Impact of physical therapists’ instructions on function and the perception of post-dry needling soreness in mechanical cervical pain; a randomized clinical trial

BackgroundTo investigate the impact of physical therapists’ instructions on the perception of post dry needling (DN) soreness and function in patients with mechanical neck pain.MethodsSeventy-five patients with neck pain were randomly assigned to three groups: “positive” group (n = 25) received positive verbal input; “negative” group (n = 25) received negative verbal input, and control group (n = 25) did not receive any input about post-needling soreness. All three groups received DN of a trigger point in the upper trapezius muscle. The subjective pain experience, pressure pain threshold (PPT), and neck disability Index (NDI) were assessed before and after DN.ResultsPatients in all groups showed improvement in pain, PPT and NDI. There were no significant differences in pain (P = 0.41) and PPT (P = 0.68) in the positive and negative groups compared with the control group. Significant difference in function was seen with the NDI after DN of patients in the positive and negative groups compared with the control group (P = 0.011, standard error: 1.08–1.5).ConclusionConsidering that the power of our study may be too low to draw more definitive conclusions, DN appears to be an effective technique to improve pain and mechanical hyperalgesia. The experience of post-needling soreness does not appear to influence the outcome of DN on pain, PPT, and NDI. Post-needling soreness does not seem to be a limiting factor in achieving acceptable outcomes, especially when clinicians offer DN within a therapeutic emphasizing a positive patient response. This study questions whether any treatments need to be offered to patients receiving DN.     

Current evidence on where to end a fusion within the thoracolumbar junction most preferably – A systematic literature review

Proximal junctional kyphosis (PJK) is one main complication in the surgical treatment of adult spinal deformities. Ending within the thoracolumbar junction (TLJ) should but cannot always be avoided to reduce the risk for PJK. With this systematic review we sought to define the most preferable vertebra within the TLJ to minimize the risk for PJK and establish recommendations based on our findings. We conducted a systematic literature review by scanning the MEDLINE database in accordance with the PRISMA criteria. All articles addressing primary long-distance dorsal thoracolumbar fusion of at least three segments to treat adult spinal deformities were included. 1385 articles were identified and three were included to this review. The first study showed significantly higher rates of PJK in patients where the construct was extended to T7 or higher when compared to an ending at T11 to L1. The second article stated that an expansion to the TLJ resulted in significantly less surgical revisions due to PJK reduction. On the other hand, the third article found that a fusion of the whole thoracic spine reduces the PJK incidence postoperatively. Even though the most favorable vertebra within the TLJ to avoid PJK best could not yet be determined, our study identifies several principles that represent the current state of evidence for surgical treatment of adult scoliosis. Proper preoperative decision making based on thorough analysis and interpretation of the patient's sagittal alignment parameters can improve the individual outcome critically.     

老年股骨近端骨折患者并发症的预见性护理

目的总结老年股骨近端骨折患者并发症的预防和护理对策。方法将192例患者分成对照组96例与观察组96例。对照组使用常规护理方法,观察组在常规护理基础上强化并发症的预防护理。观察、记录两组患者并发症的发生率和满意度。结果观察组患者住院期间并发症的发生率均低于对照组,满意度高于对照组,差异均有统计学意义(P0.05)。结论实施预见性护理对降低老年股骨近端骨折患者的并发症、提高满意度有较好的临床效果,预见性护理策略和精细的护理工作模式是今后护理工作方向。     

髓内钉和钢板治疗肱骨近端骨折的Meta分析

目的比较髓内钉和钢板两种内固定治疗肱骨近端骨折的安全性、有效性及差异性。方法计算机检索Pub Med、CENTRAL、EMbase、the ISI Web of Knowledge Databases、VIP、CNKI、CBM和万方数据库,查找所有比较髓内钉和钢板钢板治疗肱骨近端骨折的随机对照试验(RCT)及临床对照试验(CCT),检索时限均为建库至2015年12月31日。同时手检纳入文献的参考文献。按纳入排除标准由两人独立进行筛选、资料提取和质量评价后,采用Rev Man5.3软件进行Meta分析。结果共纳入14个研究,1010例患者。Meta分析结果显示:与钢板相比,髓内钉治疗手术时间更短[MD=-23.04,95%CI(-28.47,-17.60),P0.1]、术中出血量较少[SMD=-3.14,95%CI(-4.21,-2.08),P0.1]、骨折愈合时间更短[SMD=-3.03,95%CI(-3.77,-2.28),P0.1],总的并发症无统计学意义[RR=0.38,95%CI(0.25,0.57),P=0.24];然而,ASES评分显示钢板组优于髓内钉组[SMD=-0.63,95%CI(-0.98,-0.28),P0.1],Costant-Murley评分差异无统计学意义[SMD=-0.05,95%CI(-0.21,0.11),P0.1],末次随访时颈干角差异无统计学意义[MD=0.09,95%CI(-0.22,0.40),P0.1],末次随访时Neer征差异无统计学意义[RR=0.51,95%CI(0.25,1.03),P0.1]。结论本系统研究发现,总体而言,治疗肱骨近端骨折时,髓内钉优于钢板。但这一结论仍然需要大样本、高质量的研究及采用关键性指标,进行进一步的论证。     

A critical overview of the current myofascial pain literature – January 2018

The majority of papers included in the quarterly review discuss various aspects of dry needling (DN), which continues to be of interest to researchers and clinicians. A study by Liu et al. is the first paper to examine the effects of DN of acetylcholine, esterase and receptors. The study provides support for the integrated trigger point hypothesis and for DN. A paper by Hightower and colleagues found an intriguing link between low magnesium levels in the drink water supply, vitamin D, and myofascial pain, cancer, tendon ruptures, and colon polyps. Contributions originated in the Brazil, China, Germany, Iran, India, Poland, South Korea, Spain, Taiwan, Turkey, and the US.     

Radiographical definition of the proximal tibiofibular joint – A cross-sectional study of 2984 knees and literature review

BackgroundProximal tibiofibular joint (PTFJ) injuries are not uncommon but relatively understudied. This study evaluates the effectiveness of 2 radiographic methods in assessing the integrity of the PTFJ.Study designThis is a cross-sectional study of 2984 consecutive patients with knee X-rays done in a single institution over a 4-month period. A total of 5968 knee X-rays were assessed using 2 methods–[1] The direction in which the fibula points to in relation to the lateral femoral epicondyle on anteroposterior view and Blumensaat line on lateral view. [2] The degree of tibiofibular overlap as percentage of widest portion of the fibula head. Sensitivity and specificity of these methods in diagnosing a disrupted PTFJ are calculated. Variables including quality of X-rays, weight-bearing status of AP views and degree of knee flexion on lateral views are also recorded. Univariate analysis was carried out to investigate the association between variables using chi-square test for nominal data and student t-test for continuous data.ResultsThe fibular points towards the lateral femoral epicondyle on AP view in 94.4% of the patients and points towards the posterior half of the Blumensaat line on lateral view in 98.1% of the patients. Using this method, weight-bearing X-rays are significantly associated with the direction the fibula is pointing (p < 0.01) on the AP view and the degree of knee flexion is associated with the direction the fibula is pointing (p < 0.01) on the lateral view.The AP tibiofibular overlap ranges from >0% to <75% in 94.1% of the patients and the lateral tibiofibular overlap ranges from >0% to <75% in 84.5% of the patients.This method is associated with whether true orthogonal X-rays of the knees are taken (p = 0.048).ConclusionThe direction in which the fibula is pointing and the percentage of tibiofibular overlap are highly specific radiographic methods useful in defining the PTFJ. The first method requires a weight-bearing view on AP assessment and >20 degrees of flexion on lateral assessment. True orthogonal AP and lateral views are required for the second method to be used.     

Small bowel gastrointestinal stromal tumor presenting with gastrointestinal bleeding in patient with type 1 Neurofibromatosis: Management and laparoscopic treatment. Case report and review of the literature

Introduction and importanceGastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the gastrointestinal tract. It may be asymptomatic; nevertheless, gastrointestinal bleeding is the most frequent symptom, due to mucosal erosion. Its poor lymph node metastatic spread makes GIST often suitable of minimally invasive surgical approach. The importance of this study is to increase the awareness among physicians about this condition in particular scenarios as in our case and to stress the role of laparoscopic surgery.Case presentationA 74-year-old female patient presented to the emergency department with hematemesis, followed by haematochezia and melena. The patient had a medical history of type 1 Neurofibromatosis (NF1). She underwent, after CT scan, esophagogastroduodenoscopy, and endoscopic haemostasis. Finally, we performed a laparoscopic resection of a mass of the first jejunal loop. The postoperative period was predominantly uneventful. Pathological examination confirmed a low-risk GIST.Clinical discussionProximal jejunal GIST may cause an upper and lower gastrointestinal bleeding. A multidisciplinary team approach is mandatory for the correct management of this disease and its complications (bleeding). GISTs are indicated as the most commonly gastrointestinal NF1 associated tumours. In case of localised and resectable GIST surgical treatment is the mainstay and laparoscopic surgery is a valid alternative.ConclusionIn case of abdominal bleeding mass in a NF1 patient, it is important to keep in mind the well-known association between NF1 and GIST to facilitate the diagnosis and to quickly perform the appropriate treatment. Laparoscopic approach is safe and effective if the oncological radicality is respected.