Menthol-Based Topical Analgesic Induces Similar Upper and Lower Body Pain Pressure Threshold Values: A Randomized Trial.

CONTEXT: Both health professionals and consumers use menthol-based topical analgesics extensively for the temporary relief of pain from musculoskeletal ailments or injury. However, there are no reports of differences in the pain pressure threshold (PPT) or the relative effectiveness of topical analgesics to reduce pain in the upper and lower body muscles and tendons. The objective of this study was to investigate whether differences existed in PPT and relative pain attenuation associated with a menthol-based topical analgesic over a variety of upper and lower body muscles and tendons. DESIGN: Randomized allocation, controlled, intervention study. METHODS: Sixteen participants (10 females and 6 males) were tested on their dominant or nondominant side. The order of specific muscle/tendon testing was also randomized, which included upper body (middle deltoid, biceps brachii, and lateral epicondylar tendon) and lower body locations (quadriceps, hamstrings, gastrocnemius, lumbosacral erector spinae muscles, and patellar and Achilles tendons). The PPT was monitored before and 15 minutes following the application of a menthol-based topical analgesic. RESULTS: A menthol-based topical analgesic increased PPT (decreased pain sensitivity) overall (P = .05; 11.6% [2.4%]; d = 1.05) and PPT was higher (P < .0001; 31.5%-44.2%; d = 1.03-1.8) for lower versus upper body locations. CONCLUSIONS: Health professionals and the public can be assured of similar reductions in pain sensitivity independent of the location of application of a menthol-based topical analgesic.

Prevalence and risk factors of self-reported wrist and hand symptoms and clinically confirmed carpal tunnel syndrome among office workers in China: a cross-sectional study.

BACKGROUND: Carpal tunnel syndrome (CTS) is a common cause of pain, numbness and tingling in the wrist and hand region and is associated with repetitive wrist and hand use in office workers. However, scarce knowledge exists about the epidemiology of clinically confirmed CTS among Chinese office workers. This study aimed to investigate the prevalence of wrist/hand symptoms and CTS in office workers in China and to identify associated risk factors. METHODS: A cross-sectional survey was carried out in a metropolitan city in China involving 969 respondents (aged 17-49 years) from 30 workplaces. A questionnaire was distributed to each participant to collect their demographic, work-related physical and psychosocial factors, and wrist and hand symptoms. The wrist and hand pain/numbness symptoms were marked on a body chart and the nature and intensity of symptoms, nocturnal symptoms, as well as aggravating activities were also recorded. Clinically confirmed CTS cases were screened based on the history, Phalen's test, Tinel Sign and skin sensation testing among symptomatic respondents. Logistic regression was employed to estimate the odds ratio (OR) and 95% confidence interval (95% CI) for the occurrence of self-reported wrist and hand symptoms and clinically confirmed CTS. RESULTS: The clinically confirmed CTS prevalence was 9.6%. The prevalence of wrist and hand symptoms were 22 and 15%, respectively. Frequently working in pain was associated with higher odds of CTS. Multivariate modelling adjusted for age and gender showed that prolonged computer use time and working without breaks were associated with presence of wrist/hand symptoms (adjusted ORs: 1.11 (95% CI 1.02-1.22) and 1.88 (95% CI 1.12-3.14)). Educational level was inversely associated with CTS and smoking was associated with wrist/hand complaints (adjusted OR: 2.20 (95% CI 1.19-4.07)). CONCLUSIONS: The prevalence of work-related clinically confirmed CTS symptoms among young office workers in China is high. Frequently working in pain is closely associated with clinically confirmed CTS. Intense computer use and no breaks at work are associated with wrist and hand symptoms.

A prospective study of gastro-oesophageal reflux disease symptoms and quality of life 1-year post-laparoscopic sleeve gastrectomy.

INTRODUCTION: There are concerns that laparoscopic sleeve gastrectomy (LSG) can cause severe gastro-oesophageal reflux disease (GORD). The aim of this study was to assess GORD symptoms and quality of life following LSG. METHODS: A prospective study of patients undergoing LSG (2014-2016) was performed with follow-up by DeMeester Reflux/Regurgitation Score, Bariatric Quality of Life Index (BQLI) and Bariatric Analysis and Reporting Outcome System (BAROS) Score pre-operatively, 6 months and 1-year post-operatively. RESULTS: Twenty-two patients were studied. Mean modified DeMeester Reflux/Regurgitation Score improved from 2.25 (±0.67) pre-operatively to 0.81 (±0.25) at 12 months (P = 0.04). At 12 months, two patients had symptomatic reflux, but overall satisfaction score was unaffected. Mean BQLI Score underwent a non-significant improvement at 12 months. BAROS Score showed all patients to have excellent (n = 19) or very good (n = 3) results (12 months). CONCLUSION: GORD symptoms improve for most patients' 1-year post-operatively. A small proportion of patients will develop troublesome GORD, but overall satisfaction remains high.

The Efficacy of Dynamic Contract-Relax Stretching on Delayed-Onset Muscle Soreness Among Healthy Individuals: A Randomized Clinical Trial.

OBJECTIVE: To evaluate the efficacy of dynamic contract-relax stretching on delayed-onset muscle soreness (DOMS) in the calf muscle of healthy individuals. DESIGN: Randomized clinical trial. SETTING: Research laboratory. PARTICIPANTS: Three groups of 16 healthy participants (n = 48) were recruited by convenience sampling. INTERVENTIONS: Three sets of resisted bilateral heel-raising exercises until exhaustion were conducted to initiate DOMS. Participants were randomly allocated into control group without any interventions, dynamic contract-relax stretching (DS), or static stretching (SS) groups. Dynamic contract-relax stretching and SS groups performed DS and SS, respectively, on the dominant leg twice a day for 5 consecutive days (before time points of outcome measurements at 24, 48, 72, 96, and 120 hours postexercise, respectively). MAIN OUTCOME MEASURES: Muscle soreness, lower leg girth, pressure pain threshold (PPT), range of motion (ROM), and muscle strength were measured before exercise, immediately after, and at 24, 48, 72, 96, and 120 hours postexercise. RESULTS: There was a significant effect of time in all outcome measures including muscle soreness, lower leg girth, PPT, ROM, and muscle strength; however, there were no significant group differences or group by time interactions. CONCLUSIONS: The effect of DS on relieving DOMS in the calf muscle is insignificant in this study. Further evidence is needed to prove the efficacy of DS on DOMS. CLINICAL RELEVANCE: Stretching is commonly recommended before and after exercise; however, this study showed no significant impact of DS or SS in treating DOMS.

Exercise and ankle sprain injuries: a comprehensive review.

Ankle sprains are common in team sports and sports played on courts, and often result in structural and functional alterations that lead to a greater reinjury risk. Specific exercises are often used to promote neuromuscular improvements in the prevention and rehabilitation of ankle injuries. This literature review summarizes the neuromuscular characteristics of common ankle sprains and the effectiveness of exercise as an intervention for improving neuromuscular function and preventing reinjury. Our review found that appropriate exercise prescription can increase static and dynamic balance and decrease injury recurrence. In particular, the addition of dynamic activities in the exercise program can be beneficial because of the anticipatory postural adjustments identified as a key factor in the injury mechanism.

Diagnostic Musculoskeletal Ultrasound for Medial Collateral Ligament Injuries: Applications in Rehabilitation.

Medial collateral ligament (MCL) injuries are prevalent in sports and other physical activities and constitute a significant cause of knee pain and dysfunction. Traditional diagnostic modalities such as magnetic resonance imaging (MRI) are often utilized for their detailed visualization capabilities. However, musculoskeletal ultrasound (MSK-US) has emerged as a pivotal diagnostic tool in the evaluation of MCL injuries due to its non-invasive nature, cost-effectiveness, and dynamic imaging capabilities. This article reviews the utility and advantages of MSK-US in diagnosing MCL injuries, with a specific focus on its implications for rehabilitation providers. We discuss the technical aspects of ultrasound (US) imaging, including the sonographic appearance of MCL injuries across various grades, and compare its diagnostic accuracy with other imaging modalities such as MRI. Additionally, the role of US in monitoring the healing process and guiding rehabilitation strategies is explored. This review emphasizes the practical application of MSK-US in clinical settings, offering rehabilitation providers a comprehensive understanding of how US can be integrated into patient management protocols to enhance outcomes in patients with MCL injuries.

Utilizing Diagnostic Musculoskeletal Ultrasound for Assessment of the Infraspinatus Muscle and Tendon: Implications for Rehabilitation Professionals.

The rotator cuff, comprising the subscapularis, supraspinatus, infraspinatus, and teres minor muscles, plays a crucial role in stabilizing the glenohumeral joint by securing the head of the humerus within the glenoid cavity of the scapula. The tendinous insertions of these muscles generate tension within the capsule, enhancing joint stability during muscular activity. The rotator cuff is susceptible to damage from disease, injury, or trauma, which can result in tears or ruptures of one or more tendons. The evaluation of the infraspinatus muscle and tendon is vital for diagnosing and managing various shoulder pathologies. Accurate imaging to determine the specific muscle involvement and injury severity significantly impacts treatment decisions. Diagnostic musculoskeletal ultrasound (MSK-US) has emerged as a valuable tool for assessing the infraspinatus muscle and tendon, offering real-time, dynamic assessment capabilities essential for precise diagnosis and effective rehabilitation planning. This article reviews the utility and advantages of MSK-US in evaluating the infraspinatus muscle and tendon, emphasizing technique specifics, diagnostic accuracy, and comparative efficacy against other imaging modalities. It details a systematic approach to the ultrasound examination technique for the infraspinatus, including patient positioning and identification of common pathologies such as tears, tendinopathy, and calcifications. With recent advancements in transducer strength, image resolution, and operator training, ultrasound serves as an excellent alternative imaging modality for diagnosing rotator cuff tears. This article aims to equip rehabilitation professionals with a comprehensive understanding of MSK-US as a diagnostic tool for the infraspinatus, promoting more precise diagnosis, treatment planning and improved patient outcomes.

MSK Ultrasound: A Powerful Tool for Evaluating and Diagnosing Pectoralis Major Injuries in Healthcare Practice.

Accurately diagnosing pectoralis major injuries, particularly in athletes, often presents a challenge for healthcare practitioners. Although pectoralis muscle injuries are relatively uncommon, the diagnosis of a tear may be overlooked without careful screening by a thorough physical examination of both the injured and uninjured sides. While magnetic resonance imaging (MRI) has traditionally held the gold standard, musculoskeletal ultrasound (MSKUS) has emerged as a viable alternative. This article delves into the power of MSKUS in evaluating and diagnosing pectoralis major injuries, highlighting its dynamic capabilities, real-time visualization, and cost-effectiveness in comparison to MRI. By equipping healthcare professionals with a thorough understanding of MSKUS's potential, this article aims to empower them to confidently diagnose and manage pectoralis major injuries, ultimately improving patient outcomes and facilitating a faster return to function.

Enhancing the Diagnosis of Lateral Ankle Sprains: The Role of MSK Diagnostic Ultrasound in Evaluating ATFL and CFL.

Lateral ankle sprains, predominantly involving the anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL), constitute a significant portion of sports-related injuries, with a notable rate of recurrence and progression to chronic instability. Precise diagnosis and effective treatment of the ATFL and CFL injuries are crucial in preventing long-term complications. Musculoskeletal (MSK) diagnostic ultrasound has emerged as a pivotal tool in the rehabilitation sector, particularly in assessing lateral ankle ligament injuries. This article will highlight its benefits over traditional diagnostic methods and the emerging role of MSK diagnostic ultrasound as a superior tool for accurate, cost-effective, and comprehensive assessment of these injuries. We discuss the technology's ability to provide objective, real-time imagery, facilitating accurate diagnosis, treatment planning, and injury monitoring emphasizing the need for a standardized approach to ultrasound evaluation to improve diagnostic accuracy and patient outcomes.

MSK Diagnostic Ultrasound for the Assessment of the Acromioclavicular Joint.

The acromioclavicular joint (ACJ), a key element in shoulder movement and stability, is prone to various injuries such as sprains, dislocations, and osteoarthritis, typically resulting from physical trauma or wear and tear. Accurate and timely diagnosis is paramount for effective treatment and rehabilitation. Musculoskeletal (MSK) ultrasound has emerged as a pivotal diagnostic tool due to its ability to visualize soft tissues and provide real-time imaging. This non-invasive tool is also invaluable for monitoring healing progress and the evolution of osteoarthritic changes. This article reviews the application of MSK ultrasound in the evaluation of ACJ injuries, highlighting its advantages, specific applications, and recent technological advancements that enhance its diagnostic capabilities.

Utilizing Diagnostic Musculoskeletal Ultrasound in the Evaluation of Cubital Tunnel Syndrome and Ulnar Nerve Pathology.

Cubital Tunnel Syndrome (CTS), is a frequently encountered condition in clinical settings, typically arising from static or dynamic compression of the ulnar nerve. CTS is characterized by the irritation of the ulnar nerve within the cubital tunnel and is a common neuropathic condition that can significantly impact functional abilities and quality of life. This article explores the utility of diagnostic musculoskeletal ultrasound (MSK-US) in the evaluation of the cubital tunnel and the ulnar nerve. The cubital tunnel syndrome, a common entrapment neuropathy of the ulnar nerve, often presents diagnostic challenges. Traditionally, nerve conduction studies and electromyography have been the primary diagnostic tools used to diagnose CTS. Given the superficial nature of the ulnar groove and its adjacent structures, MSK-US imaging known for its non-invasive nature and high-resolution imaging capabilities, has become an increasingly valuable tool in the assessment and management of various musculoskeletal conditions. This article reviews the technical aspects of MSK-US, its advantages in visualizing the ulnar nerve and related structures, and its implications in clinical practice for rehabilitation providers. By integrating MSK-US in the evaluation of CTS, rehabilitation professionals can enhance diagnostic accuracy, tailor interventions, and improve patient outcomes.

Use of Diagnostic Musculoskeletal Ultrasound in the Evaluation of Piriformis Syndrome: A Review for Rehabilitation Providers.

Piriformis Syndrome (PS) is a neuromuscular condition caused by the entrapment of the sciatic nerve at the level of the piriformis muscle (PM) and can cause significant discomfort and disability. PS is often misdiagnosed due to its overlapping symptoms with other lumbar and sciatic issues and as such, diagnosing PS remains challenging despite recent invasive and non-invasive diagnostic methods. Diagnostic musculoskeletal ultrasound (MSK US) offers a non-invasive, cost-effective alternative for the identification and evaluation of PS, providing dynamic, real-time imaging of the PM and adjacent structures. This article reviews the applications, advantages, and procedural insights of MSK US in the diagnosis of PS, emphasizing its relevance in rehabilitation settings. We discuss the technical aspects of ultrasound use, interpretation of findings, and integration into clinical practice, aiming to enhance the diagnostic accuracy and therapeutic outcomes for patients with suspected PS.

The Utilization of Diagnostic Musculoskeletal Ultrasound in the Evaluation of Gluteus Medius Tendon Pathology: A Perspective for Rehabilitation Providers.

Gluteus medius tendon pathology, encompassing tendinopathy and tears, is a significant source of lateral hip pain and functional impairment. Traditional diagnostic approaches have relied on clinical examination and magnetic resonance imaging (MRI). However, the advent of diagnostic musculoskeletal ultrasound (MSKUS) has transformed the evaluation process. Musculoskeletal ultrasound has emerged as a highly valuable diagnostic tool in the evaluation of gluteus medius tendon pathology, offering a non-invasive, cost-effective, and dynamic assessment method. This modality provides real-time visualization of soft tissue, enabling the detailed examination of tendon structure, vascularity, and associated musculature. For rehabilitation providers, understanding the application, strengths, and limitations of diagnostic MSKUS can enhance clinical decision-making, facilitate targeted therapeutic interventions, and potentially expedite the recovery process. This article reviews the application of MSKUS in diagnosing gluteus medius tendon pathology and its implications for rehabilitation practice. This should help to equip rehabilitation professionals with knowledge to better integrate this diagnostic tool into their clinical repertoire.

The Use of MSK Ultrasound with Quadriceps Muscle Injury.

Quadriceps muscle injury is a common occurrence, especially among athletes. While a careful history and a thorough physical examination are important steps in the assessment of quadriceps muscle pathology, it is still difficult to differentiate the type and severity of the pathology. Because of this difficulty, musculoskeletal ultrasound (MSK-US) is an invaluable tool in the diagnosis of quadriceps muscle or tendon injury. Utilizing this noninvasive imaging technique, medical professionals can easily diagnose and monitor muscle and tendon disorders to quickly determine the correct treatment plan for each individual case. The ability to view these structures in real-time allows identification of any present pathologies. MSK-US has become a useful component in diagnosing quadriceps muscle and tendon injuries due to its ability to clearly display the affected structures without exposing the patient to radiation or utilizing ionized contrast media. MSK-US provides valuable insight into fluid dynamics around joints and can even detect myotendinous tears that might otherwise be overlooked with the clinical examination or symptoms usually reported by patients. MSK-US can provide precise visualization of edema and can easily distinguish between benign and potentially pathological findings which make it an integral part of any holistic evaluation of quadriceps muscle and tendon injury. Additionally, it can be used to track the progress of physical therapy treatments and monitor tissue healing. This information is invaluable in ensuring an optimal outcome for any quadriceps muscle and tendon injury. Therefore, when used in combination with clinical tests, MSK-US can drastically increase the accuracy of the clinical examination. By utilizing this technology, healthcare practitioners have reliable access to more comprehensive diagnostics for musculoskeletal injuries and diseases than ever before. Clinicians are then able to tailor rehabilitation plans more effectively and ensure their patients receive proper treatment. As a result, recovery times may be shortened, and patients are able to return to their normal activities more quickly.

MSK Ultrasound - An IJSPT Perspective.

MSK ultrasound is a valuable imaging technique which has become increasingly popular in recent years. This efficient technique proves beneficial in a variety of ways. MSK ultrasound effectively streamlines the process by enabling practitioners to securely and accurately image and assess structures all in one simple step. By allowing healthcare providers to access critical information quickly and conveniently, MSK ultrasound can help identify conditions early when interventions are most effective. Moreover, it may be able to shorten diagnostic times and reduce costs through more cost-effective use of resources such as imaging and laboratory testing. Furthermore, MSK ultrasound can provide additional insights into musculoskeletal anatomy and help improve patient care and outcomes. In addition, utilizing this method reduces exposure to radiation and provides enhanced patient comfort with its quick scan duration. MSK ultrasound has a high potential to provide quick and accurate diagnosis of MSK disturbances when used correctly. As clinicians become more comfortable and familiar with this technology, we will continue to see its use expand for various MSK assessments. In this commentary we'll explore how ultrasound can be used in physical therapy, specifically for musculoskeletal assessment. We'll also look at some of the potential benefits and limitations of using ultrasound in PT practice.

The Use of MSK Ultrasound in the Evaluation of Elbow Ulnar Collateral Ligament Injuries.

As physical therapists, understanding the anatomy and biomechanics of the musculoskeletal system is essential for accurate diagnosis and effective treatment outcomes. Musculoskeletal ultrasound (MSK-US) is one tool that has revolutionized the way physical therapists evaluate musculoskeletal pathology. Specific to the elbow, assessing the ulnar collateral ligament (UCL) proves especially beneficial for providing both diagnosis and treatment planning. By directly visualizing static and dynamic loads to the ligament, physical therapists can gain valuable information about underlying pathology and guide the therapeutic decision-making process. In this sound byte, we will look at how incorporating MSK-US imaging into your patient assessments can provide you with more comprehensive data to make informed clinical decisions when treating UCL injuries in the elbow.

Musculoskeletal Ultrasound: An Essential Tool in Diagnosing Patellar Tendon Injuries.

Musculoskeletal (MSK) ultrasound has emerged as a vital tool in diagnosing patellar tendon injuries. Traditional imaging techniques, such as X-rays and Magnetic Resonance Imaging, have certain limitations in assessing soft tissue structures or may not be easily accessible. MSK ultrasound, with its high-resolution, real-time imaging capabilities, offers a cost-effective, safe, and patient-friendly alternative. It allows for accurate visualization of the patellar tendon's structure and function, thereby facilitating the identification of pathological changes such as thickening, thinning, or disruption which aids in diagnosing conditions such as tendonitis, partial tears, and ruptures. Furthermore, MSK ultrasound serves as an invaluable tool for guiding interventions like injections, as it provides real-time imaging. This article explores the role and benefits of MSK ultrasound in diagnosing patellar tendon injuries, highlighting its cost-effectiveness, accessibility, real-time assessment capabilities, and reduced patient burden compared to other imaging modalities. Despite its numerous benefits, the need for ongoing research to enhance its utility is highlighted. As technology advances, MSK ultrasound is set to revolutionize the early detection and management of patellar tendon injuries.

Using MSK Ultrasound in the Evaluation of Subscapularis Injuries.

The shoulder is an area that can be prone to a variety of injuries, including subscapularis tendon tears. The subscapularis muscle is one of the four muscles that make up the rotator cuff in the shoulder and plays an essential role in stabilizing the shoulder joint while at the same time facilitating internal rotation of the humerus. Injuries to the subscapularis can occur due to trauma, overuse, or degeneration, leading to pain, weakness, and limited mobility. When injury occurs, subscapularis tendon tears are often difficult to diagnose and evaluate due to their location deep within the shoulder joint. While traditional imaging techniques like radiographs, and magnetic resonance imaging may give us insight into the structures present, they do not always provide detailed enough information for clinicians. Ultrasound has become increasingly popular in musculoskeletal (MSK) rehabilitation as it allows for direct visualization of soft tissue abnormalities like tendinopathies or subtle rotator cuff tear patterns. In this Ultrasound Bites article, we will discuss how MSK ultrasound can be used in the evaluation of subscapularis tendon pathology with a specific focus on its utility in the physical therapy clinic.

The Application of Musculoskeletal Ultrasound in the Diagnosis of Supraspinatus Injuries.

Musculoskeletal (MSK) diagnostic ultrasound has become an invaluable tool in the assessment of musculoskeletal pathologies, including rotator cuff injuries, notably the supraspinatus tendon. MSK ultrasound, characterized by high-resolution and real-time imaging capabilities, presents a cost-effective, safe, and patient-friendly alternative. This modality allows precise visualization of the supraspinatus tendon's structure and function, aiding in the identification of pathological alterations, such as thickening, thinning, or disruption, critical in diagnosing conditions like tendonitis, partial tears, and ruptures. In this manuscript, we detail the diagnostic utility of MSK ultrasound in assessing supraspinatus injuries, discussing the indications, techniques, and findings relevant to the supraspinatus tendon. Moreover, we examine the advantages and limitations of this imaging modality and provide a step-by-step guide for accurate supraspinatus tendon evaluation. The evidence suggests that MSK ultrasound is a dependable and cost-effective imaging technique for diagnosing supraspinatus injuries when executed by skilled operators.