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Withers HG, Liu H, Glinsky JV, Chu J, Jennings MD, Hayes AJ, Starkey I, Palmer BA, Szymanek L, Cruwys JJ, Wong D, Duong K, Barnett A, Tindall M, Lucas B, Lambert TE, Taylor D, Sherrington C, Ferreira M, Maher C, Zadro J, Hart K, Hodge W, Harvey LA. Patients', physiotherapists' and other stakeholders' experiences and perceptions about supported home physiotherapy for people with musculoskeletal conditions: a qualitative study. Physiotherapy 2024; 124:143-153. [PMID: 38901217 DOI: 10.1016/j.physio.2024.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2022] [Revised: 12/17/2023] [Accepted: 01/23/2024] [Indexed: 06/22/2024]
Abstract
OBJECTIVES Exercise, support and advice are the key treatment strategies of musculoskeletal problems. The aims of this study were to determine patients', physiotherapists', and other stakeholders' perspectives about supported home physiotherapy for the management of musculoskeletal problems and to identify the barriers and facilitators to rolling out this model of physiotherapy service delivery. METHODS This study was conducted as part of a process evaluation run alongside a large trial designed to determine whether supported home physiotherapy is as good or better than a course of in-person physiotherapy. Forty interviews were conducted with 20 trial participants, 15 physiotherapists, and 5 other stakeholders. The interviews were semi-structured and based on interview guides. Each interview was transcribed and a three-tiered coding tree was developed. RESULTS Six key themes were identified. Supported home physiotherapy (i) is convenient for some patients, (ii) does not always align with patients' and therapists' expectations about treatment (iii) is suitable for some but not all, (iv) can reduce personal connection and accountability, (v) has implications for physiotherapists' workloads, and (vi) has barriers and facilitators to future implementation. CONCLUSIONS Findings suggest that patients are far more accepting of supported home physiotherapy than physiotherapists assume. This model of service delivery could be rolled out to improve access to physiotherapy and to provide a convenient and effective way of delivering physiotherapy to some patients with musculoskeletal conditions if our trial results indicate that supported home physiotherapy is as good or better than in-person physiotherapy. CLINICAL TRIAL REGISTRY NUMBER ACTRN12619000065190 CONTRIBUTIONS OF THIS PAPER.
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Affiliation(s)
- Hannah G Withers
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, C/O Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Hueiming Liu
- The George Institute for Global Health, University of New South Wales, Level 5, 1 King St, Newtown, NSW 2042, Australia.
| | - Joanne V Glinsky
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, C/O Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Jackie Chu
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, C/O Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Matthew D Jennings
- Allied Health Services, Liverpool Hospital, Locked Bag 7103, Liverpool, NSW 1871, Australia.
| | - Alison J Hayes
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, NSW 2006, Australia.
| | - Ian Starkey
- Blacktown and Mt Druitt Hospitals, PO Box 792, Seven Hills, NSW 1730, Australia.
| | - Blake A Palmer
- Blacktown and Mt Druitt Hospitals, PO Box 792, Seven Hills, NSW 1730, Australia.
| | - Lukas Szymanek
- Camden and Campbelltown Hospital, Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560, Australia.
| | - Jackson J Cruwys
- Camden and Campbelltown Hospital, Campbelltown Hospital, Therry Road, Campbelltown, NSW 2560, Australia.
| | - David Wong
- Liverpool Hospital, Level 2 Health Services Building, Corner Campbell and Goulbourn Street, Liverpool, NSW 2170, Australia.
| | - Kitty Duong
- Liverpool Hospital, Level 2 Health Services Building, Corner Campbell and Goulbourn Street, Liverpool, NSW 2170, Australia.
| | - Anne Barnett
- Bankstown-Lidcombe Hospital, Locked Mail Bag 1600, Bankstown, NSW 2200, Australia.
| | - Matthew Tindall
- Bankstown-Lidcombe Hospital, Locked Mail Bag 1600, Bankstown, NSW 2200, Australia.
| | - Barbara Lucas
- Royal North Shore Hospital, Building 30, Level 2, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Tara E Lambert
- Royal North Shore Hospital, Building 30, Level 2, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Deborah Taylor
- Physiotherapy Department RNSH, Building 30, Level 2, Pacific Highway, St Leonards, NSW 2065, Australia.
| | - Catherine Sherrington
- The University of Sydney, Institute for Musculoskeletal Health, King George V Building, Level 10 Missenden Road, Camperdown NSW 2050, Australia.
| | - Manuela Ferreira
- The University of Sydney, Sydney Musculoskeletal Health, School of Health Sciences, Royal North Shore Hospital, Level 10 The Kolling Building, St Leonards, NSW 2065, Australia.
| | - Christopher Maher
- The University of Sydney, Institute for Musculoskeletal Health, King George V Building, Level 10 Missenden Road, Camperdown NSW 2050, Australia.
| | - Joshua Zadro
- The University of Sydney, Institute for Musculoskeletal Health, King George V Building, Level 10 Missenden Road, Camperdown NSW 2050, Australia.
| | - Kerry Hart
- ARTD Consultants, Level 4, 352 Kent St, Sydney, NSW 2000, Australia.
| | - Wendy Hodge
- ARTD Consultants, Level 4, 352 Kent St, Sydney, NSW 2000, Australia.
| | - Lisa A Harvey
- John Walsh Centre for Rehabilitation Research, Kolling Institute, Faculty of Medicine and Health, University of Sydney, C/O Royal North Shore Hospital, Pacific Highway, St Leonards, NSW 2065, Australia.
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Francisco IM, Tozzo MC, Martins J, de Oliveira AS. Adherence of individuals with shoulder pain to home exercise booklets: Barriers, facilitators, and the impact of disability, self-efficacy, and treatment expectations. Musculoskelet Sci Pract 2024; 72:102956. [PMID: 38691980 DOI: 10.1016/j.msksp.2024.102956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 03/29/2024] [Accepted: 04/09/2024] [Indexed: 05/03/2024]
Abstract
BACKGROUND home exercise booklets offer several benefits to individuals with shoulder pain. However, it is necessary to investigate the factors that determine adherence to home exercises. OBJECTIVES 1) To investigate the level of adherence of individuals with chronic shoulder pain to a home exercise booklet conducted without the mediation of a healthcare professional, 2) To describe the barriers and facilitators to adherence, and 3) to determine if shoulder disability, self-efficacy, and treatment expectations are predictors of the level of adherence. DESIGN prospective longitudinal study. METHODS A total of 47 individuals with chronic shoulder pain were recruited. The Numeric Pain Rating Scale (NPRS) was used to assess pain intensity, the Shoulder Pain and Disability Index (SPADI) to measure shoulder disability, the Pain Self-Efficacy Questionnaire (PSEQ-10) for self-efficacy, and a likert scale to measure treatment expectations. Adherence was measured by Exercise Adherence Assessment Scale (EAAE-Br). RESULTS A total of 23 individuals (48.93%) adhered to the home exercise program. The most commonly cited barriers were pain and health-related issues, while the most cited facilitators were pain improvement and symptom relief. Barriers associated with adherence were time constraints and other commitments, while the facilitator associated with adherence was enjoying the exercises. Binary logistic regression analysis revealed that shoulder disability, self-efficacy, and treatment expectations were unable to predict adherence to home exercises in individuals with shoulder pain [F (1,47) = 2.384; p = 0.130; R2 = 0.056]. CONCLUSION The study revealed barriers and facilitators to home exercise in individuals with shoulder pain. Disability, self-efficacy, and treatment expectations were not able to predict adherence.
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Affiliation(s)
- Isabela Maria Francisco
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Marcela Camargo Tozzo
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Jaqueline Martins
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Anamaria Siriani de Oliveira
- Department of Health Sciences, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto, SP, Brazil.
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Kwan SA, Massaglia JE, Aita DJ, Matzon JL, Rivlin M. Radiographic Edema Is a Predictor of de Quervain's Tenosynovitis. J Wrist Surg 2024; 13:333-338. [PMID: 39027022 PMCID: PMC11254476 DOI: 10.1055/s-0043-1772713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 07/25/2023] [Indexed: 07/20/2024]
Abstract
Background de Quervain's tenosynovitis (DeQ) is a clinical diagnosis; however, due to the symptom overlap with other pathologies, it can occasionally be challenging to make an accurate diagnosis, especially for nonorthopaedic trained physicians. Questions/Purposes We hypothesized that the ratio of radial-sided to ulnar-sided soft tissue swelling could serve as a universally accessible diagnostic tool to assist in differentiating DeQ from other upper extremity conditions. Patients and Methods We retrospectively identified patients with isolated DeQ (M65.4), thumb carpometacarpal arthritis (M18.X), or carpal tunnel syndrome (G56.0x) between 2018 and 2019. Five blinded, independent reviewers evaluated anterior-posterior radiographs of the affected wrist. A digital caliper was used to measure the shortest distance from the lateral cortex of the distal radius and the medial cortex of the distal ulna to the outer edge of the radial and ulnar soft tissue shadows, respectively. Results The mean radial:ulnar ratio in the DeQ group was significantly larger than in the control groups. The interclass correlation coefficient showed strong agreement between all measurements. Patients with a radial:ulnar ratio of 1.7 or higher had a 61% chance of having DeQ with a 56.5% sensitivity, 66.3% specificity, 59.3% positive predictive value (PPV), and 63.8% negative predictive value. A ratio of more than 2.5 correlates to a 55% chance of having DeQ with a sensitivity of 12.9%, specificity of 96.9%, and PPV of 78.6%. Conclusion The ratio of radial- to ulnar-sided wrist edema can be used as a novel diagnostic aid in DeQ, especially for those not trained in orthopaedics or hand surgery. Level of Evidence Level IV, diagnostic study.
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Affiliation(s)
- Stephanie A. Kwan
- Department of Orthopaedic Surgery, Jefferson Health, Stratford, New Jersey
| | | | - Daren J. Aita
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Jonas L. Matzon
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, Pennsylvania
| | - Michael Rivlin
- Department of Hand and Orthopaedic Surgery, Rothman Orthopaedic Institute, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, Pennsylvania
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Brindisino F, Girardi G, Crestani M, Assenza R, Andriesse A, Giovannico G, Pellicciari L, Salomon M, Venturin D. Rehabilitation in subjects with frozen shoulder: a survey of current (2023) clinical practice of Italian physiotherapists. BMC Musculoskelet Disord 2024; 25:573. [PMID: 39044183 PMCID: PMC11265321 DOI: 10.1186/s12891-024-07682-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 07/10/2024] [Indexed: 07/25/2024] Open
Abstract
OBJECTIVE Frozen Shoulder (FS) is a musculoskeletal pathology that leads to disability, functional decline, and a worsening in quality of life. Physiotherapists are the primary professionals involved in the treatment of FS, and it is essential to determine if their practice aligns with evidence-based suggestions. AIM The aim is to assess the knowledge, skills, and operational strategies of Italian physiotherapists regarding FS and compare them with the existing literature. METHODS A web-based, anonymous, and voluntary cross-sectional survey was developed and administered to Italian physiotherapists to evaluate their clinical practices. RESULTS A total of 501 physiotherapists (38.5% female), completed the survey. More than half were under 35 years old (67.8%), declared working in private practice settings or being self-employed (57.1%), and were primarily engaged with musculoskeletal patients (81.8%). For subjects with FS at their first access, 21.4% identified X-rays as the most useful imaging technique to recognize pathologies beyond rehabilitation competence. In terms of general management, the majority reported working with an orthopaedic or physiatrist (47.5%) or in a multidisciplinary team (33.5%). Regarding manual therapy techniques, 63.3% of physiotherapists preferred intense degree mobilization, posterior direction, and moderate pain at the end of the range of motion for low irritable/high stiffness FS; however, there is a lack of consensus for managing very irritable/low stiffness FS. The majority of physiotherapists (57.7%) concurred that stretching improves the balance between metalloproteinase and its inhibitors. Additionally, 48.3% of physiotherapists selected mobile phone videos and messages to improve patients' compliance with exercises at home and for motivational/educational purposes. DISCUSSION AND CONCLUSION The clinical practices of Italian physiotherapists in FS subjects sometimes deviate from evidence-based recommendations. While some discrepancies may be attributed to the existing uncertainties in the literature regarding knowledge and management strategies for FS patients, the authors recommend a stronger adherence to evidence-based practice.
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Affiliation(s)
- Fabrizio Brindisino
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy.
| | - Giuseppe Girardi
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | - Mauro Crestani
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
- Department of Neurosciences, Biomedicine and Movement Sciences, University of Verona, Verona, Italy
| | - Raffaele Assenza
- Physiotherapy Private Practice c/o Assenza Physical Therapy, Rome, Italy
| | - Arianna Andriesse
- Medical Translation Private Practice c/o Andriesse Medical Translator, Rome, Italy
| | - Giuseppe Giovannico
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
| | | | - Mattia Salomon
- Department of Clinical Science and Translational Medicine, University of Roma "Tor Vergata", Rome, Italy
| | - Davide Venturin
- Department of Medicine and Health Science "Vincenzo Tiberio", University of Molise, Campobasso, Italy
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Lo CW, Sum KWR, Leung FLE, Yang Y, Chan KL, Lam KK, Lau KW, Sum CH, Lin WL, Ho SH, Lin ZX. Efficacy of soothing cream gel in the range of motion and chronic pain at the shoulder and elbow: protocol of a double-blinded, randomised, placebo-controlled trial. BMJ Open 2024; 14:e085856. [PMID: 38969378 PMCID: PMC11227787 DOI: 10.1136/bmjopen-2024-085856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 06/03/2024] [Indexed: 07/07/2024] Open
Abstract
INTRODUCTION Upper limb problems have a significant impact on the global population leading to pain and restricted joint mobility, ultimately impacting their quality of life. Traditional treatments, such as non-steroidal anti-inflammatory drugs and corticosteroids, often come with undesirable side effects, prompting patients to seek alternative therapies. In this trial, we hypothesise that soothing cream gel (SCG) will improve range of motion and chronic pain in the shoulder and elbow. The objective of this trial is to evaluate the efficacy of SCG in improving the range of motion and chronic pain in the shoulder and elbow. METHODS AND ANALYSIS A double-blinded, randomised, placebo-controlled trial is conducted to compare the effects of SCG and placebo gel. SCG contains Vitis vinifera essence, Melaleuca viridiflora essential oil, etc, and is manufactured according to Good Manufacturing Practice standards. The placebo gel will be processed with similar appearance, texture and scent but will lack active ingredients. 70 participants with upper limb problems will be recruited from four study sites, including clinical centres and a sport department at the Chinese University of Hong Kong (CUHK). Participants will be randomly assigned to either treatment group or placebo group for 2 weeks. Primary outcome will be the range of motion in the upper limb, assessed by a goniometer, to measure active flexion and abduction for the shoulder, and active flexion and extension for the elbow. The primary efficacy analyses will be based on the full analysis set following the intention-to-treat principle. ETHICS AND DISSEMINATION The trial has obtained approval from the joint CUHK-New Territories East Cluster (CRE-2023.142), and the patient enrolment commenced in July 2023. Written informed consent will be obtained from all participants prior to participation. Study results will be disseminated through publication in peer-reviewed journals and presentations at conference. TRIAL REGISTRATION NUMBER NCT05799391.
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Affiliation(s)
- Cho Wing Lo
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kim Wai Raymond Sum
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | | | - Yijian Yang
- Department of Sports Science and Physical Education, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Leung Chan
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Koon Kit Lam
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Kam Wai Lau
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Chi Him Sum
- Hong Kong Institute of Integrative Medicine, The Chinese University of Hong Kong, Hong Kong, China
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Wai Ling Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Shing Hin Ho
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
| | - Zhi-Xiu Lin
- School of Chinese Medicine, The Chinese University of Hong Kong, Hong Kong, China
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Abudula X, Maimaiti P, Yasheng A, Shu J, Tuerxun A, Abudujilili H, Yang R. Factors associated with frozen shoulder in adults: a retrospective study. BMC Musculoskelet Disord 2024; 25:493. [PMID: 38926699 PMCID: PMC11200817 DOI: 10.1186/s12891-024-07614-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2024] [Accepted: 06/20/2024] [Indexed: 06/28/2024] Open
Abstract
OBJECTIVE This study aims to explore the risk factors associated with frozen shoulder patients and further analyze the relationship between gender and diabetes with frozen shoulder. METHOD We have reviewed the data of 1205 frozen shoulder patients in China's Xinjiang region from 2018 to 2023. The collected information included patients' gender, occupation, place of origin, marital status, age, the season of disease onset, duration of illness, etiology, surgical history, hypertension, diabetes, respiratory diseases, knee joint disease, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, sleep quality, smoking and alcohol consumption, and constipation. We have used multifactor logistic regression analysis to identify the risk factors for a frozen shoulder. RESULTS Single-factor logistic regression analysis showed that the number of females, patients with diabetes, knee joint disease, constipation, and patients with poor sleep quality in the observation group are higher than in the control group (P < 0.05). There were no statistically significant differences between the two groups in terms of occupation, place of origin, marital status, age, season of disease onset, duration of illness, etiology, surgical history, hypertension, respiratory diseases, hyperlipidemia, cardiovascular diseases, cervical spondylosis, lumbar disc herniation, rheumatoid arthritis, hyperuricemia, smoking, and alcohol consumption history (P > 0.05). Multivariate analysis showed that the final model included four variables: gender, diabetes history, sleep, and constipation. Among them, the OR values of gender and diabetes history were more significant than 1, indicating that they were independent risk factors for frozen shoulder, while the OR values of sleep and constipation were less than 1, suggesting that they were negatively associated with the occurrence of frozen shoulder. CONCLUSION The results of this study suggest that gender and diabetes are independent risk factors for frozen shoulder. Additionally, poor sleep quality and constipation also can be correlated with the occurrence of a frozen shoulder.
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Affiliation(s)
- Xiarepa Abudula
- Nursing School of Xinjiang Medical University, Urumqi, 830054, China
| | - Palida Maimaiti
- Nursing School of Xinjiang Medical University, Urumqi, 830054, China.
| | | | - Jiaojiao Shu
- Nursing School of Xinjiang Medical University, Urumqi, 830054, China
| | - Asiguli Tuerxun
- Nursing School of Xinjiang Medical University, Urumqi, 830054, China
| | | | - Ruiqi Yang
- Nursing School of Xinjiang Medical University, Urumqi, 830054, China
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Chong HH, Pradhan A, Dhingra M, Liong W, Hau MYT, Shah R. Advancements in de Quervain Tenosynovitis Management: A Comprehensive Network Meta-Analysis. J Hand Surg Am 2024; 49:557-569. [PMID: 38613563 DOI: 10.1016/j.jhsa.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2023] [Revised: 02/08/2024] [Accepted: 03/06/2024] [Indexed: 04/15/2024]
Abstract
PURPOSE This study presents a network meta-analysis aimed at evaluating nonsurgical treatment modalities for de Quervain tenosynovitis. The primary objective was to assess the comparative effectiveness of nonsurgical treatment options. METHODS The systematic review was conducted following Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guidelines. Searches were performed in multiple databases, and studies meeting predefined criteria were included. Data extraction, risk of bias assessment, and statistical analysis were carried out to compare treatment modalities. The analysis was categorized into short-term (within six weeks), medium-term (six weeks up to six months), and long-term (one year) follow-up. RESULTS The analysis included 14 randomized controlled trials encompassing various treatment modalities for de Quervain tenosynovitis. In the short-term, extracorporeal shockwave therapy demonstrated statistically significant improvement in visual analog scale pain scores compared with placebo. Extracorporeal shockwave therapy also ranked highest in the treatment options based on its treatment effects. Corticosteroid injections (CSIs) combined with casting and laser therapy with orthosis showed favorable outcomes. Corticosteroid injection alone, platelet-rich plasma injections alone, acupuncture, and orthosis alone did not significantly differ from placebo in visual analog scale pain score. In the medium-term, extracorporeal shockwave therapy remained the top-ranking option for visual analog scale pain score, followed by CSI with casting. In the long-term (one year), CSI alone and platelet-rich plasma injections demonstrated sustained pain relief. Combining CSI with orthosis also appeared promising when compared with CSI alone. CONCLUSIONS Corticosteroid injection with a short duration of immobilization remains the primary and effective treatment for de Quervain tenosynovitis. Extracorporeal shockwave therapy can be considered a secondary option. Alternative treatment modalities, such as isolated therapeutic injection, should be approached with caution because they did not show substantial benefits over placebo. TYPE OF STUDY/LEVEL OF EVIDENCE Therapeutic I.
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Affiliation(s)
- Han Hong Chong
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom.
| | - Akhilesh Pradhan
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Mohit Dhingra
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - William Liong
- Department of Orthopaedic, Hospital Shah Alam, Shah Alam, Selangor, Malaysia
| | - Melinda Y T Hau
- Department of Trauma & Orthopaedic, University Hospitals of Leicester National Health Service (NHS) Trust, Leicester, United Kingdom
| | - Rohi Shah
- Department of Trauma & Orthopaedic, Nottingham University Hospitals National Health Service (NHS) Trust, Nottingham, United Kingdom
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Rangra P, Dickson L, Jagadamma KC. Service evaluation: Three subjective questions that aid in identifying frozen shoulder-Within a multi-centre musculoskeletal physiotherapy department in primary care. Musculoskeletal Care 2024; 22:e1886. [PMID: 38643407 DOI: 10.1002/msc.1886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 04/10/2024] [Indexed: 04/22/2024]
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Mason SJ, Brading LM, Kane K, Conaghan PG, Kingsbury SR, McHugh GA. Barriers and facilitators to engaging with a digital self-management programme for painful distal upper limb musculoskeletal disorders: A qualitative exploratory study. Health Expect 2024; 27:e14056. [PMID: 38858844 PMCID: PMC11164711 DOI: 10.1111/hex.14056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2023] [Revised: 03/01/2024] [Accepted: 04/12/2024] [Indexed: 06/12/2024] Open
Abstract
INTRODUCTION People living with a painful distal upper limb musculoskeletal disorder (DUL-MSD) often experience pain, difficulty in doing everyday tasks and a reduced quality of life. Currently, there are challenges in the treatment of DUL-MSDs, highlighting the need to develop innovative approaches to rehabilitation. A potential solution is to develop and implement a digital self-management rehabilitation programme focussing on optimising recovery, improving function and reducing pain. Before developing this programme, we aimed to identify the barriers and facilitators to using a digital health intervention (DHI) for self-management of DUL-MSDs. OBJECTIVE This study aimed to investigate the potential barriers and facilitators to using a DHI with people living with DUL-MSDs and healthcare professionals (HCPs). METHODS A qualitative exploratory study was carried out with purposely selected participants consisting of 15 participants with DUL-MSDs and 13 HCPs. Three focus groups (FGs) and four semistructured interviews with DUL-MSD participants and semistructured interviews with 13 HCPs were conducted. FGs and interviews were digitally recorded, transcribed and analysed using reflexive thematic analysis. RESULTS To address challenges in the care and management of DUL-MSDs, both HCPs and people living with a DUL-MSD welcomed the development of a DHI. This study identified several barriers and facilitators that would influence engagement with a digital intervention. Findings suggest that in developing a DHI, attention needs to be paid to digital design features, usability, tailoring, personalisation and consideration of how well usual care could be replicated digitally without direct HCP involvement. CONCLUSION The identified digital design features of importance to participants will inform the design of a digital self-management rehabilitation programme for people living with DUL-MSDs. Addressing the barriers and facilitators to engagement with a DHI is essential in ensuring its relevance and acceptability to those who will use it. PATIENT OR PUBLIC CONTRIBUTION Patient and Public Involvement and Engagement (PPIE) was integral throughout the study. PPIE members contributed to the development and planning of this study, checked and confirmed the relevance of the findings and are involved in the dissemination plans.
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Affiliation(s)
- Samantha J. Mason
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - Lucy M. Brading
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
| | - Kathleen Kane
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- Bone Cancer Research TrustLeedsUK
| | - Philip G. Conaghan
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
| | - Sarah R. Kingsbury
- Leeds Institute of Rheumatic and Musculoskeletal MedicineUniversity of LeedsLeedsUK
- NIHR Leeds Biomedical Research CentreLeedsUK
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Cevik J, Keating N, Hornby A, Salehi O, Seth I, Rozen WM. Corticosteroid injection versus immobilisation for the treatment of De Quervain's tenosynovitis: A systematic review and meta-analysis. HAND SURGERY & REHABILITATION 2024; 43:101694. [PMID: 38642740 DOI: 10.1016/j.hansur.2024.101694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2024] [Revised: 03/28/2024] [Accepted: 04/02/2024] [Indexed: 04/22/2024]
Abstract
OBJECTIVE De Quervain's tenosynovitis causes pain and impairment of thumb function. Conservative treatments comprise corticosteroid injection and immobilization, and it is unclear which offers greater efficacy. Previous reviews were limited by the small number of included studies; thus an updated review and meta-analysis is warranted. METHODS A systematic review of the PubMed, Embase, and Web of Science databases was conducted. Randomized control trials comparing corticosteroid injection to immobilization were included. Two authors screened articles, extracted data, and assessed the risk of bias of included studies. Meta-analyses using the random-effects model were conducted, calculating pooled relative risks and mean differences with 95% confidence intervals. RESULTS 16 studies comprising 1206 patients were included. Corticosteroid injection showed greater treatment success than immobilization (relative risk: 1.61; 95% confidence interval: 1.21-2.15). Combining treatments demonstrated greater efficacy than immobilization (relative risk: 2.15; 95% confidence interval: 1.77-2.62) or injection alone (relative risk: 1.23; 95% confidence interval: 1.12-1.34). Pain and disability scores were lower with injection than immobilization and with combined treatment than with either alone. CONCLUSION Corticosteroid injection is more effective than immobilization for De Quervain's tenosynovitis, and combining the two treatments provides additional benefit. We recommend corticosteroid injection in first line treatment and immobilization as adjuvant therapy. Further research is required regarding optimal corticosteroid and local anesthetic formulations.
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Affiliation(s)
- Jevan Cevik
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, 3199, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, 3004, Australia.
| | - Niamh Keating
- St Vincent's Hospital Melbourne, 41 Victoria Parade, Fitzroy, Victoria, 3065, Australia
| | - Alice Hornby
- The Royal Children's Hospital, 50 Flemington Road, Parkville, Victoria, 3052, Australia
| | - Omar Salehi
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, 3199, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, 3004, Australia
| | - Ishith Seth
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, 3199, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, 3004, Australia
| | - Warren M Rozen
- Department of Plastic and Reconstructive Surgery, Peninsula Health, Frankston, Victoria, 3199, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Monash University, Frankston, Victoria, 3004, Australia
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11
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Rhim HC, Schon JM, Xu R, Schowalter S, Ha J, Hsu C, Andrew M, Robinson DM, Tenforde AS, Daneshvar DH. Targeting the Sweet Spot: A Systematic Review With Meta-Analysis of Anterior Versus Posterior Glenohumeral Joint Injections for Adhesive Capsulitis. Clin J Sport Med 2024:00042752-990000000-00191. [PMID: 38810121 DOI: 10.1097/jsm.0000000000001228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/31/2024]
Abstract
OBJECTIVE To compare clinical outcomes following steroid injections using the anterior and posterior approaches. DESIGN Systematic review with meta-analysis. SETTING Embase, Web of Science, and Cochrane Center Register of Controlled Trials were searched for randomized control trials (RCTs) and prospective comparative studies. PATIENTS Patients with adhesive capsulitis. INTERVENTIONS Glenohumeral steroid injections using either anterior or posterior approach. MAIN OUTCOME MEASURES Pain visual analog scale (VAS) and shoulder range of motion (ROM) at 12 weeks, accuracy, and adverse events. Standardized mean difference (SMD) for VAS and weighted mean difference (WMD) for ROMs. RESULTS We identified 6 RCTs and one prospective comparative study with a total of 468 patients. While there was no difference in pain VAS at 12 weeks between the 2 approaches (SMD, -0.86; 95% CI, -1.76 to 0.04), the anterior approach resulted in greater improvements in external rotation (WMD, 8.08; 95% CI, 0.79-15.38) and abduction (WMD, 6.76; 95% CI, 3.05-10.48) compared with the posterior approach. Subgroup analysis with RCTs that utilized steroid injection with hydrodilatation for both approaches demonstrated greater reduction in pain VAS at 12 weeks with the anterior approach (SMD, -0.52; 95% CI, -0.98 to -0.07). Overall, procedures were well tolerated without major complications. CONCLUSIONS While pain reduction is similar, the anterior approach may be more beneficial in restoring shoulder external rotation and abduction compared with the posterior approach at 12 weeks. Steroid injection combined with hydrodilatation may further improve pain control when performed with the anterior approach at 12 weeks.
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Affiliation(s)
- Hye Chang Rhim
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jason M Schon
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Raylin Xu
- Harvard Medical School, Boston, Massachusetts; and
| | - Sean Schowalter
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Jane Ha
- Clinical and Translational Epidemiology Unit, Harvard Medical School/Massachusetts General Hospital, Boston, Massachusetts
| | - Connie Hsu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Michael Andrew
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - David M Robinson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
| | - Daniel H Daneshvar
- Department of Physical Medicine and Rehabilitation, Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, Massachusetts
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12
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Lin YJ, Chung CY, Chen CPC, Hsieh YW, Wang CF, Chen CC. The Feasibility and Efficacy of Remote App-Guided Home Exercises for Frozen Shoulder: A Pilot Study. Healthcare (Basel) 2024; 12:1095. [PMID: 38891171 PMCID: PMC11171612 DOI: 10.3390/healthcare12111095] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2024] [Revised: 05/20/2024] [Accepted: 05/23/2024] [Indexed: 06/21/2024] Open
Abstract
Home exercise programs are beneficial in managing frozen shoulder (FS), yet adherence remains challenging. This pilot study introduces the remote app, Defrozen, designed for home exercises and assesses its feasibility and clinical outcomes in FS patients undergoing intra-articular and sub-acromial corticosteroid treatment. Over a four-week period, patients used the Defrozen-app, engaging in guided exercises. The feasibility of the intervention was assessed through several measurement scales, including adherence, the Technology Acceptance Model 2 (TAM2), the System Usability Scale (SUS), and User Satisfaction and Engagement (USE). Clinical outcomes included pain scale, Oxford Shoulder Score (OSS), Quick Disability of the Arm, Shoulder, and Hand (QuickDASH) Score, and passive range of motion. The TAM2 results indicated high perceived usefulness (4.5/5), ease of use (4.8/5), and intention to use (4.4/5); the SUS score was high at 81.7/100, complemented by USE scores reflecting ease of learning (4.9/5) and satisfaction (4.3/5). Clinical outcomes showed significant pain reduction, improved shoulder function, reduced shoulder-related disability, and increased shoulder range of motion. These findings suggest the Defrozen-app as a promising solution for FS, significantly improving adherence and showing potential to enhance clinical outcomes. However, these clinical outcome results are preliminary and necessitate further validation through a large-scale randomized controlled trial to definitively confirm efficacy and assess long-term benefits.
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Affiliation(s)
- Yi-Jun Lin
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Chia-Ying Chung
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Carl P. C. Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
| | - Yu-Wei Hsieh
- Department of Occupational Therapy and Graduate Institute of Behavioral Sciences, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan;
| | - Ching-Fu Wang
- Department of Biomedical Engineering, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan;
- Biomedical Engineering Research and Development Center, National Yang Ming Chiao Tung University, Taipei 112304, Taiwan
| | - Chih-Chi Chen
- Department of Physical Medicine and Rehabilitation, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan 333423, Taiwan; (Y.-J.L.); (C.-Y.C.); (C.P.C.C.)
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13
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Zhou Y, Yin X, Wang C, Yu D. Gene association analysis to determine the causal relationship between immune-mediated inflammatory diseases and frozen shoulder. Medicine (Baltimore) 2024; 103:e38055. [PMID: 38728465 PMCID: PMC11081594 DOI: 10.1097/md.0000000000038055] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Accepted: 04/05/2024] [Indexed: 05/12/2024] Open
Abstract
Multiple studies have indicated a potential correlation between immune-mediated inflammatory diseases (IMIDs) and Frozen shoulder (FS). To explore the genetic causal relationship between IMIDs and FS using 2-sample Mendelian randomization (MR) analysis. Genome-wide association study (GWAS) summary data for FS were obtained from Green's study, while data for 10 IMIDs were sourced from the FinnGen Consortium. The MR analysis was performed using inverse variance weighting, MR Egger, and weighted median methods. IVW, as the primary MR analysis technique, was complemented with other sensitivity analyses to validate the robustness of the results. Additionally, reverse MR analysis was further conducted to investigate the presence of reverse causal relationships. In the forward MR analysis, genetically determined 4 IMIDs are causally associated with FS: rheumatoid arthritis (odds ratio [OR] (95% confidence interval [95% CI]) = 1.05 [1.02-1.09], P < .01); type 1 diabetes (OR [95% CI] = 1.06 [1.03-1.09], P < .01); hypothyroidism (OR [95% CI] = 1.07 [1.01-1.14], P = .02); and Celiac disease (OR [95% CI] = 1.02 [1.01-1.04], P = .01). However, no causal relationship was found between 6 IMIDs (autoimmune hyperthyroidism, Crohn disease, ulcerative colitis, psoriasis, sicca syndrome and systemic lupus erythematosus) and FS. Sensitivity analyses did not detect any heterogeneity or horizontal pleiotropy. In the reverse MR analysis, no causal relationship was observed between FS and IMIDs. In conclusion, this MR study suggests a potential causal relationship between rheumatoid arthritis, type 1 diabetes, hypothyroidism, and Celiac disease in the onset and development of FS. Nevertheless, more basic and clinical research will be needed in the future to support our findings.
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Affiliation(s)
| | - Xiuping Yin
- Experimental Research Center, China Academy of Chinese Medical Sciences, Beijing, China
| | | | - Donglin Yu
- Binzhou Medical University, Yantai, China
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14
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Sato Y, Takanaka S, Izumi SI. Alteration of Interhemispheric Inhibition in Patients With Lateral Epicondylalgia. THE JOURNAL OF PAIN 2024; 25:104440. [PMID: 38065465 DOI: 10.1016/j.jpain.2023.11.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 11/23/2023] [Accepted: 11/27/2023] [Indexed: 01/12/2024]
Abstract
Patients with lateral epicondylalgia (LE) show alterations in the primary motor cortex (M1) contralateral to the affected side. Cortical alterations have been investigated by measuring intracortical facilitation/inhibition; however, their association with pain remains controversial. Furthermore, no studies have investigated changes in interhemispheric inhibition (IHI). IHI can be assessed using the ipsilateral silent period (iSP) known as the temporary inhibition of electromyographic activity evoked by transcranial magnetic stimulation in the ipsilateral M1 of the contracting muscle. To better understand the relationship between cortical alterations and pain in LE, this observational study investigated the relationship between iSP and pain in LE. Twenty-seven healthy volunteers and 21 patients with LE were recruited. The duration of iSP in the extensor carpi radialis brevis was measured. The IHI asymmetry ratio was calculated to determine the IHI balance. Pain and disability were scored using the Japanese version of the patient-rated elbow evaluation. We observed increased inhibitory input from the ipsilateral M1 on the affected side to the contralateral M1 in LE. Additionally, the IHI balance correlated with pain severity. Hence, regulating imbalanced IHI can potentially decrease lateral elbow pain in LE. PERSPECTIVE: Patients with lateral epicondylalgia (LE) experience persistent pain and cortical alterations. However, there is no established relationship between cortical alterations and pain. This study demonstrated that the interhemispheric inhibition (IHI) balance is correlated with pain. Regulating imbalanced IHI can potentially decrease lateral elbow pain in patients with LE.
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Affiliation(s)
- Yosuke Sato
- Course of Rehabilitation, Department of Health Sciences, Tohoku Fukushi University, Aoba-ku, City, Miyagi, Japan; Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Shun Takanaka
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan
| | - Shin-Ichi Izumi
- Department of Physical Medicine and Rehabilitation, Tohoku University Graduate School of Medicine, Sendai City, Miyagi, Japan; Graduate School of Biomedical Engineering, Tohoku University, Sendai City, Miyagi, Japan
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15
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Hopewell S, Srikesavan C, Evans A, Er F, Rangan A, Preece J, Francis A, Massa MS, Feldmann M, Lamb S, Nanchahal J. Anti-TNF (adalimumab) injection for the treatment of pain-predominant early-stage frozen shoulder: the Anti-Freaze-Feasibility randomised controlled trial. BMJ Open 2024; 14:e078273. [PMID: 38692727 PMCID: PMC11086567 DOI: 10.1136/bmjopen-2023-078273] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 03/01/2024] [Indexed: 05/03/2024] Open
Abstract
OBJECTIVE The Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and improve function in people with pain-predominant early-stage frozen shoulder. DESIGN Multicentre, randomised feasibility trial, with embedded qualitative study. SETTING Four UK National Health Service (NHS) musculoskeletal and related physiotherapy services. PARTICIPANTS Adults ≥18 years with new episode of shoulder pain attributable to early-stage frozen shoulder. INTERVENTIONS Participants were randomised (centralised computer generated 1:1 allocation) to either ultrasound-guided intra-articular injection of: (1) adalimumab (160 mg) or (2) placebo (saline (0.9% sodium chloride)). Participants and outcome assessors were blinded to treatment allocation. Second injection of allocated treatment (adalimumab 80 mg) or equivalent placebo was administered 2-3 weeks later. PRIMARY FEASIBILITY OBJECTIVES: (1) Ability to screen and identify participants; (2) willingness of eligible participants to consent and be randomised; (3) practicalities of delivering the intervention; (4) SD of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months. RESULTS Between 31 May 2022 and 7 February 2023, 156 patients were screened of whom 39 (25%) were eligible. The main reasons for ineligibility were other shoulder disorder (38.5%; n=45/117) or no longer in pain-predominant frozen shoulder (33.3%; n=39/117). Of the 39 eligible patients, nine (23.1%) consented to be randomised (adalimumab n=4; placebo n=5). The main reason patients declined was because they preferred receiving steroid injection (n=13). All participants received treatment as allocated. The mean time from randomisation to first injection was 12.3 (adalimumab) and 7.2 days (placebo). Completion rates for patient-reported and clinician-assessed outcomes were 100%. CONCLUSION This study demonstrated that current NHS musculoskeletal physiotherapy settings yielded only small numbers of participants, too few to make a trial viable. This was because many patients had passed the early stage of frozen shoulder or had already formulated a preference for treatment. TRIAL REGISTRATION NUMBER ISRCTN 27075727, EudraCT 2021-03509-23, ClinicalTrials.gov NCT05299242 (REC 21/NE/0214).
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Affiliation(s)
- Sally Hopewell
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cynthia Srikesavan
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Alison Evans
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Fema Er
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- South Tees Hospitals NHS Foundation Trust, The James Cook University Hospital, Middlesbrough, UK
- Department of Health Sciences, University of York, York, UK
| | - Jane Preece
- Patient and Public Involvement Representative, Kidderminster, UK
| | - Anne Francis
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - M Sofia Massa
- Oxford Clinical Trials Research Unit, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marc Feldmann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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16
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Kuo YC, Hsieh LF, Liu YF, Chang CS. Ultrasound versus palpation-guided corticosteroid injection for de Quervain disease: A randomized controlled trial. PM R 2024. [PMID: 38647254 DOI: 10.1002/pmrj.13144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 01/12/2024] [Accepted: 01/12/2024] [Indexed: 04/25/2024]
Abstract
INTRODUCTION Corticosteroid injection effectively treats de Quervain disease, and due to the high prevalence of the intracompartmental septum in the first extensor compartment, ultrasound guidance improves injection accuracy. OBJECTIVE To compare the effectiveness, adverse events, and the recurrence rate between ultrasound-guided and palpation-guided injection in patients with de Quervain disease. DESIGN Prospective, single-blind, randomized controlled trial. SETTING Rehabilitation department of a private teaching hospital. PARTICIPANTS We enrolled 49 patients, ≥20 years of age, clinically diagnosed with de Quervain disease based on their medical history and physical examination. INTERVENTIONS Patients were randomized into two groups: ultrasound-guided and palpation-guided injection. Both groups received a mixture of 10 mg triamcinolone acetonide (10 mg/1 mL) and 0.3 mL 1% lidocaine. MAIN OUTCOME MEASURES The primary outcome measure was the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score at 1 week. The secondary outcome measures were visual analog scale for pain (pain VAS) score, patient satisfaction, and adverse events or complications from the interventions at 1 week, 3 months, and 6 months. RESULTS Both groups showed improvement over time in QuickDASH scores and pain VAS (p < .001); however, no statistically significant differences were noted between the groups for either QuickDASH scores (p = .22) or pain VAS (p = .30). In addition, no statistically significant differences were found between the groups in terms of patient satisfaction (p = .76) and adverse events (p = .47, .33, .58) at the 1-week, 3-month, and 6-month follow-ups. CONCLUSIONS Both ultrasound-guided and palpation-guided injections effectively treated de Quervain disease. During a 6-month follow-up, there were no statistically significant differences between the groups in pain relief, upper limb function, or patient satisfaction. However, the palpation-guided group showed a tendency for more recurrence and skin side effects.
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Affiliation(s)
- Ying-Chen Kuo
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Lin-Fen Hsieh
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
- School of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan
| | - Ya-Fang Liu
- Administration Division, Research Department, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
| | - Chia-Sung Chang
- Department of Physical Medicine & Rehabilitation, Shin Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan
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17
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Nishimura Y, Tsutsumi M, Yamamoto R, Sakuraya T, Emura K, Arakawa T. Morphological differences between the dorsal and palmar septa of the first extensor compartment in relation to the brachioradialis and pronator quadratus. Ann Anat 2024; 253:152228. [PMID: 38340878 DOI: 10.1016/j.aanat.2024.152228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Revised: 02/01/2024] [Accepted: 02/06/2024] [Indexed: 02/12/2024]
Abstract
BACKGROUND The first extensor compartment of the wrist is known as a frequent site of stenosing tenosynovitis, referred to as de Quervain's disease. De Quervain's disease occurs more frequently in the dorsal part of the first extensor compartment than in the palmar part; however, the anatomical reason why the dorsal part is worse remains poorly elucidated. This study clarified the morphological differences between the dorsal and palmar parts by examining their relationship with the surrounding structures. METHODS In this study, a total of 35 wrists from 23 Japanese cadavers were used. Twenty-five wrists were randomly assigned for macroscopic analysis, and the remaining 10 wrists were used for histological analysis. RESULTS The palmar septum of the first extensor compartment was connected to the brachioradialis tendon and superficial head of the pronator quadratus and was histologically stout compared to the dorsal septum. Despite several anatomical variations, such as the septum between the abductor pollicis longus/extensor pollicis brevis and the multiple tendons of these muscles, the aforementioned characteristics of the fibrous sheath in the first extensor compartment were identical in all specimens. CONCLUSION In contrast to the fragile structure of the dorsal septum, the stout structure of the palmar septum could be related to the low occurrence of symptoms of de Quervain's disease. The present results could play a role in revealing the pathogeny and establish the precise treatment for de Quervain's disease and provide an anatomical basis for kinesiological/biomechanical studies.
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Affiliation(s)
- Yuka Nishimura
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan
| | - Masahiro Tsutsumi
- Inclusive Medical Sciences Research Institute, Morinomiya University of Medical Sciences, 1 26-16 Nankokita, Suminoe-ku, Osaka 559-8611, Japan; Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Rintaro Yamamoto
- Department of Clinical Anatomy, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Tohma Sakuraya
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan; Department of Anatomy, Division of Oral Structure, Function and Development, Asahi University School of Dentistry, Mizuho, Gifu, Japan
| | - Kenji Emura
- Faculty of Health Care Sciences, Himeji Dokkyo University, Himeji, Japan
| | - Takamitsu Arakawa
- Department of Rehabilitation Sciences, Kobe University Graduate School of Health Sciences, Kobe, Japan.
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Núñez-Cortés R, Espin A, Pérez-Alenda S, López-Bueno R, Cruz-Montecinos C, Vincents-Seeberg KG, Püschel TA, Calatayud J, Andersen LL. Association Between Pain Coping and Symptoms of Anxiety and Depression, and Work Absenteeism in People With Upper Limb Musculoskeletal Disorders: A Systematic Review and Meta-analysis. Arch Phys Med Rehabil 2024; 105:781-791. [PMID: 37490961 DOI: 10.1016/j.apmr.2023.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Revised: 06/02/2023] [Accepted: 07/07/2023] [Indexed: 07/27/2023]
Abstract
OBJECTIVE To determine the prospective association of pain coping strategies and symptoms of anxiety and depression with work absenteeism in people with upper limb musculoskeletal disorders. DATA SOURCES A systematic search of PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases was conducted from inception to September 23, 2022. STUDY SELECTION Prospective observational studies of adults with upper limb musculoskeletal disorders were included. Included studies had to provide data on the association of pain coping strategies (catastrophizing, kinesiophobia, self-efficacy or fear avoidance) or symptoms of anxiety and depression with work absenteeism. DATA EXTRACTION Study selection, data extraction, and assessment of methodological quality (Newcastle Ottawa Scale) were performed by 2 independent authors. Random-effects models were used for quantitative synthesis. DATA SYNTHESIS Eighteen studies (n=12,393 participants) were included. Most studies (77.8%) reported at least 1 significant association between 1 or more exposure factors (pain coping strategies or symptoms of anxiety and depression) and work absenteeism. Meta-analyses showed a statistically significant correlation between the exposure factors of catastrophizing (r=0.28, 95% confidence interval [CI]: 0.15 to 0.40; P<.0001) and symptoms of anxiety and depression (r=0.23, 95% CI: 0.10 to 0.34; P=.0003) with work absenteeism. The correlation between self-efficacy and work absenteeism was non-significant (r=0.24, 95% CI: -0.02 to 0.47; P=.0747). CONCLUSIONS Rehabilitation teams should consider assessing catastrophizing and symptoms of anxiety and depression to identify patients at risk for work absenteeism. Addressing these variables may also be considered in return-to-work programs for individuals with upper limb disorders.
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Affiliation(s)
- Rodrigo Núñez-Cortés
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile
| | - Ander Espin
- National Research Centre for the Working Environment, Copenhagen, Denmark; Ageing On Research Group, Department of Physiology, University of the Basque Country (UPV/EHU), Leioa, Spain; Biocruces Bizkaia Health Research Institute, Barakaldo, Spain
| | - Sofía Pérez-Alenda
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain
| | - Rubén López-Bueno
- National Research Centre for the Working Environment, Copenhagen, Denmark; Department of Physical Medicine and Nursing, University of Zaragoza, Zaragoza, Spain; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain
| | - Carlos Cruz-Montecinos
- Department of Physiotherapy, Physiotherapy in Motion Multispeciality Research Group (PTinMOTION), University of Valencia, Valencia, Spain; Department of Physical Therapy, Faculty of Medicine, University of Chile, Santiago, Chile; Division of Research, Development and Innovation in Kinesiology, Kinesiology Unit, San José Hospital, Santiago, Chile
| | | | - Thomas A Püschel
- Ecology and Evolutionary Biology Division, School of Biological Sciences, University of Reading, Reading, United Kingdom
| | - Joaquín Calatayud
- National Research Centre for the Working Environment, Copenhagen, Denmark; Exercise Intervention for Health Research Group (EXINH-RG), Department of Physiotherapy, University of Valencia, Valencia, Spain.
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Paluch AJ, Burden EG, Batten TJ, Knight B, Anaspure R, Aboelmagd S, Evans JP, Smith CD. Defining tennis elbow characteristics - The assessment of magnetic resonance imaging defined tendon pathology in an asymptomatic population. Shoulder Elbow 2024; 16:206-213. [PMID: 38655416 PMCID: PMC11034470 DOI: 10.1177/17585732221146731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2022] [Revised: 12/03/2022] [Accepted: 12/04/2022] [Indexed: 04/26/2024]
Abstract
Background This radiological study aims to assess the prevalence of lateral elbow pathology in an asymptomatic population using 3.0T magnetic resonance imaging (MRI). Methods Bilateral elbow MRI was undertaken in 30 asymptomatic volunteers. Exclusion criteria included elbow pain within 3 months, elbow trauma or previous diagnosis of lateral epicondylar tendinopathy. Baseline patient-reported outcome measures were recorded along with age and body mass index (BMI). Two musculoskeletal radiologists independently graded the degree of abnormality at the common extensor tendon. Results Thirty volunteers were categorised according to age; 35-44 (n = 10), 45-54 (n = 11), and 55-65 (n = 9) with a 1:1 male-to-female ratio. Radiological evidence of tendon abnormality was found in 37% of volunteers. The proportion with abnormal findings increased with age; 35-44 (10%), 45-54 (36%), 55-65 (67%) and BMI; 18-24.9 (23%), 25-29.9 (43%), > 30 (67%). Changes were generally 'mild' or 'moderate', with a single volunteer showing 'severe' pathology. Kappa for the radiographic agreement was 0.91 (0.83-0.98). Discussion This study has demonstrated MRI findings suggestive of pathology at the common extensor tendon to be prevalent in an asymptomatic population, increasing with age and BMI. This draws into question the diagnostic and prognostic value of MRI imaging in lateral epicondylar tendinopathy, especially in older patients.
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Affiliation(s)
- Anthony J Paluch
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Eleanor G Burden
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Timothy J Batten
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Beatrice Knight
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Rahul Anaspure
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Sharief Aboelmagd
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Jonathan Peter Evans
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
| | - Christopher D Smith
- Princess Elizabeth Orthopaedic Centre, Royal Devon and Exeter NHS Foundation Trust, Devon, UK
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Zagarella A, Folco G, Monti CB, Rizzo A, Arrigoni P, Vismara V, Cassin S, Gallazzi MB. Semiquantitative index of symptomatic minor instability of the lateral elbow at CT arthrography (SMILE index): clinical applicability and reproducibility study. Eur Radiol 2024; 34:2742-2750. [PMID: 37704855 DOI: 10.1007/s00330-023-10233-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Revised: 08/12/2023] [Accepted: 08/18/2023] [Indexed: 09/15/2023]
Abstract
OBJECTIVE To assess the applicability of a semiquantitative index for symptomatic minor instability of the lateral elbow (SMILE). MATERIALS AND METHODS CT arthrograms of consecutive patients with lateral elbow pain who underwent ultrasound-guided CT arthrography at our orthopedic center between April 2019 and May 2022 were included. Images were acquired at 100 kVp and 80 mAs. An expert radiologist (R1) and a radiology resident (R2) retrospectively performed an independent, blinded evaluation of the arthrograms to assess the presence of imaging findings suggestive of elbow instability. The SMILE index (0-8) was obtained adding (I) radial head chondromalacia (0 - 1); (II) humeral capitellum chondromalacia (0 - 1); (III) humeral trochlear ridge chondromalacia (0 - 1); (IV) annular ligament laxity (0 - 2); (V) synovial thickening (0 - 1); (VI) humeroradial joint asymmetry (0 - 1); and (VII) capsular tear (0 - 1). R1 repeated the assessment after 14 days. Cohen's weighted κ statistic and raw concordance were used to appraise reproducibility. RESULTS Eighty patients (median age 49 years, interquartile range 40-53 years, 49, 61% males) underwent CT arthrography at our center, and 10 (12%) of them underwent bilateral elbow examination, leading to 90 included CT arthrograms. Median SMILE index was 4 (IQR: 2-5) for R1, 4 (IQR: 2-5) for R2, and 4 (IQR: 2-5) for the second assessment by R1. Intra-reader agreement was excellent (κ = 0.94, concordance 87%), while inter-reader agreement was substantial (κ = 0.75, concordance 67%). CONCLUSION The proposed SMILE index showed good reproducibility; further studies are warranted to correlate our index with clinical and surgical data. CLINICAL RELEVANCE STATEMENT Our scoring system allows a standardized evaluation of patients with lateral elbow pain and instability suitable for application into clinical practice, complementing the orthopedic surgeon's clinical diagnosis with imaging findings that may aid treatment choices. KEY POINTS • Lateral elbow pain is often interpreted clinically as lateral epicondylitis, but it can also encompass intra-articular pathology. • The proposed arthrographic index allows comprehensive quantification of lateral elbow pathology with good reproducibility and application times. • Our index provides the orthopedic surgeon with information regarding intra-articular findings, aiding treatment choices.
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Affiliation(s)
- Andrea Zagarella
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.
| | - Gianluca Folco
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Caterina Beatrice Monti
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Aldo Rizzo
- Scuola di Specializzazione in Radiodiagnostica, Università degli Studi di Milano, Milan, Italy
| | - Paolo Arrigoni
- U.O.C. 1° Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Valeria Vismara
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milan, Italy
| | - Simone Cassin
- Scuola di Specializzazione in Ortopedia e Traumatologia, Università degli Studi di Milano, Milan, Italy
| | - Mauro Battista Gallazzi
- U.O.C. Radiodiagnostica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
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21
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Tamai K, Hamada J, Nagase Y, Morishige M, Naito M, Asai H, Tanaka S. Frozen shoulder. An overview of pathology and biology with hopes to novel drug therapies. Mod Rheumatol 2024; 34:439-443. [PMID: 37632764 DOI: 10.1093/mr/road087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 08/07/2023] [Accepted: 08/18/2023] [Indexed: 08/28/2023]
Abstract
Frozen shoulder (FS) is a common disorder characterized by spontaneous onset of shoulder pain accompanied by progressive loss of range-of-motions. The cause of FS is still unclear, and radical therapy has not been established. With the final aim of preventing or curing FS at an earlier stage, we reviewed the pathological and biological features of this disease. Many studies indicate that the main pathology of FS is inflammation initially and fibrosis later. There are inflammatory cytokines, immune cells, fibrotic growth factors, and type-III collagen in the synovium and the joint capsule. The immune cell landscape switches from the macrophages to T cells. Activated fibroblasts seem to regulate the inflammatory and fibrotic processes. The imbalance between matrix metalloproteinases and tissue inhibitors of metalloproteases might promote fibrosis. Additionally, advanced glycation end-products are noted in the FS synovium. Diabetes mellitus and hypothyroidism are closely related to the development of FS. In terms of nonsurgical treatment, oral or intra-articular glucocorticoids are the only drugs that provide early benefit. Some other anti-inflammatory or antifibrotic drugs may potentially control the FS, but have not been proven effective in the clinical setting. Future studies should be targeted to develop steroid-sparing agents that inhibit biological events in FS.
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Affiliation(s)
- Kazuya Tamai
- Department of Orthopedic Surgery, Tohto Bunkyo Hospital, Tokyo, Japan
| | - Junichiro Hamada
- Department of Orthopedic Surgery, Kuwano Kyoritsu Hospital, Fukushima, Japan
| | - Yuichi Nagase
- Department of Rheumatology Surgery, Tokyo Metropolitan Tama Medical Center, Fuchu, Tokyo, Japan
| | | | - Masashi Naito
- Department of Orthopedic Surgery, National Hospital Organization Sagamihara National Hospital, Sagamihara, Kanagawa, Japan
| | - Hideaki Asai
- Department of Orthopedic Surgery, Yashio Central General Hospital, Yashio, Saitama, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo Hospital, Tokyo, Japan
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Bateman M, Saunders B, Cooper K, Littlewood C, Hill JC. Exploring the feasibility and acceptance of an optimised physiotherapy approach for lateral elbow tendinopathy: a qualitative investigation within the OPTimisE trial. BMJ Open 2024; 14:e073816. [PMID: 38485170 PMCID: PMC10941140 DOI: 10.1136/bmjopen-2023-073816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 02/28/2024] [Indexed: 03/17/2024] Open
Abstract
OBJECTIVES To explore the acceptability of an optimised physiotherapy (OPTimisE) intervention for people with lateral elbow tendinopathy (LET) and feasibility of comparing it to usual care in a randomised controlled trial. DESIGN Semistructured interviews, analysed using thematic analysis and mapped onto the COM-B model of behaviour change. SETTING Conducted as part of the OPTimisE Pilot & Feasibility randomised controlled trial within physiotherapy departments in the United Kingdom National Health Service. PARTICIPANTS 17 patients with LET (purposively sampled to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation) and all 8 physiotherapists involved as treating clinicians or site principal investigators. RESULTS Four themes were identified. First, participants reported the OPTimisE intervention as acceptable. Second, differences between the OPTimisE intervention and usual care were identified, including the use of an orthosis, holistic advice/education including modifiable risk factors, forearm stretches, general upper body strengthening and a more prescriptive exercise-dosing regimen. Third, participants provided feedback related to the trial resources, which were viewed positively, but identified language translation as a need. Fourth, feedback related to trial processes identified the need for changes to outcome collection and reduction of administrative burden. From the perspective of adopting the OPTimisE intervention, we found evidence that participants were able to change their behaviour. Considering the findings through the lens of the COM-B model, the intervention is likely to be deliverable in practice and the trial can be delivered at scale with some additional support for physiotherapists. CONCLUSIONS Overall, the OPTimisE intervention was found to be different to usual care and acceptable to patients and physiotherapists. The study highlighted the need to refine trial processes and resources prior to a full-scale trial, to reduce administrative burden, increase support for physiotherapists, improve return rate of outcome questionnaires and provide language translation. TRIAL REGISTRATION NUMBER ISRCTN database 19 July 2021. https://www.isrctn.com/ISRCTN64444585.
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Affiliation(s)
- Marcus Bateman
- University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
- Faculty of Medicine & Health Sciences, Keele University, Keele, UK
| | | | | | - Chris Littlewood
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
| | - Jonathan C Hill
- Faculty of Medicine & Health Sciences, Keele University, Keele, UK
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23
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Di Mascio L, Hamborg T, Mihaylova B, Kassam J, Shah B, Stuart B, Griffin XL. The Adhesive Capsulitis Corticosteroid and Dilation (ACCorD) randomized controlled trial. Bone Jt Open 2024; 5:162-173. [PMID: 38432256 PMCID: PMC10909438 DOI: 10.1302/2633-1462.53.bjo-2023-0114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/05/2024] Open
Abstract
Aims Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. Methods In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia, physiotherapy, and joint injections; most people can be managed without an operation. Currently, there is variation in the type of joint injection: 1) CSI, thought to reduce the inflammation of the capsule reducing pain; and 2) HD, where a small volume of fluid is injected into the shoulder joint along with the steroid, aiming to stretch the capsule of the shoulder to improve pain, but also allowing greater movement. The creation of musculoskeletal hubs nationwide provides infrastructure for the early and effective management of frozen shoulder. This potentially reduces costs to individuals and the wider NHS perhaps negating the need for a secondary care referral. Results We will conduct a multicentre RCT comparing CSI and HD in combination with CSI alone. Patients aged 18 years and over with a clinical diagnosis of frozen shoulder will be randomized and blinded to receive either CSI and HD in combination, or CSI alone. Feasibility outcomes include the rate of randomization as a proportion of eligible patients and the ability to use routinely collected data for outcome evaluation. This study has involved patients and the public in the trial design, dissemination methods, and how to include groups who are underserved by research. Conclusion We will disseminate findings among musculoskeletal clinicians via the British Orthopaedic Association, the Chartered Society of Physiotherapy, the Royal College of Radiologists, and the Royal College of General Practitioners. To ensure wide reach we will communicate findings through our established network of charities and organizations, in addition to preparing dissemination findings in Bangla and Urdu (commonly spoken languages in northeast London). If a full trial is shown to be feasible, we will seek additional National Institute for Health and Care Research funding for a definitive RCT. This definitive study will inform NICE guidelines for the management of frozen shoulder.
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Affiliation(s)
- Livio Di Mascio
- Barts Health NHS Trust, The Royal London Hospital, London, UK
| | - Thomas Hamborg
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
| | - Borislava Mihaylova
- Health Economics and Policy Research Unit, Queen Mary University of London, London, UK
| | - Jamila Kassam
- Bone and Joint Health, Queen Mary University of London, London, UK
| | - Bina Shah
- Bone and Joint Health, Queen Mary University of London, London, UK
| | - Beth Stuart
- Pragmatic Clinical Trials Unit, Queen Mary University of London, London, UK
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24
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Campos MGM, Maia LB, Mascarenhas RO, Lourenço BM, Henschke N, Oliveira VC. Effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy: A systematic review and meta-analysis. Braz J Phys Ther 2024; 28:100596. [PMID: 38402668 PMCID: PMC10904251 DOI: 10.1016/j.bjpt.2024.100596] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 02/02/2024] [Accepted: 02/11/2024] [Indexed: 02/27/2024] Open
Abstract
BACKGROUND Lateral elbow tendinopathy is a common musculoskeletal disorder. Effectiveness of non-invasive therapies for this health condition are unclear. OBJECTIVE To investigate the effectiveness of non-invasive therapies on pain, maximum grip strength, disability, and quality of life for lateral elbow tendinopathy. METHODS Searches were conducted on MEDLINE, Embase, CINAHL, AMED, PEDro, Cochrane Library, SPORTDiscus and PsycINFO without language or date restrictions up to May 3rd, 2023. Randomized trials investigating the effectiveness of any non-invasive therapy compared with control or other invasive interventions were included. Two independent reviewers screened eligible trials, extracted data, and assessed the risk of bias of included trials and certainty of the evidence. RESULTS Twenty-two different therapies investigated in 47 randomized trials were included in the quantitative analysis. Moderate certainty evidence showed that betamethasone valerate medicated plaster may reduce disability (mean difference -6.7; 95% CI -11.4, -2.0) in the short-term when compared with placebo. Low certainty evidence showed that acupuncture may reduce disability (MD -9.1; 95% CI -11.7, -6.4) in the short-term when compared with sham. Moderate to very low certainty of evidence also showed small to no effect of non-invasive therapies on pain intensity, maximum grip strength, and disability outcomes in the short-term compared to control or invasive interventions. Most therapies had only very low certainty of evidence to support their use. CONCLUSIONS Decision-making processes for lateral elbow tendinopathy should be carefully evaluated, taking into consideration that most investigated interventions have very low certainty of evidence. There is an urgent call for larger high-quality trials.
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Affiliation(s)
- Mariana G M Campos
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Laísa B Maia
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Rodrigo O Mascarenhas
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Bianca M Lourenço
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil
| | - Nicholas Henschke
- Institute for Musculoskeletal Health, School of Public Health, The University of Sydney, Sydney, Australia
| | - Vinicius C Oliveira
- Postgraduate Program in Rehabilitation and Functional Performance, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil; Postgraduate Program in Health Sciences, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Diamantina, MG, Brazil.
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25
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Tam W, Yip J, Fang C, Yick K, Ng S. An optimal de Quervain's tenosynovitis splint with ergonomic thumb support and evenly distributed pressure. Heliyon 2024; 10:e26330. [PMID: 38420402 PMCID: PMC10900954 DOI: 10.1016/j.heliyon.2024.e26330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 02/10/2024] [Accepted: 02/12/2024] [Indexed: 03/02/2024] Open
Abstract
Splinting is a conventional treatment for de Quervain's tenosynovitis (dQt). However, existing splints have problems such as excessive thermal discomfort and poor fit, which have been pointed out in previous studies. This study proposes a new functional splint consisting of both hard and soft materials with the aim of providing wear comfort with a good fit and sufficient stability of the injured hand. Thumb support of the splint is an important component that controls and protects the affected thumb. To develop an ergonomically shaped thumb support, 16 participants with dQt were recruited for three-dimensional (3D) scanning of their hands. The angles of the wrist and the curvature of the thumb were measured using computer software, and the results were used as a reference for the design of the prototype supports. Excessive pressure on particular regions, such as bony areas, may cause discomfort or pain. To ensure the wear comfort of the proposed splint, a finite element model (FEM) was built to simulate the wear process of the splint and hence to predict the pressure distribution exerted from the splint onto the hand of the wearer. The simulated results show that the pressure is evenly distributed over the hand, indicating that patients are likely to wear the proposed splint comfortably during their treatment period.
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Affiliation(s)
- W.S. Tam
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong
| | - J. Yip
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong
| | - C. Fang
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - K.L. Yick
- School of Fashion and Textiles, The Hong Kong Polytechnic University, Hong Kong
| | - S.P. Ng
- School of Professional Education and Executive Development, The Hong Kong Polytechnic University, Hong Kong
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26
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Waslen A, Friesen KB, Lang AE. Do Sex and Age Influence Scapular and Thoracohumeral Kinematics During a Functional Task Protocol? J Appl Biomech 2024; 40:29-39. [PMID: 37917968 DOI: 10.1123/jab.2023-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2023] [Revised: 08/14/2023] [Accepted: 08/27/2023] [Indexed: 11/04/2023]
Abstract
There is mixed evidence on the role that biological sex plays in shoulder biomechanics despite known differences in musculoskeletal disorder prevalence between males and females. Additionally, advancing age may contribute to shoulder kinematic changes. The purpose of this study was to determine if sex and age influenced scapular and thoracohumeral kinematics during a range of functional tasks. Sixty healthy participants aged 19-63 years (30 males; 30 females) completed a functional task protocol while their upper limb motion was recorded. Scapular and humeral angles were calculated and compared with multiple linear regressions to assess the interaction effects of sex and age. Shoulder kinematics were not different between sex and age groups for many of the functional tasks. However, females had lower humeral external rotation in the overhead lift task (15°, P < .001), and less scapular anterior tilt angles in the forward transfer task (6°, P < .001) than males. Age was positively associated with humeral elevation (R2 = .330, P < .001) and scapular rotation (R2 = .299, P < .001) in the Wash Axilla task. There exist some kinematic differences between sex and with advancing age for select functional tasks, which should be considered for musculoskeletal disorder development.
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Affiliation(s)
- Alexander Waslen
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Kenzie B Friesen
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Angelica E Lang
- College of Medicine, University of Saskatchewan, Saskatoon, SK, Canada
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27
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Chen Y, Wu X, Zhang Y, Chen J. Genetic causal association between frozen shoulder and carpal tunnel syndrome: a two-sample mendelian randomization. BMC Musculoskelet Disord 2024; 25:58. [PMID: 38216946 PMCID: PMC10790250 DOI: 10.1186/s12891-024-07186-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2023] [Accepted: 01/09/2024] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Observational studies have suggested an association between frozen shoulder (FS) and carpal tunnel syndrome (CTS). However, due to challenges in establishing a temporal sequence, the causal relationship between these two conditions remains elusive. This study, based on aggregated data from large-scale population-wide genome-wide association studies (GWAS), investigates the genetic causality between FS and CTS. METHODS Initially, a series of quality control measures were employed to select single nucleotide polymorphisms (SNPs) closely associated with the exposure factors. Two-sample Mendelian randomization (MR) was utilized to examine the genetic causality between FS and CTS, employing methods including Inverse-Variance Weighted (IVW), MR-Egger, Weighted Median, Simple Mode, and Weighted Mode approaches. Subsequently, sensitivity analyses were conducted to assess the robustness of the MR analysis results. RESULTS IVW analysis results indicate a positive causal relationship between CTS and FS (p < 0.05, OR > 1), while a negative causal relationship between the two conditions was not observed. Heterogeneity tests suggest minimal heterogeneity in our IVW analysis results (p > 0.05). Multivariable MR testing also indicates no pleiotropy in our IVW analysis (p > 0.05), and stepwise exclusion tests demonstrate the reliability and stability of the MR analysis results. Gene Ontology (GO) pathway analysis reveals enrichment of genes regulated by the associated SNPs in the TGFβ-related pathways. CONCLUSION This study provides evidence of the genetic causal association between frozen shoulder and carpal tunnel syndrome and provides new insights into the genetics of fibrotic disorders.
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Affiliation(s)
- Yang Chen
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Xiaojin Wu
- Department of Ultrasound, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China
| | - Yongxing Zhang
- Department of Orthopedics, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China
| | - Jian Chen
- Department of Ultrasound, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, China.
- Department of Ultrasound, The Fourth Affiliated Hospital, Zhejiang University School of Medicine, Yiwu, Zhejiang, China.
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28
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Liyanage E, Chellapillai D, Liyanage I, Samarakoon C, Samarasekara H, Rikas M. Sinhala version of the Cornell Musculoskeletal Discomfort Questionnaire: Cross-cultural adaptation and validation. Work 2024; 77:547-559. [PMID: 37718826 DOI: 10.3233/wor-220295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/19/2023] Open
Abstract
BACKGROUND Work-related musculoskeletal disorders (WMSDs) are highly prevalent among people who work in sedentary jobs. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) is a valid tool to assess WMSDs, but is not available in the local language of Sri Lanka (Sinhala). OBJECTIVE To cross-culturally adapt the original CMDQ from English to Sinhala and evaluate its psychometric properties. METHODS The linguistic and cultural adaptation of the CMDQ to the Sinhala (Si-CMDQ) language followed international guidelines. The adapted pre-version was tested for comprehensibility among 32 subjects from different educational and occupational backgrounds. The Content Validity Index (CVI) was computed with ratings from five experts. The questionnaire was validated further by 111 security guards employed at the university. The tool was validated with reference to the Numeric Rating Scale. Test-retest reliability was assessed at two time points one week apart and internal consistency was tested. RESULTS The Si-CMDQ showed adequate cross-cultural, content and construct validity, internal consistency, and test-retest reliability. The Kappa coefficient showed excellent agreement between NRS and Si-CMDQ frequency scale. Spearman's correlation coefficients showed a moderate to a strong significant positive correlation between NRS and the severity scale of Si-CMDQ. The Kappa values for test-retest reliability were moderate to excellent for the three scales of CMDQ. The internal consistency was high. CONCLUSION The Si-CMDQ fulfilled the psychometric requirement for questionnaires. This tool will be beneficial to assess WMSDs among sedentary workers in different occupations in Sri Lanka.
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Affiliation(s)
- Esther Liyanage
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Dhananjee Chellapillai
- Department of Physiotherapy, Faculty of Allied Health Sciences, General Sir John Kotelawala Defence University, Colombo, Sri Lanka
| | - Indrajith Liyanage
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Chamini Samarakoon
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Heshani Samarasekara
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
| | - Mohamed Rikas
- Department of Physiotherapy, Faculty of Allied Health Sciences, University of Peradeniya, Kandy, Sri Lanka
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Chanthana P, Atthakomol P, Manosroi W, Wongpakaran T, Kraisarin J, Sananpanich K. Comparison of patient preferences and responsiveness among common patient-reported outcome measures for hand/wrist injuries or disorders. J Orthop Traumatol 2023; 24:2. [PMID: 36622514 PMCID: PMC9829933 DOI: 10.1186/s10195-022-00681-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/28/2022] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) were developed to examine patients' perceptions of functional health. Most studies compare the responsiveness of each type of questionnaire. However, reports of patient preferences among PROMs commonly used with patients with hand/wrist injuries or disorders are limited. This study aimed to compare patient preferences, factors associated with those preferences and responsiveness among the Disability of the Arm, Shoulder, and Hand (DASH), Michigan Hand Outcomes Questionnaire (MHQ), Patient-Rated Wrist/Hand Evaluation (PRWHE) and EQ-5D in patients with hand/wrist injuries or disorders. MATERIAL AND METHODS This retrospective cohort study collected data on 183 patients with hand/wrist injuries or diseases who had visited a hand/wrist outpatient clinic or were hospitalized for surgery between 2017 and 2020. Patients had to be at least 18 years old and able to complete the four questionnaires included in the study. The four PROMs (DASH, MHQ, PRWHE and EQ-5D) were administered to the patients prior to treatment. After completing the questionnaires, patients were asked to answer two open-ended questions regarding their preferences. Multinomial logistic regression was used to identify factors related to patient preferences. Results are presented as the relative risk ratio (RRR). The standardized response mean (SRM) was used to evaluate questionnaire responsiveness. RESULTS Of the 183 patients, most preferred the PRWHE questionnaire (n = 74, 41%), with the main reasons cited being "specific to injuries/diseases and reflects hand/wrist function (n = 23, 31%)" and "easy to complete (n = 22, 30%)." Sex was found to be associated with patient preference after adjusting for demographic data and reasons for choosing a PROM as confounders (RRR = 0.46, P value = 0.049). The PRWHE had the highest SRM, followed by DASH (0.92 and 0.88, respectively). CONCLUSIONS The PRWHE is the most preferred by patients and is the most responsive questionnaire. It is recommended for use in clinical practice in situations where a clinician would like to use only one PROM for evaluating patients with various types of hand/wrist problems. LEVEL OF EVIDENCE Prognostic III.
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Affiliation(s)
- Phongniwath Chanthana
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Pichitchai Atthakomol
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Musculoskeletal Science and Translational Research Center, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worapaka Manosroi
- grid.7132.70000 0000 9039 7662Clinical Epidemiology and Clinical Statistic Center, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand ,grid.7132.70000 0000 9039 7662Division of Endocrinology, Department of Internal Medicine, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Tinakon Wongpakaran
- grid.7132.70000 0000 9039 7662Department of Psychiatry, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Jirachart Kraisarin
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Kanit Sananpanich
- grid.7132.70000 0000 9039 7662Department of Orthopaedics, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Raeesi J, Negahban H, Kachooei AR, Moradi A, Ebrahimzadeh MH, Daghiani M. Comparing the effect of physiotherapy and physiotherapy plus corticosteroid injection on pain intensity, disability, quality of life, and treatment effectiveness in patients with Subacromial Pain Syndrome: a randomized controlled trial. Disabil Rehabil 2023; 45:4218-4226. [PMID: 36398695 DOI: 10.1080/09638288.2022.2146215] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Accepted: 11/04/2022] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare the short and medium-term effects of physiotherapy plus corticosteroid injection (combined) with physiotherapy alone on pain intensity, disability, Quality of Life (QoL), and treatment effectiveness in patients with Subacromial Pain Syndrome (SAPS). METHODS In this double-blind, parallel Randomized Controlled Trial (RCT), 50 patients with SAPS were randomly assigned into combined (N = 25, a single injection 3-6 days before physiotherapy) and physiotherapy alone group (N = 25). Pain, disability, QoL, and treatment-effectiveness were measured at pre-intervention, post-intervention, and 3 and 6-month follow-up with Visual Analog Scale (VAS), Shortened Disability of the Arm, Shoulder, and Hand (Quick-DASH), Shoulder Pain and Disability Index (SPADI) (primary outcome measure), Western Ontario Rotator Cuff (WORC), and Global Rating of Change (GRC) respectively. A 2 × 4 (group × time) mixed model analysis of variance (ANOVA) was applied for analysis. RESULTS The ANOVA revealed statistically significant group-in-time interaction for all outcome measures (p-value < 0.05). The independent t-test showed more effectiveness in the combined group at medium-term, as the mean scores of almost all outcome measures were substantially lesser (p < 0.01). Moreover, in short-time, despite a greater number of patients stating "completely recovered" in the combined group, there was no statistically significant difference between groups. CONCLUSIONS Effects of physiotherapy plus corticosteroid injection could be more long-lasting than physiotherapy alone in improving pain intensity, disability, QoL, and treatment effectiveness in patients with SAPS. TRIAL REGISTRATION NUMBER IRCT20201010048980N1.IMPLICATIONS FOR REHABILITATIONShoulder pain is common, persistent, and predominantly results from subacromial pain syndrome (SAPS).Physiotherapy and corticosteroid injections are effective interventions for this condition.Comprehensive physiotherapy alone can be as effective as corticosteroid injection combined with physiotherapy in the short term.A combined approach versus physiotherapy alone may have more medium-term effects on SAPS patients' pain, disability, quality of life, and treatment effectiveness.
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Affiliation(s)
- Javad Raeesi
- School of Physical Therapy, Health and Rehabilitation Sciences Department, Western University, London, Canada
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
| | - Hossein Negahban
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Amir Reza Kachooei
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | - Ali Moradi
- Orthopedic Research Center, Mashhad University of Medical Sciences, Mashhad, Iran
| | | | - Maryam Daghiani
- Department of Physiotherapy, School of Paramedical Sciences, Mashhad University of Medical Science, Mashhad, Iran
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Flintoft-Burt M, Stanier P, Planner A, Thahal H, Woods D. Recurrence of the frozen shoulder after hydrodilatation, what is the true incidence? Shoulder Elbow 2023; 15:610-618. [PMID: 37981967 PMCID: PMC10656972 DOI: 10.1177/17585732221124914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2022] [Revised: 06/05/2022] [Accepted: 08/23/2022] [Indexed: 11/21/2023]
Abstract
Purpose of the study To assess the outcome and recurrence rates of frozen shoulder treated by hydrodilatation in an independent hospital setting. Method Patients presenting to a shoulder clinic from August 2019 to July 2021 with a diagnosis of frozen shoulder were offered hydrodilatation. Data included primary or secondary frozen shoulder, length of symptoms, and diabetic status. An Oxford Shoulder Score was completed prior to hydrodilatation. Using ultrasound guidance, 40 mg Triamcinolone and local anaesthetic (10-25 mL depending on patient tolerance) were injected into the rotator interval. At a mean of 9 months, patients recorded their tolerance of the procedure, subsequent progress, the need for further treatment, and their current Oxford Shoulder Score. Results From 55 shoulders, six patients had a failure to improve and 10 patients had a transient improvement followed by recurrence (29%). 2/21 (9.5%) patients had 25 mL injected compared to 14/34 (41%) who had < = 20 mL (p = 0.012). 14/43 (33%) of primary frozen shoulder patients had a recurrence, compared with 2/12 (16%) secondary frozen shoulder patients, p = 0.019. Conclusion Further treatment was indicated in 14/34 (41%) of patients who underwent hydrodilatation in the frozen stage of frozen shoulder and could not tolerate more than 20 mL of injection, and was more commonly required in primary (33%) versus secondary (16%) frozen shoulder.
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Affiliation(s)
| | - Paul Stanier
- Trauma and Orthopaedics, Great Western Hospitals NHS Foundation Trust, Swindon, UK
| | - Andy Planner
- Radiology, BMI The Ridgeway Hospital, Swindon, UK
| | | | - David Woods
- Orthopaedics, BMI The Ridgeway Hospital, Swindon UK
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Kim YH, Cho HY, Kim SH. Short-Term Effects of Centralization of the Glenohumeral Joint and Dynamic Humeral Centering on Shoulder Pain, Disability, and Grip Strength in Patients with Secondary Subacromial Impingement Syndrome. Healthcare (Basel) 2023; 11:2914. [PMID: 37998406 PMCID: PMC10671653 DOI: 10.3390/healthcare11222914] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2023] [Revised: 10/30/2023] [Accepted: 11/06/2023] [Indexed: 11/25/2023] Open
Abstract
Subacromial impingement syndrome (SIS) is one of the most common causes of shoulder pain in adults and is caused by muscle imbalance around the shoulder joint, which is referred to as secondary SIS. Centralization of the glenohumeral joint (CGH), one of the intervention methods for this, targets strengthening the control ability of the rotator cuff. Dynamic humeral centering (DHC) targets the learning of selective contractile function of the pectoralis major and latissimus dorsi as depressors of the humeral head. This study aims to determine the short-term effects of CGH and DHC on pain, disability, and grip strength in patients with secondary SIS. Forty-eight patients with secondary SIS participated in the study and were randomly allocated into three groups (CGH group (n = 16), DHC group (n = 16), and simple exercise group (n = 16)) and received the intervention for 50 min. The Constant-Murley score was used to assess shoulder pain and disability (primary outcome), and a hand-held dynamometer was used to assess grip strength (secondary outcome). Measurements were performed before the intervention and one day after the intervention. The results showed that the Constant-Murley score improved in the CGH and DHC groups. In addition, pain and disability (range of motion scores) improved in both the CGH and DHC groups. Improvements in disability (shoulder strength) and grip strength were seen only in the CGH group. Both CGH and DHC can be used as methods for short-term pain release and disability recovery in secondary SIS. In particular, CGH appears to be more effective in the short-term improvement in shoulder strength and grip strength.
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Affiliation(s)
- Yong-Hee Kim
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea;
| | - Hwi-Young Cho
- Department of Health Science, Gachon University Graduate School, Incheon 21936, Republic of Korea;
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea
| | - Sung-Hyeon Kim
- Department of Physical Therapy, College of Health Science, Gachon University, Incheon 21936, Republic of Korea
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Chongkriengkrai T, Koonalinthip N, Jongprasitkul H, Piriyajarukul A, Surarangsit T, Boonhong J. Effectiveness of high-intensity laser application combined with splinting and therapeutic exercise in subacute de Quervain's tenosynovitis: A pilot study. Lasers Med Sci 2023; 38:229. [PMID: 37783935 DOI: 10.1007/s10103-023-03892-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2023] [Accepted: 09/21/2023] [Indexed: 10/04/2023]
Abstract
The purpose of this study is to determine the additional effect of high-intensity laser therapy (HILT) when combined with therapeutic exercise and splinting in the treatment of patients diagnosed with de Quervain's tenosynovitis. Nineteen patients diagnosed with de Quervain's tenosynovitis were randomly divided into two groups: the HILT group and the sham HILT group. A total of 9 HILT or sham HILT sessions were administered, with 3 sessions per week for 3 consecutive weeks. Both groups received the thumb spica splint and therapeutic exercise. A comparison was conducted between the two groups, as well as pre- and post-treatment, focusing on the following outcomes: Visual Analog Scale (VAS) for pain, hand grip strength, and Thai version of Patient-Rated Wrist and Hand Evaluation (PRWHE-Thai) as a disability score. No significant differences were found between the HILT group and the sham group across all evaluated outcomes. However, when examining changes within each group over time, both the HILT and sham groups showed significant reductions in pain and improvements in disability score at the follow-up assessments compared to baseline. On the other hand, no statistically significant differences were observed in grip strength outcomes at any of the measured time points. The combination of HILT with a splint and exercise demonstrates effectiveness as a method for pain management and functional improvement in patients with subacute de Quervain's tenosynovitis. It is important to note that HILT does not offer any additional advantages when compared to the combined use of a splint and exercise.
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Affiliation(s)
- Tanach Chongkriengkrai
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Nantawan Koonalinthip
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand.
| | - Hathaya Jongprasitkul
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
| | - Apatchanee Piriyajarukul
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Tuangtip Surarangsit
- Department of Rehabilitation Medicine, King Chulalongkorn Memorial Hospital, The Thai Red Cross Society, Bangkok, Thailand
| | - Jariya Boonhong
- Department of Rehabilitation Medicine, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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Vidal E, Castro-Gutierrez E, Arisaca R, Paz-Valderrama A, Albiol-Pérez S. Serious Game for Fine Motor Control Rehabilitation for Children With Epileptic Encephalopathy: Development and Usability Study. JMIR Form Res 2023; 7:e50492. [PMID: 37788071 PMCID: PMC10582812 DOI: 10.2196/50492] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2023] [Revised: 08/23/2023] [Accepted: 08/24/2023] [Indexed: 10/04/2023] Open
Abstract
BACKGROUND Epileptic encephalopathy (EE) is defined as the presence of frequent epileptiform activity that adversely impacts development, typically causing the slowing or regression of developmental skills, and is usually associated with frequent seizures. One of the main disturbances in EE is in the coordination of the upper extremities and hands. Traditional rehabilitation for this type of pathology focuses on the alleviation of gross or fine motor disability. In the last few years, the use of low-cost devices together with customized serious games has shown improvements in motor disorders and enrichments in activities of daily living. OBJECTIVE This study aims to explore the feasibility of a new serious game for improving fine motor control in children with EE. METHODS The participants were 4 children with EE (male: n=2, 50%; female: n=2, 50%) who were classified as belonging to level 1 in the Gross Motor Classification System. The children were tested over 10 sessions during the intervention period (before and after treatment). The clinical tests performed were the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition and Pittsburgh Rehabilitation Participation Scale. The subscales of the Bruininks-Oseretsky Test of Motor Proficiency, 2nd edition were fine motor precision, fine motor integration, manual dexterity, and upper-limb coordination. At the end of the first session, we used the User Satisfaction Evaluation Questionnaire to analyze user satisfaction. RESULTS The significance outcomes for a Student t test (1-tailed) were as follows: P=.009 for fine motor precision, P=.002 for fine motor integration, P=.56 for manual dexterity, and P=.99 for upper-limb coordination. The participation rate as measured using the Pittsburgh Rehabilitation Participation Scale was between good and very good, which means that, based on the therapist's evaluation, interest, independence, and motivation were achieved by each participant. The mean User Satisfaction Evaluation Questionnaire score was close to 30, which is the maximum value. CONCLUSIONS The results support the use of the proposed serious game as a complement in therapeutic sessions during the rehabilitation processes for children with EE. Significant improvements in fine motor control and activities of daily living revealed that the proposed serious game is beneficial for fine motor disorders of this pathology.
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Affiliation(s)
- Elizabeth Vidal
- Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | | | - Robert Arisaca
- Universidad Nacional de San Agustín de Arequipa, Arequipa, Peru
| | | | - Sergio Albiol-Pérez
- Aragón Health Research Institute (IIS Aragón), Universidad de Zaragoza, Teruel, Spain
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Aly M, Fashina C, Hagiga A, Hafez A, Di Mascio L. Transcatheter arterial embolisation for the relief of shoulder and elbow chronic joint pain refractory to conventional treatment: Systematic review. J Med Imaging Radiat Oncol 2023; 67:756-768. [PMID: 37814448 DOI: 10.1111/1754-9485.13590] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 09/21/2023] [Indexed: 10/11/2023]
Abstract
Angiogenesis and accompanying nerve fibres might cause unsettling joint pain. Studies have suggested that transcatheter arterial embolisation (TAE) of these abnormal neovessels could relieve pain and symptoms in patients with upper limb joint pain refractory to conventional treatment. This study aims to investigate the efficacy and safety of TAE in treating chronic pain of shoulder and elbow joints that have been resistant to other treatments. Using six databases, a systematic review was performed following Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The primary outcome involved changes in the visual analogue scale (VAS) after TAE; while secondary outcomes involved comparing other parameters where relevant. Average VAS decreased from baseline, then at 1 day, 1 week, 1 month, 3 months, 4 months, 6 months, 1 year, 2 years and 44 months (7.5 at baseline vs. 4.7, 4.3, 3.4, 2.1, 2.5, 1.2, 0.7, 1.1 and 0.1, respectively). Average Quick-DASH scores decreased from baseline, then at 1, 3 and 6 months (61.3 at baseline vs. 30.6, 19.3 and 6.9, respectively). Minor adverse events were reported in 27/143 (18.9%) patients, where they resolved spontaneously or with oral analgesia. TAE is a possible treatment option for refractory shoulder and elbow joint pain; however, randomised controlled trials are still required.
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Affiliation(s)
| | | | - Ahmed Hagiga
- Queen Victoria Hospital NHS Foundation Trust, East Grinstead, UK
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Bateman M, Hill JC, Cooper K, Littlewood C, Saunders B. Lived experience of people with lateral elbow tendinopathy: a qualitative study from the OPTimisE pilot and feasibility trial. BMJ Open 2023; 13:e072070. [PMID: 37643850 PMCID: PMC10465899 DOI: 10.1136/bmjopen-2023-072070] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Accepted: 07/10/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES To explore the lived experience of people with lateral elbow tendinopathy (LET) and its impact on everyday life. DESIGN Qualitative semi-structured interviews, analysed using thematic analysis. SETTING Conducted as part of the mixed-methods OPTimisE pilot and feasibility randomised controlled trial of outpatient physiotherapy patients in the UK. PARTICIPANTS 17 participants with LET, purposively sampled from the trial to provide representativeness based on age, sex, ethnicity, deprivation index and treatment allocation. RESULTS Four themes were identified from the participants' responses: (1) cause of onset-typically symptoms were attributed to: sudden changes in activity, repetitive work or compensating for other musculoskeletal conditions; (2) impact on everyday life-which included substantial impacts on quality-of-life, particularly due to pain disturbing sleep and difficulties performing daily tasks (related to work and hobbies) due to pain, although most reported being able to persevere with work; (3) self-help and understanding of the condition-with uncertainty about the appropriateness and potential harm of online advice and confusion from the diagnostic term 'Tennis Elbow' that non-sporting individuals struggled to relate to; (4) healthcare experiences-the treatments received were highly variable and often perceived as ineffectual. CONCLUSIONS For the first time, the lived experience of people from a range of backgrounds suffering from LET has been explored. Findings suggest that people frequently related the cause to a specific activity. They reported substantial impacts on daily tasks, sleep, work and hobbies. People also reported hesitancy to trust online information without formal healthcare advice, were confused by the common label of 'Tennis Elbow', and perceived the wide array of healthcare treatment options they had received to offer false hope and be largely ineffective. This study provides stimulus for clinicians to consider the advice and treatment provided, and whether the messages conveyed reflect the favourable natural history of the condition. TRIAL REGISTRATION NUMBER ISRCTN64444585.
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Affiliation(s)
- Marcus Bateman
- Derby Shoulder Unit, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | | | | | - Chris Littlewood
- Faculty of Health, Social Care & Medicine, Edge Hill University, Ormskirk, UK
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Cunha B, Ferreira R, Sousa ASP. Home-Based Rehabilitation of the Shoulder Using Auxiliary Systems and Artificial Intelligence: An Overview. SENSORS (BASEL, SWITZERLAND) 2023; 23:7100. [PMID: 37631637 PMCID: PMC10459225 DOI: 10.3390/s23167100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Revised: 08/07/2023] [Accepted: 08/09/2023] [Indexed: 08/27/2023]
Abstract
Advancements in modern medicine have bolstered the usage of home-based rehabilitation services for patients, particularly those recovering from diseases or conditions that necessitate a structured rehabilitation process. Understanding the technological factors that can influence the efficacy of home-based rehabilitation is crucial for optimizing patient outcomes. As technologies continue to evolve rapidly, it is imperative to document the current state of the art and elucidate the key features of the hardware and software employed in these rehabilitation systems. This narrative review aims to provide a summary of the modern technological trends and advancements in home-based shoulder rehabilitation scenarios. It specifically focuses on wearable devices, robots, exoskeletons, machine learning, virtual and augmented reality, and serious games. Through an in-depth analysis of existing literature and research, this review presents the state of the art in home-based rehabilitation systems, highlighting their strengths and limitations. Furthermore, this review proposes hypotheses and potential directions for future upgrades and enhancements in these technologies. By exploring the integration of these technologies into home-based rehabilitation, this review aims to shed light on the current landscape and offer insights into the future possibilities for improving patient outcomes and optimizing the effectiveness of home-based rehabilitation programs.
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Affiliation(s)
- Bruno Cunha
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health-Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
| | - Ricardo Ferreira
- Institute for Systems and Computer Engineering, Technology and Science—Telecommunications and Multimedia Centre, FEUP, University of Porto, Rua Dr. Roberto Frias, 4200-465 Porto, Portugal;
| | - Andreia S. P. Sousa
- Center for Rehabilitation Research—Human Movement System (Re)habilitation Area, Department of Physiotherapy, School of Health-Polytechnic of Porto, Rua Dr. António Bernardino de Almeida, 400, 4200-072 Porto, Portugal;
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Hegmann KT, Thiese MS, Wood EM, Kapellusch J, Foster JC, Drury DL, Kendall R, Merryweather AS. Cardiovascular Disease Risk Factors Predict the Development and Numbers of Common Musculoskeletal Disorders in a Prospective Cohort. J Occup Environ Med 2023; 65:e527-e533. [PMID: 37264528 PMCID: PMC10417266 DOI: 10.1097/jom.0000000000002895] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
OBJECTIVE The aim of the study is to assess risk of common musculoskeletal disorders (MSDs) based on cardiovascular disease (CVD) risk scores. METHODS Data from a 9-year prospective cohort of 1224 workers in three states were analyzed. Baseline data included questionnaires, structured interviews, physical examinations, anthropometric measurements, nerve conduction studies, and individualized measurement of job physical factors. Monthly follow-ups were conducted. Framingham risk scores were calculated. A priori case definitions were constructed for carpal tunnel syndrome, lateral epicondylopathy, medial epicondylopathy, and rotator cuff tendinopathy. RESULTS Adjusted RRs for one or more MSDs increased to 3.90 (95% confidence interval, 2.20-6.90) among those with 10-year cardiovascular disease risk scores greater than 15% and 17.4 (95% confidence interval, 3.85-78.62) among those with more than 4 disorders. CONCLUSIONS Cardiovascular disease factors are strongly associated with the subsequent development of common MSDs. Risks among those with multiple MSDs are considerably stronger.
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Eapen C, Rosita R, Sohani MS, Patel VD. A systematic review of the effectiveness of wrist manipulative therapy in patients with lateral epicondylitis. J Hand Ther 2023; 36:528-535. [PMID: 36918310 DOI: 10.1016/j.jht.2022.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 10/05/2022] [Accepted: 10/09/2022] [Indexed: 03/16/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION Several treatment methods treat lateral epicondylitis, but there is no consensus regarding the most effective method. Research has suggested that joint mobilizations may help recover patients with lateral epicondylitis. PURPOSE OF THE STUDY To determine if wrist joint manipulations effectively improve pain, grip strength, ROM, and functional outcome in adults with lateral epicondylitis. METHODS Searches were performed in 6 databases to identify relevant clinical trials. Three reviewers independently extracted data and assessed the methodological quality using the PEDro scale. Standard data were extracted and summarized. RESULTS A total of 4 studies met the inclusion criteria. A best-evidence synthesis was used to summarize the results. The included studies found effectiveness in favor of wrist manipulations given for at least 3 weeks to reduce pain in lateral epicondylitis against comparison groups comprising ultrasound, laser, friction massage, and exercises. Functional outcomes varied considerably among studies. Grip strength showed varied results, and no effect was seen on wrist ROM. CONCLUSION The evidence is convincing that wrist joint manipulations positively affect pain in the short term, compared to comparison groups in the management of lateral epicondylitis. Future high-quality studies are recommended.
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Affiliation(s)
- Charu Eapen
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India.
| | - Rachel Rosita
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Madhura S Sohani
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
| | - Vivek D Patel
- Department of Physiotherapy, Kasturba Medical College, Mangalore, Manipal Academy of Higher Education, Manipal, Karnataka, India
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Huang P, Hong CI, Liang CC, Wu WT, Wang JH, Yeh KT. De Quervain Tenosynovitis as a Risk Factor of New-Onset Adhesive Capsulitis: A Nationwide Cohort Study. Healthcare (Basel) 2023; 11:1758. [PMID: 37372876 DOI: 10.3390/healthcare11121758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/08/2023] [Accepted: 06/12/2023] [Indexed: 06/29/2023] Open
Abstract
This study investigated the association of de Quervain tenosynovitis (DQT) with subsequent adhesive capsulitis (AC) development. Patients with DQT between 2001 and 2017 from the Taiwan National Health Insurance Research Database were the DQT cohort. The 1:1 propensity score matching method was applied for creating control cohort. The primary outcome was defined as new-onset of AC at least 1 year after the date of confirmed diagnosis of DQT. In total, 32,048 patients with mean age 45.3 years were included. DQT was significantly positively associated with risk of new-onset AC after adjustment for baseline characteristics. Furthermore, severe DQT requiring rehabilitation was positively associated with risk of new-onset AC. In addition, male gender and age under 40 may be additional risk factors for new-onset AC, compared to female gender and age over 40. Cumulative incidence of AC after 17 years was 24.1% among patients with severe DQT requiring rehabilitation and was 20.8% among patients with DQT without rehabilitation. This is the first population-based study to demonstrate an association between DQT and new-onset AC. The findings recommend that preventive occupational therapy, including active modification for the shoulder joint and adjustments to daily activities, may be necessary for patients with DQT to reduce their risk of developing AC.
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Affiliation(s)
- Pao Huang
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Department of Special Education, National Dong Hwa University, Hualien 974, Taiwan
| | - Ching-I Hong
- Department of Special Education, National Dong Hwa University, Hualien 974, Taiwan
| | - Chung-Chao Liang
- Department of Physical Medicine and Rehabilitation, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
| | - Wen-Tien Wu
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Institute of Medical Sciences, Tzu Chi University, Hualien 970, Taiwan
| | - Jen-Hung Wang
- Department of Medical Research, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
| | - Kuang-Ting Yeh
- School of Medicine, Tzu Chi University, Hualien 970, Taiwan
- Department of Orthopedics, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien 970, Taiwan
- Graduate Institute of Clinical Pharmacy, Tzu Chi University, Hualien 970, Taiwan
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De Palma G, Sala E, Rubino S, Dalola S, Ferrari M, Marioli D, Apostoli P, Tomasi C, Righetti F, Mattioli F, Ferrari V. Objective Evaluation of Active Interactions between the Operator and Display Screen Equipment Using an Innovative Acquisition System. Bioengineering (Basel) 2023; 10:686. [PMID: 37370617 DOI: 10.3390/bioengineering10060686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Revised: 05/31/2023] [Accepted: 06/02/2023] [Indexed: 06/29/2023] Open
Abstract
The occupational risk of operators using display screen equipment (DSE) is usually evaluated according to the extent of time spent in active operator-DSE interactions. Risk assessment is based on activity data collected through questionnaires. We evaluated an original and innovative system that can objectively assess active operator-DSE interactions by collecting electrical impulses generated by the activation of mouse, keyboard and a camera that collects attentive eye-screen fixation. The main aim of this study was to evaluate the system's performance on an employee sample involved in the task of active reading and copying at a DSE workstation connected to the system. In the context of mandatory health surveillance at work, we enrolled 38 DSE operators with normal neuropsychological and eye assessments who were required to complete two predefined reading and writing tasks. The obtained results show that the system is able to collect activity data derived from operator-DSE interactions through screen fixation, keyboard tapping and mouse handling. In the copying task, the session duration as recorded by the system was highly related to the screen fixation time. In the copying task, mouse and keyboard activities were more strongly related to session duration than screen fixation. For the copying task, it was also possible to obtain individual profiles of operator-DSE interactions while performing the same standardized tasks. Collected data can allow an objective evaluation of active time spent by DSE operators at their workstations, thus allowing a more accurate occupational health risk assessment and management. Prospective analysis of individual operator-DSE interaction profiles can favor the setup of targeted preventive and organizational interventions from an of even wider worker wellbeing perspective.
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Affiliation(s)
- Giuseppe De Palma
- Unit of Occupational Health, Hygiene, Toxicology and Prevention, University Hospital ASST Spedali Civili di Brescia, 25123 Brescia, Italy
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Emma Sala
- Unit of Occupational Health, Hygiene, Toxicology and Prevention, University Hospital ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Sofia Rubino
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Simone Dalola
- Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Marco Ferrari
- Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Daniele Marioli
- Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
| | - Pietro Apostoli
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Cesare Tomasi
- Unit of Occupational Health and Industrial Hygiene, Department of Medical Surgical Specialties, Radiological Sciences and Public Health, University of Brescia, 25123 Brescia, Italy
| | - Francesca Righetti
- Neuropsychology Unit, University Hospital ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Flavia Mattioli
- Neuropsychology Unit, University Hospital ASST Spedali Civili di Brescia, 25123 Brescia, Italy
| | - Vittorio Ferrari
- Department of Information Engineering, University of Brescia, 25123 Brescia, Italy
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McBain B, Rio E, Cook J, Sanderson J, Docking S. Isometric thumb extension exercise as part of a multimodal intervention for de Quervain's syndrome: A randomised feasibility trial. HAND THERAPY 2023; 28:72-84. [PMID: 37904860 PMCID: PMC10584067 DOI: 10.1177/17589983231158499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2022] [Accepted: 01/20/2023] [Indexed: 11/01/2023]
Abstract
Introduction de Quervain's syndrome is a painful condition commonly presented to hand therapists. Exercise is utilised as an intervention, but isometric exercise has not been investigated. We aimed to assess the feasibility and safety of isometric thumb extension exercise for de Quervain's syndrome and to explore differences between high-load and low-load isometric exercise. Methods This parallel-group randomised clinical feasibility trial included individuals with de Quervain's syndrome. All participants underwent a 2 week washout period where they received an orthosis, education, and range of motion exercises. Eligible participants were then randomised to receive high or low-load isometric thumb extension exercises, performed daily for 4 weeks. Feasibility and safety were assessed by recruitment and drop-out rates, adherence, adverse events, and participant feedback via semi-structured interviews. Secondary outcomes included patient-reported outcomes for pain and function, and blinded assessment of range of motion and strength. Results Twenty-eight participants were randomised. There were no drop-outs after randomisation, and no serious adverse events. Adherence to exercise was 86.7%, with 84% of participants stating they would choose to participate again. There were clinically and statistically significant improvements in pain and function over time (p < 0.001) but not in range of motion or strength. There were no statistically significant between-group differences. Conclusions Isometric thumb extension exercise within a multimodal approach appears a safe and feasible intervention for people with de Quervain's syndrome. A large multi-centre trial would be required to compare high- and low-load isometric exercises. Further research investigating exercise and multimodal interventions in this population is warranted.
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Affiliation(s)
- Brodwen McBain
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- The Upper Limb Co, Melbourne, VIC, Australia
| | - Ebonie Rio
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | - Jill Cook
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
| | | | - Sean Docking
- La Trobe Sport and Exercise Medicine Research Centre, College of Science, Health and Engineering, La Trobe University, Bundoora, VIC, Australia
- Monash-Cabrini Department of Musculoskeletal Health and Clinical Epidemiology, Cabrini Health, Malvern, VIC, Australia
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventative Medicine, Monash University, Clayton, VIC, Australia
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Zamri M, Lans J, Eberlin KR, Garg R, Jupiter JB, Chen NC. Reintervention, PROMs, and Factors Influencing PROMs Following Surgery for de Quervain's Tenosynovitis. J Hand Microsurg 2023; 15:165-174. [PMID: 37388568 PMCID: PMC10306984 DOI: 10.1055/s-0041-1731105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/01/2023] Open
Abstract
Objective The aims of this study are to describe and identify the factors that influence patient reported outcomes following surgery of de Quervain's tenosynovitis. The secondary objective is to report the rate of reintervention following surgery of de Quervain's tenosynovitis. Patients and Methods Outcomes using the numerical rating scale (NRS) for pain, Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH), Patient-Rated Wrist Evaluation (PRWE), the Patients Reported Outcome Measurement Information System Pain Interference (PROMIS PI), and a custom de Quervain's questionnaire were obtained. A multivariable linear regression analysis was performed to identify independent factors associated with patient-reported outcomes. Results Seventy-six patients who underwent de Quervain's release participated. The average age was 52.8 years (95% confidence interval: 49.6-56.1) and median follow-up age was 7.0 years (interquartile range [IQR]: 4.3-12.0). Outcomes were: NRS of pain was 0 (IQR: 0.0-3.0), the median QuickDASH was 6.82 (IQR: 0.00-28.41), the median PRWE score was 4.0 (IQR: 0.00-18.50), and the median PROMIS PI score was 43.90 (IQR: 38.70-53.90). Eighteen (23.7%) of the patients reported pain with thumb activities, four of whom had a reintervention. Additionally, 21 (26.9%) patients reported decreased strength in the thumb compared to the contralateral side, of which two underwent a reintervention. In total, eight patients underwent reintervention of which seven had a second surgery and one had a cortisone injection. Conclusion Roughly 1 in 20 patients following de Quervain's release undergoes reintervention. Patients with high PROMIS PI scores report poor surgical outcomes more frequently. Patients with high PROMIS PI scores report higher NRS pain scores ( p < 0.05), higher QuickDASH scores ( p < 0.05), and higher PRWE scores ( p < 0.05). In practice, careful consideration of PROMIS PI scores and psychosocial factors are recommended before considering reintervention.
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Affiliation(s)
- Meryam Zamri
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
- Leiden University Medical Center (LUMC), Leiden, Netherlands
| | - Jonathan Lans
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Kyle R. Eberlin
- Hand Surgery Service, Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Rohit Garg
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Jesse B. Jupiter
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
| | - Neal C. Chen
- Hand and Upper Extremity Service, Division of Orthopaedics, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, United States
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Hopewell S, Kenealy N, Knight R, Rangan A, Dutton S, Srikesavan C, Feldmann M, Lamb S, Nanchahal J. Anti-TNF (adalimumab) injection for the treatment of adults with frozen shoulder during the pain predominant stage protocol for a multi-centre, randomised, double blind, parallel group, feasibility trial. NIHR OPEN RESEARCH 2023; 2:28. [PMID: 37881307 PMCID: PMC10593336 DOI: 10.3310/nihropenres.13275.2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Accepted: 04/18/2023] [Indexed: 10/27/2023]
Abstract
Objectives The Anti-Freaze-F trial will assess the feasibility of conducting a large randomised controlled trial to assess whether intra-articular injection of anti-TNF (adalimumab) can reduce pain and improve function in people with pain predominant early stage frozen shoulder. Methods and analysis We are conducting a multi-centre, randomised feasibility study, with an embedded qualitative sub-study. We will recruit adults ≥18 years with a new episode of shoulder pain attributable to early stage frozen shoulder, recruited from at least five UK NHS musculoskeletal and related physiotherapy services. Participants (n=84) will be randomised (centralised computer generated 1:1 allocation) to receive either: 1) intra-articular injection of anti-TNF (adalimumab 160mg) or 2) placebo injection (saline [0.9% sodium chloride]), both under ultrasound guidance. A second injection of the allocated treatment (adalimumab 80mg) or equivalent volume of placebo will be administered 2-3 weeks later. All participants will receive a physiotherapy advice leaflet providing education and advice about frozen shoulder and pain management. The primary feasibility objectives are: 1) the ability to screen and identify potential participants with pain predominant early stage frozen shoulder; 2) willingness of eligible participants to consent and be randomised to intervention; 3) practicalities of delivering the intervention, including time to first injection and number of participants receiving second injection; 4) standard deviation of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months (i.e. 12 weeks) post-randomisation in order to estimate the sample size for a definitive trial. We will also assess follow up rates and viability of patient-reported outcome measures and range of shoulder motion for a definitive trial. Research Ethics Committee approval (REC 21/NE/0214). Trial registration number ISRCTN 27075727; EudraCT number: 2021-003509-23; ClinicalTrials.gov NCT05299242.
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Affiliation(s)
- Sally Hopewell
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Nicola Kenealy
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Ruth Knight
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Amar Rangan
- James Cook University Hospital, South Tees Hospitals NHS Foundation Trust, Middlesbrough, UK
- Hull York Medical School and Department of Health Sciences, University of York, York, UK
| | - Susan Dutton
- Oxford Clinical Trials Research Unit / Centre for Statistics in Medicine, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Cynthia Srikesavan
- Centre for Rehabilitation Research in Oxford, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Marc Feldmann
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Sarah Lamb
- College of Medicine and Health, University of Exeter, Exeter, UK
| | - Jagdeep Nanchahal
- Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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Chys M, De Meulemeester K, De Greef I, Murillo C, Kindt W, Kouzouz Y, Lescroart B, Cagnie B. Clinical Effectiveness of Dry Needling in Patients with Musculoskeletal Pain-An Umbrella Review. J Clin Med 2023; 12:jcm12031205. [PMID: 36769852 PMCID: PMC9917679 DOI: 10.3390/jcm12031205] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/18/2023] [Accepted: 01/20/2023] [Indexed: 02/05/2023] Open
Abstract
The number of systematic reviews (SR) summarizing the literature regarding the clinical effects of Dry Needling (DN) has increased rapidly. Yet, rigorous evidence about the clinical effectiveness of this technique is still lacking. The aim of this umbrella review is to summarize the evidence about the clinical effects of trigger point DN on musculoskeletal disorders across all body regions. PubMed, Web of Science and Embase were searched to identify SRs examining the effect of DN (as a stand-alone intervention or combined with another treatment modality) compared to sham/no intervention or a physical therapy (PT) intervention with at least one clinical outcome in the domain of pain or physical functioning. Risk of bias (RoB) was assessed with the AMSTAR-2 tool. Quantification of the overlap in primary studies was calculated using the corrected covered area (CCA). The electronic search yielded 2286 results, of which 36 SRs were included in this review. Overall, DN is superior to sham/no intervention and equally effective to other interventions for pain reduction at short-term regardless of the body region. Some SRs favored wet needling (WN) over DN for short-term pain reductions. Results on physical functioning outcomes were contradictory across body regions. Limited data is available for mid- and long-term effects. DN has a short-term analgesic effect in all body regions and may be of additional value to the interventions that are used to date in clinical practice. Several studies have shown an additional treatment effect when combining DN to physiotherapeutic interventions compared to these interventions in isolation. There is a substantial need for the standardization of DN protocols to address the problem of heterogeneity and to strengthen the current evidence.
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Affiliation(s)
- Marjolein Chys
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Correspondence:
| | | | - Indra De Greef
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Carlos Murillo
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
- Pain in Motion International Research Group, 1000 Brussels, Belgium
| | - Wouter Kindt
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Yassir Kouzouz
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Bavo Lescroart
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
| | - Barbara Cagnie
- Department of Rehabilitation Sciences, Ghent University, 9000 Ghent, Belgium
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Marigi EM, Dancy M, Alexander A, Marigi IM, Clark J, Krych AJ, Camp CL, Okoroha KR. Lateral Epicondylitis: Critical Analysis Review of Current Nonoperative Treatments. JBJS Rev 2023; 11:01874474-202302000-00007. [PMID: 36800442 DOI: 10.2106/jbjs.rvw.22.00170] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
Abstract
» Lateral epicondylitis (LE) or tennis elbow is a common cause of elbow pain in the general population, especially women in the fourth and fifth decades of life who participate in repetitive forceful movements involving the wrist and forearm. » The pathogenesis of this overuse injury is believed to start from an overload event leading to a microtear in or near the origin of the extensor carpi radialis brevis that is subsequently prone to additional injury and structural weakness over time. » Treatment of LE often begins with a wide variety of nonoperative modalities including rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy. For recalcitrant symptoms, additional nonoperative therapies are implemented; however, there remains a lack of comparative efficacy between these adjunct treatments. » In this article, we examine the available literature regarding nonoperative management of LE and provide supplementary insight into the effectiveness of current modalities.
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Affiliation(s)
- Erick M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Malik Dancy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Andrew Alexander
- Department of Physical Medicine and Rehabilitation, Mayo Clinic, Rochester, Minnesota
| | - Ian M Marigi
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Julian Clark
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
| | - Aaron J Krych
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota
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Muacevic A, Adler JR. Work-Related De Quervain's Tensosynovitis (DQT): The Diagnosis Dilemma. Cureus 2023; 15:e33458. [PMID: 36751202 PMCID: PMC9899502 DOI: 10.7759/cureus.33458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2023] [Indexed: 01/07/2023] Open
Abstract
A female presented with right wrist pain for nine months. The diagnosis was De Quervain's tenosynovitis; her condition was initially managed conservatively, but later she needed surgery due to the lack of improvement. No workplace intervention had been implemented because her hand surgeons did not consider her occupational exposures. It was later discovered that there was significant exposure to ergonomic hazards at her workplace. She received accommodations in her workplace that led to reduction of exposure to ergonomic hazards and the subsequent dramatic improvement in her condition. This case report indicates that some orthopedists do not appreciate the role of occupational exposure to ergonomic hazards in the pathogenesis of similar conditions. Occupational medicine specialists and orthopedists should, therefore, communicate with each other to reach a consensus regarding the association between occupational exposures to ergonomic hazards and work-related upper limb disorders (WRULDs).
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Guo J, Peng C, He Q, Li Y. Type 2 diabetes and the risk of synovitis-tenosynovitis: a two-sample Mendelian randomization study. Front Public Health 2023; 11:1142416. [PMID: 37213626 PMCID: PMC10192564 DOI: 10.3389/fpubh.2023.1142416] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/31/2023] [Indexed: 05/23/2023] Open
Abstract
Introduction It has been shown that people with type 2 diabetes have a higher risk of synovitis and tenosynovitis, but previous studies were mainly observational, which may be biased and does not allow for a cause-and-effect relationship. Therefore, we conducted a two-sample Mendelian randomization (MR) study to investigate the causal relationship. Method We obtained data on "type 2 diabetes" and "synovitis, tenosynovitis" from published large-scale genome-wide association studies (GWAS). The data were obtained from the FinnGen consortium and UK Biobank, both from European population samples. We used three methods to perform a two-sample MR analysis and also performed sensitivity analysis. Results The results of all three MR methods we used for the analysis illustrated that T2DM increases the risk factor for the development of synovitis and tenosynovitis. Specifically, for the IVW method as the primary analysis outcome, OR = 1.0015 (95% CI, 1.0005 to 1.0026), P = 0.0047; for the MR Egger method as the supplementary analysis outcome, OR = 1.0032 (95% CI, 1.0007 to 1.0056), P = 0.0161; for the weighted median method, OR = 1.0022 (95% CI, 1.0008 to 1.0037), p = 0.0018. In addition, the results of our sensitivity analysis suggest the absence of heterogeneity and pleiotropy in our MR analysis. Conclusion In conclusion, the results of our MR analysis suggest that T2DM is an independent risk factor for increased synovitis and tenosynovitis.
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Affiliation(s)
- Jiale Guo
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Caiju Peng
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Qionghan He
- Chaohu Hospital of Anhui Medical University, Hefei, China
| | - Yehai Li
- Department of Orthopedics, Chaohu Hospital of Anhui Medical University, Hefei, China
- *Correspondence: Yehai Li
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Moellhoff N, Throner V, Frank K, Benne A, Adelmann S, Coenen M, Giunta RE, Haas-Lützenberger E. Visualization of the location and level of pain in common wrist pathologies using color-coded heatmaps. Arch Orthop Trauma Surg 2023; 143:1095-1102. [PMID: 35666312 PMCID: PMC9925519 DOI: 10.1007/s00402-022-04479-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2022] [Accepted: 05/12/2022] [Indexed: 11/02/2022]
Abstract
BACKGROUND Pain of the hand and wrist affects a large patient population. If the onset is unrelated to recent trauma, the first medical contact is rarely established with a specialized hand surgeon. OBJECTIVE The objective of this investigation was to (1) visualize the localization of hand pain using pain-related heatmaps in common wrist pathologies, (2) to test whether differences between these pathologies exist with regard to sociodemographic and pain-related aspects, and (3) to evaluate the major patient-reported complaints associated with the pathologies. METHODS This observational cross-sectional study included patients suffering from: thumb basal joint arthritis (CMC-1-OA), dorsal wrist ganglions, and TFCC tears. Patients marked the location of maximum pain projection on hand graphics depicting the outline of the palmar and dorsal hand. Color-graded frequency heat maps were generated for the wrist pathologies investigated. Daily life impairments were assessed and clustered into groups of functions/activities. RESULTS 120 patients with a mean age of 44.3 years were investigated. The diagnostic groups showed significant differences regarding the level and location of pain, as well as daily life impairments. Patients with CMC-1-OA presented with increased pain levels compared to patients with dorsal wrist ganglions and TFCC tears. Daily life impairment was rated highest when household chores were adversely affected, and sport activities were symptomatic/painful. All groups showed significant skin surface pain projection, which was visualized in heatmaps. While general trends in pain localization were visible, pain levels were also reported distal/proximal and palmar/dorsal to the pathology. CONCLUSIONS Knowledge of main demographic parameters, pain projection, and degree of impairment in daily activities can help physicians to narrow differential diagnosis of wrist pain during first patient contact. Patients should then be referred to hand surgeons for specialist examination, to further differentiate the origin of the pain.
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Affiliation(s)
- Nicholas Moellhoff
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Veronika Throner
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Konstantin Frank
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Ashley Benne
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Sonja Adelmann
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Michaela Coenen
- grid.5252.00000 0004 1936 973XDepartment of Medical Information Processing, Biometry, and Epidemiology (IBE), Chair for Public Health and Health Services Research, Research Unit for Biopsychosocial Health, LMU Munich, Munich, Germany ,Pettenkofer School of Public Health, Munich, Germany
| | - Riccardo E. Giunta
- grid.5252.00000 0004 1936 973XDivision of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336 Munich, Germany
| | - Elisabeth Haas-Lützenberger
- Division of Hand, Plastic and Aesthetic Surgery, University Hospital, LMU Munich, Ziemssenstr. 5, 80336, Munich, Germany.
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Experiences and needs of physiotherapists and exercise therapists regarding the management of working people with complaints of the arm, neck and shoulder (CANS): A focus group study. Musculoskelet Sci Pract 2022; 62:102644. [PMID: 35985147 DOI: 10.1016/j.msksp.2022.102644] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2022] [Revised: 07/23/2022] [Accepted: 08/01/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND Non-traumatic complaints of the arm, neck and/or shoulder (CANS) are difficult-to-treat musculoskeletal conditions. CANS treatment has varying degrees of success, particularly in the working population. OBJECTIVES To evaluate the experiences and needs of physiotherapists (PTs) and exercise therapists (ETs) regarding the treatment of working patients with CANS. DESIGN An exploratory qualitative focus group study was conducted. METHOD Qualitative data were collected from 27 therapists who were purposefully recruited for their broad range of experience and qualifications. The data was analysed using thematic analysis. RESULTS Both PTs and ETs assess CANS extensively by exploring their patients' psychosocial factors, work-related factors, illness beliefs, and working conditions. Therapists apply hands-off treatment interventions, such as coaching the patient to make behavioural changes and providing self-management support. However, therapists experience many difficulties in these areas, resulting in a need to learn more about coaching techniques for behavioural change, engaging in meaningful conversations about the patient's perspective, supporting patients in building a strong social network in the workplace, and creating a professional network for collaboration. CONCLUSIONS The treatment of working people with CANS is difficult for PTs and ETs. Therapists express a need to learn more about supporting self-management, applying coaching techniques and engaging in meaningful conversations. Moreover, therapists indicate a need to establish a professional multidisciplinary network to support collaborations with other disciplines to treat working patients with CANS.
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