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 : 2014-07-01DOI: 10.1179/1753614614Z.00000000073
J. Patijn
Abstract In pain research, functional magnetic resonance imaging (fMRI) plays an increasingly important role, which raises questions about the clinical significance of fMRI for the treatment and diagnosis of pain in general. All the more so because some publications suggest replacing the ‘subjective"’visual analogue scale pain score with the ‘objective’ results in fMRI. The fMRI technique as such and its relation to pain in research conditions has a large number of objections. One of the major limitations is the fact that in a very limited number of fMRI studies (8%), the results are reproduced within the study format itself (test–retest). This makes interpretation and mutual comparison of the fMRI studies extremely difficult. Therefore the clinical value of fMRI for treatment and diagnosis is hard to estimate.
在疼痛研究中，功能磁共振成像(functional magnetic resonance imaging, fMRI)发挥着越来越重要的作用，这也引发了人们对fMRI在一般疼痛治疗和诊断中的临床意义的质疑。更重要的是，一些出版物建议用功能磁共振成像的“客观”结果取代“主观”的“视觉模拟量表”疼痛评分。功能磁共振成像技术本身及其与研究条件下疼痛的关系存在大量反对意见。其中一个主要的限制是，在非常有限的fMRI研究中(8%)，结果在研究形式本身(测试-再测试)中被复制。这使得fMRI研究的解释和相互比较非常困难。因此，功能磁共振成像在治疗和诊断中的临床价值难以估计。
{"title":"Functional MRI in pain: A valuable and/or reliable diagnostic tool for your pain patient?","authors":"J. Patijn","doi":"10.1179/1753614614Z.00000000073","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000073","url":null,"abstract":"Abstract In pain research, functional magnetic resonance imaging (fMRI) plays an increasingly important role, which raises questions about the clinical significance of fMRI for the treatment and diagnosis of pain in general. All the more so because some publications suggest replacing the ‘subjective\"’visual analogue scale pain score with the ‘objective’ results in fMRI. The fMRI technique as such and its relation to pain in research conditions has a large number of objections. One of the major limitations is the fact that in a very limited number of fMRI studies (8%), the results are reproduced within the study format itself (test–retest). This makes interpretation and mutual comparison of the fMRI studies extremely difficult. Therefore the clinical value of fMRI for treatment and diagnosis is hard to estimate.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"75 - 78"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716738","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 : 2014-07-01DOI: 10.1179/1753615414Y.0000000028
David W. Allen
Abstract Objective To investigate the precision of acupuncture needle placement using two methods of guidance (termed assisted and guided). Method A lamb shoulder in vitro study model was chosen. In the case of assisted acupuncture, the track the needle would take was visualized before subsequent blind needle placement. For guided acupuncture, the needle placement was seen in real-time. In total, 33 measurements of needle tip–target distance were performed for each of the two methods of acupuncture needle placement. Descriptive statistics were used to compare the precision of the two methods. Repeated measurements were analysed to investigate operator reliability using the intra-class correlation coefficient (ICC) statistic. Results In terms of precision of needle placement, guided placement was more precise than assisted. Guided acupuncture (0.2 mm ± 0.19 SD) was more precise than assisted (4.4 mm ± 4.08 SD). Operator reliability of measurement of needle tip–target distance was good for both methods. Assisted method gave an ICC of 0.99, whereas the guided method was 0.90. Discussion Precision of acupuncture placement is improved by diagnostic ultrasound guidance. The utilization of diagnostic ultrasound prior to needling in anatomically challenging areas may contribute to patient safety. The visualization of needle track anatomy may facilitate skill acquisition when training in acupuncture.
{"title":"Precision of acupuncture placement using diagnostic ultrasound","authors":"David W. Allen","doi":"10.1179/1753615414Y.0000000028","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000028","url":null,"abstract":"Abstract Objective To investigate the precision of acupuncture needle placement using two methods of guidance (termed assisted and guided). Method A lamb shoulder in vitro study model was chosen. In the case of assisted acupuncture, the track the needle would take was visualized before subsequent blind needle placement. For guided acupuncture, the needle placement was seen in real-time. In total, 33 measurements of needle tip–target distance were performed for each of the two methods of acupuncture needle placement. Descriptive statistics were used to compare the precision of the two methods. Repeated measurements were analysed to investigate operator reliability using the intra-class correlation coefficient (ICC) statistic. Results In terms of precision of needle placement, guided placement was more precise than assisted. Guided acupuncture (0.2 mm ± 0.19 SD) was more precise than assisted (4.4 mm ± 4.08 SD). Operator reliability of measurement of needle tip–target distance was good for both methods. Assisted method gave an ICC of 0.99, whereas the guided method was 0.90. Discussion Precision of acupuncture placement is improved by diagnostic ultrasound guidance. The utilization of diagnostic ultrasound prior to needling in anatomically challenging areas may contribute to patient safety. The visualization of needle track anatomy may facilitate skill acquisition when training in acupuncture.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"64 - 74"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722937","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 : 2014-07-01DOI: 10.1179/1753615414Y.0000000035
P. Wheeler
Abstract Objective To identify outcomes for patients undergoing high-volume image-guided injection (HVIGI) for Achilles tendinopathy symptoms. Methods This is a prospective case-series design for all patients undergoing HVIGI in a single NHS Sports Medicine Clinic, performed by a single sports medicine consultant. HVIGI was performed with 10 ml 1% lidocaine, 40 ml saline, but unlike previously published case series, without corticosteroid or aprotinin. Results Sixteen patients were identified, of whom 14 had follow-up data available, with a mean duration of follow-up of 347 days. Overall, 50% were pain-free or virtually pain-free (recorded as a score of 0–1 on a 10-point visual analogue scale (VAS)) at the most recent follow-up. There was an average reduction in VAS score overall of 6.1 points on a 0–10 VAS, and an improvement in the Victorian Institute of Sport Assessment - Achilles (VISA-A) score of 41 points on the percentage scale. However, 14% of patients who underwent HVIGI required surgical intervention for on-going symptoms. Discussion HVIGI without corticosteroid appears to be an effective procedure for patients with recalcitrant Achilles tendon symptoms. Small sub-group numbers limit formal analysis, but suggest that there may be more benefit of HVIGI in patients with Achilles symptoms of less than 3 years. Further work is needed to formally establish benefits from HVIGI for patients with Achilles tendinopathy and to identify optimal injectate.
{"title":"The use of high-volume image-guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study","authors":"P. Wheeler","doi":"10.1179/1753615414Y.0000000035","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000035","url":null,"abstract":"Abstract Objective To identify outcomes for patients undergoing high-volume image-guided injection (HVIGI) for Achilles tendinopathy symptoms. Methods This is a prospective case-series design for all patients undergoing HVIGI in a single NHS Sports Medicine Clinic, performed by a single sports medicine consultant. HVIGI was performed with 10 ml 1% lidocaine, 40 ml saline, but unlike previously published case series, without corticosteroid or aprotinin. Results Sixteen patients were identified, of whom 14 had follow-up data available, with a mean duration of follow-up of 347 days. Overall, 50% were pain-free or virtually pain-free (recorded as a score of 0–1 on a 10-point visual analogue scale (VAS)) at the most recent follow-up. There was an average reduction in VAS score overall of 6.1 points on a 0–10 VAS, and an improvement in the Victorian Institute of Sport Assessment - Achilles (VISA-A) score of 41 points on the percentage scale. However, 14% of patients who underwent HVIGI required surgical intervention for on-going symptoms. Discussion HVIGI without corticosteroid appears to be an effective procedure for patients with recalcitrant Achilles tendon symptoms. Small sub-group numbers limit formal analysis, but suggest that there may be more benefit of HVIGI in patients with Achilles symptoms of less than 3 years. Further work is needed to formally establish benefits from HVIGI for patients with Achilles tendinopathy and to identify optimal injectate.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"103 - 96"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723408","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 : 2014-07-01DOI: 10.1179/1753614614Z.00000000081
M. Hutson
Musculoskeletal medicine, as practised by dedicated musculoskeletal physicians, provides an opportunity for translating conceptual beliefs into medical practice. Given the current level of angst regarding the National Health System (NHS) in the UK, it also offers me the opportunity for reflection. I would initially like to review some aspects of the evidence for our practice. How did we obtain and how do we continue to obtain evidence? Do we believe that evidence-based medicine, as it has been understood since its formal inception, still works for us? Despite the plethora of published scientific evidence and guidelines over the last 20 years, it is tempting and possibly true to state that the ‘evidence’ that we hold dear to us and use consistently in our medical practice comes primarily from those teachers with whom we had our first contact. There are still diverse beliefs, even a sectarian divide, among the musculoskeletal/manual medicine community. Within that community, decades ago, James Cyriax had (and indeed continues to have) many advocates. I have often used the term ‘structuralism’ to describe his approach, based on patho-anatomy and a beautifully devised examination system. ‘Across the divide’ is the traditional osteopathic approach (which Cyriax so despised) that is centred on somatic dysfunction, with its more subtle manual diagnostic findings, which can also be appealing too. Polarization of approaches to health issues have been present since the days of Asclepius (God of Medicine) and his daughter Hygiea (Goddess of Health) in Ancient Greece, though it is gratifying that in musculoskeletal medical practice in the UK over the more recent decades during which Still, Cyriax, and Lewit have been pre-eminent, there has developed a realization that we can live together, learn from each other, and practise the medical creed in which we have most belief, while acknowledging and implementing beliefs from ‘the other side’. The international situation, particularly in Europe, with respect to musculoskeletal/manual medicine is much the same. Followers of gurus throughout Europe created sects, to the extent that in some countries opinions have been very much divided as to the direction that manual medicine should take, based on their initial teaching. However, this appears to have gradually changed, leading to combined efforts being made to establish an accepted subspecialty of manual medicine within the European Union of Medical Specialists (UEMS). In the UK, 1991 was a momentous year when the Institute of Orthopaedic Medicine (based on the Cyriax approach) held talks with the British Association of Manipulative Medicine, which was based on a pragmatic approach, and the London College of Osteopathic Medicine, based on traditional osteopathic concepts, and agreed to form British Institute of musculoskeletal medicine (BIMM), in which there would be full recognition of and acceptance of underlying concepts as described. BIMM has continued to promo
由专门的肌肉骨骼医生进行的肌肉骨骼医学为将概念信念转化为医疗实践提供了机会。考虑到目前人们对英国国家卫生系统(NHS)的担忧程度，这也给了我一个反思的机会。首先，我想回顾一下我们实践中证据的一些方面。我们是如何获得证据的?我们将如何继续获得证据?我们相信循证医学，就像它正式诞生以来所理解的那样，仍然对我们有效吗?尽管在过去的20年里发表了大量的科学证据和指导方针，但我们在医疗实践中所珍视和一贯使用的“证据”主要来自于我们第一次接触的那些老师，这是很诱人的，而且可能是正确的。在肌肉骨骼/手工医学社区中，仍然存在不同的信仰，甚至宗派分歧。几十年前，在这个社区里，James Cyriax有(现在仍然有)很多支持者。我经常用“结构主义”这个词来形容他的方法，这种方法基于病理解剖学和设计精美的检查系统。“跨越鸿沟”是传统的整骨疗法(Cyriax非常鄙视)，它以躯体功能障碍为中心，采用更微妙的手动诊断结果，这也很有吸引力。自古希腊的阿斯克勒庇俄斯(医神)和他的女儿健神(健康女神)时代以来，健康问题的两极分化就一直存在，尽管令人欣慰的是，在英国的肌肉骨骼医学实践中，在最近几十年里，斯蒂尔、西里亚克斯和莱维特都非常杰出，人们已经认识到，我们可以共同生活，相互学习，实践我们最相信的医学信条。同时承认并执行来自“另一方”的信念。肌肉骨骼/手工医学方面的国际情况，特别是欧洲的情况大致相同。在整个欧洲，古鲁的追随者们创立了教派，以至于在一些国家，根据他们最初的教导，对于手工医学应该采取的方向，意见分歧很大。然而，这种情况似乎已逐渐改变，导致在欧洲医学专家联盟(UEMS)内共同努力建立一个公认的手工医学亚专科。在英国，1991年是一个重要的年份，骨科医学研究所(基于Cyriax方法)与基于实用方法的英国手法医学协会(British Association of Manipulative Medicine)和基于传统整骨疗法概念的伦敦整骨医学学院(London College of Osteopathic Medicine)举行会谈，并同意成立英国肌肉骨骼医学研究所(British Institute of muscle - skeletal Medicine, BIMM)，其中将充分承认和接受所描述的基本概念。从那以后，BIMM继续推广这种折衷的体系。但是，从个人的角度来看，证据往往会受到我们形成时期的强烈影响，在这段时间里，我们开始相信对我们最有意义的“真理”和体系。我个人的职业生涯可以很好地说明这种情况。在我早期的医疗实践中，我一直是Cyriax的忠实弟子，我接触并使用了与国际骨科和手工医学概念相关的手工技术，特别是来自美国和捷克共和国。我的思维开阔了，我相信我对功能性肌肉骨骼问题的理解大大扩展了，我是一个更好的医生。然而，预期一个观点或一个教派将永远处于优势地位是不明智的。世界不是这样运转的。总是会有从事肌肉骨骼医学的临床医生，他们的观点在概念上与其他人不同，特别是那些坚持结构病理学和接受功能失调概念的人之间强调的差异。在英国，GPWSI(对肌肉骨骼医学有特殊兴趣的全科医生)有优势的通信:Michael Hutson, Village House, Owthorpe, Nottingham NG12 3GE, UK。电子邮件:mahutson@aol.com
{"title":"The current state of musculoskeletal medicine","authors":"M. Hutson","doi":"10.1179/1753614614Z.00000000081","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000081","url":null,"abstract":"Musculoskeletal medicine, as practised by dedicated musculoskeletal physicians, provides an opportunity for translating conceptual beliefs into medical practice. Given the current level of angst regarding the National Health System (NHS) in the UK, it also offers me the opportunity for reflection. I would initially like to review some aspects of the evidence for our practice. How did we obtain and how do we continue to obtain evidence? Do we believe that evidence-based medicine, as it has been understood since its formal inception, still works for us? Despite the plethora of published scientific evidence and guidelines over the last 20 years, it is tempting and possibly true to state that the ‘evidence’ that we hold dear to us and use consistently in our medical practice comes primarily from those teachers with whom we had our first contact. There are still diverse beliefs, even a sectarian divide, among the musculoskeletal/manual medicine community. Within that community, decades ago, James Cyriax had (and indeed continues to have) many advocates. I have often used the term ‘structuralism’ to describe his approach, based on patho-anatomy and a beautifully devised examination system. ‘Across the divide’ is the traditional osteopathic approach (which Cyriax so despised) that is centred on somatic dysfunction, with its more subtle manual diagnostic findings, which can also be appealing too. Polarization of approaches to health issues have been present since the days of Asclepius (God of Medicine) and his daughter Hygiea (Goddess of Health) in Ancient Greece, though it is gratifying that in musculoskeletal medical practice in the UK over the more recent decades during which Still, Cyriax, and Lewit have been pre-eminent, there has developed a realization that we can live together, learn from each other, and practise the medical creed in which we have most belief, while acknowledging and implementing beliefs from ‘the other side’. The international situation, particularly in Europe, with respect to musculoskeletal/manual medicine is much the same. Followers of gurus throughout Europe created sects, to the extent that in some countries opinions have been very much divided as to the direction that manual medicine should take, based on their initial teaching. However, this appears to have gradually changed, leading to combined efforts being made to establish an accepted subspecialty of manual medicine within the European Union of Medical Specialists (UEMS). In the UK, 1991 was a momentous year when the Institute of Orthopaedic Medicine (based on the Cyriax approach) held talks with the British Association of Manipulative Medicine, which was based on a pragmatic approach, and the London College of Osteopathic Medicine, based on traditional osteopathic concepts, and agreed to form British Institute of musculoskeletal medicine (BIMM), in which there would be full recognition of and acceptance of underlying concepts as described. BIMM has continued to promo","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"59 1","pages":"85 - 86"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716830","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 : 2014-07-01DOI: 10.1179/1753614614Z.00000000075
C. Clark, S. Docherty, N. Osborne, A. Khattab
Abstract Study design Cross-sectional laboratory study. Objective To compare the difference in passive re-positioning accuracy in the frontal plane, as a measure of lumbar kinaesthesis, between participants with chronic non-specific low back pain (CNSLBP) and healthy volunteers. Background Evidence suggests that spinal kinaesthesis impacting on spinal stability might be compromised in those with CNSLBP. It is suggested that in those with CNSLBP, there may be changes in ligamentous patho-physiology which lead to altered kinaesthetic perception. Methods Fourteen female participants, representing two groups, took part in the study. Participants in group one (n = 7) were those with CNSLBP (mean age 47.1 ± 15.41) and participants in group two (n = 7) were healthy volunteers (mean age 45.6 ± 10.63). There were no significant differences between the groups with regards to age, education, height, weight, hip, and waist circumference and all were right handed. Passive lumbar re-positioning accuracy was measured in the frontal plane using a motorized plinth with the Zebris® ultrasound-based motion analyser and the target positions were 10° left and right lumbar side flexion and neutral. Results The mean reporting error for the neutral position for participants with CNSLBP vs. healthy volunteers was <2.4° and <2.2° on both occasions (P > 0.05), respectively. The mean reporting error in left-side flexion for participants with CNSLBP vs. healthy volunteers was <1.5° and <2.0° on both occasions (P < 0.01; P < 0.05). The mean reporting error in right-side flexion for participants with CNSLBP vs. healthy volunteers was <2.1° and <1.1° on both occasions (P > 0.05). Conclusion There was a statistically significant difference in passive re-positioning accuracy to the left side only between participants with CNSLBP and healthy volunteers. This may represent an important finding in relation to structures that provide sensory information and the integration of that information in those with CNSLBP.
{"title":"A pilot study to compare passive lumbar spine re-positioning error in those with chronic low back pain with healthy volunteers","authors":"C. Clark, S. Docherty, N. Osborne, A. Khattab","doi":"10.1179/1753614614Z.00000000075","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000075","url":null,"abstract":"Abstract Study design Cross-sectional laboratory study. Objective To compare the difference in passive re-positioning accuracy in the frontal plane, as a measure of lumbar kinaesthesis, between participants with chronic non-specific low back pain (CNSLBP) and healthy volunteers. Background Evidence suggests that spinal kinaesthesis impacting on spinal stability might be compromised in those with CNSLBP. It is suggested that in those with CNSLBP, there may be changes in ligamentous patho-physiology which lead to altered kinaesthetic perception. Methods Fourteen female participants, representing two groups, took part in the study. Participants in group one (n = 7) were those with CNSLBP (mean age 47.1 ± 15.41) and participants in group two (n = 7) were healthy volunteers (mean age 45.6 ± 10.63). There were no significant differences between the groups with regards to age, education, height, weight, hip, and waist circumference and all were right handed. Passive lumbar re-positioning accuracy was measured in the frontal plane using a motorized plinth with the Zebris® ultrasound-based motion analyser and the target positions were 10° left and right lumbar side flexion and neutral. Results The mean reporting error for the neutral position for participants with CNSLBP vs. healthy volunteers was <2.4° and <2.2° on both occasions (P > 0.05), respectively. The mean reporting error in left-side flexion for participants with CNSLBP vs. healthy volunteers was <1.5° and <2.0° on both occasions (P < 0.01; P < 0.05). The mean reporting error in right-side flexion for participants with CNSLBP vs. healthy volunteers was <2.1° and <1.1° on both occasions (P > 0.05). Conclusion There was a statistically significant difference in passive re-positioning accuracy to the left side only between participants with CNSLBP and healthy volunteers. This may represent an important finding in relation to structures that provide sensory information and the integration of that information in those with CNSLBP.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"104 - 110"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716753","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 : 2014-07-01DOI: 10.1179/1753614614Z.00000000067
Margaret Taylor
Reply to the audit by Hourigan et al. of the Primary care awareness of coccydynia in Devon: I wonder why the authors did not give the general practitioners the option of choosing prolotherapy as a treatment for coccydynia. When the authors did their literature search, they must have noticed the 2008 paper by Khan et al. in which 37 patients with average visual analog scale (VAS) for pain of 8.5 were treated with 20% glucose (dextrose) and lignocaine. After the first treatment, the average pain VAS was reduced to 3.4 and 2.5 after the second injection. In eight patients who still had pain VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Minimal or no improvement was noted in seven patients; the remaining 30 patients had good pain relief. The authors concluded that dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. They suggest that randomized studies are needed to compare prolotherapy with local steroid injections. However, since there are no long-term (or short-term) side effects of glucose injections comparable to the skin atrophy and delayed long-term healing with steroid injections, it seems more logical to use the least harmful treatment first. In my practice I have not found it necessary to use radiological imaging. Localizing the strained ligaments by palpation is perfectly adequate, as strained enthuses are tender as well as painful. Treating all the painful points around the coccyx, including the tip, the sacrococcygeal joint and often also the sides, where some fibres of the sacrotuberous ligaments insert, with 20% glucose and 0.1% lignocaine, results in complete or adequate relief of pain within four treatments.
{"title":"Coccydynia in primary care","authors":"Margaret Taylor","doi":"10.1179/1753614614Z.00000000067","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000067","url":null,"abstract":"Reply to the audit by Hourigan et al. of the Primary care awareness of coccydynia in Devon: I wonder why the authors did not give the general practitioners the option of choosing prolotherapy as a treatment for coccydynia. When the authors did their literature search, they must have noticed the 2008 paper by Khan et al. in which 37 patients with average visual analog scale (VAS) for pain of 8.5 were treated with 20% glucose (dextrose) and lignocaine. After the first treatment, the average pain VAS was reduced to 3.4 and 2.5 after the second injection. In eight patients who still had pain VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Minimal or no improvement was noted in seven patients; the remaining 30 patients had good pain relief. The authors concluded that dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. They suggest that randomized studies are needed to compare prolotherapy with local steroid injections. However, since there are no long-term (or short-term) side effects of glucose injections comparable to the skin atrophy and delayed long-term healing with steroid injections, it seems more logical to use the least harmful treatment first. In my practice I have not found it necessary to use radiological imaging. Localizing the strained ligaments by palpation is perfectly adequate, as strained enthuses are tender as well as painful. Treating all the painful points around the coccyx, including the tip, the sacrococcygeal joint and often also the sides, where some fibres of the sacrotuberous ligaments insert, with 20% glucose and 0.1% lignocaine, results in complete or adequate relief of pain within four treatments.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"82 - 82"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716926","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 : 2014-07-01DOI: 10.1179/1753615414Y.0000000030
J. Flynn, A. Clough
Abstract This case report presents a commonly presenting clinical condition in the context of evidence informed literature on tendinopathy and a systematic applied reasoning (SAR) model of clinical problem solving as an aide-memoire to develop the clinical management of lateral epicondylopathy.
{"title":"Whole upper limb strengthening in treatment of lateral epicondylopathy","authors":"J. Flynn, A. Clough","doi":"10.1179/1753615414Y.0000000030","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000030","url":null,"abstract":"Abstract This case report presents a commonly presenting clinical condition in the context of evidence informed literature on tendinopathy and a systematic applied reasoning (SAR) model of clinical problem solving as an aide-memoire to develop the clinical management of lateral epicondylopathy.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"1 1","pages":"111 - 116"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723216","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 : 2014-07-01DOI: 10.1179/1753614614Z.00000000070
J. Inklebarger
Abstract The literature reports that 39% of chronic lower back pain may be attributed to intervertebral disc derangement. However, definitive diagnosis of discogenic lower back pain (DLBP) remains challenging. Clinical examination may be normal and the correlative utility of magnetic resonance imaging findings such as the high intensity zone is controversial. Researchers have identified a complex interplay of degenerative, immunohistological, and biomechanical overload factors as causative. Due to difficulties in diagnosis through physical examination and imaging alone, provocative discography is still the gold standard for surgical planning, by measuring intradiscal pressure, finding extradiscal dye extravasation, and by reproducing concordant pain against controls. This remains so, despite the known sequelae of latent acceleration of disc degeneration following the procedure. Lumbar interbody fusion (LIF), in its various forms, is the traditional surgical management for intractable pain from DLBP. However, due to this surgery's known complications of progressive biomechanical overload and degeneration of adjacent non-fused segments, it is regarded as an end of the line management. Artificial disc implants may offer an improved biomechanical alternative to LIF, but its efficacy is uncertain; while new non-surgical managements, such as stem cell regeneration and gene therapy, show promise but require further investigation. This paper explores some of the research opinions, theories of causation, and management strategies.
{"title":"Discogenic lower back pain: Current concepts","authors":"J. Inklebarger","doi":"10.1179/1753614614Z.00000000070","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000070","url":null,"abstract":"Abstract The literature reports that 39% of chronic lower back pain may be attributed to intervertebral disc derangement. However, definitive diagnosis of discogenic lower back pain (DLBP) remains challenging. Clinical examination may be normal and the correlative utility of magnetic resonance imaging findings such as the high intensity zone is controversial. Researchers have identified a complex interplay of degenerative, immunohistological, and biomechanical overload factors as causative. Due to difficulties in diagnosis through physical examination and imaging alone, provocative discography is still the gold standard for surgical planning, by measuring intradiscal pressure, finding extradiscal dye extravasation, and by reproducing concordant pain against controls. This remains so, despite the known sequelae of latent acceleration of disc degeneration following the procedure. Lumbar interbody fusion (LIF), in its various forms, is the traditional surgical management for intractable pain from DLBP. However, due to this surgery's known complications of progressive biomechanical overload and degeneration of adjacent non-fused segments, it is regarded as an end of the line management. Artificial disc implants may offer an improved biomechanical alternative to LIF, but its efficacy is uncertain; while new non-surgical managements, such as stem cell regeneration and gene therapy, show promise but require further investigation. This paper explores some of the research opinions, theories of causation, and management strategies.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"50 - 53"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716594","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 : 2014-07-01DOI: 10.1179/1753615414Y.0000000029
F. Blackman, E. Atkins
Abstract Objective A pilot study to investigate whether the addition of grade B mobilization to a muscle strengthening home exercise programme improves outcomes for patients with symptomatic early-stage hip osteoarthritis. Methods Twenty-three patients were randomized into either a home exercise group (n = 12) or grade B mobilization group (n = 11). Both groups carried out a muscle strengthening home exercise programme for 6 weeks. In addition, the grade B mobilization group received 6 weekly sessions of grade B hip mobilization (passive stretching techniques) and carried out stretches at home. Outcome measures included the visual analogue scale for pain, the Lower Extremity Functional Scale and goniometric measurement of hip flexion and medial rotation at baseline (week 1) and after the 6-week treatment period (week 7). Results Twenty-one participants (91%) completed the trial. Both groups showed improvement in all outcome measures. The change in pre-/post-treatment scores was significantly greater in the grade B mobilization group for pain (t(19) = 2.378, P = 0.03, large effect size d = 1.02) and passive hip flexion (t(19) = −4.192, P = 0.001, large effect size d = 1.80). No significant difference was found for function (t(19) = 0.444, P = 0.662, small effect size d = 0.20) or passive hip medial rotation (t(19) = −1.053, P = 0.305, moderate effect size d = 0.46). However, these results are inconclusive as this pilot study was underpowered. Discussion A worthwhile benefit may exist from the addition of grade B mobilization to a muscle strengthening home exercise programme, particularly with pain and passive hip flexion. This warrants further investigation. Although this pilot study demonstrated a feasible design, recommendations have been made for its development.
【摘要】目的一项初步研究，探讨在肌肉强化家庭运动项目中加入B级运动是否能改善早期症状性髋关节骨关节炎患者的预后。方法23例患者随机分为家庭运动组(n = 12)和B级运动组(n = 11)。两组都进行了为期6周的肌肉强化家庭锻炼计划。此外，B级活动组每周接受6次B级髋关节活动(被动拉伸技术)，并在家中进行拉伸。结果测量包括疼痛的视觉模拟量表、下肢功能量表以及基线(第1周)和6周治疗期后(第7周)髋关节屈曲和内侧旋转的角度测量。结果21名参与者(91%)完成了试验。两组的所有结果指标均有改善。B级活动组治疗前/治疗后评分的变化显著大于疼痛组(t(19) = 2.378, P = 0.03，大效应量d = 1.02)和被动髋屈曲组(t(19) = - 4.192, P = 0.001，大效应量d = 1.80)。功能(t(19) = 0.444, P = 0.662，小效应量d = 0.20)和被动髋关节内侧旋转(t(19) = - 1.053, P = 0.305，中等效应量d = 0.46)无显著差异。然而，这些结果是不确定的，因为这项初步研究的动力不足。在增强肌肉的家庭锻炼计划中增加B级活动可能会有一个值得注意的好处，特别是对于疼痛和被动髋关节屈曲。这值得进一步调查。虽然这项试点研究证明了一种可行的设计，但已经为其发展提出了建议。
{"title":"The effect of adding grade B hip mobilization to a muscle strengthening home exercise programme on pain, function, and range of movement in adults with symptomatic early-stage hip osteoarthritis: A pilot study for a randomized controlled trial","authors":"F. Blackman, E. Atkins","doi":"10.1179/1753615414Y.0000000029","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000029","url":null,"abstract":"Abstract Objective A pilot study to investigate whether the addition of grade B mobilization to a muscle strengthening home exercise programme improves outcomes for patients with symptomatic early-stage hip osteoarthritis. Methods Twenty-three patients were randomized into either a home exercise group (n = 12) or grade B mobilization group (n = 11). Both groups carried out a muscle strengthening home exercise programme for 6 weeks. In addition, the grade B mobilization group received 6 weekly sessions of grade B hip mobilization (passive stretching techniques) and carried out stretches at home. Outcome measures included the visual analogue scale for pain, the Lower Extremity Functional Scale and goniometric measurement of hip flexion and medial rotation at baseline (week 1) and after the 6-week treatment period (week 7). Results Twenty-one participants (91%) completed the trial. Both groups showed improvement in all outcome measures. The change in pre-/post-treatment scores was significantly greater in the grade B mobilization group for pain (t(19) = 2.378, P = 0.03, large effect size d = 1.02) and passive hip flexion (t(19) = −4.192, P = 0.001, large effect size d = 1.80). No significant difference was found for function (t(19) = 0.444, P = 0.662, small effect size d = 0.20) or passive hip medial rotation (t(19) = −1.053, P = 0.305, moderate effect size d = 0.46). However, these results are inconclusive as this pilot study was underpowered. Discussion A worthwhile benefit may exist from the addition of grade B mobilization to a muscle strengthening home exercise programme, particularly with pain and passive hip flexion. This warrants further investigation. Although this pilot study demonstrated a feasible design, recommendations have been made for its development.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"54 - 63"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723113","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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