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Query: UMLS:C0030193 (pain)
 261,466 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Ultrasound (US) is used widely to treat patients with supraspinatus tendinitis, subacromial bursitis, or adhesive capsulitis (SSA). No double blind studies of US in the treatment of SSA, however, have been conducted. This study was designed to determine whether the addition of US can further decrease pain and increase range of motion in those receiving the usual courses of ROM exercises and nonsteroidal anti-inflammatory drugs (NSAIDs) or ROM exercises in patients with SSA. Twenty patients with SSA were randomized to receive true or sham US three times a week for four weeks. All other aspects of treatment remained constant (ROM exercises and NSAIDs or ROM exercises). The physician, the physical therapist, and the patients were blinded throughout the study regarding the delivery of the true or sham US. Of the multiple variables analyzed (pain, ROM, and function), no significant difference was found between the sham or true US groups. Although the study group was small, the results suggest that US is of little or no benefit when combined with ROM exercises and NSAIDs or ROM exercises in the treatment of SSA.
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PMID:Ultrasound therapy of subacromial bursitis. A double blind trial. 351 78

The elbow joint is a key joint for positioning of the hand. Four operations have to be considered for the rheumatoid elbow: removal of rheumatoid nodules and bursectomy, resection of the radial head, synovectomy, and arthroplasty. Synovectomy and arthroplasty are carefully analyzed, both from the point of view of recent international literature as well as personal experience. Synovectomy of the elbow is highly effective even when performed relatively late (stage 3 according to Larsen-Dahle-Eek) insofar as pain relief and swelling are concerned. In long-term disease, deterioration as assessed by radiology can usually not be prevented, but clinical improvement may be the reason for the relatively rare indication for arthroplasty. According to recent literature, the results of elbow arthroplasty vary greatly. Fully constrained hinges should no longer be used, and no decision has been made so far on whether semiconstrained or nonconstrained surface replacement is preferred. We use the semiconstrained GSB Mark II prosthesis, which has provided results in nearly 50 cases that rank among the best reported from the point of view of pain relief, improvement of ROM, and low complication rate. Use of our so-called transtricipital approach to the elbow has proved particularly valuable, especially with regard to lack of extension and muscle strength.
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PMID:[Elbow joint]. 376 20

Limited joint mobility (LJM) has been identified as a manifestation of diabetes in some children; this study assessed whether LJM is a phenomenon that also affects persons with adult-onset diabetes mellitus (DM). For the purpose of this study, I defined LJM as limitation in at least two anatomical areas of the right upper extremity. I studied 19 right-handed men (10 without DM, 9 with adult-onset DM) aged 53 to 70 years. The right upper extremity active range of motion of eight motions was evaluated, as was the ability to flatten the hand fully. Intrarater reliability of the results of testing the ROM of six subjects on three occasions was calculated to have an average intraclass correlation coefficient of .98. Student's t-test results showed that the patients with DM had significantly less (p less than .05) ROM in their fingers and in shoulder abduction than the age-matched controls, suggesting that some adults with DM do have LJM. If the limitations are major, progressive, or symptomatic, physical therapy would be indicated to maintain ROM, to minimize pain, and to help the patient to be functionally independent. The results of this study suggest that physical therapists should be aware of the need to address LJM when treating patients with DM. For prophylactic treatment, patients with DM could be instructed routinely in ROM exercises.
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PMID:Limited joint mobility in adults with diabetes mellitus. 380 47

In the preoperative state, there were similar local findings on both sides of the wrist joint involved by rheumatoid arthritis in the roentgenogram. Synovectomy was performed on the one side of the wrist joint. Thirty six cases were compared with untreated controls and evaluated annually for eight years. From the roentgenological point of view, both wrists have almost similarly taken a turn for the worse. In spite of synovectomy, prevention of joint destruction has been unsuccessful. In the operated wrists it was due to ROM and pronation-supination which significantly improved wrist joint function. Although this improved level has been favorably maintained, there was a decline in dorsipalmar flexion and radio-ulnar flexion year after year. The results in the operated wrists were adequately better than the untreated wrists. Relief of pain was reported as follows: 94.4% : 2 years after the operation 84.8% : 4 years 81.3% : 6 years 80.0% : 8 years Synovectomy was followed by significantly less pain and satisfaction of treatment as reported by most patients. However analgetic effects of early synovectomy that was performed was ineffective and prevention of the destruction of joints roentgenologically met with negative results. The validity and the permanency of this synovectomy study was proved by the comparative evaluations made between the treated wrist joints and the untreated wrist joints, and also by the established clinical results.
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PMID:[Clinical results of synovectomy for rheumatoid wrist compared with the opposite side (author's transl)]. 731 Feb 2

The data available indicate that ROM, strengthening and aerobic conditioning exercises are safe for patients with OA, RA or AS, despite earlier concerns that exercise might exacerbate joint symptoms or accelerate disease. Less clear are the therapeutic benefits of exercise. In patients with OA, stretching, strengthening, and aerobic conditioning programmes can improve the deficits observed in these patients. The improvements observed generally have been small, and the evidence that these individual improvements result in improved overall function is minimal. None the less, it is likely that exercise will reduce pain, improve endurance for physical activities and improve cardiovascular fitness. Study of the long-term effects of exercise in the geriatric population, for sustaining independent living and functioning, is critically important for future health care and social expenditures. In RA, strengthening and aerobic conditioning exercise programmes can increase muscle strength and cardiovascular fitness and probably improve physical function as well. Improvements demonstrated in patients with RA seem more convincing than those in patients with OA and AS; this probably represents their poorer physical status prior to exercising. For patients with AS, intensive physiotherapy brings statistically significant short-term improvements in spinal and hip ROM which are only modestly clinically significant. It is possible that spinal mobility exercises decelerate loss of mobility over the long term, but controlled studies are needed to confirm this. Improvement in respiratory function with exercise appears to be related to cardiopulmonary fitness and perhaps to improvements in diaphragmatic respiration rather than to changes in thoracic cage mobility. Given the overall safety and likely benefits of the described forms of exercise, exercise should be included in the overall treatment of patients with OA, RA or AS. Careful patient evaluation and education about exercise should be a part of the exercise programme.
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PMID:Exercise for arthritis. 814 42

The purpose of this study was to analyse the effects of preoperative physiotherapy on pain and function in 39 patients scheduled for unicompartmental prosthetic knee replacement. Nineteen patients were selected at random to receive preoperative physiotherapy. The control group received no preoperative therapy. Evaluations were performed 3 months prior to surgery, immediately before and 3 months after operation. Evaluations included: Clinical assessment, measurements of the knee muscle strength, self-selected walking speed and the oxygen cost of walking. Three months before surgery the patients in both groups had similar types and levels of problems. Before surgery patients who had received physiotherapy showed slight improvements in pain, perceived stability of the knee during walking, and faster self-selected and maximal walking speeds compared to the control group, but were unchanged in muscle strength, ROM, and oxygen cost. Three months after surgery pain was significantly decreased in all patients, however, no significant differences were found between the two groups for any variable except muscle strength. This was unchanged compared to preoperative values for patients of the control group while patients who received preoperative physiotherapy showed a decrease in strength. In summary, this study did not disclose any major benefit from the program of preoperative physiotherapy tested.
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PMID:Effect of preoperative physiotherapy in unicompartmental prosthetic knee replacement. 846 63

We evaluated the outcome of and compared two rehabilitation programs (clinic-based versus home) after a mid-third patellar autograft reconstruction of the anterior cruciate ligament. Thirty-seven patients (28 male, 9 female; average age, 24.1 years) completed the study. Fifteen of these patients received clinic-based rehabilitation (three visits per week for 6 weeks prescribed), and 22 patients received home-based physical therapy (number of visits determined by patient response). Knee ROM, Lysholm, Visual Analogy Scale, (VAS) pain rating, hop test, KT-1000, and Sickness Impact Profile (SIP) were evaluated preoperatively and postoperatively. All patients reported good satisfaction with the function of their knee at average follow-up of 21.6 months (range, 12 to 48). Patients managed by home rehabilitation averaged 2.85 visits as compared with 14.2 for clinic-centered patient (P < .05). There were no differences in functional or subjective outcomes in the different postoperative rehabilitation regimens, with both groups reporting high satisfaction and improved quality of life. Cost savings in the home rehabilitation group were significant.
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PMID:A prospective outcome study of rehabilitation programs and anterior cruciate ligament reconstruction. 919 22

This is a prospective clinical and radiological study of the treatment of talocalcaneal deformity or degeneration by a modified technique of isolated talocalcaneal fusion. Thirty-six patients were evaluated with clinical examination, plain dorsoplantar and oblique radiographs, and computed tomography scanning or magnetic resonance imaging in a follow-up of 32.5 months (range, 20-62 months). Indications for arthrodesis were posterior tibial tendon rupture with secondary osteoarthritis (12 cases) and secondary posttraumatic osteoarthritis (24 cases). On a visual analog pain scale, the patients graded their pain at 4.4 before surgery and at 1.1 after surgery. The subjective results were 33% complete satisfaction, 28% satisfaction with minor reservation, 31% satisfaction with major reservation, and 9% dissatisfaction. The overall objective results were excellent in 47%, good in 31%, fair in 17%, and poor in 6% of cases. A further advantage of this type of talocalcaneal fusion is a large remaining range of motion in the neighboring joints, at the ankle (in 76% the same or better ROM than before surgery), and at Chopart's joint (in 69% the same or better ROM than before surgery). The fusion rate was high (95%).
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PMID:Isolated talocalcaneal interposition fusion: a prospective follow-up study. 934 97

27 patients (28 cases), were treated for perilunate dislocations in 20 and fracture-dislocations in 8. Capitate displacement was dorsal in 27 cases and palmar in 1 case, and in 16, the scaphoid was fractured. There was no substantial delay of treatment. In 8 patients treated with closed reduction, follow-up averaged 6 (1-15) years. 19 patients (20 cases) who underwent early open reduction with K-wire stabilization and ligamentous repair, had an average follow-up of 2 (0.5-7) years. The clinical outcome was evaluated using a scoring system based on pain, occupation, ROM and grip strength, while the radiographic outcome was assessed according to findings of carpal instability, nonunion of scaphoid, and/or arthrotic changes. In patients treated with closed reduction, results were fair in 3 and poor in 5, while patients treated with early open reduction had a better clinical score with 4 excellent, 9 good, 3 fair and 4 poor results. These findings suggest that perilunate fracture-dislocations are too unstable to be treated with closed reduction. In addition, a combined approach was found effective in the management of dorsal perilunate dislocations. Finally, open reduction presupposes reparation of the torn scapholunate ligament, to obtain normal carpal kinematics.
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PMID:Perilunate dislocations and fracture-dislocations. Closed and early open reduction compared in 28 cases. 938 68

Resection arthroplasty of the metacarpophangeal joints stabilized by a Swanson-Silastic-spacer is the golden standard in MP-joint destruction in R.A. 57 (Gr. I), 91 (Gr. II), and 102 (Gr. III) arthroplasties of the metacarpophalangeal joint were assessed in three groups of patients 3.5 years (Gr. I), 4.3 years (Gr. II), and 10.1 years (Gr. III), respectively, postoperatively on the average. In patients of group I titanium protectors, called grommets, were used additionally. Nearly all patients reported a marked relief of pain. Ulnar drift was corrected from an average of 22 degrees (Gr. I), 23 degrees (Gr. II), and 34 degrees (Gr. III) preoperatively. to 8 degrees (Gr. I), 7 degrees (Gr. II), and 12 degrees (Gr. III), respectively, postoperatively. Active range of motion remains unchanged with an average of 33 degrees (Gr. I), 38 degrees (Gr. II), and 42 degrees (Gr. III) ROM preoperatively and 42 degrees (Gr. I), 37 degrees (Gr. II), and 36 degrees (Gr. III) ROM, respectively, postoperatively. The average extension deficit had improved from 45 degrees (Gr. I), 32 degrees (Gr. II), and 33 degrees (Gr. III) at surgery to 18 degrees (Gr. I), 11 degrees (Gr. II), and 11 degrees (Gr. III), respectively, at the time of follow-up. Functional improvement of the hand was found in the medium term in 82% and in the longterm in 75% of the patients. The radiographical findings showed surrounding osteolysis in 45.7% (Gr. I), 63.5% (Gr. II), and 89.4% (Gr. III) of the implants and 0% (Gr. I), 16.5% (Gr. II), and 26.9% (Gr. III) broken spacers. From the medium to the longterm run there is an increase in radiographical deterioration. The additional use of titanium grommets in MP-joint arthroplasty seems to reduce reactive osteolysis and protects Swanson Silastic-spacers from breakage without substantial influence on the clinical outcome.
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PMID:[Therapy of rheumatoid destruction of the middle finger metacarpophalangeal joint with a Swanson silastic implant stabilized resection arthroplasty: comparative study of long and intermediate term results with and without implantation of titanium grommets]. 946 82


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