The use of medical infrared thermography in the detection of tendinopathy: a systematic review

Background: Tendinopathy is a common sports-related injury. A variety of assessment tools are available but none are diagnostic. We aimed to evaluate the utility of Medical Infrared Thermography (MIT) as a tendinopathy detection tool.

Objectives: To guide clinical assessment paradigms by reviewing and critically evaluating the application of MIT for detecting and staging tendinopathy.

Methods: PubMed, Web of Science, OVID and Cochrane Library were searched for papers evaluating the use of MIT for tendinopathy detection, published in English from inception to March 2015. Reference lists and citing articles were also searched. Six of 748 studies fulfilled the inclusion criteria and were quality assessed.

Results: There is strong evidence for the role of MIT in the detection of chronic lateral elbow epicondylalgia and limited for patellar tendinopathy, with statistically significant side to side temperature differences when comparing injured to non-injured limbs, characterised by the presence of ‘hot spots’ over a clinically diagnosed tendinopathy. However, MIT of rotator cuff tendinopathy shows no significant difference between injured and non-injured. No work was found on Achilles tendinopathy, plantar fasciitis, gluteal or wrist tendinopathy.

Conclusion: The available evidence suggests a role for MIT in the detection of lateral epicondylitis and patellar tendinopathy, however the utility for grading pathology or staging recovery have not been studied in sufficient detail to clarify the relationship between thermographic measurement and severity. There was inconclusive evidence to support the role of MIT in the detection of rotator cuff and various other tendinopathies, and this research is therefore warranted.     

Manual therapy and exercise for impingementrelated shoulder pain

Abstract

Background: Shoulder complaints are among the commonest causes of musculoskeletal pain. They are potentially disabling and frequently cause absenteeism from work and claims for sickness benefits. One of the most prevalent subtypes of shoulder pain is impingement. This is often managed physiotherapeutically, with 'hands-on' manual therapy and exercises being mainstays.

Objectives: To assess the effectiveness of manual therapy and exercises to improve pain, disability and function in people with shoulder impingement.

Methods: A systematic review was conducted including systematic reviews, quasi-randomized trials and randomized controlled trials published up to October 2008. Searches included the Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Medline, Embase, Cinahl and PEDro. Methodological quality and risk of bias were assessed with appropriate instruments. All findings were critically analysed and discussed, and summary conclusions formulated.

Results: Eight systematic reviews and six randomized controlled trials were included. Methodological quality and risk of bias as well as population and treatment parameters varied. Clinical heterogeneity prevented meta-analysis, thus all findings were synthesized narratively. The included research provides limited evidence to support the use of manual therapy and exercise interventions for shoulder impingement. This primarily relates to subacute and chronic conditions and short to medium-term effectiveness.

Conclusions: Manual therapy and exercise seem effective for shoulder impingement, but varying methodological quality and risk of bias in reviews and trials warrant caution in the interpretation of the results. There is a need for further good-quality primary research.     

Subacromial impingement syndrome: a musculoskeletal condition or a clinical illusion?

Abstract

Background: Subacromial impingement syndrome is considered by many to be the most common of the musculoskeletal conditions affecting the shoulder. It is based on a hypothesis that acromial irritation leads to external abrasion of the bursa and rotator cuff.

Objectives: The aim of this paper is to review the evidence for the acromial irritation theory and in doing so challenge the rationale for subacromial decompression.

Major findings: There is a body of evidence that suggests there is a lack of concordance regarding (i) the area of tendon pathology and acromial irritation, (ii) the shape of the acromion and symptoms, (iii) the proposal that irritation leads to the development of tendinitis and bursitis, and (iv) imaging changes and symptoms and the development of the condition. In addition, there is no certainty that the benefit derived from the surgery is due to the removal of the acromion as research suggests that a bursectomy in isolation may confer equivalent benefit. It is also possible that the benefit of surgery is due to placebo or simply enforces a sustained period of relative rest which may allow the involved tissues to achieve relative homeostasis. It is possible that pathology originates in the tendon and as such surgery does not address the primary pathoaetiology. This view is strengthened by the findings of studies that have demonstrated no increased clinical benefit from surgery when compared with exercise. Additionally, exercise therapy is associated with a substantially reduced economic burden and less sick leave.

Conclusion: As there is little evidence for an acromial impingement model, a more appropriate name may be ‘subacromial pain syndrome’. Moreover, surgery should only be considered after an appropriate period of appropriately structured rehabilitation.     

Inertial Flywheel Resistance Training in Tendinopathy Rehabilitation: A Scoping Review

BackgroundInertial Flywheel Resistance Training (IFRT) has recently emerged as a beneficial rehabilitation option for some musculoskeletal disorders. Although the use of resistance training as treatment for tendinopathy has become widespread, it is unclear if IFRT has efficacy as a treatment option for tendinopathies.ObjectiveTo identify current evidence on IFRT in the treatment of tendinopathy, evaluating intervention parameters and outcomes.MethodsThis scoping review was reported in accordance with the PRISMA Extension for Scoping Reviews (PRISMA-ScR). Databases searched included MEDLINE, CINAHL, AMED, EMBase, SPORTDiscus, Cochrane library (Controlled trials, Systematic reviews), and five trial registries. Two independent reviewers screened studies at title, abstract and full text. Following screening, data were extracted and charted, and presented as figures and tables alongside a narrative synthesis. Any study design conducted on adults, investigating the effects of IFRT for tendinopathy were included. Data were extracted on intervention parameters and outcomes of IFRT interventions.ResultsFour studies on patellar tendinopathy were included. A variety of outcomes were assessed, including pain, function, strength, power, and tendon morphological and mechanical properties, particularly changes in tendon thickness. IFRT intervention parameters were largely homogenously prescribed, with slight variances.ConclusionDespite a paucity of studies to date on the effects of IFRT for treating tendinopathy, preliminary evidence for beneficial effects of IFRT on clinical outcomes in patellar tendinopathy is encouraging. As IFRT is a relatively new and unexplored method in tendinopathy rehabilitation, definitive conclusions, and recommendations cannot be made at present, which should be addressed in future research, due to the potential therapeutic benefits highlighted in this review.     

Calcific tendinopathy of the rotator cuff. Conservative management with 434 Mhz local microwave diathermy (hyperthermia): A case study

Purpose. To report the effects of local microwave diathermy (hyperthermia) at 434 Mhz on calcific tendinopathy of the shoulder in two middle aged patients.

Methods. Two middle-aged women with calcific tendinopathy of the shoulder were treated with local microwave diathermy (hyperthermia) at 434 Mhz three times a week for four weeks. Plain radiographs and ultrasonography demonstrated calcific deposits in the area of infraspinatus or supraspinatus. Shoulder Pain and Disability Index (SPADI) and passive Range of Motion (ROM) were used to assess the response to treatment.

Results. At the end of the treatment period, the improvement as measured by the SPADI score was respectively 30% for the first patient and 40% for the second patient with an improvement of the shoulder passive ROM for both patients. The calcific deposits seen on the initial radiographs and ultrasonography were no longer visible. At 1 year follow-up, both patients continued to be symptom free.

Conclusions. Hyperthermia is a safe option in the management of calcific tendinopathy of the shoulder. Prospective randomized controlled studies with long term assessment are needed to further document its therapeutic efficacy.     

Effects of high- and low-energy radial shock waves therapy combined with physiotherapy in the treatment of rotator cuff tendinopathy: a retrospective study

Purpose: The aim of this study was to investigate the efficacy of high- and low-energy radial shock waves combined with physiotherapy for rotator cuff tendinopathy patients.

Methods: Data from rotator cuff tendinopathy patients received high- or low-energy radial shock waves combined with physiotherapy or physiotherapy alone were collected. The Constant and Murley score and visual analog scale score were collected to assess the effectiveness of treatment in three groups at 4, 8, 12, and 24?weeks.

Results: In total, 94 patients were involved for our retrospective study. All groups showed remarkable improvement in the visual analog scale and Constant and Murley score compared to baseline at 24?weeks. The high-energy radial shock waves group had more marked improvement in the Constant and Murley score compared to the physiotherapy group at 4 and 8?weeks and at 4?weeks when compared with low-energy group. Furthermore, high-energy radial shock waves group had superior results on the visual analog scale at 4, 8, and 12?weeks compared to low-energy and physiotherapy groups.

Conclusions: This retrospective study supported the usage of high-energy radial shock waves as a supplementary therapy over physiotherapy alone for rotator cuff tendinopathy by relieving the symptoms rapidly and maintaining symptoms at a satisfactory level for 24?weeks.

• Implications for Rehabilitation

• High-energy radial shock waves can be a supplemental therapy to physiotherapy for rotator cuff tendinopathy.

• We recommend the usage of high-energy radial shock waves during the first 5 weeks, at an interval of 7 days, of physiotherapy treatment.

• High-energy radial shock waves treatment combined with physiotherapy can benefit rotator cuff tendinopathy by relieving symptoms rapidly and maintain these improvements at a satisfactory level for quite a long time.

     

Limited scientific evidence supports the use of conservative treatment interventions for pain and function in patients with subacromial impingement syndrome: randomized control trials

Abstract

Background: Different conservative treatment interventions are often used to decrease pain and improve function in patients with subacromial impingement syndrome (SAIS). However, the current evidence to support the use of these interventions has not been established.

Objectives: To determine the evidence for conservative treatment interventions regarding pain and function compared to any intervention for SAIS patients.

Methods: A systematic review of randomized controlled trials, published in English between 1 January 1999 and 31 May 2010, was performed using PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Cochrane Library and manual searching. The methodological quality (PEDro scale) and evidence grade (SBU) were rated. Eight studies were of high quality, four were medium quality, and eight were low quality. Various conservative treatment interventions were evaluated: acupuncture, electrotherapy modalities, exercises, mixed modalities, changing posture, and use of a functional brace.

Results: Limited scientific evidence (LSE) indicates positive effects of exercise and mixed modalities regarding pain and function and high-intensity laser therapy (HILT) regarding pain in SAIS patients. LSE also indicate no effect of electrotherapy modalities, apart from HILT, as treatment for SAIS.

Conclusions: The lack of high quality interventions limits the ability to draw conclusions regarding efficacy from several of the included studies. However, exercise may be as efficient as surgery, manual therapy in combination with exercise seems to be more effective than exercise alone and high-dose exercises seem to be more effective than low-dose exercises. Furthermore, there is contradictory evidence to support the use of acupuncture.     

Quadriceps tendinopathy — a forgotten pathology for physiotherapists? A systematic review of the current evidence-base

Abstract

Background: The evidence-base surrounding the pathophysiology and management of specific tendinopathies has evolved over the past 20 years. Recent research examining lower limb tendinopathies has focussed primarily on Achilles and patellar tendon injuries. However, on further examination of the different types of patella/knee tendinopathies, confusion has arisen surrounding the diagnosis and management of patellar compared to quadriceps tendinopathy.

Objectives: The purpose of this paper was to critically examine the evidence-base surrounding the diagnosis and management of quadriceps tendinopathy.

Methods: A systematic literature search of published and unpublished literature databases was conducted to identify literature pertaining to quadriceps tendinopathy. Data from each paper were extracted to examine four key areas related to quadriceps tendinopathy: nomenclature, prevalence, assessment, and management.

Results: Twelve studies satisfied the eligibility criteria and were included in the review. On analysis, little literature has been published solely informing clinicians on the pathology, diagnosis, or management of quadriceps tendinopathy. The terms patellar tendinopathy and jumper’s knee have been incorrectly used interchangeably with quadriceps tendinopathy. Activities such as repetitive squatting and prolonged knee flexion have been associated with the development of this tendinopathy. Sports such as football and volleyball have been cited as causative factors. Quadriceps tendinopathy’s principal diagnostic feature is pain on palpation of the quadriceps/patella interface, and resisted knee extension with the knee hyperflexed. There are no clear recommendations on how to specifically treat quadriceps tendinopathy.

Conclusion: Quadriceps tendinopathy is less commn than patellar tendinopathy. Possibly as a result of this, little is known about how to assess and manage this particular knee tendinopathy. Further research is required to determine the optimal management strategy for patients diagnosed with quadriceps tendinopathy, acknowledging the biomechanical and anatomical difference of the quadriceps compared to the patellar tendon.     

Immediate effects of kinesiotaping on acromiohumeral distance and shoulder proprioception in individuals with symptomatic rotator cuff tendinopathy

BackgroundKinesiotaping is widely used for the rehabilitation of rotator cuff tendinopathy. It has been argued to reduce symptoms and functional limitations through improvement of proprioceptive feedback. In addition, kinesiotaping has been reported to increase the subacromial space in healthy subjects. However, its effects on the acromiohumeral distance and shoulder proprioception of individuals with rotator cuff tendinopathy have not been ascertained. This study investigated the immediate effects of kinesiotaping on the acromiohumeral distance and shoulder proprioception in individuals with rotator cuff tendinopathy.MethodsTwenty-two individuals with chronic rotator cuff tendinopathy were included. The acromiohumeral distance was measured using an ultrasound scanner at rest and 60° shoulder abduction. Proprioception was measured through active joint repositioning in low- (45°–65°) and mid-amplitude (80°–100°) of shoulder flexion and abduction. A wireless inertial measurement unit system was used to quantify shoulder angles. First, measurements were taken without kinesiotaping. Thereafter, kinesiotaping was applied on the symptomatic shoulder, and the same measurements were retaken. Repeated measures ANOVAs were used for statistical analyses.FindingsKinesiotaping induced a significant increase in acromiohumeral distance at 60° abduction (∆AHD = 0.94 mm; 95%CI: 0.50–1.38, p < 0.001), exceeding the minimal detectable change (0.70 mm). No significant difference was observed in acromiohumeral distance at rest or in proprioception during active joint repositioning in both low- and mid-amplitude (p > 0.05).InterpretationKinesiotaping led to an immediate increase in acromiohumeral distance at 60° of abduction that, although it seems a minor change (↑10.5%), it may be significant for symptomatic patients, whereas it had no immediate effect on active joint repositioning.     

The management of shoulder impingement and related disorders: A systematic review on diagnostic accuracy of physical tests and manual therapy efficacy

BackgroundDiagnostic accuracy of physical tests and effectiveness of musculoskeletal rehabilitation of shoulder disorders are still debated.ObjectivesTo investigate diagnostic accuracy of physical tests, efficacy of physiotherapy and coherence between target of assessment and intervention for shoulder impingement and related disorders like bursitis, rotator cuff and long head biceps tendinopathy and labral lesions.MethodsA systematic search of four databases was conducted, including RCTs and cross-sectional studies. Cochrane Risk of Bias and QUADAS-2 were adopted for critical appraisal and a narrative synthesis was undertaken.Results6 RCTs and 2 cross-sectional studies were appraised. Studies presented low to moderate risk of bias. There is a lack of evidence to support the mechanical construct guiding the choice of physical tests for diagnosis of impingement. Manual techniques appear to yield better results than placebo and ultrasounds, but not better than exercise therapy alone. Discrepancy between the goal of assessment strategies and the relative proposed treatments were present together with high heterogeneity in terms of selection of patients, type of endpoints and follow-ups.ConclusionsMusculoskeletal physiotherapy seems to be an effective treatment for patients with shoulder pain although it is still based on weak diagnostic clinical instruments. The adoption of more functional and prognostic assessment strategies is advisable to improve coherence between evaluation and treatment.     

Use of Mobilization with Movement in the Treatment of a Patient with Subacromial Impingement: A Case Report

Abstract

Mobilization with movement (MWM) is a fairly new therapeutic technique commonly used by physical therapists. The purpose of this case report was to describe the use of MWM in the treatment of a 27-year old left-hand dominant male patient referred to physical therapy with a diagnosis of supraspinatus tendinopathy secondary to impingement. Interventions consisted of MWM and other manual therapy techniques, modalities, and therapeutic exercises. Outcome measures used included goniometric active range of motion (AROM) measurements and manual muscle tests of the shoulder, impingement tests, and the Shoulder Pain and Disability Index (SPADI) and Short Form-36 (SF-36) questionnaires. Specific outcome measures used to describe the response to MWM of the glenohumeral joint included the Numeric Pain Rating Scale (NPRS) and goniometric measurement of abduction AROM. After the first MWM treatment (session 2/12), the 6/10 pre-application NPRS score during shoulder abduction was reduced to 3/10 post-application; however, abduction AROM did not improve (95°). At the final MWM treatment (session 6/12), the pre-application NPRS score during abduction was reduced from 3/10 to 0/10 post-application; abduction AROM increased from 130° to 175°. After 12 sessions, there was a decrease from moderate pain (7/10) to little or no pain (0-1/10) during active shoulder abduction; restricted (95°) to full shoulder abduction active range of motion (180°); and an improvement in the SPADI score from 45% to 8% with no pain or ADL activity difficulty scores >2. This case report indicates that MWM may be an effective treatment intervention for patients with subacromial impingement. Future research is needed to study the efficacy and mechanisms of this treatment technique.     

Percutaneous ultrasound-guided treatment of shoulder tendon calcifications: Clinical and radiological follow-up at 6 months

IntroductionCalcific tendinitis of the shoulder is a common condition characterized by chronic pain and/or very painful acute episodes. Different treatments are used during painful flare-up, but they are often ineffective. US-guided percutaneous needle aspiration/lavage is proving to be an effective means for eliminating these calcifications.Materials and methodsWe treated 123 consecutive patients (mean age 48 years) with calcific tendinitis of the shoulder. Fifty-five patients had persistent symptoms requiring 2 or more treatments with lavage and intrabursal steroid infiltration. Before and after treatment, US studies were done independently by 2 radiologists with experience in musculoskeletal ultrasound. Results were concordant in over 90% of the cases. Constant Shoulder Scores were calculated before and 6 months after treatment. At 6 months, MRI was performed to identify impingement and/or bursitis.ResultsPost-treatment Constant scores were significantly improved in all 68 patients treated once (Group 1: mean scores 28.6 vs. 81.4) and in 52 of the 55 treated twice or more (Group 2: mean scores 34.1 vs. 71.1) (p < 0.0001 in both cases). Pretreatment Constant scores were similar in patients with and without shoulder impingement on MRI (31.2 vs. 30.9, respectively), but after treatment the impingement group’s scores were significantly higher (82.2 vs. 73.3, respectively; p < 0.001).ConclusionsUS-guided percutaneous needle aspiration/lavage is an effective and economic treatment for calcific tendinitis of the shoulder. Pretreatment MRI should be done to check for impingement since it is often associated with an incomplete response to the first treatment.     

The Use of Biologics for Hip Preservation

Purpose of ReviewA wide array of nonoperative modalities to treat hip pain are aimed at restoring and maintaining the structural and physiologic characteristics of the joint. The purpose of this review is to describe the current understanding of biologics in hip pathology by providing an evidence-based overview of treatment modalities available for orthopedic surgeons.Recent FindingsThe use of biologics as a primary treatment or adjunct to traditional management has shown encouraging results for the treatment of hip pain. Studies have demonstrated safety with minimal complications when using platelet rich plasma, hyaluronic acid, or stem cells to treat hip pain caused by osteoarthritis, femoroacetabular impingement syndrome, tendinopathy, or osteonecrosis of the femoral head. Several studies have been able to demonstrate meaningful clinical results that can improve treatment standards for hip pain; however, more work must be performed to better delineate the appropriate protocols, indications, and limitations of each modality.SummaryRecent advances have inspired renewed interest in biologics for patients with hip pain. We present a concise review of platelet rich plasma, hyaluronic acid, stem cells, and matrix metalloprotease inhibitors and their applicability to hip preservation surgery.     

The Role of Therapeutic Exercise in the Conflicting and Unstable Shoulder

Abstract

Context: The use of therapeutic exercise and manual therapy in rehabilitation of the unstable and conflicting shoulder (UCS) is widespread. In the literature, there are several electromyographical studies that have analysed the effect of specific physical exercises and clinical trials on the effectiveness of specific rehabilitative protocols. However, it has not been established yet what is the best intervention for these disorders.

Objective: In order to establish general recommendations for the treatment of UCS, we have reviewed the results of some electromyographical studies to identify the best exercises to recruit specifically the shoulder girdle muscles and some clinical trials that have proposed the utilisation of therapeutic exercise and manual therapy for UCS.

Methods: Review of the literature of the last 10 years. We have searched Pedro, Medline and the Cochrane Library for randomised clinical trials, systematic reviews and electromyographical studies on rehabilitative protocols based on therapeutic exercise and manual therapy.

Outcomes: It is common practice for clinicians to consider the involvement of patients with shoulder instability or impingement in a programme of exercises, before proceeding to a surgical intervention. Our analysis of the literature provides evidence of the efficacy of manual therapy associated with therapeutic exercises for decrease in pain, recovery of patient's strength and restoration of abilities.

Conclusions: While the analysed studies are inconclusive, on the basis of the available data, we suggest some general rehabilitative principles for the treatment of the unstable and conflicting shoulder.     

Use of thoracic spine manipulation in the treatment of adhesive capsulitis: a case report

Abstract

Adhesive capsulitis (AC) is a common and disabling shoulder condition seen in physical therapy, and there is no clear consensus as to the best treatment approach. Recently there has been emerging evidence that manual therapy directed at the thoracic spine may be beneficial for patients with shoulder pain; however, this has not been examined specifically in patients with AC. The purpose of this paper is to present the case of 59-year-old female referred to physical therapy with a diagnosis of AC. The patient presented with complaints of left shoulder pain and significant limitations in range of motion (ROM) and upper extremity function. The initial treatment included exercises and manual therapy directed at the glenohumeral and scapulothoracic joints, and after 10 visits only minimal progress had been made. Further examination revealed mobility and ROM deficits in the thoracic spine, and manual therapy directed at this region was incorporated into her treatment. After the first session of thoracic spine manual therapy (TSMT) a 25 degree improvement was noted in active shoulder flexion. After four total visits of TSMT substantial improvements in pain, ROM, and function were noted compared to those made during the first 10 visits. This case adds to the emerging evidence that manual therapy directed at the thoracic spine should be considered for patients with shoulder pain.     

Intertester reliability of shoulder complaints diagnoses in primary health care

Objective: Shoulder complaints are frequently encountered in general practice, but precise diagnosing is challenging. This study investigated agreement of shoulder complaints diagnoses between clinicians in a primary health care setting.

Design: Cross-sectional study.

Setting: Four primary health care clinicians used patients’ history and functional examination of the shoulder by selective tissue tension techniques (STTs), to diagnose shoulder complaints.

Subjects: 62 patients, aged 18–75 years.

Main outcome measure: Reliability of diagnoses was assessed by observed intertester agreement and Cohen’s kappa. A total of 372 diagnostic pairs were available for intertester comparisons.

Results: Six diagnoses were assigned by all clinicians; supraspinatus-, infraspinatus-, subscapularis-tendinopathies; chronic subacromial bursitis; glenohumeral capsulitis, and acromioclavicular joint lesion. The observed agreement on these diagnoses ranged from 0.84 for glenohumeral capsulitis to 0.97 for acromioclavicular joint lesion. Kappa scores were 0.46 (95% CI 0.33, 0.58) for chronic subacromial bursitis; 0.53 (95% CI 0.34, 0.68), 0.59 (95% CI 0.47, 0.70), and 0.68 (95% CI 0.53, 0.82) for infraspinatus -, supraspinatus -, and subscapularis-tendinopathy, respectively. For glenohumeral capsulitis and acromioclavicular lesion kappa scores were 0.66 (95% CI 0.57, 0.73) and 0.78 (95% CI 0.61, 0.90). Kappa scores were higher for individual diagnoses than for individual tests, except for limitation in passive abduction (0.70, 95% CI 0.62, 0.78) and passive lateral rotation (0.66, 95% CI 0.57, 0.73).

Conclusions: Although experienced clinicians showed substantial intertester agreement, precise diagnoses of shoulder complaints in primary health care remain a challenge. The present results call for further research on refined diagnoses of shoulder complaints.

• Key points

• Based on medical history and a systematic functional examination by selective tissue tension techniques (STTs), we investigated the agreement of shoulder complaints diagnoses across four primary health care clinicians and 62 patients.

• ??Agreements on diagnoses were generally better than the agreement on individual tests.

• ??Good kappa scores were obtained for the diagnoses glenohumeral capsulitis, rotator cuff tendinopathy, and acromioclavicular lesion.

• ??Further research is necessary to investigate the diagnostic validity of functional shoulder examination by the STTs method.

     

Validity and reliability of the French translation of the VISA-A questionnaire for Achilles tendinopathy

Purpose: The Victorian Institute of Sport Assessment – Achilles tendinopathy questionnaire (VISA-A) evaluates the clinical severity of Achilles tendinopathy. The aim of this study was to translate the VISA-A into French and to study the reliability and validity of this French version, the VISA-AF.

Method: The VISA-A was translated into French to produce the VISA-AF using a validated methodology in six steps. Thereafter, several psychometric properties of this French version such as test–retest reliability, internal consistency, construct validity and floor and ceiling effects were evaluated. Therefore, we recruited 116 subjects, distributed into 3 groups: pathological patients (n?=?31), at-risk athletes (n?=?63) and healthy people (n?=?22).

Results: The final version of the VISA-AF was approved by an expert committee. On a scale ranging from 0 to 100, the average scores of the VISA-AF obtained were 59 (±?18) for the pathological group, 99 (±?1) for the healthy group and 94 (±?7) for the at-risk group. The VISA-AF shows excellent reliability, low correlations with the discriminant subscales of the SF-36 and moderate correlations with the convergent subscales of the SF-36.

Conclusions: The French version of the VISA-A is equivalent to its original version and is a reliable and valid questionnaire for French-speaking patients with Achilles tendinopathy.

• Implication for Rehabilitation

• The VISA-AF questionnaire is a reliable translation of the original VISA-A, from English into French, which is one of the most widespread languages in the world.

• The VISA-AF questionnaire is now a valid instrument that can be used by clinicians and researchers to assess the severity of pain and disability of French-speaking subjects with Achilles tendinopathy.

• The VISA-AF is a questionnaire to assess the severity of Achilles tendinopathy symptoms but is not a diagnostic tool.

     

Current concepts in the conservative management of the frozen shoulder

Abstract

Background: Frozen shoulder syndrome remains largely of unknown etiology and selecting the best evidence-based practice remains a challenge for physiotherapists.

Objectives: The objective for this review was to explore existing studies from January 2000 to September 2009 in order to highlight optimal physiotherapy interventions for the treatment of frozen shoulder syndrome. A search of five databases was performed using the relevant search terms frozen shoulder, adhesive capsulitis, physiotherapy, physical therapy and rehabilitation.

Major findings: Five papers were selected for review and variations in quality scores were observed. Results showed that mobilization techniques, both with and without exercise, were effective in improving shoulder range of movement and functional ability. High-grade, end-range mobilizations and mobilizations with movement had the best outcomes. Supervised neglect was shown to be favourable over intense physiotherapy in achieving near pain free function at 24 months. Finally, deep heating with stretching was superior to superficial heating with stretching and to stretching alone, in terms of shoulder range of movement and function.

Conclusions: Although results provide support for a range of treatment strategies, the methodological quality is variable and firm conclusions are difficult to establish. Until an increase in high-quality studies with similar interventions and outcome measures exist, comparisons are not possible and identifying the best evidence-based practice will remain problematic within the musculoskeletal physiotherapy field.     

The efficacy of sclerosing injections in the treatment of painful tendinopathy

Abstract

Background: Based on the assumption that neovascularization is a cause of tendon pain, sclerosing injections have increasingly been used to treat chronic tendon conditions. A number of clinical studies have investigated the efficacy of this intervention.

Objective: The aim of this study was to review the literature relating to the use of sclerosing injections for the management of painful tendinopathy.

Method: Medline, CINAHL, PEDro, Cochrane Database, PubMed, EMBASE, AMED, Scopus, and Web of Science were searched. Of 4632 abstracts identified, 24 were retained for further analysis. Each abstract was assessed by three reviewers; nine studies (four randomized controlled trials, four pilot studies, and one comparative study) met our inclusion criteria. Quality was assessed using the Downs and Black Scale.

Results: Two outcome measures were utilized: visual analogue score (VAS) for pain and estimated assessment of neovascularization. Seven trials reported some improvement in pain. Results from the three highest quality trials were inconclusive. Five trials reported a change in neovascularization pre- and post-intervention. One trial additionally used the Victoria Institute of Sports Assessment (VISA) to record pain outcomes.

Conclusions: The clinical significance of neovascularization as a cause of pain is contentious. Currently, there is insufficient robust evidence to support the use of sclerosing injections in the treatment of painful tendinopathy with concomitant neovascularity. Further clinical, imaging and laboratory studies investigating the relationship between neovascularity, tendon pain and its management are required.