International musculoskeletal medicine最新文献

{"title":"Osteomyelitis of the ischium: An often missed diagnosis, case study report","authors":"F. Naim, Khamis Elessi","doi":"10.1179/1753614614Z.00000000072","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000072","url":null,"abstract":"Abstract The pelvic bones and especially the ischium are rare sites for osteomyelitis. The case of a 30-year-old man with osteomyelitis in the ischium is presented, where persistent pain was not accompanied by markers of acute inflammation. Details of further investigation and treatment are described. Osteomyelitis must be kept in mind as a possible differential diagnosis of persisting pain around the pelvis, and appropriate investigations carried out.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"79 - 81"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000072","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716605","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional MRI in pain: A valuable and/or reliable diagnostic tool for your pain patient?","authors":"J. Patijn","doi":"10.1179/1753614614Z.00000000073","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000073","url":null,"abstract":"Abstract In pain research, functional magnetic resonance imaging (fMRI) plays an increasingly important role, which raises questions about the clinical significance of fMRI for the treatment and diagnosis of pain in general. All the more so because some publications suggest replacing the ‘subjective\"’visual analogue scale pain score with the ‘objective’ results in fMRI. The fMRI technique as such and its relation to pain in research conditions has a large number of objections. One of the major limitations is the fact that in a very limited number of fMRI studies (8%), the results are reproduced within the study format itself (test–retest). This makes interpretation and mutual comparison of the fMRI studies extremely difficult. Therefore the clinical value of fMRI for treatment and diagnosis is hard to estimate.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"75 - 78"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000073","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716738","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Precision of acupuncture placement using diagnostic ultrasound","authors":"David W. Allen","doi":"10.1179/1753615414Y.0000000028","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000028","url":null,"abstract":"Abstract Objective To investigate the precision of acupuncture needle placement using two methods of guidance (termed assisted and guided). Method A lamb shoulder in vitro study model was chosen. In the case of assisted acupuncture, the track the needle would take was visualized before subsequent blind needle placement. For guided acupuncture, the needle placement was seen in real-time. In total, 33 measurements of needle tip–target distance were performed for each of the two methods of acupuncture needle placement. Descriptive statistics were used to compare the precision of the two methods. Repeated measurements were analysed to investigate operator reliability using the intra-class correlation coefficient (ICC) statistic. Results In terms of precision of needle placement, guided placement was more precise than assisted. Guided acupuncture (0.2 mm ± 0.19 SD) was more precise than assisted (4.4 mm ± 4.08 SD). Operator reliability of measurement of needle tip–target distance was good for both methods. Assisted method gave an ICC of 0.99, whereas the guided method was 0.90. Discussion Precision of acupuncture placement is improved by diagnostic ultrasound guidance. The utilization of diagnostic ultrasound prior to needling in anatomically challenging areas may contribute to patient safety. The visualization of needle track anatomy may facilitate skill acquisition when training in acupuncture.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"64 - 74"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000028","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65722937","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The current state of musculoskeletal medicine","authors":"M. Hutson","doi":"10.1179/1753614614Z.00000000081","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000081","url":null,"abstract":"Musculoskeletal medicine, as practised by dedicated musculoskeletal physicians, provides an opportunity for translating conceptual beliefs into medical practice. Given the current level of angst regarding the National Health System (NHS) in the UK, it also offers me the opportunity for reflection. I would initially like to review some aspects of the evidence for our practice. How did we obtain and how do we continue to obtain evidence? Do we believe that evidence-based medicine, as it has been understood since its formal inception, still works for us? Despite the plethora of published scientific evidence and guidelines over the last 20 years, it is tempting and possibly true to state that the ‘evidence’ that we hold dear to us and use consistently in our medical practice comes primarily from those teachers with whom we had our first contact. There are still diverse beliefs, even a sectarian divide, among the musculoskeletal/manual medicine community. Within that community, decades ago, James Cyriax had (and indeed continues to have) many advocates. I have often used the term ‘structuralism’ to describe his approach, based on patho-anatomy and a beautifully devised examination system. ‘Across the divide’ is the traditional osteopathic approach (which Cyriax so despised) that is centred on somatic dysfunction, with its more subtle manual diagnostic findings, which can also be appealing too. Polarization of approaches to health issues have been present since the days of Asclepius (God of Medicine) and his daughter Hygiea (Goddess of Health) in Ancient Greece, though it is gratifying that in musculoskeletal medical practice in the UK over the more recent decades during which Still, Cyriax, and Lewit have been pre-eminent, there has developed a realization that we can live together, learn from each other, and practise the medical creed in which we have most belief, while acknowledging and implementing beliefs from ‘the other side’. The international situation, particularly in Europe, with respect to musculoskeletal/manual medicine is much the same. Followers of gurus throughout Europe created sects, to the extent that in some countries opinions have been very much divided as to the direction that manual medicine should take, based on their initial teaching. However, this appears to have gradually changed, leading to combined efforts being made to establish an accepted subspecialty of manual medicine within the European Union of Medical Specialists (UEMS). In the UK, 1991 was a momentous year when the Institute of Orthopaedic Medicine (based on the Cyriax approach) held talks with the British Association of Manipulative Medicine, which was based on a pragmatic approach, and the London College of Osteopathic Medicine, based on traditional osteopathic concepts, and agreed to form British Institute of musculoskeletal medicine (BIMM), in which there would be full recognition of and acceptance of underlying concepts as described. BIMM has continued to promo","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"59 1","pages":"85 - 86"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000081","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The use of high-volume image-guided injections (HVIGI) for Achilles tendinopathy – A case series and pilot study","authors":"P. Wheeler","doi":"10.1179/1753615414Y.0000000035","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000035","url":null,"abstract":"Abstract Objective To identify outcomes for patients undergoing high-volume image-guided injection (HVIGI) for Achilles tendinopathy symptoms. Methods This is a prospective case-series design for all patients undergoing HVIGI in a single NHS Sports Medicine Clinic, performed by a single sports medicine consultant. HVIGI was performed with 10 ml 1% lidocaine, 40 ml saline, but unlike previously published case series, without corticosteroid or aprotinin. Results Sixteen patients were identified, of whom 14 had follow-up data available, with a mean duration of follow-up of 347 days. Overall, 50% were pain-free or virtually pain-free (recorded as a score of 0–1 on a 10-point visual analogue scale (VAS)) at the most recent follow-up. There was an average reduction in VAS score overall of 6.1 points on a 0–10 VAS, and an improvement in the Victorian Institute of Sport Assessment - Achilles (VISA-A) score of 41 points on the percentage scale. However, 14% of patients who underwent HVIGI required surgical intervention for on-going symptoms. Discussion HVIGI without corticosteroid appears to be an effective procedure for patients with recalcitrant Achilles tendon symptoms. Small sub-group numbers limit formal analysis, but suggest that there may be more benefit of HVIGI in patients with Achilles symptoms of less than 3 years. Further work is needed to formally establish benefits from HVIGI for patients with Achilles tendinopathy and to identify optimal injectate.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"103 - 96"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000035","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723408","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Discogenic lower back pain: Current concepts","authors":"J. Inklebarger","doi":"10.1179/1753614614Z.00000000070","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000070","url":null,"abstract":"Abstract The literature reports that 39% of chronic lower back pain may be attributed to intervertebral disc derangement. However, definitive diagnosis of discogenic lower back pain (DLBP) remains challenging. Clinical examination may be normal and the correlative utility of magnetic resonance imaging findings such as the high intensity zone is controversial. Researchers have identified a complex interplay of degenerative, immunohistological, and biomechanical overload factors as causative. Due to difficulties in diagnosis through physical examination and imaging alone, provocative discography is still the gold standard for surgical planning, by measuring intradiscal pressure, finding extradiscal dye extravasation, and by reproducing concordant pain against controls. This remains so, despite the known sequelae of latent acceleration of disc degeneration following the procedure. Lumbar interbody fusion (LIF), in its various forms, is the traditional surgical management for intractable pain from DLBP. However, due to this surgery's known complications of progressive biomechanical overload and degeneration of adjacent non-fused segments, it is regarded as an end of the line management. Artificial disc implants may offer an improved biomechanical alternative to LIF, but its efficacy is uncertain; while new non-surgical managements, such as stem cell regeneration and gene therapy, show promise but require further investigation. This paper explores some of the research opinions, theories of causation, and management strategies.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"50 - 53"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000070","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A pilot study to compare passive lumbar spine re-positioning error in those with chronic low back pain with healthy volunteers","authors":"C. Clark, S. Docherty, N. Osborne, A. Khattab","doi":"10.1179/1753614614Z.00000000075","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000075","url":null,"abstract":"Abstract Study design Cross-sectional laboratory study. Objective To compare the difference in passive re-positioning accuracy in the frontal plane, as a measure of lumbar kinaesthesis, between participants with chronic non-specific low back pain (CNSLBP) and healthy volunteers. Background Evidence suggests that spinal kinaesthesis impacting on spinal stability might be compromised in those with CNSLBP. It is suggested that in those with CNSLBP, there may be changes in ligamentous patho-physiology which lead to altered kinaesthetic perception. Methods Fourteen female participants, representing two groups, took part in the study. Participants in group one (n = 7) were those with CNSLBP (mean age 47.1 ± 15.41) and participants in group two (n = 7) were healthy volunteers (mean age 45.6 ± 10.63). There were no significant differences between the groups with regards to age, education, height, weight, hip, and waist circumference and all were right handed. Passive lumbar re-positioning accuracy was measured in the frontal plane using a motorized plinth with the Zebris® ultrasound-based motion analyser and the target positions were 10° left and right lumbar side flexion and neutral. Results The mean reporting error for the neutral position for participants with CNSLBP vs. healthy volunteers was <2.4° and <2.2° on both occasions (P > 0.05), respectively. The mean reporting error in left-side flexion for participants with CNSLBP vs. healthy volunteers was <1.5° and <2.0° on both occasions (P < 0.01; P < 0.05). The mean reporting error in right-side flexion for participants with CNSLBP vs. healthy volunteers was <2.1° and <1.1° on both occasions (P > 0.05). Conclusion There was a statistically significant difference in passive re-positioning accuracy to the left side only between participants with CNSLBP and healthy volunteers. This may represent an important finding in relation to structures that provide sensory information and the integration of that information in those with CNSLBP.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"104 - 110"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000075","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Coccydynia in primary care","authors":"Margaret Taylor","doi":"10.1179/1753614614Z.00000000067","DOIUrl":"https://doi.org/10.1179/1753614614Z.00000000067","url":null,"abstract":"Reply to the audit by Hourigan et al. of the Primary care awareness of coccydynia in Devon: I wonder why the authors did not give the general practitioners the option of choosing prolotherapy as a treatment for coccydynia. When the authors did their literature search, they must have noticed the 2008 paper by Khan et al. in which 37 patients with average visual analog scale (VAS) for pain of 8.5 were treated with 20% glucose (dextrose) and lignocaine. After the first treatment, the average pain VAS was reduced to 3.4 and 2.5 after the second injection. In eight patients who still had pain VAS of more than 4 after the second injection, a third injection was given 4 weeks later. Minimal or no improvement was noted in seven patients; the remaining 30 patients had good pain relief. The authors concluded that dextrose prolotherapy is an effective treatment option in patients with chronic, recalcitrant coccygodynia and should be used before undergoing coccygectomy. They suggest that randomized studies are needed to compare prolotherapy with local steroid injections. However, since there are no long-term (or short-term) side effects of glucose injections comparable to the skin atrophy and delayed long-term healing with steroid injections, it seems more logical to use the least harmful treatment first. In my practice I have not found it necessary to use radiological imaging. Localizing the strained ligaments by palpation is perfectly adequate, as strained enthuses are tender as well as painful. Treating all the painful points around the coccyx, including the tip, the sacrococcygeal joint and often also the sides, where some fibres of the sacrotuberous ligaments insert, with 20% glucose and 0.1% lignocaine, results in complete or adequate relief of pain within four treatments.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"82 - 82"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753614614Z.00000000067","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65716926","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Whole upper limb strengthening in treatment of lateral epicondylopathy","authors":"J. Flynn, A. Clough","doi":"10.1179/1753615414Y.0000000030","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000030","url":null,"abstract":"Abstract This case report presents a commonly presenting clinical condition in the context of evidence informed literature on tendinopathy and a systematic applied reasoning (SAR) model of clinical problem solving as an aide-memoire to develop the clinical management of lateral epicondylopathy.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"1 1","pages":"111 - 116"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000030","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of adding grade B hip mobilization to a muscle strengthening home exercise programme on pain, function, and range of movement in adults with symptomatic early-stage hip osteoarthritis: A pilot study for a randomized controlled trial","authors":"F. Blackman, E. Atkins","doi":"10.1179/1753615414Y.0000000029","DOIUrl":"https://doi.org/10.1179/1753615414Y.0000000029","url":null,"abstract":"Abstract Objective A pilot study to investigate whether the addition of grade B mobilization to a muscle strengthening home exercise programme improves outcomes for patients with symptomatic early-stage hip osteoarthritis. Methods Twenty-three patients were randomized into either a home exercise group (n = 12) or grade B mobilization group (n = 11). Both groups carried out a muscle strengthening home exercise programme for 6 weeks. In addition, the grade B mobilization group received 6 weekly sessions of grade B hip mobilization (passive stretching techniques) and carried out stretches at home. Outcome measures included the visual analogue scale for pain, the Lower Extremity Functional Scale and goniometric measurement of hip flexion and medial rotation at baseline (week 1) and after the 6-week treatment period (week 7). Results Twenty-one participants (91%) completed the trial. Both groups showed improvement in all outcome measures. The change in pre-/post-treatment scores was significantly greater in the grade B mobilization group for pain (t(19) = 2.378, P = 0.03, large effect size d = 1.02) and passive hip flexion (t(19) = −4.192, P = 0.001, large effect size d = 1.80). No significant difference was found for function (t(19) = 0.444, P = 0.662, small effect size d = 0.20) or passive hip medial rotation (t(19) = −1.053, P = 0.305, moderate effect size d = 0.46). However, these results are inconclusive as this pilot study was underpowered. Discussion A worthwhile benefit may exist from the addition of grade B mobilization to a muscle strengthening home exercise programme, particularly with pain and passive hip flexion. This warrants further investigation. Although this pilot study demonstrated a feasible design, recommendations have been made for its development.","PeriodicalId":88907,"journal":{"name":"International musculoskeletal medicine","volume":"36 1","pages":"54 - 63"},"PeriodicalIF":0.0,"publicationDate":"2014-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1179/1753615414Y.0000000029","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"65723113","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}