Association of Hip Radiograph Findings With Pain and Function in Patients Presenting With Low Back Pain.

BACKGROUND: Relationships between low back pain (LBP) and the hip in patient cohorts have been described primarily in patients with moderate to severe hip osteoarthritis (OA). Less is known about the links of LBP with hip radiographic findings of hip deformity and minimal OA. OBJECTIVE: To describe the incidence of radiographic hip deformity or hip OA; to describe and compare spine- and hip-related pain and function in the subset of patients who were found to have radiographic hip deformity or hip OA; and to compare patients with evidence of radiographic hip deformity or hip OA to patients without hip radiographic findings. DESIGN: Prospective cohort study with cross-sectional design. SETTING: Tertiary university. PATIENTS: A total of 63 patients (40 women, 23 men) with a mean age of 48.5 ± 14 years with LBP and a minimum of one positive provocative hip test. METHODS: Hip radiographs were assessed by an independent examiner for hip OA and deformity. MAIN OUTCOME MEASUREMENTS: Comparisons of hip and lumbar spine pain and function were completed for patients with radiographic findings of hip OA or deformity. RESULTS: Moderate to severe hip OA was found in 12 of 60 patients (20.0%). At least one measurement of femoroacetabular impingement (FAI) was found in 14 of 60 patients (23.3%) to 33 of 45 patients (73.3%). At least one measurement of developmental hip dysplasia (DDH) was found in 7 of 60 patients (11.6%) to 11 of 63 patients (17.4%). Greater pain and reduced hip and lumbar spine function were found in the patients with moderate to severe hip OA. Patients with LBP and FAI were found to have significantly greater extremes of pain and reduced lumbar spine function. CONCLUSION: Links between the hip and the spine affecting pain and function may be found in patients with LBP and hip deformity and before the onset of radiographic hip OA, and may be associated with hip deformity. Further investigation is needed to better understand these links and their potential impact on prognosis and treatment of LBP. LEVEL OF EVIDENCE: II.

Neurochemical analysis of primary motor cortex in chronic low back pain.

The involvement of the primary motor cortex (M1) in chronic low back pain (LBP) is a relatively new concept. Decreased M1 excitability and an analgesic effect after M1 stimulation have been recently reported. However, the neurochemical changes underlying these functional M1 changes are unknown. The current study investigated whether neurochemicals specific to neurons and glial cells in both right and left M1 are altered. N-Acetylaspartate (NAA) and myo-inositol (mI) were measured with proton magnetic resonance spectroscopy in 19 subjects with chronic LBP and 14 healthy controls. We also examined correlations among neurochemicals within and between M1 and relationships between neurochemical concentrations and clinical features of pain. Right M1 NAA was lower in subjects with LBP compared to controls (p = 0.008). Left M1 NAA and mI were not significantly different between LBP and control groups. Correlations between neurochemical concentrations across M1s were different between groups (p = 0.008). There were no significant correlations between M1 neurochemicals and pain characteristics. These findings provide preliminary evidence of neuronal depression and altered neuronalglial interactions across M1 in chronic LBP.

Predictors of upper extremity symptoms and functional impairment among workers employed for 6 months in a new job.

BACKGROUND: We sought to identify personal and work-related predictors of upper extremity symptoms and related functional impairment among 1,108 workers employed for 6 months in a new job. METHODS: We collected data at baseline and 6-month follow-up using self-administered questionnaires. Multivariate logistic regression models were created for each outcome variable. Predictors included personal risk factors, physical work exposures and psychosocial factors. RESULTS: Independent predictors for upper extremity symptoms at 6-month follow-up were age, Caucasian race, female gender, baseline history of UE symptoms, and job tasks involving wrist bending or forceful gripping. Independent predictors for functional impairment were baseline history and severity of UE symptoms, wrist bending, and social support. CONCLUSIONS: Both personal and work-related factors were independent predictors of upper extremity symptoms and functional impairment in this working population. We found different risk factors for symptoms than for functional impairment related to symptoms.