A randomized blinded comparative study of clinical response to surface anatomy guided injection versus sonography guided injection of hyaloronic acid in patients with primary knee osteoarthritis.

BACKGROUND AND AIM: Comparison between the effect of sonographic guided and blind knee injection of hyaluronic acid has been evaluated in this study. METHODS AND MATERIALS: Sixty-one patients with primary knee osteoarthritis were randomly allocated into two groups and received intrabursal injection of hyaloronic acid over 3 weeks. The difference between baseline amounts of Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Knee Injury and Osteoarthritis Outcome Score and visual analogue scale (VAS) score and these amounts after 6 and 12 weeks were calculated and subsequently compared between the two groups. RESULTS: Among all scores and indices, WOMAC pain and function subscales changed significantly (both in the short-term and long-term follow-up). The mean differences of WOMAC subscale pain in those who had received intra-articular injection under the guidance of sonography were significantly higher than those in patients who had received blind injections after 6 and 12 weeks. The mean differences of WOMAC subscale function in those who had received ultrasonography guided intra-articular injection were significantly higher than those in patients, who had received blind injections after 6 and 12 weeks. The mean in differences of the 10-cm VAS (both at rest and after 50-feet walk) in the two groups was statistically significant after 6 weeks, but did not remain significant after 12 weeks. CONCLUSION: Application of sonography might improve the response of patients to intra-articular injection of hyaloronic acid, at least in certain clinical indices.

Treatment of Subacromial Impingement Syndrome: Platelet-Rich Plasma or Exercise Therapy? A Randomized Controlled Trial.

BACKGROUND: Subacromial impingement syndrome (SAIS) is the most common disorder of the shoulder. The evidence for the effectiveness of treatment options is inconclusive and limited. Therefore, there is a need for more evidence in this regard, particularly for long-term outcomes. HYPOTHESIS: Platelet-rich plasma (PRP) would be an effective method in treating subacromial impingement. STUDY DESIGN: Randomized controlled trial; Level of evidence, 1. METHODS: This was a single-blinded randomized clinical trial with 1-, 3-, and 6-month follow-up. Sixty-two patients were randomly placed into 2 groups, receiving either PRP or exercise therapy. The outcome parameters were pain, shoulder range of motion (ROM), muscle force, functionality, and magnetic resonance imaging findings. RESULTS: Both treatment options significantly reduced pain and increased shoulder ROM compared with baseline measurements. Both treatments also significantly improved functionality. However, the treatment choices were not significantly effective in improving muscle force. Trend analysis revealed that in the first and third months, exercise therapy was superior to PRP in pain, shoulder flexion and abduction, and functionality. However, in the sixth month, only shoulder abduction and total Western Ontario Rotator Cuff score were significantly different between the 2 groups. CONCLUSION: Both PRP injection and exercise therapy were effective in reducing pain and disability in patients with SAIS, with exercise therapy proving more effective.

Reliability of assessment of upper trapezius morphology, its mechanical properties and blood flow in female patients with myofascial pain syndrome using ultrasonography.

OBJECTIVE: In the present study, the intra-rater reliability of upper trapezius morphology, its mechanical properties and intramuscular blood circulation in females with myofascial pain syndrome were assessed using ultrasonography. DESIGN: A total of 37 patients (31.05 ± 10 years old) participated in this study. Ultrasonography producer was set up in three stages: a) Gray-scale: to measure muscle thickness, size and area of trigger points; b) Ultrasound elastography: to measure muscle stiffness; and c) Doppler imaging: to assess blood flow indices. RESULTS: According to data analysis, all variables, except End Diastolic Velocity (EDV), had excellent reliability (>0.806). Intra-class Correlation Coefficient (ICC) for EDV was 0.738, which was considered a poor to good reliability. CONCLUSION: The results of this study introduced a reliable method for developing details of upper trapezius features using muscular ultrasonography in female patients. These variables could be used for objective examination and provide guidelines for treatment plans in clinical settings.

Ultrasonography for the assessment of the upper trapezius properties in healthy females: a reliability study.

BACKGROUND: to date, an assessment of morphometric features, muscle stiffness and blood flow in the upper trapezius among healthy females at rest and contraction states has not been conducted. So, in the current research, the intra-rater reliability of ultrasonographic features of upper trapezius in healthy females was examined. METHOD: in this study stiffness and thickness of the upper trapezius in rest and contraction states were measured by ultrasonography on 12 healthy female subjects (28.33±5.05 years old). Color Doppler imaging was used to assess muscle circulation in the rest state only. Every step and calculation of measurements was repeated 3 times with the same rater. Therefore, in total 36 measurements were done for each variable. RESULTS: according to the analysis, the value of intra class correlation coefficient (ICC) for total variables showed an excellent level of reliability. Thickness at contraction had maximum reliability (ICC= 0.993) and Minimum Diastolic Velocity had the lowest reliability (ICC=0.771). CONCLUSIONS: the results of current research demonstrated that real time ultrasonography is a reliable method for measurement of various parameters of upper trapezius, including morphometric features, its stiffness and blood supply in non-symptomatic females. These mentioned variables can likely be used for objective assessment and provide numerical reference value for clinical plans.