Comparison of the effect of Western-made unloading knee brace with physical therapy in Asian patients with medial compartment knee osteoarthritis-A preliminary report.

PURPOSE: To compare the effect of unloading knee brace with physical therapy (PT) in Asian patients with osteoarthritis (OA) of the knee. METHOD: This is a non-random, two-group comparative study. Patients with medial compartment knee OA (n = 41) were assigned to either the brace group (n = 20) or PT group (n = 21). Patients in the brace group were fitted with an unloading knee brace for three months and the PT group received a 60-min session of physiotherapy over the affected knee, three times a week, for three months. The primary outcome measures were the pain visual analogue scale (VAS) and the Western Ontario McMaster University Osteoarthritis Index (WOMAC); the second outcome measures were the 36-item Short-Form Health Survey (SF-36) and patient's satisfaction. The patients were evaluated at baseline, and at one month and three months. RESULTS: Group comparison showed no significant difference regarding pain VAS, WOMAC, SF-36, and patient's satisfaction, except stiffness in WOMAC (P = .006) and social functioning in SF-36 (P = .007). Time and group interaction revealed significant differences only in general health (P = .007) and mental health (P = .006) of SF-36. Within-group comparison found that pain VAS and WOMAC decreased significantly at one months and three months in both groups. CONCLUSION: The effect of brace fitting in patients with knee OA was similar to that of physical therapy. A Western-made unloading knee brace is acceptable in some Asian people with knee OA. CLINICAL TRIAL REGISTRATION NUMBER: NCT02712710.

[Hyperbaric Oxygen Therapy and Acute Carbon Monoxide Poisoning].

Carbon monoxide poisoning is the most commonly seen cause of poisoning in the emergency room (ER). The high affinity between carbon monoxide and hemoglobin and their complex biological characteristics greatly increase the risks of cardiac, nervous, muscular, and kidney diseases. In severe cases, patients may lose consciousness or die in just a few minutes. In recent years, hyperbaric oxygen therapy has been applied extensively in patients with severe conditions such as carbon monoxide poisoning and cerebral hypoxia. Hyperbaric oxygen accelerates the decomposition of carbon monoxide in hemoprotein. Therefore, treating patients with similar conditions in the ER with hyperbaric oxygen as soon as possible will improve their cognitive disorder and postpone their neuropsychological sequelae. ER nurses typically play a decisive role in saving patients with carbon monoxide poisoning. This research scrutinizes a case analysis of using hyperbaric oxygen to treat carbon monoxide poisoning and offers general rules for the use of hyperbaric oxygen. Further, the research elaborates from the perspective of ER nursing staffs the management and care of acute carbon monoxide poisoning and hyperbaric oxygen therapy nursing care. The aim of this research is to offer references for members of the ER nursing team and to enable this team to provide accurate and effective medical measures to patients during the "golden hours" of nursing care. Achieving this will help ensure that patients receive comprehensive nursing and care, thus reducing the harm suffered by patients and increasing the rate of survival.

Characteristics Associated with the Differential Activity of Nondominant and Dominant Affected Hands in Patients with Poststroke Right Hemiparesis.

OBJECTIVES: Spontaneous arm use in patients with poststroke hemiparesis is crucial to the recovery of functional interaction. Patients with stroke and subsequent right hemiparesis have more difficulty adapting to a right-handed environment. The aim of this study was to use wearable devices to assess the asymmetry and difference in the amount of activity of the nondominant and dominant affected hands among patients with stroke and right hemiparesis. The real activity of both hands was measured to assess the correlation with various aspects of the International Classification of Functioning, Disability and Health (ICF). Subjects and Methods. Patients with stroke and right hemiparesis were recruited. They were divided into two groups according to the affected hand. Groups A and B comprised patients with affected nondominant and dominant hands, respectively. The Fugl-Meyer assessment-Upper Extremity (FM-UE) scores, Motor Activity Log (MAL), and hand function domain scores on the Stroke Impact Scale (SIS) were used for assessment. Patients were asked to wear smart wearable devices on both hands 24 hours a day for a month. The amount of activity in both hands was recorded and analyzed. RESULTS: A total of 29 patients with stroke were divided into group A (n = 14) and group B (n = 15). FM-UE scores were significantly and strongly correlated with the amount of use (AOU) in the MAL. The recorded differential real activity of both hands in group B was significantly lower than that in group A. The asymmetry index of hand use was significantly less favorable in group B. However, no significant differences in AOU in the MAL, FM-UE, and hand function domain in the SIS were identified between the nondominant and dominant affected hands. CONCLUSIONS: The asymmetry and differential activity of both hands were worse in the patients with poststroke right hemiparesis, whose dominant hand was affected. However, no differences of three aspects of the ICF were found between dominant and nondominant affected hands.

Lumbar facet injection for the treatment of chronic piriformis myofascial pain syndrome: 52 case studies.

BACKGROUND AND AIMS: The aim of this study was to demonstrate the effectiveness of lumbar facet joint injection for piriformis myofascial pain syndrome. METHODS: Fifty-two patients with chronic myofascial pain in the piriformis muscle each received a lumbar facet injection into the ipsilateral L5-S1 facet joint region, using the multiple insertion technique. Subjective pain intensity, trunk extension range, and lumbar facet signs were measured before, immediately after, and 2 weeks after injection. Thirty-six patients received follow-up for 6 months. RESULTS: Immediately after the injection, 27 patients (51.9%) had complete pain subsidence, 19 patients (36.5%) had pain reduction to a tolerable level, and only 6 patients (11.5%) had no pain relief to a tolerable level. Mean pain intensity was reduced from 7.4±0.9 to 1.6±2.1 after injection (P<0.01). This effectiveness lasted for 2 weeks in 49 patients (94.2%), and lasted for approximately 6 months in 35 (97.2%) of 36 patients. The mean range of motion increased from 13.4±6.8 degrees to 22.1±6.0 degrees immediately after injection, and further increased 2 weeks and 6 months later. Immediately after injection, 45 patients (86.5%) had no facet sign. In addition, 90.4% and 94.4% of patients had no facet sign after 2 weeks and after 6 months, respectively. CONCLUSIONS: It is important to identify the possible cause of piriformis myofascial pain syndrome. If this pain is related to lumbar facet lesions, lumbar facet joint injection can immediately suppress piriformis myofascial pain symptoms. This effectiveness may last for at least 6 months in most patients. This study further supports the importance of eliminating the underlying etiological lesion for complete and effective relief of myofascial pain syndrome.

Changes in blood pressure and related autonomic function during cervical traction in healthy women.

Cervical traction is a physical therapy procedure frequently used to treat cervical disk lesions, cervical spondylosis, and cervical facet joint lesions. We have observed rare cases of side effects in elderly patients, but not in women younger than 30 years.In this pilot study, 96 young women were randomly divided into 3 groups to study the effect of cervical traction with different traction weights on blood pressure, heart rate, heart rate variability, and correlated autonomic adjustment. Cervical traction weight used was 10% of the patient's body weight in group A (n=32), 20% in group B (n=32), and 30% in group C (n=32). Assessments of blood pressure, heart rate, heart rate variability, percentage of high- and low-frequency signals, and low-frequency/high-frequency ratio were performed before, during, and 20 minutes after traction. We found that systolic blood pressure, diastolic blood pressure, and heart rate variability elevated during cervical traction and returned nearly to original levels immediately after traction in group C, but not in groups A or B. There were no significant changes in heart rate, percentage of high- or low-frequency signals, and low-frequency/high-frequency ratio in all 3 groups during or after cervical traction.Cervical traction with a traction weight approximately 10% to 20% of body weight can be safely provided without significant compromise of cardiovascular function. However, heavy traction weight (30% of body weight) should be avoided, especially for a patient with cardiovascular disease.

Remote effects of dry needling on the irritability of the myofascial trigger point in the upper trapezius muscle.

OBJECTIVE: To investigate the remote effect of dry needling on the irritability of a myofascial trigger point in the upper trapezius muscle. DESIGN: Thirty-five patients with active myofascial trigger points in upper trapezius muscles were randomly divided into two groups: 18 patients in the control group received sham needling, and 17 patients in the dry-needling group received dry needling into the myofascial trigger point in the extensor carpi radialis longus muscle. The subjective pain intensity, pressure pain threshold, and range of motion of the neck were assessed before and immediately after the treatment. RESULTS: Immediately after dry needling in the experimental group, the mean pain intensity was significantly reduced, but the mean pressure threshold and the mean range of motion of cervical spine were significantly increased. There were significantly larger changes in all three parameters of measurement in the dry-needling group than that in the control group. CONCLUSIONS: This study demonstrated the remote effectiveness of dry needling. Dry needling of a distal myofascial trigger point can provide a remote effect to reduce the irritability of a proximal myofascial trigger point.

Injection in the cervical facet joint for shoulder pain with myofascial trigger points in the upper trapezius muscle.

The goal of this double-blinded, randomized, controlled study was to confirm the effectiveness of the cervical facet joint injection in treating shoulder pain with the myofascial trigger point in the upper trapezius muscle secondary to cervical facet lesion. Eighty-nine patients with chronic unilateral shoulder pain due to myofascial trigger points in the upper trapezius muscle received an injection to the C4-5 facet joint in the experimental group and to the corresponding unilateral multifidi muscle in the control group. Subjective pain intensity and pressure pain threshold of the myofascial trigger point were assessed, and the prevalence of endplate noise in the myofascial trigger point region was measured in 28 patients before, immediately after, and 1 month after the injection. Half of the patients in the experimental group, but none of the control patients, reported being completely pain free 1 month after the injection. Both the decrease in the pain intensity and the increase in pressure pain threshold were significantly more in the experimental group than in the control group either immediately or 1 month after the injection. There was no significant difference in the change of endplate noise prevalence between the 2 groups. This study demonstrates that intra-articular or peri-articular injection into the cervical facet joint region can effectively inactivate the upper trapezius myofascial trigger point secondary to the facet lesion.

Carpal tunnel syndrome treated with a diode laser: a controlled treatment of the transverse carpal ligament.

OBJECTIVE: The purpose of this placebo-controlled study was to investigate the therapeutic effects of the 830-nm diode laser on carpal tunnel syndrome (CTS). BACKGROUND DATA: Many articles in the literature have demonstrated that low-level laser therapy (LLLT) may help to alleviate various types of nerve pain, especially for CTS treatment. We placed an 830-nm laser directly above the transverse carpal ligament, which is between the pisiform and navicular bones of the tested patients, to determine the therapeutic effect of LLLT. MATERIALS AND METHODS: Thirty-six patients with mild to moderate degree of CTS were randomly divided into two groups. The laser group received laser treatment (10 Hz, 50% duty cycle, 60 mW, 9.7 J/cm(2), at 830 nm), and the placebo group received sham laser treatment. Both groups received treatment for 2 wk consisting of a 10-min laser irradiation session each day, 5 d a week. The therapeutic effects were assessed on symptoms and functional changes, and with nerve conduction studies (NCS), grip strength assessment, and with a visual analogue scale (VAS), soon after treatment and at 2-wk follow-up. RESULTS: Before treatment, there were no significant differences between the two groups for all assessments (p > 0.05). The VAS scores were significantly lower in the laser group than the placebo group after treatment and at follow-up (p < 0.05). After 2 wk of treatment, no significant differences were found in grip strengths or for symptoms and functional assessments (p > 0.05). However, there were statistically significant differences in these variables at 2-wk follow-up (p < 0.05). Regarding the findings of NCS, there was no statistically significant difference between groups after treatment and at 2-wk follow-up. CONCLUSIONS: LLLT was effective in alleviating pain and symptoms, and in improving functional ability and finger and hand strength for mild and moderate CTS patients with no side effects.

Assessments of chronodispersion and tacheodispersion of F waves in patients with spinal cord injury.

OBJECTIVE: To evaluate the chronodispersion and tacheodispersion of F waves in patients with spinal cord injury and to determine whether these parameters are more sensitive than those of standard F waves. DESIGN: F chronodispersion and F tacheodispersion as well as F wave latencies, amplitude, and persistence were measured in tibial nerves of 23 male patients with different scales of spinal cord injury and 23 normal subjects. Spasticity was measured and correlated with F chronodispersion in spinal cord injury patients. RESULTS: F chronodispersion of 6.4 +/- 1.9 msec (mean +/- SD) obtained in spinal cord injury patients was found to be significantly greater than the results of 3.9 +/- 1.6 msec in normal controls (P < 0.05). F chronodispersion was greater in spinal cord injury patients with complete cord lesion. A positive correlation was found between F chronodispersion and Ashworth Scores in spinal cord injury patients. There were no significant differences in minimal latency, amplitude, persistence of F waves, and F tacheodispersion between spinal cord injury patients and normal subjects. CONCLUSIONS: Measurement of F chronodispersion may provide a useful and sensitive electrophysiologic assessment in evaluation of spinal cord injury and serve as an evident tool for differentiating pathologic from normal state motoneuron excitability in spinal cord lesion.