Lumbar spine segmental mobility assessment: an examination of validity for determining intervention strategies in patients with low back pain

OBJECTIVE: To examine the predictive validity of posterior-anterior (PA) mobility testing in a group of patients with low back pain (LBP). DESIGN: Randomized controlled trial. SETTING: Outpatient physical therapy clinics. PARTICIPANTS: Patients with LBP (N=131; mean age +/- standard deviation, 33.9+/-10.9 y; range, 19-59 y), and a median symptom duration of 27 days (range, 1-5941 d). Patients completed a baseline examination, including PA mobility testing, and were categorized with respect to both hypomobility and hypermobility (present or absent), and treated for 4 weeks. INTERVENTION: Seventy patients were randomized to an intervention involving manipulation and 61 to a stabilization exercise intervention. MAIN OUTCOME MEASURES: Oswestry Disability Questionnaire (ODQ) scores were collected at baseline and after 4 weeks. Three-way repeated measures analyses of variance (ANOVAs) were performed to assess the effect of mobility categorization and intervention group on the change on the ODQ with time. Number-needed-to-treat (NNT) statistics were calculated. RESULTS: Ninety-three (71.0%) patients were judged to have hypomobility present and 15 (11.5%) were judged with hypermobility present. The ANOVAs resulted in significant interaction effects. Pairwise comparisons showed greater improvements among patients receiving manipulation categorized with hypomobility present versus absent (mean difference, 23.7%; 95% confidence interval [CI], 5.1%-42.4%), and among patients receiving stabilization categorized with hypermobility present versus absent (mean difference, 36.4%; 95% CI, 10.3%-69.3%). For patients with hypomobility, failure rates were 26% with manipulation and 74.4% with stabilization (NNT=2.1; 95% CI, 1.6-3.5). For patients with hypermobility, failure rates were 83.3% and 22.2% for manipulation and stabilization, respectively (NNT=1.6; 95% CI, 1.2-10.2). CONCLUSIONS: Patients with LBP judged to have lumbar hypomobility experienced greater benefit from an intervention including manipulation; those judged to have hypermobility were more likely to benefit from a stabilization exercise program.     

Lumbar instability: an evolving and challenging concept

Identification and management of chronic lumbar spine instability is a clinical challenge for manual physical therapists. Chronic lumbar instability is presented as a term that can encompass two types of lumbar instability: mechanical (radiographic) and functional (clinical) instability (FLI). The components of mechanical and FLI are presented relative to the development of a physical therapy diagnosis and management. The purpose of this paper is to review the historical framework of chronic lumbar spine instability from a physical therapy perspective and to summarize current research relative to clinical diagnosis in physical therapy.     

The inter-rater reliability of clinical tests that best predict the subclassification of lumbar segmental instability: structural,functional and combined instability

ObjectivesThis study investigated the inter-rater reliability of three structural end range lumbar segmental instability tests with the highest positive likelihood ratio (+ LR) against flexion–extension radiographs, and three functional mid-range clinical tests that predict the success of lumbar stabilisation exercises in patients with recurrent or chronic low-back pain (R/CLBP). The study also investigated the reliability of lumbar segmental instability, subclassification as: functional, structural and combined instability.MethodForty adults with R/CLBP (30 men and 10 women), aged 21–71 years, underwent repeated measurements of specific clinical tests for structural or functional lumbar segmental instability.ResultsAll functional-instability tests: the prone instability test (PIT), the aberrant motion test and the average passive straight-leg raise (PSLR>91°) test showed a high percentage agreement (90, 97·5 and 95%, respectively) and a high kappa coefficient (0·71, 0·79 and 0·77, respectively). In addition, two structural tests: the lumbar flexion range of motion (ROM) >53° and the passive lumbar extension test (PLET) showed a high percentage agreement (82 and 73%, respectively), and a moderate kappa coefficient (0·48 and 0·46, respectively). The lack of hypomobility with the posteroanterior (PA) glide test was found to be unreliable (agreement = 25%; k = − 0·02). Locating the pain-provoking segment, as the first portion of PIT, was found to be moderately reliable (k = 0·41). The subclassification categories of lumbar segmental instability (functional, structural and combined) were found to be significantly reliable (PABAK) 0·90, 0·70 and 0·95, respectively).DiscussionAll investigated tests (except the lack of hypomobility with the PA glide test), in addition to subclassifying the categories of lumbar segmental instability, were significantly reliable in the assessment of lumbar instability.     

西藏那曲地区肺结核117例的X线分析(附广东省湛江市肺结核109例X线对照)

目的提高对藏北那曲高原地区肺结核X线表现的认识。方法藏北那曲地区1996年7月至1999年9月间肺结核117例,初诊均拍摄胸部平片,并与沿海城市湛江同期、同年龄109例肺结核作对照,按1998年结核病新分类法分类,作者用双盲法分析两组的X线表现,用χ2检验作统计分析。结果(1)原发型肺结核比例高,占7.69%,其中成人比例高,占4.3%,对照组继发型肺结核比例高,占93.6%;(2)病变形态呈肺段大片状比例高,占16.2%,对照组呈斑片状比例高,占74.3%;(3)病变侵及4个肺野及以上占31.6%,对照组约占16.5%;少见部位多见,如下肺野结核,占12.8%,而对照组仅占0.9%;(4)以空洞病变为主比例并不高,占11.97%,对照组占32.1%。两组比较,均有显著性差异(均P<0.01)。结论西藏那曲地区肺结核X线表现有明显不同于南方沿海城市湛江的特点。     

Thoracic Kyphosis and Lumbar Lordosis Assessment by Radiography and Photogrammetry: A Review of Normative Values and Reliability

Objective

The purpose of this study was to review referential values for thoracic kyphosis and lumbar lordosis for radiography and photogrammetry analysis and search for information about the interrater and intrarater reliability.

Ultrasonographic findings of Pachydermodactyly (PDD): A case report

Pachydermodactyly (PDD) is a rare and benign dermatological disease. Several diagnostic imaging modalities have been used in the evaluation of the disease, for instance, X-ray and magnetic resonance imaging (MRI), while ultrasonography was largely underused. In addition to the dermal thickening recorded in previous literature, we also observed the thickening of the collateral ligament by ultrasound. Based on this finding, some treatments that may damage ligaments, such as intralesional corticosteroids or surgery, should be carefully selected.     

连颅双胎畸形影像表现与手术对照(及文献复习)

目的报道1例连颅双胎罕见畸形并复习文献,提高对连颅双胎畸形的认识。方法一对女性连颅双胎婴儿的影像学表现,与手术对照。结果影像学表现与手术所见一致。结论现代影像发展可发现复杂畸形,对其矫形手术具有重要意义。     

Computer photogrammetry as a postural assessment in Schwartz-Jampel syndrome: A case report

The Schwartz-Jampel Syndrome (SJS) is a rare genetic disorder characterized by myotonia and bone dysplasia, which may change the posture. The subject of this case report was a seven-year-old boy diagnosed with SJS and presenting generalized muscle and joints contractures. The purpose of the present case report was to identify postural asymmetries in a patient with SJS through photogrammetry. Postural analysis was conducted using photogrammetry with the Postural Assessment Software (SAPO®). Photogrammetry is a postural assessment system performed through photographic images. These images are acquired by camera and transported to the computer. SAPO® software performs the assessment of this photograph throughout 3D analysis and compares with a predefined protocol. The results of the present case report document several recurrent postural imbalances seen in SJS including myotonia, facial dysmorphism, and skeletal deformities. Thus, even with little evidence in the literature, physical therapy treatment is indicated to increase the functionality of the individual.     

The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study

Demirbag D, Unlu E, Ozdemir F, Genchellac H, Temizoz O, Ozdemir H, Demir MK. The relationship between magnetic resonance imaging findings and postural maneuver and physical examination tests in patients with thoracic outlet syndrome: results of a double-blind, controlled study.

Objectives

To investigate the differences in findings from magnetic resonance imaging (MRI) in the neutral and provocative positions, and to examine the relationship between these differences and the results of physical examination tests in patients with thoracic outlet syndrome (TOS).

Design

Prospective.

Setting

University physical medicine and rehabilitation outpatient and radiology clinics.

Participants

Twenty-nine patients and 12 healthy controls. All of the patients had positive bilateral TOS stress tests; control group participants were symptom free and had negative TOS stress tests bilaterally.

Interventions

Not applicable.

Main Outcome Measures

All participants underwent Adson’s test, the Halsted maneuver, and a hyperabduction test. All were evaluated with MRI while in 2 positions: the neutral position (upper extremities adducted) and in a provocative position. Measurements were obtained at the interscalene triangle, at the costoclavicular space, and at the retropectoralis minor space.

Results

There was a significant difference in MRI findings between the neutral and provocative position in the patients (P<.05), but there were no significant differences in the control group. There was a significant difference in the positional change values in MRI between the patients and the control subjects (P<.05). The difference was found in the minimum costoclavicular distance between patients with a positive Halsted maneuver and a negative Halsted maneuver (P<.05).

Conclusions

Our findings indicate that MRI findings in patients in a provocative position are more valuable in the diagnosis of TOS, and these findings are in accord with findings from the physical evaluation tests.     

甲型H1N1流感的胸部X线和CT表现

目的 探讨甲型H1N1流感患者胸部X线和CT表现。方法 回顾性分析47例经临床确诊为甲型H1N1流感患者的胸部影像资料。患者均于病初摄X线胸片,其中4例连续多次复查,5例同时接受CT检查。结果 47例患者胸部X线表现正常者11例(11/47,23.40%),表现异常者36例(36/47,76.60%)。36例异常胸部影像主要表现为:①分布特点:单侧分布11例(11/36,30.56%),双侧分布25例(25/36,69.44%);②病变特征:实变影8例(8/36,22.22%),磨玻璃密度影6例(6/36,16.67%),实变合并磨玻璃影4例(4/36,11.11%),网状影3例(3/36,8.33%);③主要集中带:中央带3例(3/36,8.33%),周边带13例(13/36,36.11%);④病变累及范围:限于1个肺野18例(18/36,50.00%),分布于2个肺野15例(15/36,41.67%),≥3个肺野3例(3/36,8.33%);⑤其他:胸腔积液2例(2/36,5.56%);部分患者CT检查见纵隔淋巴结肿大。结论 甲型H1N1流感患者病初起时部分胸部X线表现正常;X线和螺旋CT常表现为单边或双边片状影、磨玻璃密度影,有或无合并灶,部分合并胸膜炎症和纵隔淋巴结肿大。     

Imaging sonographic findings of in a case of proliferating trichilemmal tumor of a finger: A case report

Proliferating trichilemmal tumor (PTT) is a rare tumor that originates from the outer root sheath of a hair follicle. About 90% of PTTs occur on the scalp. The sonographic findings of PTT in the subungual region have not been reported previously. In our case, sonography showed a heterogeneous mass containing echogenic foci with no detectable intratumoral vascularity. These echogenic foci probably represent keratin and cholesterol. © 2017 Wiley Periodicals, Inc. J Clin Ultrasound 46 :215–217, 2018     

电测法结合X线直视摄影术在根管长度测量中的应用

目的研究电测法结合X线直视摄影术(Radiovisiography,RVG)在根管长度测量中的应用价值。方法临床选取84颗患牙共计192个根管,随机分为两组,实验组运用电测法结合RVG对根管工作长度进行测量,对照组仅用电测法。结果实验组根管充填的满意率达89.36%,明显高于对照组的76.53%(P<0.05)。结论运用电测法结合RVG插针确定根管工作长度较准确,能进一步提高根管充填的满意率。     

A comprehensive physical therapy evaluation for Male Chronic Pelvic Pain Syndrome: A case series exploring common findings

IntroductionMale Chronic Pelvic Pain Syndrome (MCPPS) is a complex condition and difficult to decipher due to the multifactorial etiologies and system interrelationships. No studies to date have described a movement-based, multisystem assessment including the musculoskeletal, visceral, nervous, lymphatic and vascular systems, as well as manual prostate mobility testing.The purpose of this paper is to demonstrate the importance of a comprehensive physical therapy evaluation to identify predominant mechanical and movement-based dysfunctions related to multiple anatomical structures and their interrelationships. Furthermore, symptoms and potentially confounding psychosocial, and environmental factors linked to MCPPS will be presented, and an overview of prospective treatment will be provided.MethodA retrospective analysis of evaluative findings for ten men was performed. The men, with an average age 35 (range 24–46) were referred to physical therapy for MCPPS.ResultsThis retrospective analysis of ten patients identifies potential contributing pain factors associated with MCPPS. Similarities in clinical presentation among men suffering from MCPPS were identified to include predominant mechanical dysfunctions of the thoraco-lumbar spine, the liver, the kidney, the femoral nerve, the bladder, the prostate, and the pelvic floor.ConclusionThe observations in this retrospective study demonstrate that the use of a multisystem assessment approach in patients with MCPPS is critical for their more effective treatment. On the basis of these findings, and the close mechanical interrelationships of the anatomical elements involved and multisystem MCPPS etiologies, larger-scale research is warranted.     

A systematic perspective for assessment and intervention: A case study

A systemic perspective was employed in completing a phonological analysis and developing an intervention plan for Jarrod, a 7;0 year old child who exhibited a severe speech sound disorder characterized by inconsistency. Results of the Systemic Phonological Analysis of Child Speech (SPACS) revealed a limited sound system that was characterized by phonotactic inventory constraints, positional constraints, and sequence constraints. Mapping the child-to-adult sound systems through phoneme collapses revealed a logical and symmetrical system that maintained systematicity, yet permitted variability. Based on the organizational principles suggested by the phoneme collapses, targets were identified for intervention using the distance metric approach, which is based on the function of sounds within a given system rather than the characteristics of a given sound, and assumes that targets will interact dynamically with the child's unique sound system. Finally, a multiple oppositions treatment approach intended to facilitate learning across phoneme collapses and lead to system-wide phonological restructuring was described.     

Association between clinical signs assessed by manual segmental examination and findings of the lumbar facet joints on magnetic resonance scans in subjects with and without current low back pain: A prospective,single-blind study

The relevance of magnetic resonance imaging (MRI) findings such as facet joint (FJ) effusion and edema in low back pain (LBP) is still unknown. Therefore, we prospectively evaluated the presence of these MRI findings in the lumbar spine (Th12-S1) and their association with pain evoked by manual segmental FJ provocation tests (spinal percussion, springing, and segmental rotation tests) in 75 subjects with current LBP (?30 days in the past 3 months) compared with 75 sex- and age-matched control subjects. FJs were considered painful, if ?1 provocation test triggered LBP. FJs were classified as true positives, if the same FJ was painful and showed effusion and/or edema. FJs with effusion and/or edema and painful FJs were present significantly more frequently in subjects with LBP, but these conditions were also common in control subjects (27% vs 21% and 50% vs 12%, respectively). Effusion and/or edema were present in 65 subjects with LBP (87%) and in 56 control subjects (75%, not significant); painful FJs were present in 68 (91%) and 29 (39%) (P < 0.01) LBP and control subjects, respectively. True-positive findings occurred in 16% of LBP FJs and in 2% of control FJs (P < 0.01); 46 LBP subjects (61%) and 9 control subjects (12%, P < 0.01) had true-positive findings. Pain on provocation and FJ effusion and/or edema were significantly correlated only in patients with LBP. In conclusion, only true-positive findings (ie, concurrent effusion and/or edema and positive provocation test results in the same FJ) discriminate well enough between control subjects and subjects with current LBP, whereas neither effusion and/or edema nor FJ provocations tests alone are suitable to detect suspected FJ arthropathy.     

Mini mental state examination (MMSE) in substance users and non substance users: A comparison study

ABSTRACT

Background: Due to its progressive nature, substance use impacts the entire aspects of life, and can result in adverse repercussions on mental status. Accordingly, the current article seeks to compare the mental status of substance abusers with that of normal individuals.Methods: The study is a cross-sectional research. The study population is comprised of 50 methamphetamine users, 52 opium users, and 100 normal individuals referred to Farabi Psychiatric Hospital in Kermanshah, 2018, in Iran. The subjects were selected by convenience sampling method and matched in terms of demographic characteristics. Data collection was performed using Mental State Examination (MMSE) and demographic questionnaire.Results: The results showed that mean scores of orientation, attention, and mental status were significantly different between the normal and substance abusers (P < .05). However, the above-mentioned difference was not significant between methamphetamine abusers and opioid abusers (P > .05). In addition, the mean score of the language tests was statistically significant only among the normal and methamphetamine abusers (P < .05).

Conclusions: Based on the obtained results, it can be concluded that the opium and methamphetamine users showed poorer performance in MMSE than the normal group.     

Ultrasonographic findings of gonarthritis caused by toothpick: A case report

We report a rare case of a 5‐year‐old patient with a toothpick in the knee joint resulting in septic arthritis. The toothpick was detected in the joint by sonography and was confirmed at surgery. A wooden foreign body is an uncommon cause of arthritis. This case report is followed by a discussion of the value of sonography in the diagnosis of wooden foreign‐body arthritis. © 2013 Wiley Periodicals, Inc. J Clin Ultrasound 42 :379–381, 2014