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2.
BMC Health Serv Res ; 20(1): 246, 2020 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-32209091

RESUMO

BACKGROUND: The first aim of this research was to investigate the current prevalence of musculoskeletal ultrasound in Dutch physiotherapy practices. The second aim was to explore experiences of physiotherapists with musculoskeletal ultrasound in a primary care setting with patients presenting with shoulder complaints. METHODS: A random sample of 1000 owners of primary care physiotherapy practices was sent a questionnaire to investigate the prevalence of musculoskeletal ultrasound. A second questionnaire was sent to physiotherapists using musculoskeletal ultrasound to explore experiences with it in patients with shoulder complaints. RESULTS: The net response rate of the first questionnaire was 57.7%. In 18% of the physiotherapy practices musculoskeletal ultrasound was offered. Sixty-nine physiotherapists returned the second questionnaire. Physiotherapists indicated they most often used musculoskeletal ultrasound in patients with shoulder complaints, mainly for suspected tissue damage (83.7%), followed by making a diagnosis (63.3%) and for determining the choice of treatment (36.7%). Physiotherapists reported the biggest advantage was that they were better able to diagnose presenting shoulder complaints. The most frequently mentioned disadvantage of the use of musculoskeletal ultrasound was that assessment is difficult and that there is a risk that findings may not be sufficiently linked to history and physical examination. CONCLUSION: One in six physiotherapy practices in the Netherlands offer musculoskeletal ultrasound. It is mainly used for patients with shoulder complaints, with an emphasis on detecting tissue damage and as an aid for diagnosis. Physiotherapists trained to work with musculoskeletal ultrasound seem enthusiastic and are at the same time aware of its disadvantages.


Assuntos
Dor Musculoesquelética/diagnóstico por imagem , Fisioterapeutas/psicologia , Modalidades de Fisioterapia/estatística & dados numéricos , Atenção Primária à Saúde , Adulto , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Fisioterapeutas/estatística & dados numéricos , Dor de Ombro/diagnóstico por imagem , Ultrassonografia/estatística & dados numéricos
3.
Scand J Med Sci Sports ; 30(7): 1221-1231, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32201993

RESUMO

BACKGROUND: Conflicting and limited high-quality prospective data are available on the associations between cam morphology and hip and groin symptoms and range of motion (ROM). OBJECTIVES: This cross-sectional cohort study investigated associations between cam morphology presence, size and duration and symptoms and ROM. METHODS: Academy male football players (n = 49, 17-24 years) were included. Standardized antero-posterior pelvic and frog-leg lateral radiographs were obtained at baseline, 2.5- and 5-year follow-up. The femoral head-neck junction was quantified by: Visual score. Cam morphology (flattening or prominence), large cam (prominence). Alpha angle. Cam morphology (≥60°), large cam (≥78°). Cam morphology duration was defined as long (first present at baseline) or short (only from 2.5- to 5-year follow-up). Current symptoms at 5-year follow-up were assessed using a hip and groin pain question and by the "Hip and Groin Outcome Score" (HAGOS). HAGOS scores were categorized into: most symptoms (≥2 domains in lowest interquartile range [IQR]), least symptoms (≥2 domains in highest IQR). Hip ROM was measured by goniometry at 5-year follow-up. RESULTS: Large cam morphology based on visual score was associated with hip and groin pain (23.8% vs. 7.1%, OR: 3.17, CI: [1.15-8.70], P = .026), but not with HAGOS scores. Cam morphology presence, size, and duration were associated with limited flexion of around 6° and/or 3° to 6° for internal rotation. CONCLUSION: Cam morphology presence, size, and duration were associated with limited hip flexion and/or internal rotation, but differences might not exceed the minimal clinical important difference. Whether cam morphology results in symptoms is uncertain.


Assuntos
Virilha/fisiopatologia , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/fisiopatologia , Futebol , Adolescente , Adulto , Atletas , Humanos , Masculino , Medição da Dor , Amplitude de Movimento Articular , Inquéritos e Questionários , Adulto Jovem
5.
J Dtsch Dermatol Ges ; 17(9): 913-921, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31538737

RESUMO

OBJECTIVE: Comparison of fluorescence optical imaging (FOI) with grayscale (GS) and power Doppler ultrasound (PDUS) to detect joint inflammation in patients with confirmed or suspected psoriatic arthritis (PsA). METHODS: Patients (n = 60) with psoriasis and tenderness and/or swelling of joints were separated into two groups: diagnosis confirmed by the treating dermatologist before the start of the study (n = 26), and suspected PsA (n = 34). GS/PDUS of the hand most clinically affected was performed with a dorsal/palmar view (wrist, MCP, PIP, DIP2-5). FOI examination was carried out in a standardized manner by analyzing the predefined Phases 1-3. RESULTS: FOI was found to be more sensitive than ultrasound (US) for detection of inflammation in PIP/DIP joints (p = 0.035). Confirmed PsA patients showed more findings in FOI P2 and P3, while suspected PsA patients showed more findings in P1. In the confirmed PsA group, most involved joints were MCP joints, while in the suspected PsA group, more involved wrist joints and DIP joints (p = 0.006) were detected with FOI. CONCLUSIONS: The differences between the confirmed and suspected groups indicate that FOI is helpful in the detection of early PsA since P1 may correspond to acute inflammation, whereas P2 and P3 enhancement reflect chronic inflammation. Fluorescence optical imaging might therefore be a novel diagnostic tool for early PsA diagnosis.


Assuntos
Artrite Psoriásica/diagnóstico por imagem , Adulto , Idoso , Diagnóstico Precoce , Edema/diagnóstico por imagem , Feminino , Articulações dos Dedos/diagnóstico por imagem , Dermatoses da Mão/diagnóstico por imagem , Humanos , Masculino , Microscopia de Fluorescência/métodos , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico por imagem , Imagem Óptica/métodos , Ultrassonografia , Articulação do Punho/diagnóstico por imagem
6.
Psychophysiology ; 56(12): e13452, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31429944

RESUMO

Anticipation of a painful experience can influence brain activity and increase sensitivity to experimental somatosensory stimuli in healthy adults, but this response is poorly understood among individuals with chronic musculoskeletal pain (CMP). Studies of brain and perceptual responses to somatosensory stimuli are used to make inferences about central nervous system dysfunction as a potential mechanism of symptoms. As such, we sought to (a) determine the influence of pain anticipation on pain-relevant brain regions and pain perception, and (b) characterize potential differences in these responses between Gulf War Veterans with CMP and matched healthy control (CO) Veterans. CMP (N = 30) and CO Veterans (N = 31) were randomized to conditions designed to generate expectations that either painful (pain) or nonpainful (no pain) stimuli would be administered. Brain responses to five nonpainful thermal stimuli were measured during fMRI, and each stimulus was rated for pain intensity and unpleasantness. In the pain condition, an incremental linear decrease in activity across stimuli was observed in the posterior cingulate cortex, cingulate cortex, and middle temporal gyrus. Further, in the pain condition, differential responses were observed between CMP and CO Veterans in the middle temporal gyrus. These findings indicate that brain responses to nonpainful thermal stimuli in Veterans with CMP are sensitive to pain anticipation, and we recommend accounting for the influence of pain anticipation in future investigations of central nervous system dysfunction in CMP.


Assuntos
Antecipação Psicológica/fisiologia , Córtex Cerebral/fisiopatologia , Dor Crônica/fisiopatologia , Dor Musculoesquelética/fisiopatologia , Percepção da Dor/fisiologia , Sensação Térmica/fisiologia , Percepção do Tato/fisiologia , Adulto , Córtex Cerebral/diagnóstico por imagem , Dor Crônica/diagnóstico por imagem , Guerra do Golfo , Humanos , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico por imagem , Veteranos
7.
Arthritis Rheumatol ; 71(12): 2034-2046, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31309740

RESUMO

OBJECTIVE: To evaluate whether different types of sacroiliac (SI) joint lesions identified by magnetic resonance imaging (MRI) could differentiate axial spondyloarthritis (SpA) from conditions with buttock or pelvic pain attributable to other reasons, including postpartum women and healthy subjects. METHODS: The study was designed as a prospective, cross-sectional study involving 204 participants, comprising patients with axial SpA (n = 41) and control groups of subjects with or without SI joint pain, including patients with lumbar disc herniation (n = 25), women with (n = 46) or without (n = 14) postpartum buttock/pelvic pain (having given birth within the preceding 4-16 months), hospital cleaning staff (n = 26), long-distance runners (n = 23), and healthy men (n = 29). Participants underwent clinical examination and MRI, and MRIs were evaluated in a blinded manner by 2 readers according to the Spondyloarthritis Research Consortium of Canada (SPARCC) SI joint inflammation and structural lesion scores. SPARCC score cutoff levels were defined as scores above a certain threshold. Primary analyses were based on reader agreement with regard to the presence of SI joint pathologic features on MRI ("concordant reads"). Sensitivity, specificity, and positive and negative predictive values were calculated. RESULTS: SI joint ankylosis and backfill were detected by MRI only in patients with axial SpA (32% and 37%, respectively), while bone marrow edema (BME) and fat lesions were seen in all non-axial SpA control groups (3-39% with BME and 4-14% with fat lesions). SI joint erosion was present only in patients with axial SpA and in women with postpartum buttock/pelvic pain (at erosion score cutoffs of >1 and >4, 61% and 34%, respectively, in patients with axial SpA, and 9% and 2%, respectively, in women with postpartum buttock/pelvic pain). A SPARCC BME score of ≥5 was present only in patients with axial SpA (56%) and in women with postpartum buttock/pelvic pain (24%), while fat lesions were present, albeit rarely, at high SPARCC cutoff scores in nearly all groups. Of the 38 women from the non-postpartum control groups who had given birth (mean time since birth 9.7 years), 2 (5%) had BME, whereas none had SI joint erosion or fat lesions, and none had a BME score of ≥4. CONCLUSION: BME and fat lesions were most pronounced in patients with axial SpA, but also occurred in other groups, particularly women with postpartum buttock/pelvic pain. Erosion above a certain SPARCC score threshold as well as backfill and ankylosis were highly specific for axial SpA.


Assuntos
Imagem por Ressonância Magnética/estatística & dados numéricos , Dor Musculoesquelética/diagnóstico por imagem , Dor Pélvica/diagnóstico por imagem , Articulação Sacroilíaca/diagnóstico por imagem , Espondilartrite/diagnóstico por imagem , Adulto , Doenças da Medula Óssea/diagnóstico por imagem , Nádegas/diagnóstico por imagem , Nádegas/patologia , Estudos Transversais , Diagnóstico Diferencial , Edema/diagnóstico por imagem , Feminino , Humanos , Deslocamento do Disco Intervertebral/diagnóstico por imagem , Deslocamento do Disco Intervertebral/patologia , Masculino , Período Pós-Parto , Valor Preditivo dos Testes , Gravidez , Estudos Prospectivos , Valores de Referência , Articulação Sacroilíaca/patologia , Sensibilidade e Especificidade , Índice de Gravidade de Doença , Adulto Jovem
8.
Medicine (Baltimore) ; 98(14): e15023, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30946335

RESUMO

RATIONALE: Gorham-Stout disease (GSD) is a rare disorder characterized by multiple osteolytic lesions, sometimes complicated by chylothorax. The aim of this case report is to introduce a very rare case of Gorham-Stout syndrome, which involved several bones along with chylous pericardial and pleural effusions detected by Tc-sulfur colloid (SC) lymphoscintigraphy and single photon emission computed tomography/computed tomography (SPECT/CT). PATIENT CONCERNS: A 15-year-old girl presented to our hospital complaining of shortness of breath and bone pain. DIAGNOSIS: The CT showed multiple osteolytic lesions, left-sided pleural effusion, and pericardial effusion. Tc-SC lymphoscintigraphy showed discontinuation of thoracic duct and tracer accumulation on the left side chest. SPECT/CT revealed increased radioactivity uptake in pleural, pericardial effusions, and some thoracolumbar spines. Diagnostic thoracentesis to identify the nature of pleural effusion and histopathology of biopsy in the right femoral to that of the bone lesion were performed. Based on the clinical information, histopathologic, and radiographic findings, the diagnosis of GSD was made. INTERVENTIONS: The patient received thoracic duct ligation and bisphosphonates treatment. OUTCOMES: After receiving thoracic duct ligation and bisphosphonates treatment, the patient's symptoms of bone pain and dyspnea were relieved, and the pericardial and pleural fluid was diminished dramatically. At the 3-month and 9-month follow-up visit, the patient had nearly complete remission without any complication. LESSONS: The Tc-SC lymphoscintigraphy and SPECT/CT could provide significant value assessing the lymphatic abnormity and evaluating the extent of disease, therefore aiding to guide decision making in the clinic.


Assuntos
Quilotórax/diagnóstico por imagem , Linfocintigrafia/métodos , Dor Musculoesquelética/diagnóstico por imagem , Osteólise Essencial/diagnóstico por imagem , Tomografia Computadorizada com Tomografia Computadorizada de Emissão de Fóton Único/métodos , Adolescente , Quilotórax/etiologia , Feminino , Humanos , Dor Musculoesquelética/etiologia , Osteólise Essencial/complicações , Compostos Radiofarmacêuticos , Coloide de Enxofre Marcado com Tecnécio Tc 99m
9.
Br J Hosp Med (Lond) ; 80(4): 192-195, 2019 Apr 02.
Artigo em Inglês | MEDLINE | ID: mdl-30951433

RESUMO

Heel pain is a common presentation in primary care and affects a wide range of the population but predominantly elderly, obese and athletic patients. History and clinical assessment are paramount in the management of this condition but the presentation can confound clinicians, necessitating the use of imaging to confirm or clarify the diagnosis when there is clinical uncertainty. This article illustrates the various conditions producing heel pain to help clinicians determine the appropriate imaging modality to image the common causes of heel pain. A linked article detailing the management of heel pain is included in this issue ( https://doi.org/10.12968/hmed.2019.80.4.196 ).


Assuntos
Calcanhar/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico por imagem , Tendão do Calcâneo/diagnóstico por imagem , Bursite/diagnóstico por imagem , Calcâneo/diagnóstico por imagem , Calcâneo/lesões , Fasciíte Plantar/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Fraturas de Estresse/diagnóstico por imagem , Humanos , Imagem por Ressonância Magnética , Osteoartrite/diagnóstico por imagem , Radiografia , Articulação Talocalcânea/diagnóstico por imagem , Síndrome do Túnel do Tarso/diagnóstico por imagem , Tendinopatia/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Ultrassonografia
10.
Skeletal Radiol ; 48(5): 741-751, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30612161

RESUMO

OBJECTIVE: Slipping rib syndrome (SRS) affects adolescents and young adults. Dynamic ultrasound plays a potential and likely significant role; however, limited data exist describing the protocol and techniques available. It is our intent to describe the development of a reproducible protocol for imaging in patients with SRS. MATERIALS AND METHODS: Retrospective review of suspected SRS patients from March 2017 to April 2018. A total of 46 patients were evaluated. Focused history and imaging was performed at the site of pain. Images of the ribs were obtained in the parasagittal plane at rest and with dynamic maneuvers. Dynamic maneuvers included Valsalva, crunch, rib push maneuver, and any provocative movement that elicited pain. Imaging was compared with records from the pediatric surgeon specializing in slipping ribs. Statistical analysis was performed. RESULTS: Thirty-six of the 46 patients had a diagnosis of SRS, and had an average age of 17 years. Thirty-one patients were female, 15 were male. Thirty-one out of 46 (67%) were athletes. Average BMI was 22.6. Dynamic ultrasound correctly detected SRS in 89% of patients (32 out of 36) and correctly detected the absence in 100% (10 out of 10). Push maneuver had the highest sensitivity (87%; 0.70, 0.96) followed by morphology (68%; 0.51, 0.81) and crunch maneuver (54%; 0.37, 0.71). Valsalva was the least sensitive (13%; 0.04, 0.29). CONCLUSION: Dynamic ultrasound of the ribs, particularly with crunch and push maneuvers, is an effective and reproducible tool for diagnosing SRS. Valsalva plays a limited role. In addition to diagnosing SRS, ultrasound can give the surgeon morphological data and information on additional ribs at risk, thereby assisting in surgical planning.


Assuntos
Dor no Peito/diagnóstico por imagem , Dor no Peito/fisiopatologia , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/fisiopatologia , Costelas/diagnóstico por imagem , Costelas/fisiopatologia , Ultrassonografia/métodos , Adolescente , Atletas , Feminino , Humanos , Masculino , Estudos Retrospectivos , Sensibilidade e Especificidade , Síndrome , Adulto Jovem
11.
Int J Rheum Dis ; 22(2): 222-227, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30187686

RESUMO

AIM: Most heel pain occurs at the posterior or plantar aspect, where main entheses of the heel are located. However, simple radiographs as basic work-up tools, their features based on their association with local symptoms in the heel in ankylosing spondylitis (AS) patients, have rarely been described. METHOD: Forty patients with AS and unilateral heel pain were enrolled to evaluate radiographic differences between symptomatic and asymptomatic heels. The two groups were assessed according to symptom location: posterior (group PS) or plantar (group PL). Typical abnormalities in bone and/or soft tissue on the heel due to inflammation were compared. RESULTS: In group PS (20 cases), 19 (95%) symptomatic feet and 7 (35%) asymptomatic feet showed abnormal findings on the posterior heel and symptomatic feet showed 6 (30%) plantar abnormalities. Erosion of the posterior calcaneal tuberosity, obliteration of the retrocalcaneal recess (RR), and swelling shadows with increased thickness on posterior soft tissue were observed more frequently and significantly in symptomatic feet in group PS (P < 0.05). In group PL (20 cases), 11 (55%) symptomatic feet and 8 (40%) asymptomatic feet showed abnormalities on the plantar heel and symptomatic feet showed 14 (70%) posterior abnormalities, and none showed significant differences between symptomatic and asymptomatic feet. CONCLUSION: Among simple radiographic alterations on heels with AS, such changes around the enthesis of the Achilles as bony erosion and RR obliteration with swollen posterior soft tissue are strongly related to current painful posterior heels. Assessment of enthesitis of the Achilles tendon in AS using plain radiography seems to be valid.


Assuntos
Tendão do Calcâneo/diagnóstico por imagem , Calcâneo/diagnóstico por imagem , Entesopatia/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico por imagem , Espondilite Anquilosante/diagnóstico por imagem , Doenças Assintomáticas , Entesopatia/etiologia , Humanos , Dor Musculoesquelética/etiologia , Medição da Dor , Valor Preditivo dos Testes , Estudos Retrospectivos , Espondilite Anquilosante/complicações
16.
Rev. esp. med. nucl. imagen mol. (Ed. impr.) ; 37(3): 191-202, mayo-jun. 2018. tab, ilus
Artigo em Espanhol | IBECS | ID: ibc-174502

RESUMO

La patología del pie y tobillo es una de las más frecuentes del sistema musculoesquelético y de gran repercusión en la calidad de vida de los pacientes. El diagnóstico preciso supone un desafío clínico importante debido a que la compleja anatomía y la función del pie dificultan la localización del origen del dolor por un examen clínico de rutina. En el estudio de la patología del pie se han utilizado técnicas anatómicas (radiografía, resonancia magnética [RM], ultrasonido y tomografía computarizada [TC]) y funcionales (gammagrafía ósea [GO], tomografía de emisión de positrones [PET] y RM). La imagen híbrida combina las ventajas de los estudios morfológicos y funcionales de forma sinérgica, ayudando al clínico en la gestión de problemas complejos. En este artículo profundizamos en la anatomía y en la biomecánica del pie y tobillo y describimos las indicaciones potenciales de las técnicas hibridas actuales disponibles para el estudio de la patología del pie y tobillo


Disorders of the foot and ankle are some of the most frequent ones affecting the musculoskeletal system and have a great impact on patients’ quality of life. Accurate diagnosis is an important clinical challenge because of the complex anatomy and function of the foot, that make it difficult to locate the source of the pain by routine clinical examination. In the study of foot pathology, anatomical imaging (radiography, magnetic resonance imaging [MRI], ultrasound and computed tomography [CT]) and functional imaging (bone scan, positron emission tomography [PET] and MRI) techniques have been used. Hybrid imaging combines the advantages of morphological and functional studies in a synergistic way, helping the clinician manage complex problems. In this article we delve into the anatomy and biomechanics of the foot and ankle and describe the potential indications for the current hybrid techniques available for the study of foot and ankle disease


Assuntos
Humanos , Imagem Multimodal/métodos , Doenças do Pé/diagnóstico por imagem , Fraturas Ósseas/diagnóstico por imagem , Traumatismos do Tornozelo/diagnóstico por imagem , Tomografia Computadorizada com Tomografia por Emissão de Pósitrons/métodos , Fraturas do Tornozelo/diagnóstico por imagem , Ossos do Tarso/diagnóstico por imagem , Diagnóstico Precoce , Pé Diabético/diagnóstico por imagem , Doenças do Pé/fisiopatologia , Doenças do Pé/cirurgia , Imagem por Ressonância Magnética , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/etiologia , Tomografia Computadorizada de Emissão de Fóton Único/métodos , Tornozelo/diagnóstico por imagem
17.
Pain Res Manag ; 2018: 8286190, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-29770163

RESUMO

Background: Rotator cuff tendinopathy is a primary cause of shoulder pain and dysfunction. Several effective nonsurgical treatment methods have been described for chronic rotator cuff tendinopathy. Prolotherapy with polydeoxyribonucleotide (PDRN), which consists of active deoxyribonucleotide polymers that stimulate tissue repair, is a nonsurgical regenerative injection that may be a viable treatment option. The objective of this study was to assess the efficacy of PDRN in the treatment of chronic rotator cuff tendinopathy. Method: The records of patients with chronic rotator cuff tendinopathy (n=131) were reviewed retrospectively, and the patients treated with PDRN prolotherapy (n=32) were selected. We measured the main outcome of the shoulder pain and disability index score on a numerical rating scale of average shoulder pain. Results: Compared with baseline data, significant improvements in the shoulder pain and disability index and pain visual analog scale scores were demonstrated at one week after the end of treatment, and at one month and three months later. Conclusions: PDRN prolotherapy may improve the conservative treatment of painful rotator cuff tendinopathy for a specific subset of patients.


Assuntos
Dor Musculoesquelética , Polidesoxirribonucleotídeos/uso terapêutico , Proloterapia/métodos , Lesões do Manguito Rotador/complicações , Ultrassonografia , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/tratamento farmacológico , Dor Musculoesquelética/etiologia , Medição da Dor , Estudos Retrospectivos , Tendinopatia/complicações , Tendinopatia/etiologia , Resultado do Tratamento
18.
Musculoskelet Sci Pract ; 36: 32-42, 2018 08.
Artigo em Inglês | MEDLINE | ID: mdl-29727802

RESUMO

Musicians report a high prevalence of annual musculoskeletal pain (86-89%), attributed to prolonged playing times consisting of repetitive static and dynamic muscle activity. The aim of this study was to explore, compare and synthesise evidence on electromyographic (EMG) muscle activity in neck, shoulder and spinal musculature between painful and asymptomatic instrumental musicians. Ovid, Wiley, Web of Science and Scopus databases were searched in August 2016 for cross-sectional studies that compared EMG activity of neck, shoulder and spinal musculature between musicians with musculoskeletal pain and asymptomatic comparisons. An updated search was performed in May 2017, adding a further study. Two authors independently assessed papers for inclusion and then quality, determined using a modified Downs and Black Checklist. Means and standard deviations were extracted from each study to calculate effect sizes and compare results. Six studies were found to fulfil inclusion criteria. Five studies were deemed high-quality with one being low-quality. Conflicting evidence was found supporting increases in upper trapezius EMG muscle activity in musicians reporting of pain. Moderate-quality evidence indicates increased SCM activity in musicians reporting pain. There was limited evidence supporting increased activity of deltoids, lower trapezius and the upper cervical extensors in musicians reporting of musculoskeletal pain. Meta-analysis of results of three studies assessing upper trapezius activity were conflicting with these not being statistically significant. Further studies with prospective designs, larger population sizes and on broader instrumental groups are warranted.


Assuntos
Distúrbios Distônicos/diagnóstico por imagem , Distúrbios Distônicos/fisiopatologia , Músculo Esquelético/diagnóstico por imagem , Músculo Esquelético/fisiopatologia , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/fisiopatologia , Cervicalgia/fisiopatologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pescoço/diagnóstico por imagem , Pescoço/fisiopatologia , Cervicalgia/diagnóstico por imagem , Doenças Profissionais/diagnóstico por imagem , Doenças Profissionais/fisiopatologia , Estudos Prospectivos , Ombro/diagnóstico por imagem , Ombro/fisiopatologia
19.
Arch Orthop Trauma Surg ; 138(8): 1059-1067, 2018 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-29728835

RESUMO

INTRODUCTION: Hip dysplasia is characterized by reduced acetabular coverage of the femoral head leading to an increased mechanical load on the hip joint and the acting hip muscles. Potentially, the muscles and tendons functioning close to the hip joint may present with overuse-related ultrasonography findings. The primary aim was to report the prevalence of muscle-tendon-related abnormalities detected by ultrasonography in 100 patients with symptomatic hip dysplasia. The secondary aim was to investigate correlations between muscle-tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons. MATERIALS AND METHODS: One hundred patients (17 men) with a mean age of 29 ± 9 years were included. Muscle-tendon-related abnormalities were detected with a standardized ultrasound examination. Correlations between muscle-tendon-related abnormalities detected by ultrasonography and clinically identified pain related to muscles and tendons were tested with Spearman's rank correlation coefficient. RESULTS: The most prevalent ultrasonography findings were identified in the iliopsoas tendon [50% (95% CI 40; 60)], the adductor longus tendon [31% (95% 22; 40)] and the gluteus medius/minimus tendons [27% (18; 36)]. Significant correlations between ultrasonography findings and pain related to muscles and tendons were only found for the iliopsoas tendon (ρ = 0.24 and p = 0.02) and the gluteus medius/minimus tendons (ρ = 0.35 and p < 0.001). CONCLUSIONS: Muscle-tendon-related abnormalities detected by ultrasonography in the hip and groin region are common in patients with symptomatic hip dysplasia, and the ultrasonography findings of the iliopsoas and gluteus medius/minimus tendons are weakly to moderately correlated to pain related to muscles and tendons in these structures. Both the iliopsoas and the gluteus medius/minimus have a pronounced stabilizing role in the dysplastic hip joint, and the common muscle-tendon-related abnormalities in these patients may be caused by injuries related to excessive use or degenerative changes in the muscle-tendon tissue.


Assuntos
Transtornos Traumáticos Cumulativos/diagnóstico por imagem , Transtornos Traumáticos Cumulativos/etiologia , Luxação do Quadril/complicações , Articulação do Quadril/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico por imagem , Dor Musculoesquelética/etiologia , Adulto , Idoso , Transtornos Traumáticos Cumulativos/epidemiologia , Feminino , Luxação do Quadril/fisiopatologia , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/epidemiologia , Prevalência , Ultrassonografia , Adulto Jovem
20.
Int J Qual Health Care ; 30(7): 565-570, 2018 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-29635290

RESUMO

Objective: To evaluate the appropriateness of magnetic resonance imaging (MRI) of the knee requested by primary care physicians. Design: Retrospective observational study. Setting: Six primary care centres in the Elche Department of Health of the Valencian Community, Spain. Participants: Three hundred patients with knee pain who were prescribed MRI. Main Outcome Measures: Data were collected from the electronic clinical history, which allowed us to assess the appropriateness and inappropriateness of the MRI requests for the knee based on the American College of Radiology (ACR) criteria. A multivariate logistic regression model was used to identify factors associated with an inappropriate request. Results: About 45% (41-49%) of knee MRI prescriptions were assessed as inappropriate. The frequency was higher in female patients (odds ratio, OR = 1.96; P = 0.03). A history of knee trauma and urgent use of MRI were associated with a lower frequency of inappropriate requests (OR = 0.14, P < 0.001 and OR = 0.32, P = 0.03, respectively). In 82% of cases, the request for MRI was deemed inappropriate because it was used as the initial imaging test. The availability of a previous radiograph of the knee significantly reduced the rate of inappropriate requests (OR = 0.05, P < 0.001); only 47% of the patients had a previous radiograph. Conclusions: The percentage of inappropriate knee MRI prescriptions is high. Protocols should be put in place to improve the appropriateness of MRI requests by promoting understanding of the appropriate use of MRI among primary care physicians.


Assuntos
Articulação do Joelho/diagnóstico por imagem , Imagem por Ressonância Magnética/normas , Médicos de Atenção Primária , Humanos , Dor Musculoesquelética/diagnóstico por imagem , Radiografia , Estudos Retrospectivos , Espanha
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