Gastric volvulus. More common than previously thought?

Gastric volvulus is torsion of the stomach, which can compromise the gastric orifices and result in either acute or chronic and intermittent symptoms. We believe that gastric volvulus, especially when partial or intermittent, may be more common than has been previously thought. The condition should be suspected in any patient who has a history of retching or vomiting and has a paraesophageal hiatus hernia or eventration of the diaphragm. The classic triad of retching, severe and constant epigastric pain, and difficulty in passing a nasogastric tube should suggest the presence of acute gastric volvulus. The diagnosis is confirmed by specific findings on the upper gastrointestinal series. Acute gastric volvulus is a surgical emergency. Definitive treatment of recurrent chronic gastric volvulus is usually surgical, although conservative measures may have limited success.     

Physiotherapist‐led suprascapular nerve blocks for persistent shoulder pain: Evaluation of a new service in the UK

Introduction

This service evaluation explored and reported findings from a new physiotherapist‐led service offering suprascapular nerve blocks (SSNBs) to patients with persistent shoulder pain.

Methods

We collected data before the SSNB injection and at the 6‐weeks and 6‐month follow‐up from consecutive patients with persistent shoulder pain being treated by physiotherapists or an anaesthetist. Outcomes were patient‐reported pain (numerical rating scale [NRS 0 to 10]), patient‐specific functional score (PSFS) and health‐related quality of life [the EuroQol five dimensions questionnaire (EQ5D‐5 L)]. Exploratory analyses compared baseline and follow‐up scores within each clinician delivery group (physiotherapists, anaesthetist).

Results

Forty patients (mean age 57 years [standard deviation {SD} 12]; 63% female) received an SSNB from a physiotherapist, eight patients (mean age 59 years [SD 11]; female 88%) received an SSNB from an anaesthetist. At the 6‐week follow‐up, the physiotherapy group showed a mean reduction in pain (on the NRS): 2.2 (95% confidence interval [CI] 1.3 to 3.0) and an improvement in function (on the PSFS): –1.3 (95% CI –1.9 to ?0.4). Similar changes were found in those treated by the anaesthetist (pain: 1.3 [95% CI –1.18 to 3.80]; function: –1.4 (95% CI –3.18 to 0.35]). Very small changes, that were not statistically significant, were found in EQ5D‐5 L scores. At the 6‐month follow‐up, the mean reduction in pain (NRS) was maintained at 2.0 (95% CI 0.99 to 2.95) for the physiotherapy group.

Conclusion

The results provide early, exploratory evidence that patients with persistent shoulder pain treated by physiotherapists using palpation‐guided SSNBs achieve clinically important changes in pain and function in the short and medium term.