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.     

Repetitive lifting and spinal shrinkage, effects of age and lifting technique

The assumed advantages of the so-called leg-lifting technique over the back-lifting technique are still the subject of much debate. The present study was aimed at studying the consequences of performing both lifting techniques on net lumbar moments and spinal shrinkage. Furthermore, the relation between age and spinal shrinkage was studied. Five subjects approximately 40 years old and six subjects 20 years old performed six 5-min bouts of repetitive lifting using each technique on a separate day. Net lumbar moments were calculated using a two-dimensional dynamic linked segment model. Spinal shrinkage was measured at T₁₂ and at the head after each bout of lifting and every 5 min during 1 h preceding the lifting bouts. The peak moments were marginally but significantly higher in the leg-lift. No differences in mean moments and shrinkage between lifting techniques were found. The shrinkage after the back-lift was more pronounced in the older subjects and a similar tendency was found after the leg-lift. The creep rate, i.e. the rate at which the shrinkage approaches its equilibrium was higher in the older subjects. No clear relations of anthropometrical variables and net moments with shrinkage was found. The common advice of using a leg-lift rather than a back-lift was not supported by the present study. Both the mechanical load on the low back (net moments) and the resulting shrinkage show considerable interindividual variation, the causes of which need further elucidation.

The leg-lifting technique is still widely advocated, thought its merits from a biomechanical point of view have been questioned. In this study spinal shrinkage and lumbar moments calculated by means of a dynamic linked segment model are used to compare the leg-lift to the more commonly used back-lift.     

Three-dimensional bone kinematics in an anterior laxity test of the ankle joint

Questions addressed in this in-vitro study are (1) what are the actual three-dimensional kinematics of talus and calcaneus during an anterior drawer test as performed with the quasi-static anterior ankle tester (QAAT) (2) does laxity measurement with the QAAT represent the true anterior translation of talus relative to the tibia?. Simultaneous measurements were made with the QAAT and a three-dimensional kinematics analysis system in five specimens. The three-dimensional translations and rotations on three axes were analysed at 25, 50 and 100 N of applied anterior load, with increased ligament damage. For four out of five remaining specimens, anterior translation values of talus and calcaneus and values as measured with the QAAT show a significant increase with growing ligament damage and with higher loads. Skeletal motions of talus and calcaneus show great similarity in three different motion axes, with increased ligament damage and at any given load. Skeletal translations and rotations of talus and calcaneus show great similarity during an anterior drawer movement of the ankle joint. Anterior skeletal translation of the talus and calcaneus show fair correlation with the anterior displacements measurements of the QAAT. These QAAT measurements show an overestimation of the laxity value by more than 200% irrespective of the load applied.     

Classification of thoracic and lumbar spine fractures: problems of reproducibility

Reproducibility of fracture classification systems in general has been a matter of controversy. The reproducibility of spinal fracture classifications has not been sufficiently studied. We studied the inter-observer and intra-observer reproducibility of the Magerl (AO) classification using radiograms, CTs and MRIs of 53 patients. We compared this classification with the older and simpler Denis classification. Five observers classified the fractures, first using the radiograms and CTs and, 6 weeks later, with radiograms and MRIs. Three of the observers repeated the readings after 3 months. Three observers also classified the fractures according to Denis. Agreement was measured using Cohen's kappa test. The type (A, B, C) classification of the AO system was fairly reproducible with CTs. With MRI this was only moderate. Group subclassification of the types yielded higher kappa values, corresponding to substantial agreement. The agreement was, in general, better with the Denis classification, but the variance was higher due to the difficulty of finding proper categories for some injury patterns. Although the AO classification allows proper registration of all kinds of injury, the reproducibility, especially at the type level, is problematic. Use of MRI and better definition of the distinctive properties of the three different types may enhance the reproducibility of the scheme.