Changes Over Time in the Strain on the Inferior Iliofemoral Ligament During a Sustained 5-Minute High-Force Long-Axis Distraction Mobilization: A Cadaveric Study.

OBJECTIVE: To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes. DESIGN: A cross-sectional laboratory cadaveric study. SETTING: Anatomy laboratory. PARTICIPANTS: Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13). INTERVENTIONS: High-force LADM in open-packed position was sustained for a period of 5 minutes. MAIN OUTCOME MEASURE(S): Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes. RESULTS: Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001). CONCLUSIONS: When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular-ligament tissue.

The effectiveness of manual therapy on pain, physical function, and nerve conduction studies in carpal tunnel syndrome patients: a systematic review and meta-analysis.

AIM OF THE STUDY: Systematic review and meta-analysis to assess the effectiveness of manual therapy in improving carpal tunnel syndrome (CTS) symptoms, physical function, and nerve conduction studies. METHOD: MEDLINE, Web of Science, SCOPUS, Cochrane Library, TRIP database, and PEDro databases were searched from the inception to September 2021. PICO search strategy was used to identify randomized controlled trials applying manual therapy on patients with CTS. Eligible studies and data extraction were conducted independently by two reviewers. Methodology quality and risk of bias were assessed by PEDro scale. Outcomes assessed were pain intensity, physical function, and nerve conduction studies. RESULTS: Eighty-one potential studies were identified and six studies involving 401 patients were finally included. Pain intensity immediately after treatment showed a pooled standard mean difference (SMD) of - 2.13 with 95% confidence interval (CI) (- 2.39, - 1.86). Physical function with Boston Carpal Tunnel Syndrome Questionnaire (BCTS-Q) showed a pooled SMD of - 1.67 with 95% CI (- 1.92, - 1.43) on symptoms severity, and a SMD of - 0.89 with 95% CI (- 1.08, - 0.70) on functional status. Nerve conduction studies showed a SMD of - 0.19 with 95% CI (- 0.40, - 0.02) on motor conduction and a SMD of - 1.15 with 95% CI (- 1.36, - 0.93) on sensory conduction. CONCLUSIONS: This study highlights the effectiveness of manual therapy techniques based on soft tissue and neurodynamic mobilizations, in isolation, on pain, physical function, and nerve conduction studies in patients with CTS.

The Effect of Scapular Fixation on Scapular and Humeral Head Movements during Glenohumeral Axial Distraction Mobilization.

Background and Objectives: Glenohumeral axial distraction mobilization (GADM) is a usual mobilization technique for patients with shoulder dysfunctions. The effect of scapular fixation on the movement of the scapula and the humeral head during GADM is unknown. To analyze the caudal movement of the humeral head and the rotatory movement of the scapula when applying three different intensities of GADM force with or without scapular fixation. Materials and Methods: Fifteen healthy subjects (mean age 28 ± 9 years; 73.3% male) participated in the study (twenty-eight upper limbs). Low-, medium- and high-force GADM in open-packed position were applied in scapular fixation and non-fixation conditions. The caudal movement of humeral head was evaluated by ultrasound measurements. The scapular rotatory movement was assessed with a universal goniometer. The magnitude of force applied during GADM and the region (glenohumeral joint, shoulder girdle, neck or nowhere) where subjects felt the effect of GADM mobilization were also recorded. Results: A greater caudal movement of the humeral head was observed in the non-scapular fixation condition at the three grades of GADM (p < 0.008). The rotatory movement of the scapula in the scapular fixation condition was practically insignificant (0.05−0.75°). The high-force GADM rotated scapula 18.6° in non-scapular fixation condition. Subjects reported a greater feeling of effect of the techniques in the glenohumeral joint with scapular fixation compared with non-scapular fixation. Conclusions: The caudal movement of the humeral head and the scapular movement were significantly greater in non-scapular fixation condition than in scapular fixation condition for the three magnitudes of GADM force.

Effectiveness of Dry Needling Therapy on Pain, Hip Muscle Strength, and Physical Function in Patients With Hip Osteoarthritis: A Randomized Controlled Trial.

OBJECTIVE: To investigate the short-term effects of dry needling (DN) on physical function, pain, and hip muscle strength in patients with hip osteoarthritis (OA). DESIGN: A double-blind, placebo-control, randomized controlled trial. SETTING: Private practice physiotherapy clinic. PARTICIPANTS: Patients with unilateral hip OA (N=45) were randomly allocated to a DN group, sham DN group, or control group. INTERVENTIONS: Patients in the DN and sham groups received 3 treatment sessions. Three active myofascial trigger points (MTrPs) were treated in each session with DN or a sham needle procedure. The treatment was applied in active MTrPs of the iliopsoas, rectus femoris, tensor fasciae latae, and gluteus minimus muscles. MAIN OUTCOME MEASURES: Physical function was assessed with the Western Ontario and McMaster Universities (WOMAC) physical function subscale, the timed Up and Go test, and the 40-meter self-paced walk test. Intensity of hip pain related to physical function was evaluated using the visual analog scale and WOMAC pain subscale. The maximal isometric force of hip muscles was recorded with a handheld dynamometer. RESULTS: Significant group by time interactions were shown for physical function, pain, and hip muscle force variables. Post hoc tests revealed a significant reduction in hip pain and significant improvements in physical function and hip muscle strength in the DN group compared with the sham and control groups. The DN group showed within- and between-groups large effect sizes (d>0.8). CONCLUSIONS: DN therapy in active MTrPs of the hip muscles reduced pain and improved hip muscle strength and physical function in patients with hip OA. DN in active MTrPs of the hip muscles should be considered for the management of hip OA.

Sensory function in headache: a comparative study among patients with cluster headache, migraine, tension-type headache, and asymptomatic subjects.

AIMS: Studies evaluating sensory function of the entire trigeminocervical region in patients with cluster headache (CH), migraine (MH), and tension-type headache (TH) are required. The purpose of the present study was to evaluate and compare sensory function in the trigeminocervical region in patients with CH, MH, and TH and healthy controls (HC). METHODS: Quantitative sensory testing (QST), including pressure pain threshold (PPT), tactile detection threshold (TDT), prick detection threshold (PDT), and two-point detection threshold (2PDT), was evaluated in 139 patients with headache (CH = 16, MH = 52, TH = 71) and 30 HC. Test sites included bilaterally the first, second, and third divisions of trigeminal nerve (V1, V2, and V3), cervical spine, and thenar eminence. RESULTS: TH presented significantly lower PPT values compared with CH (p < 0.015), MH (p < 0.048), and HC (p < 0.009), while MH demonstrated significantly lower values than HC (p = 0.001-0.023). When analyzing TDT, CH in the symptomatic side presented significantly higher values in V1 compared with MH (p = 0.001), TH (p < 0.001), and HC (p < 0.001) and in V2 compared with TH (p = 0.035). No statistically significant differences were found for PDT (p > 0.005). With regard to 2PDT, CH-s presented significantly higher values in V1 with respect to HC (p = 0.016) but lower values in V2 compared with MH (p < 0.001) and TH (p = 0.003). CONCLUSION: The results of the present study indicate specific and different altered mechanical sensory thresholds in CH, MH, and TH patients compared with HC subjects.

Dimensional Changes of the Tarsal Tunnel During Foot and Ankle Positions: Anatomical Study.

The tarsal tunnel is a fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and foot and ankle movements appear to move and change tunnel shape. However, the effect of foot and ankle movements is not clear. The aim of this study was to measure tarsal tunnel dimensions in anatomical position of the foot and ankle and quantify its changes at different positions in cadavers. A cross-sectional study with a total of 16 cryopreserved lower extremities from cadaveric specimens were used. The foot was cut using an anatomical saw at the level of the tarsal tunnel. Measurements of the cross-sectional area (CSA), transverse diameter (TD), longitudinal diameter (LD) were taken in anatomical position and during foot and ankle movements. All the tarsal tunnel measurements were significantly modified by ankle plantar flexion (p < .05). The CSA increased by 68.97 mm2 (p < .001), the TD increased by 1.40 mm (p < .002) and the LD increased by 2.55 mm (p < .007). The TD was also significantly modified by the inversion position of the ankle, showing an increase of 0.84 mm (p < .004). The rest of the ankle positions did not produce significant changes in tarsal tunnel measurements. Foot and ankle plantar flexion position produce and increase in the CSA and the TD of the tarsal tunnel at its distal end in cadavers. This could suggest a reduction in tarsal tunnel pressure during plantar flexion.

Dimensional Changes of the Tibial Nerve and Tarsal Tunnel in Different Ankle Joint Positions in Asymptomatic Subjects.

The tarsal tunnel is a clinically important fibrous osseous conduit for the tibial nerve and associated tendons. It is mechanically dynamic, and normal ankle movements appear to change the tunnel shape, potentially having an impact on the tibial nerve. The objective of this study was to measure changes in the tibial nerve and tarsal tunnel dimensions in plantarflexion and dorsiflexion of the ankle joint in healthy subjects. A cross-sectional study with 13 volunteer subjects and a total of 18 records was designed. The cross-sectional area, anterior-posterior distance, transverse distance, and flattening ratio of the tibial nerve were measured by using ultrasound in plantarflexion and dorsiflexion of the ankle joint. The anterior-posterior distance of the tarsal tunnel was also measured. The tunnel anterior-posterior distance significantly increased during plantarflexion (p < .001) and decreased during dorsiflexion (p = .027) of the ankle. From plantarflexion to dorsiflexion of the ankle, the tibial nerve cross-sectional area significantly decreased (p = .035). The anterior-posterior distance also decreased significantly (p < .001), whereas the transverse distance increased (p < .001), thus decreasing the flattening ratio of the tibial nerve (p < .001). Ankle joint position determined significant changes in the shape and dimensions of the tibial nerve at the tarsal tunnel.

Effects of diacutaneous fibrolysis in patients with mild to moderate symptomatic carpal tunnel syndrome: a randomized controlled trial.

OBJECTIVE:: To compare the effects of diacutaneous fibrolysis with sham in patients with mild to moderate carpal tunnel syndrome. DESIGN:: Double-blind (patient and evaluator) randomized controlled trial. SETTING:: Miguel Servet University Hospital, Zaragoza, Spain. SUBJECTS:: A total of 52 patients (72 wrists) with carpal tunnel syndrome, 41 women and 11 men, mean age was 46.9 (8.8) years. They were divided into two groups: diacutaneous fibrolysis group and sham group. INTERVENTIONS:: Real diacutaneous fibrolysis in diacutaneous fibrolysis group and sham diacutaneous fibrolysis in sham group. Both groups received five sessions in the forearm, wrist and hand. MAIN MEASURES:: Neurophysiological parameters assessed at baseline and at the end of the treatment. Intensity of nocturnal symptoms (visual analogue scale (VAS)) and upper limb functional capacity (Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire) at baseline, at the end of the treatment and one month after treatment. RESULTS:: Diacutaneous fibrolysis group (n = 30 wrists) improved in nerve conduction distal motor latency (mean difference: -0.26, 95% confidence interval (CI): -0.49/-0.26), sensory conduction velocity (mean difference: 6.52, 95% CI: 3.52/9.51), intensity of nocturnal symptoms (mean difference: -2.24, 95% CI: -4.08/-2.04) and upper limb functional capacity (mean difference: -19, 95% CI: -26.1/-11.9) compared to the sham group (n = 30 wrists) ( P < 0.02, P < 0.01, P < 0.01 and P < 0.01, respectively). At one-month follow-up, improvements in the nocturnal symptoms and upper limb functional capacity were maintained compared to the sham group ( P < 0.01). CONCLUSION:: Diacutaneous fibrolysis provides short-term and one-month follow-up, improvements in sensory conduction velocity, motor distal latency, symptoms and functional capacity in patients with mild to moderate carpal tunnel syndrome.

Immediate Effects of Upper Cervical Translatoric Mobilization on Cervical Mobility and Pressure Pain Threshold in Patients With Cervicogenic Headache: A Randomized Controlled Trial.

OBJECTIVE: The purpose of this study was to evaluate the immediate effects of upper cervical translatoric spinal mobilization (UC-TSM) on cervical mobility and pressure pain threshold in subjects with cervicogenic headache (CEH). METHODS: Eighty-two volunteers (41.54 ± 15.29 years, 20 male and 62 female) with CEH participated in the study and were randomly divided into the control and treatment groups. The treatment group received UC-TSM and the control group remained in the same position for the same time as the UC-TSM group, but received no treatment. Cervical mobility (active cervical mobility and flexion-rotation test), pressure pain thresholds over upper trapezius muscles, C2-3 zygapophyseal joints and suboccipital muscles, and current headache intensity (visual analog scale) were measured before and immediately after the intervention by 2 blinded investigators. RESULTS: After the intervention, UC-TSM group exhibited significant increases in total cervical mobility (P = .002, d = 0.16) and the flexion-rotation test (P < .001, d = 0.81-0.85). No significant difference in cervical pressure pain thresholds were observed between groups (P > .05). Nevertheless, there was a significantly lower intensity of headache in the UC-TSM group (P = .039, d = 0.57). CONCLUSIONS: Upper cervical translatoric spinal mobilization intervention increased upper, and exhibited a tendency to improve general, cervical range of motion and induce immediate headache relief in subjects with CEH.

Diagnostic accuracy of the upper limb neurodynamic test 1 using neurodynamic sequencing in diagnosis of carpal tunnel syndrome.

BACKGROUND: The upper limb neurodynamic test 1 is used in the diagnosis of median nerve neuropathies such as carpal tunnel syndrome but its diagnostic validity remains limited. Neurodynamic sequencing has been suggested to increase the specificity of the neurodynamic tests, however, to date, information on the diagnostic accuracy of this variation in neurodynamic testing is required. OBJECTIVES: The aim of this study was to analyze the diagnostic validity of the local sequence of ULNT1 (LS-ULNT1) (i.e. a sequence that begins at the joint where the problem is (wrist) and progressively moves joints further away from it), in the diagnosis of CTS. A secondary aim was to describe the location of sensory responses to this modified neurodynamic test sequence. DESIGN: A prospective diagnostic accuracy study was designed. METHOD: Nerve conduction studies were used as the gold standard. The LS-ULNT1 was performed in 58 consecutive patients (17 men, 44 women) with suspected CTS. RESULTS: Sensitivity of the LS-ULNT1 was 65.7% (CI 48.0-80.9%) and the specificity was 95.7% (CI 78.1-99.9%). The positive and negative likelihood ratios were >5 and < 0.5, respectively, indicating the ability of the test to generate small but sometimes important changes in post-test probability. CONCLUSIONS: The overall results of this study showed that the LS-ULNT1 could be useful in confirming the diagnosis of CTS. The test demonstrated high specificity and the +LR indicated the ability of the test to generate changes in posttest probability, especially with a positive LS-ULNT1 result.

Relevance of Tibial Fixation during Tibiotarsal Joint Traction: Descriptive Cross-Sectional Study.

Background: The effect of tibial fixation on the movement of the talus during the tibiotarsal axial traction technique (TATT) is unknown. The aim was to evaluate the effect on the tibiotarsus when applying three different intensities of TATT force with or without tibial fixation in healthy subjects, and to assess the reliability of detecting the different forces applied. Also, the discomfort generated during the technique would be analysed. Methods: A cross-sectional study was conducted in thirty lower limbs. Three magnitudes of TATT force in an open-packed position were applied in tibial fixation and non-fixation conditions. The axial traction movement was measured by ultrasound, and the magnitudes of the force applied during low-medium and high TATT force were recorded in both conditions. Patients were asked about the level of discomfort perceived during the technique. Results: The most significant distance increase (mm) was observed in the tibial fixation condition at all magnitudes of the TATT (F = 102.693, p < 0.001). The discomfort sensation (numeric rating scale, "NRS") was higher in the non-fixation condition (p > 0.05). The application of the technique showed good reliability (>0.75 ICC) for the detection of the applied force. Conclusions: The TATT in the tibial fixation condition produced more significant axial movement of the talus (mm) relative to the tibia than the non-tibial fixation condition did. The detection of the magnitudes of movement showed good reliability (ICC: 0.75 to 0.92). The technique was well tolerated at all force magnitudes, with the tibial fixation condition being the most tolerable.

Is the cadaveric model valid for examining orthopaedic manual therapy techniques? A cross-sectional comparative study in vivo and in vitro.

BACKGROUND: Cadaveric models are sometimes used to test the effect of manual techniques. We have not found any studies comparing the effect of tibiotarsal joint distraction on cadaveric models versus live models for clinical use. The aim was to compare the effect on tibiotarsal joint distraction movement when applying three force magnitudes of tibiotarsal axial traction technique force between a cadaveric model and volunteers. In addition, to compare the magnitude of force applied between the cadaveric model and volunteers. Finally, to assess the reliability of applying the same magnitude of force in three magnitudes of tibiotarsal axial traction force. METHODS: A cross-sectional comparative study was conducted. Sixty ankle joints were in open-packed position and three magnitudes of tibiotarsal axial traction technique force were applied. Tibiotarsal joint distraction movement was measured with ultrasound. FINDINGS: No differences were found in applied force or tibiotarsal joint distraction between volunteers and cadavers in each magnitude of force (p > 0.05). The application of the technique showed moderate reliability for detecting low forces in both models. For medium and high force, it showed good reliability in the in vitro model and excellent reliability in the live model. INTERPRETATION: The amount of distraction produced in the tibiotarsal joint was similar in volunteers and cadavers. The cadaveric model is a valid model for testing and investigating orthopaedic manual therapy techniques. The force applied was similar in the two models. Medium and high force detection showed good reliability, while low force showed moderate.

Effect of cervical contralateral lateral flexion on the median nerve and fascia at the wrist - Cadaveric study.

BACKGROUND: Neurodynamic tests are an essential aspect of the physical examination of the patient when suspicion of neural involvement exists. A manoeuvre that is hypothesised to move nerves differentially relative to other structures (structural differentiation) has been proposed as a necessary part of neurodynamic testing for differential diagnosis. However, although the specificity of structural differentiation for peripheral nerve over muscle has been demonstrated in some body regions, no study has tested specificity of nerve movement relative to fascia. OBJECTIVES: The aim of this study was to measure the effect of the cervical contralateral lateral flexion (CCLF) as an structural differentiation manoeuvre for the median nerve compared to fascia (superficial and deep) at the wrist during the upper limb neurodynamic test 1 (ULNT1). DESIGN: A cross-sectional study was performed in 5 fresh frozen cadavers. METHODS: Excursion and strain in the fascia (superficial and deep) and the median nerve were measured at the wrist with structural differentiation during the ULNT1. KINOVEA software was used to measure kinematic parameters. RESULTS: CCLF resulted in significant proximal excursion in the median nerve (p < 0.001*) but not in the strain. CCLF neither produced changes in strain nor excursion in the superficial and deep fascia (p > 0.05). CONCLUSION: This study showed that CCLF produced significant differential excursion in the median nerve at the wrist compared to the local superficial and deep fascia during the ULNT1. The data support CCLF in mechanical differentiation between nerve and fascia in this area in diagnosis of local sources of wrist pain.

In Vivo Effects of Joint Movement on Nerve Mechanical Properties Assessed with Shear-Wave Elastography: A Systematic Review and Meta-Analysis.

Peripheral nerves are subjected to mechanical tension during limb movements and body postures. Nerve response to tensile stress can be assessed in vivo with shear-wave elastography (SWE). Greater tensile loads can lead to greater stiffness, which can be quantified using SWE. Therefore, this study aimed to conduct a systematic review and meta-analysis to perform an overview of the effect of joint movements on nerve mechanical properties in healthy nerves. The initial search (July 2023) yielded 501 records from six databases (PubMed, Embase, Scopus, Web of Science, Cochrane, and Science Direct). A total of 16 studies were included and assessed with a modified version of the Downs and Black checklist. Our results suggest an overall tendency for stiffness increase according to a pattern of neural tensioning. The main findings from the meta-analysis showed a significant increase in nerve stiffness for the median nerve with wrist extension (SMD [95%CI]: 3.16 [1.20, 5.12]), the ulnar nerve with elbow flexion (SMD [95%CI]: 2.91 [1.88, 3.95]), the sciatic nerve with ankle dorsiflexion (SMD [95%CI]: 1.13 [0.79, 1.47]), and the tibial nerve with both hip flexion (SMD [95%CI]: 2.14 [1.76, 2.51]) and ankle dorsiflexion (SMD [95%CI]: 1.52 [1.02, 2.02]). The effect of joint movement on nerve stiffness also depends on the nerve segment, the amount of movement of the joint mobilized, and the position of other joints comprised in the entirety of the nerve length. However, due to the limited number of studies, many aspects of nerve behavior together with the effect of using different ultrasound equipment or transducers for nerve stiffness evaluation still need to be fully investigated.

The effectiveness of hip interventions in patients with low-back pain: A systematic review and meta-analysis.

BACKGROUND: Low-back pain (LBP) may be directly or indirectly related to impairments from the hip joint. OBJECTIVE: To evaluate the effectiveness of hip interventions on pain and disability in patients with LBP in the short-, medium-, and long-term. METHODS: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in November 2022. Randomized controlled trials involving hip-targeted interventions compared to specific low back interventions in patients with LBP were selected. The outcomes were pain intensity and disability. The quality of the studies was assessed with the risk of bias tool. GRADE was used to rate the certainty of evidence. Meta-analyses were conducted using random effects models. RESULTS: A total of 2581 studies were screened. Eight were included in the meta-analysis involving 508 patients with LBP. The results provided very low certainty that both hip strengthening and hip stretching improved pain (MD = -0.66; 95% CI -0.86, -0.48; I2:0%) (MD = -0.55; 95% CI -1.02, -0.08) and disability (SMD = -0.81; 95% CI -1.53, -0.10; I2: 80%) (SMD = -1.03; 95% CI -1.82, -0.25) in the short-term, respectively. No benefits were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence. CONCLUSIONS: Very low certainty evidence suggest a positive effect of hip strengthening in isolation or combined with specific low back exercise and hip stretching combined with specific low back exercise for decreasing pain intensity and disability in the short-term, in patients with LBP. SYSTEMATIC REVIEW REGISTRATION NUMBER: PROSPERO CRD42022303173.

Effect of Scapular Fixation on Lateral Movement and Scapular Rotation during Glenohumeral Lateral Distraction Mobilisation.

BACKGROUND: Glenohumeral lateral distraction mobilisation (GLDM) is used in patients with shoulder mobility dysfunction. No one has examined the effect of scapular fixation during GLDM. The aim was to measure and compare the lateral movement of the humeral head and the rotational movement of the scapula when three different magnitudes of forces were applied during GLDM, with and without scapular fixation. METHODS: Seventeen volunteers were recruited (n = 25 shoulders). Three magnitudes of GLDM force (low, medium, and high) were applied under fixation and non-fixation scapular conditions in the open-packed position. Lateral movement of the humeral head was assessed with ultrasound, and a universal goniometer assessed scapular rotation. RESULTS: The most significant increase in the distance between the coracoid and the humeral head occurred in the scapular fixation condition at all three high-force magnitudes (3.72 mm; p < 0.001). More significant scapular rotation was observed in the non-scapular fixation condition (12.71°). A difference in scapula rotation (10.1°) was observed between scapular fixation and non-scapular fixation during high-force application. CONCLUSIONS: Scapular fixation resulted in more significant lateral movement of the humeral head than in the non-scapular fixation condition during three intensities of GLDM forces. The scapular position did not change during GLDM with the scapular fixation condition.

Is the Straight Leg Raise Suitable for the Diagnosis of Radiculopathy? Analysis of Diagnostic Accuracy in a Phase III Study.

The straight leg raise test (SLR) has been proposed to detect increased nerve mechanosensitivity of the lower limbs in individuals with low back pain. However, its validity in the diagnosis of lumbosacral radiculopathy shows very variable results. The aim of this study was to analyse the diagnostic validity of the SLR including well-defined diagnostic criteria (a change in symptoms with the structural differentiation manoeuvre and the reproduction of the patient's symptoms during the test or the asymmetries in the range of motion or symptoms location between limbs) in a sample of participants in phase III with suspicion of lumbar radiculopathy using the electrodiagnostic studies (EDX) as the reference standard. A phase III diagnostic accuracy study was designed. In total, 142 individuals with suspected lumbosacral radiculopathy referred for EDX participated in the study. Each participant was tested with EDX and SLR. SLR was considered positive using three diagnostic criteria. The sensitivity of the SLR for Criterion 3 was 89.02% (CI 81.65-96.40), the specificity was 25.00% (CI 13.21-36.79), and the positive and negative likelihood ratios were 1.19 (CI 1.01-1.40) and 0.44 (0.21-0.94), respectively. SLR showed limited validity in the diagnosis of lumbosacral radiculopathy. The incorporation of more objective diagnostic criteria (asymmetry in range of motion or localisation of symptoms) improved the diagnostic validity but the imprecision of the confidence intervals limited the interpretation of the results.

The Effectiveness of Dry Needling in Patients with Hip or Knee Osteoarthritis: A Systematic Review and Meta-Analysis.

BACKGROUND: Osteoarthritis is one of the most common degenerative joint diseases. The main symptoms of the osteoarthritis have been linked to the presence of myofascial trigger points in the soft tissues. Dry needing (DN) is the most investigated technique for the treatment of myofascial trigger points. Thus, the aim of this study was to evaluate the effectiveness of DN in pain and physical function in patients with osteoarthritis in the short-, medium- and long-term. METHODS: PubMed, Cochrane Library, PEDro, Web of Science, and SCOPUS databases were searched in September 2022. Randomized controlled trials involving DN compared to non-pharmacological interventions, sham techniques or no additional treatment were selected. Quality of the studies was assessed with PEDro scale and risk of bias with Cochrane Collaboration tool. Meta-analyses were conducted using fixed or random effects models according to the Cochrane handbook for systematic reviews of interventions. RESULTS: Seven studies were included in the meta-analysis involving 291 patients with osteoarthritis. The methodological quality of the included studies ranged from fair to high. DN showed significant improvements in pain intensity (SMD = -0.76; 95% CI: -1.24, -0.29; I2: 74%) and physical function (SMD = -0.98; 95% CI: -1.54, -0.42; I2: 75%) in the short-term. No differences were found in the medium- or long-term. The risk of bias, heterogeneity, and imprecision of the results downgraded the level of evidence to very low. CONCLUSIONS: Very low-quality evidence suggests a positive effect of DN for reducing pain intensity and improving physical function in the short term in patients with osteoarthritis. Further investigation is needed to determine a medium- and long-term effects.

Diacutaneous Fibrolysis Intervention in Patients with Mild to Moderate Carpal Tunnel Syndrome May Avoid Severe Cases in Elderly: A Randomized Controlled Trial.

BACKGROUND: Carpal Tunnel Syndrome (CTS) mainly affects adults of working age. The prevalence of severe cases is higher in elderly patients (>65 years old). Clinical guidelines recommend conservative treatment as the best option in the initial stages of CTS to avoid severe cases. Diacutaneous Fibrolysis (DF) has demonstrated to improve nerve conduction studies and mechanosensitivity. The main purpose was to quantify changes in the cross-sectional area (CSA) of the median nerve, transversal carpal ligament (TCL) thickness, numbness intensity, and the subjective assessment of clinical change after DF treatment in patients with CTS. METHODS: a double-blind, randomized, placebo-controlled trial was designed. A number of 44 patients (60 wrists) with CTS were randomized to the DF group or the sham group. CSA and TCL thickness variables were registered by ultrasound. Clinical variables were assessed by the visual analogue scale and GROC scale. SPSS version 24.0 for MAC was used for statistical analysis. The group by time interaction between groups was analyzed using two-way repeated measures analysis of variance. RESULTS: The DF group reduced CSA with a mean of 0.45 mm2 (IC 95% 0.05 to 0.86) and TCL thickness with a mean reduction of 0.4 mm (IC 95% 0.6 to 2.1) compared to the sham group (p < 0.01, p < 0,03, respectively). Additionally, the DF group decreased the numbness intensity with a mean reduction of 3.47 (IC 95% 2.50 to 4.44, p < 0.01) and showed a statistically significant improvement on the GROC scale (p < 0.01). CONCLUSIONS: DF treatment may significantly reduce CSA and TCL thickness, numbness intensity, and improved clinical perspective. DF applied in patients with mild to moderate CTS may prevent the progression of the disease as they age.

Differential movement of the median nerve and biceps brachii at the elbow in human cadavers.

BACKGROUND: It is important to establish if mechanical testing for physical problems in the human is specific or non-specific for structures - e.g. muscle and nerve. The median nerve at the wrist can be moved in preference to its adjacent flexor digitorum longus muscle, but it is necessary to know if this specificity extends to the elbow. We therefore measured mechanical behaviour of the median nerve at the elbow compared to its adjacent muscle - biceps brachii. METHODS: This cross-sectional study on nine fresh frozen cadaver upper limbs used differential variable reluctance transducers and Vernier callipers to measure strain and excursion in the median nerve and biceps brachii during cervical contralateral lateral flexion in glenohumeral abduction: 0°, 30°, 60° and 90°. FINDINGS: Proximal excursion and strain with contralateral lateral flexion occurred in the median nerve primarily at 60° and 90° abduction (p < 0.05), but no changes occurred in the muscle (p > 0.05). INTERPRETATION: This study provides evidence of emphasising load to peripheral nerve over biceps at the elbow during cervical contralateral lateral flexion.