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Gray JL, Singh G, Uttley L, Balasubramanian SP. Routine thyroglobulin, neck ultrasound and physical examination in the routine follow up of patients with differentiated thyroid cancer-Where is the evidence? Endocrine 2018; 62:26-33. [PMID: 30128957 PMCID: PMC6153587 DOI: 10.1007/s12020-018-1720-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2018] [Accepted: 08/10/2018] [Indexed: 12/18/2022]
Abstract
PURPOSE Patients with differentiated thyroid cancer (DTC) typically have a favourable prognosis and recurrence as late as 45 years after diagnosis has been reported. International clinical guidelines for monitoring recommend routine thyroglobulin, ultrasound and physical examination for the detection of recurrence. The aim of this review was to systematically review whether routine monitoring using thyroglobulin (Tg), neck ultrasound and physical examination for recurrence in differentiated thyroid cancer patients is effective in improving patient survival and/or quality of life. METHODS Primary studies were retrieved via a comprehensive search of three electronic bibliographic databases (PubMed, Web of Science Core Collection and Cochrane Library) without time restriction. Eligible studies must have reported on disease-free patients with DTC subject to long-term routine surveillance. The primary and secondary outcomes of interest were overall survival (or other survival parameters) and quality of life, respectively. RESULTS Literature searches yielded 5529 citations, which were screened by two reviewers. 241 full texts were retrieved. No randomised controlled trials or two-arm cohort studies on the effectiveness of any of the three specified interventions were identified. However, three 'single-arm' studies reporting long-term follow-up outcomes in patients undergoing regular surveillance were identified and appraised. CONCLUSIONS This review highlights a lack of empirical evidence to support current use of routine surveillance in DTC. Although early detection is possible, routine surveillance may lead to unnecessary intervention.
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Affiliation(s)
- Jessica L Gray
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK
| | - Gautam Singh
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK
| | - Lesley Uttley
- School of Health and Related Research, University of Sheffield, Sheffield, UK
| | - Saba P Balasubramanian
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, UK.
- Endocrine Surgery Unit, Directorate of General Surgery, Sheffield Teaching Hospitals, Sheffield, UK.
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Abu Ghazaleh H, Hashem R, Forbes A, Dilwayo TR, Duaso M, Sturt J, Halson-Brown S, Mulnier H. A Systematic Review of Ultrasound-Detected Lipohypertrophy in Insulin-Exposed People with Diabetes. Diabetes Ther 2018; 9:1741-1756. [PMID: 30014243 PMCID: PMC6167307 DOI: 10.1007/s13300-018-0472-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2018] [Indexed: 12/19/2022] Open
Abstract
INTRODUCTION Lipohypertrophy (LH) is a common complication occurring in diabetes individuals. The most common methods used include palpation, visual examination and/or ultrasound (US). To date, there is limited information on the detection sensitivity among the different techniques used to identify LH. This systematic review aimed to identify studies that examined insulin-related LH using US detection to identify the prevalence, characteristics and morphology of LH, and to compare US and clinical palpation methods for detecting LH. METHODS Three electronic databases were systematically searched for studies detecting LH using US in insulin users. Articles were screened for eligibility and included studies were appraised using quality assessment tools. The quality of the evidence was evaluated using Grading of Recommendations Assessment, Development and Evaluation, and the extracted data was synthesised narratively. RESULTS Sixteen articles were included in the review providing data on 1722 patients. The prevalence of LH prevalence varied from 14.5% to 88% (median 56.6%). Identified risk factors for the development of included insulin injection behaviour such as a lack of injection site rotation and social factors such as low education level. Four studies compared LH detection by US to palpation, providing inconsistent results. One study showed that palpation detected 64% more LH, whilst two studies demonstrated that US identified 50% more sites and extended areas of LH (additional ~ 5 cm2). Another study provided comparable estimates between palpation and US in clinicians trained to detect LH (97%). CONCLUSION The evidence highlights a lack of congruence in results pertaining to the detection sensitivity of US and palpation for LH sites. More research with robust study design is needed to verify whether clinically palpation is sufficient to detect LH, or whether US would increase the precision of LH assessment to help address this common clinically significant problem.
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Affiliation(s)
- Haya Abu Ghazaleh
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK.
| | - Rabab Hashem
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Angus Forbes
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | | | - Maria Duaso
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Susan Halson-Brown
- Department of Women and Children's Health, School of Life Course Sciences, King's College London, St. Thomas' Hospital, London, UK
| | - Henrietta Mulnier
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Brates D, Molfenter SM, Thibeault SL. Assessing Hyolaryngeal Excursion: Comparing Quantitative Methods to Palpation at the Bedside and Visualization During Videofluoroscopy. Dysphagia 2018; 34:298-307. [PMID: 30043080 DOI: 10.1007/s00455-018-9927-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2018] [Accepted: 07/17/2018] [Indexed: 11/29/2022]
Abstract
PURPOSE Hyolaryngeal excursion (HE) is typically assessed via palpation during clinical swallowing exams (CSE) or visually during videofluoroscopy (VFSS). Minimal evidence exists to support the use of these perceptual methods for judging HE. We investigated whether binary judgment of HE differentiates quantitative measures of hyoid movement, using frame-by-frame VFSS analysis to measure anatomically scaled peak hyoid positions. METHODS Medical records of patients who received a CSE and VFSS within a 24-h period were reviewed. Clinician ratings of HE ('reduced' or 'normal') were collected from CSE and VFSS reports, along with rater experience. Five ml puree swallows were extracted from each VFSS for randomized, blinded analysis. Peak hyoid position from C4 was captured in anterior, superior, and hypotenuse positions and expressed relative to C2-C4 length. T-test comparisons of hyoid positions between patients judged to have reduced versus normal HE on palpation and VFSS were conducted. RESULTS Eighty-seven patients (56 male, mean age 61) met criteria. Peak anterior hyoid position was significantly different between patients judged to have reduced (mean = 89.2% C2-C4) and normal (mean = 110.6% C2-C4) HE on palpation (p = 0.001). Further analysis revealed no effect of clinician experience on differentiation of objective measures based on palpation. No differences were found across any objective measures when compared to clinician VFSS ratings. CONCLUSIONS Clinicians appeared to be able to differentiate peak anterior hyoid movement but not superior or hypotenuse movement on palpation. On VFSS visualization, no significant differences were found between swallows judged to have reduced versus normal HE in any directional dimension. While perceptual methods may contribute to clinical decision-making, clinicians should remain cautious when making judgments about HE using these methods.
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Affiliation(s)
- Danielle Brates
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA.,Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA
| | - Sonja M Molfenter
- Department of Communicative Sciences and Disorders, NYU Steinhardt, 665 Broadway, 9th Floor, New York, NY, 10012, USA
| | - Susan L Thibeault
- Division of Otolaryngology-Head and Neck Surgery, University of Wisconsin School of Medicine and Public Health, Wisconsin Institutes for Medical Research (WIMR), BLDG. 1485, 1111 Highland Avenue, Madison, WI, 53705-2275, USA.
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Konieczka C, Gibson C, Russett L, Dlot L, MacDermid J, Watson L, Sadi J. What is the reliability of clinical measurement tests for humeral head position? A systematic review. J Hand Ther 2018; 30:420-431. [PMID: 28802538 DOI: 10.1016/j.jht.2017.06.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 04/24/2017] [Accepted: 06/15/2017] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Physiotherapists routinely assess the position of the humeral head (HH) in patients with shoulder pain. PURPOSE OF THE STUDY To conduct a systematic review to determine the quality and content of studies that evaluated the reliability of clinical measurement methods for assessing the HH position. METHODS Five databases and gray literature were searched for studies fitting the eligibility criteria. After abstract and full-text review, the included studies were appraised using the Quality Appraisal of Reliability Studies checklist. Articles were considered of high quality if 8 was achieved on the checklist, and the overall quality of evidence was classified using prespecified criteria. Multiple raters extracted and performed quality ratings; a consensus process was used to finalize the reliability data that were synthesized and presented in a narrative synthesis. Reliability was classified as excellent if the intracorrelation coefficients or intercorrelation coefficients (ICCs) reported exceeded 0.75. RESULTS Fifteen studies on the reliability of ultrasound (US) and 3 studies on palpation were included. The methodologic quality was moderate in 17 of 18 studies. The intrarater reliability for all studies was excellent (ICC, 0.76-0.99) with the exception of the 90° abduction in internal rotation position (ICC, 0.48) for palpation. The inter-rater reliability tended to be lower (ICC, 0.48-0.68) for palpation and higher (ICC, 0.66-0.99) for US. Physiotherapists demonstrated excellent intrarater reliability across different levels of training in ultrasonography. DISCUSSION Our study found a moderate overall level of evidence to support the use of US for assessing HH position in symptomatic or asymptomatic subjects. CONCLUSION A moderate overall level of evidence exists for the use of US to reliably assess the HH position. Limited research supports the methods used for palpation within a clinical setting. LEVEL OF EVIDENCE 2a.
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Affiliation(s)
- Christine Konieczka
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Christine Gibson
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leeann Russett
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Leah Dlot
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Joy MacDermid
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada
| | - Lyn Watson
- LifeCare, Prahran Sports Medicine Centre, Prahran, Victoria, Australia
| | - Jackie Sadi
- Faculty of Health Science, School of Physical Therapy, Western University, Elborn College, London, Ontario, Canada.
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Bhattacharjee S, Maitra S, Baidya DK. Comparison between ultrasound guided technique and digital palpation technique for radial artery cannulation in adult patients: An updated meta-analysis of randomized controlled trials. J Clin Anesth 2018; 47:54-59. [PMID: 29574288 DOI: 10.1016/j.jclinane.2018.03.019] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2018] [Revised: 03/09/2018] [Accepted: 03/19/2018] [Indexed: 10/17/2022]
Abstract
STUDY OBJECTIVE Possible advantages and risks associated with ultrasound guided radial artery cannulation in-comparison to digital palpation guided method in adult patients are not fully known. We have compared ultrasound guided radial artery cannulation with digital palpation technique in this meta-analysis. DESIGN Meta-analysis of randomized controlled trials. SETTING Trials conducted in operating room, emergency department, cardiac catheterization laboratory. PATIENTS PubMed and Cochrane Central Register of Controlled Trials (CENTRAL) were searched (from 1946 to 20th November 2017) to identify prospective randomized controlled trials in adult patients. INTERVENTION Two-dimensional ultrasound guided radial artery catheterization versus digital palpation guided radial artery cannulation. MEASUREMENTS Overall cannulation success rate, first attempt success rate, time to cannulation and mean number of attempts to successful cannulation. Odds ratio (OR) and standardized mean difference (SMD) or mean difference (MD) with 95% confidence interval (CI) were calculated for categorical and continuous variables respectively. RESULTS Data of 1895 patients from 10 studies have been included in this meta- analysis. Overall cannulation success rate was similar between ultrasound guided technique and digital palpation [OR (95% CI) 2.01 (1.00, 4.06); p = 0.05]. Ultrasound guided radial artery cannulation is associated with higher first attempt success rate of radial artery cannulation in comparison to digital palpation [OR (95% CI) 2.76 (186, 4.10); p < 0.001]. No difference was seen in time to cannulate [SMD (95% CI) -0.31 (-0.65, 0.04); p = 0.30] and mean number of attempt [MD (95% CI) -0.65 (-1.32, 0.02); p = 0.06] between USG guided technique with palpation technique. CONCLUSION Radial artery cannulation by ultrasound guidance may increase the first attempt success rate but not the overall cannulation success when compared to digital palpation technique. However, results of this meta-analysis should be interpreted with caution due presence of heterogeneity.
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Affiliation(s)
- Sulagna Bhattacharjee
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
| | - Souvik Maitra
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India.
| | - Dalim K Baidya
- Department of Anaesthesiology, Pain Medicine & Critical Care, All India Institute of Medical Sciences, New Delhi, India
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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädisches Fachzentrum, Seehauser Straße 2, 82418, Murnau, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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Thibault-Gagnon S, Goldfinger C, Pukall C, Chamberlain S, McLean L. Relationships Between 3-Dimensional Transperineal Ultrasound Imaging and Digital Intravaginal Palpation Assessments of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia. J Sex Med 2018; 15:346-360. [PMID: 29502982 DOI: 10.1016/j.jsxm.2017.12.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/16/2017] [Revised: 12/23/2017] [Accepted: 12/26/2017] [Indexed: 11/17/2022]
Abstract
BACKGROUND Digital intravaginal palpation remains the favored method for clinical assessment of pelvic floor muscle (PFM) function in women; however, there is growing interest in using transperineal ultrasound imaging (TPUSI). TPUSI does not involve vaginal penetration, making it particularly relevant for PFM assessment in women with genito-pelvic pain and penetration disorders. AIMS To study the relations between measures of PFM morphology and function assessed using 3-dimensional (3D) TPUSI and PFM assessment through intravaginal palpation. METHODS 77 nulliparous premenopausal women with (n = 38) and without (n = 39) PVD participated. 3D TPUSI was used to measure levator hiatal dimensions at rest, at maximal voluntary contraction (MVC) of the PFMs, and at maximal Valsalva maneuver (MVM). Intravaginal palpation was used to assess PFM strength, PFM tone, PFM relaxation after contraction, and vaginal flexibility; each was scored using an ordinal grading scale. Ultrasound and palpation outcomes were compared using Spearman correlation coefficients and Kruskal-Wallis 1-way analyses of variance by rank. OUTCOMES Outcomes included ultrasound measures of the levator hiatal area, anteroposterior diameter, and left-right transverse diameter at rest, at MVC, and at MVM; raw and relative changes in hiatal dimensions between rest and MVC and between rest and MVM; and palpation measures of PFM strength, tone, and relaxation after contraction, and vaginal flexibility. RESULTS Weak to fair correlations were found between ultrasound and palpation measures. A smaller levator hiatus at rest was associated with greater PFM tone, less PFM relaxation, and less vaginal flexibility. Greater levator hiatal constriction and shortening of the hiatal anteroposterior diameter at MVC were associated with greater palpated PFM strength. Greater hiatal distention at MVM was associated with lower PFM tone and greater relaxation. CLINICAL TRANSLATION 3D TPUSI and intravaginal palpation provide related but distinct information about PFM function in young women with and without PVD with high functioning PFMs. STRENGTHS AND LIMITATIONS This was the first study to compare PFM assessment using 3D TPUSI and intravaginal palpation in nulliparous premenopausal women. A main strength of the study was the inclusion of women with PVD and asymptomatic controls, which provided a wide range in outcomes because differences in PFM morphology and function exist between women with and without PVD. The lack of inclusion of older women and women with weaker and/or hypotonic PFMs limits the generalizability of the findings. CONCLUSION Although TPUSI has several advantages, including painless application, it is not recommended as a replacement for digital palpation in the clinical assessment of PFM function. Thibault-Gagnon S, Goldfinger C, Pukall C, et al. Relationships Between 3-Dimensional Transperineal Ultrasound Imaging and Digital Intravaginal Palpation Assessments of the Pelvic Floor Muscles in Women With and Without Provoked Vestibulodynia. J Sex Med 2018;15:346-360.
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Affiliation(s)
| | | | - Caroline Pukall
- Department of Psychology, Queen's University, Kingston, ON, Canada
| | - Susan Chamberlain
- Department of Obstetrics and Gynecology, Queen's University, Kingston, ON, Canada
| | - Linda McLean
- University of Ottawa, School of Rehabilitation Sciences, Ottawa, ON, Canada.
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Póvoa LC, Ferreira APA, Zanier JFC, Silva JG. Accuracy of Motion Palpation Flexion-Extension Test in Identifying the Seventh Cervical Spinal Process. J Chiropr Med 2018; 17:22-29. [PMID: 29628805 DOI: 10.1016/j.jcm.2017.11.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2017] [Revised: 11/18/2017] [Accepted: 11/20/2017] [Indexed: 10/17/2022] Open
Abstract
Objective The aim of this study was to evaluate the accuracy of a motion palpation procedure, the flexion-extension test, in localizing the spinous process of the seventh cervical vertebra (C7). Methods We analyzed 101 adult participants with metal markers that permitted the identification of the C7 spinous process. This analysis occurred during a flexion-extension test and was confirmed by radiography. Data sample characteristics were analyzed by descriptive statistics, and the relationship between independent variables (weight, height, sex, age, and body mass index [BMI]) and dependent variables (coincidence between the most prominent vertebra and the stationary vertebra, as determined by the flexion-extension test) was determined via logistic regression. Results The sample population was 48.5% male with a mean age of 56.8 years (standard deviation, ±14.9) and a mean BMI of 25.54 kg/m2 (standard deviation, ±5.5). In 54.5% of cases, the C7 spinous process was correctly identified by the flexion-extension test. The agreement between the flexion-extension test and radiography in accuracy of localization of the C7 spinous process was significant (P = .021), as was the correct localization of C7 (P = .05). Conclusion The localization of the C7 spinous process was more accurate in individuals with a BMI <25 kg/m2 and whose most prominent vertebra coincided with the stationary vertebra as determined by the flexion-extension test.
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Affiliation(s)
- Luciana C Póvoa
- Rehabilitation Science Postgraduate Program, Human Analysis Movement Lab, Augusto Motta University Center, Rio de Janeiro, Brazil.,Brazilian Osteopathic Institute, Rio de Janeiro, Brazil.,Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil.,Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil
| | - Ana P A Ferreira
- Rehabilitation Science Postgraduate Program, Human Analysis Movement Lab, Augusto Motta University Center, Rio de Janeiro, Brazil.,Brazilian Osteopathic Institute, Rio de Janeiro, Brazil.,Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil.,Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil
| | - José F C Zanier
- Department of Radiology, Estado do Rio de Janeiro Universtiy, Rio de Janeiro, Brazil
| | - Julio G Silva
- Human Analysis Movement Lab, Praça das Nações, Rio de Janeiro, Brazil.,Department of Physical Therapy, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil
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Luedtke K, May A. Stratifying migraine patients based on dynamic pain provocation over the upper cervical spine. J Headache Pain 2017; 18:97. [PMID: 28952052 PMCID: PMC5615079 DOI: 10.1186/s10194-017-0808-0] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 09/17/2017] [Indexed: 01/03/2023] Open
Abstract
Background Migraine patients usually report a high prevalence of neck pain preceding or during the migraine attack. A recent investigation of musculoskeletal dysfunctions in migraine patients concluded that neck pain is not simply a symptom of the migraine attack but corresponds to identifiable muscle and joint alterations. Particularly pain provocation using palpation of the joints in the upper cervical spine was significantly more prevalent in patients with migraine than in headache-free participants. Methods One hundred seventy-nine migraineurs (diagnosed according to IHS classification criteria version III beta) and 73 age- and gender-matched healthy controls were examined by a physiotherapist blinded towards the diagnosis, using a palpation technique over the upper cervical spine. The palpation combined oscillating movements and sustained pressure. Findings Using simple palpation of the upper cervical spine, migraine patients can be stratified into three groups: painfree (11%), local pain only (42%), and pain referred to the head during sustained pressure (47%). Combining both test components (palpation and sustained pressure) has a high sensitivity and specificity for migraine. Conclusions The response to palpation of the upper cervical spine may indicate migraine subtypes. The presence of musculoskeletal dysfunctions of the upper cervical spine should be identified and treated to avoid ongoing nociceptive input into the trigeminocervical complex. Trial registration German Clinical Trial Register DRKS-ID: DRKS00009622.
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Affiliation(s)
- Kerstin Luedtke
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany
| | - Arne May
- Department of Systems Neuroscience, University Medical Center Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Germany.
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Abstract
The subject of this article is the anatomy of the respiratory tract with an emphasis on the larynx. A differentiation is made between the upper and lower airways according to topographical and functional aspects, the limits of which are marked by the lower section of the larynx. The focus is on the anatomy of the structures involved, which are relevant for emergency medicine.
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Affiliation(s)
- M Schulze
- Institut für Anatomie, Universitätsmedizin Rostock AöR, Gertrudenstr. 9, 18057, Rostock, Deutschland.
| | - A Wree
- Institut für Anatomie, Universitätsmedizin Rostock AöR, Gertrudenstr. 9, 18057, Rostock, Deutschland
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Ferreira APA, Póvoa LC, Zanier JFC, Machado DC, Ferreira AS. Sensitivity for palpating lumbopelvic soft- tissues and bony landmarks and its associated factors: A single-blinded diagnostic accuracy study. J Back Musculoskelet Rehabil 2017; 30:735-744. [PMID: 28453451 DOI: 10.3233/bmr-150356] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
BACKGROUND Evidence on the diagnostic performance of palpatory methods and possible confounding factors is scarce. OBJECTIVES To examine the sensitivity of palpatory methods for location of lumbopelvic landmarks and to assess its association with personal characteristics. METHODS Eighty-three participants (41 men, 55.6 (16.5) years, 25.9 (4.8) kg/m2 [mean (SD)]) were enrolled in this single-blinded study. Fourteen body and softy-tissue landmarks were sequentially palpated from the spinous process of L4 to the ischial tuberosity. CT-scan images were used to assess what landmark was located. RESULTS Sensitivity for location was in range 22-86% for soft-tissues and 26-69% for bony landmarks. Reduction in sensitivity was observed from the quadratus lumborum to the inferior and lateral angle of the sacrum (86-26% and 75-33%, left and right sides, respectively). Palpations of L4 and L5 spinous processes were systematically more cephalic than other landmarks. Gender was weakly correlated to almost all landmarks (rpb= 0.333 or weaker). Body mass index was weakly correlated to the accurate location of ILAS and quadratus lumborum, great trochanter, PSIS, and piriformis (rpb=-0.307 or weaker). CONCLUSIONS Systematic and propagation errors were present using sequential palpatory methods. Palpation in men was more sensitive and higher BMI was associated with lower sensitivity for lumbopelvic landmarks.
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Affiliation(s)
- A P A Ferreira
- Instituto Brasileiro de Osteopatia, Centro, CEP 22440-901, RJ, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
| | - L C Póvoa
- Instituto Brasileiro de Osteopatia, Centro, CEP 22440-901, RJ, Brasil.,Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
| | - J F C Zanier
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Vila Isabel, CEP 20551-030, RJ, Brasil
| | - D C Machado
- Hospital Universitário Pedro Ernesto, Universidade do Estado do Rio de Janeiro, Vila Isabel, CEP 20551-030, RJ, Brasil
| | - A S Ferreira
- Programa de Pós-graduação em Ciências da Reabilitação, Centro Universitário Augusto Motta, Bonsucesso, CEP 21041-010, RJ, Brasil
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Pagé I, Descarreaux M, Sobczak S. Development of a new palpation method using alternative landmarks for the determination of thoracic transverse processes: An in vitro study. Musculoskelet Sci Pract 2017; 27:142-149. [PMID: 27697392 DOI: 10.1016/j.math.2016.09.005] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Revised: 09/08/2016] [Accepted: 09/13/2016] [Indexed: 12/25/2022]
Abstract
Palpation methods (PMs) have been proposed to guide clinicians in locating the thoracic transverse processes (TTPs). However, no studies have assessed the validity of TTPs palpation or the added value of musculoskeletal ultrasound (MSU). The objectives of the present study were (1) to explore the validity of TTPs location using palpation as commonly performed by clinicians, (2) to develop an accurate and valid PM, and (3) to assess the added value of MSU. A standardized procedure was used on six cadavers. It consisted in the insertion of markers through the T3, T5, T6 and T8 TTPs and spinous processes, which were identified using palpation and MSU. First, a fresh cadaver was used to explore the validity of the common palpation method. Since poor validity was observed, one intermediate and a final PMs were tested on a total of five Thiel-embalmed specimens. A descriptive analysis was performed and agreement between MSU and the final PM was determined. The final PM led to the proper determination of all TTPs on three specimens with a mean error of 4 ± 1.8 mm in relation to the TTPs center. The coefficient of variations and root mean square errors were ≤0.15 and 0.21 mm, respectively. Bland-Altman plot showed no differences between palpation and MSU. In conclusion, this study reports the validity of a new PM using multiple landmarks to guide TTPs determination and for which MSU does not seem to add value in accuracy. These results may have important clinical implications for clinicians using palpation.
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Affiliation(s)
- Isabelle Pagé
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada.
| | - Martin Descarreaux
- Département des sciences de l'activité physique, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada
| | - Stéphane Sobczak
- Département d'anatomie, Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada; Groupe de Recherche sur les affections neuromusculosquelettiques (GRAN), Université du Québec à Trois-Rivières, 3351 boul. des Forges, CP. 500, Trois-Rivières, Québec, G9A 5H7, Canada
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Rogers T, Marino ML, Dusza SW, Bajaj S, Usatine RP, Marchetti MA, Marghoob AA. A Clinical Aid for Detecting Skin Cancer: The Triage Amalgamated Dermoscopic Algorithm (TADA). J Am Board Fam Med 2016; 29:694-701. [PMID: 28076252 DOI: 10.3122/jabfm.2016.06.160079] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2016] [Revised: 06/03/2016] [Accepted: 06/13/2016] [Indexed: 11/08/2022] Open
Abstract
PURPOSE Family physicians (FPs) frequently evaluate skin lesions but may not have the necessary training to accurately and confidently identify lesions that require skin biopsy or specialist referral. We evaluated the diagnostic performance of a new, simplified dermoscopy algorithm for skin cancer detection. METHODS In this cross-sectional, observation study, attendees of a dermoscopy course evaluated 50 polarized dermoscopy images of skin lesions (27 malignant and 23 benign) using the Triage Amalgamated Dermoscopic Algorithm (TADA). The dermoscopic criteria of TADA include architectural disorder (ie, disorganized or asymmetric distribution of colors and/or structures), starburst pattern, blue-black or gray color, white structures, negative network, ulcer, and vessels. The study occurred after 1 day of basic dermoscopy training. Clinical information related to palpation (ie, firm, dimpling) was provided when relevant. RESULTS Of 200 course attendees, 120 (60%) participated in the study. Participants included 64 (53.3%) dermatologists and 41 (34.2%) primary care physicians, 19 (46.3%) of whom were FPs. Fifty-two (43%) individuals had no previous dermoscopy training. Overall, the sensitivity and specificity of TADA for malignant skin lesions was 94.8% and 72.3%, respectively. Previous dermoscopy training and years of dermoscopy experience were not associated with diagnostic sensitivity (P = .13 and P = .05, respectively) or specificity (P = .36 and P = .21, respectively). Specialty type was not associated with sensitivity (P = .37) but dermatologists had a higher specificity than nondermatologists (79% v. 72%, P = .008). CONCLUSIONS After basic instruction, TADA may be a useful dermoscopy algorithm for FPs who examine skin lesions as it has a high sensitivity for detecting skin cancer.
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Abstract
The wrist and hand form a highly complex organ that is of great importance in almost all daily activities. The hand serves as a tool and an organ of sense. Injuries of the hand and wrist as well as mechanical, neurological or systemic inflammatory changes are common. Taking a detailed history can already lead to a diagnosis. Almost all structures of the hand are easily accessible for clinical examination, i. e. inspection, palpation and clinical tests, including dynamic testing. Diagnostic imaging completes the examination procedure.
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Affiliation(s)
- H R Springorum
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland.
| | - C Baier
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Götz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - T Schwarz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - A Benditz
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - J Grifka
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
| | - G Heers
- Orthopädische Klinik der Universität Regensburg, Asklepios Klinikum Bad Abbach, Kaiser-Karl-V. Allee 3, 93077, Bad Abbach, Deutschland
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Le Clec'h Y, Peterson CK, Brunner F, Pfirrmann CWA. Cervical Facet Joint Imaging-Guided Injections: A Comparison of Outcomes in Patients Referred Based on Imaging Findings Vs Palpation for Pain. J Manipulative Physiol Ther 2016; 39:480-486. [PMID: 27523428 DOI: 10.1016/j.jmpt.2016.06.004] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 06/28/2016] [Accepted: 06/29/2016] [Indexed: 11/18/2022]
Abstract
OBJECTIVES The purpose of this study was to compare outcomes of patients referred for cervical facet joint injections by either a medical doctor (MD) primarily basing the selection of facet levels on structural changes found on imaging vs a doctor of chiropractic (DC) selecting the levels for injection based on palpation for pain. METHODS This was a prospective cohort outcome study including 121 consecutive patients receiving cervical facet injections with completed outcomes questionnaires. Medical doctors referred 91 patients and DCs referred 30 patients. Baseline pain numerical rating scale (NRS) data were collected. Outcomes collected at 1 day, 1 week, and 1 month after injection included NRS pain levels and overall "improvement" using the Patient Global Impression of Change scale (primary outcome). The responses "much better" and "better" were considered "improved." The proportion improved was compared between the 2 groups using the χ(2) test. NRS change scores for the 2 groups were compared using the unpaired t test. RESULTS At 1 day, "improvement" was reported in 44.8% of DC-and 29.7% of MD-referred patients (P = .17). At 1 week, 37.9% of DC-and 21.3% of MD-referred patients reported improvement (P = .03). At 1 month, 50.0% of DC-and 31.0% of MD-referred patients reported improvement (P = .1). CONCLUSIONS A greater proportion of DC-referred patients (injection level based on palpation for pain) reported "improvement" at all follow-up time points. This finding reached statistical significance at 1 week. These findings may be because DCs use palpation for pain to determine injection level whereas MDs rely more on imaging findings. The results suggest that the reported moderate results of facet injections partially may be due to the inaccurate selection of the spinal level treated.
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Affiliation(s)
| | - Cynthia K Peterson
- Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland; Department of Chiropractic Medicine, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland.
| | - Florian Brunner
- Department of Rheumatology, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland
| | - Christian W A Pfirrmann
- Department of Radiology, Orthopaedic University Hospital Balgrist, University of Zürich, Switzerland
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Abstract
Myofascial pain syndrome is started to be recognized as one of important factors of pain in cancer patients. However, no reports on features of myofascial trigger points were found in terminally-ill cancer populations. This time, we encountered 5 patients with myofascial pain syndrome and terminal cancer in whom delirium developed due to increased doses of opioid without a diagnosis of myofascial pain syndrome on initial presentation. The delirium subsided with dose reductions of opioid and treatment of myofascial pain syndrome. The common reason for a delayed diagnosis among the patients included an incomplete palpation of the painful sites, which led to unsuccessful myofascial trigger points identification. The features of myofascial trigger points included single onset in the cancer pain management site with opioid and the contralateral abdominal side muscles of the non-common sites. Withdrawal reflexes associated with cancer pain in the supine position, which are increasingly seen in the terminal cancer patients, were considered to have contributed to this siuation. We consider that careful palpation of the painful site is important, in order to obtain greater knowledge and understanding of the features of myofascial trigger points.
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Affiliation(s)
- Hideaki Hasuo
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
| | - Tatsuhiko Ishihara
- Department of Palliative Care, Okayama Saiseikai General Hospital, Okayama, Japan
| | - Kenji Kanbara
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
| | - Mikihiko Fukunaga
- Department of Psychosomatic Medicine, Kansai Medical University, Osaka, Japan
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Ames R, Jarosz BS, Baglin J, Da Costa C. Functional Knee Extension Test (FKET): Inter-rater palpatory agreement and visual analysis during a non-weight bearing functional assessment of the knee. J Bodyw Mov Ther 2015; 19:656-65. [PMID: 26592224 DOI: 10.1016/j.jbmt.2014.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2014] [Revised: 12/19/2014] [Accepted: 12/22/2014] [Indexed: 11/21/2022]
Abstract
OBJECTIVE The purpose of this study was to evaluate the inter-rater reliability of the Functional Knee Extension Test (FKET), a non-weight bearing functional assessment of the knee that is utilized within clinical practice. METHODS The design was a single-session, test-retest reliability study. Active knee extension was assessed and documented by each examiner for each of the visual, palpatory and vastus medialis obliqus (VMO) components of the FKET on fifty-seven healthcare professionals. RESULTS The Kappa (κ) statistic for the inter-rater reliability for the visual, palpatory and VMO variables of the FKET were slight-to-fair (0.13-0.26), fair-to-moderate (0.39-0.50), and moderate-to-almost perfect (0.57-0.93) reliability, respectively. The p-values for all variables, besides 'Visual RIGHT: TibTubExt' and 'Visual LEFT: TibTubExt' indicated statistically significant evidence of agreement above random guessing. Estimates for κ on the 'VMO Quantity: No contact' and 'VMO Timing: Start then stop' variables could not be calculated as ratings only existed across one row of the crosstabulation. CONCLUSION This study demonstrated that the palpatory and VMO components of the FKET have sufficient reliability to justify utilization within clinical practice. Future research is needed to determine whether the implementation of a functional knee assessment protocol, including the FKET could enhance levels of reliability in clinical decision-making of knee function.
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Isaka T, Ito H, Yokose T, Kondo T, Nagata M, Nishii T, Yamada K, Nakayama H, Masuda M. Prediction of lung tumor palpability using high-resolution computed tomography. Asian Cardiovasc Thorac Ann 2015; 24:23-9. [PMID: 26542781 DOI: 10.1177/0218492315615480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Palpation is the most important means of locating lung tumors and resecting them with sufficient margins. This study aimed to predict the palpability of pulmonary lesions using high-resolution computed tomography. METHODS Eighty-six pulmonary lesions were palpated in fresh resected lung specimens from July 2013 to March 2014. The following parameters were compared between 10 impalpable and 76 palpable lesions: maximum tumor size in pulmonary and bone window level settings, consolidation tumor size in pulmonary window level setting, and pleural-tumor distance. In 54 adenocarcinomas, the lepidic component and fibrosis foci rates were compared between the two groups. RESULTS Tumor size in bone window level setting and the consolidation tumor size were significantly smaller in the impalpable group (both p < 0.001), and an operational cutoff of 5 mm was identified by receiver-operating characteristic analysis (sensitivity/specificity was 90.0%/94.7% and 90.0%/86.9%, respectively). Pulmonary lesions were impalpable with 87.5% probability when the tumor size in bone window level setting was ≤ 5 mm and the pleural-tumor distance was ≥ 5 mm, and with 85.7% probability when the consolidation tumor size was ≤ 5 mm and the pleural-tumor distance was ≥ 5 mm. Lepidic component and fibrosis foci rates of impalpable/palpable lesions were 96.0%/52.8% and 4.0%/24.7%, respectively (both p < 0.001). CONCLUSIONS Tumor size in bone window level setting or a consolidation tumor size ≤ 5 mm and pleural-tumor distance ≥ 5 mm are simple criteria that are potentially useful indicators for preoperative marking to locate small-sized lepidic-predominant adenocarcinomas with few fibrotic foci.
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Affiliation(s)
- Tetsuya Isaka
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan Department of Surgery, Yokohama City University, Yokohama, Japan
| | - Hiroyuki Ito
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Tomoyuki Yokose
- Department of Pathology, Kanagawa Cancer Center, Yokohama, Japan
| | - Tetsuro Kondo
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Masashi Nagata
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Teppei Nishii
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Kouzo Yamada
- Department of Thoracic Oncology, Kanagawa Cancer Center, Yokohama, Japan
| | - Haruhiko Nakayama
- Department of Thoracic Surgery, Kanagawa Cancer Center, Yokohama, Japan
| | - Munetaka Masuda
- Department of Surgery, Yokohama City University, Yokohama, Japan
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Seyed Siamdoust SA, Mohseni M, Memarian A. Endotracheal Tube Cuff Pressure Assessment: Education May Improve but not Guarantee the Safety of Palpation Technique. Anesth Pain Med 2015; 5:e16163. [PMID: 26161313 PMCID: PMC4493730 DOI: 10.5812/aapm.5(3)2015.16163] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2014] [Revised: 10/27/2014] [Accepted: 12/15/2014] [Indexed: 12/27/2022] Open
Abstract
Background: Endotracheal Tube Cuff Pressure (ETCP) should be kept in the range of 20 - 30 cm H2O. Earlier studies suggested that ETCP assessment by palpation of pilot balloon results in overinflation or underinflation and subsequent complications such as tracheal wall damage and aspiration. Objectives: The current study aimed to evaluate the effect of an in vitro educational program on the ability of anesthesia personnel to inflate Endotracheal Tube Cuffs (ETT) within safe pressure limits. Patients and Methods: The survey included two series of blinded ETCP measurements in intubated patients before and two weeks after an in vitro educational intervention. The in vitro educational program included two separate trials. The anesthesia personnel were asked to inflate an ETT cuff inserted in a tracheal model using their usual inflation technique. In the same session, six ETTs at different pressure levels were examined by the participants and their estimation of ETCP was recorded. After the in vitro assessment, the participants were informed about the actual pressure of the in vitro ETCPs and were allowed to train their fingers by in vitro pilot balloon palpation with validated manometer measurements. Results: The mean ETCP after the in vitro survey was significantly lower than the mean ETCP before the intervention (45 ± 13 vs. 51 ± 15 cm H2O, P = 0.002). The rate of measurements within the safe pressure limits significantly improved after the in vitro education (24.2% vs. 39.7%, P = 0.002). Conclusions: Implementing educational programs with the introduction of estimation techniques besides the use of manometer as a standard intraoperative monitoring will improve the safety of the practice.
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Affiliation(s)
| | - Masood Mohseni
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
- Corresponding author: Masood Mohseni, Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran. Tel: +98-2164352326, Fax: +98-2166509059, E-mail:
| | - Arash Memarian
- Department of Anesthesiology, Rasoul Akram Medical Center, Iran University of Medical Sciences, Tehran, Iran
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Khoddami SM, Ansari NN, Jalaie S. Review on Laryngeal Palpation Methods in Muscle Tension Dysphonia: Validity and Reliability Issues. J Voice 2015; 29:459-68. [PMID: 25795346 DOI: 10.1016/j.jvoice.2014.09.023] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2014] [Accepted: 09/16/2014] [Indexed: 02/08/2023]
Abstract
BACKGROUND Laryngeal palpation is a common clinical method for the assessment of neck and laryngeal muscles in muscle tension dysphonia (MTD). OBJECTIVE To review the available laryngeal palpation methods used in patients with MTD for the assessment, diagnosis, or document of treatment outcomes. STUDY DESIGN (METHOD) A systematic review of the literature concerning palpatory methods in MTD was conducted using the databases MEDLINE (PubMed), ScienceDirect, Scopus, Web of science, Web of knowledge and Cochrane Library between July and October 2013. Relevant studies were identified by one reviewer based on screened titles/abstracts and full texts. Manual searching was also used to track the source literature. RESULTS There were five main as well as miscellaneous palpation methods that were different according to target anatomical structures, judgment or grading system, and using tasks. There were only a few scales available, and the majority of the palpatory methods were qualitative. Most of the palpatory methods evaluate the tension at both static and dynamic tasks. There was little information about the validity and reliability of the available methods. CONCLUSION The literature on the scientific evidence of muscle tension indicators perceived by laryngeal palpation in MTD is scarce. Future studies should be conducted to investigate the validity and reliability of palpation methods.
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Affiliation(s)
- Seyyedeh Maryam Khoddami
- Department of Speech Therapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Noureddin Nakhostin Ansari
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
| | - Shohreh Jalaie
- Department of Physiotherapy, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran.
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Dueber J, Pang JC, Lew M, Jing X, Heider A, Davenport R, Bernacki KD, Kantola S, Roh MH. Value of ultrasound guidance in cytopathologist-performed fine-needle aspirations of palpable lesions. J Am Soc Cytopathol 2015; 4:195-202. [PMID: 31051754 DOI: 10.1016/j.jasc.2014.12.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2014] [Revised: 12/24/2014] [Accepted: 12/24/2014] [Indexed: 06/09/2023]
Abstract
INTRODUCTION Fine-needle aspirations (FNAs) of palpable masses are often performed by cytopathologists without ultrasound (US) guidance. Nonetheless, variations in the actual depth of palpable masses lead to occasional challenges. US guidance allows cytopathologists to visualize the mass and guide needle placement. This study retrospectively addressed the utility of US by comparing FNAs performed by cytopathologists on palpable masses with and without US guidance. MATERIALS AND METHODS Cytopathologist-performed FNAs with and without US guidance from March 1, 2013 to July 1, 2014 were identified. The number of passes, location of lesions, and interpretations were recorded. Available slides were reviewed to determine the proportion of passes that contained diagnostic cellular material and cases in which diagnostic material was present on the first needle pass. RESULTS In this study, 134 palpation-guided FNAs and 118 US-guided FNAs were analyzed. The percentage of nondiagnostic cases was significantly lower for US-guided FNAs (2.5%) than for palpation-guided FNAs (12.7%; P = 0.004). The average number of needle passes was significantly lower for US-guided FNAs (2.9) than for palpation-guided FNAs (3.6; P = 0.0002). Twenty-two of 118 of US-guided FNAs (18.6%) and 6 of 134 palpation-guided FNAs (4.5%) were completed after only a single pass (P = 0.0008). The percentage of passes with diagnostic material was significantly higher for US-guided FNAs (73.6% versus 60%; P = 0.0002). CONCLUSIONS For palpable masses, US-guidance adds value to cytopathologists in obtaining diagnostic cellular material more often on the first pass and with fewer passes overall than by palpation alone. This has a potentially beneficial impact on patient care owing to the increased precision and accuracy of needle guidance with ultrasonography.
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Affiliation(s)
- Julie Dueber
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Judy C Pang
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Madelyn Lew
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Xin Jing
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Amer Heider
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Robertson Davenport
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Kurt D Bernacki
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Scott Kantola
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan
| | - Michael H Roh
- Department of Pathology, University of Michigan Health System, 1500 E. Medical Center Drive, Ann Arbor, Michigan.
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Grigoriu AI, Dinomais M, Rémy-Néris O, Brochard S. Impact of Injection-Guiding Techniques on the Effectiveness of Botulinum Toxin for the Treatment of Focal Spasticity and Dystonia: A Systematic Review. Arch Phys Med Rehabil 2015; 96:2067-78.e1. [PMID: 25982240 DOI: 10.1016/j.apmr.2015.05.002] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2014] [Revised: 04/16/2015] [Accepted: 05/04/2015] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To conduct a systematic review of the impact of different injection-guiding techniques on the effectiveness of botulinum toxin type A (BoNT-A) for the treatment of focal spasticity and dystonia. DATA SOURCES MEDLINE via PubMed, Academic Search Premier, PASCAL, The Cochrane Library, Scopus, SpringerLink, Web of Science, EM Premium, and PsycINFO. STUDY SELECTION Two reviewers independently selected studies based on predetermined inclusion criteria. DATA EXTRACTION Data relating to the aim were extracted. Methodological quality was graded independently by 2 reviewers using the Physiotherapy Evidence Database assessment scale for randomized controlled trials (RCTs) and the Downs and Black evaluation tool for non-RCTs. Level of evidence was determined using the modified Sackett scale. DATA SYNTHESIS Ten studies were included. Seven were randomized. There was strong evidence (level 1) that instrumented guiding (ultrasonography [US], electrical stimulation [ES], electromyogram [EMG]) was more effective than manual needle placement for the treatment of spasmodic torticollis, upper limb spasticity, and spastic equinus in patients with stroke, and spastic equinus in children with cerebral palsy. Three studies provided strong evidence (level 1) of similar effectiveness of US and ES for upper and lower limb spasticity in patients with stroke, and spastic equinus in children with cerebral palsy, but there was poor evidence or no available evidence for EMG or other instrumented techniques. CONCLUSIONS These results strongly recommend instrumented guidance of BoNT-A injection for the treatment of spasticity in adults and children (ES or US), and of focal dystonia such as spasmodic torticollis (EMG). No specific recommendations can be made regarding the choice of instrumented guiding technique, except that US appears to be more effective than ES for spastic equinus in adults with stroke.
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Affiliation(s)
| | - Mickael Dinomais
- LUNAM, University of Angers, University Hospital of Angers, Rehabilitation Department, Angers, France; LUNAM, University of Angers, Angers Laboratory for Research in Engineering Systems (LARIS)-UPRES EA, Angers, France
| | - Olivier Rémy-Néris
- University Hospital of Brest, Rehabilitation Department, Brest, France; Western Brittany University, Brest, France; National Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
| | - Sylvain Brochard
- University Hospital of Brest, Rehabilitation Department, Brest, France; Western Brittany University, Brest, France; National Institute of Health and Medical Research (INSERM) UMR 1101, Medical Data Treatment (LaTIM), Brest, France
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Cooperstein R, Blum C, Cooperstein EC. Assessment of Consistency Between the Arm-Fossa Test and Gillet Test: A Pilot Study. J Chiropr Med 2015; 14:24-31. [PMID: 26693214 DOI: 10.1016/j.jcm.2014.12.006] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2014] [Revised: 10/09/2014] [Accepted: 10/13/2014] [Indexed: 11/25/2022] Open
Abstract
OBJECTIVE The purpose of this pilot study was to test methods needed to conduct a study with adequate power to investigate consistency between the arm-fossa test (AFT) and the Gillet test. METHODS A convenience sample of chiropractic college students enrolled in a weekend Sacro-Occipital Technique seminar participated. Each was tested with AFT and sacroiliac orthopedic tests, including the Gillet test. Statistical testing included calculation of κ for consistency of the AFT and Gillet test and their diagnostic efficiency. RESULTS This study recruited 14 participants. Important issues arose in gathering and recording data, the standardization of examiner methods, and the flow of participants to examination stations. κ for AFT and Gillet test consistency = 0.55, corresponding to "moderate." CONCLUSION This pilot suggests that the future study should include a mix of symptomatic and asymptomatic participants; record trichotomous data, where appropriate; use washout periods between diagnostic tests; and refine the selection of orthopedic tests deployed besides the AFT. The preliminary data are consistent with but do not establish due to the very small sample size and experimental design issues, that a positive AFT may be consistent with a negative Gillet test.
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Affiliation(s)
- Robert Cooperstein
- Professor Palmer Center for Chiropractic Research, Palmer Chiropractic College, West, San Jose, CA
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Wood CD, Vijayvergia M, Miller FH, Carroll T, Fasanati C, Shea LD, Brinson LC, Woodruff TK. Multi-modal magnetic resonance elastography for noninvasive assessment of ovarian tissue rigidity in vivo. Acta Biomater 2015; 13:295-300. [PMID: 25463483 PMCID: PMC4295766 DOI: 10.1016/j.actbio.2014.11.022] [Citation(s) in RCA: 39] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2014] [Revised: 10/29/2014] [Accepted: 11/12/2014] [Indexed: 12/11/2022]
Abstract
For centuries, physicians have relied on touch to palpate tissue and detect abnormalities throughout the body. While this time-tested method has provided a simple diagnostic examination for large, superficial abnormalities, it does not permit quantifiable measurements of stiffness in deeper, small organs. Advances in noninvasive imaging to measure tissue rigidity represent important extensions of manual palpation techniques. Tissue fibrosis occurs with age in many organs; in the ovary, it is thought to be a marker of polycystic ovary syndrome and age-related idiopathic infertility, although quantitative assessment of fibrosis in this deep, abdominal tissue has not been possible. We used noninvasive methods to quantify ovarian tissue rigidity and clarify the role of tissue stiffness in reproductive health. With proper validation against accepted standards, noninvasive imaging techniques may become the quantitative counterpart to interior probing palpation methods and invasive (surgical) diagnoses, with applications across many clinical settings, including evaluation of adolescent and young adult ovarian function.
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Affiliation(s)
- Charles D Wood
- Department of Mechanical Engineering, Northwestern University, 2145 Sheridan Rd, Evanston, IL 60201, USA
| | - Mayank Vijayvergia
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Evanston, IL 60201, USA
| | - Frank H Miller
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St, Clair Suite 800, Chicago, IL 60611, USA
| | - Timothy Carroll
- Department of Biomedical Engineering, Northwestern University, 2145 Sheridan Rd, Evanston, IL 60201, USA; Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St, Clair Suite 800, Chicago, IL 60611, USA
| | - Charles Fasanati
- Department of Radiology, Northwestern University Feinberg School of Medicine, 676 N St, Clair Suite 800, Chicago, IL 60611, USA
| | - Lonnie D Shea
- Department of Chemical and Biological Engineering, Northwestern University, 2145 Sheridan Rd, Evanston, IL 60201, USA
| | - L Catherine Brinson
- Department of Mechanical Engineering, Northwestern University, 2145 Sheridan Rd, Evanston, IL 60201, USA; Department of Materials Science and Engineering, Northwestern University, 2220 Campus Drive, Evanston, IL 60201, USA.
| | - Teresa K Woodruff
- Department of Obstetrics and Gynecology, Northwestern University Feinberg School of Medicine, 303 E. Superior St, Chicago, IL 60611, USA
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Dabirmoghaddam P, Sharifkashany S, Mashali L. Ultrasound-guided fine needle aspiration cytology in the assessment of cervical metastasis in patients undergoing elective neck dissection. Iran J Radiol 2014; 11:e7928. [PMID: 25763085 PMCID: PMC4341177 DOI: 10.5812/iranjradiol.7928] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/27/2012] [Revised: 08/11/2013] [Accepted: 09/10/2013] [Indexed: 11/16/2022]
Abstract
BACKGROUND In head and neck cancer patients, diagnosis of metastatic cervical adenopathy is essential for treatment planning and prognosis assessment. Treatment of patients with head and neck cancer with clinically negative cervical lymph node (N0) remains controversial. While routine neck treatment would result in overtreatment in many patients, observation may delay the diagnosis and decrease the patients' survival. OBJECTIVES To gain insights into the unclear questions regarding the value of diagnostic modalities in patients with N0 neck, this study was designed to compare the diagnostic efficacy of palpation, ultrasonography (US) and ultrasound-guided fine needle aspiration (USGFNA) in detecting cervical lymph node metastasis. PATIENTS AND METHODS Forty-two patients with head and neck cancer who underwent US and USGFNA prior to elective neck dissection were studied. Histopathologic findings of the neck specimens were compared with each diagnostic technique. RESULTS Of the 53 neck dissection specimens, histopathology showed metastases in 16 cases. The overall accuracy of USGFNA, US and palpation was 96%, 68% and 70%, respectively. The specificity of USGFNA was superior to palpation and US alone. USGFNA had the highest sensitivity, predictive value and accuracy in detecting cervical metastases compared with other performed tests. CONCLUSIONS In our study, USGFNA was superior to palpation and US in detecting metastasis in clinically negative necks. This method can be recommended as a diagnostic tool in preoperative assessment of patients without palpable metastasis, but further investigations are needed before this modality could be considered as an alternative to elective neck dissection.
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Affiliation(s)
- Payman Dabirmoghaddam
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
- Corresponding author: Payman Dabirmoghaddam, Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, North Saadi Ave., P.O. Box: 1145765111, Tehran, Iran. Tel: +98-2166703037, Fax: +98-2166760245, E-mail:
| | - Shervin Sharifkashany
- Department of Radiology, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
| | - Leila Mashali
- Otolaryngology Research Center, Amiralam Hospital, Tehran University of Medical Sciences, Tehran, Iran
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Barbero M, Bertoli P, Cescon C, Macmillan F, Coutts F, Gatti R. Intra-rater reliability of an experienced physiotherapist in locating myofascial trigger points in upper trapezius muscle. J Man Manip Ther 2013; 20:171-7. [PMID: 24179324 DOI: 10.1179/2042618612y.0000000010] [Citation(s) in RCA: 51] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
OBJECTIVES Myofascial trigger points (MTrPs) are considered the principal clinical feature of myofascial pain syndrome (MPS). An MTrP consists of spot tenderness within a taut band of muscle fibers and its stimulation can produce both local and referred pain. The clinical diagnosis of MPS depends on correct history taking and a physical examination aimed at identifying the presence of MTrP. The purpose of this study was to investigate the intra-rater reliability of a palpation protocol used for locating an MTrP in the upper trapezius muscle. METHODS Twenty-four subjects with MTrP in the upper trapezius muscle were examined by an experienced physiotherapist. During each of eight experimental sessions, subjects were examined twice in randomized order using a palpation protocol. An anatomical landmark system was defined and the MTrP location established using X and Y values. RESULTS The intraclass correlation coefficient ICC(1,1) values were 0.62 (95% CI: 0.30-0.81) for X and 0.81 (95% CI: 0.61-0.91) for Y. The Bland-Altman plots for X and Y showed a mean of difference of 0.04 and -0.2 mm, respectively. Limits of agreement for X ranged from -26.3 to 26.2 mm and for Y from -27 to 26.4 mm. DISCUSSION The ICC(1,1) for the observed values revealed a moderate to high correlation and the Bland-Altman analysis showed means of difference very close to zero with narrow limits of agreement. An experienced physiotherapist can reliably identify MTrP locations in upper trapezius muscle using a palpation protocol.
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Affiliation(s)
- Marco Barbero
- Department of Health Sciences, University of Applied Sciences and Arts of Southern Switzerland, SUPSI, Manno, Switzerland ; School of Health Sciences, Queen Margaret University, Edinburgh, UK
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Bron C, Franssen J, Wensing M, Oostendorp RAB. Interrater reliability of palpation of myofascial trigger points in three shoulder muscles. J Man Manip Ther 2011; 15:203-15. [PMID: 19066669 DOI: 10.1179/106698107790819477] [Citation(s) in RCA: 107] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
This observational study included both asymptomatic subjects (n=8) and patients with unilateral or bilateral shoulder pain (n=32). Patient diagnoses provided by the referring medical physicians included subacromial impingement, rotator cuff disease, tendonitis, tendinopathy, and chronic subdeltoid-subacromial bursitis. Three raters bilaterally palpated the infraspinatus, the anterior deltoid, and the biceps brachii muscles for clinical characteristics of a total of 12 myofascial trigger points (MTrPs) as described by Simons et al. The raters were blinded to whether the shoulder of the subject was painful. In this study, the most reliable features of trigger points were the referred pain sensation and the jump sign. Percentage of pair-wise agreement (PA) was >/= 70% (range 63-93%) in all but 3 instances for the referred pain sensation. For the jump sign, PA was >/= 70% (range 67-77%) in 21 instances. Finding a nodule in a taut band (PA = 45-90%) and eliciting a local twitch response (PA = 33-100%) were shown to be least reliable. The best agreement about the presence or absence of MTrPs was found for the infraspinatus muscle (PA = 69-80%). This study provides preliminary evidence that MTrP palpation is a reliable and, therefore, potentially useful diagnostic tool in the diagnosis of myofascial pain in patients with non-traumatic shoulder pain.
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Hart J, Neely C. Allowing a possible margin of error when assessing student skills in spinous process location. J Chiropr Educ 2011; 25:182-185. [PMID: 22069343 PMCID: PMC3204954 DOI: 10.7899/1042-5055-25.2.182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2010] [Revised: 11/01/2010] [Accepted: 01/24/2011] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Spinal palpation is subject to inconsistency between examiners. When testing students on the location of vertebral spinous processes, faculty examiners may wish to allow for a margin of error that is observed between experienced practitioners. This study attempts to determine such a margin of error for selected vertebral levels that could be allowed in testing situations at Sherman Chiropractic College. This could serve as a model for other chiropractic colleges in determining their margins of error. METHODS Two faculty clinicians palpated spinous processes at four different vertebral levels (C2, T3, T9, and L2) on 18 student volunteers. Differences for each vertebral level, along with one, two, and three standard deviations, were calculated. RESULTS AVERAGE DIFFERENCES BETWEEN EXAMINERS INCREASED CAUDALLY, AS FOLLOWS: C2, 4.23 ± 3.77 mm; T3, 13.41 ± 10.53 mm; T9, 18.17 ± 17.62 mm; L2, 18.70 ± 16.58 mm. DISCUSSION In this study, faculty examiners exhibited variation in their locations of spinous processes for these vertebrae. These variations could be allowed when assessing student skills in locating these spinous processes at this chiropractic college. CONCLUSION In this study, differences between examiners plus or minus one standard deviation ranged from 4.23 ± 3.77 mm for C2 to 18.70 ± 16.58 mm for L2. The concept of margin of error should be considered by faculty examiners when assessing the skill of students in locating the spinous process of various vertebral levels.
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Affiliation(s)
- John Hart
- Address correspondence to John Hart, Sherman College of Chiropractic, PO Box 1452, Spartanburg, SC 29304 (e-mail: )
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Kim HW, Jin GU, Lim YS, Kwon HU, Kang PS, Cho CK. Identification of the L4-5 interspinous space using difference in heights of two consecutive spinous processes. Korean J Anesthesiol 2009; 56:652-657. [PMID: 30625805 DOI: 10.4097/kjae.2009.56.6.652] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The appropriate landmark of spinal puncture is important for preventing spinal cord injury. L4 spinous process (SP) is the largest in size and L5 is the smallest. In this study 'height of SP' is the longitudinal length of SP on lumbar AP view. The purpose of this study was to identify the L4-5 interspinous space (ISS) using difference between L4, 5 SP heights. METHODS Sixty-six patients scheduled for spine surgery were enrolled. After induction of general anesthesia, patients were changed to a prone position. The lumbar vertebrae were palpated from the lowest point of the lumbar spine and cranially. We palpated the difference in spinous process heights and marked the point of step-off from L4 SP to L5 SP. The level was radiologically confirmed. Direction of estimation error and the effects of spondylolisthesis, sex, and obesity were also analyzed. RESULTS The number of accurate identification of the L4-5 ISS in males was 36 (85.7%), in females was 17 (70.8%), and in total 53 (80.3%). The difference between L4 and L5 SP heights (DL4-5SPHs) and sex affect the results. DL4-5SPHs were larger in concordant patients than in discordant patients (7.2 +/- 4.9 mm: 5.0 +/- 1.6 mm, P < 0.05). Among errors, there were more cephalad identified cases compared to caudad identified ones (12.1%: 7.6%). CONCLUSIONS The identification of L4-5 ISS using SP height difference was considerably accurate. So, we considered this might be a useful method for spinal anesthesia.
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Affiliation(s)
- Hyun Woo Kim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
| | - Gyong Uk Jin
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
| | - Young Su Lim
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
| | - Hee Uk Kwon
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
| | - Po Soon Kang
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
| | - Choon Kyu Cho
- Department of Anesthesiology and Pain Medicine, College of Medicine, Konyang University, Daejeon, Korea.
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Thakur JS, Sharma ML, Mohan C, Mohindroo NK, Kaushik NK. Clinicopathological and radiological evaluation of cervical lymph node metastasis in head and neck malignancies. Indian J Otolaryngol Head Neck Surg 2007; 59:327-31. [PMID: 23120466 DOI: 10.1007/s12070-007-0094-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
The cervical lymphadenopathy due to metastasis carry poor prognosis. The status of cervical nodes is of critical interest to surgical, radiation and medical oncologists who manage patients with head and neck cancers. We conducted a prospective randomized study to assess the role of palpation, ultrasound and CT in detection of cervical metastasis in 25 patients presented to us with head and neck malignancy irrespective of cervical nodal status. It was observed that clinical examination was least sensitive (73.33%) when compared with computerized tomography (80%) and ultrasound (93.93%). The computerized tomography was found to be most specific (90%) when compared to clinical examination or ultrasonography (70% each).
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Affiliation(s)
- Jagdeep S Thakur
- Department of Otolaryngology - Head & Neck Surgery, I. G. Medical College, Shimla, HP 171 001 India
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