Treatment of myofascial trigger points in common shoulder disorders by physical therapy: A randomized controlled trial [ISRCTN75722066]

Background  

Shoulder disorders are a common health problem in western societies. Several treatment protocols have been developed for the clinical management of persons with shoulder pain. However available evidence does not support any protocol as being superior over others. Systematic reviews provide some evidence that certain physical therapy interventions (i.e. supervised exercises and mobilisation) are effective in particular shoulder disorders (i.e. rotator cuff disorders, mixed shoulder disorders and adhesive capsulitis), but there is an ongoing need for high quality trials of physical therapy interventions. Usually, physical therapy consists of active exercises intended to strengthen the shoulder muscles as stabilizers of the glenohumeral joint or perform mobilisations to improve restricted mobility of the glenohumeral or adjacent joints (shoulder girdle). It is generally accepted that a-traumatic shoulder problems are the result of impingement of the subacromial structures, such as the bursa or rotator cuff tendons. Myofascial trigger points (MTrPs) in shoulder muscles may also lead to a complex of symptoms that are often seen in patients diagnosed with subacromial impingement or rotator cuff tendinopathy. Little is known about the treatment of MTrPs in patients with shoulder disorders.     

Anterior stabilization of pathologic dens fractures

By an anterior approach, six pathologic dens fractures were stabilized with screws and methyl methacrylate cement. All the patients had immediate pain relief and could be mobilized without external support. Using the anterior approach, the tumor can be removed and the instability neutralized at the site of the lesion.     

The correlation between osteoarthrosis as seen on radiographs and on arthroscopy

The correlation between arthroscopic and radiographic osteoarthrosis was studied in 63 patients (51 +/- 12 years) with degenerative changes in the medial compartment of the knee involving the medial meniscus with or without chondral damage. Chondral damage on arthroscopy was classified in grades 1-3 modified after Outerbridge. The radiographic evaluation was done according to Ahlb?ck classification. Twenty-eight patients (44%) did not show any significant chondral damage on arthroscopy (grades 0-1). The radiographic findings in this group were usually normal. Three patients, however, showed a slight narrowing of the medial joint space (Ahlb?ck I). All three had severely degenerated menisci, and two of them showed superficial fibrillation of both the tibia and the femur. Twenty-four patients (38%) showed a partial thickness chondral damage with fragmentation of the surface (grade 2). Radiographic findings were usually normal; however, patients with involvement of both the tibia and the femur often showed a joint space narrowing on radiographs. Eleven patients (18%) showed destruction of the cartilage down to subchondral bone (grade 3). The typical radiographic finding was a joint space obliteration (Ahlb?ck II). Involvement also of the lateral compartment as assessed on arthroscopy was significantly more common in patients with 2nd and 3rd degree chondral disease and Ahlb?ck II and III on radiographs than in those with 2nd and 3rd degree chondral damage and normal radiographs. In all but one of the patients with involvement of both compartments, the lateral compartment was considered normal on radiographic examination.     

L-arginine reverses the antinatriuretic effect of cyclosporin in renal transplant patients

BACKGROUND: Cyclosporin has been shown to facilitate renal vasoconstriction and to have an antinatriuretic effect. The existence of an interference of cyclosporin with the vasodilating properties of endothelium mediated by nitric oxide production could mediate these effects. On the other hand, the infusion of the nitric oxide precursor L-arginine has been shown to induce renal vasodilatation and to facilitate natriuresis in normal volunteers. We have investigated the renal effects of the administration of an infusion of L-arginine in renal transplant patients chronically treated with cyclosporin. To facilitate the analysis of the data the effects of the administration of a similar dose of cyclosporin on renal function during the infusion of a vehicle were also investigated during the administration of a vehicle of L-arginine. DESIGN: Ten male renal transplant patients, chronically treated with cyclosporin and with a stable renal function were studied during 2 consecutive days after the administration of the usual morning dose of cyclosporin. The first day they received an intravenous infusion of vehicle and the second the infusion of graded doses of L-arginine (50, 100, 150 mg/kg/h) during 3 consecutive h. RESULTS: The first day, after cyclosporin administration a significant fall (P < 0.01) was observed in natriuresis and kaliuresis in the absence of changes in renal plasma flow and glomerular filtration rate. After the administration of L-arginine significant (P < 0.01) increases of renal plasma flow, glomerular filtration rate, and natriuresis were seen. The increase in blood levels of cyclosporin after its administration did not differ between days 1 and 2. CONCLUSION: These results indicate that L-arginine facilitates renal vasodilatation and natriuresis in renal transplant patients. Furthermore, the observed increase in sodium excretion could indicate that L-arginine counteracts the antinatriuretic effect of cyclosporin.