Prevalence of cold-related musculoskeletal pain according to self-reported threshold temperature among the Finnish adult population.

BACKGROUND: Exposure to cold reportedly increases musculoskeletal pains. We assessed the prevalence of such pain and self-reported threshold temperature (TT) at which the pain emerges. METHODS: A random sample of 6591 people in Finland, aged 25-74 years, answered a questionnaire on repeated cold-related musculoskeletal pain (CMP) and its TT. The response rate was 64%. We used quantile regression to quantify the effects of personal characteristics and region of residence on TT at various locations of its distribution. RESULTS: Of the participants, 1892 (30%) experienced CMP in at least one body site and 1692 reported TT. Ten percent of the participants who perceived CMP did so at -2 °C, 50% at -14 °C and 90% at -23 °C. Residence in the South elevated TT by 1-6 °C compared with residence in the North, depending on the proportion of participants reporting CMP at various temperatures. Joint disorders increased TT at milder temperatures, at which only 10% of all participants perceived CMP, whereas back disorders did so mainly at lower temperatures, at which 70% were affected. Overweight was associated with a 2 °C lower TT, and physical inactivity with a 1 °C higher TT, and TT increased by 1 °C per 10-year increase in age. The greatest model-estimated difference in median TT between subgroups was 12 °C. CONCLUSIONS: People suffering from musculoskeletal disorders and those living in the warmer areas of Finland need special advice to protect themselves against the cold. Our study provides preliminary information to support such advice.

Cost effectiveness of periradicular infiltration for sciatica: subgroup analysis of a randomized controlled trial.

STUDY DESIGN: A subgroup analysis of a prospective, randomized controlled trial was performed. OBJECTIVE: To describe the cost effectiveness of periradicular infiltration with steroid in subgroups of patients with sciatica. SUMMARY OF BACKGROUND DATA: A recent trial on periradicular infiltration indicated that a methylprednisolone-bupivacaine combination had a short-term effect, as compared with that of saline. This report describes the efficacy and cost effectiveness of steroid in subgroups of patients with sciatic. METHODS: This study involved 160 patients with unilateral sciatica. Outcome assessments were leg pain (100-mm visual analog scale), disability on the Oswestry Low Back Disability Questionnaire, and the Nottingham Health Profile. Data on medical costs and sick leaves also were gathered. Patients were randomized for periradicular infiltration with either methylprednisolone-bupivacaine or saline. The adjusted between-group treatment differences at each follow-up assessment, the number of patients free of leg pain (responders, cutoff 75%), and efficacy by the area-under-the-curve method were calculated. For the cost-effectiveness estimate, the total costs were divided by the number of responders. The rate of operations in different subgroups was evaluated by Kaplan-Meier analysis. RESULTS: In the case of contained herniations, the steroid injection produced significant treatment effects and short-term efficacy in leg pain and in Nottingham Health Profile emotional reactions. For symptomatic lesions at L3-L4-L5, steroid was superior to saline for leg pain, disability, and straight leg raising in the short term. By 1 year, steroid seemed to have prevented operations for contained herniations, costing $12,666 less per responder in the steroid group (P < 0.01). For extrusions, steroid seemed to increase the operation rate, and the steroid infiltration was more expensive, costing $4445 per responder (P < 0.01). CONCLUSIONS: In addition to short-term effectiveness for contained herniations and lesions at L3-L4-L5, steroid treatment also prevented surgery for contained herniations. However, steroid was countereffective for extrusions. The results of the subgroup analyses call for a verification study.

Surgical treatment of resistant tennis elbow. A prospective, randomised study comparing decompression of the posterior interosseous nerve and lengthening of the tendon of the extensor carpi radialis brevis muscle.

We compared decompression of the posterior interosseous nerve (PIN) and lengthening of the distal tendon of the extensor carpi radialis brevis (ECRB) for treatment of tennis elbow in a randomised trial of 28 patients. Fourteen underwent decompression of PIN and 14, lengthening of ERCB. The groups did not differ significantly with regard to age, sex and work activities. The average duration of preoperative symptoms was 23 months. The PIN was exposed in the groove between the brachioradialis and brachialis muscles and decompressed at the arcade of Frohse by means of a 1-2 cm incision through the supinator muscle. The ECRB tendon was lengthened by Z-plasty at the dorsilateral aspect of the forearm. No postoperative complications occurred. The outcome after the primary operation was successful in 50% of the PIN group and in 43% of the ECRB group. Four of the 5 patients with a poor outcome were reoperated in the former group and 3 in the latter. The overall outcome after a mean follow-up of 31 months after the primary operation was successful in 60% of the cases.

Periradicular infiltration for sciatica: a randomized controlled trial.

STUDY DESIGN: A randomized, double-blind trial was conducted. OBJECTIVES: To test the efficacy of periradicular corticosteroid injection for sciatica. SUMMARY OF BACKGROUND DATA: The efficacy of epidural corticosteroids for sciatica is controversial. Periradicular infiltration is a targeted technique, but there are no randomized controlled trials of its efficacy. METHODS: In this study 160 consecutive, eligible patients with sciatica who had unilateral symptoms of 1 to 6 months duration, and who never underwent surgery were randomized for double-blind injection with methylprednisolone bupivacaine combination or saline. Objective and self-reported outcome parameters and costs were recorded at baseline, at 2 and 4 weeks, at 3 and 6 months, and at 1 year. RESULTS: Recovery was better in the steroid group at 2 weeks for leg pain (P = 0.02), straight leg raising (P = 0.03), lumbar flexion (P = 0.05), and patient satisfaction (P = 0.03). Back pain was significantly lower in the saline group at 3 and 6 months (P = 0.03 and 0.002, respectively), and leg pain at 6 months (13.5, P = 0.02). Sick leaves and medical costs were similar for both treatments, except for cost of therapy visits and drugs at 4 weeks, which were in favor of the steroid injection (P = 0.05 and 0.005, respectively). By 1 year, 18 patients in the steroid group and 15 in the saline group underwent surgery. CONCLUSIONS: Improvement during the follow-up period was found in both the methylprednisolone and saline groups. The combination of methylprednisolone and bupivacaine seems to have a short-term effect, but at 3 and 6 months, the steroid group seems to experience a "rebound" phenomenon.

Long-term follow-up of conservatively treated chronic tennis elbow patients. A prospective and retrospective analysis.

This study aimed to assess the long-term outcome of progressive exercise and local pulsed ultrasound in the treatment of 30 chronic tennis elbow patients (2 men, 18 women, mean age 42.3 years). The patients were originally randomised into 1) four-step progressive exercise (EX, n = 16) and 2) local pulsed ultrasound (US, n = 14) treatment groups. Before the beginning of the treatment, the groups were similar in terms of pain scores, sick-leave days and duration of symptoms. The patients underwent an 8-week treatment intervention. Long-term follow-up evaluation of the patients was performed 1) prospectively using a pain questionnaire on VAS and pain drawings classified into 5 categories, and 2) retrospectively with a postal questionnaire (which was sent to the patients to fill in. Sick-leave days, medical and physiotherapy visits, operations, early retirements and job relocations were inquired in the postal questionnaire. The diagnosis-related sick-leave days of the patients were collected from the Database of the Social Insurance Institution of Finland and the number of operations from the local hospital register. Twenty-three patients (12 in the EX group and 11 in the US group) responded. The mean follow-up time was 36 months. After the treatment the patients in the EX group needed significantly less physiotherapy (p = 0.02), fewer medical consultations (p = 0.005) and other treatments and had fewer sick-leave days (p = 0.005) than before the treatment intervention. The patients in the US group had after the treatment intervention more 17 medical visits (ns), 291 sick-leave days (ns) and less 95 physiotherapy visits (ns) than before the treatment. Eight patients (67%) in the EX group and 5 (45%) in the US group still held their previous job, while two patients in the US group, but none in the EX group were absent from work because of the tennis elbow syndrome. The patients in the EX group reported significantly lower pain scores on VAS than those in the US group. The mean pain drawing category was 1.5 in the EX group and 2.7 in the US group (p = 0.008). All the pain scores and pain drawing categories in the EX group had changed to be significantly better than in the US group, where only pain under strain had significantly improved. Because of resistant symptoms, 5 patients were operated in the US group and one in the EX group. Neither spontaneous healing, nor self-limiting of the disorder were noted during the follow-up period. The progressive exercise evaluated in this study showed beneficial long-term effects compared to ultrasound treatment in terms of pain alleviation and working ability, and the functional overall condition of the exercise patients was also better. Exercise may be able to prevent chronicity and should hence be tried and recommended.

Bilaterally decreased motor performance of arms in patients with chronic tennis elbow.

OBJECTIVE: To measure the motor performance of arms in patients with chronic unilateral tennis elbow. DESIGN: Cross-sectional case-control study. SETTING: University hospital clinic admitting chronic hand patients. SUBJECTS: Thirty-two patients with chronic unilateral tennis elbow syndrome and 32 age- and gender-matched controls. MAIN OUTCOME MEASURES: The motor performance of arms was measured with the Human Performance Measurement/Basic Elements of Performance system using the module for hands and the protocol of the device. Reaction times, speed of movement, and coordination as a combination of speed of movement and accuracy (number of correct hits) were measured. The results were compared between patients and controls. RESULTS: Simple one-choice and two-choice reaction times were 19% to 36% slower in the patients than in the controls, and speed of movement was 31% to 32% slower in the patients than in the controls. The differences were statistically significant. The coordination results were 9.6bits/sec in the patients and 9.7bits/sec in the controls. The difference was not statistically significant. The reaction times and speed of movement did not differ significantly between the patients' involved and healthy arms. The patients' healthy arms showed significantly slower reaction times and speed of movement than the corresponding arms of the controls. CONCLUSIONS: Unilateral chronic tennis elbow patients have bilaterally decreased reaction times and speed of movement of arms compared with age- and gender-matched controls. The cause for this phenomenon is unclear; the decreased motor performance may be primary and show an increased susceptibility to develop the tennis elbow syndrome or it may be a result of chronicity.