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Journal of Medical Case Reports May 2024Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often...
INTRODUCTION
Evaluating isolated extremity discomfort can be challenging when initial imaging and exams provide limited information. Though subtle patient history hints often underlie occult pathologies, benign symptoms are frequently miscategorized as idiopathic.
CASE PRESENTATION
We present a case of retained glass obscuring as acute calcific periarthritis on imaging. A 48-year-old White male with vague fifth metacarpophalangeal joint pain had unrevealing exams, but radiographs showed periarticular calcification concerning inflammation. Surgical exploration unexpectedly revealed an encapsulated glass fragment eroding bone. Further history uncovered a forgotten glass laceration decade prior. The foreign body was removed, resolving symptoms.
DISCUSSION
This case reveals two imperative diagnostic principles for nonspecific extremity pain: (1) advanced imaging lacks specificity to differentiate inflammatory arthropathies from alternate intra-articular processes such as foreign bodies, and (2) obscure patient history questions unearth causal subtleties that direct accurate diagnosis. Though initial scans suggested acute calcific periarthritis, exhaustive revisiting of the patient's subtle decade-old glass cut proved pivotal in illuminating the underlying driver of symptoms.
CONCLUSION
Our findings underscore the critical limitations of imaging and the vital role that meticulous history-taking plays in clarifying ambiguous chronic limb presentations. They spotlight the imperative of probing even distant trauma when symptoms seem disconnected from causative events. This case reinforces the comprehensive evaluation of all subtle patient clues as key in illuminating elusive extremity pain etiologies.
Topics: Humans; Male; Middle Aged; Foreign Bodies; Calcinosis; Glass; Diagnosis, Differential; Metacarpophalangeal Joint; Periarthritis; Arthralgia; Radiography
PubMed: 38741133
DOI: 10.1186/s13256-024-04475-6 -
Medicine May 2024Multiple studies have indicated a potential correlation between immune-mediated inflammatory diseases (IMIDs) and Frozen shoulder (FS). To explore the genetic causal...
Multiple studies have indicated a potential correlation between immune-mediated inflammatory diseases (IMIDs) and Frozen shoulder (FS). To explore the genetic causal relationship between IMIDs and FS using 2-sample Mendelian randomization (MR) analysis. Genome-wide association study (GWAS) summary data for FS were obtained from Green's study, while data for 10 IMIDs were sourced from the FinnGen Consortium. The MR analysis was performed using inverse variance weighting, MR Egger, and weighted median methods. IVW, as the primary MR analysis technique, was complemented with other sensitivity analyses to validate the robustness of the results. Additionally, reverse MR analysis was further conducted to investigate the presence of reverse causal relationships. In the forward MR analysis, genetically determined 4 IMIDs are causally associated with FS: rheumatoid arthritis (odds ratio [OR] (95% confidence interval [95% CI]) = 1.05 [1.02-1.09], P < .01); type 1 diabetes (OR [95% CI] = 1.06 [1.03-1.09], P < .01); hypothyroidism (OR [95% CI] = 1.07 [1.01-1.14], P = .02); and Celiac disease (OR [95% CI] = 1.02 [1.01-1.04], P = .01). However, no causal relationship was found between 6 IMIDs (autoimmune hyperthyroidism, Crohn disease, ulcerative colitis, psoriasis, sicca syndrome and systemic lupus erythematosus) and FS. Sensitivity analyses did not detect any heterogeneity or horizontal pleiotropy. In the reverse MR analysis, no causal relationship was observed between FS and IMIDs. In conclusion, this MR study suggests a potential causal relationship between rheumatoid arthritis, type 1 diabetes, hypothyroidism, and Celiac disease in the onset and development of FS. Nevertheless, more basic and clinical research will be needed in the future to support our findings.
Topics: Humans; Bursitis; Mendelian Randomization Analysis; Genome-Wide Association Study; Arthritis, Rheumatoid; Diabetes Mellitus, Type 1; Genetic Predisposition to Disease; Hypothyroidism; Polymorphism, Single Nucleotide
PubMed: 38728465
DOI: 10.1097/MD.0000000000038055 -
Healthcare (Basel, Switzerland) Apr 2024The fitness sector has experienced significant expansion, with fitness instructors (FIs) playing a pivotal role. Given the demands of their profession, understanding...
BACKGROUND
The fitness sector has experienced significant expansion, with fitness instructors (FIs) playing a pivotal role. Given the demands of their profession, understanding their health profile is crucial. This study's purpose is to explore the prevalence of fitness instructors' occupational health-related problems.
METHODS
A questionnaire covering sociodemographic, occupational, and health-related items was administered. Statistical analyses, including Mann-Whitney U and chi-square tests, Spearman's rho correlations, and logistic regressions, were conducted.
RESULTS
Fifty-nine FIs reported occupational health-related problems, with the majority occurring during instruction (66.1%), being muscular (32.2%), and knee (15.3%), the most common type and localization. Significant statistical differences were observed between injured and non-injured FIs, including sex ( = 0.012), years as an FI ( = 0.001), weekly days worked ( = 0.039), and daily hours worked ( = 0.013). Weak negative (-0.284 - -0.362) statistically significant correlations were found between health problems; weight; height; main activity; and FIs in the workplace. Logistic regressions identified significant models showing that having a sport/physical exercise background and practicing it regularly were less likely to report bursitis (OR 0.018; = 0.020) and hip injuries (OR 0.026; = 0.037).
CONCLUSIONS
Approximately one-third of FIs reported occupational-related health problems, predominantly musculoskeletal injuries. Sociodemographic, personal, and occupational factors appear to influence the prevalence of these health problems.
PubMed: 38727434
DOI: 10.3390/healthcare12090877 -
BMJ Open Diabetes Research & Care May 2024This study aimed to assess the causal relationship between diabetes and frozen shoulder by investigating the target proteins associated with diabetes and frozen shoulder...
INTRODUCTION
This study aimed to assess the causal relationship between diabetes and frozen shoulder by investigating the target proteins associated with diabetes and frozen shoulder in the human plasma proteome through Mendelian randomization (MR) and to reveal the corresponding pathological mechanisms.
RESEARCH DESIGN AND METHODS
We employed the MR approach for the purposes of establishing: (1) the causal link between diabetes and frozen shoulder; (2) the plasma causal proteins associated with frozen shoulder; (3) the plasma target proteins associated with diabetes; and (4) the causal relationship between diabetes target proteins and frozen shoulder causal proteins. The MR results were validated and consolidated through colocalization analysis and protein-protein interaction network.
RESULTS
Our MR analysis demonstrated a significant causal relationship between diabetes and frozen shoulder. We found that the plasma levels of four proteins were correlated with frozen shoulder at the Bonferroni significance level (p<3.03E-5). According to colocalization analysis, parathyroid hormone-related protein (PTHLH) was moderately correlated with the genetic variance of frozen shoulder (posterior probability=0.68), while secreted frizzled-related protein 4 was highly correlated with the genetic variance of frozen shoulder (posterior probability=0.97). Additionally, nine plasma proteins were activated during diabetes-associated pathologies. Subsequent MR analysis of nine diabetic target proteins with four frozen shoulder causal proteins indicated that insulin receptor subunit alpha, interleukin-6 receptor subunit alpha, interleukin-1 receptor accessory protein, glutathione peroxidase 7, and PTHLH might contribute to the onset and progression of frozen shoulder induced by diabetes.
CONCLUSIONS
Our study identified a causal relationship between diabetes and frozen shoulder, highlighting the pathological pathways through which diabetes influences frozen shoulder.
Topics: Humans; Mendelian Randomization Analysis; Proteome; Bursitis; Biomarkers; Blood Proteins; Protein Interaction Maps; Prognosis; Male; Diabetes Mellitus; Female
PubMed: 38719509
DOI: 10.1136/bmjdrc-2023-003966 -
JSES Reviews, Reports, and Techniques May 2024
PubMed: 38706666
DOI: 10.1016/j.xrrt.2024.02.002 -
BMJ Open May 2024The Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The Anti-Freaze-F (AFF) trial assessed the feasibility of conducting a definitive trial to determine whether intra-articular injection of adalimumab can reduce pain and improve function in people with pain-predominant early-stage frozen shoulder.
DESIGN
Multicentre, randomised feasibility trial, with embedded qualitative study.
SETTING
Four UK National Health Service (NHS) musculoskeletal and related physiotherapy services.
PARTICIPANTS
Adults ≥18 years with new episode of shoulder pain attributable to early-stage frozen shoulder.
INTERVENTIONS
Participants were randomised (centralised computer generated 1:1 allocation) to either ultrasound-guided intra-articular injection of: (1) adalimumab (160 mg) or (2) placebo (saline (0.9% sodium chloride)). Participants and outcome assessors were blinded to treatment allocation. Second injection of allocated treatment (adalimumab 80 mg) or equivalent placebo was administered 2-3 weeks later. PRIMARY FEASIBILITY OBJECTIVES: (1) Ability to screen and identify participants; (2) willingness of eligible participants to consent and be randomised; (3) practicalities of delivering the intervention; (4) SD of the Shoulder Pain and Disability Index (SPADI) score and attrition rate at 3 months.
RESULTS
Between 31 May 2022 and 7 February 2023, 156 patients were screened of whom 39 (25%) were eligible. The main reasons for ineligibility were other shoulder disorder (38.5%; n=45/117) or no longer in pain-predominant frozen shoulder (33.3%; n=39/117). Of the 39 eligible patients, nine (23.1%) consented to be randomised (adalimumab n=4; placebo n=5). The main reason patients declined was because they preferred receiving steroid injection (n=13). All participants received treatment as allocated. The mean time from randomisation to first injection was 12.3 (adalimumab) and 7.2 days (placebo). Completion rates for patient-reported and clinician-assessed outcomes were 100%.
CONCLUSION
This study demonstrated that current NHS musculoskeletal physiotherapy settings yielded only small numbers of participants, too few to make a trial viable. This was because many patients had passed the early stage of frozen shoulder or had already formulated a preference for treatment.
TRIAL REGISTRATION NUMBER
ISRCTN 27075727, EudraCT 2021-03509-23, ClinicalTrials.gov NCT05299242 (REC 21/NE/0214).
Topics: Humans; Adalimumab; Female; Male; Middle Aged; Injections, Intra-Articular; Bursitis; Feasibility Studies; Adult; Shoulder Pain; Treatment Outcome; Aged; Pain Measurement; United Kingdom; Ultrasonography, Interventional
PubMed: 38692727
DOI: 10.1136/bmjopen-2023-078273 -
Journal of Orthopaedic Surgery and... Apr 2024Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality... (Comparative Study)
Comparative Study Randomized Controlled Trial
Comparative effectiveness of low-level laser therapy versus muscle energy technique among diabetic patients with frozen shoulder: a study protocol for a parallel group randomised controlled trial.
BACKGROUND
Diabetes mellitus is one of the fastest-growing health challenges of the twenty-first century with multifactorial impact including high rates of morbidity and mortality as well as increased healthcare costs. It is associated with musculoskeletal complications, with frozen shoulder being commonly reported. While low-level laser therapy (LLLT) and muscle energy technique (MET) are commonly used to manage this condition, there remains a lack of agreement on the most effective approach, with limited research available on their comparative efficacy.
OBJECTIVES
To evaluate the comparative effectiveness of LLLT versus MET among diabetic patients with frozen shoulder.
METHODS
This is a single-centre, prospective, single-blind, randomised controlled trial with three parallel groups to be conducted at Ahmadu Bello University Teaching Hospital, Zaria, Kaduna State, Nigeria. Sixty diabetic patients with frozen shoulder will be randomly assigned into LLLT group, MET group, or control group in a 1:1:1 ratio. All the groups will receive treatment three times weekly for 8 weeks. The primary outcome will be shoulder function and the secondary outcomes will include pain intensity, shoulder ROM, interleukin-6 (IL-6), depression, anxiety, and quality of life (QoL). All outcomes will be assessed at baseline, at post 8-week intervention, and at 3 months follow-up.
DISCUSSION
This will be the first randomised controlled trial to evaluate the comparative effectiveness of LLLT versus MET on both clinical and psychological parameters among diabetic patients with frozen shoulder. The findings of the study may provide evidence on the efficacy of these interventions and most likely, the optimal treatment approach for frozen shoulder related to diabetes, which may guide clinical practice.
TRIAL REGISTRATION
Pan African Clinical Trials Registry (PACTR202208562111554). Registered on August 10, 2022.
Topics: Humans; Bursitis; Low-Level Light Therapy; Prospective Studies; Single-Blind Method; Treatment Outcome; Male; Adult; Female; Middle Aged; Diabetes Complications; Randomized Controlled Trials as Topic; Range of Motion, Articular; Quality of Life; Aged; Diabetes Mellitus
PubMed: 38689290
DOI: 10.1186/s13018-024-04735-7 -
Clinical Case Reports Apr 2024Bicipitoradial bursitis is an unusual cause of cubital fossa pain in PsA patients. Bedside Ultrasound is a valuable tool to correlate the source of pain in rheumatic and...
Bicipitoradial bursitis is an unusual cause of cubital fossa pain in PsA patients. Bedside Ultrasound is a valuable tool to correlate the source of pain in rheumatic and musculoskeletal diseases.
PubMed: 38659500
DOI: 10.1002/ccr3.8782 -
Acta Ortopedica Mexicana 2024Acute calcific periarthritis (ACP) in the interphalangeal joints of the hand is rare, with less than 100 cases reported. A rare case of ACP in a proximal interphalangeal...
Acute calcific periarthritis (ACP) in the interphalangeal joints of the hand is rare, with less than 100 cases reported. A rare case of ACP in a proximal interphalangeal (PIP) joint of the hand, in a young black woman, after acute trauma, is presented. She experienced severe pain and limited range of motion, and was medicated with an oral corticoid, which was followed by a rapid resolution of the symptoms. At six months, there were no signs of clinical or radiographic recurrence. Recognition of ACP allows for avoiding unnecessary treatments. In this case, treatment with corticoids might have played a role in a faster recovery.
Topics: Humans; Female; Finger Joint; Periarthritis; Calcinosis; Acute Disease; Finger Injuries; Adult
PubMed: 38657153
DOI: No ID Found -
BMC Musculoskeletal Disorders Apr 2024Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness... (Randomized Controlled Trial)
Randomized Controlled Trial
Efficacy of a high-intensity home stretching device and traditional physical therapy in non-operative management of adhesive capsulitis - a prospective, randomized control trial.
BACKGROUND
Historically, in-person physical therapy serves as a foundational component of nonoperative treatment of adhesive capsulitis (AC). This study compares the effectiveness of an at-home high-intensity stretch (HIS) device to traditional physical therapy (PT) and to PT in combination with the HIS device. We hypothesize that the HIS device will be as effective as PT alone or as combination therapy in the first-line treatment of AC and use of the HIS device will exhibit improvement at higher rate.
METHODS
Thirty-four patients with idiopathic adhesive capsulitis and a minimum of 12 months follow-up were included in this study. Patients were randomized into one of the three groups: HIS device, PT alone, or HIS device + PT. Passive range of motion (ROM), American Shoulder and Elbow Surgeons (ASES), and Simple Shoulder Test (SST) scores were measured. Additionally, patient satisfaction, compliance and complications were recorded. Paired t-test, ANOVA and Chi-squared tests were used in analysis.
RESULTS
Final ROM in all planes improved for all groups compared to baseline (p < 0.001), with only HIS device group able to restore > 95% of contralateral ROM in all planes at final follow-up. Patients with PT alone were on average slowest to improve ROM from baseline, at 3 months, 6 months, and 1 year in all planes except internal rotation. ASES and SST scores improved for all groups when compared to baseline (p < 0.001). Use of HIS-device resulted in greater improvement in SST and ASES Total scores compared to PT alone (p = 0.045, and p = 0.048, respectively).
CONCLUSIONS
Use of an at-home high-intensity stretching device for conservative treatment of idiopathic adhesive capsulitis improves outcomes in ROM and in ASES and SST scores both when used as an adjunct to physical therapy and when used alone.
TRIAL REGISTRATION
The study protocol was registered at www.
CLINICALTRIALS
gov (20/05/2022, NCT05384093).
Topics: Humans; Treatment Outcome; Prospective Studies; Shoulder Joint; Bursitis; Physical Therapy Modalities; Range of Motion, Articular
PubMed: 38643086
DOI: 10.1186/s12891-024-07448-4