scholarly journals Effectiveness of Focused Shockwave Therapy versus Radial Shockwave Therapy for Noncalcific Rotator Cuff Tendinopathies: A Randomized Clinical Trial

2021 ◽  
Vol 2021 ◽  
pp. 1-9
Author(s):  
Chengxin Li ◽  
Zhizhuo Li ◽  
Lijun Shi ◽  
Peixu Wang ◽  
Fuqiang Gao ◽  
...  

Background. The superiority of focused shockwave therapy (F-SWT) versus radial shockwave therapy (R-SWT) for treating noncalcific rotator cuff tendinopathies remains controversial. This study is aimed at comparing the effectiveness of F-SWT versus R-SWT for the management of noncalcific rotator cuff tendinopathies. Methods. A total of 46 patients affected by noncalcific rotator cuff tendinopathies were randomly divided into 2 groups of 23 individuals. Patients in group A received 4 sessions of F-SWT, while patients in group B were treated by 4 sessions of R-SWT. In each session, mean energy flux density (EFD) for F-SW 3000 shots was 0.09 ± 0.018  mJ/mm2 with 5.1 ± 0.5  Hz, while average pressure for R-SW 3000 shots was 4.0 ± 0.35 bar with 3.2 ± 0.0  Hz. Pain level and shoulder function were assessed with the numerical rating scale (NRS) and Constant-Murley Scale (CMS). The primary endpoint was the change in the mean NRS pain score from baseline to 24 weeks after the intervention. Secondary endpoints were changes in the mean NRS pain scores at all other follow-up points, changes in the mean CMS scores, and radiographic findings. Results. There were no significant differences between the two groups regarding NRS pain score and CMS score within 24 weeks after intervention (all p > 0.05 ). However, F-SWT resulted in significantly lower NRS compared with R-SWT at 24 weeks and 48 weeks after treatment ( 2.7 ± 1.0 vs. 4.5 ± 1.2 and 1.4 ± 1.0 vs. 3.0 ± 0.8 , respectively, all p < 0.001 ). Similar results were found in CMS changes and radiographic findings. Conclusions. Both F-SWT and R-SWT are effective in patients with noncalcific rotator cuff tendinopathy. F-SWT proved to be significantly superior to R-SWT at long-term follow-up (more than 24 weeks). This trial is registered with ChiCTR1900022932.

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Riccardo Compagnoni ◽  
Alessandra Menon ◽  
Simone Radaelli ◽  
Francesco Lanzani ◽  
Mauro B. Gallazzi ◽  
...  

Abstract Background Calcific tendinitis of the shoulder has a tendon involvement that could evolve to rotator cuff tear and shoulder osteoarthritis. This study aimed to evaluate the prevalence of glenohumeral osteoarthritis and rotator cuff tears in patients affected by calcific tendinitis at a minimum follow-up of 10 years after diagnosis. Methods Patients diagnosed with calcific tendinitis of the shoulder with a minimum follow-up of 10 years were contacted and invited for a clinical and radiological evaluation. Information on the demographics, affected and dominant side, bilateral shoulder pain, type of treatment, habits, systemic or musculoskeletal diseases, reoperation of the index shoulder, and subjective satisfaction was collected. The clinical evaluation was performed using Constant–Murley score (CMS), American Shoulder and Elbow Surgeons Score (ASES), and numerical rating scale (NRS); isometric strength in forwarding flexion and abduction was also measured. Each patient also underwent an ultrasound examination to evaluate rotator cuff tendon integrity and a shoulder radiograph to evaluate osteoarthritis. Results Seventy-nine patients were available for a phone interview, and 35 agreed to be examined. The mean age was 58.89 (± 7.9) years at follow-up. The prevalence of glenohumeral osteoarthritis was 17.14% in the study population, with significant progression in 14.29% of the cases, without rotator cuff full-thickness tears. x-Ray examination showed residual calcifications in 31 patients, with a mean diameter of 5.54 mm. In 30 cases, there was a reduction of the diameter; in 4 cases, the calcification increased in size; and in 1 case, the size did not change. The mean ASES score was 74.1 (± 22.7) in the group with calcifications larger than 2 mm and 89.4 (± 8.2) in patients with smaller calcifications (p = 0.08) without correlation with the type of treatment performed. Conclusions Calcific tendinitis is a self-resolving disease without rotator cuff tears at long-term follow-up or degenerative glenohumeral progression. Level of Evidence: 3, cohort study.


2014 ◽  
Vol 32 (4) ◽  
pp. 312-319 ◽  
Author(s):  
Fengmin Zhao ◽  
Victor T. Chang ◽  
Charles Cleeland ◽  
James F. Cleary ◽  
Edith P. Mitchell ◽  
...  

Purpose To understand changes in pain severity over time and to explore the factors associated with pain changes in ambulatory patients with solid tumors. Patients and Methods We enrolled 3,106 patients with invasive cancer of the breast, prostate, colon/rectum, or lung from multiple sites. At baseline and 4 to 5 weeks later, patients rated their pain level on a 0 to 10 numerical rating scale. A 2-point change in pain score was defined as a clinically significant change in pain. Multivariable logistic models were fitted to examine the effects of pain management and demographic and clinical factors on change in pain severity. Results We analyzed 2,761 patients for changes in pain severity. At initial assessment, 53.0% had no pain, 23.5% had mild pain, 10.3% had moderate pain, and 13.2% had severe pain. Overall, one third of patients with initial pain had pain reduction within 1 month of follow-up, and one fifth had an increase, and the improvement and worsening of pain varied by baseline pain score. Of the patients without pain at initial assessment, 28.4% had pain (8.9% moderate to severe) at the follow-up assessment. Logistic regression analysis showed that inadequate pain management was significantly associated with pain deterioration, as were lower baseline pain level, younger age, and poor health status. Conclusion One third of patients have pain improvement and one fifth experience pain deterioration within 1 month after initial assessment. Inadequate pain management, baseline pain severity, and certain patient demographic and disease characteristics are associated with pain deterioration.


2013 ◽  
Vol 38 (8) ◽  
pp. 866-874 ◽  
Author(s):  
J. F. Goubau ◽  
C. K. Goorens ◽  
P. Van Hoonacker ◽  
B. Berghs ◽  
D. Kerckhove ◽  
...  

We present the results of a 5 year prospective follow-up study on the functional outcome after total replacement of the trapeziometacarpal joint with the Ivory prosthesis (Memometal, Stryker Corporate, Kalamazoo, Michigan, USA) in 22 patients. The female to male ratio was 21:1 and the mean age was 66 (range 54–78) years. The mean follow-up period was 67 (range 60–77) months after operation. Patient satisfaction was high. The mobility of the operated thumb was restored to a range of motion comparable to the contralateral thumb. Key pinch and grip strength improved by 13% and 31%, respectively. Overall function, according to Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) score, improved by 59%. Pain decreased by 85% according to the numerical rating scale. Radiological evaluation revealed no loosening of the implant after 5 years except in one patient who required revision due to polythene wear with secondary joint instability. Another patient had asymptomatic polythene wear that required no revision but remains in follow-up. The 5 year overall survival of the prosthesis was 95%. These medium-term results suggest that the Ivory arthroplasty is a reliable option for treating advanced trapeziometacarpal arthritis, because it appears to give a very good functional outcome and has the potential for long-term survival rates.


Pain Medicine ◽  
2020 ◽  
Author(s):  
William Jeremy Beckworth ◽  
Benjamin A Abramoff ◽  
Iain M Bailey ◽  
Sook Yoon ◽  
Monica Umpierrez ◽  
...  

Abstract Objective Prospectively evaluate the clinical outcomes of acute cervical radiculopathy with respect to soft disc herniations vs osteophytes. Methods Sixty consecutive patients who had had cervical radiculopathy for ≤1 month were enrolled in the study. Inclusion criteria were radicular pain greater than axial pain and a pain score ≥4 out of 10 on a numerical rating scale. Patients had at least one positive clinical finding: motor, sensory, or reflex changes. Plain films and magnetic resonance imaging were ordered. Follow-up was at 6 weeks and 3, 6, and 12 months. Outcomes included pain scores (neck and upper limb), neck disability index, medication use, opioid use, and need for surgery. Two attending musculoskeletal radiologists reviewed imaging findings for osteophytes vs soft disc herniations at the symptomatic level. Results More than 75% reduction in pain was seen in 77% of patients with soft disc herniations and 66% of patients with osteophytes (P &gt; 0.05) at 12 months. A pain score ≤2 out of 10 within 6 to 12 months was seen in 86% of patients with soft disc herniations and 81% of patients with osteophytes (P &gt; 0.05). Moderate or marked improvement at 12 months was seen in 85% of patients with soft discs and 77% of patients with osteophytes (P &gt; 0.05). Baseline–to–12-month numerical rating scale pain scores of patients with soft discs vs osteophytes had overlapping confidence intervals at each follow-up. At 12 months, very few had undergone surgery (7% of patients with soft discs, 11% of patients with osteophytes; P &gt; 0.05) or were on opioids (7% of patients with soft discs, 9% of patients with osteophytes; P &gt; 0.05). Conclusions The majority of patients, but not all patients, with acute radiculopathies improved with time. This was seen with both soft disc herniations and osteophytes.


2016 ◽  
Vol 45 (1) ◽  
pp. 42-49 ◽  
Author(s):  
Kyu Sung Chung ◽  
Jeong Ku Ha ◽  
Ho Jong Ra ◽  
Gun Woo Nam ◽  
Jin Goo Kim

Background: Medial meniscus posterior root tears (MMPRTs) lead to extrusion of the meniscus during weightbearing as well as loss of the ability of the meniscus to generate hoop stress. This loss of load-sharing ability leads to progressive arthritic changes. However, there have been no studies that correlate the correction of meniscus extrusion with clinical outcomes. Hypothesis: Decreased meniscus extrusion is associated with better clinical and radiographic outcomes compared with increased meniscus extrusion after MMPRT pullout fixation. Study Design: Case-control study; Level of evidence, 3. Methods: A total of 39 patients who underwent MMPRT pullout fixation and had been observed for more than 5 years were recruited for this study. The mean follow-up period was 69.8 months. Participants were categorized into 2 groups according to the direction of meniscus extrusion: group A (increased extrusion; 23 patients) and group B (decreased extrusion; 16 patients). Meniscus extrusion was assessed in the coronal plane on magnetic resonance imaging preoperatively and at 1 year postoperatively. The postoperative clinical outcomes (Lysholm and International Knee Documentation Committee [IKDC] scores) and radiographic results (Kellgren-Lawrence [K-L] grade and medial joint space) were compared between groups. Results: Meniscus extrusion in group A increased significantly from a mean (±SD) of 3.5 ± 0.9 mm preoperatively to 5.1 ± 1.4 mm at 1 year postoperatively ( P < .001), whereas in group B, it decreased significantly from 4.1 ± 1.3 mm preoperatively to 3.5 ± 1.4 mm at 1 year postoperatively ( P < .001). The K-L arthritis grade (0/1/2/3/4) significantly progressed in group A (from 2/12/9/0/0 preoperatively to 0/1/14/8/0 postoperatively, respectively; P = .009) but not in group B (from 1/11/4/0/0 preoperatively to 0/6/8/2/0 postoperatively, respectively; P = .274). The mean final Lysholm and IKDC scores in group B (88.1 ± 12.1 and 79.0 ± 11.4, respectively) were significantly better than those in group A (81.0 ± 9.0 and 71.1 ± 7.8, respectively) ( P < .05). There was less medial joint space narrowing at final follow-up in group B (0.6 ± 0.8 mm) than in group A (1.1 ± 0.6 mm) ( P = .015). Progression of the K-L arthritis grade was seen in 50% (8/16) of the patients in group B compared with 87% (20/23) of the patients in group A ( P = .027). Conclusion: The current study demonstrates that in patients with MMPRTs, pullout fixation leads to favorable midterm outcomes, regardless of meniscus extrusion at 1-year follow-up. However, patients with decreased meniscus extrusion at postoperative 1 year have more favorable clinical scores and radiographic findings at midterm follow-up than those with increased extrusion at 1 year. This study indicates that one of the main goals of the repair of MMPRTs is to reduce meniscus extrusion as much as possible.


2021 ◽  
Vol 27 (1) ◽  
Author(s):  
Oluwatobi Ayodeji Fasola ◽  
Augustine Oghenewyin Takure ◽  
Olayiwola B. Shittu

Abstract Background Transrectal ultrasound (TRUS)-guided prostate biopsy is a potentially painful procedure, due to the insertion of the TRUS probe in the anus and multiple passes of the biopsy needle through the rectum and prostate. Several methods of reducing pain and discomfort have been described. These include intra-rectal local anaesthetic gel (IRLA) instillation, periprostatic nerve block (PPNB), caudal block (CB) and oral analgesics. CB has potential complications of dural puncture and anaesthetic failure, while PPNB may be complicated by intravascular injection with systemic local anaesthetic toxicity. Only few studies have compared transrectal PPNB with CB with equivocal results. This study compared transrectal PPNB to CB in terms of efficacy of analgesia and incidence of complications. Methods A prospective randomized clinical trial was carried out among 80 consenting patients with an indication for TRUS-guided prostate biopsy in the Urology division of [BLINDED FOR PEER REVIEW]. Eighty participants were each randomized to either of Group A (CB with 10 ml of 2% lidocaine) or Group B (PPNB with a total of 20 ml of 1% lidocaine). Pain was assessed using an 11-point numerical rating scale (NRS), and questions on satisfaction with the procedure and willingness for a repeat procedure were asked. The incidence of complications was also recorded. Results There were no significant differences in the mean ages, body mass indices (BMIs), prostate-specific antigen (PSA) levels, digital rectal examination (DRE) findings and prostate sizes between the two groups. The mean NRS scores at administration of block, insertion of TRUS probe, prostate biopsy, 30 min and 1 day after biopsy were 2.9 ± 2.3, 2.1 ± 2.2, 3.1 ± 2.6, 1.4 ± 2.2 and 0.2 ± 0.4 respectively for CB and 3.1 ± 2.2, 2.3 ± 1.2, 2.8 ± 2.7, 1.4 ± 1.7 and 0.3 ± 0.5, respectively, for the PPNB group. There were no significant differences between the mean scores in both groups. There were also no statistically significant differences in the incidences of complications in both groups. Conclusion The two methods of analgesia are similar in efficacy and are equally safe to employ in the performance of TRUS-guided prostate biopsy. Both methods can be learned to increase the repertoire of the urologist when faced with a TRUS-guided prostate biopsy. Trial registration PACTR, PACTR202012779661309. Registered 11th December 2020—Retrospectively registered, https://pactr.samrc.ac.za/TrialDisplay.aspx?TrialID=14564.


2020 ◽  
Author(s):  
Snigdha Shubham ◽  
Manisha Nepal ◽  
Ravish Mishra ◽  
Kishor Dutta

Abstract Background The purpose of this study was to compare postoperative pain between apical patency and non-patency groups and to evaluate the influence of number of visits, vitality of teeth, group of teeth and preoperative pain on post-operative pain. Methods One hundred sixty patients were included in the study. Patients were randomly divided into: Group A (n = 80) contained apical patency maintaining group and Group B (n = 80) contained those treated without maintaining apical patency. Each group was subdivided into equal number of patients treated in single visit (n = 40) and multiple visits (n = 40), including vital (n = 20) and non-vital teeth (n = 20) and single- rooted teeth (n = 10) and multiple-rooted teeth (n = 10). Apical patency was maintained with a size 10 K-file during conventional hand filing step-back shaping procedure. Intensity of pain was recorded before treatment and on days 1, 2, and 7 after treatment using a numerical rating scale. Statistical analysis was done using Mann -Whitney U test and Spearman correlation. Results There was statistically significant difference (p < 0.05) in postoperative pain scores between the groups on 1st, 2nd and 7th day follow up. Postoperative pain in patency maintaining group was not influenced by number of visit and group of teeth treated. Whereas, vital teeth when patency was maintained in multiple visits root canal treatment post-operative pain was statistically significant (p = 0.02) in day 1 follow up. Pre-operative pain also influenced postoperative pain with statistically significant difference and positive correlation between the groups. Conclusions Our study concluded that maintenance of apical patency increased postoperative pain. Post-operative pain was not influenced by number of visits, and group of teeth. However, for patency group, vital tooth treated in multiple visits results in more postoperative in 1st day follow up. In addition, pre-operative pain also has influence on post-operative pain.


2019 ◽  
Vol 2019 ◽  
pp. 1-8 ◽  
Author(s):  
Yangjing Lin ◽  
Jin Cao ◽  
Changgui Zhang ◽  
Liu Yang ◽  
Xiaojun Duan

Background. Both percutaneous Achilles tendon lengthening by triple hemisection and the traditional open Z-lengthening are effective methods for Achilles tendon contracture. This study aims to evaluate the efficacy and safety of this new therapeutic method, which is based on the percutaneous sliding technique with three hemi-cuts in the tendon, as compared with the traditional open Z-lengthening. Methods. Retrospective analysis of the Achilles tendon contracture cases in our hospital between January 2010 and September 2016 was conducted. Twenty-five cases received percutaneous Achilles tendon lengthening (group A), and 30 patients who underwent open Z-lengthening during the same period were in the control group (group B). Operative time and hospital stay were statistically analyzed. Incision complication, equinus recurrence rate and Achilles tendon rupture morbidity were recorded. The function was assessed by American Orthopaedic Foot & Ankle Society (AOFAS) score. All cases in group A received Magnetic Resonance Imaging (MRI) of ankle preoperatively and in the follow-ups. Results. The mean follow-up period was 42.04 months in group A and 61.7 months in group B. The entire operative time and the mean hospitalization days were lower in group A than in group B. No incision and infection complication occurred in group A. The infection rate in group B was 3.3%. Equinus recurrence rate was 4% in group A and the equinus recurrence rate in group B was 21.4%. In group A, the mean AOFAS score increased from 64 ± 10.16 points preoperatively to 96.08 ± 3.17 at final follow-up, while the score in group B increased from 63.48 ± 6.2 points to 85.4 ± 10.3. MRI showed continuity of the Achilles tendon and homogeneous signal in group A. Conclusion. Modified surgery can significantly reduce the risk of Achilles tendon rupture, provide better balance in soft tissue strength between ankle dorsiflexion and ankle plantarflexion, helping to avoid recurrence of the deformity.


2015 ◽  
Vol 41 (3) ◽  
pp. 322-327 ◽  
Author(s):  
J. K. Thillemann ◽  
T. M. Thillemann ◽  
B. Munk ◽  
K. Krøner

We retrospectively evaluated a consecutive series of 42 Motec thumb carpometacarpal total joint arthroplasties. The primary endpoint was revision with implant removal and trapeziectomy. At follow-up the disability of the arm shoulder and hand (DASH) score, pain on numerical rating scale at rest and with activity and serum chrome and cobalt concentrations were assessed for both unrevised and revised patients. At a mean follow-up of 26 months, 17 patients had been revised. The 2 year cumulative revision rate was 42% (95% CI, 28–60%). The DASH score and pain scores at rest and with activity were comparable between the patients whose thumbs remained unrevised and those revised. Patients with elevated serum chrome and cobalt levels had significantly higher DASH and pain scores, but elevated levels were not associated with revision. The revision rate in this study is unacceptably high. However, pain and DASH scores after revision are acceptable and comparable with patients with non-revised implants. Level of evidence: IV


Author(s):  
Junqi Huang ◽  
Jiajia Cheng ◽  
Shitian Tang ◽  
Bo Shi ◽  
Gang Liu ◽  
...  

Abstract Background Arthroscopic rotator cuff repair has recently been popularized for treating tears. In a biomechanical trial, the Mason-Allen stitch improved the fixation quality of poorly vascularized tendons. The use of this technique involving the subscapularis tendon remains rare. The aim of this study was to evaluate the clinical outcomes of Mason-Allen technique repaired subscapularis tendons. Methods A retrospective research of collected data from 98 patients with subscapularis tears who had undergone arthroscopic repair between May 2015 and December 2018. There were 75 males and 23 females. The mean age was 56.4 ± 9.6 years and the mean follow-up was 12.5 ± 4.0 months. The visual analog scale (VAS), American Shoulder and Elbow Surgeons (ASES) score, and Constant-Murley score were used to analyze shoulder function. An MRI was performed to assess the integrity of the repair. Results Patients had significantly less pain and a better active range of motion compared with preoperative levels. VAS improved significantly from a preoperative mean of 3.42 to a postoperative mean of 1.91. ASES increased significantly from the preoperative mean of 43.6 to the postoperative mean of 74.5. Seven cases suffered from retears, which were confirmed by an MRI examination. Conclusion Arthroscopic rotator cuff repair with the Mason-Allen method resulted in a decreased level of pain and satisfied function recovery.


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