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3.
J Surg Res ; 246: 476-481, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31668607

RESUMO

INTRODUCTION: Rib fractures are a major problem in trauma patients, and the associated pain is not well understood. Measuring total pain experience, duration, and intensity could facilitate comparisons of treatments. This study was intended to evaluate the feasibility of quantifying pain over the course of an admission and identify factors associated with increased pain experience in adults with rib fractures. METHODS: Patients admitted to a level I trauma center with rib fractures between 2015 and 2017 were included. Maximum pain score (verbal or nonverbal) was captured for each hospital day. Total pain was defined as the sum of the area under the curve (AUC) of the max pain scores plotted against time. A general linear model was used to determine demographic, injury, and clinical predictors of the pain AUC. RESULTS: We identified 3713 patients. Increased pain experienced (greater AUC) was associated with age group 40-59 y compared with 18-39 y (B = 6.1, P = 0.002); Injury Severity Score 9-14 (B = 11.5, P < 0.001) and ≥16 (B = 36.9, P < 0.0001); patients with flail chest versus multiple rib fractures (B = 17.1, P < 0.001); and patients who underwent rib fixation (B = 20.7, P = 0.004). Decreased pain experience was observed for male gender (B = -3.7, P = 0.032) and blunt mechanism of injury (B = -13.7, P < 0.0001). CONCLUSIONS: This study demonstrates the feasibility of measuring patients' total pain experience over the duration of their admission. Pain is a subjective but relevant measure of patients' experience. Our study identifies a number of predictive factors, some expected and some unexpected. Increased overall experience pain following fixation may be the result of severe pain before intervention.


Assuntos
Tórax Fundido/diagnóstico , Fixação Interna de Fraturas/efeitos adversos , Dor Musculoesquelética/diagnóstico , Medição da Dor/métodos , Fraturas das Costelas/complicações , Adolescente , Adulto , Fatores Etários , Estudos de Viabilidade , Feminino , Tórax Fundido/etiologia , Humanos , Escala de Gravidade do Ferimento , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Estudos Retrospectivos , Fraturas das Costelas/diagnóstico , Fraturas das Costelas/cirurgia , Índice de Gravidade de Doença , Fatores Sexuais , Fatores de Tempo , Centros de Traumatologia/estatística & dados numéricos , Adulto Jovem
4.
Medicine (Baltimore) ; 98(51): e18149, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31860962

RESUMO

RATIONALE: Retroperitoneal schwannomas are very rare and may grow very close to major abdominal vessels. Since the surgical approach to the retroperitoneal space may be complex due to surrounding vital organs, including major vessels, laparoscopic surgery is challenging and has only been recently adopted. Here, we report a case of laparoscopic resection of a large retroperitoneal schwannoma attached to large vital vessels. PATIENT CONCERNS: A 62-year-old woman presented with a chief complaint of pain in the lower right limb with consequent claudication, which had lasted for approximately 1 year. DIAGNOSES: Magnetic resonance imaging revealed a solid oval mass measuring 45 × 32 × 39 mm, located medially to the right iliopsoas muscle at the level of the intersomatic space between the 5th lumbar vertebra and the 1st sacral vertebra. This mass was inhomogeneously hypointense in T2 due to the presence of cystic areas, with intense and inhomogeneous contrast enhancement, compatible with the diagnosis of a schwannoma. The mass compressed the inferior caval vein near its bifurcation and the right common iliac vein, anteriorly dislocating the ipsilateral iliac arterial axis. INTERVENTIONS: A multidisciplinary team skilled in vascular and pelvic laparoscopy was involved. The patient underwent laparoscopic surgery via an anterior transperitoneal approach with right adnexectomy and radical excision of the tumor. The surgery lasted 120 minutes without intraoperative complications. Blood loss was less than 100 mL. The histologic diagnosis was a benign Schwannoma; grade I according to World Health Organization classification. OUTCOMES: The postoperative course was uneventful. At the 10-month follow-up, the patient had no recurrences and was asymptomatic. LESSONS: Laparoscopic removal of large retroperitoneal schwannomas, even if attached to major vital vessels, is feasible and safe when performed by experienced surgeons.


Assuntos
Laparoscopia/métodos , Neurilemoma/diagnóstico , Neurilemoma/cirurgia , Neoplasias Retroperitoneais/diagnóstico , Neoplasias Retroperitoneais/cirurgia , Veia Cava Inferior/patologia , Idoso , Biópsia por Agulha , Feminino , Seguimentos , Humanos , Imuno-Histoquímica , Comunicação Interdisciplinar , Extremidade Inferior , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Invasividade Neoplásica/patologia , Estadiamento de Neoplasias , Neurilemoma/diagnóstico por imagem , Doenças Raras , Neoplasias Retroperitoneais/diagnóstico por imagem , Medição de Risco , Resultado do Tratamento
5.
BMC Musculoskelet Disord ; 20(1): 624, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881879

RESUMO

BACKGROUND: Patellar tendinopathy is an extremely debilitating condition and its treatment usually requires a combination of clinical approaches. Therapeutic ultrasound (TUS) is one of the most available electrophysical agent in rehabilitation settings; however, there is also a lack of high-quality studies that test different dosimetric aspects of TUS. Thus, the purpose of this study is to evaluate the short-, medium-, and long-term effects of the combination of high-energy TUS with a rehabilitation program for patellar tendinopathy. METHODS: This will be a randomized, placebo-controlled trial with blinding of patients, assessors, and therapist. The setting is an outpatient physical therapy clinic. We will recruit 66 participants (male and female) aged between 18 and 40 years and presenting with patellar tendinopathy. A treatment combining high-energy dose TUS and a rehabilitation program for patellar tendinopathy will be delivered twice a week for 8 weeks. The control group will receive the same treatment, but with a placebo TUS. The effectiveness of the intervention will be measured at the beginning (baseline), midpoint (4 weeks), and end of treatment (8 weeks), as well as at 3- and 6-months post-treatment. Primary outcomes will be pain intensity (visual analogue scale, VAS), and VISA-P questionnaire and primary time points will be baseline (T0) and the end of the program (T2). Also, IPAQ-short form questionnaire, muscle strength (manual dynamometry), 2D kinematics, pain pressure threshold (PPT) algometry, thermography, and magnetic resonance imaging (MRI) will be collected. DISCUSSION: TUS will be applied in an attempt to enhance the results obtained with the rehabilitation program proposed in this study, as well as stimulate some repair responses in individuals undergoing treatment for patellar tendinopathy, which in turn may optimize and improve treatment programs for patellar tendinopathy as well as to establish new guidelines for the application of TUS. TRIAL REGISTRATION: This study was prospectively registered at April-3rd-2018 and updated at September-1st-2019 in the Brazilian Registry of Clinical Trials (REBEC) under the registration number: RBR-658n6w.


Assuntos
Terapia por Exercício/métodos , Dor Musculoesquelética/terapia , Ligamento Patelar/efeitos da radiação , Tendinopatia/terapia , Terapia por Ultrassom/métodos , Adolescente , Adulto , Terapia Combinada/métodos , Feminino , Humanos , Masculino , Força Muscular/fisiologia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/fisiopatologia , Medição da Dor , Ligamento Patelar/patologia , Ensaios Clínicos Controlados Aleatórios como Assunto , Tendinopatia/complicações , Tendinopatia/patologia , Tendinopatia/fisiopatologia , Resultado do Tratamento , Adulto Jovem
6.
BMC Musculoskelet Disord ; 20(1): 630, 2019 Dec 28.
Artigo em Inglês | MEDLINE | ID: mdl-31883516

RESUMO

BACKGROUND: Many patients will seek care from a podiatrist for plantar heel pain (PHP), while few of these patients will also be seen by a physical therapist. Physical therapists can provide treatment that is not a part of routine podiatric care for PHP and may provide additional improvement. Therefore, the purpose of this study was to examine the effects of interdisciplinary care for PHP that incorporated physical therapy treatment after initiating podiatric treatment. METHODS: Eligible individuals with PHP that presented to a podiatrist were randomized to receive usual podiatric care (uPOD) or usual podiatric care plus physical therapy treatment (uPOD+PT). The primary outcome was change in foot and ankle ability measure (FAAM) at 6-months. Secondary outcomes included change in numeric pain rating scale (NPRS), patient-reported success, and 6-week and 1-year endpoints. Patient-reported success was defined as the top two global rating of change scale rankings. Primary analysis was intention-to-treat (ITT) using analysis by covariance adjusted to baseline scores, and a secondary per-protocol (PP) analysis was performed analyzing only those who completed treatment. RESULTS: Ninety-five individuals participated and were included in the ITT analysis, and 79 were included in the PP analysis. For the primary outcome of FAAM change from baseline to 6-months, both groups improved significantly (uPOD+PT: 26.8 [95% CI 21.6, 31.9]; uPOD: (20 [15.6, 24.4]), but there was no between-group difference (4.3 [- 1, 9.6]). For secondary outcomes, the uPOD+PT group demonstrated greater improvement in NPRS at 6 weeks (0.9 [0.3, 1.4]) and 1 year (1.5 [0.6, 2.5]) in the ITT analysis. In the PP analysis, the uPOD+PT group demonstrated greater improvement in FAAM at 6 months (7.7 [2.1, 13.3]) and 1 year (5.5 [0.1, 10.8]), NPRS at 6 weeks (0.9 [0.2, 1.6]), 6 months (1.3 [0.6, 2.1]) and 1 year (1.3 [0.6, 2.1]), and in patient-reported success (relative risk [95% CI]) at 6 weeks (2.8 [1.1, 7.1]), 6 months (1.5 [1.1, 2.1]), and 1 year (1.5 [1.1, 1.9]). CONCLUSIONS: There was no significant benefit of uPOD+PT in the primary outcome of FAAM change at 6 months. Secondary outcomes and PP analysis indicated additional benefit of uPOD+PT, mostly observed in individuals who completed treatment. TRIAL REGISTRATION: Prospectively registered May 24, 2013 at www.clinicaltrials.gov (NCT01865734).


Assuntos
Fasciíte Plantar/terapia , Dor Musculoesquelética/terapia , Modalidades de Fisioterapia , Podiatria/métodos , Adolescente , Adulto , Idoso , Terapia Combinada/métodos , Fasciíte Plantar/complicações , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Equipe de Assistência ao Paciente , Fatores de Tempo , Resultado do Tratamento , Adulto Jovem
7.
BMC Musculoskelet Disord ; 20(1): 631, 2019 Dec 29.
Artigo em Inglês | MEDLINE | ID: mdl-31884949

RESUMO

BACKGROUND: Patients with temporomandibular joint disorder (TMD) often complain of pain in other areas. Several studies have been conducted on spinal pain in TMD patients, but have contained only limited information. Therefore, this study analyzed the relationship between TMD and spinal pain in greater detail by using nationwide data. METHODS: A total of 12,375 TMD patients from the Korean National Health Insurance Review and Assessment database were analyzed. Controls were selected using propensity score-matching. The McNemar test, chi-square test, and paired t-test were used to compare the prevalence and severity of spinal pain between cases and matched controls. Logistic regression and linear regression models were used to analyze factors affecting the prevalence and severity of spinal pain in patients with TMD. RESULTS: The annual period prevalence of TMD was 1.1%. The prevalence was higher in younger individuals than in individuals of other ages and was higher in women than in men. The medical expenditure for TMD per person was $86. Among TMD patients, 2.5% underwent surgical procedures and 0.3% were hospitalized. The prevalence of spinal pain in patients with TMD was 48%, whereas that in the control group was 34%. Increased severity of TMD was associated with an increased probability of spinal pain. The medical expenditure, mean number of visits, and lengths of treatment for spinal pain were greater for patients with TMD than for controls ($136 vs. $81, 4.8 days vs. 2.7 days, 5.5 days vs. 3.3 days). Higher TMD grade was associated with greater differences in average medical expenditure, number of visits, and lengths of treatment for spinal pain between cases and controls. Additionally, for women, living in a rural area and having an older age and more severe TMD were associated with a greater probability of spinal pain and higher medical expenditure related to spinal pain. CONCLUSION: A strong association was observed between the presence of TMD and the presence of spinal pain. The association became stronger as the severity of TMD increased, indicating a positive correlation between the severity of TMD and spinal pain.


Assuntos
Dor Musculoesquelética/epidemiologia , Doenças da Coluna Vertebral/epidemiologia , Transtornos da Articulação Temporomandibular/epidemiologia , Adulto , Fatores Etários , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Medição da Dor , Prevalência , Pontuação de Propensão , República da Coreia/epidemiologia , Medição de Risco , Fatores de Risco , Saúde da População Rural/estatística & dados numéricos , Índice de Gravidade de Doença , Fatores Sexuais , Doenças da Coluna Vertebral/diagnóstico , Transtornos da Articulação Temporomandibular/diagnóstico , Adulto Jovem
8.
J Diabetes Res ; 2019: 6324348, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31886282

RESUMO

Aim: To investigate the associations between diabetes and musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis. Methods: Self-reported data were provided by the nationwide Danish National Health Survey 2013. Inclusion criteria were age ≥ 40 years and known diabetes status. The exposure variable was diabetes, and the outcome variables included musculoskeletal pain during the last 14 days in three body sites (back/lower back, limbs, and shoulder/neck), osteoarthritis, osteoporosis, and rheumatoid arthritis. Logistic regression analyses adjusted for age, gender, BMI, education, marital status, and physical activity were performed. Results: 9,238 participants with diabetes were 65.6 ± 11.0 (mean ± SD) years old; 55.6% were males. 99,980 participants without diabetes were 59.2 ± 11.8 years old; 46.7% were males. Diabetes was associated with back/lower back pain (OR 1.2 (CI 95% 1.1-1.2), p < 0.001), pain in the limbs (1.4 (1.3-1.4), p < 0.001), shoulder/neck pain (1.2 (1.1-1.3), p < 0.001), osteoarthritis (1.3 (1.2-1.4), p < 0.001), osteoporosis (1.2 (1.1-1.4), p = 0.010), and rheumatoid arthritis (1.6 (1.4-1.7), p < 0.001). In participants with diabetes, physical activity was associated with reduced pain (e.g., back/lower back pain (0.7 (0.6-0.7), p < 0.001)). Conclusion: Diabetes was associated with elevated odds of having musculoskeletal pain. Diabetes was also associated with elevated odds of having osteoarthritis, osteoporosis, and rheumatoid arthritis. The most frequent disease in individuals with diabetes was osteoarthritis. The reported pain may have negative impacts on the level of physical activity. Health-care professionals should remember to inform patients with diabetes that musculoskeletal pain, osteoarthritis, osteoporosis, and rheumatoid arthritis are not contraindications to exercise training.


Assuntos
Artrite Reumatoide/epidemiologia , Diabetes Mellitus/epidemiologia , Dor Musculoesquelética/epidemiologia , Osteoartrite/epidemiologia , Osteoporose/epidemiologia , Adulto , Idoso , Artrite Reumatoide/diagnóstico , Estudos Transversais , Dinamarca/epidemiologia , Diabetes Mellitus/diagnóstico , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Osteoartrite/diagnóstico , Osteoporose/diagnóstico , Prevalência , Medição de Risco , Fatores de Risco
9.
Pediatr Rheumatol Online J ; 17(1): 86, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882011

RESUMO

BACKGROUND: Chronic musculoskeletal pain (MSP) is frequent in adolescents and has major medical and social consequences. In many cases, when no cause has been clearly established, this pain may be considered to be chronic idiopathic MSP. Our study seeks to identify general criteria for this type of pain through the experience of professionals from tertiary care centers with expertise in pediatric and adolescent chronic MSP. METHODS: Cross-sectional multicenter qualitative study. Semi-structured interviews of 25 professionals at a rheumatology reference center and in its network for pain management, including diverse specialists and professions. Interpretative Phenomenological Analysis is used to explore the data. RESULTS: This approach led us to identify 10 themes organized around three superordinate themes covering different stages of the diagnostic process: 1) the medical pain history up to the consultation at the reference center; 2) the professional's subjective feelings about the clinical presentation; 3) from the clinical examination to diagnosis and treatment of chronic idiopathic MSP. The main elements guiding this diagnosis do not come from the physical examination but from the medical history and the professionals' subjective feelings, that is, their clinical judgment. The professionals' impression of uneasiness and frustration, induced by patients and their parents, is of major importance. CONCLUSION: The principal elements guiding the diagnosis of chronic idiopathic MSP do not come primarily from the physical examination but rather from the pain history and the health professional's subjective feelings. Our results suggest that the concept of Juvenile Fibromyalgia (JFM) does not appear to cover all situations of chronic idiopathic MSP in adolescence. A constellation of non-organic criteria enables diagnosis of the latter; these criteria should be validated to avoid medical nomadism and multiple investigations and to shorten the interval until patients receive optimal pain management. CLINICAL TRIAL REGISTRATION: clinicaltrials.gov, NCT03171792, https://clinicaltrials.gov/ct2/show/NCT03171792?term=LACHAL&cntry=FR&city=paris&rank=1.


Assuntos
Dor Crônica/diagnóstico , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Medição da Dor/métodos , Pesquisa Qualitativa , Adolescente , Adulto , Dor Crônica/terapia , Estudos Transversais , Feminino , Humanos , Masculino , Dor Musculoesquelética/terapia , Adulto Jovem
10.
BMC Musculoskelet Disord ; 20(1): 531, 2019 Nov 13.
Artigo em Inglês | MEDLINE | ID: mdl-31722704

RESUMO

BACKGROUND: Prognosis of musculoskeletal disorders following injury is essential in determining appropriate treatment and care. A generic validated prognostic tool to stratify risk of poor recovery for people with musculoskeletal injuries after road traffic crash is not available. This study aimed to examine differences in recovery, return to work and health related quality of life between low and high-risk of poor recovery people with musculoskeletal injuries stratified by the Short form - Örebro Musculoskeletal Pain Screening Questionnaire (SF-OMPSQ). METHODS: In an inception cohort study, participants with non-fracture musculoskeletal injury with the main site being the neck, lower back or lower limb were stratified into low (score ≤ 50) and high (score > 50) risk of poor recovery using the SF-OMPSQ score at baseline. We assessed the proportion of fully recovered participants (Global Perceived Effect scale ≥4), the proportion returning to work and changes in short form 12-item (SF-12) scores between baseline and 6-month follow-up in low and high-risk groups. Modified Poisson regression was used to estimate the adjusted risk ratio (RR) of being recovered and return to work in the low and high-risk groups. Paired t-test was used to compare changes in SF-12 physical and mental component summary scales, and chi-square test was used to assess the significance of the risk ratio of fully recovered between low and high-risk groups. RESULTS: The study included 498 participants (166 with neck, 78 with lower back and 254 with lower limb injuries). The proportion of being recovered was significantly higher in the low than the high-risk groups (Adjusted risk ratio: 2.96 [95% CI: 1.81 to 4.82]). Significantly more people in the low-risk group returned to work (91.0%) than the high-risk group (54.6%). People at low-risk had higher SF-12 scores at baseline and 6-month follow-up than those at high-risk. There were no differences between injury types for recovery and return to work at 6 months. CONCLUSION: The SF-OMPSQ could be recommended as a generic prognostic tool to identify individuals with musculoskeletal injuries early after road traffic injury, who would have a higher or lower likelihood of recovering or returning fully to pre-injury work. TRIAL REGISTRATION: Australia New Zealand Clinical trial registry identification number - ACTRN12613000889752. Registered 09 August 2013.


Assuntos
Acidentes de Trânsito , Dor Lombar/diagnóstico , Dor Musculoesquelética/diagnóstico , Cervicalgia/diagnóstico , Medição da Dor/métodos , Inquéritos e Questionários , Ferimentos e Lesões/diagnóstico , Adulto , Feminino , Nível de Saúde , Humanos , Dor Lombar/epidemiologia , Dor Lombar/terapia , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/epidemiologia , Dor Musculoesquelética/terapia , Cervicalgia/epidemiologia , Cervicalgia/terapia , New South Wales/epidemiologia , Valor Preditivo dos Testes , Prognóstico , Qualidade de Vida , Recuperação de Função Fisiológica , Retorno ao Trabalho , Medição de Risco , Fatores de Risco , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/terapia , Adulto Jovem
11.
BMC Musculoskelet Disord ; 20(1): 518, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699076

RESUMO

BACKGROUND: This study proposed to investigate whether high-sensitivity C-reactive protein (hs-CRP) is an independent risk factor for long head of biceps tendon (LHBT) tear and whether hs-CRP can increase accuracy in diagnosing LHBT tear. METHODS: This study involved 582 shoulders of 557 consecutive patients who received arthroscopic examinations at the authors' institution between January 2010 and July 2018. The strengths of associations between LHBT tear and various factors were determined by calculating the odds ratios (ORs), with 95% confidence intervals (CIs), using logistic regression analyses. The studied variables were demographic, physical, social, metabolic, comorbidity, hs-CRP, and pain on a visual analog scale (VAS) factors, as well as those related to rotator cuff tear (RCT). Significant factors in the multivariable logistic analysis were evaluated to determine their diagnostic values, including their likelihood ratios and post-test probabilities for LHBT tear. RESULTS: In the multivariable analysis, five variables were significant: age, retraction degree of Patte, subscapularis tendon tear, hs-CRP > 1 mg/L, and pain VAS (p ≤ 0.01). The best combination of determinations for diagnosing LHBT tear, which yielded a strong positive likelihood ratio of 19.07 and a high post-test probability of 96%, was age ≥ 67 years, subscapularis tendon tear, grade of Patte ≥2, hs-CRP > 1, and pain VAS ≥ 7. CONCLUSIONS: Serum hs-CRP > 1 mg/L is an independent risk factor for LHBT tear, along with the expected risk factors of age, subscapularis tendon tear, retraction degree of Patte, and pain VAS. Serum hs-CRP > 1 mg/L increases the diagnostic accuracy for LHBT tear. LEVEL OF EVIDENCE: Level IV, Clinical case series.


Assuntos
Artroscopia , Proteína C-Reativa/análise , Músculo Esquelético/lesões , Dor Musculoesquelética/diagnóstico , Lesões do Manguito Rotador/diagnóstico , Adulto , Fatores Etários , Idoso , Biomarcadores/sangue , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Músculo Esquelético/diagnóstico por imagem , Dor Musculoesquelética/sangue , Dor Musculoesquelética/etiologia , Medição da Dor , Valor Preditivo dos Testes , Prognóstico , Estudos Prospectivos , Amplitude de Movimento Articular , Lesões do Manguito Rotador/sangue , Lesões do Manguito Rotador/complicações , Índice de Gravidade de Doença , Articulação do Ombro/diagnóstico por imagem , Articulação do Ombro/lesões
12.
Pediatrics ; 144(6)2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31744891

RESUMO

OBJECTIVES: To evaluate the longitudinal effects of metabolic and bariatric surgery (MBS) on the prevalence of musculoskeletal and lower extremity (LE) pain, physical function, and health-related quality of life. METHODS: The Teen Longitudinal Assessment of Bariatric Surgery study (NCT00474318) prospectively collected data on 242 adolescents undergoing MBS at 5 centers over a 3-year follow-up. Joint pain and physical function outcomes were assessed by using the Health Assessment Questionnaire Disability Index, Impact of Weight on Quality of Life - Kids, and the Short Form 36 Health Survey. Adolescents with Blount disease (n = 9) were excluded. RESULTS: Prevalent musculoskeletal and LE pain were reduced by 40% within 12 months and persisted over 3 years. Adjusted models revealed a 6% lower odds of having musculoskeletal pain (odds ratio = 0.94, 95% confidence interval: 0.92-0.99) and a 10% lower odds of having LE pain (odds ratio = 0.90, 95% confidence interval: 0.86-0.95) per 10% reduction of BMI. The prevalence of poor physical function (Health Assessment Questionnaire Disability Index score >0) declined from 49% to <20% at 6 months (P < .05), Physical comfort and the physical component scores, measured by the Impact of Weight on Quality of Life - Kids and the Short Form 36 Health Survey, improved at 6 months postsurgery and beyond (P < .01). Poor physical function predicted persistent joint pain after MBS. CONCLUSIONS: Joint pain, impaired physical function, and impaired health-related quality of life significantly improve after MBS. These benefits in patient-reported outcomes support the use of MBS in adolescents with severe obesity and musculoskeletal pain and suggest that MBS in adolescence may reverse and reduce multiple risk factors for future joint disease.


Assuntos
Cirurgia Bariátrica/psicologia , Cirurgia Bariátrica/tendências , Exercício Físico/psicologia , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/psicologia , Qualidade de Vida/psicologia , Adolescente , Cirurgia Bariátrica/efeitos adversos , Estudos de Coortes , Exercício Físico/fisiologia , Feminino , Seguimentos , Humanos , Estudos Longitudinais , Masculino , Obesidade Mórbida/psicologia , Obesidade Mórbida/cirurgia , Estudos Prospectivos
13.
BMC Musculoskelet Disord ; 20(1): 446, 2019 Oct 14.
Artigo em Inglês | MEDLINE | ID: mdl-31610787

RESUMO

BACKGROUND: Subacromial impingement syndrome is a common problem in primary healthcare. It often include tendinopathy. While exercise therapy is effective for this condition, it is not clear which type of exercise is the most effective. Eccentric exercises has proven effective for treating similar tendinopathies in the lower extremities. The aim of this systematic review was therefore to investigate the effects of eccentric exercise on pain and function in patients with subacromial impingement syndrome compared with other exercise regimens or interventions. A secondary aim was to describe the included components of the various eccentric exercise regimens that have been studied. METHODS: Systematic searches of PubMed, Cochrane Library and PEDro by two independent authors. Included studies were assessed using the PEDro scale for quality and the Cochrane scale for clinical relevance by two independent authors. Data were combined in meta-analyses. GRADE was applied to assess the certainty of evidence. RESULTS: Sixty-eight records were identified. Seven studies (eight articles) were included, six were meta-analysed (n = 281). Included studies were of moderate quality (median PEDro score 7, range 5-8). Post-treatment pain was significantly lower after eccentric exercise compared with other exercise: MD -12.3 (95% CI - 17.8 to - 6.8, I2 = 7%, p < 0.001), but this difference was not clinically important. Eccentric exercise provided no significant post-treatment improvement in function compared with other exercise: SMD -0.10 (95% CI - 0.79 to 0.58, I2 = 85%, p = 0.76). Painful eccentric exercise showed no significant difference compared to pain-free eccentric exercise. Eccentric training regimes showed both similarities and diversity. Intervention duration of 6-8 weeks was almost as effective as 12 weeks. CONCLUSIONS: Evidence of low certainty suggests that eccentric exercise may provide a small but likely not clinically important reduction in pain compared with other types of exercise in patients with subacromial impingement syndrome. It is uncertain whether eccentric exercise improves function more than other types of exercise (very low certainty of evidence). Methodological limitations of existing studies make these findings susceptible to change in the future. TRIAL REGISTRATION: PROSPERO CRD42019126917 , date of registration: 29-03-2019.


Assuntos
Terapia por Exercício/métodos , Dor Musculoesquelética/reabilitação , Síndrome de Colisão do Ombro/reabilitação , Tendinopatia/reabilitação , Terapia por Exercício/efeitos adversos , Humanos , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Síndrome de Colisão do Ombro/complicações , Tendinopatia/etiologia , Resultado do Tratamento
15.
Tunis Med ; 97(1): 163-166, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31535711

RESUMO

A brown tumor is a rare complication of hyperparathyroidism. Its circumstances of discovery are multiple and its symptoms are nonspecific. We report here two cases with deceptive forms of multiple brown tumors discovered in patients with bone pain. It was a parathyroid adenoma in both cases. So, measurement of parathyroid hormone (even in absence of hypercalcemia) should be systematic in every patient with lytic skeletal images.


Assuntos
Adenoma/diagnóstico , Neoplasias Ósseas/diagnóstico , Neoplasias das Paratireoides/diagnóstico , Adenoma/complicações , Adenoma/patologia , Idoso de 80 Anos ou mais , Neoplasias Ósseas/secundário , Diagnóstico Diferencial , Feminino , Humanos , Hiperparatireoidismo Primário/complicações , Hiperparatireoidismo Primário/diagnóstico , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Osteólise/diagnóstico , Osteólise/etiologia , Síndromes Paraneoplásicas/diagnóstico , Neoplasias das Paratireoides/complicações , Neoplasias das Paratireoides/patologia
16.
BMC Musculoskelet Disord ; 20(1): 432, 2019 Sep 14.
Artigo em Inglês | MEDLINE | ID: mdl-31521142

RESUMO

BACKGROUND: Due to advances in hip arthroscopy, the number of surgical procedures has increased dramatically. The diagnostic challenge in patients with longstanding hip and groin pain, as well as the increasing number of hip arthroscopies, may lead to a higher number of patients referred to tertiary care for consideration for surgery. Therefore, the aims were: 1) to describe the prevalence of hip-related groin pain in patients referred to tertiary care due to longstanding hip and groin pain; and 2) to compare patient characteristics and patient-reported outcomes for patients categorized as having hip-related groin pain and those with non-hip-related groin pain. METHODS: Eighty-one patients referred to the Department of Orthopedics at Skåne University Hospital for longstanding hip and groin pain were consecutively included and categorized into hip-related groin pain or non-hip-related groin pain using diagnostic criteria based on current best evidence (clinical examination, radiological examination and intra-articular block injection). Patient characteristics (gender (%), age (years), BMI (kg/m2)), results from the Hip Sports Activity Scale (HSAS), the SF-36, the Copenhagen Hip and Groin Outcome Score (HAGOS), and pain distribution (pain manikin) were collected. Parametric and non-parametric statistics were used as appropriate for between-group analysis. RESULTS: Thirty-three (47%) patients, (30% women, 70% men, p < 0.01), were categorized as having hip-related groin pain. The hip-related groin pain group had a higher activity level during adolescence (p = 0.013), and a higher pre-injury activity level (p = 0.034), compared to the non-hip-related groin pain group. No differences (mean difference (95% CI)) between hip-related groin pain and non-hip-related groin pain were observed for age (0 (- 4; 4)), BMI (- 1.75 (- 3.61; 0.12)), any HAGOS subscales (p ≥ 0.318), any SF-36 subscales (p ≥ 0.142) or pain distribution (p ≥ 0.201). CONCLUSIONS: Only half of the patients referred to tertiary care for long-standing hip and groin pain, who were predominantly men with a high activity level, had hip-related groin pain. Self-reported pain localization and distribution did not differ between patients with hip-related groin pain and those with non-hip-related groin pain, and both patient groups had poor perceived general health, and hip-related symptoms and function.


Assuntos
Artralgia/complicações , Impacto Femoroacetabular/epidemiologia , Virilha , Dor Musculoesquelética/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Adulto , Artralgia/terapia , Estudos Transversais , Feminino , Impacto Femoroacetabular/diagnóstico , Impacto Femoroacetabular/etiologia , Articulação do Quadril , Humanos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Exame Físico , Prevalência , Autorrelato/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Fatores de Tempo
17.
BMJ Case Rep ; 12(8)2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31466970

RESUMO

A 62-year-old man with essential hypertension and right L4-L5 hemilaminectomy was referred to rheumatology for evaluation of severe arthralgia and myalgia for 12 months. Review of symptoms was significant for night sweats and 20 pounds unintentional weight loss. Physical examination was significant for holosystolic murmur best heard at the cardiac apex of unclear chronicity. Laboratory investigations revealed elevated inflammatory markers, white blood cell count and B-type natriuretic peptide. Transoesophageal echocardiogram showed flail posterior mitral leaflet with severe mitral regurgitation and two vegetations (2.5×1 cm and 1.6×0.3 cm). Abdominal CT showed new focal splenic infarcts, and a brain MRI revealed subacute infarcts, consistent with the embolic phenomenon. Blood cultures grew Granulicatella elegans The patient underwent mitral valve replacement surgery followed by 6 weeks of parenteral therapy with vancomycin and gentamicin, with full recovery at a 3-month follow-up.


Assuntos
Endocardite Bacteriana/diagnóstico por imagem , Endocardite Bacteriana/microbiologia , Insuficiência da Valva Mitral/diagnóstico por imagem , Dor Musculoesquelética/diagnóstico , Antibacterianos/administração & dosagem , Antibacterianos/uso terapêutico , Carnobacteriaceae/isolamento & purificação , Ecocardiografia Transesofagiana , Endocardite/diagnóstico , Endocardite Bacteriana/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Insuficiência da Valva Mitral/cirurgia , Dor Musculoesquelética/etiologia , Peptídeo Natriurético Encefálico/sangue , Infarto do Baço/diagnóstico por imagem , Infarto do Baço/etiologia , Tomografia Computadorizada por Raios X , Resultado do Tratamento
18.
BMC Musculoskelet Disord ; 20(1): 382, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429748

RESUMO

BACKGROUND: The aim of this study was to compare the reliability and validity of the CARDS and French classification systems for lumbar DS. METHODS: Between May 2013 and December 2016, 158 consecutive patients diagnosed with single-level lumbar DS were included in this study, and all underwent lumbar fusion. All patients underwent long-cassette standing anterioposterior and lateral radiographs of the spine preoperatively and postoperatively. The images were graded according to the CARDS and French classification systems by two orthopedic spinal surgeons and two orthopedic spinal fellows, independently. Clinical outcome measures used were the visual analog scale, Oswestry Disability Index, and the 36-Item Short Form Health Survey. Clinical data were collected before surgery and 1 year after surgery. RESULTS: A total of 146 patients were finally included in this study and followed up for at least 1 year. When grading using the CARDS system, the κ values for inter- and intraobserver reliability were 0.837 and 0.869, respectively, representing perfect agreement. The interobserver κ value for the French classification was 0.693 and the intraobserver κ value was 0.743, both representing substantial agreement. CARDS Type D patients have higher preoperative back pain scores and better improvement after surgery compared with non-Type D patients. Mean back and leg pain was worse in French Type 5 patients, while the most significant improvement was also seen in Type 5 patients after surgery. CONCLUSIONS: Both CARDS and French classification systems have acceptable reliability and validity. The CARDS system is easier to utilize and has better reliability. LEVEL OF EVIDENCE: IV.


Assuntos
Dor Lombar/diagnóstico , Dor Musculoesquelética/diagnóstico , Índice de Gravidade de Doença , Fusão Vertebral , Espondilolistese/diagnóstico , Adulto , Idoso , Idoso de 80 Anos ou mais , Avaliação da Deficiência , Feminino , Seguimentos , Humanos , Perna (Membro) , Dor Lombar/etiologia , Dor Lombar/cirurgia , Vértebras Lombares/diagnóstico por imagem , Vértebras Lombares/patologia , Vértebras Lombares/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/cirurgia , Medição da Dor , Período Pós-Operatório , Período Pré-Operatório , Reprodutibilidade dos Testes , Espondilolistese/complicações , Espondilolistese/cirurgia , Resultado do Tratamento
19.
Int J Rehabil Res ; 42(4): 316-321, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31425347

RESUMO

Objective of this study was to investigate the gender-related differential item function of 12-item WHODAS 2.0 amongst patients with chronic musculoskeletal pain. This was a cross-sectional survey study among 1,988 patients at a university Physical and Rehabilitation Medicine outpatient clinic. To assess DIF, WHODAS 2.0 items were dichotomized as `none' rated by respondents as `0' versus `any limitation' rated as `1,2,3 or 4'. The item response theory analysis was used to define discrimination and difficulty parameters of a questionnaire. The probit logistic regression was used to test uniformity of DIF between gender groups. The results of DIF analysis were presented and evaluated graphically as item characteristic curves based on 2-parameter IRT analysis of dichotomized responses. High to perfect discrimination ability was observed for all the items except one. Difficulty levels of eight items were shifted towards the elevated disability level, four items demonstrated a perfect difficulty property. Significant DIF between genders was observed in seven of 12 items. The detected DIFs were uniform. For item `household', `emotional affection' and `work', men had to experience slightly worse disability than women to achieve the same score. A reverse effect was observed for items `concentration', `washing', `dressing' and dealing with strangers. In this study, significant DIF between genders was found in seven of twelve items of 12-item WHODAS 2.0. amongst 1988 patients with chronic musculoskeletal pain. All the detected DIFs were uniform. Regardless gender-related DIF shown in seven out of 12 items, we recommend using and studying 12-item WHODAS 2.0 in different populations.


Assuntos
Avaliação da Deficiência , Dor Musculoesquelética/diagnóstico , Psicometria/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Pessoas com Deficiência , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/classificação , Dor Musculoesquelética/psicologia , Exame Físico , Centros de Reabilitação , Fatores Sexuais , Inquéritos e Questionários
20.
BMC Musculoskelet Disord ; 20(1): 375, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421668

RESUMO

BACKGROUND: Lateral epicondylitis or tennis elbow is a frequent condition with long-lasting symptoms. In order to identify predictors for treatment success and pain in lateral epicondylitis, we used data from a randomized controlled trial. This trial investigated the efficacy of physiotherapy alone or combined with corticosteroid injection for acute lateral epicondylitis in general practice. METHODS: The outcomes treatment success and pain score on VAS were assessed at 6, 12, 26 and 52 weeks. We ran a univariate binary logistic regression with generalized estimating equations (GEE) and subsequently an adjusted multilevel logistic regression to analyze the association between potential prognostic indicators and the outcome success/ no success. To assess the changes in pain score we used a two-level multilevel linear regression (MLR) followed by an adjusted MLR model with random effects. RESULTS: The most consistent predictor for reduced treatment success at all time points was a high Pain Free Function Index score signifying more pain on everyday activities. Being on paid sick-leave and having a recurring complaint increased short term treatment success but gave decreased long-term treatment success. The patients reporting symptoms after engaging in probable overuse in an unusual activity, tended towards increased treatment success at all time-points, but significant only at 12 weeks. The most consistent predictor of increased pain at all time points was a higher overall complaints score at baseline. CONCLUSIONS: Our results suggest that in treating acute lateral epicondylitis, a consideration of baseline pain, a registration of the patient's overall complaint on a VAS scale and an assessment of the patient's perceived performance in everyday activities with the Pain Free Function Index can be useful in identifying patients that will have a more protracted and serious condition. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT00826462 . Date of registration January 22, 2009. The Trial was prospectively registrated.


Assuntos
Glucocorticoides/administração & dosagem , Dor Musculoesquelética/diagnóstico , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Adulto , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Injeções Intralesionais , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Medição da Dor , Modalidades de Fisioterapia , Prognóstico , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento , Triancinolona/administração & dosagem
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