Pub Date : 2014-04-01DOI: 10.1179/1753614614Z.00000000061
T. Wedatilake, R. Suppiah, O. Adams, J. Newton
Abstract Objective To describe the effectiveness of intravenous pamidronate in the treatment of resistant osteitis pubis (OP) in athletes. Methods Eight consecutive high-level amateur athletes attending a Sport and Exercise Medicine clinic with refractory OP and bone marrow oedema (BME) of the symphysis pubis on magnetic resonance imaging (MRI) were treated with intravenous pamidronate infusions. Patients above 60 kg in weight received 60 mg intravenous pamidronate and those below 60 kg received 30 mg. Patients were offered a second dose after a 3-month interval if symptoms had not improved sufficiently. Primary outcome measure was return to sport. Secondary outcome measures were pain scores on a 0–10 scale and a rating of overall improvement pre- and post-infusion. Results Mean symptom duration was 19 months. Five patients rated themselves as ‘significantly improved’ and one had ‘some improvement’. All five patients who reported a ‘significant improvement’ returned to sport. Pain scores improved: (1) at rest (1.07 to 0.29, P = 0.10); (2) during activities of daily living (4.3 to 1.2, P = 0.004); and (3) during sport (8.1 to 1.2, P = 0.001). Discussion This study provides objective evidence to support the use of pamidronate to treat refractory OP with associated BME.
{"title":"Treatment of osteitis pubis with pamidronate in athletes","authors":"T. Wedatilake, R. Suppiah, O. Adams, J. Newton","doi":"10.1179/1753614614Z.00000000061","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000061","url":null,"abstract":"Abstract Objective To describe the effectiveness of intravenous pamidronate in the treatment of resistant osteitis pubis (OP) in athletes. Methods Eight consecutive high-level amateur athletes attending a Sport and Exercise Medicine clinic with refractory OP and bone marrow oedema (BME) of the symphysis pubis on magnetic resonance imaging (MRI) were treated with intravenous pamidronate infusions. Patients above 60 kg in weight received 60 mg intravenous pamidronate and those below 60 kg received 30 mg. Patients were offered a second dose after a 3-month interval if symptoms had not improved sufficiently. Primary outcome measure was return to sport. Secondary outcome measures were pain scores on a 0–10 scale and a rating of overall improvement pre- and post-infusion. Results Mean symptom duration was 19 months. Five patients rated themselves as ‘significantly improved’ and one had ‘some improvement’. All five patients who reported a ‘significant improvement’ returned to sport. Pain scores improved: (1) at rest (1.07 to 0.29, P = 0.10); (2) during activities of daily living (4.3 to 1.2, P = 0.004); and (3) during sport (8.1 to 1.2, P = 0.001). Discussion This study provides objective evidence to support the use of pamidronate to treat refractory OP with associated BME.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"23 - 25"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000061","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716023","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 : 2014-04-01DOI: 10.1179/1753614614Z.00000000065
A. Clough, J. Horne, F. Earle, P. Clough
Assessment and management of WAD in the whiplash capital of Europe: are U.K. physiotherapists divided? Angela Clough1, J. Horne2, F. Earle2, P. Clough3 Clinical Lead Physiotherapist. Hull & East Yorkshire NHS Trust, Dept of Psychology, University of Hull, Dept of Psychology, Manchester Metropolitan University Method: A multi method approach was adopted: An empirical case study design was adopted to investigate the impact of context on diagnosis and classification (n= 182). ‘Almost’ identical case studies were assessed by physiotherapists. Only the cause of the injury was different (sport vs. RTA).An epidemiological approach, examining whiplash reporting. General RTA statistics were compared to collision injuries in Rugby where the impact forces were recorded. In depth interviews were carried out with a range of practitioners (n= 9) focusing on the causes and treatments of whiplash. Specific objective: To investigate variations in the diagnosis and treatment of WAD within the UK physiotherapy community. Results: 1. The case studies showed that physiotherapists were significantly more likely (p< 0.05) to report that an injury was whiplash if it was apparently related to an RTA rather than a sports context. 2. The epidemiological approach showed that WAD could be significantly under reported in contact sports. 3. The interviews showed different treatment approaches were adopted by physiotherapists from differing specialist areas. Conclusions: The present series of studies show that: The context of the injury significantly influences the diagnosis., Whiplash injuries appear to be over reported in RTAs and under reported in sports., The WAD guidelines are available, but do not appear to prevent some of this variation., Practitioners from different domains agree on the causation of whiplash and core principles of clinical problem solving but have differing views on classification and intervention.
欧洲鞭打之都WAD的评估和管理:英国物理治疗师是否存在分歧?Angela Clough1, J. Horne2, F. Earle2, P. Clough3临床首席物理治疗师。方法:采用多方法方法:采用实证案例研究设计，研究情境对诊断和分类的影响(n= 182)。物理治疗师评估了“几乎”相同的案例研究。只是受伤的原因不同(运动与RTA)。流行病学方法，检查鞭打报告。一般的RTA统计数据与橄榄球的碰撞伤害进行了比较，其中记录了冲击力。对一系列从业人员(n= 9)进行了深入访谈，重点是颈椎扭伤的原因和治疗。具体目的:调查在英国物理治疗界WAD的诊断和治疗的变化。结果:1。病例研究表明，如果损伤明显与RTA而非运动相关，物理治疗师更有可能(p< 0.05)报告为颈椎扭伤。2. 流行病学方法表明，在接触性运动中，WAD可能明显少报。3.访谈显示，来自不同专业领域的物理治疗师采用了不同的治疗方法。结论:目前的一系列研究表明:损伤的背景显著影响诊断。在rta中，鞭状损伤的报道似乎过多，而在体育运动中则少报。WAD的指导方针是可用的，但似乎并不能阻止这种变化。不同领域的医生对鞭打的病因和临床解决问题的核心原则是一致的，但对鞭打的分类和干预有不同的看法。
{"title":"Society of Musculoskeletal Medicine Conference, London, March 2014","authors":"A. Clough, J. Horne, F. Earle, P. Clough","doi":"10.1179/1753614614Z.00000000065","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000065","url":null,"abstract":"Assessment and management of WAD in the whiplash capital of Europe: are U.K. physiotherapists divided? Angela Clough1, J. Horne2, F. Earle2, P. Clough3 Clinical Lead Physiotherapist. Hull & East Yorkshire NHS Trust, Dept of Psychology, University of Hull, Dept of Psychology, Manchester Metropolitan University Method: A multi method approach was adopted: An empirical case study design was adopted to investigate the impact of context on diagnosis and classification (n= 182). ‘Almost’ identical case studies were assessed by physiotherapists. Only the cause of the injury was different (sport vs. RTA).An epidemiological approach, examining whiplash reporting. General RTA statistics were compared to collision injuries in Rugby where the impact forces were recorded. In depth interviews were carried out with a range of practitioners (n= 9) focusing on the causes and treatments of whiplash. Specific objective: To investigate variations in the diagnosis and treatment of WAD within the UK physiotherapy community. Results: 1. The case studies showed that physiotherapists were significantly more likely (p< 0.05) to report that an injury was whiplash if it was apparently related to an RTA rather than a sports context. 2. The epidemiological approach showed that WAD could be significantly under reported in contact sports. 3. The interviews showed different treatment approaches were adopted by physiotherapists from differing specialist areas. Conclusions: The present series of studies show that: The context of the injury significantly influences the diagnosis., Whiplash injuries appear to be over reported in RTAs and under reported in sports., The WAD guidelines are available, but do not appear to prevent some of this variation., Practitioners from different domains agree on the causation of whiplash and core principles of clinical problem solving but have differing views on classification and intervention.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"38 - 41"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000065","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716858","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 : 2014-04-01DOI: 10.1179/1753615414Y.0000000027
N. Rao, S. Beremauro, D. Pabari, D. Deeab
Abstract Purpose To evaluate overall experience and relief from symptoms from our Morton's neuroma injection service. Materials and methods A telephone questionnaire was carried out between June 2011 and April 2012 on patients diagnosed with Morton's neuroma on ultrasound (US). This was to evaluate whether patients had gained benefits from the service in terms of symptomatic relief and also to gain a general understanding of whether the service had worked efficiently. A visual analogue score for pain, ranging from 1 (no pain) to 10 (Worst pain ever) was utilized to assess pre- and post-procedure responses. This specifically examined the time periods: before the injection, 1 week after, at follow up, and at the time when the questionnaire was asked. The patients' satisfactions with the service as well as any complications were ascertained. Patients with repeated episodes or bilateral injections were counted as one episode each. Results A total of 33 patients were identified (from a potential of 47, survey response rate of 70%) who had undergone injections for Morton's neuromas in the 10-month period, this included 9 males and 24 females. Injections were carried out under US guidance in real time, using an injection of Depo-Medrone injection (methylprednisolone acetate) 40 mg instilled into the neuroma. The mean pain score before the injection was 8.3 out of 10 (range 6−10). Mean score at time of follow up (or 2 months) was 4 (range 1–10). The majority of patients (19) required no medication after the procedure. There were 9 out of 33 recorded complications (27%), none of these were infection related. The mean overall experience score of the service was 7.9 out of 10 (range 4–10). Conclusions At our institution, we have been able to provide an intra-neural injection service with high satisfaction rates among patients. Injections have helped to alleviate symptoms among the majority, at least in the short-/mid-term although their long-term outcomes still appear quite variable.
{"title":"Service evaluation outcomes of a Morton's neuroma injection service: A district hospital experience","authors":"N. Rao, S. Beremauro, D. Pabari, D. Deeab","doi":"10.1179/1753615414Y.0000000027","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000027","url":null,"abstract":"Abstract Purpose To evaluate overall experience and relief from symptoms from our Morton's neuroma injection service. Materials and methods A telephone questionnaire was carried out between June 2011 and April 2012 on patients diagnosed with Morton's neuroma on ultrasound (US). This was to evaluate whether patients had gained benefits from the service in terms of symptomatic relief and also to gain a general understanding of whether the service had worked efficiently. A visual analogue score for pain, ranging from 1 (no pain) to 10 (Worst pain ever) was utilized to assess pre- and post-procedure responses. This specifically examined the time periods: before the injection, 1 week after, at follow up, and at the time when the questionnaire was asked. The patients' satisfactions with the service as well as any complications were ascertained. Patients with repeated episodes or bilateral injections were counted as one episode each. Results A total of 33 patients were identified (from a potential of 47, survey response rate of 70%) who had undergone injections for Morton's neuromas in the 10-month period, this included 9 males and 24 females. Injections were carried out under US guidance in real time, using an injection of Depo-Medrone injection (methylprednisolone acetate) 40 mg instilled into the neuroma. The mean pain score before the injection was 8.3 out of 10 (range 6−10). Mean score at time of follow up (or 2 months) was 4 (range 1–10). The majority of patients (19) required no medication after the procedure. There were 9 out of 33 recorded complications (27%), none of these were infection related. The mean overall experience score of the service was 7.9 out of 10 (range 4–10). Conclusions At our institution, we have been able to provide an intra-neural injection service with high satisfaction rates among patients. Injections have helped to alleviate symptoms among the majority, at least in the short-/mid-term although their long-term outcomes still appear quite variable.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"13 - 18"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000027","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722623","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 : 2014-04-01DOI: 10.1179/1753614614Z.00000000060
British Institute of Musculoskeletal Medicine Winter Symposium, Stratford City, London, December 2013
英国肌肉骨骼医学研究所冬季研讨会，斯特拉特福市，伦敦，2013年12月
{"title":"British Institute of Musculoskeletal Medicine Winter Symposium, Stratford City, London, December 2013","authors":"","doi":"10.1179/1753614614Z.00000000060","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000060","url":null,"abstract":"British Institute of Musculoskeletal Medicine Winter Symposium, Stratford City, London, December 2013","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"36 - 37"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000060","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716397","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 : 2014-04-01DOI: 10.1179/1753615414Y.0000000026
J. Hiett, D. Chan, P. Hourigan
Abstract Purpose To assess whether being under the age of 20 is a significant ‘red flag’ in the presentation of first time low back pain. Method Retrospective case note analysis of patients under 20 years of age, referred into a secondary care service with pain (not deformity) over a 1-year period. Results The case notes of 86 new patients were reviewed. One patient with a serious pathology was identified, an eosinophilic granuloma. Fifty-six patients presented with non-specific mechanical spinal pain. Nine patients presented with a spondylolysis with or without associated spondylolisthesis and seven with disc degeneration/prolapse with nerve root pain. Thirteen patients (15%) received invasive treatment, six undergoing surgery (pars inter-articularis repair and discectomies), and seven had an injection (pars inter-articularis blocks, facet joint injections, transforaminal nerve root blocks or caudal epidural). Conclusion This study does not support the hypothesis that being aged under 20 years at the time of presentation alone is a specific risk factor for serious pathology in patients with spinal pain.
{"title":"Back pain in the under 20s would appear to be a ‘red flag’ of dubious significance: Results of a retrospective case note analysis","authors":"J. Hiett, D. Chan, P. Hourigan","doi":"10.1179/1753615414Y.0000000026","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000026","url":null,"abstract":"Abstract Purpose To assess whether being under the age of 20 is a significant ‘red flag’ in the presentation of first time low back pain. Method Retrospective case note analysis of patients under 20 years of age, referred into a secondary care service with pain (not deformity) over a 1-year period. Results The case notes of 86 new patients were reviewed. One patient with a serious pathology was identified, an eosinophilic granuloma. Fifty-six patients presented with non-specific mechanical spinal pain. Nine patients presented with a spondylolysis with or without associated spondylolisthesis and seven with disc degeneration/prolapse with nerve root pain. Thirteen patients (15%) received invasive treatment, six undergoing surgery (pars inter-articularis repair and discectomies), and seven had an injection (pars inter-articularis blocks, facet joint injections, transforaminal nerve root blocks or caudal epidural). Conclusion This study does not support the hypothesis that being aged under 20 years at the time of presentation alone is a specific risk factor for serious pathology in patients with spinal pain.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"19 - 22"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000026","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722490","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 : 2014-04-01DOI: 10.1179/1753614614Z.00000000063
M. Laupheimer
Abstract Vitamin D and fish oil supplements are used in the treatment of musculoskeletal conditions. This informal review outlines current research on these two supplements in musculoskeletal medicine: vitamin D supplementation is shown to have potential benefits in various areas including osteoporosis, osteoarthritis, low back pain, and rehabilitation of musculoskeletal conditions; fish oil supplements may benefit inflammatory pain and some muscle symptoms.
{"title":"Vitamin D and omega-3 fatty acids in musculoskeletal medicine","authors":"M. Laupheimer","doi":"10.1179/1753614614Z.00000000063","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000063","url":null,"abstract":"Abstract Vitamin D and fish oil supplements are used in the treatment of musculoskeletal conditions. This informal review outlines current research on these two supplements in musculoskeletal medicine: vitamin D supplementation is shown to have potential benefits in various areas including osteoporosis, osteoarthritis, low back pain, and rehabilitation of musculoskeletal conditions; fish oil supplements may benefit inflammatory pain and some muscle symptoms.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"32 - 35"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000063","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716713","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 : 2014-04-01DOI: 10.1179/1753614614Z.00000000062
M. Friedrich, Janette Kothe, E. Seidel, L. Beyer
Abstract Purpose In subjects with neck-shoulder complaints at visual display unit (VDU) work places (>4 hours daily) the influence through a multifocal lens design on the head-eye-movement was examined. Materials and methods The head-eye-movement (head-eye-mover ratio horizontal) was determined in 100 presbyopic subjects with the Vision Print® (Essilor). The subjects were randomized and single-blind divided to three different interventions, group I: head-, II: eye-mover design, III: nearwork design, and a control group with no intervention. Results In presbyopic subjects with neck-shoulder discomfort a workstation seams to contribute to the manifestation of the pathological stereotype eye mover in the horizontal gaze shift. With the multifocal lenses a significant reduction in complaints in the shoulder and neck area for the groups I, II and III was found. The change of the head-eye-mover ratio (horizontal) in the direction of increased head movement was shown tendencially in all supplied groups, but not in the control group. Conclusion If a patient with neck-shoulder complaints needs an optometric treatment (single or multifocal glasses) a modification of the work place is required and the supply with spectacles has to take place before a therapeutic intervention. On top of this a consultation for movement stimulating working conditions must take place.
{"title":"Relation between head and eye movement and neck and shoulder complaints in presbyopic VDU users","authors":"M. Friedrich, Janette Kothe, E. Seidel, L. Beyer","doi":"10.1179/1753614614Z.00000000062","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000062","url":null,"abstract":"Abstract Purpose In subjects with neck-shoulder complaints at visual display unit (VDU) work places (>4 hours daily) the influence through a multifocal lens design on the head-eye-movement was examined. Materials and methods The head-eye-movement (head-eye-mover ratio horizontal) was determined in 100 presbyopic subjects with the Vision Print® (Essilor). The subjects were randomized and single-blind divided to three different interventions, group I: head-, II: eye-mover design, III: nearwork design, and a control group with no intervention. Results In presbyopic subjects with neck-shoulder discomfort a workstation seams to contribute to the manifestation of the pathological stereotype eye mover in the horizontal gaze shift. With the multifocal lenses a significant reduction in complaints in the shoulder and neck area for the groups I, II and III was found. The change of the head-eye-mover ratio (horizontal) in the direction of increased head movement was shown tendencially in all supplied groups, but not in the control group. Conclusion If a patient with neck-shoulder complaints needs an optometric treatment (single or multifocal glasses) a modification of the work place is required and the supply with spectacles has to take place before a therapeutic intervention. On top of this a consultation for movement stimulating working conditions must take place.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"26 - 31"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000062","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716135","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 : 2014-04-01DOI: 10.1179/1753615413Y.0000000024
Neil Liffen
Abstract Background Diagnostic ultrasound is regarded as the gold standard for imaging tendinopathies for diagnosis, focusing rehabilitation, and guided intervention. However, there are no published diagnostic ultrasound protocols for the Achilles tendon which represent best practice. In the Felixstowe Community Hospital Physiotherapy Department a protocol for diagnostic ultrasound examination of the Achilles tendon was implemented in January 2013 and acts as a local guideline. Objectives To determine whether a local Achilles tendon image protocol is being adhered to in diagnostic ultrasound examinations of mid-portion Achilles tendinopathy. A pre-determined 75% adherence to the protocol was set as the standard representing best practice in diagnostic ultrasound examination of the Achilles tendon. A target of 100% of diagnostic ultrasound examinations should meet this standard. Methods Data collection of acquired and archived diagnostic ultrasound examinations with a subsequent diagnosis of mid-portion Achilles tendinopathy was included. A proforma was developed to collect data to determine whether diagnostic ultrasound examinations met the protocol standard. Results The sample included all patients from 1 January to 31 May 2013 (n = 30). The study population included 16 females and 14 males with a mean age of 54.2 (SD ± 15.01) years and mostly represented by the age category 36–65 years (76.7%). This audit demonstrated that 73% (22 patients from 30) of diagnostic ultrasound examinations adhered to the standard set. This audit demonstrated inconsistencies in performing components of the diagnostic ultrasound examination procedure including the region of interest power Doppler, contra-lateral grey-scale, contra-lateral power Doppler, split screen images and annotation. Conclusions The audit has highlighted the need to enhance Achilles tendon diagnostic ultrasound examinations; a number of recommendations have been made in improving the service for Achilles tendon examinations. It is envisaged that by adoption of these recommendations the musculo-skeletal service for these patients at the Felixstowe Community Hospital Physiotherapy Department will be enhanced before commencement of the second Clinical Audit Cycle is undertaken.
{"title":"Achilles tendon diagnostic ultrasound examination: A locally designed protocol and audit","authors":"Neil Liffen","doi":"10.1179/1753615413Y.0000000024","DOIUrl":"https://doi.org/10.1179/1753615413Y.0000000024","url":null,"abstract":"Abstract Background Diagnostic ultrasound is regarded as the gold standard for imaging tendinopathies for diagnosis, focusing rehabilitation, and guided intervention. However, there are no published diagnostic ultrasound protocols for the Achilles tendon which represent best practice. In the Felixstowe Community Hospital Physiotherapy Department a protocol for diagnostic ultrasound examination of the Achilles tendon was implemented in January 2013 and acts as a local guideline. Objectives To determine whether a local Achilles tendon image protocol is being adhered to in diagnostic ultrasound examinations of mid-portion Achilles tendinopathy. A pre-determined 75% adherence to the protocol was set as the standard representing best practice in diagnostic ultrasound examination of the Achilles tendon. A target of 100% of diagnostic ultrasound examinations should meet this standard. Methods Data collection of acquired and archived diagnostic ultrasound examinations with a subsequent diagnosis of mid-portion Achilles tendinopathy was included. A proforma was developed to collect data to determine whether diagnostic ultrasound examinations met the protocol standard. Results The sample included all patients from 1 January to 31 May 2013 (n = 30). The study population included 16 females and 14 males with a mean age of 54.2 (SD ± 15.01) years and mostly represented by the age category 36–65 years (76.7%). This audit demonstrated that 73% (22 patients from 30) of diagnostic ultrasound examinations adhered to the standard set. This audit demonstrated inconsistencies in performing components of the diagnostic ultrasound examination procedure including the region of interest power Doppler, contra-lateral grey-scale, contra-lateral power Doppler, split screen images and annotation. Conclusions The audit has highlighted the need to enhance Achilles tendon diagnostic ultrasound examinations; a number of recommendations have been made in improving the service for Achilles tendon examinations. It is envisaged that by adoption of these recommendations the musculo-skeletal service for these patients at the Felixstowe Community Hospital Physiotherapy Department will be enhanced before commencement of the second Clinical Audit Cycle is undertaken.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"1 - 12"},"PeriodicalIF":0.0,"publicationDate":"2014-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615413Y.0000000024","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722874","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 : 2013-12-01DOI: 10.1179/1753615413Y.0000000025
Ian A Bernstein
Abstract Community musculoskeletal services in Ealing are organized with an integrated care approach, with most patients being managed in primary care and community settings, while, at the same time, providing clear and fast routes to secondary care. This is both clinically effective and cost-effective, reserving hospital referral for patients most likely to need surgery. Ealing Clinical Commissioning Group (CCG) implemented a ‘See and Treat’ interface clinic model to improve surgical conversion rates, reduce unnecessary hospital referrals, and provide community treatment more efficiently than a triage model. A high-profile general practitioner (GP) education programme enabled GPs to triage in their practices and manage patients without referral. The integrated care approach was implemented incrementally in three phases between 2005 and 2013, with a fourth phase planned for 2015. In Phase 3, only patients triaged by GPs to hospital outpatients are triaged by a referral management service, serviced by senior clinicians from the community musculoskeletal service. This secondary triage accounts for 15% of total GP referrals. The remainder being booked directly with no further triage beyond the initial GP triage unless marked ‘urgent’.
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