AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodol...AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.展开更多
The purpose of this study was to examine the combined effects of knee extension strength (KES), visual acuity (VA), and knee joint pain (KP) on gait in 212 older women. Including, walking speed, cadence, were selected...The purpose of this study was to examine the combined effects of knee extension strength (KES), visual acuity (VA), and knee joint pain (KP) on gait in 212 older women. Including, walking speed, cadence, were selected as gait parameters. Knee extension strength was measured by isometric knee extension strength, while knee joint pain and decreased visual acuity were evaluated by subjective judgment. The combine effect of KP and KES factors was examined. Stance time was significantly longer in persons with both-KP than in persons with no KP. In addition, people with superior KES had significantly greater values in walking speed, cadence, and step length, and lower values in stance time and walking angle than those with inferior KES. Furthermore, double support time showed that persons with both-KP have significantly greater values than persons with no or one-KP in the inferior KES group. Also, persons with the inferior KES had significantly greater values in persons with both-KP. The combine effect of KES and VA factors was examined. There are significant differences between the superior and the inferior KES groups. In conclusion, the elderly with both the factors of decreasing KES and both-KP, as compared to the elderly with just one of those factors, have markedly different gait properties.展开更多
Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pa...Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points;p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint.展开更多
The zygapophysial joints(z-joints), together with the intervertebral disc, form a functional spine unit. The joints are typical synovial joints with an innervation from two medial branches of the dorsal rami. The join...The zygapophysial joints(z-joints), together with the intervertebral disc, form a functional spine unit. The joints are typical synovial joints with an innervation from two medial branches of the dorsal rami. The joint capsule and the surrounding structures have an extensive nerve supply. The stretching of the capsule and loads being transmitted through the joint can causepain. The importance of the z-joints as a pain generator is often underestimated because the prevalence of z-joint pain(10%-80%) is difficult to specify. Z-joint pain is a somatic referred pain. Morning stiffness and pain when moving from a sitting to a standing position are typical. No historic or physical examination variables exist to identify z-joint pain. Also, radiologic findings do not have a diagnostic value for pain from z-joints. The method with the best acceptance for diagnosing z-joint pain is controlled medial branch blocks(MBBs). They are the most validated of all spinal interventions, although false-positive and false-negative results exist and the degree of pain relief after MBBs remains contentious. The prevalence of z-joint pain increases with age, and it often comes along with other pain sources. Degenerative changes are commonly found. Z-joints are often affected by osteoarthritis and inflammatory processes. Often additional factors including synovial cysts, spondylolisthesis, spinal canal stenosis, and injuries are present. The only truly validated treatment is medial branch neurotomy. The available technique vindicates the use of radiofrequency neurotomy provided that the correct technique is used and patients are selected rigorously using controlled blocks.展开更多
Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of D...Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.展开更多
BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence,mortality,and onset of disability.As a neurodevelopmental therapy,neuromuscular joint facilitation(NJF)is widely used in the treatment of ort...BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence,mortality,and onset of disability.As a neurodevelopmental therapy,neuromuscular joint facilitation(NJF)is widely used in the treatment of orthopedic and neurological disorders in the clinical practice.It is mainly used for central nervous system diseases or orthopedic diseases,movement disorders,and pain rehabilitation.According to related studies,NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain(HSP).AIM To investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.METHODS Forty patients with HSP were randomly divided into a treatment group and a control group.The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone.All patients were assessed by using the visual analogue scale(VAS),Fugl-Meyer assessment(FMA),Barthel index(BI),and passive range of motion(PROM)before and after the training.All the clinical data were analyzed using SPSS 20.0 statistical software.RESULTS There was no statistical difference in the general characteristics between the two groups.In the terms of duration of treatment,age,and pre-treatment indicators,the two groups were comparable(P>0.05).After the treatment,VAS,PROM,BI,and FMA scores were significantly improved in the two groups of patients(P<0.05).The VAS,PROM and FMA scores were significantly higher in the treatment group than in the control group(P<0.05).However,there was no significant difference in BI scores between the two groups(P>0.05).CONCLUSION Both acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective,and can improve the clinical symptoms of patients.Acupuncture combined with NJF can improve the upper limb motor function,relieve pain,and increase joint mobility in patients with HSP.The combination therapy is better than acupuncture alone.However,there is no significant difference in improving the score of patients’self-care ability.展开更多
AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Pa...AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = 0.015.CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.展开更多
Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of os...Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.展开更多
This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified int...This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified into three groups: those without knee pain or a knee disorder, those with knee pain, and those with a knee disorder. The subjects took a knee extension strength test and an ADL survey. Knee extension strength and ADL scores (total score and each domain score of the motions of locomotion, posture change, stability, and manipulation) were selected as the evaluation parameters. The knee extension strength, total ADL score and each domain score of the motions of locomotion, posture change, and stability ranged from low to high in the following order: the group with a knee disorder, the group with knee pain, and the group without pain or a knee disorder. Moreover, manipulation scores were significantly inferior in the group with a knee disorder compared with the other two groups. In conclusion, the female elderly with knee pain or a knee disorder have inferior knee extension strength and ADL with respect to the motions of locomotion, posture change and stability. In addition, with regard toknee extension strength with respect to theabove three motions, the elderly with a knee disorder have inferior scores when compared with the elderly who have only knee pain;thus, they find it difficult to perform activities involving the knee joints.展开更多
We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or w...We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.展开更多
Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent p...Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent primary total knee arthroplasty were included in the study. Patients having “cruciate retaining total knee arthroplasty” and with a change of the joint line ≥8 mm and patients having “posterior stabilized total knee arthroplasty” and with a change of the joint line ≥5 mm were selected as the study group (group 1, n = 32). A total of 47 patients having similar demographic characteristics with the study group and the joint line changing below the predetermined level or remaining unchanged were included as the control group (group 2). The 2 groups were compared according to the presence of knee pain, the localization and spread of the pain, iliotibial band, tension and pain in the patellar tendon and quadriceps tendon, front knee pain during squatting, VAS pain score, OBER test positivity, Knee Society knee and function score, and general patient satisfaction. Results: There were statistically significant more lateral knee pain (p < 0.001), OBER test positivity (p < 0.001) and iliotibial band tension (p < 0.001) in group 1 compared to group 2. However, there were no statistically significant differences between the 2 groups regarding rest pain (p = 0.855), pain during squatting (p = 0.761), exertional pain (p = 0.322), pain in the patellar tendon (p = 0.643) and quadriceps tendon (p = 0.873), Knee Society knee (p = 0.954) and function (p = 0.955) scores, and general satisfaction (p = 0.968). Conclusion: In total knee prosthesis operations, distal displacement of the joint line can result in lateral knee pain and iliotibial band tension. However, considering the results of total knee arthroplasty our findings have showed that this condition has no effect on knee functions and patient satisfaction.展开更多
Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptom...Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.展开更多
目的观察浮针疗法治疗早中期膝骨关节炎对关节软骨厚度的影响。方法将60例早中期膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组采用浮针治疗,对照组采用电针治疗。观察两组治疗前后疼痛视觉模拟量表(visual analog scale,VAS...目的观察浮针疗法治疗早中期膝骨关节炎对关节软骨厚度的影响。方法将60例早中期膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组采用浮针治疗,对照组采用电针治疗。观察两组治疗前后疼痛视觉模拟量表(visual analog scale,VAS)评分、疼痛开始缓解时间、Lysholm膝关节功能评分、平衡功能及股骨内侧和外侧髁软骨厚度的变化。结果治疗组疼痛开始缓解时间短于对照组(P<0.05)。治疗后,两组VAS评分以及平衡功能的横向标准差和前后标准差均较治疗前降低(P<0.05),Lysholm膝关节功能评分、平衡功能的稳定极限均较治疗前升高(P<0.05)。治疗后3个月,两组VAS评分较治疗前降低(P<0.05),Lysholm膝关节功能评分较治疗前升高(P<0.05),膝关节内外侧髁软骨厚度均较治疗前增加(P<0.05)。治疗后和治疗后3个月,治疗组VAS评分均低于对照组(P<0.05),Lysholm膝关节功能评分均高于对照组(P<0.05)。治疗后,治疗组横向标准差低于对照组(P<0.05),稳定极限高于对照组(P<0.05)。结论浮针治疗早中期膝骨关节炎起效速度优于电针治疗,能有效缓解疼痛症状及提高膝关节功能,可改善软骨损伤。展开更多
文摘AIM: To investigate the diagnostic validity and therapeutic value of lumbar facet joint interventions in managing chronic low back pain.METHODS: The review process applied systematic evidence-based assessment methodology of controlled trials of diagnostic validity and randomized controlled trials of therapeutic efficacy. Inclusion criteria encompassed all facet joint interventions performed in a controlled fashion. The pain relief of greater than 50% was the outcome measure for diagnostic accuracy assessment of the controlled studies with ability to perform previously painful movements, whereas, for randomized controlled therapeutic efficacy studies, the primary outcome was significant pain relief and the secondary outcome was a positive change in functional status. For the inclusion of the diagnostic controlled studies, all studies must have utilized either placebo controlled facet joint blocks or comparative local anesthetic blocks. In assessing therapeutic interventions, short-term and long-term reliefs were defined as either up to 6 mo or greater than 6 mo of relief. The literature search was extensive utilizing various types of electronic search media including Pub Med from 1966 onwards, Cochrane library, National Guideline Clearinghouse, clinicaltrials.gov, along with other sources includingprevious systematic reviews, non-indexed journals, and abstracts until March 2015. Each manuscript included in the assessment was assessed for methodologic quality or risk of bias assessment utilizing the Quality Appraisal of Reliability Studies checklist for diagnostic interventions, and Cochrane review criteria and the Interventional Pain Management Techniques- Quality Appraisal of Reliability and Risk of Bias Assessment tool for therapeutic interventions. Evidence based on the review of the systematic assessment of controlled studies was graded utilizing a modified schema of qualitative evidence with best evidence synthesis, variable from level Ⅰ to level Ⅴ.RESULTS: Across all databases, 16 high quality diagnostic accuracy studies were identified. In addition, multiple studies assessed the influence of multiple factors on diagnostic validity. In contrast to diagnostic validity studies, therapeutic efficacy trials were limited to a total of 14 randomized controlled trials, assessing the efficacy of intraarticular injections, facet or zygapophysial joint nerve blocks, and radiofrequency neurotomy of the innervation of the facet joints. The evidence for the diagnostic validity of lumbar facet joint nerve blocks with at least 75% pain relief with ability to perform previously painful movements was level Ⅰ, based on a range of level Ⅰ to Ⅴ derived from a best evidence synthesis. For therapeutic interventions, the evidence was variable from level Ⅱ to Ⅲ, with level Ⅱ evidence for lumbar facet joint nerve blocks and radiofrequency neurotomy for long-term improvement(greater than 6 mo), and level Ⅲ evidence for lumbosacral zygapophysial joint injections for short-term improvement only.CONCLUSION: This review provides significant evidence for the diagnostic validity of facet joint nerve blocks, and moderate evidence for therapeutic radiofrequency neurotomy and therapeutic facet joint nerve blocks in managing chronic low back pain.
文摘The purpose of this study was to examine the combined effects of knee extension strength (KES), visual acuity (VA), and knee joint pain (KP) on gait in 212 older women. Including, walking speed, cadence, were selected as gait parameters. Knee extension strength was measured by isometric knee extension strength, while knee joint pain and decreased visual acuity were evaluated by subjective judgment. The combine effect of KP and KES factors was examined. Stance time was significantly longer in persons with both-KP than in persons with no KP. In addition, people with superior KES had significantly greater values in walking speed, cadence, and step length, and lower values in stance time and walking angle than those with inferior KES. Furthermore, double support time showed that persons with both-KP have significantly greater values than persons with no or one-KP in the inferior KES group. Also, persons with the inferior KES had significantly greater values in persons with both-KP. The combine effect of KES and VA factors was examined. There are significant differences between the superior and the inferior KES groups. In conclusion, the elderly with both the factors of decreasing KES and both-KP, as compared to the elderly with just one of those factors, have markedly different gait properties.
文摘Background: The sacroiliac joint (SIJ) is an important cause of chronic low back pain, implicated in 15% - 30% of all cases. While radiofrequency neurotomy (RFN) is the interventional treatment of choice for spinal pain originating from the facet joints, fewer studies have investigated its potential for treating SIJ pain, and its long-term efficacy is unknown. Objectives: To obtain a real-world view of RFN treatment outcomes for SIJ pain by conducting an observational study within a community pain practice, among a heterogeneous patient group receiving standard-of-care diagnostic workup and treatment. Study Design: A prospective, observational study, with data collection over five years, was conducted at the authors' private practice. Patients & Methods: A cohort of 215 patients underwent fluoroscopically guided SIJ RFN of the dorsal and lateral branches of S1-S3 and the descending branch of L5. All patients had previously had their diagnosis of SIJ pain confirmed by controlled comparative analgesic blocks of relevant nerves, and recorded pre-procedure pain levels on the 11-point Numerical Rating Scale (NRS). Outcome measures included pain, and a Likert scale to measure alterations to analgesic use, changes to paid employment status and patient satisfaction. Results: We demonstrate an average pain reduction of 2.3 ± 2.1 NRS points following RFN (baseline pain score of 6.9 ± 1.7 to a follow-up average of 4.6 ± 2.7 NRS points;p ≤ 0.01). At a mean follow-up period of 14.9 ± 10.9 months (range 6 - 49 months), an overall 42.2% of patients reduced their analgesic use. Of the patients for whom employment capacity was applicable (82 patients), 21 patients reported an improvement. Overall, 67% of patients were satisfied with their outcome of post-RFN treatment. No complications occurred. Limitations: This observational study had no independent control group and only included a single study site. Conclusions: RFN is a safe and effective treatment for pain confirmed to originate from the sacroiliac joint.
文摘The zygapophysial joints(z-joints), together with the intervertebral disc, form a functional spine unit. The joints are typical synovial joints with an innervation from two medial branches of the dorsal rami. The joint capsule and the surrounding structures have an extensive nerve supply. The stretching of the capsule and loads being transmitted through the joint can causepain. The importance of the z-joints as a pain generator is often underestimated because the prevalence of z-joint pain(10%-80%) is difficult to specify. Z-joint pain is a somatic referred pain. Morning stiffness and pain when moving from a sitting to a standing position are typical. No historic or physical examination variables exist to identify z-joint pain. Also, radiologic findings do not have a diagnostic value for pain from z-joints. The method with the best acceptance for diagnosing z-joint pain is controlled medial branch blocks(MBBs). They are the most validated of all spinal interventions, although false-positive and false-negative results exist and the degree of pain relief after MBBs remains contentious. The prevalence of z-joint pain increases with age, and it often comes along with other pain sources. Degenerative changes are commonly found. Z-joints are often affected by osteoarthritis and inflammatory processes. Often additional factors including synovial cysts, spondylolisthesis, spinal canal stenosis, and injuries are present. The only truly validated treatment is medial branch neurotomy. The available technique vindicates the use of radiofrequency neurotomy provided that the correct technique is used and patients are selected rigorously using controlled blocks.
基金supported by the Washington University Institute of Clinical and Translational Sciences (No. UL1 TR000448) (Schmidt)the National Center for Advancing Translational Sciences (No. TLl TR000449) (Schmidt)+1 种基金the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development, and National Institute of Neurological Disorders and Stroke (No. K23 HD067343,K12 HD055931) (Harris-Hayes)the National Center for Medical Rehabilitation Research, National Institute of Child Health and Human Development (No. R15HD059080)
文摘Background:Dynamic knee valgus(DKV)is an abnormal movement pattern visually characterized by excessive medial movement of the lower extremity during weight bearing.Differences in hip and knee kinematic components of DKV may explain the emergence of different pain problems in people who exhibit the same observed movement impairment.Using a secondary analysis of exiting data sets,we sought to determine whether hip and knee frontal and transverse plane angles during a functional task differed between women with patellofemoral pain and women with chronic hip joint pain and the relationship between joint-specific kinematics and pain in these 2 pain populations.Methods:In the original studies,3-dimensional hip and knee kinematics during a single-limb squat were obtained in 20 women with patellofemoral pain and 14 women with chronic hip joint pain who demonstrated visually classified DKV.Pain intensity during the squat was assessed in both groups.For the secondary analysis,kinematic data were compared between pain groups using their respective control groups as a reference.Within each pain group,correlation coefficients were used to determine the relationship between kinematics and pain during the squat.Results:Hip adduction and contralateral pelvic drop were greater in those with chronic hip joint pain compared to those with patellofemoral pain(effect sizes ≥0.40).Greater knee external rotation(r= 0.47,p= 0.04)was correlated with greater knee pain in those with patellofemoral pain,while greater hip adduction(r = 0.53,p = 0.05)and greater hip internal rotation(r = 0.55,p = 0.04)were correlated with greater hip pain in those with chronic hip joint pain.Conclusion:Hip frontal plane motion was greater in those with chronic hip joint pain compared to those with patellofemoral pain.In both groups,greater abnormal movement at the respective joint(e.g.,knee external rotation in the patellofemoral pain group and hip adduction and internal rotation in the chronic hip joint pain group)was associated with greater pain at that joint during a single-limb squat.
文摘BACKGROUND Stroke is a type of cerebrovascular disease with high prevalence,mortality,and onset of disability.As a neurodevelopmental therapy,neuromuscular joint facilitation(NJF)is widely used in the treatment of orthopedic and neurological disorders in the clinical practice.It is mainly used for central nervous system diseases or orthopedic diseases,movement disorders,and pain rehabilitation.According to related studies,NJF can also be used as a rehabilitation treatment in patients with hemiplegic shoulder pain(HSP).AIM To investigate the clinical efficacy of acupuncture combined with NJF in patients with HSP.METHODS Forty patients with HSP were randomly divided into a treatment group and a control group.The treatment group was treated with acupuncture combined with NJF and the control group was treated with acupuncture alone.All patients were assessed by using the visual analogue scale(VAS),Fugl-Meyer assessment(FMA),Barthel index(BI),and passive range of motion(PROM)before and after the training.All the clinical data were analyzed using SPSS 20.0 statistical software.RESULTS There was no statistical difference in the general characteristics between the two groups.In the terms of duration of treatment,age,and pre-treatment indicators,the two groups were comparable(P>0.05).After the treatment,VAS,PROM,BI,and FMA scores were significantly improved in the two groups of patients(P<0.05).The VAS,PROM and FMA scores were significantly higher in the treatment group than in the control group(P<0.05).However,there was no significant difference in BI scores between the two groups(P>0.05).CONCLUSION Both acupuncture alone and acupuncture combined with NJF in the treatment of HSP are effective,and can improve the clinical symptoms of patients.Acupuncture combined with NJF can improve the upper limb motor function,relieve pain,and increase joint mobility in patients with HSP.The combination therapy is better than acupuncture alone.However,there is no significant difference in improving the score of patients’self-care ability.
基金Supported by PhD studentship awarded by the University of Nottingham(to Warner SC)EULAR project grant to AMV,No.108239ARUK Pain Centre,No.18769
文摘AIM To investigate a comprehensive range of factors that contribute to long-term patient satisfaction post-total joint replacement(TJR) in people who had undergone knee or hip replacement for osteoarthritis.METHODS Participants(n = 1151) were recruited from Nottinghamshire post-total hip or knee replacement. Questionnaire assessment included medication use, the pain-DETECT questionnaire(PDQ) to assess neuropathic pain-like symptoms(NP) and TJR satisfaction measured on average 4.8 years post-TJR. Individual factors were tested for an association with post-TJR satisfaction, before incorporating all factors into a full model. Data reduction was carried out using LASSO and receiveroperator characteristic(ROC) curve analysis was used to quantify the contribution of variables to post-TJR satisfaction.RESULTS After data reduction, the best fitting model for post-TJR satisfaction included various measures of pain, history of revision surgery, smoking, pre-surgical X-ray severity, WOMAC function scores and various comorbidities. ROC analysis of this model gave AUC = 0.83(95%CI: 0.80-0.85). PDQ scores were found to capture much of the variation in post-TJR satisfaction outcomes: AUC = 0.79(0.75-0.82). Pre-surgical radiographic severity was associated with higher post-TJR satisfaction: OR_(satisfied) = 2.06(95%CI: 1.15-3.69), P = 0.015.CONCLUSION These results highlight the importance of pre-surgical radiographic severity, post-TJR function, analgesic medication use and NP in terms of post-TJR satisfaction. The PDQ appears to be a useful tool in capturing factors that contribute to post-TJR satisfaction.
文摘Hip joint osteoarthritis, a widespread disabling disease with no known cause, produces considerable bouts of intractable pain as a result of multiple disease associated problems. This paper examines some sources of osteoarthritic hip joint pain, a poorly understood topic at best. Presented in three parts are data retrieved from several sources, including animal models. It is concluded that to improve the effectiveness of treatments designed to minimize hip osteoarthritis pain, a better understanding of the diverse origins of hip joint pain, and hip joint neurology, may permit the development of more precise as well as targeted pain strategies.
文摘This study aimed at examining the differences in leg strength and activities of daily living (ADL) ability among groups with various knee problems. The subjects consisted of 328 elderly females who were classified into three groups: those without knee pain or a knee disorder, those with knee pain, and those with a knee disorder. The subjects took a knee extension strength test and an ADL survey. Knee extension strength and ADL scores (total score and each domain score of the motions of locomotion, posture change, stability, and manipulation) were selected as the evaluation parameters. The knee extension strength, total ADL score and each domain score of the motions of locomotion, posture change, and stability ranged from low to high in the following order: the group with a knee disorder, the group with knee pain, and the group without pain or a knee disorder. Moreover, manipulation scores were significantly inferior in the group with a knee disorder compared with the other two groups. In conclusion, the female elderly with knee pain or a knee disorder have inferior knee extension strength and ADL with respect to the motions of locomotion, posture change and stability. In addition, with regard toknee extension strength with respect to theabove three motions, the elderly with a knee disorder have inferior scores when compared with the elderly who have only knee pain;thus, they find it difficult to perform activities involving the knee joints.
文摘We present the case of a 60 yrs old male who, following a routine, uneventful, fluoroscopically guided L5/S1 facet joint rhizolysis and sacro-iliac joint (SIJ) injection developed an unexpected inability to stand or walk, a condition known as astasia-abasia. Initial concern had been that this neurological phenomenon was as a result of complications of his chronic pain intervention. Despite an essentially normal neurological examination and dedicated battery of neurological imaging and special testing, no cause was identified. Over a 7-day period of in-patient admission and physical rehabilitation symptoms resolved entirely. In the course of the workup for this episode, it was suggested that the phenomenon was the result of a side effect of dexamfetamine, an agent that had been prescribed for the patient by his neurologist for treatment of his narcolepsy. On the back of this episode, this treatment was discontinued by his neurologist following an outpatient consultation. Subsequent repeated SIJ injections were entirely uneventful and the patient experienced no further occurrences of this phenomenon.
文摘Aim: In this study, the relationship between the change in the joint line and lateral knee pain was evaluated after primary total knee arthroplasty. Material and method: Between 2005 and 2012, patients who underwent primary total knee arthroplasty were included in the study. Patients having “cruciate retaining total knee arthroplasty” and with a change of the joint line ≥8 mm and patients having “posterior stabilized total knee arthroplasty” and with a change of the joint line ≥5 mm were selected as the study group (group 1, n = 32). A total of 47 patients having similar demographic characteristics with the study group and the joint line changing below the predetermined level or remaining unchanged were included as the control group (group 2). The 2 groups were compared according to the presence of knee pain, the localization and spread of the pain, iliotibial band, tension and pain in the patellar tendon and quadriceps tendon, front knee pain during squatting, VAS pain score, OBER test positivity, Knee Society knee and function score, and general patient satisfaction. Results: There were statistically significant more lateral knee pain (p < 0.001), OBER test positivity (p < 0.001) and iliotibial band tension (p < 0.001) in group 1 compared to group 2. However, there were no statistically significant differences between the 2 groups regarding rest pain (p = 0.855), pain during squatting (p = 0.761), exertional pain (p = 0.322), pain in the patellar tendon (p = 0.643) and quadriceps tendon (p = 0.873), Knee Society knee (p = 0.954) and function (p = 0.955) scores, and general satisfaction (p = 0.968). Conclusion: In total knee prosthesis operations, distal displacement of the joint line can result in lateral knee pain and iliotibial band tension. However, considering the results of total knee arthroplasty our findings have showed that this condition has no effect on knee functions and patient satisfaction.
文摘Lumbar synovial cysts are benign fluid collections thought to form in a background of facet joint degeneration, allowing for fluid to leak from the joint capsule and form cysts in the synovium. Although often asymptomatic, patients with symptomatic synovial cysts will present with low back pain and possibly an associated radiculopathy. Clinicians can consider conservative management, epidural steroid injection, surgical intervention, or facet joint block with aspiration and rupture. This case describes a 59-year-old male facilities manager with intermittent low back pain for one year with worsening right-sided radicular symptoms secondary to a lumbar facet joint synovial cyst in the context of severe facet arthropathy and microinstability. The patient’s low back pain and radicular symptoms were refractory to conservative treatment. Imaging demonstrated a lumbar synovial cyst and subsequent management included transforaminal epidural steroid injection and facet joint block with cyst aspiration and rupture. The patient’s radicular pain resolved but axial lumbar pain returned after 3 weeks of relief. Follow-up imaging demonstrated decreased cyst size with fluid accumulation and joint space widening. Although the cyst was successfully decompressed with resolution of radicular pain, the underlying facet arthropathy remains contributing to persistent axial low back pain and potential for continued degenerative changes including cyst recurrence.
文摘目的观察浮针疗法治疗早中期膝骨关节炎对关节软骨厚度的影响。方法将60例早中期膝骨关节炎患者随机分为治疗组和对照组,每组30例。治疗组采用浮针治疗,对照组采用电针治疗。观察两组治疗前后疼痛视觉模拟量表(visual analog scale,VAS)评分、疼痛开始缓解时间、Lysholm膝关节功能评分、平衡功能及股骨内侧和外侧髁软骨厚度的变化。结果治疗组疼痛开始缓解时间短于对照组(P<0.05)。治疗后,两组VAS评分以及平衡功能的横向标准差和前后标准差均较治疗前降低(P<0.05),Lysholm膝关节功能评分、平衡功能的稳定极限均较治疗前升高(P<0.05)。治疗后3个月,两组VAS评分较治疗前降低(P<0.05),Lysholm膝关节功能评分较治疗前升高(P<0.05),膝关节内外侧髁软骨厚度均较治疗前增加(P<0.05)。治疗后和治疗后3个月,治疗组VAS评分均低于对照组(P<0.05),Lysholm膝关节功能评分均高于对照组(P<0.05)。治疗后,治疗组横向标准差低于对照组(P<0.05),稳定极限高于对照组(P<0.05)。结论浮针治疗早中期膝骨关节炎起效速度优于电针治疗,能有效缓解疼痛症状及提高膝关节功能,可改善软骨损伤。
文摘背景:腰椎小关节炎是引起下腰痛的一个主要原因,目前主要依靠MRI进行初步定性诊断,但仍有一定漏诊、误诊的概率发生,因此MR T2^(*)mapping成像技术有望成为定量检查腰椎小关节炎软骨损伤的重要检测手段。目的:探讨MR T2^(*)mapping成像技术在定量分析腰椎小关节炎软骨损伤退变中的应用价值。方法:收集南京医科大学第四附属医院2020年4月至2022年3月门诊或住院合并下腰痛共110例患者,设为病例组;同时招募无症状志愿者80例,设为对照组。对所有纳入对象L1-S1的小关节行3.0 T MR扫描,获取T2^(*)mapping横断位图像和T2WI图像,分别对所有小关节软骨进行Weishaupt分级及T2^(*)值测量,收集数据并行统计学分析。不同小关节Weishaupt分级之间小关节软骨T2^(*)值比较采用单因素方差分析。结果与结论:①经统计分析发现,病例组腰椎小关节软骨T2^(*)值(17.6±1.5)ms明显较对照组(21.4±1.3)ms降低,差异有显著性意义(P<0.05);②在病例组中,随着腰椎小关节Weishaupt分级增加,小关节软骨T2^(*)值也呈逐渐下降趋势,且这种差异有显著性意义(P<0.05);③提示T2^(*)mapping能够较好地显示腰椎小关节软骨损伤的早期病理变化,腰椎小关节软骨的T2^(*)值能够定量评估腰椎小关节的软骨损伤程度;T2^(*)mapping成像技术能为影像学诊断腰椎小关节炎软骨早期损伤提供很好的理论依据,具有重要的临床应用价值。
