Association between Pain Sensitivity, Central Sensitization, and Functional Disability in Adolescents With Joint Hypermobility.

PURPOSE: The purpose of this study was to examine the association between pain sensitivity, central sensitization, and functional disability in adolescents with joint hypermobility. DESIGN AND METHODS: A cross-sectional descriptive design was utilized for this study. A sample of 40 adolescents being evaluated for chronic pain and autonomic nervous system dysfunction were recruited. Subjects were evaluated for pain, function, central sensitization, and sensitivity on pain and touch sensory nerve fiber types. Data were analyzed to detect associations between variables. RESULTS: Joint hypermobility had a moderately significant correlation with central sensitization measured by the Central Sensitization Inventory, as well as increased pain sensitivity as evidenced by hypersensitivity of Aδ sensory nerve fibers. The presence of central sensitization was also positively associated with level of functional disability. CONCLUSIONS: Findings implicate joint hypermobility as a possible antecedent to pain hypersensitivity and central sensitization syndromes that when recognized and addressed effectively may reduce functional disability in those affected. PRACTICE IMPLICATIONS: It is important for pediatric nurses that work with adolescents that have chronic pain to understand variables that may impact pain and functional disability in order to develop methods to increase function, reduce pain, and increase perceived quality of life.

Horizontal Slide Creates Less Cervical Motion When Centering an Injured Patient on a Spine Board.

BACKGROUND: A patient with a suspected cervical spine injury may be at risk for secondary neurologic injury when initially placed and repositioned to the center of the spine board. OBJECTIVES: We sought to determine which centering adjustment best limits cervical spine movement and minimizes the chance for secondary injury. METHODS: Using five lightly embalmed cadaveric specimens with a created global instability at C5-C6, motion sensors were anchored to the anterior surface of the vertebral bodies. Three repositioning methods were used to center the cadavers on the spine board: horizontal slide, diagonal slide, and V-adjustment. An electromagnetic tracking device measured angular (degrees) and translation (millimeters) motions at the C5-C6 level during each of the three centering adjustments. The dependent variables were angular motion (flexion-extension, axial rotation, lateral flexion) and translational displacement (anteroposterior, axial, and medial-lateral). RESULTS: The nonuniform condition produced significantly less flexion-extension than the uniform condition (p = 0.048). The horizontal slide adjustment produced less cervical flexion-extension (p = 0.015), lateral bending (p = 0.003), and axial rotation (p = 0.034) than the V-adjustment. Similarly, translation was significantly less with the horizontal adjustment than with the V-adjustment; medial-lateral (p = 0.017), axial (p < 0.001), and anteroposterior (p = 0.006). CONCLUSIONS: Of the three adjustments, our team found that horizontal slide was also easier to complete than the other methods. The horizontal slide best limited cervical spine motion and may be the most helpful for minimizing secondary injury based on the study findings.

Thermal capsulorrhaphy for acute or chronic shoulder instability.

During the past two decades, arthroscopic procedures have been replacing traditional, more invasive orthopedic surgical procedures. As technology becomes more advanced, the opportunity to provide a greater number of minimally invasive surgical interventions continues to improve. Thermal modification of joint capsule and ligamentus tissues, a recent introduction to medical science, has been investigated extensively during the past six years. Arthroscopic thermal capsulorrhaphy is one such procedure, and it is performed on individuals with a history of joint instability. These patients now can be treated surgically without large incisions and significant shoulder joint trauma. The thermal unit in both monopolar and bipolar models has similar properties to those of the basic electrosurgical unit. Relatively low-temperature heat is directed to the supportive structures of the shoulder joint causing the tissues to expand. This tightens a previously stretched and attenuated shoulder capsule.

Examining separated symphysis pubis.

Separated symphysis pubis (SSP) is a rare condition that results in a separation of the symphysis pubis bone in late pregnancy or during delivery and occurs in otherwise healthy pregnancies as a result of hormonal and/or biomechanical factors. Several researchers have examined the issue in the Scandinavian countries, where it appears to be more prevalent possibly due to a genetic link. Symptoms range from mild discomfort to total debilitation. Differential diagnosis includes exclusion of more serious medical conditions. The nurse midwife's role is prompt diagnosis, medical consultation, support, and education.