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American Family Physician Jan 2021Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located... (Review)
Review
Adults commonly present to their family physicians with hip pain, and diagnosing the cause is important for prescribing effective therapy. Hip pain is usually located anteriorly, laterally, or posteriorly. Anterior hip pain includes referred pain from intra-abdominal or intrapelvic causes; extra-articular etiologies, such as hip flexor injuries; and intra-articular etiologies. Intra-articular pain is often caused by a labral tear or femoroacetabular impingement in younger adults or osteoarthritis in older adults. Lateral hip pain is most commonly caused by greater trochanteric pain syndrome, which includes gluteus medius tendinopathy or tear, bursitis, and iliotibial band friction. Posterior hip pain includes referred pain such as lumbar spinal pathology, deep gluteal syndrome with sciatic nerve entrapment, ischiofemoral impingement, and hamstring tendinopathy. In addition to the history and physical examination, radiography, ultrasonography, or magnetic resonance imaging may be needed for a definitive diagnosis. Radiography of the hip and pelvis should be the initial imaging test. Ultrasound-guided anesthetic injections can aid in the diagnosis of an intra-articular cause of pain. Because femoroacetabular impingement, labral tears, and gluteus medius tendon tears typically have good surgical outcomes, advanced imaging and/or early referral may improve patient outcomes.
Topics: Adult; Buttocks; Diagnosis, Differential; Family Practice; Female; Hip; Hip Injuries; Hip Joint; Humans; Male; Musculoskeletal Diseases; Pain
PubMed: 33448767
DOI: No ID Found -
Chinese Journal of Traumatology =... Dec 2018Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb... (Review)
Review
Since the phantom limb sensation was first described by the French military surgeon Ambroise Pare in the 16th century, the number of studies surrounding phantom limb pain has increased every year. Especially in recent decades, scientists have achieved a better understanding of the mechanism and treatment of phantom limb pain. Although many hypotheses have been agreed and many treatments have been proven effective, scientists still do not have a very systematic understanding of the phantom limbs. The purpose of this review article is to summarize recent researches focusing on phantom limb in order to discuss its definition, mechanisms, and treatments.
Topics: Amputation, Surgical; Humans; Lower Extremity; Phantom Limb
PubMed: 30583983
DOI: 10.1016/j.cjtee.2018.04.006 -
BMC Neurology Oct 2021The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
The objective of the current study is to evaluate the effects of phantom exercises on phantom limb pain, mobility status, and quality of life in lower limb amputees treated with mirror therapy and routine physiotherapy.
METHODS
It is a randomized controlled trial in which 24 unilateral lower limb amputees (above and below the knee) were randomly assigned to two equal groups i.e., control group (mirror therapy and conventional physical therapy) and experimental group in which, phantom exercises were given, additionally. Physical therapy included conventional therapeutic exercises while phantom exercises include imagining the movement of the phantom limb and attempting to execute these movements Data were collected at baseline, after 2 and 4 weeks of intervention using VAS (pain), AMP (mobility) and RAND SF-36 Version 1.0 (QOL) questionnaires. All statistical analyses were done with IBM SPSS 25.0 with 95% CI.
RESULTS
Twenty-four amputees (17 males and 7 females) participated in this trial. The Mean age of the participants in experimental and control groups was 45.3 ± 11.1 years and 40.5 ± 12.5 years respectively. After the intervention, the pain (VAS score) was significantly lower in the experimental group (p = 0.003). Similarly, the experimental group demonstrated a significantly better score in the "bodily pain" domain of SF-36 (p = 0.012). Both groups significantly (p < 0.05) improved in other domains of SF-36 and ambulatory potential with no significant (p > 0.05) between-group differences.
CONCLUSIONS
The Addition of phantom exercises resulted in significantly better pain management in lower limb amputees treated with mirror therapy and routine physiotherapy.
TRIAL REGISTRATION
This study is registered in the U.S National Library of Medicine. The clinical trials registration number for this study is NCT04285138 ( ClinicalTrials.gov Identifier) (Date: 26/02/2020).
Topics: Adult; Amputees; Female; Humans; Lower Extremity; Male; Middle Aged; Pain Measurement; Phantom Limb; Quality of Life
PubMed: 34706654
DOI: 10.1186/s12883-021-02441-z -
Musculoskeletal Science & Practice Dec 2022Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as... (Meta-Analysis)
Meta-Analysis Review
BACKGROUND
Among upper limb tendinopathies, rotator cuff-related shoulder pain and lateral elbow tendinopathy are the most representative disorders. Therapeutic exercise arises as an effective approach, but there is no consensus about the optimal progression criteria.
OBJECTIVE
To compare progression criteria and effectiveness of isolated, progressive exercises in the management of upper limb tendinopathies. Additionally, to perform a meta-analysis of pain/function for the selected programs.
DESIGN
Systematic Review and Meta-Analysis.
METHOD
Database search of randomized-controlled-trials including progressive exercise was conducted in PubMed and Scopus until October 2020. Meta-analysis' inclusion criteria were: no data duplicity; 3-months follow-up; comparison between any type of progressive exercise program. Risk of bias was assessed with PEDro score, and level of evidence followed GRADE guidelines. Effect size was calculated with Cohen's d.
RESULTS
Eleven studies were included. GRADE revealed low-quality evidence for meta-analysis of pain during activity (d = 0.29) and function (d = 0.33) at 3 months. Progression criteria were categorised into two divisions, being pain the central concept. Pain (rest/activity/night) and function improved significantly within-group, but between-group changes were heterogeneous. Meta-analysis regarding pain showed good homogeneity with significant, moderate effects (I = 20%; p = 0.005; mean d = 0.29); function yielded important heterogeneity with non-significant, moderate effects (I = 81%; p = 0.17; mean d = 0.33).
CONCLUSIONS
Pain was the most frequent benchmark when modulating and progressing the exercises, although other criteria were found such as fatigue or self-perceived ability. Progressive exercise seems effective to manage upper limb tendinopathies, but the superiority of a progression criterion against others remains unclear. Low-quality evidence supported progressive exercise with eccentric components in adding a significant and moderate effect on pain/function at short-term.
Topics: Humans; Tendinopathy; Exercise Therapy; Rotator Cuff; Shoulder Pain; Upper Extremity
PubMed: 35964498
DOI: 10.1016/j.msksp.2022.102645 -
Journal of Hand Therapy : Official... 2020Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented... (Review)
Review
INTRODUCTION
Affordable virtual reality (VR) technology is now widely available. Billions of dollars are currently being invested into improving and mass producing VR and augmented reality products.
PURPOSE OF THE STUDY
The purpose of the present study is to explore the potential of immersive VR to make physical therapy/occupational therapy less painful, more fun, and to help motivate patients to cooperate with their hand therapist.
DISCUSSION
The following topics are covered: a) psychological influences on pain perception, b) the logic of how VR analgesia works, c) evidence for reduction of acute procedural pain during hand therapy, d) recent major advances in VR technology, and e) future directions-immersive VR embodiment therapy for phantom limb (chronic) pain.
CONCLUSION
VR hand therapy has potential for a wide range of patient populations needing hand therapy, including acute pain and potentially chronic pain patients. Being in VR helps reduce the patients' pain, making it less painful for patients to move their hand/fingers during hand therapy, and gamified VR can help motivate the patient to perform therapeutic hand exercises, and make hand therapy more fun. In addition, VR camera-based hand tracking technology may be used to help therapists monitor how well patients are doing their hand therapy exercises, and to quantify whether adherence to treatment increases long-term functionality. Additional research and development into using VR as a tool for hand therapist is recommended for both acute pain and persistent pain patient populations.
Topics: Acute Pain; Analgesia; Chronic Pain; Exercise Therapy; Hand; Humans; Video Games; Virtual Reality
PubMed: 32482376
DOI: 10.1016/j.jht.2020.04.001 -
BMC Musculoskeletal Disorders Jun 2018Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to... (Randomized Controlled Trial)
Randomized Controlled Trial
BACKGROUND
Lateral epicondylitis is frequently seen in racquet sport players and the treatments are usually symptomatic rather than curative. Taping therapy is cheap and easy to apply in the sport field. In this study we valued the effectiveness of Kinesio taping (KT) on immediate pain control for patients with chronic lateral epicondylitis.
METHODS
We conducted a randomized, double-blinded, cross-over study with 15 patients with chronic lateral epicondylitis. All participants received two taping sessions in a random order with a 3-day interval in between: one with KT and the other with sham taping (ST). Pain perceived during resisted wrist extension and at rest using numeric rating scale (NRS), the pain-free grip strength, and the pressure pain threshold, were measured before and 15 min after the tape was applied.
RESULTS
A significant reduction of 2.1 ± 1.6 (Z = - 3.081, P = 0.002) and 0.7 ± 0.8 (Z = - 2.428, P = 0.015) was found on a NRS with KT and ST, respectively, indicating that both taping sessions produced immediate pain relief for resisted wrist extension. Both taping sessions significantly improved the pain-free grip strength with increases of 3.31 ± 5.05 (Z = - 2.615, P = 0.009) and 2.43 ± 3.31 (Z = - 2.783, P = 0.005) kg found with KT and ST, respectively. Compared with ST, KT exhibited superiority in controlling pain experienced during resisted wrist extension (Z = - 2.168, P = 0.030).
CONCLUSIONS
Taping produced unneglectable placebo effects on pain relief and painf-free grip strength for patients with lateral epicondylitis, and KT seemed to have additional effects on controlling pain that was elicited by resisted wrist extension.
TRIAL REGISTRATION
ISRCTN13618356 (retrospectively registered on 13/02/2017).
Topics: Adult; Athletic Tape; Chronic Disease; Cross-Over Studies; Double-Blind Method; Elbow; Female; Humans; Male; Middle Aged; Pain; Pain Measurement; Range of Motion, Articular; Tennis Elbow; Wrist
PubMed: 29921250
DOI: 10.1186/s12891-018-2118-3 -
Atencion Primaria May 2022To evaluate the experiencie with a health education program in Primary Care in patients with chronic shoulder pain of musculoskeletal origin, on pain and disability and... (Observational Study)
Observational Study
OBJECTIVE
To evaluate the experiencie with a health education program in Primary Care in patients with chronic shoulder pain of musculoskeletal origin, on pain and disability and establish the protocol in primary care.
DESIGN
Quasi-experimental longitudinal descriptive observational study.
LOCATION
Arroyo de la Vega Health Center, Alcobendas, Madrid.
PARTICIPANTS
Patients referred by their Primary Care Physician to the Primary Care Physiotherapy Unit for shoulder pain of musculoskeletal origin.
INTERVENTION
7 group sessions of health education and therapeutic exercise.
MAIN MEASUREMENTS
Pain intensity was assessed through the Visual Analogue Scale (VAS), the disability of the upper limb with the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire and the level of disability and shoulder pain with the Shoulder Pain and Disability Index (SPADI) questionnaire.
RESULTS
Statistically significant differences were found in the reduction of pain and disability (P<.01), in addition, drug use and recurrences were reduced.
CONCLUSIONS
The shoulder physiotherapy protocol with health education was effective in reducing pain and disability in patients with chronic shoulder pain of musculoskeletal origin in Primary Care.
Topics: Chronic Pain; Health Education; Humans; Musculoskeletal Pain; Observational Studies as Topic; Physical Therapy Modalities; Primary Health Care; Shoulder; Shoulder Pain; Upper Extremity
PubMed: 35461039
DOI: 10.1016/j.aprim.2022.102284 -
Deutsches Arzteblatt International Dec 2022Background: Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The...
BACKGROUND
Background: Complex regional pain syndrome (CRPS) is a relatively common complication, occurring in 5% of cases after injury or surgery, particularly in the limbs. The incidence of CPRS is around 5-26/100 000. The latest revision of the International Statistical Classification of Diseases and Related Health Problems (ICD-11) now categorizes CRPS as a primary pain condition of multifactorial origin, rather than a disease of the skeletal system or the autonomic nervous system.
METHODS
Method: Based on a selective search of the literature, we summarize current principles for the diagnosis and treatment of CRPS.
RESULTS
Results: Regional findings in CRPS are accompanied by systemic symptoms, especially by neurocognitive disorders of body perception and of symptom processing. The therapeutic focus is shifting from predominantly passive peripheral measures to early active treatments acting both centrally and peripherally. The treatment is centered on physiotherapy and occupational therapy to improve sensory perception, strength, (fine) motor skills, and sensorimotor integration/ body perception. This is supported by stepped psychological interventions to reduce anxiety and avoidance behavior, medication to decrease inflammation and pain, passive physical measures for reduction of edema and of pain, and medical aids to improve functioning in daily life. Interventional procedures should be limited to exceptional cases and only be performed in specialized centers. Spinal cord and dorsal root ganglion stimulation, respectively, are the interventions with the best evidence.
CONCLUSION
Conclusion: The modern principles for the diagnosis and treatment of CRPS consider both, physiological and psychological mechanisms, with the primary goal of restoring function and participation. More research is needed to strengthen the evidence base in this field.
Topics: Humans; Complex Regional Pain Syndromes; Pain; Physical Therapy Modalities; Extremities; Pain Measurement
PubMed: 36482756
DOI: 10.3238/arztebl.m2022.0358 -
The Journal of Manual & Manipulative... Apr 2023Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred)...
Low back pain (LBP) that radiates to the leg is not always related to a lesion or a disease of the nervous system (neuropathic pain): it might be nociceptive (referred) pain. Unfortunately, patients with low-back related leg pain are often given a variety of diagnoses (e.g. 'sciatica'; 'radicular pain'; pseudoradicular pain"). This terminology causes confusion and challenges clinical reasoning. It is essential for clinicians to understand and recognize predominant pain mechanisms. This paper describes pain mechanisms related to low back-related leg pain and helps differentiate these mechanisms in practice using clinical based scenarios. We illustrate this by using two clinical scenarios including patients with the same symptoms in terms of pain localization (i.e. low-back related leg pain) but with different underlying pain mechanisms (i.e. nociceptive versus neuropathic pain).
Topics: Humans; Low Back Pain; Leg; Pain Measurement; Sciatica; Neuralgia; Pain, Referred
PubMed: 35735104
DOI: 10.1080/10669817.2022.2092266 -
Trials Apr 2022Clinical recommendations suggest exercises as the main treatment modality for patients with knee osteoarthritis (OA). This study aimed to compare the effects of two...
Comparison of the open kinetic chain and closed kinetic chain strengthening exercises on pain perception and lower limb biomechanics of patients with mild knee osteoarthritis: a randomized controlled trial protocol.
BACKGROUND
Clinical recommendations suggest exercises as the main treatment modality for patients with knee osteoarthritis (OA). This study aimed to compare the effects of two different exercise interventions, i.e., open kinetic chain (OKC) and closed kinetic chain (CKC) exercises, on the pain and lower limb biomechanics of patients with mild knee OA.
METHOD
A total of 66 individuals with painful early knee OA, aged 50 years and above, with body mass index (BMI) between 18.9kg/m and 29.9 kg/m in Kelantan, Malaysia, will be recruited in this study. Participants will be randomly allocated into three different groups, either the OKC, CKC, or control groups. All three groups will attend an individual session with a physiotherapist. The participants in the OKC and CKC groups will perform the exercises three times weekly for 8 weeks at their home. The control group will receive education about clinical manifestations, risk factors, diagnosis, treatment, and nursing care for knee via printed materials. The primary outcomes include self-reported pain scores (visual analog scale), disability scores (Western Ontario and McMaster Universities Arthritis Index), and quality of life scores (Osteoarthritis Knee and Hip Quality of Life). Secondary outcomes include lower limb biomechanics during gait and sit-to-stand as well as isokinetic knee strength. The outcomes will be measured before and after the intervention.
DISCUSSION
The present study will compare the effects of two different home-based exercise intervention programs among patients with mild knee OA. The study findings will provide vital information that can be used to design an effective exercise program that aims at delaying the OA progression.
TRIAL REGISTRATION
The protocol was registered on 22 December 2020 at ClinicalTrials.gov (registration number: NCT04678609 ).
Topics: Biomechanical Phenomena; Exercise Therapy; Humans; Lower Extremity; Osteoarthritis, Knee; Pain; Pain Perception; Quality of Life; Randomized Controlled Trials as Topic; Treatment Outcome
PubMed: 35428274
DOI: 10.1186/s13063-022-06153-8