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González-de-la-Flor Á. A New Clinical Examination Algorithm to Prescribe Conservative Treatment in People with Hip-Related Pain. Pain Ther 2024; 13:457-479. [PMID: 38698256 PMCID: PMC11111658 DOI: 10.1007/s40122-024-00604-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Accepted: 04/04/2024] [Indexed: 05/05/2024] Open
Abstract
Hip-related pain is a common issue in active adults affecting their quality of life, mobility, and overall function, and it can lead to persistent disability. However, diagnosing hip-related pain is challenging due to the many potential sources and causes, including intra-articular and extra-articular pathology, and referred pain from other areas (lumbar or groin related pain). To address this, there is a need for a clinical algorithm based on the best available evidence and expert consensus. This algorithm could guide healthcare professionals in assessing and managing patients with hip-related pain, during the diagnosis, test selection, intervention, monitoring, and promoting collaboration among various healthcare providers. This clinical algorithm for hip-related pain is a comprehensive, flexible, adaptable to different settings, and regularly updated to incorporate new research findings. This literature review aims to establish a clinical algorithm specifically for prescribing exercise treatment to patients with hip-related pain, addressing their individual needs and enhancing their overall care.
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Affiliation(s)
- Ángel González-de-la-Flor
- Faculty of Sport Sciences, Universidad Europea de Madrid, Calle Tajo s/n, 28670, Villaviciosa de Odón, Madrid, Spain.
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2
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Karaoğlan M, Küçükçay Karaoğlan B. PENG for chronic pain: the clinical effectiveness of pericapsular nerve group block in chronic hip pain. Hip Int 2024:11207000241227542. [PMID: 38380579 DOI: 10.1177/11207000241227542] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Abstract
OBJECTIVES To evaluate the efficiency and tolerability of pericapsular nerve group block (PENG) for the treatment of chronic hip pain. METHODS This is a retrospective, single-centre, 4-group study conducted over a 3-month period to find out the most typical cause of chronic hip pain. A total of 112 patients with symptomatic hip osteoarthritis (OA), Stage 2-3, greater trochanteric pain (GTPS) and chronic pain after total hip arthroplasty (cTHA), who had an ultrasound-guided PENG block, were selected. To assess the effectiveness of the treatment, the Western Ontario and McMaster Universities osteoarthritis index (WOMAC) and visual analogue scale (VAS) scores of the patients prior to treatment were compared with their scores after the 1st week, 1st month, and 3rd month of treatment. The study also aimed to analyse the patients' initial feelings of alleviation following the block (1st VAS/2) and problems experienced both during and after the block. RESULTS The parameters studied included pain, stiffness, and results of physical activity in the 1st week, 1st month, and 3rd month following PENG block application. At the beginning of the 1st week, of the 112 patients who were administered a PENG block for hip pain, we reported a 62% improvement in pain, a 52% reduction in stiffness, and a 53% increase in physical activity. Even though these results slightly declined in the 1st and 3rd months, the rates were still higher than 45%. CONCLUSIONS Overall, the PENG block was well-tolerated by the patients in our study. No treatment-related infections or any other serious complications were observed.
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3
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Suarez-Ahedo C, Camacho-Galindo J, López-Reyes A, Martinez-Gómez LE, Pineda C, Domb BG. A comprehensive review of hip arthroscopy techniques and outcomes. SAGE Open Med 2024; 12:20503121231222212. [PMID: 38249944 PMCID: PMC10798066 DOI: 10.1177/20503121231222212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Accepted: 12/04/2023] [Indexed: 01/23/2024] Open
Abstract
Transforming the orthopedic landscape, hip arthroscopy pioneers a minimally invasive surgical approach for diagnosing and addressing hip pathologies. With its origins dating back to Burman's 1931 cadaveric study, this groundbreaking technique gained clinical relevance in 1939 through Takagi's report. However, the 1980s marked the actual emergence of hip arthroscopy for treating a wide range of hip disorders. Now, a staple in modern orthopedics, hip arthroscopy empowers patients with previously undiagnosed and untreated hip conditions, enabling them to obtain relief and reclaim their lives. By employing a compact camera and specialized tools, surgeons expertly navigate the hip joint, performing procedures from excising loose bodies and mending labral tears to addressing femoroacetabular impingement and tackling other intricate issues. This innovative approach has dramatically elevated patients' quality of life, allowing them to embrace targeted treatments and resume daily activities without resorting to lifestyle alterations.
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Affiliation(s)
- Carlos Suarez-Ahedo
- Adult Hip and Knee Reconstruction Department, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
- American Hip Institute, Chicago, IL, USA
| | | | - Alberto López-Reyes
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Laura E Martinez-Gómez
- Geriatric Science Laboratory, National Rehabilitation Institute of Mexico, Mexico City, Mexico
| | - Carlos Pineda
- National Rehabilitation Institute of Mexico, Mexico City, Mexico
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Mourad C, Vande Berg B. Osteoarthritis of the hip: is radiography still needed? Skeletal Radiol 2023; 52:2259-2270. [PMID: 36538067 PMCID: PMC10509135 DOI: 10.1007/s00256-022-04270-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2022] [Revised: 11/12/2022] [Accepted: 11/18/2022] [Indexed: 12/24/2022]
Abstract
Diagnosis of hip osteoarthritis (OA) is based on clinical arguments, and medical imaging is obtained to confirm the diagnosis and rule out other possible sources of pain. Conventional radiographs are recommended as the first line imaging modality to investigate chronic hip pain. They should be obtained in a rigorous technique that includes an antero-posterior (AP) radiograph of the pelvis. The choice of the appropriate lateral view depends on the clinical indication, Lequesne's false profile being valuable in the assessment of OA. Magnetic resonance imaging (MRI) is more sensitive to detect joint effusion/synovitis, cartilage, labral, and bone marrow lesions. However, structural joint changes are frequent in asymptomatic population and neither radiographs nor MRI have shown a good correlation with pain and functional impairment. MRI seems to be more suitable than radiographs as a biomarker for clinical trials addressing early OA. The absence of a validated MR biomarker of early OA, together with issues related to machine availability and MRI protocol repeatability, prevent the widespread use of MRI in clinical trials.
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Affiliation(s)
- Charbel Mourad
- Department of Diagnostic and Interventional Radiology, Hôpital Libanais Geitaoui CHU, Beyrouth, 1100, Achrafieh, Lebanon.
| | - Bruno Vande Berg
- Department of Radiology, Cliniques CHC Montlégia, Boulevard Patience Et Beaujonc 2, 4000, Liège, Belgium
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Harper KD, Park KJ, Incavo SJ. Management of Hip Abductor Tears and Recalcitrant Trochanteric Bursitis in Native Hips. J Am Acad Orthop Surg 2023; 31:e769-e777. [PMID: 37647539 DOI: 10.5435/jaaos-d-23-00224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Accepted: 07/10/2023] [Indexed: 09/01/2023] Open
Abstract
Hip abductor tears have recently gained recognition as a more prevalent injury than previously thought. This article will detail the pathophysiology of injury, physical symptoms commonly found at presentation, diagnostic imaging to best diagnose tears and when they should be ordered, and how to properly classify the injury and finally summarize the treatment options available with expert opinions about which are most successful.
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Affiliation(s)
- Katharine D Harper
- From the Department of Orthopedic Surgery, Washington DC Veterans Affairs Medical Center, Washington, DC (Harper and Incavo) and the Department of Orthopedics & Sports Medicine, Houston Methodist Hospital, Houston, Texas (Park)
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6
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Kearns GA, Moore AK, Munger L, Seth S, Day M. Care for the patient with hip pain. Nurse Pract 2023; 48:21-28. [PMID: 37458312 DOI: 10.1097/01.npr.0000000000000038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/20/2023]
Abstract
ABSTRACT Hip pain is a common and sometimes disabling condition that affects adults in the primary care setting. The NP must understand the assessment, diagnosis, and treatment options for patients with hip pain. Proper care of these patients often involves conservative medical management and coordination with physical therapy.
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Parodi D, Villegas D, Escobar G, Bravo J, Tobar C. Deep Gluteal Pain Syndrome: Endoscopic Technique and Medium-Term Functional Outcomes. J Bone Joint Surg Am 2023; 105:762-770. [PMID: 36943908 DOI: 10.2106/jbjs.22.00394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
BACKGROUND Sciatic nerve entrapment is an entity that generates disabling pain, mainly when the patient is sitting on the involved side. According to some studies, the presence of fibrovascular bands has been described as the main cause of this pathology, and the sciatic nerve's decompression by endoscopic release has been described as an effective treatment generally associated with a piriformis tenotomy. The aim of this study was to present the medium-term functional results of endoscopic release of the sciatic nerve without resection of the piriformis tendon. METHODS This prospective, observational study included 57 patients who underwent an endoscopic operation for sciatic nerve entrapment between January 2014 and January 2019. In all cases, a detailed medical history was obtained and a physical examination and a functional evaluation were performed using the modified Harris hip score (mHHS), the 12-item International Hip Outcome Tool (iHOT-12), and the visual analog scale (VAS) for pain. All patients had pelvic radiographs and magnetic resonance imaging (MRI) scans of the hip on the involved side and underwent a prior evaluation by a spine surgeon. RESULTS This study included 20 male and 37 female patients with a mean age of 43.6 years (range, 24 to 88 years) and a mean follow-up of 22.7 months. The median mHHS improved from 59 to 85 points. The median iHOT-12 improved from 60 to 85 points. The median VAS decreased from 7 to 2. Postoperative complications occurred in 12% of patients: 1 patient with extensive symptomatic hematoma, 3 patients with hypoesthesia, and 3 patients with dysesthesia. CONCLUSIONS Endoscopic release of the sciatic nerve by resection of fibrovascular bands without piriformis tenotomy is a technique with good to excellent functional results comparable with those of techniques in the literature incorporating piriformis tenotomy. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Dante Parodi
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Fundación Médica San Cristóbal, Santiago, Chile
| | - Diego Villegas
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Department of Orthopaedic Surgery, Hospital Padre Hurtado, Santiago, Chile
| | - Gonzalo Escobar
- Department of Orthopaedic Surgery, Hospital Universitario Austral, Buenos Aires, Argentina
| | - José Bravo
- Orthopaedic Residency Program, Universidad del Desarrollo, Santiago, Chile
| | - Carlos Tobar
- Department of Orthopaedic Surgery, Clínica RedSalud Providencia, Santiago, Chile
- Fundación Médica San Cristóbal, Santiago, Chile
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8
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Donnelly GM, Moore IS. Sports Medicine and the Pelvic Floor. Curr Sports Med Rep 2023; 22:82-90. [PMID: 36866951 DOI: 10.1249/jsr.0000000000001045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
ABSTRACT The female athlete is seen as a specialist population meaning female considerations, such as pelvic floor dysfunction, are not widely taught within sports medicine. Females have unique anatomical characteristics compared with males including a wider pelvic diameter and an additional orifice in the form of the vagina. Furthermore, symptoms of pelvic floor dysfunction are prevalent among female athletes and transitional periods in their lifespan. They also are a barrier to training and performance. Therefore, it is essential that sports medicine practitioners understand how to identify and manage pelvic floor dysfunction. This report aims to describe the anatomy and function of the pelvic floor, outline the types and rates of pelvic floor dysfunction, discuss evidence-based management, and raise awareness of perinatal bodily changes. Practical recommendations are made to aid sports organizations and sports medicine practitioners in supporting the female athlete and in using a proactive approach to manage the perinatal athlete.
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Affiliation(s)
| | - Isabel S Moore
- Cardiff School of Sport & Health Sciences, Cardiff Metropolitan University, UNITED KINGDOM
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9
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Vermeylen K, Van Aken D, Versyck B, Casaer S, Bleys R, Bracke P, Groen G. Deep posterior gluteal compartment block for regional anaesthesia of the posterior hip: a proof-of-concept pilot study. BJA OPEN 2023; 5:100127. [PMID: 37587997 PMCID: PMC10430842 DOI: 10.1016/j.bjao.2023.100127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 01/11/2023] [Accepted: 01/23/2023] [Indexed: 08/18/2023]
Abstract
Background Various regional anaesthesia approaches to branches of the anterior lumbar plexus have been proved effective in providing analgesia in hip surgery. However, some patients still experience significant residual posterior hip pain attributed to the posterior nerve supply of the hip. This not only suggests that anterior approaches may not always provide sufficient pain relief, but also that the blocking of major nerves supplying the posterior pericapsular region is needed. Methods We present an ultrasound-guided technique to block all major nerves supplying the posterior capsule of the hip joint. The optimal target area was determined by ultrasound imaging, cross-sectional digitised anatomy, and cadaver research, and was found in the deep gluteal compartment. Furthermore, this posterior pericapsular deep-gluteal block was evaluated in two patients. Results The spread of dye in the cadaver was observed deep to the gluteus maximus and in between the quadratus femoris and piriformis muscles, and conformed to the presumed location during the ultrasound procedure. It included all major supplying nerves to the posterior hip capsule, that is the superior gluteal nerve, nerve to quadratus femoris and sciatic nerve. In both patients where this posterior pericapsular deep-gluteal block was applied the pain was substantially reduced (numeric rating scale: 4 to 1 and 7 to 1). Conclusion We present a successful ultrasound-guided technique targeting the deep gluteal compartment to block all major nerves supplying the hip joint's posterior capsule. This posterior pericapsular deep-gluteal block can be applied as an additional block in hip surgery, with also a possible role in chronic hip pathology.
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Affiliation(s)
- Kris Vermeylen
- Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium
| | - David Van Aken
- Department of Anaesthesia, Department of Radiology, AZ Klina, Brasschaat, Belgium
| | - Barbara Versyck
- Department of Anaesthesia, AZ Turnhout, Turnhout, Belgium
- Department of Anaesthesia, Catharina Hospital, Eindhoven, the Netherlands
| | - Sari Casaer
- Department of Anaesthesia, Gasthuiszusters Antwerpen, Antwerp, Belgium
| | - Ronald Bleys
- Department of Functional Anatomy, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Peter Bracke
- Department of Radiology, AZ Klina, Brasschaat, Belgium
| | - Gerbrand Groen
- Anesthesiology Pain Center, Department of Anesthesiology, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands
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10
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Eberlin CT, Kucharik MP, Cherian NJ, Meek WM, McInnis KC, Martin SD. Adhesive Capsulitis of the Hip: A Case Presentation and Review. Orthop Rev (Pavia) 2022; 14:37679. [DOI: 10.52965/001c.37679] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
There remains a paucity of literature addressing adhesive capsulitis of the hip (ACH), making the diagnosis and treatment a continued challenge for healthcare providers. ACH encompasses restricted hip range-of-motion and pain that progresses through analogous Stages (1-4) to adhesive capsulitis of the shoulder. We report a case presentation of a middle-aged man that illustrates the significance of certain patient factors and provide a review of current literature to aid in the diagnostic evaluation and treatment for addressing ACH. Initial conservative treatment of ACH includes the appropriate management of associated comorbidities, oral and/or injectable pharmacologics, and physical therapy. While frequently resolving with time, refractory cases of ACH may require more aggressive approaches including pressure dilation, manipulation under anesthesia, synovectomy, capsular release and, for select patients, total hip arthroplasty. Given the limited available literature addressing ACH, healthcare providers may be forced to rely on a small number of published case reports and outdated review articles to guide their diagnostic evaluation and treatment approaches. Thus, this case presentation and review provides an updated approach to better diagnose and manage patients with ACH.
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Affiliation(s)
| | | | | | - Wendy M Meek
- Massachusetts General Hospital - Mass General Brigham
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11
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Abstract
This article discusses the pathophysiology, assessment techniques, and management of hip pain in adults and the role of nurses in caring for patients with hip pain.
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Affiliation(s)
- Larry Munger
- At the Texas Tech University Health Sciences Center in Lubbock, TX, Larry Munger is an assistant professor in the Department of Rehabilitation and the Masters of Athletic Training Program, Amy Moore is a professor of nursing, Gary Kearns is an assistant professor in the Department of Rehabilitation Sciences Doctor of Physical Therapy Program, and Shelly Seth is an assistant professor at the School of Nursing
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12
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Qiao L, Li R. Influence of Personalized Health Management Model Based on Internet Mode on Self-Management Ability and Life Quality of Patients with Chronic Diseases Undergoing Physical Examination. COMPUTATIONAL AND MATHEMATICAL METHODS IN MEDICINE 2022; 2022:4434436. [PMID: 35983524 PMCID: PMC9381198 DOI: 10.1155/2022/4434436] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 06/22/2022] [Accepted: 06/24/2022] [Indexed: 11/17/2022]
Abstract
Objective To explore the influence of personalized health management model based on the Internet mode on self-management ability and life quality of patients with chronic diseases of physical examination. Methods Sixty patients with chronic diseases who went through physical examination from February 2019 to April 2021 were enrolled in our hospital. The patients were arbitrarily assigned into control and research group. The former group received routine nursing, and the latter group received personalized health management mode based on the Internet mode. The nursing satisfaction, self-management behavior ability, blood pressure level, physiological index, mastery of health knowledge, and life quality scores were compared. Results In terms of nursing satisfaction, the research group was very satisfied in 20 cases, satisfactory in 9 cases, and general in 1 case, with a satisfaction rate of 100.00%; In the control group, 15 cases were very satisfied, 9 cases were satisfied, 1 case was general, 5 cases were not satisfied, and the satisfaction rate was 83.33%; The nursing satisfaction of the research group was higher (P < 0.05). Compared with the self-management behavior ability, the scores of diet control, regular medication, correct medication, and smoking cessation in the research group were remarkably higher (P < 0.05). There exhibited no significant difference in blood pressure level before intervention (P > 0.05); after intervention, the blood pressure levels lessened. Compared with the control group, the systolic blood pressure and diastolic blood pressure of the research group were lower (P < 0.05). The levels of triglyceride, total cholesterol, low-density lipoprotein, and fasting blood glucose in the research group were remarkably lower (P < 0.05). Compared with the control group, the scores of health knowledge in the research group were remarkably higher, including the harm of smoking, the use of drugs, the importance of persisting in taking drugs, the pathogenesis of chronic diseases, the effect of emotional management on the disease, and the dietary awareness in the research group (P < 0.05). There exhibited no significant difference in the score of life quality before nursing (P > 0.05); after nursing, the score of life quality lessened, and the scores of physiological function, psychological function, social function, and health self-cognition in the research group were lower (P < 0.05). Conclusion The personalized health management model based on the Internet mode can effectively enhance the chronic disease physiological indexes such as blood pressure, blood lipids, and blood sugar and improve the self-management ability of the patients with chronic disease, which is worth further popularizing and applying in the clinical physical examination in clinic.
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Affiliation(s)
- Li Qiao
- Physical Examination Department, Yuncheng First Hospital Yuncheng, Shanxi 044000, China
| | - Ruijuan Li
- The Pain Department, Yuncheng First Hospital Yuncheng, Shanxi 044000, China
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Tran A, Reiter DA, Prologo JD, Cristescu M, Gonzalez FM. Review of Extraosseous Applications of Thermal Ablation in the Treatment of Moderate to Severe Large Joint Osteoarthritis. Semin Musculoskelet Radiol 2021; 25:745-755. [PMID: 34937115 DOI: 10.1055/s-0041-1735474] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Osteoarthritis (OA) is the most common joint disease worldwide, leading to significant pain, restricted range of motion, and disability. A gap exists between short- and long-term symptom-relieving therapies. Although arthroplasty is an effective treatment for symptomatic end-stage disease, most patients ultimately do not receive a joint replacement due to suboptimal surgical qualifications, comorbidities, or an aversion to surgery. The lack of additional treatment options in this setting makes opioid agonists a commonly used pharmacologic agent, contributing to the addiction epidemic that greatly afflicts our communities. Cooled radiofrequency ablation (CRFA) has arisen as a treatment modality in the setting of moderate to severe OA among patients refractory to conservative management, generally showing greater efficacy compared with other existing strategies. This review focuses on the benefits of CRFA and its technical feasibility as a management option among patients experiencing debilitating large joint OA with limited clinical options.
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Affiliation(s)
- Andrew Tran
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - David A Reiter
- Department of Radiology and Imaging Sciences, and Orthopedics, Emory University School of Medicine, Atlanta, Georgia
| | - J David Prologo
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Mircea Cristescu
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Felix M Gonzalez
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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14
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Buchanan P, Vodapally S, Lee DW, Hagedorn JM, Bovinet C, Strand N, Sayed D, Deer T. Successful Diagnosis of Sacroiliac Joint Dysfunction. J Pain Res 2021; 14:3135-3143. [PMID: 34675642 PMCID: PMC8517984 DOI: 10.2147/jpr.s327351] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Accepted: 09/28/2021] [Indexed: 12/04/2022] Open
Abstract
Background Sacroiliac joint (SIJ) pain is one of the most common causes of low back pain, accounting for 15 to 30% of all cases. Although SIJ dysfunction accounts for a large portion of chronic low back pain prevalence, it is often overlooked or under diagnosed and subsequently under treated. The purpose of this review was to establish a best practices model to effectively diagnose SIJ pain through detailed history, physical exam, review of imaging, and diagnostic block. Methods A literature search was performed on the diagnosis of sacroiliac joint pain and sacroiliac joint dysfunction. The authors proposed diagnostic recommendations based upon the available literature and a detailed understanding of diagnosing SIJ pain. Results The practitioner must focus on the history, location of pain, observed gait pattern, and perform key points of the physical exam including sacroiliac provocative maneuvers. If the patient exhibits at least three provocative maneuvers then the SIJ may be considered as a possible source of pain. Additionally, a thorough review of the imaging should be performed to rule out other etiologies of low back pain. In the absence of any pathognomonic tests or examination findings, diagnostic SIJ blocks have evolved as the diagnostic standard. Conclusion The diagnosis of SIJ pain is a multifaceted process that involves a careful assessment including differentiating other pain generators in the region. This involves careful history taking, appropriate physical examination including provocative maneuvers and diagnostic injections. Once the diagnosis is confirmed, long-term solutions may be considered, including recent advances in sacral lateral branch denervation and sacroiliac joint fusion.
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Affiliation(s)
- Patrick Buchanan
- Department of Pain Medicine, Spanish Hills Interventional Pain Specialists, Camarillo, CA, USA
| | - Shashank Vodapally
- Department of Physical Medicine and Rehabilitation, Michigan State University, East Lansing, MI, USA
| | - David W Lee
- Department of Pain Medicine, Fullerton Orthopedic Surgery Medical Group, Fullerton, CA, USA
| | - Jonathan M Hagedorn
- Department of Anesthesiology and Perioperative Medicine, Division of Pain Medicine, Mayo Clinic, Rochester, MN, USA
| | - Christopher Bovinet
- Department of Pain Medicine, The Spine Center of Southeast Georgia, Brunswick, GA, USA
| | - Natalie Strand
- Department of Anesthesiology, Division of Pain Medicine, Mayo Clinic, Phoenix, AZ, USA
| | - Dawood Sayed
- Department of Anesthesiology, Division of Pain Medicine, The University of Kansas Medical Center, Kansas City, KS, USA
| | - Timothy Deer
- Department of Pain Medicine, The Spine and Nerve Center of the Virginias, Charleston, WV, USA
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15
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Feigin G, Peng PWH. Hip Ablation Techniques. Phys Med Rehabil Clin N Am 2021; 32:757-766. [PMID: 34593141 DOI: 10.1016/j.pmr.2021.05.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Radiofrequency ablation (RFA) is still an emergent technique for the management of chronic hip pain. Although the ablation technique for facet articular branches of lumbar and cervical spine was already established, the literature on the targets and technique of needle placement for hip denervation are evolving. This article summarizes the current understanding of the anatomy of the articular branches, sonoanatomy, and the suggested techniques for the RFA of the hip. It also reviews the literature on the clinical studies.
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Affiliation(s)
- Guy Feigin
- Department of Anesthesia & Pain Management, The University of Toronto, Toronto Western Hospital, Women's College Hospital, Wasser Pain Management Clinic, Mount Sinai Hospital, McL 2-405, TWH, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada; Department of Anesthesiology, Critical Care and Pain Management the Meir Medical Center, Kfar Saba, Israel.
| | - Philip W H Peng
- Department of Anesthesia & Pain Management, The University of Toronto, Toronto Western Hospital, Women's College Hospital, Wasser Pain Management Clinic, Mount Sinai Hospital, McL 2-405, TWH, 399 Bathurst Street, Toronto, Ontario M5T 2S8, Canada
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16
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Vasanthan LT, Chockalingam M. Simple vacuum cup to identify the primary myofascial restriction: the root cause of pain elsewhere. BMJ Case Rep 2021; 14:14/2/e240214. [PMID: 33602777 PMCID: PMC7896563 DOI: 10.1136/bcr-2020-240214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Identification of the primary source of pain determines the success of musculoskeletal pain management. A detailed history and physical examination are the current gold standards for identifying musculoskeletal pain source in day-to-day clinical practice. This process, at times, may potentially result in inadequate/inappropriate identification of the pain source. In this case report, we present the usefulness of a simple and inexpensive vacuum cup. We found that this accurately identified the primary pain source, distant from and unrelated to the site of pain presentation in a 30-year-old man with back pain. Routine use of this simple technique in conjunction with the regular musculoskeletal examination may better identify primary restrictions in the body tissues. Based on our experience, we propose that this approach has the potential to offer better outcomes in the treatment of musculoskeletal pain in the future.
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Affiliation(s)
- Lenny Thinagaran Vasanthan
- Physiotherapy Unit, Physical Medicine and Rehabilitation Department, Christian Medical College Vellore, Vellore, Tamil Nadu, India
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Ranker A, Oergel M, Aschoff HH, Jaiman A, Krettek C, Schiller J, Liodakis E. Preoperative femoral abduction angle correlates with initial postoperative lateral hip pain after transcutaneous osseointegrated prosthetic system (TOPS) in transfemoral amputees. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2021; 31:1225-1233. [PMID: 33471264 DOI: 10.1007/s00590-021-02872-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Accepted: 01/08/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE To analyse whether a preoperative femoral abduction angle (FAA) correlates with postoperative initial lateral hip pain (LHP) in above-knee amputees (AKA) treated with transcutaneous osseointegrated prosthetic system (TOPS). METHODS Pre- and postoperative long-leg radiographs of eighteen unilateral AKA (mean age 51.55y ± 12.16) were retrospectively measured. FAA was measured on both sides. Pain intensity of LHP was measured by numeric rating scale (NRS) preoperatively and every week for four weeks from the first day of weight loading. Pearson's r was calculated for correlation. Furthermore, odds ratio for LHP ≥ 5/10 NRS and relative FAA > 13° was calculated. RESULTS FAA significantly decreased in the postoperative period (pre/post. 15.33° ± 4.22; p < 0.001). Median LHP was 0/10 NRS (min.0, max.3) preoperatively and 4/10 NRS (min.2, max. 7, p < 0.001) postoperatively after first loading. Interestingly, it decreased within four weeks to a median of 0.5/10 NRS (min.0, max. 3) without intervention. A strong correlation was seen on the amputated side between preoperative FAA and LHP after loading (r = 0.835, p < 0.001), as well as the relative FAA to LHP after loading (r = 0.732, p < 0.001) and between the gap of pre- to postoperative FAA and LHP. Odds ratio for LHP ≥ 5/10 and relative FAA > 13° was 6.4 (95%CI = 0.55; 74.89). CONCLUSION The preoperative FAA strongly correlates with postoperative LHP. Surgeons should be aware of high risk of LHP that can limit prosthetic training. High preoperative FAAs should be realised in the decision meeting of TOPS implantation and pre-rehabilitative reduction of the FAA should be taken into consideration.
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Affiliation(s)
- Alexander Ranker
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany. .,Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
| | - Marcus Oergel
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Horst-Heinrich Aschoff
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Ashish Jaiman
- Central Institute of Orthopaedics, Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, India
| | - Christian Krettek
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Jörg Schiller
- Department of Rehabilitation Medicine, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
| | - Emmanouil Liodakis
- Department of Trauma Surgery, Hannover Medical School, Carl-Neuberg-Str. 1, 30625, Hannover, Germany
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Hawk C, Whalen W, Farabaugh RJ, Daniels CJ, Minkalis AL, Taylor DN, Anderson D, Anderson K, Crivelli LS, Cark M, Barlow E, Paris D, Sarnat R, Weeks J. Best Practices for Chiropractic Management of Patients with Chronic Musculoskeletal Pain: A Clinical Practice Guideline. J Altern Complement Med 2020; 26:884-901. [PMID: 32749874 PMCID: PMC7578188 DOI: 10.1089/acm.2020.0181] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Objective: To develop an evidence-based clinical practice guideline (CPG) through a broad-based consensus process on best practices for chiropractic management of patients with chronic musculoskeletal (MSK) pain. Design: CPG based on evidence-based recommendations of a panel of experts in chronic MSK pain management. Methods: Using systematic reviews identified in an initial literature search, a steering committee of experts in research and management of patients with chronic MSK pain drafted a set of recommendations. Additional supportive literature was identified to supplement gaps in the evidence base. A multidisciplinary panel of experienced practitioners and educators rated the recommendations through a formal Delphi consensus process using the RAND Corporation/University of California, Los Angeles, methodology. Results: The Delphi process was conducted January-February 2020. The 62-member Delphi panel reached consensus on chiropractic management of five common chronic MSK pain conditions: low-back pain (LBP), neck pain, tension headache, osteoarthritis (knee and hip), and fibromyalgia. Recommendations were made for nonpharmacological treatments, including acupuncture, spinal manipulation/mobilization, and other manual therapy; modalities such as low-level laser and interferential current; exercise, including yoga; mind-body interventions, including mindfulness meditation and cognitive behavior therapy; and lifestyle modifications such as diet and tobacco cessation. Recommendations covered many aspects of the clinical encounter, from informed consent through diagnosis, assessment, treatment planning and implementation, and concurrent management and referral. Appropriate referral and comanagement were emphasized. Conclusions: These evidence-based recommendations for a variety of conservative treatment approaches to the management of common chronic MSK pain conditions may advance consistency of care, foster collaboration between provider groups, and thereby improve patient outcomes.
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Affiliation(s)
- Cheryl Hawk
- Texas Chiropractic College, Pasadena, TX, USA
| | | | | | | | | | | | | | | | | | | | | | - David Paris
- VA Northern CA Health Care System, Redding, CA, USA
| | - Richard Sarnat
- Advanced Medicine Integration Group, L.P., Columbus, OH, USA
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19
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French HP, Deasy M, Gallagher R, O'Grady A, Doyle F. Prevalence of Hip or Groin Pain in Adolescents: A Systematic Review and Meta-Analysis. Pain Pract 2020; 20:792-811. [PMID: 32362057 DOI: 10.1111/papr.12907] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 04/01/2020] [Accepted: 04/26/2020] [Indexed: 12/25/2022]
Abstract
Musculoskeletal pain is a common cause of pain in adolescence and can be an important predictor of future pain. The prevalence of hip or groin pain that could potentially affect different adolescent populations has not yet been systematically reviewed. This systematic review aimed to determine the prevalence of hip or groin pain in this population. Five electronic databases were searched until January 2019 for eligible studies that included males and females 13 to 19 years of age. Study selection, data extraction, and risk of bias assessments were completed by 2 independent researchers. Based on inclusion criteria, 8 population-based, 8 clinical, and 4 sports populations were included. Studies were conducted in Europe, North America, and Australia. The prevalence was dichotomized into "0 to 3 months" and "3 months and above." Meta-analyses were performed to estimate the prevalence from 0 to 3 months, and individual estimates were reported for studies of 3 months and above. The overall prevalence of hip or groin pain in all adolescents from 0 to 3 months was 12% (95% confidence interval [CI] 6%, 23%) based on 10 studies, and was 7% (95% CI 6%, 10%) based on 7 population studies. Caution should be applied to these estimates due to substantial study heterogeneity. The pain prevalence in cerebral palsy from 0 to 3 months based on 4 studies was 13% (95% CI 10%, 15%). Individual prevalence estimates were 6% and 31% in obese and 4% in hypermobility populations, respectively, and ranged from 6% to 100% in 4 sports studies. The validity of these estimates is compromised by poor methodological quality.
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Affiliation(s)
| | - Margaret Deasy
- Physiotherapy Department, Sports Surgery Clinic, Santry, Dublin, Ireland
| | | | | | - Frank Doyle
- Royal College of Surgeons in Ireland, Dublin, Ireland
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20
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Billham J, Cornelson SM, Koch A, Nunez M, Estrada P, Kettner N. Diagnosing acetabular labral tears with hip traction sonography: a case series. J Ultrasound 2020; 24:547-553. [PMID: 32240531 DOI: 10.1007/s40477-020-00446-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Accepted: 02/26/2020] [Indexed: 12/25/2022] Open
Abstract
PURPOSE Three cases of acetabular labral tear (ALT) diagnosed with sonography (US) are reported. We aim to show utility for US with the addition of manual hip traction as an adjunctive modality to the current diagnostic imaging of choice, magnetic resonance arthrography (MRA), for diagnosing ALT. METHODS Three cases of young athletic patients with similar clinical presentations are reported. All received US examination of the hip with attention to the labrum that included a novel long-axis hip traction technique which assisted in diagnosing ALT. RESULTS In the first and second cases, MRA and orthopedic consult were obtained for confirmation of the diagnosis. Arthroscopy was performed to correct the ALT. The third patient declined an MRA. Conservative management consisted of McKenzie method active care, resulting in return to sport in the third case. CONCLUSION These three cases demonstrate the clinical and sonographic presentation of ALT. The dynamic long-axis hip traction protocol facilitated the use of US as an adjunctive modality for diagnosing ALT by increasing the visualization of the defect.
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Affiliation(s)
- Jessica Billham
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA.
| | - Stacey M Cornelson
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Amy Koch
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Mero Nunez
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Patricia Estrada
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
| | - Norman Kettner
- Department of Radiology, Logan University, 1851 Schoettler Rd, Chesterfield, MO, USA
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Savic M, D’Angelo K. Exploring the role of microinstability of the hip: an atypical presentation of femoroacetabular impingement (FAI) and labral tear in a collegiate endurance athlete: a case report. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2019; 63:187-196. [PMID: 31988540 PMCID: PMC6973754] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVE This case is designed to aid practitioners in understanding the potential role of hip microinstability as a possible underlying source of hip pain and dysfunction. CASE PRESENTATION A 25-year-old female collegiate cross-country athlete presented with a 2-year history of progressive left hip and groin pain. Extensive clinical examination and imaging confirmed the presence of cam-type femoroacetabular impingement, a labral tear and gluteal tendinopathy. Despite multiple intra and extra-articular pathologies, understanding the role of hip instability and implementing a rehabilitation exercise program focused on hip joint centration alleviated the patient's symptoms at rest and during activity. SUMMARY A robust history and physical exam of the hip is essential with the addition of imaging when testing criteria is positive. Clinicians should be aware of the role hip microinstability plays and its clinical implications when in the presence of other contributing factors such as generalized joint laxity, and/or intra-articular pathology.
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Affiliation(s)
- Mitchell Savic
- Division of Graduate Studies, Canadian Memorial Chiropractic College, Toronto, Ontario
- Private practice, Burlington, Ontario
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22
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The ambiguity of sciatica as a clinical diagnosis: A case series. J Am Assoc Nurse Pract 2019; 32:589-593. [PMID: 31567779 DOI: 10.1097/jxx.0000000000000288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Sciatica as a clinical diagnosis is nonspecific. A diagnosis of sciatica is typically used as a synonym for lumbosacral radiculopathy. However, the differential for combined low back and leg pain is broad, and the etiology can be one several different conditions. The lifetime prevalence of sciatica ranges from 12.2% to 43%, and nonsuccessful outcomes of treatment are prevalent. Nurse practitioners and other primary care clinicians often have minimal training in differential diagnosis of the complex causes of lower back and leg pain, and many lack adequate time per patient encounter to work up these conditions. Differentiating causes of low back and leg pain proves challenging, and inadequate or incomplete diagnoses result in suboptimal outcomes. Chiropractic care availability may lessen demands of primary care with respect to spinal complaints, while simultaneously improving patient outcomes. The authors describe three patients referred from primary care with a clinical diagnosis of sciatica despite differing underlying pathologies. More precise clinical terminology should be used when diagnosing patients with combined low back and leg pain. Nurse practitioners and other clinicians' triage, treat, and determine appropriate referrals for low back and leg pain. Multidisciplinary care including chiropractic may add value in settings where patients with lower back and leg pain are treated.
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Kumar P, Hoydonckx Y, Bhatia A. A Review of Current Denervation Techniques for Chronic Hip Pain: Anatomical and Technical Considerations. Curr Pain Headache Rep 2019; 23:38. [DOI: 10.1007/s11916-019-0775-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
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24
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Demirel A, Baykara M, Koca TT, Berk E. Ultrasound elastography findings in piriformis muscle syndrome. Indian J Radiol Imaging 2019; 28:412-418. [PMID: 30662201 PMCID: PMC6319104 DOI: 10.4103/ijri.ijri_133_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Background: Piriformis muscle syndrome (PMS) is relatively less known and underestimated because it is confused with other clinical pathological conditions. Delays in its diagnosis may lead to chronic somatic dysfunction and muscle weakness. Objective: Here, we aimed to evaluate the diagnostic performance of the ultrasound elastography (UE) as an easy, less-invasive, and cost-effective method for early diagnosis of PMS. Materials and Methods: Twenty-eight cases clinically diagnosed as PMS at the outpatient clinic were evaluated by UE. The elastographic strain ratio was calculated by dividing the strain value of the subcutaneous fat tissue by the mean stress value of the muscle beneath. The diagnostic performances of the strain rate measures were compared using the receiver operating characteristic curve analysis. Results: Twenty-one (N = 21) cases were female, and seven (N = 7) of the cases were male. The mean age was 45 years (ranged 24–62 years). The strain rates of piriformis muscle (PM) and gluteus maximus (GM) muscles were significantly higher on the PMS-diagnosed side (P < 0.001). The cutoff value of UE strain ratio for the PM and GM were 0.878 [95% confidence interval (CI) 0.774–0.981] and 0.768 (95% CI 0.622–0.913), respectively, and the sensitivity and specificity values were, respectively, 80.95% and 85.71% for the PM, and they were, respectively, 85.71% and 66.67% for the GM. Conclusion: We showed that the muscle elasticity and tissue hardening increased on the problematic side both on PM and GM. UE may provide early diagnosis of PMS, thereby increasing the possibility of treatment with less invasive methods.
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Affiliation(s)
- Adnan Demirel
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Murat Baykara
- Department of Radiology, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Tuba Tülay Koca
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
| | - Ejder Berk
- Department of Physical Medicine and Rehabilitation, Faculty of Medicine, Sütçü İmam University, Kahramanmaraş, Turkey
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Lee YJ, Kim SH, Chung SW, Lee YK, Koo KH. Causes of Chronic Hip Pain Undiagnosed or Misdiagnosed by Primary Physicians in Young Adult Patients: a Retrospective Descriptive Study. J Korean Med Sci 2018; 33:e339. [PMID: 30584417 PMCID: PMC6300658 DOI: 10.3346/jkms.2018.33.e339] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2018] [Accepted: 10/02/2018] [Indexed: 01/26/2023] Open
Abstract
BACKGROUND Hip pain is a common musculoskeletal complaint in general practice. Although comprehensive diagnostic approach on hip pain is mandatory for adequate treatment, un- or mis-diagnosis is not rare in primary care. The aim of this study was to analyze descriptively un- or mis-diagnosed hip pain cases referred from primary care to a tertiary hospital, especially in young adults ≤ 50 years old. METHODS We retrospectively analyzed a consecutive cohort of 150 patients (≤ 50 years old) with chronic hip pain (≥ 6 weeks), which was not diagnosed or misdiagnosed based on the information provided on the referral form. RESULTS Overall an average 32 cases/month were referred due to hip pain without a diagnosis or with an incorrect diagnosis. Among them, 150 patients were enrolled in this study and 146 (97.3%) could be allocated to a specific disease by using data from routine clinical practice. Four common final diagnoses were femoroacetabular impingement (FAI) syndrome (55.3%), hip dysplasia (HD, 13.3%), referred pain from the lumbar spine (9.3%), and spondyloarthritis (SpA, 7.3%). In patients with FAI syndrome, 37 (44.0%) had pincer-type FAI and 33 (39.8%) had combined-type. Although the pain site or gender was not tightly clustered, the distribution of final diagnosis was significantly different according to hip pain location or gender. Especially, SpA or HD was not observed in younger women subgroup or elder men subgroup, respectively, when stratified by the mean age of participants. CONCLUSION Most (> 80%) young patients with hip pain, a difficult issue to diagnosis for many primary physicians, had FAI syndrome, HD, spine lesions, and SpA. This study could give a chance to feedback information about cases with un- or mis-diagnosed hip pain, and it suggests that primary physicians need to be familiar with the diagnostic approach for these 4 diseases.
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Affiliation(s)
- Yun Jong Lee
- Division of Rheumatology, Department of Internal Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Sang-Hwan Kim
- Department of Orthopedic Surgery, Barun Mind Hospital, Daejeon, Korea
| | - Sang Wan Chung
- Department of Internal Medicine, Graduate School, Kyung Hee University, Seoul, Korea
| | - Young-Kyun Lee
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Kyung-Hoi Koo
- Department of Orthopedic Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Grant C, Pajaczkowski J. Conservative management of femoral anterior glide syndrome: a case series. THE JOURNAL OF THE CANADIAN CHIROPRACTIC ASSOCIATION 2018; 62:182-192. [PMID: 30662073 PMCID: PMC6319433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
BACKGROUND Femoral anterior glide syndrome is a movement impairment syndrome, which presents with anterior hip pain aggravated by hip flexion and extension. It is believed to occur because of altered muscle activation patterns contributing to altered gliding of the femoral head within the acetabulum and constant overloading and irritation of the joint structures. STUDY DESIGN Case series. CASE DESCRIPTION Three elite athletes diagnosed with femoral anterior glide syndrome were treated conservatively with the main goal of improving posterior femoral glide. Rehabilitative exercises were completed to gain independent articular control of the hip and improve hip and low back dissociation. OUTCOMES Patients received complete symptom resolution allowing them to continue participating in their sport at full capacity. They were able to perform the femoral anterior glide tests without pain and aberrant movement patterns. DISCUSSION This case series provides data to support further investigation of treatment of femoral anterior glide syndrome.
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Affiliation(s)
- Chris Grant
- Graduate Education & Research Program, Canadian Memorial Chiropractic College
| | - Jason Pajaczkowski
- Graduate Education & Research Program, Canadian Memorial Chiropractic College
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Beatty NR, Félix I, Hettler J, Moley PJ, Wyss JF. Rehabilitation and Prevention of Proximal Hamstring Tendinopathy. Curr Sports Med Rep 2017; 16:162-171. [PMID: 28498225 DOI: 10.1249/jsr.0000000000000355] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
Proximal hamstring tendinopathy (PHT) comprises a small but significant portion of hamstring injuries in athletes, especially runners. PHT is a chronic condition that is clinically diagnosed but can be supported with imaging. The main presenting complaint is pain in the lower gluteal or ischial region that may or may not radiate along the hamstrings in the posterior thigh. There is little scientific evidence on which to base the rehabilitation management of PHT. Treatment is almost always conservative, with a focus on activity modification, addressing contributing biomechanical deficiencies, effective tendon loading including eccentric training, and ultrasound-guided interventional procedures which may facilitate rehabilitation. Surgery is limited to recalcitrant cases or those involving concomitant high-grade musculotendinous pathology. The keys to PHT management include early and accurate diagnosis, optimal rehabilitation to allow for a safe return to preinjury activity level, and preventative strategies to reduce risk of reinjury.
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Affiliation(s)
- Nicholas R Beatty
- 1Physiatry Department, Hospital for Special Surgery, New York, NY; 2Sports Rehabilitation and Performance Center, Hospital for Special Surgery, New York, NY
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