Musculoskeletal Joint Pain Research Articles

0798 Detriggered - a case of tenosynovitis ameliorated by CPAP

Abstract Introduction The influence of sleep quality and pain is bidirectional (1). Sleep loss can induce hyperalgesia through upregulated inflammatory mediators such as IL-6 and TNF (2, 3). Obstructive sleep apnea (OSA) is characterized by obstructive respiratory events, hypoxemia, sleep fragmentation, and ultimately poor quality sleep. Here we present a case of how the treatment of OSA with continuous positive airway pressure (CPAP) mitigated hand inflammation and trigger finger symptoms. Report of Cases: A 60 year old male with prediabetes, hypertension, and BMI 30 presented to primary care with bilateral finger pain and stiffness. Hand orthopedics noted a tender left A1-pully 4th finger with 20 degree flexion contracture and a palpable right 3rd finger flexor tendon nodule causing definite triggering. He was diagnosed with trigger finger and initially treated with steroid injections and again 5 months later due to persistent symptoms. 10 months after the initial orthopedic visit, orthopedics planned for surgical intervention, but patient missed his surgery for unknown reasons. 7 months later, sleep medicine evaluated the patient for snoring and daytime fatigue. He underwent home sleep apnea testing which revealed a respiratory event index (REI) of 36.7 which necessitated CPAP therapy. Unfortunately, the patient was then lost to follow up in sleep medicine clinic. More than a year later, the patient showed to clinic and found to have 100% CPAP compliance with residual REI of 0.7. He enthusiastically noted improvement of daytime fatigue and trigger finger symptoms when using CPAP. When he would forget to use CPAP at night or during naps, he would wake up with returned finger pain and stiffness. Per patient, the symptoms would then resolve after re-initiation of CPAP. This consistent association of CPAP and finger symptom amelioration continued even 8 months later in most recent follow up. Conclusion To our knowledge, this is the first report of trigger finger symptoms improving with treatment of OSA. One hypothesis is that through improved sleep quality, there is a dampening of chondrocyte proliferation of the retinacular sheath and allowing unrestricted motion of the flexor tendon (4). More studies are needed to evaluate the musculoskeletal benefits of CPAP for OSA. Support (If Any) 1. Haack M. Scott Sutherlandj. Et al. Pain sensitivity and modulation in primary insomnia. Eur J Pain. 2012, 16: 522-533.2. Chhangani BS, Roehrs Ta et al. Pain sensitivity in sleepy pain-free normals. Sleep, 209, 32:1011-1017.3. Li, Joule Sarah Appleton. Association of Musculoskeletal Joint Pain with Obstructive Sleep Apena, Daytime Sleepiness, and Poor Sleep Quality in Men. Arthritis Care and Research Vol 69. No 5. May 2017.4. Makkouk Al Hasan et al. Trigger finger: etology, evaluation, and treatment. Curr Rev Musculoskeltal Med 2008. 1:92-96.

The experiences and beliefs of people with severe haemophilia and healthcare professionals on pain management, and their views of using exercise as an aspect of intervention: a qualitative study

Purpose To explore the experiences, views and beliefs of people with severe haemophilia and healthcare professionals (HCPs) on approaches for pain management, as well as their views on exercise being used as an aspect of management. Methods Taking a qualitative inquiry approach using focus groups and semi-structured interviews, participants included people with severe haemophilia living with chronic pain and haemophilia HCPs. Data were analysed using reflexive thematic analysis. Results Fourteen men with haemophilia with a median age of 47 (range 23–73) and six haemophilia HCPs agreed to participate. Of the people with haemophilia, 11 attended two focus groups and three were interviewed over telephone. Healthcare professionals were interviewed face-to-face. Two themes were conceptualised from the data: (i) haemophilia management and pain management is discordant (imbalance between good haemophilia care but poor pain management, historical medico-social influences on pain management, the need for trust); (ii) uncertain about exercise but clear on what matters (conflicting views on exercise, the need for proof of safety, personalised care). Conclusions Options for effective pain management remain limited and what is used is heavily influenced by beliefs and experience. Exercise as a treatment option in pain management is conceptually acceptable for people with haemophilia. Effective pain management requires understanding of individual beliefs and fears, and a personalised approach supported by knowledgeable, trusted clinicians. Implications for rehabilitation Musculoskeletal joint pain and its relationship with bleeding in people with haemophilia continues to be a management challenge. Current pain management strategies are of limited effectiveness with little evidence of an approach that reflects the multi-modal pain experience. Whilst exercise and rehabilitation approaches are conceptually possible for people with severe haemophilia, barriers remain regarding perception of overall safety and effectiveness. People with severe haemophilia may consider exercise as part of a pain management strategy if it is individualised, and they are supported to do it by clinicians who understand them and their haemophilia.

Prevalence of Musculoskeletal Dysfunction in Clinical Physiotherapist

Objectives : Objectives of this study was to find out musculoskeletal pain or dysfunction in clinical physiotherapist. On the basis of questionnaire rating the scale pain assessment was done. The ratings was graded by work related musculoskeletal disorders (WMSDs) questionnaire. Methodology : There were total 150 subjects , out of which 120 subjects were participates of this study. This was a study of musculoskeletal dysfunction in clinical physiotherapist. Here we evaluated scoring of pain by the work related musculoskeletal disorders (WMSDs) quessionnaire Result : There is various musculoskeletal joint pain present in clinical physiotherapist. Musculoskeletal joint dysfunction more found in males than females. Shoulder joint pain and knee pain is common in clinical physiotherapist due to standing posture. Conclusion : There is prevalence of musculoskeletal dysfunction in clinical physiotherapist.

Challenging Case in Clinical Practice: Use of an Elimination Diet for Resolution of Chronic Musculoskeletal Joint Pain

Abstract Chronic joint or musculoskeletal pain is the leading cause of disability in the United States and worldwide. Current treatment options are limited in their ability to alter disease outcome...

Association of Musculoskeletal Joint Pain With Obstructive Sleep Apnea, Daytime Sleepiness, and Poor Sleep Quality in Men.

To investigate the association of musculoskeletal pain with objectively determined obstructive sleep apnea (OSA) and subjective sleep measures in a population-based sample. Participants were community-dwelling men (n = 360) age ≥35 years from the Men Androgen Inflammation Lifestyle Environment and Stress (MAILES) study. Shoulder, back, hip, knee, hand, and foot pain were assessed by computer-assisted telephone interview or self-completed questionnaire. OSA was determined with full in-home unattended polysomnography (Embletta X100) scored by 2007 American Academy of Sleep Medicine alternative criteria. The Epworth Sleepiness Scale assessed daytime sleepiness and the Pittsburgh Sleep Quality Index assessed sleep quality. OSA was not associated with the presence of any joint pain (adjusted odds ratio [OR] 1.03 [95% confidence interval (95% CI) 0.61-1.76]). There was no association between OSA and pain in any specific joint (shoulder, back, hip, knee, hand, or foot), nor was the number of joints in pain associated with OSA. There was, similarly, no association between pain variables and excessive daytime sleepiness, except for hand pain (OR 3.10 [95% CI 1.50-6.39]). However, pain was associated with poor sleep quality: any pain (OR 2.19 [95% CI 1.25-3.82]), shoulder pain (OR 2.16 [95% CI 1.25-3.75]), back pain (OR 2.24 [95% CI 1.41-3.55]), and foot pain (OR 2.47 [95% CI 1.43-4.26]). The number of painful joints was also associated with poor sleep quality (5-6 joints versus no joints OR 7.34 [95% CI 2.30-23.42]). No association between OSA and pain or between daytime sleepiness and pain was found. Consistent with previous reports, poor sleep quality was associated with musculoskeletal pain in this population sample. The etiologic differences between OSA-related sleep disruption and poor subjective sleep quality require further investigation.

Alterations in neuromuscular function in girls with generalized joint hypermobility

BackgroundGeneralized Joint Hypermobility (GJH) is associated with increased risk of musculoskeletal joint pain. We investigated neuromuscular performance and muscle activation strategy.MethodsGirls with GJH and non-GJH (NGJH) performed isometric knee flexions (90°,110°,130°), and extensions (90°) at 20 % Maximum Voluntary Contraction, and explosive isometric knee flexions while sitting. EMG was recorded from knee flexor and extensor muscles.ResultsEarly rate of torque development was 53 % faster for GJH. Reduced hamstring muscle activation in girls with GJH was found while knee extensor and calf muscle activation did not differ between groups. Flexion-extension and medial-lateral co-activation ratio during flexions were higher for girls with GJH than NGJH girls.ConclusionsGirls with GJH had higher capacity to rapidly generate force than NGJH girls which may reflect motor adaptation to compensate for hypermobility. Higher medial muscle activation indicated higher levels of medial knee joint compression in girls with GJH. Increased flexion-extension co-activation ratios in GJH were explained by decreased agonist drive to the hamstrings.

Efficacy of musculoskeletal injections by primary care providers in the office: a retrospective cohort study

BackgroundMusculoskeletal joint pain of varied etiology can be diagnosed and treated with joint and soft-tissue corticosteroid injections.PurposeThe purpose of our study was to compare patients’ bodily pain and quality of life (QOL), in addition to the procedural benefit and patient satisfaction, before and after musculoskeletal injections in the office setting.Patients and methodsPatients were eligible for recruitment if they were over age 18 and had an injection for musculoskeletal pain from a primary care provider in an office procedural practice. Included in our analysis were knee joint/bursa, trochanteric bursa, and shoulder joint/bursa injection sites. The variables measured were pain, benefit from the injection, QOL physical and mental components, and patient satisfaction. This was a retrospective cohort study approved by the institutional review board.ResultsPatients’ pain was assessed by the patients using a six-point Likert scale (none, very mild, mild, moderate, severe, and very severe). We noted that self-perception of pain decreased from 3.10 (± standard deviation at baseline 0.96) before to 2.36 (± standard deviation after the infection 1.21) (P = 0.0001) after the injection. In terms of the impact on QOL, our patients had a pre-injection physical score of 37.25 ± 8.39 and a mental score at 52.81 ± 8.98. After the injections, the physical score improved to 42.35 ± 9.07 (P = 0.0001) and the mental to 53.54 ± 8.20 (P = 0.0001) for the overall group. Ninety-six percent of the patients reported they were satisfied or extremely satisfied in the procedure clinic.ConclusionIn this study, we found significant pain relief and improved physical QOL in patients undergoing an injection in the knee joint/bursa, shoulder joint/bursa, or trochanteric bursa by primary care providers in the office setting.

Ligament Injury and Healing: A Review of Current Clinical Diagnostics and Therapeutics

Ligament injuries are among the most common causes of musculoskeletal joint pain and disability encountered in primary practice today. Ligament injures create disruptions in the balance between joint mobility and joint stability, causing abnormal force transmission through the joint, which results in damage to other structures in and around the joint. The long-term consequence of nonhealed ligament injury is osteoarthritis, the most common joint disorder in the world today. Ligaments heal through a distinct sequence of cellular events that take place in three consecutive stages: an acute inflammatory phase, a proliferative or regenerative phase, and a tissue remodeling phase. The process can take months to resolve itself, and despite advances in therapeutics, many ligaments do not regain their normal tensile strength. Various diagnostic procedures have been used to determine and assess ligament injury. Traditionally, MRI and X-rays have been the most utilized techniques; however, because ligaments do not show up clearly with these devices, there have been many false positives and negatives reported due to inconclusive or inaccurate readings. Newer technologies, such as ultrasound and digital motion X-ray, are able to provide a more detailed image of a ligament's structure and function. Numerous strategies have been employed over the years attempting to improve ligament healing after injury or surgery. One of the most important of these is based on the understanding that monitoring early resumption of activity can stimulate repair and restoration of function and that prolonging rest may actually delay recovery and adversely affect the tissue's response to repair. Likewise, there is a shift away from the use of steroid injections and nonsteroidal anti- inflammatory medications. Although these compounds have been shown effective in decreasing the inflammation and pain of ligament injuries for up to six to eight weeks, their use has been shown to inhibit the histological, biochemical, and biomechanical properties of ligament healing. For this reason their use is cautioned against in athletes who have ligament injuries. Such products are no longer recommended for chronic soft tissue injuries or for acute ligament injuries, except for the shortest possible time, if at all. Regenerative medicine techniques, such as prolotherapy, have been shown, in both case series and clinical studies, to resolve ligament injuries of the spine and peripheral joints. More research and additional studies are needed to better assess ligament injuries and healing properties.

일개 지역 농부에서 근골격계 통증에 대한 스트레칭 운동의 효과

본 연구는 농작업자에게 스트레칭 운동을 적용하여 근골격계 통증에 대한 개선 효과를 알아보고자 하였다. 연구 대상은 28명의 일개 지역 농촌거주자가 참여하였으며 무작위 추출법에 의해 스트레칭군(n=13, <TEX>$59.67{\pm}4.77$</TEX>세)과 대조군(n=15, <TEX>$61.44{\pm}10.41$</TEX>세)으로 나누었다. 본 연구는 구조화된 설문방식을 이용하였으며, 작업관련 근골격계 질환의 증상을 갖는 신체 6부위에서 통증의 강도와 하루시기 중 통증변화에 따른 통증의 강도를 시각적 상사척도를 이용하여 측정하였다. 스트레칭군에서는 4주 동안 전체 12회의 스트레칭 치료가 실시되었다. 인구통계학적 특성과 통증의 특성에서 두군 간 유의한 차이는 없었다. 스트레칭 적용 4주후, 스트레칭군에서 팔/팔꿈치관절을 제외한 거의 모든 관절부위와 하루 중 통증정도가 치료 전에 비해 그리고 대조군에 비해 각각 유의한 개선효과를 보였다. 따라서 스트레칭은 지역사회 주거 노인 농부에서 근골격계 통증의 조절을 위한 효과적인 중재 방법 중 하나로 생각된다. This study aimed to evaluate the effects of stretching management on musculoskeletal joint pain in community indwelling elderly farmers. The study included 28 residents who lived in a rural community. All participants were assigned randomly to either the stretching group (n=13, <TEX>$59.67{\pm}4.77$</TEX> year-old) or the control group (n=15, <TEX>$61.44{\pm}10.41$</TEX> year-old). Respondents were interviewed by means of a structured questionnaire. Pain severity of 6 body areas caused by symptoms of work-related musculoskeletal disorders and pain severity on day time variations were measured by the visual analogue scale on a self-assessed questionnaire. The stretching group was administered stretching therapy (45 min, 2 sets, warming up and cool down, main exercise; total 19 stretching kinds of subset 5 fields) for 12 times for 4 weeks. There were no significant difference between the two groups in general social and pain characteristics. After 4 weeks of stretching, the stretching group showed significant improvements at almost all joint pain scores except arm/elbow, and day time variation scores of pain compared to both baseline scores, and with control group scores. These results showed that stretching therapy is one of the most useful modalities to manage musculoskeletal pain in community-based elderly farmers.

Sleep position and shoulder pain

The overuse theory for musculoskeletal joint pain cannot explain adequately the occurrence of shoulder pain in those who do not engage in activities that involve repeated and stressful use of the shoulder since the percentage of the painful right shoulders usually does not match the percentage of dominant right arms in such individuals. An alternative hypothesis is presented to propose that shoulder pain is caused by postural immobility in the decubitus or side position during sleep. Prolonged pressure on the shoulder caused by the weight of the thorax can produce enough damage to cause subsequent shoulder pain. In order to test this hypothesis, a preliminary study was carried out to compare the laterality of shoulder pain with the laterality of sleep position. The calculated laterality ratios for sleep position and shoulder pain were found to be strikingly similar, suggesting a causal relationship between the two phenomena. However, the prevalence of shoulder pain in the general population was found to be smaller than the percentage of the time people would spend sleeping in the decubitus position. This discrepancy could be explained by the idea that in order for shoulder pain to develop subjects may have to spend longer times in the same decubitus position before changing to another position than the average person would. Additional evidence from published clinical studies also supports the postural theory of shoulder pain. More studies can be done to test this hypothesis by focusing on the sleep habits of patients with shoulder pain. According to the present hypothesis shoulder pain should for the most part occur on the side that the patient preferred to sleep on before the onset of shoulder pain. The postural theory of shoulder pain provides the possibility for a new and noninvasive method to treat shoulder pain by the modification of posture during sleep.

Pulmonary function, muscle strength and mortality in old age

Numerous reports have linked extremity muscle strength with mortality but the mechanism underlying this association is not known. We used data from 960 older persons without dementia participating in the Rush Memory and Aging Project to test two sequential hypotheses: first, that extremity muscle strength is a surrogate for respiratory muscle strength, and second, that the association of respiratory muscle strength with mortality is mediated by pulmonary function. In a series of proportional hazards models, we first demonstrated that the association of extremity muscle strength with mortality was no longer significant after including a term for respiratory muscle strength, controlling for age, sex, education, and body mass index. Next, the association of respiratory muscle strength with mortality was attenuated by more than 50% and no longer significant after including a term for pulmonary function. The findings were unchanged after controlling for cognitive function, parkinsonian signs, physical frailty, balance, physical activity, possible COPD, use of pulmonary medications, vascular risk factors including smoking, chronic vascular diseases, musculoskeletal joint pain, and history of falls. Overall, these findings suggest that pulmonary function may partially account for the association of muscle strength and mortality.