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1.
Ann R Coll Surg Engl ; 102(4): 248-255, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31896272

RESUMO

INTRODUCTION: We review the literature and highlight the important factors to consider when counselling patients with non-traumatic rotator cuff tears on which route to take. Factors include the clinical outcomes of surgical and non-surgical routes, tendon healing rates with surgery (radiological outcome) and natural history of the tears if treated non-operatively. METHODS: A PRISMA-compliant search was carried out, including the online databases PubMed and Embase™ from 1960 to the end of June 2018. FINDINGS: A total of 49 of the 743 (579 PubMed and 164 Embase™) results yielded by the preliminary search were included in the review. There is no doubt that the non-surgical route with an appropriate physiotherapy programme has a role in the management of degenerative rotator cuff tears. This is especially the case in patients with significant risk factors for surgery, those who do not wish to go through a surgical treatment and those with small, partial and irreparable tears. However, rotator cuff repair has a good clinical outcome with significant improvements in pain, range of motion, strength, quality of life and sleep patterns.


Assuntos
Artroscopia/efeitos adversos , Dor Musculoesquelética/terapia , Modalidades de Fisioterapia , Lesões do Manguito Rotador/terapia , Artropatia de Ruptura do Manguito Rotador/prevenção & controle , Humanos , Dor Musculoesquelética/etiologia , Seleção de Pacientes , Qualidade de Vida , Amplitude de Movimento Articular , Fatores de Risco , Lesões do Manguito Rotador/complicações , Lesões do Manguito Rotador/fisiopatologia , Artropatia de Ruptura do Manguito Rotador/etiologia , Articulação do Ombro/fisiopatologia , Articulação do Ombro/cirurgia , Resultado do Tratamento
2.
Bone Joint J ; 102-B(1): 11-16, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31888358

RESUMO

AIMS: Debate continues about whether it is better to use a cemented or uncemented hemiarthroplasty to treat a displaced intracapsular fracture of the hip. The aim of this study was to attempt to resolve this issue for contemporary prostheses. METHODS: A total of 400 patients with a displaced intracapsular fracture of the hip were randomized to receive either a cemented polished tapered stem hemiarthroplasty or an uncemented Furlong hydroxyapatite-coated hemiarthroplasty. Follow-up was conducted by a nurse blinded to the implant at set intervals for up to one year from surgery. RESULTS: A total of 115 patients died in the year after surgery. There was a tendency towards a slightly higher mortality in those treated with the uncemented prosthesis after one year (64 vs 51; p = 0.18). For the survivors, there was no significant difference in pain score at any of the time intervals. Patients treated using the cemented hemiarthroplasty recovered mobility better than those treated with the uncemented hemiarthroplasty (mean decrease in mobility score at one year: 1.7 vs 1.1, SD 1.9; p = 0.008). There was a tendency to more periprosthetic fractures in the uncemented group (five vs two cases; p = 0.45), but overall the need for further surgery was similar in both groups (nine vs seven cases). There were four perioperative deaths in the cemented group. CONCLUSION: These results indicate that a contemporary cemented hemiarthroplasty gives better results than an uncemented hemiarthroplasty for patients with a displaced intracapsular fracture of the hip. When the condition of the patient permits, a cemented hemiarthroplasty should be used. Cite this article: Bone Joint J. 2020;102-B(1):11-16.


Assuntos
Hemiartroplastia/métodos , Fraturas do Quadril/cirurgia , Fraturas Periprotéticas/cirurgia , Idoso , Idoso de 80 Anos ou mais , Perda Sanguínea Cirúrgica/estatística & dados numéricos , Transfusão de Sangue/estatística & dados numéricos , Cimentos para Ossos/uso terapêutico , Cimentação , Feminino , Prótese de Quadril , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Duração da Cirurgia , Complicações Pós-Operatórias/etiologia , Reoperação/estatística & dados numéricos , Resultado do Tratamento
3.
J Pediatr Orthop ; 40(2): 93-96, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31923169

RESUMO

BACKGROUND: Sever disease is a common condition in active, growing children. This condition presents as pain in the heel and is thought to be an overuse condition of the calcaneal apophysis. There are currently no defined radiographic diagnostic criteria for evaluation of Sever disease, with radiographs generally showing normal appearance of the calcaneal apophysis. A better understanding of the relationship of Sever disease and skeletal maturity may allow for improved interpretation of radiographs when trying to diagnose this condition. METHODS: ICD-9 code 732.5 was used to search for patients diagnosed with Sever disease from 2007 to 2015 at a single hospital. For every patient with Sever disease with available calcaneal imaging within 40 days of diagnosis, heel x-rays were staged for calcaneal maturity score using a previously described calcaneal skeletal maturity assessment system. Controls matched by age, race, and sex were evaluated for calcaneal stage to compare with the Sever patients. RESULTS: The chart review yielded 78 patients diagnosed with Sever disease by the orthopaedic attending, 39 of which have x-rays around the time of diagnosis. Calcaneal scores averaged 2.2±0.8 for all patients, 2.1±0.9 for male individuals, and 2.3±0.8 for female individuals. The average age for male individuals was 10.4±1.9 years and for female individuals, 9.2±2.2 years. The ages of diagnosis were similar for patients with and without x-rays. Twenty-two of 39 patients with Sever disease were calcaneal stage 2, and 37 of 39 were stages 1, 2, or 3. We calculated the absolute difference from stage 2 for the Sever and control groups. Mean difference from stage 2 was 0.51±0.68 for the Sever patients and 0.95±0.79 for control patients (P=0.01). CONCLUSION: Sever disease occurs in a very narrow range of skeletal maturity, as measured by the calcaneal skeletal maturity assessment system and our observations with chronological age. When compared with age-matched and race-matched controls, stage 2 was seen more frequently in the Sever patients. If a child is not within calcaneal stages 1, 2, or 3, then a different diagnosis should be considered. LEVEL OF EVIDENCE: Level III-retrospective case-control study.


Assuntos
Calcâneo/diagnóstico por imagem , Doenças do Pé/diagnóstico por imagem , Osteíte/diagnóstico por imagem , Determinação da Idade pelo Esqueleto , Calcâneo/crescimento & desenvolvimento , Estudos de Casos e Controles , Criança , Feminino , Doenças do Pé/complicações , Humanos , Masculino , Dor Musculoesquelética/etiologia , Osteíte/complicações , Radiografia , Estudos Retrospectivos
4.
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
5.
J Pediatr Orthop ; 40(1): e68-e76, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30925579

RESUMO

BACKGROUND: A variety of treatment methods have so far been described for unicameral bone cysts (UBC). However, to the best of our knowledge, no particular consensus has yet been reached on when to operatively treat a patient with a humeral UBC. Therefore, members of the European Pediatric Orthopedic Society (EPOS) and Pediatric Orthopedic Society of North America (POSNA) were surveyed to characterize current treatment preferences. METHODS: An online electronic questionnaire was sent out to all registered EPOS and POSNA members. The survey comprised 45 questions related to the diagnosis, treatment, and follow-up characteristics of patients with UBCs of the humerus. Particular questions related to the nonoperative or surgical treatment of pathologic proximal humerus and humeral shaft fractures were also included. RESULTS: In total, 444 participants (132 EPOS and 292 POSNA members) responded, of whom 400 were actively involved in UBC treatment. The preferred diagnostic modalities to confirm the diagnosis of a UBC in the humerus were radiographs (88%), MRI in cases of questionable diagnosis (58%) or CT scan (8%). For painless UBCs 67% prefer no treatment at all except when the fracture risk is deemed high (then 53% recommend surgery); 71% of respondents would treat painful UBCs with surgery. Most common surgical techniques comprise curettage (45%), artificial bone substitutes (37%), corticosteroid injection (29%), or intramedullary stabilization (eg, rodding; 24%).Fractured, nondisplaced and mildly displaced proximal humerus UBCs and mildly displaced pathologic humerus shaft fractures are all preferably treated nonoperatively (94%, 91%, 83%, respectively). Severely displaced pathologic proximal humerus fractures are treated less often conservatively (36%) than surgically (40%), and severely displaced humerus shaft fractures are preferably treated surgically (63%) by intramedullary stabilization (60%). CONCLUSIONS: There is great variation among EPOS and POSNA members with regards to the diagnosis and treatment of UBCs in the humerus. Although some consensus on general treatment principles is seen, specific surgical treatment indications vary.Prospective randomized-controlled studies are needed to evaluate the outcomes of the different surgical approaches compared with nonoperative strategies. LEVEL OF EVIDENCE: Level V-expert opinion.


Assuntos
Cistos Ósseos/terapia , Fraturas Espontâneas/terapia , Fraturas do Úmero/terapia , Padrões de Prática Médica/tendências , Fraturas do Ombro/terapia , Cistos Ósseos/complicações , Cistos Ósseos/diagnóstico por imagem , Tratamento Conservador , Europa (Continente) , Fraturas Espontâneas/diagnóstico por imagem , Fraturas Espontâneas/etiologia , Humanos , Fraturas do Úmero/diagnóstico por imagem , Fraturas do Úmero/etiologia , Imagem por Ressonância Magnética , Dor Musculoesquelética/etiologia , América do Norte , Procedimentos Ortopédicos/métodos , Ortopedia , Pediatria , Estudos Prospectivos , Fraturas do Ombro/diagnóstico por imagem , Fraturas do Ombro/etiologia , Inquéritos e Questionários , Tomografia Computadorizada por Raios X
6.
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
7.
Unfallchirurg ; 122(11): 834-839, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31690985

RESUMO

A small proportion of patients with exertional leg pain (ELP) have deep posterior chronic exertional compartment syndrome (dp-CECS). These individuals report pain, tightness and cramps deep in the calf muscles that are elicited by exercise, but may also be present during rest to a lesser extent. Physical examination often reveals painful palpation of the flexor muscles in the area immediately dorsomedial to the tibial bone. Diagnosis is confirmed by intracompartmental pressure testing. Various entities may mimic or coincide with dp-CECS, including medial tibial stress syndrome (MTSS) and popliteal artery entrapment syndrome (PAES). Fasciotomy of multiple flexor muscles is the only treatment that achieves a beneficial outcome. The aim of this overview is to discuss the diagnosis and management of dp-CECS.


Assuntos
Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Músculo Esquelético/cirurgia , Dor Musculoesquelética/etiologia , Doença Crônica , Síndromes Compartimentais/etiologia , Exercício Físico , Fasciotomia , Humanos , Perna (Membro) , Dor Musculoesquelética/terapia
8.
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
9.
J Pediatr Orthop ; 39(10): 527-533, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599864

RESUMO

BACKGROUND: Individuals with clubfoot, treated in infancy with either the Ponseti method or comprehensive clubfoot release, often encounter pain as adults. Multiple studies have characterized residual deformity after Ponseti or surgical correction using physical exam, radiographs and pedobarography; however, the relationship between residual foot deformity and pain is not well defined. The purpose of the current study was 2-fold: (1) to evaluate the relationship between foot morphology and pain for young adults treated as infants for idiopathic clubfoot and (2) to describe and compare pedobarographic measures and outcome measures of pain and morphology among surgically treated, Ponseti treated, and typically developing feet. METHODS: We performed a case-control study of individuals treated for clubfoot at 2 separate institutions with either the Ponseti method or comprehensive clubfoot release between 1983 and 1987. All subjects (24 treated with comprehensive clubfoot release, 18 with Ponseti method, and 48 controls) were evaluated using the International Clubfoot Study Group (ICFSG) morphology scoring, dynamic pedobarography, and foot function index surveys. During pedobarography, we collected the subarch angle and arch index as well as the center of pressure progression (COPP) on all subjects. RESULTS: Foot morphology (ICFSG) scores were highly correlated with foot function index pain scores (r=0.43; P<0.001), although the difference in pain scores between the surgical and Ponseti group did not reach significance. The surgical group exhibited greater subarch angle and arch indexes than the Ponseti group, demonstrating a significant difference in morphology, a flatter foot. Finally, we found more abnormalities in foot progression, decreased COPP in the forefoot and increased COPP in the midfoot and hindfoot, in the surgical group compared with controls. CONCLUSIONS: Measures of foot morphology were correlated with pain among all treated for clubfoot. Compared with Ponseti method, comprehensive surgical release lead to greater long-term foot deformity, flatter feet and greater hindfoot loading time. LEVEL OF EVIDENCE: Level III-Therapeutic.


Assuntos
Moldes Cirúrgicos , Pé Torto Equinovaro/patologia , Pé Torto Equinovaro/terapia , Dor Musculoesquelética/etiologia , Procedimentos Ortopédicos , Adulto , Estudos de Casos e Controles , Pré-Escolar , Pé Torto Equinovaro/complicações , Feminino , Seguimentos , Pé/fisiopatologia , Humanos , Lactente , Recém-Nascido , Masculino , Pressão , Fatores de Tempo , Resultado do Tratamento , Suporte de Carga , Adulto Jovem
10.
Pain Res Manag ; 2019: 4867904, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565109

RESUMO

Local bone denervation by magnetic resonance-guided focused ultrasound (MRgFUS) is a promising tool for alleviation of pain in patients with painful bone metastasis (BM). Considering the underlying mechanism of pain alleviation, MRgFUS might be effective for various bone and joint diseases associated with local tenderness. This study was conducted to clarify the therapeutic effect of focused ultrasound in patients with various painful bone and joint diseases that are associated with local tenderness. Ten patients with BM, 11 patients with lumbar facet joint osteoarthritis (L-OA), and 19 patients with knee osteoarthritis (K-OA) were included. MRgFUS treatment was applied to the bone surface with real-time temperature monitoring at the target sites. Pain intensity was assessed using a 100 mm numerical rating scale (NRS) at various time points. Pressure pain threshold (PPT) was evaluated on the sonication area and control sites. Compared to baseline, the pain NRS scores significantly decreased in all groups 1 month after treatment, and PPT at the treated sites significantly increased in all groups 3 months after treatment. The percentage of patients who showed a ≥ 50% decrease in pain NRS scores at 1 month after treatment was 80% in BM, 64% in L-OA, and 78% in K-OA groups. PPTs were significantly higher after treatment at all evaluation time points. This study indicated that MRgFUS is effective in reducing pressure pain at the site of most severe tenderness in patients with painful bone and joint diseases. Treatment response was comparable between patients with BM, L-OA, and K-OA.


Assuntos
Dor do Câncer/terapia , Ablação por Ultrassom Focalizado de Alta Intensidade/métodos , Dor Musculoesquelética/etiologia , Dor Musculoesquelética/terapia , Osteoartrite do Joelho/terapia , Osteoartrite da Coluna Vertebral/terapia , Idoso , Neoplasias Ósseas/secundário , Neoplasias Ósseas/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/complicações , Osteoartrite da Coluna Vertebral/complicações
11.
J Bone Joint Surg Am ; 101(19): 1775-1782, 2019 Oct 02.
Artigo em Inglês | MEDLINE | ID: mdl-31577683

RESUMO

BACKGROUND: Rotator cuff disease is a major medical and economic burden due to a growing aging population, but management of rotator cuff tears remains controversial. We hypothesized that there is no difference in outcomes between patients who undergo rotator cuff repair and matched patients treated nonoperatively. METHODS: After institutional review board approval, a prospective cohort of patients over 18 years of age who had a full-thickness rotator cuff tear seen on magnetic resonance imaging (MRI) were retrospectively evaluated. After clinical evaluation, each patient elected to undergo either rotator cuff repair or nonsurgical treatment. Demographic information was collected at enrollment, and self-reported outcome measures (the Normalized Western Ontario Rotator Cuff Index [WORCnorm], American Shoulder and Elbow Surgeons score [ASES], Single Assessment Numerical Evaluation [SANE], and pain score on a visual analog scale [VAS]) were collected at baseline and at 6, 12, and >24 months. The Functional Comorbidity Index (FCI) was used to assess health status at enrollment. The size and degree of atrophy of the rotator cuff tear were classified on MRI. Propensity score analysis was used to create rotator cuff repair and nonsurgical groups matched by age, sex, symptom duration, FCI, tear size, injury mechanism, and atrophy. The Student t test, chi-square test, and regression analysis were used to compare the treatment groups. RESULTS: One hundred and seven patients in each group were available for analysis after propensity score matching. There were no differences between the groups with regard to demographics or rotator cuff tear characteristics. For all outcome measures at the time of final follow-up, the rotator cuff repair group had significantly better outcomes than the nonsurgical treatment group (p < 0.001). At the time of final follow-up, the mean outcome scores (and 95% confidence interval) for the surgical repair and nonsurgical treatment groups were, respectively, 81.4 (76.9, 85.9) and 68.8 (63.7, 74.0) for the WORCnorm, 86.1 (82.4, 90.3) and 76.2 (72.4, 80.9) for the ASES, 77.5 (70.6, 82.5) and 66.9 (61.0, 72.2) for the SANE, and 14.4 (10.2, 20.2) and 27.8 (22.5, 33.5) for the pain VAS. In the longitudinal regression analysis, better outcomes were independently associated with younger age, shorter symptom duration, and rotator cuff repair. CONCLUSIONS: Patients with a full-thickness rotator cuff tear reported improvement in pain and functional outcome scores with nonoperative treatment or surgical repair. However, patients who were offered and chose rotator cuff repair reported greater improvement in outcome scores and reduced pain compared with those who chose nonoperative treatment. LEVEL OF EVIDENCE: Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.


Assuntos
Lesões do Manguito Rotador/terapia , Manguito Rotador/cirurgia , Corticosteroides/uso terapêutico , Anti-Inflamatórios/uso terapêutico , Artroscopia/estatística & dados numéricos , Feminino , Humanos , Imobilização/estatística & dados numéricos , Masculino , Análise por Pareamento , Pessoa de Meia-Idade , Dor Musculoesquelética/etiologia , Medição da Dor , Satisfação do Paciente , Modalidades de Fisioterapia/estatística & dados numéricos , Estudos Prospectivos , Sistema de Registros , Estudos Retrospectivos , Lesões do Manguito Rotador/etiologia , Ruptura/etiologia , Ruptura/terapia , Resultado do Tratamento
12.
Unfallchirurg ; 122(11): 848-853, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31628497

RESUMO

Medial tibial stress syndrome is a common overuse injury in jumping and running athletes. It is defined as exercise-induced pain along the distal posteromedial border of the tibia and the presence of recognisable pain on palpation over a length of 5 or more centimetres. This overview article provides an evidence update on the diagnosis and management of athletes with medial tibial stress syndrome.


Assuntos
Síndrome da Tensão Tibial Medial/diagnóstico , Síndrome da Tensão Tibial Medial/terapia , Dor Musculoesquelética/etiologia , Traumatismos em Atletas/complicações , Exercício Físico , Humanos , Corrida
13.
Unfallchirurg ; 122(11): 840-847, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31628498

RESUMO

Exercise-induced leg pain (ELP) and tightness may be caused by a chronic exertional compartment syndrome (CECS). Although CECS can develop in any muscle compartment, most individuals suffer from an anterior tibial muscle CECS (ant-CECS). Typically, a patient with ant-CECS experiences discomfort toward the end of sports activity or in the hours thereafter. Physical examination may reveal tenderness upon palpation of the anterior tibial muscle belly. The gold standard diagnostic tool is a dynamic intracompartmental pressure (ICP) measurement demonstrating elevated muscle tissue pressures. Duplex analysis and imaging may be indicated for exclusion of concomitant entities such as entrapment of the popliteal artery or nerves. Conservative treatments including modification of the patient's running technique can be successful. A fasciotomy must be considered in recalcitrant cases. Residual or recurrent disease may necessitate partial removal of the fascia. The aim of this overview is to discuss the management of CECS in the anterolateral portion of the leg.


Assuntos
Síndromes Compartimentais/diagnóstico , Síndromes Compartimentais/terapia , Dor Musculoesquelética/etiologia , Doença Crônica , Síndromes Compartimentais/etiologia , Fasciotomia , Humanos , Perna (Membro) , Músculo Esquelético/cirurgia , Dor Musculoesquelética/terapia
15.
Rev. clín. med. fam ; 12(3): 155-159, oct. 2019. ilus
Artigo em Espanhol | IBECS | ID: ibc-186807

RESUMO

El dolor óseo es un problema frecuente y constituye uno de los principales motivos de consulta, puede tratarse de un problema simple o puede ser el síntoma inicial de una patología más compleja y grave. En pacientes de edad avanzada con dolor óseo no asociado a traumatismo, que no mejora con tratamiento habitual, debemos realizar el diagnóstico diferencial con mieloma múltiple entre otros. Presentamos el caso de una mujer de 83 años que acude por dolor óseo en el miembro inferior izquierdo de meses de evolución que no mejora con tratamiento analgésico. Se realiza un estudio radiografico, en el que se objetiva una lesión lítica en el fémur izquierdo y ensanchamiento mediastínico en relación con plasmocitoma esternal que causaba compresión cardiaca. Se realizó estudio complementario que confirmó el diagnóstico de mieloma múltiple


Bone pain is one of the most common chief complaints. It can be a simple problem or an initial symptom of a more complex and serious disease. In older patients with non-traumatic bone pain that does not improve with conventional treatment, differential diagnosis with multiple myeloma, among others, is required. We present the case of an 83-year-old woman with bone pain in lower limb of several months' duration that does not improve with pain medications. X-ray reveal lytic lesion in her left femur and mediastinal widening related to sternal plasmacytoma causing cardiac compression. A complementary study confirmed the diagnosis of multiple myeloma


Assuntos
Humanos , Feminino , Idoso de 80 Anos ou mais , Dor Musculoesquelética/etiologia , Mieloma Múltiplo/diagnóstico , Plasmocitoma/diagnóstico , Ossos da Perna , Diagnóstico Diferencial , Osteoporose/complicações
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.
BMC Musculoskelet Disord ; 20(1): 392, 2019 Aug 31.
Artigo em Inglês | MEDLINE | ID: mdl-31470834

RESUMO

BACKGROUND: Chronic recurrent multifocal osteomyelitis (CRMO) is a rare idiopathic autoinflammatory bone disease that mostly affects children and adolescents. It is a diagnosis of exclusions since no clinical signs and symptoms are pathognomonic. Radiological tests are often essential, but bone biopsy may be needed in unclear cases. CASE PRESENTATION: A 9-year-old Caucasian girl with a history of bone pain. The data from the history and results of laboratory tests suggested osteomyelitis, but no adequate response to the treatment was observed. A number of imaging tests did not confirm the diagnosis, therefore a bone biopsy was necessary. CONCLUSIONS: Differential diagnosis of CRMO is challenging and it is based on exclusions. Since it might be misdiagnosed or mistreated, bone biopsy should be considered in patients reporting bone pain who are unresponsive to treatment.


Assuntos
Dor Musculoesquelética/etiologia , Osteomielite/diagnóstico , Doenças Raras/diagnóstico , Artrite Infecciosa/diagnóstico , Biópsia , Medula Óssea/diagnóstico por imagem , Medula Óssea/patologia , Neoplasias Ósseas/diagnóstico , Criança , Diagnóstico Diferencial , Feminino , Humanos , Imagem por Ressonância Magnética , Osteomielite/complicações , Osteomielite/patologia , Cintilografia , Doenças Raras/complicações , Doenças Raras/patologia , Tíbia/diagnóstico por imagem , Tíbia/patologia , Tomografia Computadorizada por Raios X
18.
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
19.
BMC Musculoskelet Disord ; 20(1): 378, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31421688

RESUMO

BACKGROUND: Corticosteroid injection is frequently used for plantar heel pain (plantar fasciitis), although there is limited high-quality evidence to support this treatment. Therefore, this study reviewed randomised trials to estimate the effectiveness of corticosteroid injection for plantar heel pain. METHODS: A systematic review and meta-analysis of randomised trials that compared corticosteroid injection to any comparator. Primary outcomes were pain and function, categorised as short (0 to 6 weeks), medium (7 to 12 weeks) or longer term (13 to 52 weeks). RESULTS: A total of 47 trials (2989 participants) were included. For reducing pain in the short term, corticosteroid injection was more effective than autologous blood injection (SMD -0.56; 95% CI, - 0.86 to - 0.26) and foot orthoses (SMD -0.91; 95% CI, - 1.69 to - 0.13). There were no significant findings in the medium term. In the longer term, corticosteroid injection was less effective than dry needling (SMD 1.45; 95% CI, 0.70 to 2.19) and platelet-rich plasma injection (SMD 0.61; 95% CI, 0.16 to 1.06). Notably, corticosteroid injection was found to have similar effectiveness to placebo injection for reducing pain in the short (SMD -0.98; 95% CI, - 2.06, 0.11) and medium terms (SMD -0.86; 95% CI, - 1.90 to 0.19). For improving function, corticosteroid injection was more effective than physical therapy in the short term (SMD -0.69; 95% CI, - 1.31 to - 0.07). When trials considered to have high risk of bias were excluded, there were no significant findings. CONCLUSIONS: Based on the findings of this review, corticosteroid injection is more effective than some comparators for the reduction of pain and the improvement of function in people with plantar heel pain. However, corticosteroid injection is not more effective than placebo injection for reducing pain or improving function. Further trials that are of low risk of bias will strengthen this evidence. REGISTRATION: PROSPERO registration number CRD42016053216 .


Assuntos
Fasciíte Plantar/terapia , Glucocorticoides/administração & dosagem , Dor Musculoesquelética/terapia , Manejo da Dor/métodos , Transfusão de Sangue Autóloga , Fasciíte Plantar/complicações , Fasciíte Plantar/fisiopatologia , Órtoses do Pé , Calcanhar/fisiopatologia , Humanos , Injeções Intralesionais , Dor Musculoesquelética/diagnóstico , Dor Musculoesquelética/etiologia , Medição da Dor , Placebos/administração & dosagem , Plasma Rico em Plaquetas , Recuperação de Função Fisiológica , Resultado do Tratamento
20.
Med Arch ; 73(3): 173-177, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31404121

RESUMO

Introduction: Osteoarthritis (OA) is a chronic joint disease characterized by degeneration of the articular cartilage, changes in the physico-chemical properties of the synovial fluid and macroscopical modifications of the joint. Patients with Classes I and II of Knee OA can be treated with pharmacologic therapy. Vitamin C is key for both preventing inflammatory arthritis and maintaining healthy joints with OA. Aim: The aim of our paper is to verify the effectiveness of the addition of vitamin c in nutriceutical drugs for the therapy of the knee arthritis in the young adult. Results: Group B has a lower VAS score at 6 and 12 months with p<0.05. Not statistical difference we found in KSS during all follow up. A better quality of life was founded in Group B at 12 months in group B(p<0.05) and less use of pain killers/monthly(p<0.05). Conclusion: There is no denying that vitamin C benefits everybody, whether they have arthritis or not. Therefore, it is a good idea to maintain a healthy balance of vitamin C. Without a doubt, vitamin C benefits most people with early OA.


Assuntos
Antioxidantes/uso terapêutico , Ácido Ascórbico/uso terapêutico , Osteoartrite do Joelho/tratamento farmacológico , Adolescente , Adulto , Analgésicos/uso terapêutico , Suplementos Nutricionais , Feminino , Humanos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Dor Musculoesquelética/tratamento farmacológico , Dor Musculoesquelética/etiologia , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Medição da Dor , Adulto Jovem
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