Do the General Public and Health Care Professionals Think That Running Is Bad for the Knees? A Cross-sectional International Multilanguage Online Survey.

Background: Running is a popular sport with widely recognized health benefits. Given the high rates of knee injury in runners and the growing prevalence of knee osteoarthritis (KOA), it may be useful to assess perceptions about running and knee joint health. Purpose: The objectives of this study were to (1) explore and compare the perceptions of the general public (PUB) and health care professionals (HCPs) on the topic of running and knee health and (2) explore recommendations about running and knee health provided by HCPs. Study Design: Cross-sectional study. Methods: We conducted an online survey between June 18 and October 1, 2020. The questionnaire included questions on running and knee health, and HCPs were asked about their typical recommendations and level of confidence in providing recommendations on the topic. Perceptions (proportions) were compared between the PUB and HCPs using the chi-square test. Results: In total, 4521 responses (PUB, n = 2514; HCPs, n = 2007) were analyzed. A greater proportion of HCPs perceived regular running as healthy for knees (86% vs 68%; P < .001). More of the PUB than HCPs (P < .001) believed that running frequently (29% vs 13%), long distances (54% vs 45%), and on hard surfaces (60% vs 36%) increased the risk of developing KOA. Running for those with KOA was perceived by the PUB as posing an increased risk of getting more knee pain (48%) and needing joint replacement surgery (38%), more so than by HCPs (26% and 17%, respectively). The majority of HCPs reported being relatively confident in providing evidence-based recommendations about running and knee health and mostly recommended that runners with KOA modify training parameters instead of quit. Conclusion: More HCPs perceived running as healthy for knees when compared with the PUB. Most HCPs felt confident in providing evidence-based recommendations about running and knee health.

Quantitative volume and dynamic contrast-enhanced MRI derived perfusion of the infrapatellar fat pad in patellofemoral pain.

BACKGROUND: Patellofemoral pain (PFP) is a common knee condition and possible precursor of knee osteoarthritis (OA). Inflammation, leading to an increased perfusion, or increased volume of the infrapatellar fat pad (IPFP) may induce knee pain. The aim of the study was to compare quantitative dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) parameters, as imaging biomarkers of inflammation, and volume of the IPFP between patients with PFP and controls and between patients with and without IPFP edema or joint effusion. METHODS: Patients with PFP and healthy controls were included and underwent non-fat suppressed 3D fast-spoiled gradient-echo (FSPGR) and DCE-MRI. Image registration was applied to correct for motion. The IPFP was delineated on FSPGR using Horos software. Volume was calculated and quantitative perfusion parameters were extracted by fitting extended Tofts' pharmacokinetic model. Differences in volume and DCE-MRI parameters between patients and controls were tested by linear regression analyses. IPFP edema and effusion were analyzed identically. RESULTS: Forty-three controls and 35 PFP patients were included. Mean IPFP volume was 26.04 (4.18) mL in control subjects and 27.52 (5.37) mL in patients. Median Ktrans was 0.017 (0.016) min-1 in control subjects and 0.016 (0.020) min-1 in patients. None of the differences in volume and perfusion parameters were statistically significant. Knees with effusion showed a higher perfusion of the IPFP compared to knees without effusion in patients only. CONCLUSIONS: The IPFP has been implicated as source of knee pain, but higher DCE-MR blood perfusion, an imaging biomarker of inflammation, and larger volume are not associated with PFP. Patient's knees with effusion showed a higher perfusion, pointing towards inflammation.

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review.

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making. METHODS: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention. RESULTS: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from -0.3 (95% CI -0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (-0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery. CONCLUSIONS: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA.

RADIOGRAPHIC HIP OSTEOARTHRITIS IS PREVALENT, AND IS RELATED TO CAM DEFORMITY 12-24 MONTHS POST-HIP ARTHROSCOPY.

BACKGROUND: The prevalence of radiographic hip osteoarthritis (OA), and its relationship with outcomes after hip arthroscopy is unclear. OBJECTIVES: The aims of this study were to: (i) describe the prevalence of OA and cam deformity 12-24 months post hip arthroscopy; (ii) to determine the association between radiographic OA and cam deformity, surgical and clinical findings and symptoms; and (iii) describe the differences between legs for radiological and clinical findings. STUDY DESIGN: Cross sectional study. METHODS: Seventy patients, mean age 36.7(range 18-59) years, 12-24 months post-arthroscopy. MAIN OUTCOME MEASURES: Outcomes were collected prospectively via clinical and radiographic examination. (i)Prevalence of OA and cam deformity measured on and anteroposterior pelvic radiographs; (ii)Hip disability and Osteoarthritis Outcome Score (HOOS) and International Hip Outcome Tool (iHOT-33) patient-reported outcomes (PROs); (iii)hip internal and external rotation range of motion (ROM). Associations between OA and surgical findings, PROs and clinical findings were determined using generalized estimated equations, between operated and non-operated sides. RESULTS: The prevalence of OA was 37%. The likelihood of OA 12-24 months after surgery was positively associated with alpha angle size 12-24 months post-hip arthroscopy surgery (p=0.010). There were no differences between operated and non-operated legs in radiographic or clinical findings. CONCLUSION: Radiographic OA is prevalent in a population which has undergone hip arthroscopy. Increased OA severity is associated with a higher alpha angle 12-24 months post-surgery. LEVEL OF EVIDENCE: Cross-sectional study Level IV.

Long-term effects of a randomized, controlled, tailor-made weight-loss intervention in primary care on the health and lifestyle of overweight and obese women.

BACKGROUND: Maintenance of weight loss after a diet and exercise intervention is often low. Moreover, short follow-up periods and high attrition rates often impede translation of study results to clinical practice. OBJECTIVE: The present study evaluated the long-term effectiveness of a randomized, tailor-made lifestyle intervention, consisting of diet and exercise, on the health and lifestyle of overweight, middle-aged women in primary care. DESIGN: The intervention was part of a randomized controlled trial on the prevention of knee osteoarthritis [PROOF (PRevention of knee Osteoarthritis in Overweight Females) study]. The intervention lasted 2.5 y and consisted of visits to the dietitian and participation in physical activity classes, supervised by a physiotherapist. The outcome of main interest of the present study was weight change (in kg) 6-7 y after randomization. Additionally, the intervention's effect on change in physical activity was investigated. RESULTS: After 6 mo, weight loss was significantly higher in the intervention group (adjusted difference: 1.34 kg; 95% CI: 0.46, 2.22 kg). Over time, this difference decreased and became nonsignificant after 24 mo. Per-protocol analyses showed similar results. After 6 mo, change in physical activity was significantly higher in the intervention group (15.2%; 95% CI: 28.6%, 1.7%). Over time, this difference increased up to 29.8% (95% CI: 2.3%, 57.2%) after 6.6 y of follow-up. Per-protocol analyses showed no significant differences in change in physical activity. CONCLUSIONS: A long-lasting intervention effect on change in physical activity was found, which increased over time. For weight change, smaller differences were found, which decreased over time. In future research, greater intervention effects on weight change are expected when higher compliance rates can be reached. The present study provides important recommendations for future research. The PROOF study was registered at http://www.isrctn.com as ISRCTN42823086.

No Difference on Quantitative Magnetic Resonance Imaging in Patellofemoral Cartilage Composition Between Patients With Patellofemoral Pain and Healthy Controls.

BACKGROUND: Retropatellar cartilage damage has been suggested as an etiological factor for patellofemoral pain (PFP), a common knee condition among young and physically active individuals. To date, there is no conclusive evidence for an association between cartilage defects and PFP. Nowadays, advanced quantitative magnetic resonance imaging (MRI) techniques enable estimation of cartilage composition. PURPOSE: To investigate differences in patellofemoral cartilage composition between patients with PFP and healthy control subjects using quantitative MRI. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: Patients with PFP and healthy control subjects underwent 3.0-T MRI including delayed gadolinium-enhanced MRI of cartilage and T1ρ and T2 mapping. Differences in relaxation times of patellofemoral cartilage were compared between groups by linear regression analyses, adjusted for age, body mass index, sex, sports participation, and time of image acquisition. RESULTS: This case-control study included 64 patients and 70 controls. The mean (±SD) age was 23.2 ± 6.4 years and the mean body mass index was 22.9 ± 3.4 kg/m(2); 56.7% were female. For delayed gadolinium-enhanced MRI of cartilage, the mean T1GD relaxation times of patellar (657.8 vs 669.4 ms) and femoral cartilage (661.6 vs 659.8 ms) did not significantly differ between patients and controls. In addition, no significant difference was found in mean T1ρ relaxation times of patellar (46.9 vs 46.0 ms) and femoral cartilage (50.8 vs 50.2 ms) and mean T2 relaxation times of patellar (33.2 vs 32.9 ms) and femoral cartilage (36.7 vs 36.6 ms) between patients and controls. Analysis of prespecified medial and lateral subregions within the patellofemoral cartilage also revealed no significant differences. CONCLUSION: There was no difference in composition of the patellofemoral cartilage, estimated with multiple quantitative MRI techniques, between patients with PFP and healthy control subjects. However, clinically relevant differences could not be ruled out for T1ρ in the adolescent population. Retropatellar cartilage damage has long been hypothesized as an important factor in the pathogenesis of PFP, but study findings suggest that diminished patellofemoral cartilage composition is not associated with PFP.

Magnetic resonance imaging abnormalities after lateral ankle trauma in injured and contralateral ankles.

PURPOSE: To compare the prevalence of abnormal MRI findings associated with lateral ankle trauma in injured and contralateral ankles to identify lesions that may be pre-existent. MATERIAL AND METHODS: The study was approved by the institutional review board and informed consent was obtained from all subjects. 195 patients (mean age 37.5+14.7 years; 43% male) who visited their general practitioner 6-12 months earlier with an ankle sprain were selected. All patients completed a standardized questionnaire and underwent MRI (1.5T) of both ankles. Structural MRI abnormalities in the injured and contralateral ankle were compared using the McNemar test (for paired samples). RESULTS: Bone marrow edema was frequently seen in the injured and contralateral ankle at the talocrural joint (25.1% versus 14.8%) and subtalar joint (24.6% versus 8.7%), but significantly more frequently in the injured ankle. Anterior talofibular ligament (ATFL) and calcaneofibular ligament (CFL) lesions were frequently found in both ankles, in 55.9% and 37.4% of injured ankles respectively and in 17.9% and 5.6% of contralateral ankles respectively. Fractures, anterior and posterior tibiofibular ligament lesions, deltoid ligament lesions and signs of talonavicular osteoarthritis were almost exclusively found in injured ankles. Peroneal ligament lesions were not frequently found in both ankles. CONCLUSIONS: The prevalence of structural MRI abnormalities in patients presenting with a previous ankle sprain in primary care is very high. However, especially bone marrow edema and lateral ligament lesions can also be found in a substantial percentage of contralateral ankles and may be either pre-existent or due to increased stress on the contralateral ankle after an ankle injury Correlation with clinical findings is essential.

Chronic complaints after ankle sprains: a systematic review on effectiveness of treatments.

STUDY DESIGN: Systematic review. Objective To determine the effectiveness of treatments for patients with chronic complaints after ankle sprain. BACKGROUND: Though most people recover completely after a lateral inversion ankle injury, a considerable percentage have persistent complaints. Currently, it is still unclear which treatment options are best for these patients. METHODS: Major databases, including PubMed, Embase, CINAHL, and PEDro, were searched for randomized controlled trials and controlled clinical trials conducted from 1966 to October 2012. Due to clinical heterogeneity, the data were analyzed using a best-evidence synthesis. RESULTS: A total of 20 randomized controlled trials and 1 controlled clinical trial were included in the analysis. The included studies compared different treatments (training programs, physiotherapy, chiropractic/manual therapy, surgery, postoperative training, and functional treatment). For pain and function outcomes, limited to moderate evidence was found for effectiveness of a training program compared to conservative treatment. Two studies found a decrease of recurrences after a proprioceptive training program. Four studies showed good results for different surgical methods but did not include a nonsurgical control group for comparison. Limited evidence was found for the effectiveness of an early mobilization program after surgery. CONCLUSION: In chronic ankle complaints after an ankle sprain, a training program gives better results for pain and function, and a decrease of recurrent ankle sprains, than a wait-and-see policy. There was insufficient evidence to determine the most effective surgical treatment, but limited evidence suggests that postoperative, early mobilization was more effective than a plaster cast. LEVEL OF EVIDENCE: Therapy, level 1a-.

Effect of various kinds of cervical spinal surgery on clinical outcomes: a systematic review and meta-analysis.

The choice of a specific surgical technique should be based on its benefits and harms. Previous reviews have shown that the benefit of surgery over conservative care is not clearly demonstrated in patients with disorders of the cervical spine. Also, no additional benefit of fusion upon anterior decompression techniques could be found. A clear overview of other surgical techniques is lacking. We therefore aimed to assess the benefits and harms of cervical spinal surgery in patients with cervical disorders. We searched MEDLINE, EMBASE, CINAHL, and CENTRAL up to June 2012. Randomized controlled trials (RCTs) were selected which included adults with cervical disorders receiving a surgical intervention and that reported at least 1 clinically relevant outcome measure (eg, pain, function, recovery). Two authors independently assessed the risk of bias using the criteria recommended by the Cochrane Back Review Group and extracted the data. The quality of the evidence was rated using the GRADE method. We included 39 RCTs comparing different surgical interventions. We found low-quality evidence for no difference in effectiveness between various surgical techniques used for anterior discectomy. There is a small, clinically irrelevant benefit on recovery and pain in favour of prosthetic disc surgery when compared with fusion techniques. Unfortunately, in these studies the authors had a clear conflict of interest. The differences in benefits and harms between the various surgical techniques are small. The surgeon, patient, and health care provider can therefore make the choice of any surgical technique based on experience, preferences, or costs.

Surgery versus conservative care for neck pain: a systematic review.

OBJECTIVE: General practitioners refer patients with continued neck pain that do not respond well to conservative care frequently to secondary care for further assessment. Are surgical interventions to the cervical spine effective when compared to conservative care for patients with neck pain? DESIGN: Systematic review. METHOD: The search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to June 2011. Randomised controlled trials (RCTs) and controlled clinical trials (CCTs) of adults with neck pain, which evaluated at least one clinically relevant primary outcome measure (e.g. pain, functional status, recovery), were included. In addition, treatments had to include surgery and conservative care. Two authors independently assessed risk of bias using the criteria recommended by the CBRG and extracted the data. The quality of the evidence was rated using the GRADE method. RESULTS: Patients included had neck pain with or without radiculopathy or myelopathy. In total, three RCTs and six CCTs were identified comparing different surgical interventions with conservative care, of which one had a low risk of bias. Overall there is very low quality of evidence available on the effectiveness of surgery compared to conservative care in neck pain patients showing overall no differences. CONCLUSION: Most studies on surgical techniques comparing these to conservative care showed a high risk of bias. The benefit of surgery over conservative care is not clearly demonstrated.

Surgical techniques for sciatica due to herniated disc, a systematic review.

INTRODUCTION: Disc herniation with sciatica accounts for five percent of low-back disorders but is one of the most common reasons for spine surgery. The goal of this study was to update the Cochrane review on the effect of surgical techniques for sciatica due to disc herniation, which was last updated in 2007. MATERIALS AND METHODS: In April 2011, we conducted a comprehensive search in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDRO, ICL, and trial registries. We also checked the reference lists and citation tracking results of each retrieved article. Only randomized controlled trials (RCT) of the surgical management of sciatica due to disc herniation were included. Comparisons including chemonucleolysis and prevention of scar tissue or comparisons against conservative treatment were excluded. Two review authors independently selected studies, assessed risk of bias of the studies and extracted data. Quality of evidence was graded according to the GRADE approach. RESULTS: Seven studies from the original Cochrane review were included and nine additional studies were found. In total, 16 studies were included, of which four had a low risk of bias. Studies showed that microscopic discectomy results in a significantly, but not clinically relevant longer operation time of 12 min (95% CI 2-22) and shorter incision of 24 mm (95% CI 7-40) compared with open discectomy, but did not find any clinically relevant superiority of either technique on clinical results. There were conflicting results regarding the comparison of tubular discectomy versus microscopic discectomy for back pain and surgical duration. CONCLUSIONS: Due to the limited amount and quality of evidence, no firm conclusions on effectiveness of the current surgical techniques being open discectomy, microscopic discectomy, and tubular discectomy compared with each other can be drawn. Those differences in leg or back pain scores, operation time, and incision length that were found are clinically insignificant. Large, high-quality studies are needed, which examine not only effectiveness but cost-effectiveness as well.

Surgery versus conservative management of sciatica due to a lumbar herniated disc: a systematic review.

The effectiveness of surgery in patients with sciatica due to lumbar disc herniations is not without dispute. The goal of this study was to assess the effects of surgery versus conservative therapy (including epidural injections) for patients with sciatica due to lumbar disc herniation. A comprehensive search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to October 2009. Randomised controlled trials of adults with lumbar radicular pain, which evaluated at least one clinically relevant outcome measure (pain, functional status, perceived recovery, lost days of work) were included. Two authors assessed risk of bias according to Cochrane criteria and extracted the data. In total, five studies were identified, two of which with a low risk of bias. One study compared early surgery with prolonged conservative care followed by surgery if needed; three studies compared surgery with usual conservative care, and one study compared surgery with epidural injections. Data were not pooled because of clinical heterogeneity and poor reporting of data. One large low-risk-of-bias trial demonstrated that early surgery in patients with 6-12 weeks of radicular pain leads to faster pain relief when compared with prolonged conservative treatment, but there were no differences after 1 and 2 years. Another large low-risk-of-bias trial between surgery and usual conservative care found no statistically significant differences on any of the primary outcome measures after 1 and 2 years. Future studies should evaluate who benefits more from surgery and who from conservative care.

A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain.

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP.

Carpal tunnel syndrome. Part II: effectiveness of surgical treatments--a systematic review.

OBJECTIVE: To present an evidence-based overview of the effectiveness of surgical and postsurgical interventions to treat carpal tunnel syndrome (CTS). DATA SOURCES: The Cochrane Library, PubMed, EMBASE, CINAHL, and PEDro were searched for relevant systematic reviews and randomized controlled trials (RCTs). STUDY SELECTION: Two reviewers independently applied the inclusion criteria to select potential studies. DATA EXTRACTION: Two reviewers independently extracted the data and assessed the methodologic quality. DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of the included studies. Two reviews and 25 RCTs were included. Moderate evidence was found in favor of surgical treatment compared with splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term, and for the effectiveness of corticosteroid irrigation of the median nerve before skin closure as additive to carpal tunnel release in the short term. Limited evidence was found in favor of a double-incision technique compared with the standard incision technique. Also, limited evidence was found in favor of a mini-open technique assisted by a Knifelight instrument compared with a standard open release at 19 months of follow-up. However, in the short term and at 30 months of follow-up, no significant differences were found between the mini-open technique assisted by a Knifelight instrument compared with a standard open release. Many studies compared different surgical interventions, but no evidence was found in favor of any one of them. No RCTs explored the optimal timing strategy for surgery. No evidence was found for the efficacy of various presurgical or postsurgical treatment programs, including splinting. CONCLUSIONS: Surgical treatment seems to be more effective than splinting or anti-inflammatory drugs plus hand therapy in the midterm and long term to treat CTS. However, there is no unequivocal evidence that suggests one surgical treatment is more effective than the other. More research is needed to study conservative to surgical treatment in which also should be taken into account the optimal timing of surgery. Future research should also concentrate on optimal presurgical and postsurgical treatment programs.

Effectiveness of interventions of specific complaints of the arm, neck, and/or shoulder: 3 musculoskeletal disorders of the hand. An update.

OBJECTIVES: To provide an evidence-based overview of the effectiveness of conservative and surgical interventions for trigger finger, Dupuytren's, and De Quervain's diseases. DATA SOURCES: The Cochrane Library, PEDro, PubMed, Embase, and CINAHL were searched to identify relevant studies. STUDY SELECTION: Two reviewers independently applied the inclusion criteria to select potential relevant studies from the title and abstracts of the references retrieved by the literature search. Relevant (Cochrane) reviews and randomized controlled trials (RCTs) were included. DATA EXTRACTION: Two reviewers independently extracted the data and performed a methodologic quality assessment. DATA SYNTHESIS: A best-evidence synthesis was performed to summarize the results of the included trials. One Cochrane review (trigger finger) and 13 RCTs (trigger finger [6], Dupuytren's [4], De Quervain's [3]) were included. The trials reported on physiotherapy (De Quervain's), steroid injections (trigger finger, De Quervain's), surgical treatment (trigger finger, De Quervain's), and a postsurgical treatment (Dupuytren's). For trigger finger, moderate evidence was found for the effectiveness of steroid injections in the short-term (1-4 wk) but not for long-term outcomes. Limited evidence was found for the effectiveness of staples compared with sutures in skin closure and for intermittent compression after surgery to treat Dupuytren's disease. For other interventions, no evidence was found. CONCLUSIONS: Indications for effectiveness of some interventions for trigger finger, Dupuytren's, and De Quervain's diseases were found. Because only a few RCTs were identified, it is difficult to draw firm conclusions. High-quality RCTs are clearly needed in this field.

Effectiveness of interventions of specific complaints of the arm, neck, or shoulder (CANS): musculoskeletal disorders of the hand.

OBJECTIVES: The aim of this study was to provide an evidence-based overview of the effectiveness of (conservative and surgical) interventions for the 4 specific pain disorders of the hand: trigger finger, primary Raynaud's phenomenon, Dupuytren disease, and De Quervain's disease. This information can help clinicians in the selection of interventions in daily practice, and may give direction to future research. METHODS: Relevant review publications and randomized clinical trials (RCTs) in PubMed were searched. Data extraction and quality assessment were performed. To summarize the results of the included reviews and RCTs, a best-evidence synthesis was used. RESULTS: For primary Raynaud's phenomenon (1 review, 20 RCTs), we found strong evidence for calcium channel blockers and moderate evidence for laser therapy. Limited evidence was found for Ketanserin, Prozasin, Buflomedil, transdermal glyceryl trinitrate patches, Ginkgo biloba, and behavioral treatment with temperature feedback. Other interventions did not show clear favorable treatment effects. For Trigger finger one very small RCT was found that showed limited evidence for steroid injection. For Dupuytren disease (4 RCTs) limited evidence was found in favor of use of staples versus sutures in the Dupuytren's surgery, and for intermittent compression on the postoperative hand after surgery. For other interventions no clear positive effects could be demonstrated. For De Quervain's disease (2 RCTs), we found no efficacy of Nimesulide as addition to a Triamcinolone injection, and no clear differences between a corticosteroid injection and a splint in pregnant patients or patients breast-feeding. DISCUSSION: Well-designed and well-conducted RCTs are clearly needed in this field.

Course and predicting factors of lower-extremity injuries after running a marathon.

OBJECTIVES: To investigate in recreational runners the 3 month prognosis of and medical consumption caused by running injuries occurring shortly before or during a marathon. Possible prognostic factors for persistent complaints were also evaluated. DESIGN: Prospective cohort study. SETTING: Rotterdam, the Netherlands. PARTICIPANTS: One hundred sixty-five recreational marathon runners who reported a new running injury in the month before or during the Rotterdam Marathon 2005 and who were available for follow-up. ASSESSMENT OF DETERMINANTS: Demographic, running (training distance, frequency and duration, experience, etc), lifestyle (other sports, smoking), and injury-related factors were collected at baseline. MAIN OUTCOME MEASUREMENTS: Persistent complaints of running injuries occurring in the month before or during the Rotterdam marathon at 3 month follow-up. Potential prognostic factors for persistent complaints were analyzed by multivariate logistic regression. RESULTS: At 3 month follow-up, 25.5% of the 165 injured runners reported persistent complaints; they had little pain during exercise and almost no pain in rest. Of all 165 male runners, 27 (16.4%) visited a general practitioner because of their running injury and 40 (24.2%) visited a physiotherapist (218 times in total). Persistent complaints at 3 month follow-up were associated with non-musculoskeletal comorbidities [odds ratio (OR), 3.23; confidence interval (CI), 1.24-8.43], and calf injuries (OR, 0.37; CI, 0.13-1.05). CONCLUSIONS: One quarter of the runners had persistent complaints of their marathon-related running injury at 3 month follow-up. However, the clinical and social consequences of the injuries seem to be relatively mild. Non-musculoskeletal comorbidities at baseline are related to poor recovery, whereas recovery is also location specific.