Tender point sensitivity, range of motion, and perceived disability in subjects with neck pain.

STUDY DESIGN: Descriptive analysis of impairment and disability measures in subjects with neck pain. OBJECTIVES: To identify discrete tender points and overall pressure sensitivity and assess relationships among palpation tenderness, active cervical range of motion, visual analog scale pain scores, and Sickness Impact Profile disability scores. BACKGROUND: Palpation tenderness and cervical range of motion are used to evaluate patients with neck pain, but their ability to predict patient-perceived pain and disability is unknown. METHODS AND MEASURES: We studied 45 women and 15 men with neck pain (mean age, 35 +/- 7 years). Group 1 included 30 persons who had not sought treatment, and group 2 included 30 persons who had just been referred for treatment. RESULTS: Subjects demonstrated low mean pressure pain thresholds of tender points (2.3 +/- 1.3 kg). Regression analysis showed that only neck flexion predicted pain (R2 = 0.23), with decreased flexion associated with higher pain levels. Sickness Impact Profile total score was predicted by neck rotation (R2 = 0.31), group (R2 = 0.16), tender point pressure pain threshold (R2 = 0.04), and neck retraction (R2 = 0.03). Decreased neck rotation, neck retraction, and pressure pain thresholds were associated with higher disability. CONCLUSIONS: Neither palpation tenderness nor cervical range of motion were strong predictors of pain and disability in subjects with neck pain.

Improved detection of infective endocarditis with transesophageal echocardiography.

The incremental advantage of transesophageal echocardiography was determined by comparing results of paired transthoracic and transesophageal echocardiographic examinations performed in 61 patients for evaluation of suspected infective endocarditis. According to clinical and pathologic data, 31 of 61 (51%) patients had finding that were positive for infective endocarditis. Studies were graded as positive or negative for vegetations and were also graded for image quality. The sensitivity of transesophageal echocardiography in detecting vegetations was 88% versus 30% for transthoracic studies (p less than 0.01). For patients with aortic valve infective endocarditis, transesophageal sensitivity was 88% versus 25% for transthoracic sensitivity, because transesophageal echocardiography successfully separated vegetations from chronic valve disease caused by sclerosis or calcification (p less than 0.01). For patients with mitral valve infective endocarditis, transesophageal sensitivity was 100% versus 50% for transthoracic sensitivity, because transesophageal echocardiography distinguished vegetations from myxomatous changes or detected vegetations on prosthetic valves (p less than 0.01). Thus transesophageal echocardiography improves recognition of infective endocarditis, particularly in the presence of underlying valvular disease.