Prevalence of Malingering in Patients With Chronic Pain Referred for Psychologic Evaluation in a Medico-Legal Context

Greve KW, Ord JS, Bianchini KJ, Curtis KL. Prevalence of malingering in patients with chronic pain referred for psychologic evaluation in a medico-legal context.

Objective

To provide an empirical estimate of the prevalence of malingered disability in patients with chronic pain who have financial incentive to appear disabled.

Design

Retrospective review of cases.

Setting

A private neuropsychologic clinic in a southeastern metropolitan area.

Participants

Consecutive patients (N=508) referred for psychologic evaluation related to chronic pain over a 10-year period (1995-2005).

Interventions

Not applicable.

Main Outcome Measures

Prevalence of malingering was examined using 2 published clinical diagnostic systems (Malingered Pain-Related Disability and Malingered Neurocognitive Dysfunction) as well as statistical estimates based on well validated indicators of malingering.

Results

The prevalence of malingering in patients with chronic pain with financial incentive is between 20% and 50% depending on the diagnostic system used and the statistical model's underlying assumptions. Some factors associated with the medico-legal context such as the jurisdiction of a workers' compensation claim or attorney representation were associated with slightly higher malingering rates.

Conclusions

Malingering is present in a sizable minority of patients with pain seen for potentially compensable injuries. However, not all excess pain-related disability is a result of malingering. It is important not to diagnose malingering reflexively on the basis of limited or unreliable findings. A diagnosis of malingering should be explicitly based on a formal diagnostic system.     

A Randomized Controlled Trial Comparing Manipulation With Mobilization for Recent Onset Neck Pain

Leaver AM, Maher CG, Herbert RD, Latimer J, McAuley JH, Jull G, Refshauge KM. A randomized controlled trial comparing manipulation with mobilization for recent onset neck pain.

Objective

To determine whether neck manipulation is more effective for neck pain than mobilization.

Design

Randomized controlled trial with blind assessment of outcome.

Setting

Primary care physiotherapy, chiropractic, and osteopathy clinics in Sydney, Australia.

Participants

Patients (N=182) with nonspecific neck pain less than 3 months in duration and deemed suitable for treatment with manipulation by the treating practitioner.

Interventions

Participants were randomly assigned to receive treatment with neck manipulation (n=91) or mobilization (n=91). Patients in both groups received 4 treatments over 2 weeks.

Main Outcome Measure

The number of days taken to recover from the episode of neck pain.

Results

The median number of days to recovery of pain was 47 in the manipulation group and 43 in the mobilization group. Participants treated with neck manipulation did not experience more rapid recovery than those treated with neck mobilization (hazard ratio=.98; 95% confidence interval, .66-1.46).

Conclusions

Neck manipulation is not appreciably more effective than mobilization. The use of neck manipulation therefore cannot be justified on the basis of superior effectiveness.     

Validity of the Fingertip-To-Floor Test and Straight Leg Raising Test in Patients With Acute and Subacute Low Back Pain: A Comparison by Sex and Radicular Pain

Ekedahl KH, Jönsson B, Frobell RB. Validity of the fingertip-to-floor test and straight leg raising test in patients with acute and subacute low back pain: a comparison by sex and radicular pain.

Objective

To use self-reported disability (Roland-Morris Disability Questionnaire [RMDQ]) to assess the criterion validity of straight leg raising (SLR) test and flexion range of motion (ROM) (fingertip-to-floor test) before and after stratification by sex and presence/absence of radicular pain.

Design

Cross-sectional study.

Setting

Outpatient physical therapy clinic.

Participants

Subjects with acute/subacute low back pain with (n=40) and without (n=35) radicular pain.

Interventions

Not applicable.

Main Outcome Measures

We examined the relationship between RMDQ (reference variable) and SLR test and fingertip-to-floor test. The sample was stratified by presence/absence of radicular pain (categorized by the dichotomous slump test).

Results

In the entire sample, fair correlations were found between both physical impairment tests (ie, SLR test and flexion ROM) and self-reported disability (.27<r>.44). After stratification by sex, the correlation between RMDQ and flexion ROM and between RMDQ and nonside-specific SLR test increased in women but decreased in men. In those with radicular pain, good correlations were found between RMDQ and flexion ROM (r=.68 for men and r=.70 for women), and moderate correlation was found between the RMDQ and SLR tests of the affected side in women (r=.60), but only fair correlation was found between the RMDQ and SLR tests of the affected side in men (r=.28).

Conclusions

After stratification by sex and presence/absence of radicular pain, the present study supports a good validity of the fingertip-to-floor test for both men and women with radicular pain. The SLR test, however, was of less value as an indicator of self-reported disability after stratification, especially for men.     

Associates of Physical Function and Pain in Patients with Patellofemoral Pain Syndrome

Piva SR, Fitzgerald GK, Irrgang JJ, Fritz JM, Wisniewski S, McGinty GT, Childs JD, Domenech MA, Jones S, Delitto A. Associates of physical function and pain in patients with patellofemoral pain syndrome.

Objectives

To explore whether impairment of muscle strength, soft tissue length, movement control, postural and biomechanic alterations, and psychologic factors are associated with physical function and pain in patients with patellofemoral pain syndrome (PFPS).

Design

Cross-sectional study.

Setting

Rehabilitation outpatient.

Participants

Seventy-four patients diagnosed with PFPS.

Interventions

Not applicable.

Main Outcome Measures

Measurements were self-reported function and pain; strength of quadriceps, hip abduction, and hip external rotation; length of hamstrings, quadriceps, plantar flexors, iliotibial band/tensor fasciae latae complex, and lateral retinaculum; foot pronation; Q-angle; tibial torsion; visual observation of quality of movement during a lateral step-down task; anxiety; and fear-avoidance beliefs.

Results

After controlling for age and sex, anxiety and fear-avoidance beliefs about work and physical activity were associated with function, while only fear-avoidance beliefs about work and physical activity were associated with pain.

Conclusions

Psychologic factors were the only associates of function and pain in patients with PFPS. Factors related to physical impairments did not associate to function or pain. Our results should be validated in other samples of patients with PFPS. Further studies should determine the role of other psychologic factors, and how they relate to anxiety and fear-avoidance beliefs in these patients.     

Predictors for identifying patients with mechanical neck pain who are likely to achieve short-term success with manipulative interventions directed at the cervical and thoracic spine

Objective

The purpose of this study was to identify the prognostic factors for individuals with mechanical neck pain likely to experience improvements in both pain and disability after the application of an intervention including cervical and thoracic spine thrust manipulations.

Methods

Patients presenting with mechanical neck pain participated in a prospective single-arm trial. Participants underwent a standardized examination and then received a series of thrust manipulations directed toward the cervical, cervicothoracic, and thoracic spine. Participants were classified as having achieved a successful outcome at the second and third sessions based on their perceived recovery. Potential prognostic variables were entered into a stepwise logistic regression model to determine the most accurate set of variables for the prediction of treatment success.

Results

Data from 81 subjects were included in the analysis, of which 50 experienced a successful outcome (61.7%). Five variables including pain intensity greater than 4.5 points; cervical extension less than 46°; presence of hypomobility at T1; a negative upper limb tension test and female sex were identified. If 4 of 5 variables were present (likelihood ratio, +1.9), the likelihood of success increased from 61.7% to 75.4%.

Conclusions

This study identified several prognostic clinical factors that can potentially identify, a priori, patients with neck pain who are likely to experience a rapid response to the application of an intervention including both cervical and thoracic spine manipulations. However, no combination of the variables was able to dramatically increase the posttest probability.     

The clinical effectiveness of therapeutic massage for musculoskeletal pain: a systematic review

Objectives

To determine the effectiveness of therapeutic massage (TM) for the symptomatic relief of musculoskeletal pain, and to analyse TM intervention protocols used in studies.

Design

Systematic review of randomised controlled clinical trials and experimental studies on healthy human participants.

Participants

Patients with musculoskeletal pain and healthy participants with post-exercise pain and soreness.

Main outcome measures

Comparisons of TM with: (i) no treatment; (ii) sham interventions; and (iii) active (standard) treatment. Outcome was dichotomised as effective (TM > comparison group) or not effective (TM ≤ comparison group).

Results

Twenty studies (1341 participants) met the criteria for review. TM was superior to no treatment in five out of 10 comparisons, superior to sham (laser) treatment in one out of two comparisons, and superior to active treatment in seven out of 22 comparisons. TM was superior to comparison groups in six out of 11 studies using patients with musculoskeletal pain, and in three out of seven studies using patients with low back pain. TM was superior to comparison groups in four out of nine studies using healthy participants experiencing post-exercise pain and soreness. There were no relationships between study outcome and the TM regimen used.

Conclusions

The available evidence is inconclusive. A combination of inadequate sample sizes, low methodological quality and insufficient TM dosing is likely to have contributed to the confused evidence base.     

Pain in persons with postpolio syndrome: frequency, intensity, and impact

Stoelb BL, Carter GT, Abresch RT, Purekal S, McDonald CM, Jensen MP. Pain in persons with postpolio syndrome: frequency, intensity, and impact.

Objective

To describe the frequency, intensity, and impact of pain in persons with postpoliomyelitis syndrome (PPS).

Design

Retrospective, cross-sectional survey.

Setting

Community-based survey.

Participants

Convenience sample of people with PPS.

Interventions

Not applicable.

Main Outcome Measures

Overall intensity and duration of pain, pain sites, pain interference, pain treatments, and relief provided by pain treatments.

Results

A total of 91% (n=57) of the study participants (N=63) reported pain. The most frequently reported pain sites were the shoulders, lower back, legs, and hips. Participants reported pain intensity to be the greatest in the knees, legs, wrists, lower back, and head. Pain interfered most with sleep and with activities requiring a high level of musculoskeletal involvement. Respondents also reported pain problems that were more severe than those of the general population and than those of a sample of people with multiple sclerosis. Many treatments had been tried previously for pain, but continued use of treatments was reported by relatively few participants at the time of the survey.

Conclusions

The findings indicate that pain is a persistent and common problem in persons with PPS, highlighting the need for effective and accessible pain treatments for this population.     

Functional Assessment of Lower Extremities in Hereditary Spastic Paraplegia

Braschinsky M, Parts K, Maamägi H, Gross-Paju K, Haldre S. Functional assessment of lower extremities in hereditary spastic paraplegia.

Objectives

To characterize the spasticity and range of motion (ROM) in patients with hereditary spastic paraplegia (HSP) and to correlate these parameters with walking speed.

Design

An observational population-based cohort study.

Setting

Patient data were acquired from a population-based epidemiologic study performed earlier in Estonia.

Participants

Persons (N=46) (mean age, 50.1y) with clinically confirmed HSP diagnosis (mean duration, 20.9y) participated in the study.

Interventions

Active and passive ROMs were measured with a plastic 360° goniometer. Spasticity was evaluated by using the modified Ashworth scale (MAS). The time it took a patient to walk 10m was recorded.

Main Outcome Measures

Measurements included testing of active and passive ROM as a marker for mobility, the MAS for spasticity, and time to complete a 10-m walk.

Results

A higher degree of spasticity in hip muscles was associated with lower values of active ROM and slower walking. Walking speed was negatively correlated to disease duration and participant age.

Conclusions

The present study provides analysis of the contributions of spasticity and ROM to walking speed in HSP, both factors negatively influence gait in persons with HSP.     

Community Reintegration in Rehabilitated South Indian Persons With Spinal Cord Injury

Samuelkamaleshkumar S, Radhika S, Cherian B, Elango A, Winrose W, Suhany BT, Prakash MH. Community reintegration in rehabilitated South Indian persons with spinal cord injury.

Objectives

To explore community reintegration in rehabilitated South Indian persons with spinal cord injury (SCI) and to compare the level of community reintegration based on demographic variables.

Design

Survey.

Setting

Rehabilitation center of a tertiary care university teaching hospital.

Participants

Community-dwelling persons with SCI (N=104).

Interventions

Not applicable.

Main Outcome Measures

Craig Handicap Assessment and Reporting Technique (CHART).

Results

The mean scores for each CHART domain were physical independence 98±5, social Integration 96±11, cognitive independence 92±17, occupation 70±34, mobility 65±18, and economic self sufficiency 53±40. Demographic variables showed no statistically significant difference with any of the CHART domains except for age and mobility, level of education, and social integration.

Conclusions

Persons with SCI in rural South India who have completed comprehensive, mostly self-financed, rehabilitation with an emphasis on achieving functional ambulation, family support, and self-employment and who attend a regular annual follow-up show a high level of community reintegration in physical independence, social integration, and cognitive independence. CHART scores in the domains of occupation, mobility, and economic self-sufficiency showed lower levels of community reintegration.     

Prevalence and Impact of Pain in Multiple Sclerosis: Physical and Psychologic Contributors

Hirsh AT, Turner AP, Ehde DM, Haselkorn JK. Prevalence and impact of pain in multiple sclerosis: physical and psychologic contributors.

Objective

To characterize the prevalence and impact of pain in veterans with multiple sclerosis (MS) and to assess their association with demographic, biologic, and psychologic variables.

Design

Cross-sectional cohort study linking computerized medical record information to mailed survey data.

Setting

Veterans Health Administration (VHA).

Participants

Sixty-four percent (2994/4685) of veterans with MS who received services in VHA and also returned survey questionnaires.

Interventions

Not applicable.

Main Outcome Measures

Items assessing pain intensity, pain interference, and physical and mental health functioning.

Results

Ninety-two percent of participants reported bodily pain within the prior 4 weeks, with 69% of the total sample indicating pain of moderate or higher intensity. Eighty-five percent indicated that pain caused functional interference during the past 4 weeks, with 71% of the total sample reporting pain-related interference that was moderate or greater. No significant sex or race differences emerged for the pain indices. A significant but modest relationship between increasing age and pain interference emerged (r=.05, P<.01); however, age was not significantly related to pain intensity. Multivariate regression analyses identified pain intensity (β=.73), physical health functioning (β=-.07), and mental health functioning (β=-.13) variables as significant, unique contributors to the prediction of pain interference. The interaction of pain intensity and physical functioning was also significant but of minimal effect size (β=-.03).

Conclusions

Pain is highly prevalent and causes substantial interference in the lives of veterans with MS. The functional impact of pain in veterans with MS is influenced by pain intensity, physical health, and emotional functioning. Clinical practice should take each of these domains into consideration and reflect a biopsychosocial conceptualization.     

The Sport Injury Rehabilitation Adherence Scale: a reliable scale for use in clinical physiotherapy

Objective

To evaluate, through two studies, the factor structure, inter-rater agreement, and test-retest and inter-rater reliability of the Sport Injury Rehabilitation Adherence Scale (SIRAS).

Design

Repeated measures design in both Study 1 (video evaluation) and Study 2 (clinical evaluation).

Setting

University department (Study 1) and outpatient physiotherapy department (Study 2).

Participants

Sixty physiotherapists and physiotherapy students in Study 1 and 45 patients undergoing physiotherapy treatment for a musculoskeletal injury in Study 2.

Intervention

In Study 1, participants rated the adherence of a simulated videotaped patient demonstrating high, moderate and low adherence during rehabilitation. In Study 2, two physiotherapists rated the adherence of patients at two consecutive rehabilitation sessions.

Main outcome measure

The SIRAS.

Results

In Study 1, principal components analysis confirmed a single factor for the SIRAS, and inter-rater agreement values ranged from 0.87 to 0.93. In Study 2, inter-rater and test-retest reliability coefficients ranged from 0.76 [95% confidence interval (CI) 0.54 to 0.83] to 0.89 (95% CI 0.79 to 0.95), and from 0.63 (95% CI 0.36-0.82) to 0.76 (95% CI 0.55-0.88), respectively.

Conclusion

The SIRAS is a reliable measure with high inter-rater agreement when used to evaluate clinic-based adherence to physiotherapy rehabilitation for musculoskeletal injury.     

Pain Physiology Education Improves Pain Beliefs in Patients With Chronic Fatigue Syndrome Compared With Pacing and Self-Management Education: A Double-Blind Randomized Controlled Trial

Meeus M, Nijs J, Van Oosterwijck J, Van Alsenoy V, Truijen S. Pain physiology education improves pain beliefs in patients with chronic fatigue syndrome compared with pacing and self-management education: a double-blind randomized controlled trial.

Objective

To examine whether pain physiology education was capable of changing pain cognitions and pain thresholds in patients with chronic fatigue syndrome (CFS) and chronic widespread pain.

Design

Double-blind randomized controlled trial.

Setting

Specialized chronic fatigue clinic in university hospital.

Participants

A random sample of patients (N=48) with CFS patients (8 men, 40 women) experiencing chronic pain, randomly allocated to the control group (n=24) or experimental group (n=24). Two women in the experimental group did not complete the study because of practical issues (lack of time and restricted mobility).

Interventions

One individual pain physiology education session (experimental) or 1 pacing and self-management education session (control).

Main Outcome Measures

Algometry, the Neurophysiology of Pain Test, and questionnaires evaluating pain cognitions—the Pain Coping Inventory, the Pain Catastrophizing Scale, and the Tampa Scale for Kinesiophobia-version CFS—were completed immediately before and immediately after the intervention.

Results

After the intervention, the experimental group demonstrated a significantly better understanding of the neurophysiology of pain (P<.001) and a reduction of the Pain Catastrophizing Scale subscale “ruminating” (P=.009) compared with controls. For these variables, moderate to large Cohen d effect sizes were revealed (.79-2.53).

Conclusions

A 30-minute educational session on pain physiology imparts a better understanding of pain and brings about less rumination in the short term. Pain physiology education can be an important therapeutic modality in the approach of patients with CFS and chronic pain, given the clinical relevance of inappropriate pain cognitions.     

Effect of Intrathecal Baclofen Bolus Injection on Lower Extremity Joint Range of Motion During Gait in Patients With Acquired Brain Injury

Horn TS, Yablon SA, Chow JW, Lee JE, Stokic DS. Effect of intrathecal baclofen bolus injection on lower extremity joint range of motion during gait in patients with acquired brain injury.

Objectives

To evaluate lower extremity joint range of motion (ROM) during gait before and after intrathecal baclofen (ITB) bolus administration, and to explore the relation between changes in ROM and concurrent changes in gait speed and muscle hypertonia.

Design

Case series.

Setting

Tertiary care rehabilitation center.

Participants

Adults (N=28) with muscle hypertonia due to stroke, trauma, or anoxia.

Interventions

50-μg ITB bolus injection via lumbar puncture (75 and 100μg in 2 cases).

Main Outcome Measures

Ashworth score, self-selected gait speed, and sagittal plane ROMs in hip, knee, and ankle joints before and 2, 4, and 6 hours after ITB bolus.

Results

A significant decrease in the mean Ashworth score on the more involved side (2.0 to 1.3) and an increase in gait speed (41 to 47cm/s) were noted at different intervals after ITB bolus injection. Ankle ROM significantly increased on the more involved (13° to 15°, P<.01) and less involved (22° to 24°, P<.05) sides. ROM significantly improved, significantly worsened, or showed no significant change in 42%, 34%, and 24% of individual joints, respectively. The peak change in ROM did not coincide with the peak decrease in Ashworth score. Peak changes in ROM and speed coincided more often (P<.001) in participants who increased gait speed after ITB bolus compared with those who decreased speed. The absolute change in ROM after ITB bolus injection correlated better with the concurrent changes in speed (r=.41, P<.001) than with the baseline speed (r=.18, P<.05).

Conclusions

ITB bolus injection produces variable changes in joint ROM during gait, with significant improvements in the ankles only. Timing and magnitude of peak changes in ROM are associated with concurrent changes in speed but not muscle hypertonia.     

The clinical learning environment and supervision instrument (CLES): validity and reliability of the Dutch version (CLES+NL)

Background

The clinical learning environment and supervision scale (CLES) is a valid and reliable tool that was developed to assess the quality of nursing students’ clinical placements.

Objectives

To obtain a reliable and valid Dutch version of the CLES that is in line with the Flemish culture and educational context.

Design

Scale validation study on data provided by a cross-sectional survey.

Settings

190 wards in 31 institutions for healthcare in Flanders, Belgium.

Participants

768 student nurses enrolled in the 3 year bachelor programme at University College Ghent, Faculty of Healthcare Vesalius.

Methods

Face and content validation was followed by data collection. Factor analysis was performed using varimax rotation. Subsequently, internal consistency reliability was tested on the total scale and its subdimensions using Cronbach's alpha.

Results

We gathered 768 questionnaires. Factor analysis revealed 5 subdimensions with an eigenvalue greater than 1, explaining 71.281% of the variance. The overall internal consistency and the consistency of the five subdimensions is high. Our data supports face, content and construct validity of the CLES + NL.

Conclusions

The CLES + NL is a valid and reliable instrument that can be used to evaluate the quality of nursing wards as learning environments in Flanders.     

Physical Function, Gait, and Dynamic Balance of Transfemoral Amputees Using Two Mechanical Passive Prosthetic Knee Devices

Lythgo N, Marmaras B, Connor H. Physical function, gait, and dynamic balance of transfemoral amputees using two mechanical passive prosthetic knee devices.

Objective

To investigate the effect of the 3R90 and 3R92 (Otto Bock Healthcare) mechanical passive prosthetic knee devices on the physical function, gait, and dynamic balance (sudden stop and turn) of transfemoral amputees.

Design

Intervention study with crossover design.

Setting

University research center.

Participants

Men (N=5; mean age ± SD, 58.8±11.9y) with unilateral transfemoral amputation.

Intervention

Prosthetic knee joints (N=2; 3R90 and 3R92). Acclimatization ranged from 14 to 47 days (25.5±9.3d).

Main Outcome Measures

Physical function, gait, dynamic balance.

Results

The Timed Up and Go Test, 6-Minute Walk Test, and Four Square Step Test measures improved with the 3R92. Total scores on the Prosthesis Evaluation Questionnaire were similar for the 3R92 (82.0±6.3) and the participant's own or original device (83.9±4.8). These devices were rated higher than the 3R90 (65.5±16.8). Compared with the original device, gait velocity was significantly slower (5cm/s; P=.017) with the 3R92, but was unchanged for the 3R90. This difference was not considered clinically significant because the effect size was small (0.2). No other significant gait differences were found. Large temporal gait asymmetries observed with the original device remained with the 3R90 and 3R92 (step, ≈20%; single support, ≈30%; stance, ≈19%). Although no significant differences were found for the sudden-turn or sudden-stop tasks, the sudden-turn group success rates were highest with the original devices.

Conclusions

Gait and symmetry measures were unchanged. Gait speed was slower with the 3R92, but this was not considered to be clinically significant. Sudden-turn success rates generally were higher with the original devices. A crossover stepping movement was more difficult to implement than a side-stepping movement during sudden turns.     

Pulsed Electromagnetic Fields to Reduce Diabetic Neuropathic Pain and Stimulate Neuronal Repair: A Randomized Controlled Trial

Weintraub MI, Herrmann DN, Smith AG, Backonja MM, Cole SP. Pulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.

Objective

To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration.

Design

Randomized, double-blind, placebo-controlled parallel study.

Setting

Sixteen academic and clinical sites in 13 states.

Participants

Subjects (N=225) with DPN stage II or III were randomly assigned to use identical devices generating PEMF or sham (placebo) 2 h/d to feet for 3 months.

Interventions

Nerve conduction testing was performed serially.

Main Outcome Measures

Pain reduction scores using a visual analog scale (VAS), the Neuropathy Pain Scale (NPS), and the Patient's Global Impression of Change (PGIC). A subset of subjects underwent serial 3-mm punch skin biopsies from 3 standard lower limb sites for epidermal nerve fiber density (ENFD) quantification.

Results

Subjects (N=225) were randomized with a dropout rate of 13.8%. There was a trend toward reductions in DPN symptoms on the PGIC, favoring the PEMF group (44% vs 31%; P=.04). There were no significant differences between PEMF and sham groups in the NP intensity on NPS or VAS. Twenty-seven subjects completed serial biopsies. Twenty-nine percent of PEMF subjects had an increase in distal leg ENFD of at least 0.5 SDs, while none did in the sham group (P=.04). Increases in distal thigh ENFD were significantly correlated with decreases in pain scores.

Conclusions

PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.     

A comparison of neck movement in the soft cervical collar and rigid cervical brace in healthy subjects

Objective

The soft cervical collar has been prescribed for whiplash injury but has been shown to be clinically ineffective. As some authors report superior results for managing whiplash injury with a cervical brace, we were interested in comparing the mechanical effectiveness of the soft collar with a rigid cervical brace. Therefore, the purpose of this study was to measure ranges of motion in subjects without neck pain using a soft cervical collar and a rigid brace compared with no orthosis.

Methods

Fifty healthy subjects (no neck or shoulder pain) aged 22 to 67 years were recruited for this study. Neck movement was measured using a cervical range of motion goniometer. Active flexion, extension, right and left lateral flexion, and right and left rotation were assessed in each subject under 3 conditions: no collar, a soft collar, and a rigid cervical brace.

Results

The soft collar and rigid brace reduced neck movement compared with no brace or collar, but the cervical brace was more effective at reducing motion. The soft collar reduced movement on average by 17.4%; and the cervical brace, by 62.9%. The effect of the orthoses was not affected by age, although older subjects had stiffer necks.

Conclusion

Based on the data of the 50 subjects presented in this study, the soft cervical collar did not adequately immobilize the cervical spine.     

Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement

Bell DR, Padua DA, Clark MA. Muscle strength and flexibility characteristics of people displaying excessive medial knee displacement.

Objective

To determine differences in strength and range of motion (ROM) between participants who exhibit medial knee displacement (MKD) during a squat that is corrected by a heel lift and those who do not.

Design

Case control.

Setting

Sports medicine research laboratory.

Participants

Thirty-seven healthy subjects (control, 19; MKD, 18) with no lower-extremity injury in the past 6 months volunteered to participate.

Interventions

Not applicable.

Main Outcome Measures

Peak force was measured in newtons using a hand-held dynamometer and passive ROM was measured in degrees with a goniometer. Separate multivariate analyses of variance were used to determine differences in strength and ROM between groups. Post hoc testing was used to elucidate differences between groups.

Results

The MKD group had the following: greater hip external rotation strength (P=.03), increased hip extension strength (P=.01), less plantarflexion strength (P=.007), and increased hip external rotation ROM (P=.008).

Conclusions

The MKD group exhibited tight and weak ankle musculature. Interventions focusing on improving strength and ROM of the ankle may improve kinematics during a squat.