Ultrasound-Guided BoNT-A (Botulinum Toxin A) Injection Into the Subscapularis for Hemiplegic Shoulder Pain: A Randomized, Double-Blind, Placebo-Controlled Trial

Stroke ◽  
2021 ◽  
Author(s):  
Botao Tan ◽  
Lang Jia
Keyword(s):  
Quality Of Life ◽  
Range Of Motion ◽  
Shoulder Pain ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Analog Scale ◽  
Modified Ashworth Scale ◽  
Ashworth Scale

Background and Purpose: This study aimed to assess the efficacy of an ultrasound-guided lateral approach for BoNT-A (botulinum toxin A) injections into the subscapularis in patients with hemiplegic shoulder pain. Methods: This single-center trial used a randomized, double-blind, placebo-controlled design. The key inclusion criteria were a visual analog scale score of ≥4 cm and a modified Ashworth scale score of ≥1+. The patients were randomized to receive either BoNT-A injections or a placebo. The outcomes included the visual analog scale score, modified Ashworth scale score, pain-free passive range of motion of the hemiplegic shoulder, Fugl-Meyer assessment score for the upper extremities, and Stroke-Specific Quality-of-Life score. Results: A total of 49 hemiplegic shoulder pain patients were screened, and 36 were included. The participants receiving the BoNT-A injection reported a significant decrease in pain (visual analog scale, −1.39 [95% CI, −2.41 to −0.36]; P =0.002) and spasticity (modified Ashworth scale score for shoulder internal rotation, −0.72 [95% CI, −1.10 to −0.35]; P =0.001; modified Ashworth scale score for shoulder abduction, −0.44 [95% CI, −0.90 to −0.01]; P =0.026) and improved pain-free passive shoulder internal rotation range of motion (14.56 [95% CI, 6.70–21.41]; P <0.001) and quality of life (Stroke-Specific Quality-of-Life upper extremity subscale, P =0.025) compared with those receiving the placebo at the end point. The shoulder abduction range of motion did not significantly improve after the BoNT-A injection at the end point ( P =0.127). In addition, the patients in the BoNT-A group showed significant improvements in the visual analog scale score and shoulder external rotation range of motion at the 12-week follow-up. No injection-related adverse events were observed during or after the interventions in either group. Conclusions: The ultrasound-guided lateral approach for BoNT-A injections into the subscapularis is a precise and reliable method for reducing pain and spasticity and improving quality of life in stroke survivors with hemiplegic shoulder pain. Registration: URL: https://www.chictr.org.cn ; Unique identifier: ChiCTR1900023513.

scholarly journals Pruritus is common in patients with chronic liver disease and is improved by nalfurafine hydrochloride

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Shuhei Yoshikawa ◽  
Takeharu Asano ◽  
Mina Morino ◽  
Keita Matsumoto ◽  
Hitomi Kashima ◽  
...  
Keyword(s):  
Alkaline Phosphatase ◽  
Liver Disease ◽  
Chronic Liver Disease ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Visual Analog Scale Score ◽  
Chronic Liver ◽  
Common Complication ◽  
Analog Scale

AbstractPruritus is known to be a common complication in hepatitis patients, but the exact frequency and degree are not fully elucidated. Thus, we evaluated pruritus of 450 patients with chronic liver disease at our hospital. Pruritus was observed in 240 (53%) of the patients. Pruritus was significantly associated with males (OR = 1.51, P = 0.038) and patients with alkaline phosphatase (ALP) ≥ 200 U/L (OR = 1.56, P = 0.0495) and was significantly less in HBsAg-positive patients (OR = 0.449, P = 0.004). Seasonally, there was no difference in the frequency of pruritus between summer and winter. Of the 24 refractory pruritus patients treated with nalfurafine, 17 (71%) indicated improvement of itch, which is defined as a decrease in the visual analog scale score ≥ 30 mm. Pruritus was improved by nalfurafine both during daytime and nighttime in the Kawashima’s scores evaluation. All patients who received nalfurafine exhibited improved Kawashima’s scores ≥ 1 point during the daytime or nighttime. In conclusion, pruritus occurred in > 50% of patients with chronic liver disease, and predictors of pruritus were males and ALP ≥ 200 U/L. Nalfurafine may be useful for pruritus, regardless of whether daytime or nighttime.

scholarly journals Early hybrid nonbridging external fixation of unstable distal radius fractures in patients aged ≥50 years

2019 ◽  
Vol 48 (4) ◽  
pp. 030006051987956
Author(s):  
Pengfei Cheng ◽  
Fan Wu ◽  
Hua Chen ◽  
Chaoyin Jiang ◽  
Ting Wang ◽  
...  
Keyword(s):  
Range Of Motion ◽  
External Fixation ◽  
Scale Score ◽  
Distal Radius ◽  
Visual Analog Scale Score ◽  
Dash Score ◽  
Radius Fractures ◽  
Analog Scale ◽  
Radial Inclination ◽  
K Wires

Objective We evaluated hybrid nonbridging external fixation (NBEF) supplemented by K-wires as an effective and safe treatment option for osteoporotic distal radius fractures (DRFs) in a retrospective case series. Methods Sixteen extra-articular and one intra-articular DRF were treated by NBEF from 2016 to 2018 (mean patient age, 61.8 years; 15 women, 1 man). Radiographic parameters (volar tilt, radial inclination, and ulnar variance), range of motion, grip power, the visual analog scale score, and the Disabilities of the Arm, Shoulder and Hand (DASH) score were assessed at 4 weeks, 6 weeks, 6 months, and 12 months postoperatively. Results The volar tilt and radial inclination were restored after surgery and maintained well. The mean visual analog scale score was 4 ± 1 at 4 weeks. Range of motion was restored to 79% to 91% at 6 weeks. The DASH score was good before NBEF device removal. Two superficial pin-tract infections were easily treated with antibiotics. Conclusions Hybrid NBEF transfixes DRFs in a multiplanar fashion, and augmentation with percutaneous K-wires provides direct fixation in radial shift and withstands axial loads in fracture fragments. It allows early mobilization with rigid fixation. Hybrid NBEF is reliable for unstable extra-articular and simple intra-articular DRFs in older patients. Clinical Study registration number ChiCTR1900021712

scholarly journals DISCORDANCE IN GOALS OF CARE BETWEEN PATIENTS WITH ADVANCED CANCER AND THEIR CAREGIVERS: DOES AGE PLAY A ROLE?

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S54-S54
Author(s):  
Amy R Lipson ◽  
Sara Douglas
Keyword(s):  
Quality Of Life ◽  
Advanced Cancer ◽  
Visual Analog Scale ◽  
Treatment Decisions ◽  
Analog Scale ◽  
Goals Of Care ◽  
The Impact

Abstract Cancer is considered a family disease as the caregivers (CG’s) role extends beyond providing care as they can also help facilitate treatment decisions. While much has been reported in the literature about patient (PT) goals of care (GoC), little is known about discordance between PT and CG GoC and the impact of PT age. The variables of interest were PT and CG identified GoC using a 100-point visual analog scale (VAS) with anchors of quality of life (0) and survival (100). Discordance was defined as a &gt; 40 point difference on the VAS. The GoC data reported here were those obtained at enrollment and prior to subject’s death. A sample of 235 PTs and CGs of PTs diagnosed with advanced cancers were included in the study. Mean age for the PTs was 64.7 (SD=10.5, range =21-88) with 54% being &gt; 65. At enrollment, 28.7% of the PT-CG pairs of those PTs 65 years (X2 (1)=1.06, p=.304). At death, 61.8% (X2 (1)=31.04 &lt;.001, Φ=.49) with discord at enrollment had discord at death. For patients who were older, 66.7% who had discord at enrollment also had discord at death and for patients

Customized Foot Insoles Have a Positive Effect on Pain, Function, and Quality of Life in Patients with Medial Knee Osteoarthritis

2013 ◽  
Vol 103 (1) ◽  
pp. 50-55 ◽  
Author(s):  
Søren Thorgaard Skou ◽  
Lea Hojgaard ◽  
Ole H. Simonsen
Keyword(s):  
Quality Of Life ◽  
Physical Activity ◽  
Older Adults ◽  
Knee Osteoarthritis ◽  
Visual Analog Scale ◽  
Oxford Knee Score ◽  
Analog Scale ◽  
Custom Made ◽  
Arch Support

Background: Knee osteoarthritis (KOA) is a prevalent degenerative disease in older adults. Treatment strategies, including insoles, focus on reducing pain and physical disability. In medial KOA, insoles have been studied extensively with conflicting results, possibly due to heterogeneity in outcome measures and the intervention. We sought to investigate the effect of custom-made laterally wedged insoles on pain, function, and quality of life in patients with medial KOA. Methods: Fifty-one consecutive patients with medial KOA were prescribed custom-made insoles with arch support and a 5.0° to 8.7° lateral wedge. At follow-up, 42 of the 51 participants (22 men; mean age, 63 years; mean Kellgren-Lawrence, 3.4) participated. Retrospectively, participants were asked to rate the pain intensity in their affected knee before and after the intervention measured on a visual analog scale after 30 min of physical activity (primary outcome), at rest, at night, and after 50 m of walking. Additionally, they completed the Oxford Knee Score and the EQ-5D. The paired-samples t test was applied in the statistics. Results: The visual analog scale score after 30 min of physical activity was significantly reduced after the intervention (mean, 3.3 cm; 95% confidence interval, 2.1–4.5 cm; P &lt; .001). The same significant changes were found in all of the secondary outcomes. Conclusions: There was a significant reduction in pain and improvements in function and quality of life with custom-made laterally wedged insoles with arch support in older adults with mild-to-severe medial KOA. The customization of laterally wedged insoles may be essential for the effect in medial KOA. (J Am Podiatr Med Assoc 103(1): 50–55, 2013)

scholarly journals Awake Fiberoptic or Awake Video Laryngoscopic Tracheal Intubation in Patients with Anticipated Difficult Airway Management

2012 ◽  
Vol 116 (6) ◽  
pp. 1210-1216 ◽  
Author(s):  
Charlotte V. Rosenstock ◽  
Bente Thøgersen ◽  
Arash Afshari ◽  
Anne-Lise Christensen ◽  
Claus Eriksen ◽  
...  
Keyword(s):  
Tracheal Intubation ◽  
Difficult Airway ◽  
Scale Score ◽  
Visual Analog Scale ◽  
Difficult Intubation ◽  
Visual Analog Scale Score ◽  
Difficult Tracheal Intubation ◽  
Fiberoptic Intubation ◽  
Analog Scale ◽  
Intubation Success

Background Awake flexible fiberoptic intubation (FFI) is the gold standard for management of anticipated difficult tracheal intubation. The purpose of this study was to compare awake FFI to awake McGrath® video laryngoscope, (MVL), (Aircraft Medical, Edinburgh, Scotland, United Kingdom) intubation in patients with an anticipated difficult intubation. The authors examined the hypothesis that MVL intubation would be faster than FFI. Methods Ninety-three adult patients with anticipated difficult intubation were randomly allocated to awake FFI or awake MVL, patients were given glycopyrrolate, nasal oxygen, topical lidocaine orally, and a transtracheal injection of 100 mg lidocaine. Remifentanil infusion was administered intravenously to a Ramsay sedation score of 2-4. Time to tracheal intubation was recorded by independent assessors. The authors also recorded intubation success on the first attempt, investigators' evaluation of ease of the technique, and patients reported intubation-discomfort evaluated on a visual analog scale. Results Eighty-four patients were eligible for analysis. Time to tracheal intubation was median [interquartile range, IQR] 80 s [IQR 58-117] with FFI and 62 s [IQR 55-109] with MVL (P = 0.17). Intubation success on the first attempt was 79% versus 71% for FFI and MVL, respectively. The median visual analog scale score for ease of intubation was 2 (IQR 1-4) versus 1 (IQR 1-6) for FFI and MVL, respectively. The median visual analog scale score for patients' assessment of discomfort for both techniques was 2, FFI (IQR 0-3), MVL (IQR 0-4). Conclusions The authors found no difference in time to tracheal intubation between awake FFI and awake MVL intubation performed by experienced anesthesiologists in patients with anticipated difficult airway.

Flexor Tendon Sheath as a Source of Pain in Lesser Metatarsal Overload

2009 ◽  
Vol 99 (2) ◽  
pp. 129-134 ◽  
Author(s):  
Hugo R. Perez ◽  
Joshua Roberts
Keyword(s):  
Scale Score ◽  
Visual Analog Scale ◽  
Flexor Tendon ◽  
Metatarsophalangeal Joint ◽  
Visual Analog Scale Score ◽  
Tendon Sheath ◽  
Pain Scale ◽  
Analog Scale ◽  
Scale Scores ◽  
Flexor Tendon Sheath

Background: Lesser metatarsal overload may lead to pathologic conditions ranging from plantar metatarsophalangeal joint pain to dislocation. The flexor tendon sheath lies directly plantar to the joint. The increased pressure associated with lesser metatarsal overload may lead to synovitis and pain of the flexor tendon sheath. Methods: Fifteen consecutive patients with lesser metatarsal overload had visual analog scale scores determined at three metatarsophalangeal joint areas to determine the source of pain. The patients underwent seven maneuvers to determine the pain scale score: single-leg heel raise and palpation of the second and third metatarsophalangeal joints on the plantar proximal, plantar distal, and dorsal aspects. The patients were then injected with 0.5 mL of lidocaine, 2%, into the second and third flexor tendon sheaths, and the maneuvers were repeated. Results: Before the injection, the second metatarsophalangeal joint had a significantly greater visual analog scale score plantar than dorsal (6.9 and 2.6, P ≤ .01). The flexor tendon sheath injection significantly improved all seven pain scale scores. Conclusions: Patients with lesser metatarsal overload experienced significantly greater visual analog scale pain scores on the plantar than the dorsal aspect of the second metatarsophalangeal joint. The scores significantly improved after diagnostic injection in the flexor tendon sheaths. The flexor tendon sheaths are probably involved in patients with primarily plantar pain. (J Am Podiatr Med Assoc 99(2): 129–134, 2009)

scholarly journals Ultrasound-Guided Hydrodilatation With Triamcinolone Acetonide for Adhesive Capsulitis: A Randomized Controlled Trial Comparing the Posterior Glenohumeral Recess and the Rotator Cuff Interval Approaches

2021 ◽  
Vol 12 ◽  
Author(s):  
Jia-Chi Wang ◽  
Po-Yi Tsai ◽  
Po-Cheng Hsu ◽  
Jian-Ru Huang ◽  
Kevin A. Wang ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Rotator Cuff ◽  
Range Of Motion ◽  
Triamcinolone Acetonide ◽  
Shoulder Pain ◽  
Visual Analog Scale ◽  
Controlled Trial ◽  
Adhesive Capsulitis ◽  
Analog Scale ◽  
Randomized Controlled

For patients with adhesive capsulitis, hydrodilatation is typically performed using corticosteroids with ultrasound guidance via the posterior glenohumeral recess. Recently, a new intervention technique via the rotator cuff interval has been described. This study aimed to compare the efficacy of hydrodilatation with triamcinolone acetonide via the posterior glenohumeral recess and the rotator cuff interval in patients with adhesive capsulitis. This prospective randomized controlled trial was conducted in a tertiary care center with a follow-up period of 12 weeks. We enrolled 64 patients diagnosed with shoulder adhesive capsulitis. The subjects were randomly assigned to two groups that received hydrodilatation with corticosteroids either through the posterior glenohumeral recess or though the rotator cuff interval. The injection contained 4 ml of triamcinolone acetonide (40 mg) mixed with 4 ml of 2% lidocaine hydrochloride and 12 ml of normal saline. The shoulder pain and disability index, visual analog scale for pain, and range of motion were analyzed before and at 6 and 12 weeks after the treatment. Both groups experienced improvements in the visual analog scale scores, shoulder pain and disability index scores, and range of motion throughout the study period. A significant group-time interaction was observed in terms of the visual analog scale for pain during motion (p = 0.019), favoring hydrodilatation through the rotator cuff interval. Thus, hydrodilatation through the rotator cuff interval might be a better treatment option than that through the posterior glenohumeral recess for patients with adhesive capsulitis, considering its superior effect in alleviating pain during shoulder movement.

scholarly journals Calidad de vida relacionada con la salud en personas con hipertensión y diabetes mellitus

2021 ◽  
Vol 20 (2) ◽  
pp. 316-344
Author(s):  
Dora Inés Parra ◽  
Luís Alberto López Romero ◽  
Lina María Vera Cala
Keyword(s):  
Quality Of Life ◽  
Diabetes Mellitus ◽  
Type 2 Diabetes ◽  
Visual Analog Scale ◽  
Intervention Group ◽  
Analog Scale ◽  
Calidad De Vida ◽  
Los Grupos

Objetivo: Determinar los factores sociodemográficos y clínicos asociados a la Calidad de Vida relacionada con la salud (CVRS) en personas con hipertensión arterial y diabetes mellitus tipo 2.Métodos: Estudio analítico de corte transversal en una muestra de 184 usuarios de un programa de control de riesgo cardiovascular en Bucaramanga (Colombia). Se utilizó el instrumento EQ-5D-3L para evaluar la calidad de vida. Un modelo de regresión lineal múltiple fue llevado a cabo usando como desenlace la Escala Visual Análoga y como posibles predictores las dimensiones del EQ-5D, ajustando por edad, sexo, grupo de intervención (variable instrumental) y variables clínicas como la patología de base y el control de la misma.Resultados: La mediana de edad fue 63 años, 73,3% mujeres, 88,0% nivel socioeconómico bajo; mediana de Presión Arterial Sistólica de 130 mmHg (116,0-145,0) y de HbA1c 5,7% (5,4-6,2) en la población general, hallándose diferencias estadísticamente significativas entre los grupos de patología. La mediana de la Escala Visual Análoga fue de 80(Q1:59-Q3:95) puntos, sin diferencias estadísticamente significativas entre los grupos de patología. Manifestar dolor/malestar, tener problemas en las actividades cotidianas y el no control de la hipertensión arterial disminuyó la percepción de la calidad de vida relacionada con la salud, en 7,5, 18,1 y 7,3 puntos, respectivamente.Conclusiones: La CVRS, en general, fue alta. Esta fue mayor en las personas con diabetes mellitus tipo 2. Factores relacionados con la funcionalidad y control de la enfermedad fueron asociados con una menor percepción de la CVRS. Objective: To determine the sociodemographic and clinical factors associated with health-related Quality of Life (HRQoL) among people with hypertension and type 2 diabetes mellitus.Methods: Analytical cross-sectional study in a sample of 184 users of a cardiovascular risk control program in Bucaramanga (Colombia). The EQ-5D-3L instrument was used to assess quality of life. A multiple linear regression model was carried out using the Visual Analog Scale as the outcome and the dimensions of the EQ-5D as possible predictors, adjusting for age, sex, intervention group (instrumental variable), and clinical variables such as the disease and its control.Results: The median of age was 63 years, 73.3% women, 88.0% low socioeconomic level; Median Systolic Blood Pressure of 130 mmHg (116.0-145.0) and HbA1c 5.7% (5.4-6.2) in the general population, showing statistically significant differences between the pathology groups. The median of Visual Analog Scale was 80(Q1: 59-Q3: 95) points, with no statistically significant differences between the pathology groups. Manifesting pain/discomfort, problems with usual activities and lack of hypertension control decreased the perception of HRQoL, by 7.5, 18.1 and 7.3 points, respectively.Conclusions: The HRQoL in general was high. It was higher among people with type 2 diabetes mellitus. Factors related to the functionality and control of the disease were associated with a lower perception HRQoL.

Sign in / Sign up

Export Citation Format

Share Document