Associations Between Gluteus Medius Trigger Points With Hip Passive Range of Movement and Muscle Strength in Adults With Chronic Nonspecific Low Back Pain: A Cross-Sectional Study.

OBJECTIVE: The purpose of this study was to investigate whether there is a relationship between gluteus medius trigger points with hip passive range of motion and hip muscle strength in people with chronic nonspecific low back pain (LBP). METHODS: This was a cross-sectional, blinded study that took place in 2 rural communities in New Zealand. Assessments were carried out in physiotherapy clinics in these towns. A total of 42 participants over 18 years old experiencing chronic nonspecific LBP were recruited. After meeting inclusion criteria, participants completed the following 3 questionnaires: Numerical Pain Rating Scale, Oswestry Disability Index, and Tampa Scale of Kinesiophobia. The primary researcher (a physiotherapist) assessed each participant's bilateral hip passive range of movement (using an inclinometer) and muscle strength (using a dynamometer). Following this, a blinded trigger point assessor examined the gluteus medius muscles for the presence of active and latent trigger points. RESULTS: General linear modeling using univariate analysis revealed that there was a positive association between hip strength and trigger point status (P =.03 left internal rotation, P =.04 right internal rotation, and P =.02 right abduction). Participants with no trigger points showed higher strength values (eg, right internal rotation standard error: 0.64), and those with trigger points showed lower strength. Overall, muscles exhibiting latent trigger points were the weakest (eg, right internal rotation standard error: 0.67). CONCLUSION: The presence of active or latent gluteus medius trigger points was associated with hip weakness in adults with chronic nonspecific LBP. There was no association between gluteus medius trigger points and hip passive range of movement.

A 36-month clinical experience of the effectiveness of curettage and imiquimod 5% cream in the treatment of basal cell carcinoma.

BACKGROUND: Electrodesiccation and curettage is commonly used for the treatment of basal cell carcinomas (BCCs). Does the addition of imiquimod 5% cream improve clearance rates and cosmetic outcomes? OBJECTIVE: To evaluate a 3-year clinical experience of the effectiveness of curettage combined with imiquimod cream in the treatment of BCC. METHODS: Patients were enrolled into the study in the first 10 months of 2003. All patients had biopsy-confirmed BCCs and were treated with curettage followed by imiquimod 5% cream 5 times weekly for 6 weeks. RESULTS: Ninety patients with 101 tumors were treated; a clearance rate of 96% was obtained. Twenty-five sites were rebiopsied at 6 weeks after therapy, regardless of clinical findings. Two of these biopsies showed persistent BCC. The remaining 76 sites were followed clinically and only rebiopsied for clinical signs of reoccurrence. Two additional BCCs reoccurred at 23 months and 25 months, respectively. All patients were followed a minimum of 13 month with an average of 36 months. There were minimal cutaneous side effects and no systemic side effects. CONCLUSIONS: Curettage followed by the application of imiquimod 5% cream resulted in clearance rates of 96% at an average 36 months follow-up. The treatment was well-tolerated and appears to produce a favorable cosmetic outcome.

Topical imiquimod therapy for basal and squamous cell carcinomas: a clinical experience.

Basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (SCCs) are the most common malignancies in humans. Together, they constitute approximately 95% of nonmelanoma skin cancers (NMSCs). Surgical excision remains the mainstay of therapy of low-risk NMSC, though Mohs micrographic surgery is the gold standard for high-risk NMSC. Both methods produce high cure rates, but they may not be appropriate treatments for elderly patients who are either not surgical candidates or refuse to undergo surgery for their skin cancers. Imiquimod cream 5% is a topical immune response modifier that targets the toll-like receptors 7 and 8 and up-regulates inflammatory pathways targeting diseased tissue. This noninvasive topical therapy may be more appropriate for some patients. Herein, we describe our 5-month clinical experience in mostly elderly subjects with BCC (n=21) or SCC (n= 19) who were not candidates for surgical excision and were treated with topical imiquimod. Most subjects had a history of skin cancer, and the median age of the subjects was 78 years and 79 years in the BCC and SCC groups, respectively. After biopsy alone or biopsy followed by curettage, subjects received imiquimod cream 5% once daily 5 times weekly for 6 weeks. Twenty-three BCC lesions and 22 SCC lesions were included in the analysis. Most of the 45 lesions treated were located on the head and most were in high-risk areas. Approximately 3 months after imiquimod therapy, repeat biopsies showed that only 3 (2 BCCs and 1 SCC) lesion sites had residual tumor. After a median follow-up of 26 months, there was only one additional SCC recurrence. We also present a selection of representative case studies. Imiquimod cream 5% as adjunctive therapy to curettage was safe and well-tolerated in this mostly elderly population. The improved residual tumor and recurrence rates compared with historical rates for electrodesiccation and curettage (ED&C) alone suggest that adjunctive imiquimod therapy may be an appropriate treatment option for patients who desire or require less invasive treatment for NMSCs.