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Zabrzyńska M, Pasiński M, Gagat M, Kułakowski M, Woźniak Ł, Elster K, Antosik P, Zabrzyński J. The Association between the Extent of the Osteoarthritic Meniscus Degeneration and Cigarette Smoking-A Pilot Study. MEDICINA (KAUNAS, LITHUANIA) 2024; 60:323. [PMID: 38399610 PMCID: PMC10890507 DOI: 10.3390/medicina60020323] [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: 12/26/2023] [Revised: 01/29/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024]
Abstract
Background and Objectives: The negative effects of smoking on the musculoskeletal system were presented by many authors, although the relationship between smoking and osteoarthritis remains unclear. The aim of this paper was to investigate the negative effects of smoking on meniscal tissue in osteoarthritic knees by microscopic examination, by adapting the Bonar scoring system and its modifications. Materials and Methods: The study involved 34 patients with varus knees, from whom 65 samples of knee menisci were obtained. The mean age in the studied group was 65.385 years. The smoking status of the patients concluded that there were 13 smokers and 21 nonsmokers. Results: Among smokers, the mean classical Bonar score was 8.42 and the mean modified Bonar score was 6.65, while nonsmokers were characterized by scores of 8.51 and 7.35, respectively. There was a statistically significant negative correlation between the number of cigarettes and the collagen in the medial meniscus (p = 0.0197). Moreover, in the medial meniscus, the modified Bonar score correlated negatively with the number of cigarettes (p = 0.0180). Similarly, such a correlation was observed between the number of cigarettes and the modified Bonar score in the lateral meniscus (p = 0.04571). Furthermore, no correlation was identified between the number of cigarettes and the classical Bonar score in the lateral meniscus. There was a statistically significant difference in the collagen variable value between the smokers and nonsmokers groups (p = 0.04525). Conclusions: The microscopic investigation showed no differences in the menisci of smokers and nonsmokers, except for the collagen, which was more organized in smokers. Moreover, the modified Bonar score was correlated negatively with the number of cigarettes, which supports the role of neovascularization in meniscus pathology under the influence of tobacco smoking.
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Affiliation(s)
- Maria Zabrzyńska
- Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland
| | - Maciej Pasiński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
| | - Maciej Gagat
- Department of Histology and Embryology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
- Faculty of Medicine, Collegium Medicum, Mazovian Academy in Płock, 09-402 Płock, Poland
| | - Michał Kułakowski
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Łukasz Woźniak
- Department of Orthopaedics and Traumatology, University of Medical Sciences, 61-701 Poznan, Poland
| | - Karol Elster
- Independent Public Healthcare Center in Rypin, 87-500 Rypin, Poland; (M.K.); (K.E.)
| | - Paulina Antosik
- Department of Clinical Pathology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland;
| | - Jan Zabrzyński
- Department of Orthopaedics and Traumatology, Faculty of Medicine, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University in Toruń, 85-067 Bydgoszcz, Poland; (M.P.); (J.Z.)
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ROŠKAR S, ROJC M, PODOVŠOVNIK E, TREBŠE R. Psychometric Characteristics, Cross-Cultural Adaptation and Validation of the Slovenian Version of the Victorian Institute of Sports Assessments for Gluteal Tendinopathy Questionnaire (VISA-G). Zdr Varst 2023; 62:167-172. [PMID: 37799417 PMCID: PMC10549249 DOI: 10.2478/sjph-2023-0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Accepted: 07/06/2023] [Indexed: 10/07/2023] Open
Abstract
Introduction Greater trochanteric pain syndrome (GTPS) denotes several disorders around the lateral aspect of the hip. GTPS may develop in native hips as well as after total hip arthroplasty (THA). It is estimated that 5-12% of patients suffer from GTPS after primary THA. Despite the prevalence of GTPS, it is hard to diagnose and manage it properly. The VISA-G questionnaire was developed as a patient-reported outcome measurement tool for evaluation of GTPS. The aims of the present study were to evaluate the reliability of the VISA-G Slovenian and its construct and criterion validity. Methods After the finalization of the VISA-G Slovenian translation procedure, 59 patients with a painful trochanteric region planned for THA filled in the VISA-G Slovenian at the hospital on two occasions 5-7 days apart. On the first occasion, each patient also filled in the EQ-5D-5L questionnaire and the Harris Hip Score (HHS) was completed by the physiotherapist. Results The VISA-G Slovenian was found to have a test-retest reliability of ICC 0.977; 95% CI [0.96; 0.986]. Internal consistency was assessed with Cronbach's alpha 0.79. The statistically significant, but low, correlation between the HHS and VISA-G (r=0.48) was obtained. Concurrent validity of the VISA-G with the EQ-5D-5L showed moderate to strong correlations in Mobility, Self-Care, Usual Activities, Pain, EQ-5D-5L Index and EQ VAS, but low correlation in the Anxiety subscale. No floor and ceiling effect were obtained. Conclusions The VISA-G Slovenian has excellent psychometric properties needed to measure gluteal tendinopathy-related disability of patients in Slovenia. Thus, we recommend using the questionnaire for measuring trochanteric hip pain.
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Affiliation(s)
- Samo ROŠKAR
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
| | - Marina ROJC
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Eva PODOVŠOVNIK
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
| | - Rihard TREBŠE
- Valdoltra Orthopaedic Hospital, Jadranska cesta 31, 6280Ankaran, Slovenia
- University of Ljubljana, Faculty of Medicine, Zaloška 9, 1000Ljubljana, Slovenia
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Wasker SVZ, Challoumas D, Weng W, Murrell GAC, Millar NL. Is neurogenic inflammation involved in tendinopathy? A systematic review. BMJ Open Sport Exerc Med 2023; 9:e001494. [PMID: 36793930 PMCID: PMC9923261 DOI: 10.1136/bmjsem-2022-001494] [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] [Accepted: 01/12/2023] [Indexed: 02/11/2023] Open
Abstract
Neurogenic pain and inflammation have been hypothesised to play an important role in tendinopathy. This systematic review aimed to present and assess the evidence on neurogenic inflammation in tendinopathy. A systematic search was conducted through multiple databases to identify human case-control studies assessing neurogenic inflammation through the upregulation of relevant cells, receptors, markers and mediators. A newly devised tool was used for the methodological quality assessment of studies. Results were pooled based on the cell/receptor/marker/mediator assessed. A total of 31 case-control studies were eligible for inclusion. The tendinopathic tissue was obtained from Achilles (n=11), patellar (n=8), extensor carpi radialis brevis (n=4), rotator cuff (n=4), distal biceps (n=3) and gluteal (n=1) tendons. Through pooling the results of included studies based on the marker of neurogenic inflammation assessed, we identified possible upregulation of protein gene product 9.5 (PGP 9.5), N-methyl-D-aspartate Receptors, glutamate, glutamate receptors (mGLUT), neuropeptide Y (NPY) and adrenoreceptors in tendinopathic tissue versus control. Calcitonin gene-related peptide (CGRP) was not found to be upregulated, and the evidence was conflicting for several other markers. These findings show the involvement of the glutaminergic and sympathetic nervous systems and the upregulation of nerve ingrowth markers supporting the concept that neurogenic inflammation plays a role in tendinopathy.
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Affiliation(s)
- Shimon Vinay Zedeck Wasker
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - Dimitris Challoumas
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
| | - Wai Weng
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - George A C Murrell
- Orthopaedic Research Institute, St George Hospital Sydney, University of New South Wales, Sydney, New South Wales, Australia
| | - Neal L Millar
- School of Infection and Immunity, College of Medicine, Veterinary and Life Sciences, University of Glasgow, Glasgow, UK
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Advances in Microscopic Studies of Tendinopathy: Literature Review and Current Trends, with Special Reference to Neovascularization Process. J Clin Med 2022; 11:jcm11061572. [PMID: 35329898 PMCID: PMC8949578 DOI: 10.3390/jcm11061572] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 03/10/2022] [Accepted: 03/11/2022] [Indexed: 01/05/2023] Open
Abstract
Tendinopathy is a process of chaotic extracellular matrix remodeling followed by increased secretion of enzymes and mediators of inflammation. The histopathological assessment of tendinous tissue is crucial to formulate the diagnosis and establish the severity of tendon degeneration. Nevertheless, the microscopic analysis of tendinous tissue features is often challenging. In this review, we aimed to compare the most popular scales used in tendon pathology assessment and reevaluate the role of the neovascularization process. The following scores were evaluated: the Bonar score, the Movin score, the Astrom and Rausing Score, and the Soslowsky score. Moreover, the role of neovascularization in tendon degeneration was reassessed. The Bonar system is the most commonly used in tendon pathology. According to the literature, hematoxylin and eosin with additional Alcian Blue staining seems to provide satisfactory results. Furthermore, two observers experienced in musculoskeletal pathology are sufficient for tendinopathy microscopic evaluation. The control, due to similar and typical alterations in tendinous tissue, is not necessary. Neovascularization plays an ambiguous role in tendon disorders. The neovascularization process is crucial in the tendon healing process. On the other hand, it is also an important component of the degeneration of tendinous tissue when the regeneration is incomplete and insufficient. The microscopic analysis of tendinous tissue features is often challenging. The assessment of tendinous tissue using the Bonar system is the most universal. The neovascularization variable in tendinopathy scoring systems should be reconsidered due to discrepancies in studies.
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Crutchfield CR, Padaki AS, Holuba KS, Arney MM, O’Connor MJ, Menge TJ, Lynch TS. Open Versus Arthroscopic Surgical Management for Recalcitrant Trochanteric Bursitis: A Systematic Review. THE IOWA ORTHOPAEDIC JOURNAL 2021; 41:45-57. [PMID: 34924870 PMCID: PMC8662929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
Background While excision of the trochanteric bursae to treat lateral hip pain has increased in popularity, no comparison exists between the surgical outcomes and complications of the open and arthroscopic techniques involving trochanteric bursectomy. The purpose of this study was to determine the efficacies and complication rates of arthroscopic and open techniques for procedures involving trochanteric bursectomy. Methods The terms "trochanteric," "bursectomy," "arthroscopic," "open," "outcomes," and "hip" were searched in five electronic databases. Fifteen studies from 120 initial results were included. Patient-reported outcomes (PRO), pain, satisfaction, and complications were included for analysis. Results Five hundred-two hips in 474 total patients (77.7% female) were included in this study. The average age was 54. The fourteen distinct PRO scores that were reported by the included studies improved significantly from baseline to final mean follow-up (12-70.8 months for open; 12-42 months for arthroscopic) for both approaches, demonstrating statistically significant patient benefit in a variety of hip arthroscopy settings (P > 0.05). The complication rates of all procedures ranged from 0%-33% and failure to improve pain ranged from 0%-8%. Patient satisfaction with surgery was high at 95% and 82% reported a willingness to undergo the same surgery again. No significant mean differences were found between the open and arthroscopic techniques. Conclusion The open and arthroscopic approaches for trochanteric bursectomy are both safe and effective procedures in treating refractory lateral hip pain. No significant differences in PROs, pain, total complications, severity of complications, and total failures were seen between technique outcomes.Level of Evidence: IV.
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Affiliation(s)
| | - Ajay S. Padaki
- Columbia University Irving Medical Center, New York, NY, USA
| | - Kurt S. Holuba
- Columbia University Irving Medical Center, New York, NY, USA
| | - Monica M. Arney
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | | | - Travis J. Menge
- Spectrum Health Medical Group Orthopedics & Sports Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Thomas S. Lynch
- Columbia University Irving Medical Center, New York, NY, USA
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The Bonar Score in the Histopathological Assessment of Tendinopathy and Its Clinical Relevance-A Systematic Review. ACTA ACUST UNITED AC 2021; 57:medicina57040367. [PMID: 33918645 PMCID: PMC8069001 DOI: 10.3390/medicina57040367] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 04/02/2021] [Accepted: 04/06/2021] [Indexed: 12/20/2022]
Abstract
This study aimed to perform a comprehensive systematic review, which reports the role of the Bonar score in the histopathological assessment of tendinopathy and its clinical relevance. To identify all of the studies that reported relevant information on the Bonar scoring system and tendinopathy, an extensive search of the major and the most significant electronic databases (PubMed, Cochrane Central, ScienceDirect, SciELO, Web of Science) was performed. A systematic review of the literature was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. The extracted data included—year of study, geographical location, type of the study, radiological modifications, gender, number of patients, region of tendinopathy, mean age, control group, characteristics of the Bonar score and alterations in the scale, mean Bonar score, number of investigators, area of tendon investigation, clinical and radiological implications. An extensive search of the databases and other sources yielded a total of 807 articles. Eighteen papers were finally included in this systematic review, and of these, 13 original papers included the clinical and radiological implications of tendinopathy. Radiological evaluation was present in eight studies (both magnetic resonance imaging (MRI) and ultrasound (US)). The clinical implications were more frequent and present in 10 studies. Using the Bonar score, it is easy to quantify the pathological changes in tendinous tissue. However, its connection with clinical and radiological evaluation is much more complicated. Based on the current state of knowledge, we concluded that the neovascularization variable in the Bonar system should be reconsidered. Ideally, the microscopic assessment score should follow the established classification scale with the radiological and clinical agreement and should have a prognostic value.
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Jarlborg M, Courvoisier DS, Faundez A, Brulhart L, Finckh A, Nissen MJ, Genevay S. Greater trochanteric pain syndrome: predicting who will respond to a local glucocorticoid injection. Scand J Rheumatol 2021; 50:455-461. [PMID: 33685306 DOI: 10.1080/03009742.2021.1871643] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
Objectives: This study aimed to explore whether certain clinical tests or a rapid improvement in lateral hip pain following periarticular injection are predictive of subsequent efficacy of local glucocorticoid (GC) injection in greater trochanteric pain syndrome (GTPS).Method: This secondary analysis of a randomized controlled trial of an injection of GC and local anaesthetic (LA) versus placebo included 44 patients with GTPS. Two subgroups of patients were defined: (i) 30 min responders, reporting a decrease of ≥ 50% of the initial pain at 30 min post-injection; and (ii) positive triple test, presenting a combination of three positive clinical tests (30-second single-leg stance, FABER, and Lequesne). Median level of numeric rating scale for pain at 1 month was the primary outcome. Interaction analysis of treatment effect in the subgroups was performed using a linear regression adjusting for pain at baseline.Results: Sixteen patients (36%) were 30 min responders. In this group, GC treatment was associated with a significant improvement in pain at 1 month compared to non-responders (p = 0.03). The 30 min response was not associated with the use of LA. Positive triple test (22% of patients) was associated with higher pain scores at baseline (p = 0.03). In this group, patients who received placebo had significantly more pain at 1 month than those with the cortisone injection (p = 0.04).Conclusion: Patients with GTPS who present a rapid decrease in pain after periarticular injection, and those who display a combination of three specific clinical tests, are more likely to benefit from an injection with GC and anaesthetic.
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Affiliation(s)
- M Jarlborg
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - D S Courvoisier
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - A Faundez
- Department of Orthopaedic Surgery, Geneva University Hospital, Geneva and Hospital La Tour Spine Center, Meyrin, Switzerland
| | - L Brulhart
- Department of Rheumatology, Geneva University Hospital, Geneva and Neuchâtel Hospital, La Chaux-de-Fonds, Switzerland
| | - A Finckh
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - M J Nissen
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
| | - S Genevay
- Department of Rheumatology, Geneva University Hospital, Geneva, Switzerland
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Bussin E, Cairns B, Gerschman T, Fredericson M, Bovard J, Scott A. Topical diclofenac vs placebo for the treatment of chronic Achilles tendinopathy: A randomized controlled clinical trial. PLoS One 2021; 16:e0247663. [PMID: 33661967 PMCID: PMC7932128 DOI: 10.1371/journal.pone.0247663] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 02/11/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The application of topical diclofenac has been suggested as a possible treatment for Achilles tendinopathy. Our aim was to answer the question, is topical diclofenac more effective than placebo for the treatment of Achilles tendinopathy?. METHODS 67 participants with persistent midportion or insertional Achilles tendinopathy were randomly assigned to receive a 4 week course of 10% topical diclofenac (n = 32) or placebo (n = 35). The a priori primary outcome measure was change in severity of Achilles tendinopathy (VISA-A score) at 4 and 12 weeks. Secondary outcome measures included numeric pain rating, and patient-reported change in symptoms using a 7 point scale, from substantially worse to substantially better. Pressure pain threshold (N) and transverse tendon stiffness (N/m) were measured over the site of maximum Achilles tendon pathology at baseline and 4 weeks. RESULTS There were no statistically or clinically significant differences between the diclofenac and placebo groups in any of the primary or secondary outcome measures at any timepoint. Average VISA-A score improved in both groups (p<0.0001), but the improvements were marginal: at 4 weeks, the improvements in VISA-A were 9 (SD 11) in the diclofenac group and 8 (SD 12) in the placebo group, and at 12 weeks the improvements were 9 (SD 16) and 11 (SD13) respectively-these average changes are smaller than the minimum clinically important difference of the VISA-A. CONCLUSION The regular application of topical diclofenac for Achilles tendinopathy over a 4 week period was not associated with superior clinical outcomes to that achieved with placebo.
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Affiliation(s)
- Erin Bussin
- Fortius Sports Medicine, Burnaby, British Columbia, Canada
| | - Brian Cairns
- Faculty of Pharmaceutical Sciences, University of British Columbia, Vancouver, Canada
| | - Tommy Gerschman
- Department of Pediatrics, University of British Colombia, Vancouver, Canada
| | - Michael Fredericson
- Department of Orthpaedic Surgery, Stanford University, Stanford, California, United States of America
| | - Jim Bovard
- Department of Family Practice, University of British Columbia, Vancouver, Canada
| | - Alex Scott
- Department of Physical Therapy, University of British Columbia, Vancouver, Canada
- * E-mail:
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Jorgensen JE, Fearon AM, Mølgaard CM, Kristinsson J, Andreasen J. Translation, validation and test-retest reliability of the VISA-G patient-reported outcome tool into Danish (VISA-G.DK). PeerJ 2020; 8:e8724. [PMID: 32181058 PMCID: PMC7060749 DOI: 10.7717/peerj.8724] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Accepted: 02/10/2020] [Indexed: 11/20/2022] Open
Abstract
The Victorian Institute of Sport Assessment (VISA) questionnaire model is based on item response theory using a graded response (responses reflect increasing difficulty). The purpose of the VISA-G is to monitor patient outcomes and evaluate treatment strategies for people with greater trochanteric pain syndrome (GTPS). The primary aim of the current study was to translate and culturally adapt the VISA-G into a Danish context (DK) through forward and back translation and cognitive interviews. The second aim was to establish test–retest reliability and face validity of the VISA-G into a Danish context (DK). No major disagreements were observed between the original and translated versions of the questionnaire. A total of 58 heterogenous asymptomatic, and 49 symptomatic respondents (response rate: 92% and 78% respectively) completed the VISA-G.DK twice, 1 week apart. The VISA-G.DK had excellent internal consistency (Cronbach’s alpha: asymptomatic = 0.86; symptomatic = 0.98). The test–retest reliability was excellent for the total score: ICC: 0.961 (95% CI [0.933–0.978]). Standard Error Measurement was calculated to be 0.6. Bland–Altman plots showed no significant or relevant differences from test to retest in the total score with mean differences below 1 (0.61). The minimal detectable change was 3.17 for both groups. The VISA-G.DK was found to be valid, reliable and acceptable for use in the Danish population.
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Affiliation(s)
- Jens Erik Jorgensen
- Sofiendal Aalborg Sundhedsteam, Physiotherapy Private Practice, Aalborg, Denmark
| | - Angela M Fearon
- University of Canberra Hospital, Research Institute for Sport and Exercise, Faculty of Health University of Canberra, Bruce, ACT, Australia
| | - Carsten M Mølgaard
- Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark.,Aalborg University Hospital, Department of Orthopaedic Surgery, Aalborg, Denmark
| | - Jens Kristinsson
- Aalborg University Hospital, Department of Orthopaedic Surgery, Aalborg, Denmark
| | - Jane Andreasen
- Aalborg University Hospital, Department of Physiotherapy and Occupational Therapy, Aalborg, Denmark.,Public Health and Epidemiology Group, Aalborg University, The Faculty of Medicine, Department of Health Science and Technology, Aalborg, Denmark
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Plinsinga ML, Ross MH, Coombes BK, Vicenzino B. Physical findings differ between individuals with greater trochanteric pain syndrome and healthy controls: A systematic review with meta-analysis. Musculoskelet Sci Pract 2019; 43:83-90. [PMID: 31369906 DOI: 10.1016/j.msksp.2019.07.009] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2019] [Revised: 06/13/2019] [Accepted: 07/24/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Understanding of the biopsychosocial characteristics of greater trochanteric pain syndrome (GTPS), a prevalent lower limb tendinopathy, is currently lacking. OBJECTIVES To quantify differences in participant characteristics between individuals with GTPS and healthy control participants. DESIGN Systematic review of original studies with meta-analyses where appropriate. METHODS A comprehensive electronic search was undertaken in Pubmed, EMBASE, Web of Science and CINAHL for terms referring to GTPS. Studies that provided comparison of individuals with clinically characterized GTPS with healthy controls were included. Study quality was rated with the Joanna Briggs Institute Critical Appraisal Checklist for Cross Sectional Studies. Standardized mean differences were calculated and supported by narrative synthesis or meta-analyses where appropriate. Certainty of evidence was assessed based on the GRADE guidelines. RESULTS The search revealed 2798 studies, of which 13 studies from five research groups were included. There were 229 participants with at least three months duration of GTPS and 193 control participants. Individuals with GTPS displayed larger greater trochanteric width, greater body mass index, lower hip abductor muscle strength, higher hip abductor muscle activity, altered single leg loading and gait parameters including shorter step length and velocity. No studies investigating psychological features or sensory perception were identified. Quality of life was investigated in a single study. CONCLUSIONS Compared to healthy controls, participants with GTPS are more overweight, have poorer hip abductor muscle function and altered gait parameters. Overall quality of evidence across studies was very low based on GRADE guidelines.
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Affiliation(s)
- Melanie Louise Plinsinga
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Megan Heather Ross
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Brooke Kaye Coombes
- School of Biomedical Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia
| | - Bill Vicenzino
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, 4072, Australia.
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Docking SI, Cook J, Chen S, Scarvell J, Cormick W, Smith P, Fearon A. Identification and differentiation of gluteus medius tendon pathology using ultrasound and magnetic resonance imaging. MUSCULOSKELETAL SCIENCE & PRACTICE 2019; 41:1-5. [PMID: 30763889 DOI: 10.1016/j.msksp.2019.01.011] [Citation(s) in RCA: 25] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 10/23/2018] [Accepted: 01/18/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND It has been suggested that imaging findings play a role in directing treatment for Greater Trochanteric Pain Syndrome. Structural diagnoses associated with Greater Trochanter Pain Syndrome include gluteal tendinosis, and partial- or full-thickness gluteal tendon tears. However, few studies have compared imaging to confirmed tendon pathology observed during surgery. OBJECTIVE To investigate the ability of magnetic resonance and ultrasound imaging to identify the presence of a pathological gluteus medius tendon in comparison to surgical and histological findings. STUDY DESIGN Cross-sectional study. METHODS 26 participants undergoing gluteal tendon reconstruction surgery or hip arthroplasty were included. Prior to surgery, participants underwent both magnetic resonance (MR) (n = 23) and ultrasound (US) (n = 25) imaging. A radiologist (MR) and nuclear physicians (US) classified the gluteus medius tendon as normal, tendinosis (no tear), partial-thickness tear, or full-thickness tear. RESULTS Ultrasound identified 17 out of the 19 pathological gluteus medius tendons correctly. However, 5 of the 6 normal tendons were incorrectly identified as exhibiting pathology on ultrasound. Magnetic resonance rated 11 out of 17 pathological tendons as abnormal, with 4 out of 6 normal tendons identified correctly. Both imaging modalities were poor at identifying and differentiating between tendinosis and partial-thickness tears. CONCLUSION Both imaging modalities showed a reasonable ability to identify tendon pathology. While limited by sample size, these early findings suggest that both imaging modalities may be limited in identifying specific pathoanatomical diagnoses, such as partial-thickness tears. These limitations may misdirect treatment.
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Affiliation(s)
- Sean Iain Docking
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, 3086, Australia.
| | - Jill Cook
- La Trobe Sports and Exercise Medicine Research Centre, La Trobe University, Bundoora, 3086, Australia
| | | | - Jennie Scarvell
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, 2617, Australia
| | - Wes Cormick
- Canberra Specialist Ultrasound, Canberra, 2617, Australia
| | - Paul Smith
- Division of Surgery, The Canberra Hospital, Canberra, 2605, Australia; College of Medicine and Health Sciences, Australian National University, Canberra, 0200, Australia
| | - Angela Fearon
- Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, 2617, Australia; Research Institute for Sport and Exercise, University of Canberra, 2617, Australia
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Does Dynamic Tape change the walking biomechanics of women with greater trochanteric pain syndrome? A blinded randomised controlled crossover trial. Gait Posture 2019; 70:275-283. [PMID: 30921578 DOI: 10.1016/j.gaitpost.2019.02.031] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 01/27/2019] [Accepted: 02/26/2019] [Indexed: 02/02/2023]
Abstract
OBJECTIVES There is considerable debate among clinicians as to whether sports tape can provide mechanical support and pain relief. People with greater trochanteric pain syndrome (GTPS) have increased adduction moment, adduction angle and pelvic obliquity, likely contributing to the continuation of the pathology. We aimed to see if Dynamic Tape® could control these movements and reduce pain. METHODS Fifty women with GTPS participated in a three-dimensional gait analysis. Each participant performed three walking trials: baseline, and two subsequent trials, with active and sham applications of Dynamic Tape. The order of active and sham taping was randomised. Differences in kinetic and kinematic data were analysed using mixed model linear regressions for each condition. Pain scores were obtained before and immediately after walking trials. RESULTS Hip adduction moment was reduced at first peak by both active (p < 0.001) and sham tape (p = 0.028), with no between group difference; at second peak by the active taping (p < 0.001), with a between-group difference (p < 0.001). Adduction angle was reduced at first peak by both active (p < 0.001) and sham taping (p = 0.026), with the active taping producing a larger effect (p = 0.004); at mid-stance by active taping (p = 0.003), with a between-group difference (p = 0.002); there was no reduction at second peak. Internal rotation was reduced at the first (p < 0.001) and second peaks (p < 0.001), and mid-stance by the active taping alone (p < 0.001). Pelvic obliquity was reduced at the first peak (p = 0.019), mid-stance (p < 0.001) and second peak (p < 0.001) by the active tape, with a between-group difference at mid-stance (p = 0.03). Both the active and sham taping resulted in a clinically meaningful pain reduction. CONCLUSION Dynamic Tape produced a mechanical effect and a meaningful reduction in pain in women with GTPS. The extent that placebo or somatosensory input may have had on these results is not clear. CLINICAL TRIAL REGISTRATION NUMBER ACTRN12617001611314.
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Tu Q, Gan J, Shi J, Yu H, He S, Zhang J. Effect of transcutaneous electrical acupoint stimulation on postoperative analgesia after ureteroscopic lithotripsy: a randomized controlled trial. Urolithiasis 2018; 47:279-287. [PMID: 29557487 DOI: 10.1007/s00240-018-1056-8] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2018] [Accepted: 03/16/2018] [Indexed: 12/22/2022]
Abstract
Transcutaneous electrical acupoint stimulation (TEAS) is an effective analgesic measure. We studied the analgesic effect of TEAS by applying it alone after ureteroscopic lithotripsy, rather than applying it as a supplementary analgesic measure. Participants (n = 120) scheduled to undergo ureteroscopic holmium laser lithotripsy, were enrolled and randomly assigned into Group T (TEAS n = 60) and Group C (Control, n = 60). The participants in Group T were treated with TEAS for postoperative analgesia. TEAS were implemented on bilateral Shenyu (BL23) and Yinlingquan (SP9) at the time backward and the time at 4, 8, 12 h postoperatively. TEAS was re-implemented three times on the target acupoints for the next 2 days. When TEAS failed to meet the analgesic effect, the participants were given tramadol hydrochloride tablets of 100 mg. Participants of Group C were given tramadol hydrochloride tablets for postoperative analgesia. The primary outcome of VAS scores at the time backward (T0), 4 h (T1), 12 h (T2), 24 h (T3), 48 h (T4) postoperatively and the amount of remedy for analgesic consumption within 48 h postoperatively were compared. The secondary outcome of adverse reactions and plasma concentrations of serotonin (5-HT) and substance P (SP) at T0, T1, T2, T3, T4 were detected, respectively. The VAS scores at T1, T2, T3, T4 postoperatively in two groups were lower than T0. Compared to group C, the VAS scores at T1 (3.68 ± 0.68 vs. 4.79 ± 0.82, P = 0.01), T2 (2.64 ± 0.72 vs. 3.92 ± 0.88, P = 0.03), T3 (2.21 ± 0.88 vs. 3.38 ± 0.74, P < 0.01) in Group T were lower, and total remedy of analgesic consumption was significantly lower (127.14 ± 28.46 vs. 415.27 ± 86.37, P < 0.01) within 48 h postoperatively. The plasma concentrations of 5-HT in Group T was lower than Group C at T1 (348.54 ± 138.49 vs. 418.69 ± 124.68, P = 0.03), T2 (324.28 ± 112.73 vs. 398.52 ± 114.53, P < 0.01), T4 (309.64 ± 129.09 vs. 388.46 ± 115.36, P = 0.04) postoperatively and concentrations of SP at T1 (59.38 ± 24.68 vs. 78.93 ± 26.32, P < 0.01), T2 (49.36 ± 25.55 vs. 66.49 ± 23.57, P = 0.02), T3 (42.19 ± 24.36 vs. 64.15 ± 28.16, P = 0.04), T4 (39.26 ± 19.88 vs. 54.64 ± 20.62, P = 0.02) postoperatively were also lower than Group C. Meanwhile, the occurrences of vertigo (6.7 vs. 18.3%, P < 0.01), nausea and vomiting (11.7 vs. 21.7%, P < 0.01), constipation (10.0 vs. 20.0%, P = 0.03) in Group T were also lower. Application of TEAS alone was associated with effective alleviation of postoperative pain, reduction of postoperative analgesics consumption, decrease of plasma concentration of algogenic substance and the incidence of adverse reactions after ureteroscopic lithotripsy.
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Affiliation(s)
- Qing Tu
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China
| | - Jianhui Gan
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China.
| | - Jinlin Shi
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China
| | - Hong Yu
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China
| | - Shuangliang He
- Department of Anesthesiology, Tangshan People's Hospital, North China University of Science and Technology, No. 65 Shengli Road, Tangshan, 063000, Hebei, China
| | - Jian Zhang
- Department of Anesthesiology, The Third People's Hospital of Chengdu, Southwest Jiao Tong University, Chendu, 610000, China
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The Implication of Substance P in the Development of Tendinopathy: A Case Control Study. Int J Mol Sci 2017; 18:ijms18061241. [PMID: 28598390 PMCID: PMC5486064 DOI: 10.3390/ijms18061241] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2017] [Revised: 05/25/2017] [Accepted: 06/06/2017] [Indexed: 01/03/2023] Open
Abstract
It was reported that substance P had beneficial effects in the healing of acute tendon injury. However, the relationship between substance P and degenerative tendinopathy development remains unclear. The purpose of this study was to determine the role of substance P in the pathogenesis of tendinopathy. Healthy and tendinopathy tendon were harvested from human and tenocytes were cultured individually. The expression levels of genes associated with tendinopathy were compared. Next, substance P was exogenously administered to the healthy tenocyte and the effect was evaluated. The results showed that tendinopathy tenocytes had higher levels of COL3A1, MMP1, COX2, SCX, ACTA2, and substance P gene expression compared to healthy tenocytes. Next, substance P treatment on the healthy tenocyte displayed similar changes to that of the tendinopathy tenocytes. These differences between the two groups were also determined by Western blot. Additionally, cells with substance P had the tendinopathy change morphologically although cellular proliferation was significantly higher compared to that of the control group. In conclusion, substance P enhanced cellular proliferation, but concomitantly increased immature collagen (type 3 collagen). Substance P plays a crucial role in tendinopathy development and could be a future therapeutic target for treatment.
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Barratt PA, Brookes N, Newson A. Conservative treatments for greater trochanteric pain syndrome: a systematic review. Br J Sports Med 2016; 51:97-104. [DOI: 10.1136/bjsports-2015-095858] [Citation(s) in RCA: 50] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/19/2016] [Indexed: 01/15/2023]
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Abstract
Synopsis Tendinopathy has become the accepted term to describe a spectrum of changes that occur in damaged and/or diseased tendons. Over the past 2 decades, there have been new insights into tendon pathophysiology of relevance to clinicians, including (1) better characterization of the overuse injury process and the resultant structural and functional disruption in chronically painful tendons, (2) improved understanding of the pathomechanics associated with chronic tendon injury, and (3) greater knowledge about the influence of lifestyle factors and drugs on tendon pathology. The implications of these new insights are discussed. J Orthop Sports Phys Ther 2015;45(11):833-841. Epub 21 Sep 2015. doi:10.2519/jospt.2015.5884.
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Abstract
Synopsis Gluteal tendinopathy is now believed to be the primary local source of lateral hip pain, or greater trochanteric pain syndrome, previously referred to as trochanteric bursitis. This condition is prevalent, particularly among postmenopausal women, and has a considerable negative influence on quality of life. Improved prognosis and outcomes in the future for those with gluteal tendinopathy will be underpinned by advances in diagnostic testing, a clearer understanding of risk factors and comorbidities, and evidence-based management programs. High-quality studies that meet these requirements are still lacking. This clinical commentary provides direction to assist the clinician with assessment and management of the patient with gluteal tendinopathy, based on currently limited available evidence on this condition and the wider tendon literature and on the combined clinical experience of the authors. J Orthop Sports Phys Ther 2015;45(11):910-922. Epub 17 Sep 2015. doi:10.2519/jospt.2015.5829.
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Tilley BJ, Cook JL, Docking SI, Gaida JE. Is higher serum cholesterol associated with altered tendon structure or tendon pain? A systematic review. Br J Sports Med 2015; 49:1504-9. [PMID: 26474596 PMCID: PMC4680137 DOI: 10.1136/bjsports-2015-095100] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/18/2015] [Indexed: 01/05/2023]
Abstract
Background Tendon pain occurs in individuals with extreme cholesterol levels (familial hypercholesterolaemia). It is unclear whether the association with tendon pain is strong with less extreme elevations of cholesterol. Objective To determine whether lipid levels are associated with abnormal tendon structure or the presence of tendon pain. Methods We conducted a systematic review and meta-analysis. Relevant articles were found through an electronic search of 6 medical databases—MEDLINE, Cochrane, AMED, EMBASE, Web of Science and Scopus. We included all case–control or cross-sectional studies with data describing (1) lipid levels or use of lipid-lowering drugs and (2) tendon structure or tendon pain. Results 17 studies (2612 participants) were eligible for inclusion in the review. People with altered tendon structure or tendon pain had significantly higher total cholesterol, low-density lipoprotein cholesterol and triglycerides, as well as lower high-density lipoprotein cholesterol; with mean difference values of 0.66, 1.00, 0.33, and −0.19 mmol/L, respectively. Conclusions The results of this review indicate that a relationship exists between an individual’s lipid profile and tendon health. However, further longitudinal studies are required to determine whether a cause and effect relationship exists between tendon structure and lipid levels. This could lead to advancement in the understanding of the pathoaetiology and thus treatment of tendinopathy.
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Affiliation(s)
- Benjamin J Tilley
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia
| | - Jill L Cook
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
| | - Sean I Docking
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Australian Centre of Research into Injury in Sport and its Prevention (ACRISP), Federation University, Victoria, Australia
| | - James E Gaida
- Department of Physiotherapy, Monash University, Melbourne, Victoria, Australia Discipline of Physiotherapy, University of Canberra, Canberra, Australian Capital Territory, Australia University of Canberra, Research Institute for Sport and Exercise (UCRISE) Canberra, Australian Capital Territory, Australia
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Zhou Y, Zhou B, Tang K. The effects of substance p on tendinopathy are dose-dependent: an in vitro and in vivo model study. J Nutr Health Aging 2015; 19:555-61. [PMID: 25923486 DOI: 10.1007/s12603-014-0576-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
OBJECTIVES Substance P (SP) is known to be involved in neuropathic pain, chronic inflammation, and tendinopathy. The present study evaluated the effects of different doses of SP on tendon-derived stem cells (TDSCs) in vitro and tendons in vivo. METHODS For the in vitro study, TDSCs cultured in growth medium with different concentrations of SP (negative control, 0.1 nM, and 1.0 nM). The effects of SP on TDSCs were examined with respect to their ability to proliferate and differentiate. For the in vivo study, we injected different doses of SP (saline control, 0.5 nmol, and 5.0 nmol) into rat patella tendons to investigate the effects of SP on tendons. RESULTS Low and high doses SP significantly enhanced the proliferation ability of TDSCs. Low-dose of SP induced the expression of tenocyte-related genes; however, high-dose of SP induced the expression of non-tenocyte genes, which was evident by the high expression of PPARγ and collagen type II. In the in vivo study, only high-doses of SP (5.0 nmol) induced the tendinosis-like changes in the patella tendon injection model. Low doses of SP (0.5 nmol) enhanced the tenogenesis compared with saline injection and the high-dose SP group. CONCLUSIONS SP enhances the proliferation of TDSCs in vitro and the effects of SP on tendinopathy are dose-dependent in vivo.
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Affiliation(s)
- Y Zhou
- Kanglai Tang, Department of Orthopedic Surgery, Third Military Medical University Affiliated Southwest Hospital, Gaotanyan Str. 30, Chongqing 400038, People's Republic of China, Telephone number: 86-23-68765289; Fax number: 86-23-65656500. E-mail:
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Fearon AM, Ganderton C, Scarvell JM, Smith PN, Neeman T, Nash C, Cook JL. Development and validation of a VISA tendinopathy questionnaire for greater trochanteric pain syndrome, the VISA-G. ACTA ACUST UNITED AC 2015; 20:805-13. [PMID: 25870117 DOI: 10.1016/j.math.2015.03.009] [Citation(s) in RCA: 49] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2014] [Revised: 03/13/2015] [Accepted: 03/17/2015] [Indexed: 12/25/2022]
Abstract
BACKGROUND Greater trochanteric pain syndrome (GTPS) is common, resulting in significant pain and disability. There is no condition specific outcome score to evaluate the degree of severity of disability associated with GTPS in patients with this condition. OBJECTIVE To develop a reliable and valid outcome measurement capable of evaluating the severity of disability associated with GTPS. METHODS A phenomenological framework using in-depth semi structured interviews of patients and medical experts, and focus groups of physiotherapists was used in the item generation. Item and format clarification was undertaken via piloting. Multivariate analysis provided the basis for item reduction. The resultant VISA-G was tested for reliability with the inter class co-efficient (ICC), internal consistency (Cronbach's Alpha), and construct validity (correlation co-efficient) on 52 naïve participants with GTPS and 31 asymptomatic participants. RESULTS The resultant outcome measurement tool is consistent in style with existing tendinopathy outcome measurement tools, namely the suite of VISA scores. The VISA-G was found to be have a test-retest reliability of ICC2,1 (95% CI) of 0.827 (0.638-0.923). Internal consistency was high with a Cronbach's Alpha of 0.809. Construct validity was demonstrated: the VISA-G measures different constructs than tools previously used in assessing GTPS, the Harris Hip Score and the Oswestry Disability Index (Spearman Rho:0.020 and 0.0205 respectively). The VISA-G did not demonstrate any floor or ceiling effect in symptomatic participants. CONCLUSION The VISA-G is a reliable and valid score for measuring the severity of disability associated GTPS.
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Affiliation(s)
- A M Fearon
- ANU Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia; Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia.
| | - C Ganderton
- School of Physiotherapy, Faculty of Health Science, La Trobe University, Melbourne, Australia
| | - J M Scarvell
- Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia; Discipline of Physiotherapy, Faculty of Health, University of Canberra, Canberra, Australia
| | - P N Smith
- ANU Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia; Trauma and Orthopaedic Research Unit, the Canberra Hospital, Canberra, Australia
| | - T Neeman
- ANU Medical School, College of Medicine, Biology and Environment, Australian National University, Canberra, Australia
| | - C Nash
- Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Australia
| | - J L Cook
- Department of Physiotherapy, School of Primary Health Care, Monash University, Melbourne, Australia
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Bessette MC, Olsen JR, Mann TR, Giordano BD. Intra-articular hip injections for lateral hip pain. J Hip Preserv Surg 2014; 1:71-6. [PMID: 27011805 PMCID: PMC4765286 DOI: 10.1093/jhps/hnu012] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2014] [Revised: 08/07/2014] [Accepted: 08/20/2014] [Indexed: 11/12/2022] Open
Abstract
Occult intra-articular hip pathology is commonly found in patients with greater trochanteric pain syndrome, and may be a possible pain generator in patients with recalcitrant lateral hip pain. We investigated the effect of intra-articular hip injections in patients with recalcitrant lateral hip pain. Between September 2012 and May 2013, patients over the age of 18 with a history lateral hip pain who had received prior treatment with non-steroidal anti-inflammatory medications, physical therapy and peritrochanteric corticostroid injections were enrolled. Treatment consisted of an ultrasound guided intra-articular corticosteroid injection followed by a course of directed physical therapy and a non-steroidal anti-inflammatory medication. Patients performed GaitRite analysis at baseline and 12 weeks following the injection. In addition, the Modified Harris Hip Score (mHHS), Non-Arthritic Hip Score (NAHS), Hip Outcome Scores (HOS), Short Form 36 (SF-36) and a visual analogue pain score (VAS) were collected at baseline, 1, 6 and 12 weeks.A total of 16 patients were studied. Patients experienced significant improvements from their baseline mHHS at 1 and 12 weeks (P = 0.03, P = 0.04). The minimal clinically important difference (MCID) was exceeded at multiple timepoints on various clinical outcome surveys. Velocity and stride length were not significantly improved at 12 weeks. Intra-articular hip injections may decrease pain and improve function in patients with recalcitrant lateral hip pain, and occult intra-articular hip pathology should be considered in the etiology of lateral hip pain. Though low enrollment numbers left this study underpowered, MCID comparisons demonstrated potential benefit from this treatment.
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Affiliation(s)
- Matthew C Bessette
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Joshua R Olsen
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Tobias R Mann
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
| | - Brian D Giordano
- Department of Orthopaedics and Rehabilitation, University of Rochester Medical Center, 601 Elmwood Ave, Box 665, Rochester, NY 14642, USA
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Mousavizadeh R, Backman L, McCormack RG, Scott A. Dexamethasone decreases substance P expression in human tendon cells: an in vitro study. Rheumatology (Oxford) 2014; 54:318-23. [PMID: 25150176 DOI: 10.1093/rheumatology/keu315] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVE Glucocorticoid injections are used by rheumatologists to treat chronic tendinopathy. Surprisingly, the mechanisms by which corticosteroids induce pain relief in this condition have not been investigated. Previous studies have shown local substance P (SP) levels to be correlated with tendon pain and tissue pathology. The objective of this study was to determine whether SP production in human tenocytes is modulated by exposure to dexamethasone. METHODS Human tendon fibroblasts were cultured in the presence or absence of dexamethasone (1-400 nM), an inhibitor of the glucocorticoid receptor, RU486, recombinant TGF-β (2.5 or 5.0 ng/ml) or an inhibitor of the TGF-β receptor (A83.01), recombinant human IL-1β and IL-6. Expression levels of the genes encoding for SP (TAC1) and its preferred receptor (NK1R), IL-1α, IL-1β and IL-6 were determined with quantitative PCR and protein levels of SP were examined by EIA and western blot. RESULTS Exposure of human tendon cells to dexamethasone resulted in a time-dependent reduction of mRNA for SP in both hamstrings and Achilles tenocytes, whereas NK1R was unaffected. The reduction of SP mRNA was dependent on signalling through the glucocorticoid receptor. SP protein was substantially decreased by dexamethasone. Dexamethasone also prevented induction of SP by IL-1β and by cyclic mechanical loading. CONCLUSION This study demonstrates that dexamethasone treatment of human tendon fibroblasts reduces the expression of SP through a glucocorticoid receptor-dependent pathway. Drugs interfering with SP signalling could be a future target in the treatment of tendinopathy.
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Affiliation(s)
- Rouhollah Mousavizadeh
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Umeå University, Institute for Integrative Medical Biology, Section for Anatomy, Umeå, Sweden, Department of Orthopedic Surgery and Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Ludvig Backman
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Umeå University, Institute for Integrative Medical Biology, Section for Anatomy, Umeå, Sweden, Department of Orthopedic Surgery and Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Robert G McCormack
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Umeå University, Institute for Integrative Medical Biology, Section for Anatomy, Umeå, Sweden, Department of Orthopedic Surgery and Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada
| | - Alex Scott
- Department of Medicine, University of British Columbia, Vancouver, BC, Canada, Umeå University, Institute for Integrative Medical Biology, Section for Anatomy, Umeå, Sweden, Department of Orthopedic Surgery and Vancouver Coastal Health Research Institute, University of British Columbia, Vancouver, BC, Canada.
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