Significant Improvement In Pain Relief Research Articles

Spinal Cord High-Frequency Stimulation. The Current Experience and Future Directions.

Spinal cord stimulation (SCS) is a neuromodulation technology that has emerged as a valid treatment for chronic intractable neuropathic pain. After conventional tonic SCS, new waveforms of stimulation, like high frequency (HF), have proved that they can provide safe and effective pain relief. In addition, SCS is now being utilized more broadly as a potential treatment for a range of indications, including motor disorders and spasticity. Our study presents a retrospective analysis of 20 patients with heterogenous aetiologies of neuropathic pain treated with HF stimulation, after a standardized protocol in a temporary trial. We observed a significant improvement in pain relief according to comparisons of numerical rating scale (NRS) scores before the procedure, after the clinical trial and at latest follow-up. Two unusual clinical cases were also reported, and the pertinent literature was discussed.

Survivorship of Allologous Structural Bone Graft at a Minimum of 2 Years When Used to Address Significant Glenoid Bone Loss in Revision Shoulder Arthroplasty: A Computed Tomographic and Clinical Review.

This study assesses outcomes in revision shoulder replacements where the glenoid bone loss was managed using a structural allograft (donated femoral head) in combination with a trabecular titanium (TT) implant. We contacted patients who had undergone revision shoulder arthroplasty using the Lima Axioma TT metal-backed glenoid with an allologous bone graft as a composite who were over 2 years since surgery. Patients underwent computerd tomography evaluation, clinical review, and scoring preoperatively, at 6 months and the latest follow-up. Fifteen patients were included with a mean age of 59 (33-76). The average follow-up period was 40.5 months (24-51). 80% showed satisfactory bone graft incorporation and peg integration at the latest follow-up. Three had signs of significant bone graft resorption, although in 2 patients the pegs were still soundly fixed in the host bone. Clinically all patients showed a statistically significant improvement in pain relief, movement, and function. No unusual complications were reported. Results show femoral head structural allograft in combination with TT metal-backed glenoid baseplate is a viable option for revision total shoulder replacement in the context of massive glenoid bone loss. We do, however, acknowledge that this resorption rate is higher than in other reported series where autograft is used.

Outcomes of arthroscopic-assisted middle trapezius tendon transfer for isolated irreparable supraspinatus tendon tears: minimum 2-year follow-up.

Middle trapezius tendon (MTT) transfer has been proposed as a feasible option for managing isolated irreparable supraspinatus tears (IISTTs). However, no clinical study has been attempted. This study aimed to evaluate clinical and radiologic outcomes of arthroscopic-assisted MTT transfer in patients with IISTTs. This retrospective study included patients who underwent arthroscopic-assisted MTT transfer using fascia lata autograft for IISTTs. Clinical outcomes, including pain visual analog scale (VAS), Constant, American Shoulder and Elbow Society (ASES), University of California Los Angeles (UCLA) shoulder scores and active range of motion (aROM), were assessed. Radiographic analyses included the acromiohumeral distance (AHD), Hamada grade, and transferred tendon integrity at the final follow-up. Twenty-two patients (mean age: 63.3 ± 6.8 [51‒74] years; mean follow-up period: 28.9 ± 4.9 [24‒44] months) met the study criteria. The mean VAS, Constant, ASES, and UCLA scores improved postoperatively at the final follow-up (p < 0.001). The mean aROMs for forward flexion and abduction were significantly increased postoperatively. No significant changes of AHD (p = 0.105) and Hamada grade (p = 0.815) were observed postoperatively. One patient had a re-tear of the transferred tendon at the footprint site at the final follow-up. In this minimum 2-year follow-up study of the novel aMTT transfer using fascia lata autograft, we found significant improvement in pain relief, clinical scores, and active forward flexion and abduction. Additionally, no significant progression of cuff tear arthropathy was observed at the final follow-up. Therefore, aMTT transfer could be a promising treatment option for patients with IISTTs. However, further multicenter and long-term trials are needed to verify its effectiveness. Retrospective case series, level IV.

Total Wrist Arthroplasty with Integra Freedom® Implants: A Pilot Study with a New Evaluation System.

Recent innovations in wrist arthroplasty implants have led to remarkable improvements in terms of results with improved stability and preservation of bone stock. Despite the advances in such implants, poor outcomes and frequent complications still affect this procedure, not allowing a wider use of this treatment in wrist arthritis.The purpose of this study is to assess the preliminary mid-term results of a Wrist Arthroplasty System (Freedom®, Integra Lifesciences, Princeton, USA) in patients with rheumatoid arthritis or secondary osteoarthritis of the wrist and to propose a new classification system. We examined 12 patients (7 with rheumatoid arthritis and 5 with secondary osteoarthritis of the wrist) who underwent total wrist arthroplasties performed by a single surgeon using the fourth-generation prosthesis. Pre- and post-operative pain on a visual analogue score, functional parameters measured with Mayo Wrist score, patient-rated wrist evaluation score, range of motion, and radiographic analysis were collected. At a mean follow-up of 48 (SD 16.9) months a significant improvement (p < 0.0001) of the mean visual analogue, Mayo and PRWE scores following total wrist arthroplasty was observed. Wrist movements improved significantly (p < 0.001). We achieved significant improvements in pain relief, performance, and satisfaction both in rheumatic and non-rheumatic patients, confirmed by our scoring system. Level IV, case series.

Clinical benefits of music‐based interventions on preterm infants' health: A systematic review of randomised trials

This systematic review aimed to differentiate and isolate the results of different music-based interventions used with preterm infants in the neonatal intensive care unit and explore their clinical benefits. The last search was performed on 5July 2021 on Web of Science, Scopus, EMBASE, PsycINFO, CINAHL, LILACS and CENTRAL. Only randomised clinical trials that explored the health benefits of music-based interventions were considered. A total of 39studies were included. All music-based interventions were divided into music medicine and music therapy. The overall results suggested that music medicine interventions were associated with a significant improvement in pain relief; in turn, improvements in cardiac and respiratory function, weight gain, eating behaviour, and quiet alert and sleep states were more consistent in studies that followed a music therapy approach with the presence of a music therapist. This review supports the beneficial effects of music-based interventions on the health of preterm infants in a neonatal intensive care unit; however, it also offers suggestions for future studies in order to increase the number of interventions with music therapists, since the results of music therapy approaches were more consistent for physiological and behavioural outcomes.

Single intra-articular injection with or without intra-osseous injections of platelet-rich plasma in the treatment of osteoarthritis knee: A single-blind, randomized clinical trial

BackgroundSubchondral bony structure damage plays an essential role in the pathogenesis of osteoarthritis (OA) knee. An intra-articular injection cannot reach the damaged subchondral bony structure and treat its pathologies effectively. The objective of the study was to compare the clinical effects of single intra-articular injection with or without intra-osseous injections of PRP in the treatment of osteoarthritis (OA) knee. MethodsThis was a single-blind, parallel-group, randomized clinical trial. Fifty patients, with OA knee (K&L grade III), with ages between 50 and 65 years, were randomly allocated into ‘intra-osseous, intra-articular PRP’ (‘IO+IA-PRP’) (n = 25) or ‘intra-articular PRP’ group (‘IA-PRP’) (n = 25). Patients in the ‘IO+IA-PRP’ group received 18 ml PRP injection, and the ‘IA-PRP’ group received 8 ml PRP injection. Intra-osseous injections were given at the tibial plateau (5 ml) and femoral condyle (5 ml), along with intra-articular knee injection (8 ml), under fluoroscopic guidance. Outcomes were measured using VAS-pain, the knee injury and osteoarthritis outcome score (KOOS), and the treatment satisfaction scale. All patients (n = 50) were followed up till six months. ResultsThe mean age was 57.12(4.27) years and 57.00(4.96) years in the ‘IO+IA-PRP’ and ‘IA-PRP’ groups. Both groups showed significant improvement in pain relief (VAS pain) and KOOS parameters: pain, symptoms, ADL function, sport and recreation function, and quality of life. Compared to the ‘IA-PRP’ group, the ‘IO+IA-PRP’ group showed a greater reduction of VAS pain at six months. However, no significant difference was obtained in VAS pain-relief between these two groups (p = 0.422) at six months. Similarly, at 6 months, in inter-group comparison, except ‘sport and recreation function’ (p < 0.05), no significant differences were obtained in mean-scores of KOOS parameters: pain (p = 0.514); symptom (p = 0.148), ADL-function (p = 0.991), QoL-(p = 0.376). Patients in the ‘IO+IA-PRP’ group complained of significant ‘injection-associated’ adverse events and consumed a greater number of Acetaphenomen. ConclusionsBoth groups showed significant improvement following the intervention. Intra-osseous PRP injections did not provide any additional benefit over intra-articular PRP injection until six months regarding pain relief and functional improvement.

CLINICAL AND FUNCTIONAL ANALYSIS AFTER TOTAL KNEE ARTHROPLASTY.

ABSTRACTOsteoarthritis is a major cause of disability worldwide. Objective: To evaluate the effects of Total Knee Arthroplasty of subjects with knee osteoarthritis by the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC ). Methods: Prospective, non-randomized study with convenience sampling. We included subjects with knee osteoarthritis with indication for surgical treatment. We used WOMAC to evaluate the level of pain, joint stiffness, physical activity, and quality of life in the preoperative and postoperative phase six months after unilateral surgery. We compared WOMAC to the factors age, gender, Body Mass Index and the type of angular deformity of the knee. Results: In total, we analyzed 58 patients with significant improvements in pain relief, joint stiffness, level of physical activity, and quality of life six months after total knee arthroplasty according to WOMAC. Conclusion: Total knee arthroplasty showed positive effects on the quality of life of patients with knee osteoarthritis. Level of Evidence II, Cohort Study.

Elevated Body Mass Index Does Not Adversely Influence the Outcomes of Arthroscopic Treatment for Osteochondral Lesions of the Talus

Category:Ankle; Arthroscopy; Hindfoot; TraumaIntroduction/Purpose:Osteochondral lesion of the talus (OLTs) is a common condition found in patients with chronic ankle pain after previous ankle sprains. Conservative measures such as analgesics, activity modification and immobilisation of the affected ankle are usually applied as first line treatments. Surgical management are indicated after conservative management have failed. This study evaluates the influence of body mass index (BMI) on the early clinical outcomes of arthroscopic debridement and microfracture of OLTs.Methods:An IRB approved study was conducted between 2007 and 2017. A total of 252 patients with symptomatic OLTs who failed conservative management underwent arthroscopic debridement and microfracture of OLTs over the affected ankle. Postoperatively, all patients underwent a standardised postoperative rehabilitation protocol. Patients who underwent previous fractures, previous infections or associated ligamentous injury of the affected ankle were excluded from this study. Patients from this cohort were divided into two groups based on BMI. The normal BMI group (NB-Group) (BMI 18.5-25.0kg/m2) and raised BMI group (RB-Group) (BMI >=25kg/m2). Visual Analogue Score (VAS), American Orthopaedic Foot & Ankle Society (AOFAS) Hindfoot Score as well as the Physical and Mental Components of the Short-Form 36 Questionnaire (PCS and MCS respectively) were prospectively collected from these cohort during their standard postoperative outpatient follow up.Results:A total of 252 patients were reviewed. Patients from either group were otherwise well matched demographically (Table 1). The operative duration was significantly shorter for NB-Group compared to RB-Group. Patients from both groups had significant improvement VAS, AOFAS and PCS scores postoperatively at 6 months and 24 months after surgery (Table 2).Between both groups, patients had comparable VAS, AOFAS as well as PCS scores at preoperative, 6 months postoperative and 24 months postoperatively (p > 0.05). However, MCS in the RB-Group showed a gradual deterioration over 24 months postoperatively and was significantly poorer compared to the NB-Group at 24 months (p = 0.036) (Figure 1).Conclusion:Arthroscopic debridement and microfracture is a reliable procedure, providing significant improvement in pain relief and functional improvement in patients. A raised BMI did not adversely affect pain and functional outcomes. However, patients with raised BMI required a longer duration of procedure and had significantly poorer MCS scores at 24 months after surgery.

CONSERVATIVE MANAGEMENT OF ACUTE LUMBAR DISC HERNIATION WITH ASSOCIATED RADICULOPATHY: A STUDY

Objective: Acute disc herniation (DH) is a common cause of low back pain (LBP). It ranks fifth in the category of diseases in terms of cost of hospital care. It has higher indirect costs due to absenteeism from work and disability than any other disease. The present study was performed to assess the clinical outcomes of non-surgically treated LBP patients after 6 months of follow-up. Methods: The present study was prospective study which was performed on 450 lumbar radicular patients visiting the neurosurgery outpatient department having clinical signs and symptoms of acute lumbar DH of less than 3 month duration. Their diagnosis was confirmed by magnetic resonance imaging. The patients were treated conservatively during 6 months. Pain and disability were assessed by visual analog scale (VAS) and Oswestry disability questionnaire, respectively. Results: About 135 (30%) female and 315 (70%) male participated in the study. During the follow-up period, 27 (06%) patients (21 male and 6 female) showed poor response to conservative treatment and motor weakness and underwent surgical intervention. A significant improvement in the VAS Score was seen after 6 months of conservative treatment than initial evaluation of patients (3.12±1.84, 7.1±1.43, p=0.00). Furthermore, significant improvement in disability score of patients was seen in follow-up period (25.82±16.92, 53.66±17.66; p=0.00). Conclusion: Results of our study showed that conservative treatment in patients of acute lumbar DH have significant improvement in pain relief and disability without any notable side effect.

ADHESIVE CAPSULITIS; MANAGEMENT BY PHYSIOTHERAPY VERSUS INTRA-ARTICULAR CORTICOSTEROID INJECTION

Objective: To determine outcomes of intra-articular corticosteroids injection versus physiotherapy for the treatment of adhesive capsulitis using mean pain score on the visual analogue scale.&#x0D; Study Design: Comparative prospective study.&#x0D; Place and Duration of Study: Orthopedic outpatient department, Bahawal Victoria Hospital Bahawalpur from Jan to Jun 2021.&#x0D; Methodology: A total of 120 cases having adhesive capsulitis (frozen shoulder) were included in the study according to inclusion criteria. Non-probability consecutive sampling technique was used for the selection of cases. Patients were divided into two groups, group-A and group B, each containing 60 cases. Patients in group-A were given intra-articular steroid injection (2ml triamcinolone 40mg ± 2ml of bupivacaine). Patients in group B received ten sessions of physiotherapy by a welltrained physiotherapist under the supervision of an orthopaedic surgeon on alternate days. After six weeks, outcomes were measured in terms of pain score using a visual analogue pain scale.&#x0D; Results: Significant improvement was seen among patients in group-A with mean pain score from 7.32 ± 0.89 measured initially to 5.44 ± 1.37 measured after six weeks (p&lt;0.001). No significant improvement was found among patients in group B with a mean pain score of 7.58 ± 0.94 measured initially to 7.12 ± 0.88 measured after six weeks (p&gt;0.05).&#x0D; Conclusion: Significant improvement in pain relief can be achieved using intra-articular steroid injection administered in the shoulder as compared to supervised sessions of physiotherapy among patients with adhesive capsulitis.

Персоніфікований підхід до періопераційного анестезіологічного менеджменту тиреоїдектомій у пацієнтів із синдромом тиреотоксикозу

Актуальність. Робота присвячена вирішенню актуального завдання сучасної тиреоїдної хірургії — поліпшенню результатів хірургічного лікування пацієнтів із синдромом тиреотоксикозу. Мета дослідження — розробити персоніфікований підхід до вибору методу загальної анестезії (ЗА) та періопераційного знеболювання із застосуванням комплексу збалансованої аналгезії та сучасних методів контролю за перебігом анестезії. Матеріали та методи. На першій стадії проведено ретроспективний і проспективний аналіз (2016–2017) 440 випадків і карт пацієнтів з тиреотоксикозом, які перебували на стаціонарному лікуванні з приводу тиреоїдектомії в 2015–2017 рр., для ідентифікації супутньої патології, визначення особливостей загальної анестезії залежно від виду анестезії та її ускладнень. Друга стадія полягала в проспективному дослідженні за участю 175 пацієнтів із тиреотоксикозом після тиреоїдектомії. Результати. Синдром тиреотоксикозу погіршує фізичний статус пацієнта за критеріями Американської асоціації анестезіологів. Як інгаляційна, так і тотальна внутрішньовенна анестезія негативно впливають на показники гемодинаміки та доставку кисню. Встановлено, що поєднана анестезія із білатеральною блокадою поверхневого шийного сплетення на тлі застосування інгаляційної низькопотокової або тотальної внутрішньовенної анестезії забезпечує кращий рівень знеболювання порівняно з моноанестезією. Найкращою антиеметичною схемою є використання ЗА на тлі базової анестезії пропофолом із додаванням метоклопраміду перед індукцією анестезії. Індивідуалізація подання та корекція дози газового або внутрішньовенного анестетиків під контролем BIS­моніторингу дають змогу досягнути персоніфікації загальної анестезії. Найбільш економічно доцільним є використання ІА севофлураном за мінімально­потоковим контуром (FGF = 400 мл/хв). Висновки. Розроблено алгоритм анестезіологічного менеджменту в пацієнтів із синдромом тиреотоксикозу при тиреоїдектоміях із обґрунтуванням використання інгаляційної низькопотокової або тотальної внутрішньовенної анестезії. Отримані нові вірогідні дані дозволили розробити персоніфікований підхід до вибору методу загальної анестезії та періопераційного знеболювання із застосуванням комплексу ЗА та сучасних методів контролю за перебігом анестезії.

MatOrtho Proximal Interphalangeal Joint Arthroplasty via Lateral Approach: Minimum 2-Year Follow-Up.

Background: The MatOrtho implant is a cementless, mobile-bearing surface arthroplasty with a cobalt-chromium metal-on polyethylene articulation designed to treat osteoarthritis of the PIP joint. Early results for the prosthesis inserted through a dorsal approach have demonstrated good pain relief but no significant improvement in range of motion. In an attempt to improve the range of motion the senior author has changed his surgical practice to inserting the MatOrtho implant via a lateral approach. The purpose of this study is to assess the outcome of this change of surgical technique. Methods: Consecutive patients with osteoarthritis who underwent PIPJ replacement surgery via the lateral approach at a single institution, with a minimum follow-up period of 2 years were identified. A visual analogue score was used to assess pain. Grip strength, range of motion and functional outcomes scores were collected. Results: A total of 46 PIP joint arthroplasties were performed in 29 patients. Ten patients were lost to follow-up resulting in 33 PIP joint arthroplasties reviewed in 19 patients. Six implants failed. The mean follow-up time at the final follow-up for the remaining 25 prosthesis was 34.2 months (range 24-52). Range of motion improved from a mean of 37.2 preoperatively to a mean of 57.9 postoperatively. This was statistically significant (p = 0.0007). There was also a significant improvement in pain and functional outcome scores but not for grip strength. Conclusions: The MatOrtho PIPJ replacement delivers significant improvements in pain relief and functional outcome scores, as well as increased range of motion when the surgical procedure is performed through a lateral approach. There are, however, limitations to the use of this implant. Currently we do not consider this implant when there is instability or deformity of the PIP joint preoperatively.

Multidisciplinary approach in the treatment of tendinous foot involvement in rheumatoid arthritis

IntroductionPatients with rheumatoid arthritis frequently consult for pain resulting from involvement of the tendons of the foot. This pain negatively affects foot biomechanics and quality of life. The most widely used treatment option for this condition is ultrasound-guided steroid injection, while other treatments were recommended such as heel pad, splints, and footwear.ObjectiveTo evaluate a joint intervention (rheumatology and podiatry) comprising an orthotic-podiatric treatment and infiltrations. We evaluated the response using ultrasound monitoring, a pain scale, functional tests, and assessment of patient satisfaction.MethodsWe performed a non-controlled blinded prospective interventional study of 96 patients with foot pain and selected those with ultrasound-confirmed tendon involvement. Patients enrolled started intervention treatment and were followed for 6 months. The outcome of the intervention was compared with the patient’s baseline status. The pre-post differences in the secondary variables (pain, disability) were analyzed using the t test and contingency tables or the Mann–Whitney test.ResultsUsing our protocol, we recorded a rapid and significant reduction in the intensity of pain, in the foot function index, and in the ultrasound parameters (grayscale and Doppler). Structural damage to the tendon improved more slowly, with significant outcomes only at the last visit with respect to baseline. Abnormal foot support was detected in 50% of patients, and 79.5% were using inappropriate footwear.ConclusionsOur multidisciplinary therapeutic protocol enabled a very significant improvement in tendon involvement. It was well-tolerated, with a high degree of satisfaction, and was easily evaluated using ultrasound. No changes in background medication were necessary.Key Points• Multidisciplinary evaluation of patients with RA is advisable because it improves the treatment management in cases of inflammatory activity and structural abnormalities of the foot.• Comprising orthopedic-podiatric treatment (heel, splints, and suitable footwear) and infiltrations, in terms of clinical, ultrasound, and functional recovery of the foot tendons.• The therapy protocol we propose led to a significant improvement in pain relief and functional recovery.

Intravertebral insertion of interbody fusion cage via transpedicular approach for the treatment of stage III Kümmell disease: a technical note and case presentation

Background Kümmell disease usually occurs in the elderly osteoporosis population and develops gradually into symptomatic, progressive kyphosis of the spine. However, current surgical methods to deal with stage III Kümmell disease are less satisfying. The objective of this study was to describe a less invasive technique for treating stage III Kümmell disease. Technique A less invasive technique of intravertebral insertion of interbody fusion cage via transpedicular approach with posterior spine stabilization was applied to treat stage III Kümmell disease. Results This study details a modified technique applied in a patient with stage III Kümmell disease, showing significant improvement in pain relief, anterior column height recovery, and kyphotic angle correction. And no complications were reported during our follow-up. Conclusions Intravertebral insertion of interbody fusion cage via transpedicular approach provides advantages of acceptable correction of kyphosis, bony fusion, minimal invasion. Thus, our method was a good alternative choice for stage III Kümmell disease.

The impact of listening to music on orthopedic patients: a randomized controlled trial

Music listening represents a gold standard in the evidence-based holistic nursing practice. However, music listening is seldom involved in orthopedic postoperative settings, and only a few related studies can be retrieved in literature. The aim was to assess the effects of music during the orthopedic postoperative period, when patients frequently report pain and anxiety. A randomized controlled trial on 56 patients, equally divided in an experimental group treated with music and a control group in standard care, was conducted during their first-day of recovery from orthopedic surgery. The primary outcome was the pain level assessed with the VAS scale and the Short Form-McGill Pain Questionnaire. Secondary outcomes assessed were anxiety level, blood pressure, heart and respiratory rates and oxygen saturation. Following surgery, when clinically stabilized and soon after their return to their ward room, patients listened to music from a personal programmed playlist using their smartphones for 30 minutes. In music group, the Short Form-McGill Pain Questionnaire score significantly improved in the sensorial dimension (p=0.006) and in the affective dimension (p=0.02). Patients showed a pleasant experience in listening to music (90%), found it useful in coping with pain (64%) and improving mood (86%). Music in the orthopedic post-surgical period induced significant improvement in pain relief, representing a useful complementary intervention to drug treatment. Music listening could be a safe treatment, inexpensive and simple to manage by nurses in orthopedic postoperative settings.

No Difference in Outcome Between Articular-Sided and Bursal-Sided Tears: Comparative Study With Minimum 2-Year Follow-Up of Arthroscopic Repairs in 104 Patients in a Single-Surgeon Series

To evaluate and compare the functional outcomes after arthroscopic repair of bursal-sided versus articular-sided partial-thickness rotator cuff tears. We conducted a retrospective analysis of patients who had undergone arthroscopic tear completion and subsequent repair of symptomatic partial-thickness rotator cuff tears in a single institution from 2010 to 2015. Range of motion (ROM) (forward flexion and abduction), the pain score as measured on the Numeric Pain Rating Scale, and outcome scores (Constant-Murley score, University of California, Los Angeles shoulder score, and Oxford Shoulder Score) were calculated preoperatively and at 1 year and 2 years postoperatively. The delta difference was calculated for each outcome parameter at the respective follow-up points as the difference from the preoperative baseline score. A total of 104 patients were included. All tears involved the supraspinatus tendon and did not exceed 2 cm. Of the patients, 65 had an articular-sided tear (AST) whereas 39 had a bursal-sided tear (BST). The mean age of the patients was 53.4 years in the AST group and 55.8 years in the BST group. The AST and BST groups did not differ preoperatively in terms of age, sex, and the measured outcome parameters. Postoperatively, the patients in both groups achieved statistically significant improvement in pain relief and functional outcomes at 2 years. No statistically significant difference was observed between the 2 groups in terms of the delta-difference outcomes in ROM in forward flexion (P= .781) or abduction (P= .348), pain score (P= .187), Constant-Murley score (P= .186), University of California, Los Angeles shoulder score (P= .911), and Oxford Shoulder Score (P= .186) at 2 years. Partial-thickness rotator cuff tears treated with arthroscopic tear completion and subsequent repair achieved good outcomes in terms of ROM, functional outcomes, and pain relief at 2 years. There was no difference in outcomes regardless of whether the location of the tear was articular sided or bursal sided. Level III, retrospective comparative study.

Ultrasound-guided radiofrequency ablation in a patient with resistant intercostal neuralgia secondary to chronic osteomyelitis of anterior end of ribs

Intercostal neuralgia is a complex painful disorder characterized by intense, sharp shooting, or burning pain, along the distribution of intercostal nerve. It is difficult to treat condition in which pharmacological modalities of treatment often fail. We report a case of a 56-year-old female with postoperative sternal wound infection, following coronary artery bypass grafting, involving the left costochondral junction and left anterior ends of 7th, 8th, and 9th ribs. She presented with severe excruciating pain over left T7, T8, and T9 dermatomes for 3 months. Conservative management failed to provide significant improvement in pain relief. Hence, intercostal nerve block was performed and it provided good pain relief for 3 weeks. It was then followed by radiofrequency ablation (RFA) that provided good symptomatic pain relief at 9-month follow-up. Thus, ultrasound-guided RFA can be effectively and safely used in patients suffering from resistant intercostal neuralgia for providing quick and long-term pain relief.

Influence of myofascial therapy on painful erection – case study

Pain during sexual intercourse in men is a well-recognized symptom that is considered in the context of sexual dysfunction. Because there is no clear definition, it can be a joint feature of chronic prostatitis, chronic pelvic pain syndrome (CPPS), or come from connective tissue. Because of the many possible causes of genitourinary pain, a multimodal approach is necessary. The aim of this study is to present the effect of myofascial therapy on chronic, unpleasant, dull pain at the level of VAS = 9, occurring during erection and ejaculation, as well as during touch of the testicle in a 35-year-old man. The patient did not have erection problems, which was confirmed by an accurate and reliable tool in the form of the International Index of Erectile Function (IIEF-5). The man received two myofascial therapies, 45 min. each, 7 days apart followed by significant improvement in pain relief (VAS = 0). The manual techniques were used to find and remove changes manifested by increased muscle tone and fascia, lack of displacement of structures relative to each other, maximum painful points, and trigger points. In the follow-up examination performed after 1, 3 and 6 months, the patient confirmed that the effects of therapy were maintained. Connective tissue may play an important role in the occurrence of genitourinary pain. Physiotherapeutic examination and usage of myofascial techniques can bring beneficial effects in the form of pain relief in the relevant region.

Symptom assessment after nasal irrigation with xylitol in the postoperative period of endonasal endoscopic surgery

IntroductionChronic rhinosinusitis is an inflammatory condition of the nasal cavity and the paranasal sinuses that requires multifactorial treatment. Xylitol can be employed with nasal irrigation and can provide better control of the disease. ObjectiveTo evaluate the association between the effects of nasal lavage with saline solution compared to nasal lavage with a xylitol solution. MethodsFifty-two patients, divided into two groups (n = 26 in the “Xylitol” group and n = 26 in the “Saline solution” group) answered questionnaires validated in Portuguese (NOSE and SNOT-22) about their nasal symptoms and general symptoms, before and after endonasal endoscopic surgery and after a period of 30 days of nasal irrigation. ResultsThe “Xylitol” group showed significant improvement in pain relief and nasal symptom reduction after surgery and nasal irrigation with xylitol solution (p < 0.001). The “Saline solution” group also showed symptom improvement, but on a smaller scale. ConclusionThis study suggests that the xylitol solution can be useful in the postoperative period after endonasal endoscopic surgery, because it leads to a greater reduction in nasal symptoms.

A comparative study of passive stretching vs corticosteroid injection vs therapeutic ultrasound in plantar fasciitis

Background and Objective: This study compares passive stretching, corticosteroid injection and therapeutic ultrasound in plantar fasciitis. Materials and Methods: A total of 75 patients (age range, 18-60 years; 38 females) with PF were randomly assigned to receive either passive stretching (n = 25) or corticosteroid injection (n = 25) or therapeutic ultrasound (n=25). Passive stretching included both plantar fascia specific stretching exercise and Achilles tendon stretching exercise each applied in 10 sets of 10-second stretch and a 10-second rest 3 times a day for 6 months and supervised two times per week for 4 weeks to ensure that patients were doing the passive stretching exercise properly as they were advised. The corticosteroid injection group received a single palpation guided mixture of 40 mg of methylprednisolone and 2 ml of 2% lignocaine injection at baseline. Therapeutic ultrasound group received continuous mode, base frequency of 1MHz, power 2 w/cm2, applied during three minutes each on calcaneus medial tuberosity and on the 2 cm distal to tuberosity three times a week, for four weeks duration (total 12 sessions). Also the patients in all the 3 groups were advised to use silicon heel pads as a common modality of treatment. The patients’ functional outcome was assessed using the Foot and Ankle Ability Measure (FAAM), and relief of pain was evaluated using the Visual Analog Scale (VAS). Outcomes of interest were recorded before the treatment and at 1 month, 3 month & 6 month follow-ups. Results: Age, sex and body mass index did not significantly impact pain relief or functional outcome (P > 0.05). Out of 75 planned subjects only 68 patients could be followed up. Planned pair-wise comparisons demonstrated significant improvements in pain relief and functional outcomes in terms of both VAS (P passive stretching >therapeutic ultrasound. But for the long term improvements (6 months), passive stretching was more effective than corticosteroid injection and therapeutic ultrasound was not effective. Hence passive stretching exercise is recommended as a primary line of treatment as it is a non-invasive modality, avoids complications associated with steroid injection and has long lasting effects.