The Diagnostic Accuracy of Gluteal Trigger Points to Differentiate Radicular From Nonradicular Low Back Pain.

OBJECTIVES: Low back pain (LBP) is highly prevalent and costly to the society. Previous studies have shown an association between radicular LBP and trigger points (TrPs) in the superior-lateral quadrant of the gluteal area (GTrP). The objective of current study was to evaluate the diagnostic value of GTrP to predict nerve root involvement among patients with LBP. MATERIALS AND METHODS: In a prospective, diagnostic accuracy study 325 consecutive patients with LBP were recruited. At first step, patients were evaluated for the presence or absence of the GTrP. A different investigator, blinded to the GTrP findings, then performed history taking and physical examination. Subsequently, all patients underwent a lumbar spine magnetic resonance imaging and, when indicated, electrodiagnostic tests. On the basis of the clinical and ancillary tests findings, a multidisciplinary panel of experts (the "reference standard"), blinded to the GTrP evaluation, allocated patients to radicular versus nonradicular LBP groups. The agreement between the GTrP findings, as a diagnostic test and the reference standard allocation was evaluated in a 2 by 2 contingency table. RESULTS: The specificity of the GTrP test was 91.4% and its sensitivity was 74.1%. The area under the receiver operating characteristic curve was 0.827 (0.781 to 0.874). Positive likelihood ratio was 8.62 and negative likelihood ratio was 0.28. Positive and negative predictive values were 91.9% and 72.7%, respectively. DISCUSSION: As a clinical finding, TrPs in superior-lateral quadrant of gluteal area are highly specific indicators for radicular LBP. Incorporating these TrPs evaluation in routine physical examination of patients with LBP could decrease the need for more costly, time-consuming, and invasive diagnostic tests.

Effect of single injection of platelet-rich plasma in comparison with corticosteroid on knee osteoarthritis: a double-blind randomized clinical trial.

BACKGROUND: Evidence on the effect of platelet-rich plasma (PRP) in treating osteoarthritis (OA) is insufficient. Therefore, the present study compares the effects of a one-time injection of PRP and corticosteroid (CS). METHODS: In the present randomized double blind clinical trial, the participants who suffered from knee osteoarthritis (Grades II/III), were randomly divided into two groups: intra articular injection of PRP and CS. Knee injury and osteoarthritis outcome score (KOOS), the 20-Meter-Walk Test (20MW), active and passive ranges of motions (ROM), flexion contracture, and pain intensity based on Visual Analog Scale (VAS) were assessed before, 2-months, and 6-months after interventions. RESULTS: Forty-one participants (48 knees) were involved in the research (66.7% women; average age of 61.1±7.0 years old). Compared to the group treated with corticosteroid, pain relief (df: 6, 35; F=11.0; P=0.007), symptom free (df:6, 35; F=23.0; P<0.001), activities of daily living (ADL) (df:6, 35; F=10.7; P=0.005) and quality of life (df:6, 35; F=5.2; P=0.02) in the RPR group were significantly higher, but sporting ability was not different between the two groups (df: 6, 35; F=0.6; P=0.55). PRP was significantly more helpful for relieving patients' pain (VAS) compared to corticosteroids (df: 6, 35; F=32.0; P=0.001). It is also notable that using PRP was more helpful in improving the 20MW test than corticosteroid treatment (df: 6, 35; F=7.4; P=0.04) but none of the treatments had any impact on active flexion ROM، passive flexion ROM and flexion contracture (P>0.05). CONCLUSIONS: Our study demonstrated that one shot of PRP injection, decreased joint pain more and longer-term, alleviated the symptoms, and enhanced the activity of daily living and quality of life in short-term duration in comparison with CS.

Normal values of posterior antebrachial cutaneous nerve conduction study related to age, gender, height, and body mass index.

PURPOSE: Recent studies have proposed posterior antebrachial cutaneous (PABC) nerve could help in interpretation of some conditions in upper limb electrodiagnostic study. This study aimed to establish these normal values and to assess the effect of sex, age, height, and body mass index on these normal values. METHODS: Eligible participants were 84 healthy adult people aged between 22 and 75 years who underwent PABC nerve conduction studies. RESULTS: The mean ± SD values of the base-to-peak amplitude, peak latency, and nerve conduction velocity of all participants were 10.95 ± 2.90 µV, 2.08 ± 0.20 milliseconds, and 57.85 ± 7.83 m/second, respectively. There was a significant positive correlation between the subjects' age and the PABC onset latency, peak latency, and nerve conduction velocity (r = 0.64, P < 0.001; r = 0.6, P < 0.001; and r = 0.44, P < 0.001, respectively). A significant negative correlation was observed between age and base-to-peak amplitude and peak-to-peak amplitude of participants, as well (r = -0.38, r = -0.41, P < 0.001, respectively). The correlation of body mass index with base-to-peak amplitude and peak-to-peak amplitude were r = -0.36, P < 0.001 and r = -0.40, P < 0.001, respectively. CONCLUSIONS: This study has established normal values for PABC nerve conduction studies. Furthermore, age and body mass index must be taken into account for making diagnostic conclusion in PABC nerve conduction studies.