Sacroiliac Joint Dysfunction Treated Using Neural Therapy to the Temporomandibular Joint: A Case Report.

Temporomandibular joint disorders (TMJD) include temporomandibular joint dysfunction and bruxism. Sacroiliac joint dysfunction (SJD) is a frequent cause of non-discogenic low back pain. Studies suggest a relationship between TMJD and SJD; however, the link remains unclear. Neural therapy (NT) utilises local anaesthetic injections to treat pain by normalising a dysfunctional autonomic nervous system held responsible for initiating or propagating chronic pain. A 31-year-old female presented with a 1-year history of mechanical left-sided low back pain and sleep bruxism. Examination revealed crepitation of the left TMJ and a trigger point in the masseter muscle. Range of motion of the spine and hip joints were normal, Patrick and Geanslen tests were positive on the left side. Spine and standing flexion tests were also positive. Magnetic resonance imaging of the lumbar spine and sacroiliac joints were normal. A diagnosis of SJD was made, and the patient was treated using NT. Injections of lidocaine 0.5% to the left TMJ, the masseter muscle and intradermal segmental injections at the level of C4 were administered. The patient's back pain and TMJ tenderness reduced and continued so throughout the 3-month follow-up period. SJD may be related to TMJD, and NT may be used in its treatment.

Effectiveness of continuous versus pulsed short-wave diathermy in the management of knee osteoarthritis: A randomized pilot study.

BACKGROUND: Short-wave diathermy (SWD) is an electrotherapeutic modality used in the conservative treatment of knee osteoarthritis (KOA). Electromagnetic radiation delivered in continuous (cSWD) or pulse (pSWD) mode provides a deep heating effect on tissues. There is no consensus on outcomes of treatment with cSWD versus pSWD in KOA. The aim of this study was to compare the effects of cSWD versus pSWD on pain, functionality and walking distance in KOA. METHODS: 34 female patients aged 49-65 with KOA were randomized into two groups. A total of 27 patients completed the study. One group (n=11) was treated with cSWD, the other (n=16) with pSWD for three weeks. Patients were assessed before, after and at one month post therapy. Outcome measures included visual analogue scale (VAS) for knee pain, Western Ontario and Mcmaster University Osteoarthritis Index (WOMAC) and a six-minute walking test (6MWT). RESULTS: Based on the minimal clinically important improvement (MCII), there was a reduction in VAS and WOMAC scores in both cSWD and pSWD groups post treatment (-37.3mm, 31.2mm respectively for VAS and 26%, 23% respectively for WOMAC) and at one month post treatment. There was no difference in pre and post treatment VAS for pain, WOMAC or 6MWT scores between the two groups. There was a small post treatment effect size on between- group 6MWT scores (Cohen's d: 0.238). CONCLUSION: Both treatment options appear to be efficacious in reducing pain and improving functionality in KOA. There was no between-group difference. A larger study must be conducted to consolidate these findings.

A Comparison of Physical Therapy Modalities Versus Acupuncture in the Treatment of Fibromyalgia Syndrome: A Pilot Study.

OBJECTIVES: Physical therapy (PT) modalities are used in the treatment of fibromyalgia syndrome (FMS). Acupuncture is a treatment option often sought after by FMS patients. The aim of this study was to compare the effects of PT modalities with those of acupuncture on pain, daily function, and quality of life in FMS patients. DESIGN: A comparative effectiveness study. SETTING AND SUBJECTS: Forty-four female patients between the ages of 18-70 years presenting to Baskent University Faculty of Medicine Department of Physical and Rehabilitation Medicine with a new diagnosis of FMS according to the American College of Rheumatology, with manifestations of chronic widespread musculoskeletal pain symptoms, normal routine blood tests, and a desire to receive PT or acupuncture were included in the study. Exclusion criteria included the presence of neurologic, inflammatory, endocrinologic, and other chronic diseases, psychiatric illness, use of antidepressants or analgesics, and contraindication to treatment with PT modalities. INTERVENTIONS: One group (n = 22) received 15 sessions of hotpack, transcutaneous electrical nerve stimulation (TENS), and ultrasound to the tender points of the cervical and upper back regions. The other group (n = 22) received 10 sessions of formulated acupuncture aimed at treating pain of the neck, upper, and lower back regions. OUTCOME MEASURES: Pain, functionality, and quality of life measured using the Short Form McGill Pain Questionnaire (SF-MPQ) and Fibromyalgia Impact Questionnaire (FIQ) before and after treatment. RESULTS: There was a reduction in all SF-MPQ domains and FIQ scores after treatment in both the PT and acupuncture groups. There was no difference in pre- and post-treatment scores between the two groups. CONCLUSIONS: PT modalities and acupuncture can be effectively used in the treatment of FMS. Even though one treatment option was not found to be more beneficial than the other, longer post-treatment follow-up may help determine the superior treatment option.

Complete Decongestive Therapy Is an Option for the Treatment of Rosacea Lymphedema (Morbihan Disease): Two Cases.

BACKGROUND AND PURPOSE: Morbihan disease, also known as rosacea lymphedema, is a rare persistent form of lymphedema that is associated with the disease rosacea. Even though acne rosacea responds well to standard medical treatment, the lymphedema component of the disease is resistant to both medical and surgical therapy. Complete decongestive therapy (CDT) can be considered as a conservative alternative option for treatment of rosacea lymphedema. To date, there is no report on the use of CDT in treating facial lymphedema secondary to acne rosacea. CASE DESCRIPTION: We present 2 cases of women with a diagnosis of Morbihan disease and chronic facial lymphedema that remained resistant to drug treatment for many years before CDT was offered. The treatment program included 4 components: manual lymphatic drainage, compression bandaging, exercises to enhance lymphatic drainage, and patient education. OUTCOMES: Following 10 to 15 sessions of CDT, the first patient's facial edema had almost completely resolved. The second patient's response to treatment was assessed as moderate. DISCUSSION: To the best of our knowledge, these 2 cases of Morbihan disease treated with CDT are the first of their kind to be presented in the literature. As the treatment options for Morbihan disease remain inadequate, we believe that CDT should be considered as a treatment option in those patients who do not benefit from or refuse drug treatment, before moving on to more invasive procedures. Prospective studies should be designed to demonstrate the efficacy of CDT and provide management details.