Showing papers in "Current Reviews in Musculoskeletal Medicine in 2009"
TL;DR: Often, surgical treatment is necessary, which entails, arthroscopic debridement of labral tears and surgical repair of associated structural problems, with physical therapy being controversial.
Abstract: The hip labrum has many functions, including shock absorption, joint lubrication, pressure distribution, and aiding in stability, with damage to the labrum associated with osteoarthritis. The etiology of labral tears includes trauma, femoroacetabular impingement (FAI), capsular laxity/hip hypermobility, dysplasia, and degeneration. Labral tears present with anterior hip or groin pain, and less commonly buttock pain. Frequently, there are also mechanical symptoms including clicking, locking, and giving way. The most consistent physical examination finding is a positive anterior hip impingement test. Because of the vast differential diagnosis and the need for specialized diagnostic tools, labral tears frequently go undiagnosed during an extended period of time. Evaluation usually begins with plain radiographs to assess for dysplasia, degeneration, and other causes of pain. While magnetic resonance imaging (MRI) and computed tomography scans are unreliable for diagnosis, magnetic resonance arthrography (MRA) is the diagnostic test of choice, with arthroscopy being the gold standard. Typically, treatment begins conservatively with relative rest and non-steroid anti-inflammatory agents, with physical therapy (PT) being controversial. Often, surgical treatment is necessary, which entails, arthroscopic debridement of labral tears and surgical repair of associated structural problems.
234 citations
TL;DR: The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.
Abstract: The authors review and compare posterior lumbar interbody fusion (PLIF) with transforaminal lumbar interbody fusion (TLIF). A review of the literature is performed wherein the history, indications for surgery, surgical procedures with their respective biomechanical advantages, potential complications, and grafting substances are presented. Along with the technical advancements and improvements in grafting substances, the indications and use of PLIF and TLIF have increased. The rate of arthrodesis has been shown to increase given placement of bone graft along the weight-bearing axis. The fusion rate across the disc space is further enhanced with the placement of posterior pedicle screw–rod constructs and the application of an osteoinductive material. The chief advantages of the TLIF procedure compared with the PLIF procedure included a decrease in potential neurological injury, improvement in lordotic alignment given graft placement within the anterior column, and preservation of posterior column integrity through minimizing lamina, facet, and pars dissection.
207 citations
TL;DR: This review aims to bring the interested reader up to date with the latest news and views on the mechanisms controlling bone resorption in normal and pathological conditions.
Abstract: Upon the discovery of RANK, RANKL and OPG in the late 1990s, their importance in the maintenance of the skeletal structure and their dramatic role in bone disease were largely unexpected. In recent years the understanding of these proteins, in particular their regulation, has greatly increased. This review aims to bring the interested reader up to date with the latest news and views on the mechanisms controlling bone resorption in normal and pathological conditions.
170 citations
TL;DR: This work will elaborate on the extensive realm of degenerative changes within the axial spine for which radiological evaluation is nonspecific and causal relationships are tentative, and the clinical implications of these degenerative processes and their clinical implications.
Abstract: Low back pain (LBP) affects approximately 60–85% of adults during some point in their lives. Fortunately, for the large majority of individuals, symptoms are mild and transient, with 90% subsiding within 6 weeks. Chronic low back pain, defined as pain symptoms persisting beyond 3 months, affects an estimated 15–45% of the population. For the minority with intractable symptoms, the impact on quality of life and economic implications are considerable. Despite the high prevalence of low back pain within the general population, the diagnostic approach and therapeutic options are diverse and often inconsistent, resulting in rising costs and variability in management throughout the country. In part, this is due to the difficulty establishing a clear etiology for most patients, with known nociceptive pain generators identified throughout the axial spine. Back pain has been termed as “an illness in search of a disease.” Indeed, once “red flag” diagnoses such as cancer and fracture have been ruled out, the differential sources of low back pain remain broad, including the extensive realm of degenerative changes within the axial spine for which radiological evaluation is nonspecific and causal relationships are tentative. We will elaborate on these degenerative processes and their clinical implications. We will further discuss diagnostic approaches and the efficacy of existing treatment options.
95 citations
TL;DR: The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis; however, steroid injections should be combined with ultrasound monitoring to reduce complications.
Abstract: This article presents a review of conservative therapies for plantar fasciitis pain reduction with a discussion of steroid therapy risks The therapies reviewed include orthoses, stretching, extracorporeal shockwave, BTX-A, and corticosteroid injection/iontophoresis These modes were included based on the availability of double blinded randomized controlled trials We noted the following findings Orthoses, regardless of type, can improve pain levels Plantar stretching shows limited short-term benefit (1 month), but can reflect significant long-term improvement (10 months) Extracorporeal shockwave therapy shows equivocal benefit with some studies showing significant improvement and others showing none Although BTX-A injections were the least studied, significant pain improvement was demonstrated in the short and long term Steroid injection/iontophoresis showed significant improvement in the short term (1 month) Steroid therapy, when coupled with plantar stretching, can provide efficacious pain relief; however, steroid injections should be combined with ultrasound monitoring to reduce complications
94 citations
TL;DR: An in depth review of the efficacy, complications, and technique of both interlaminar and transforaminal cervical epidural steroid injections in the management of cervical radiculitis is reviewed.
Abstract: There has been recent concern regarding the safety of cervical epidural steroid injections. The decision to proceed with treatment requires balancing the risk and benefits. This article is an in depth review of the efficacy, complications, and technique of both interlaminar and transforaminal cervical epidural steroid injections in the management of cervical radiculitis.
84 citations
TL;DR: Calf strains are common injuries seen in primary care and sports medicine clinics and differentiate strains of the gastrocnemius or soleus is important for treatment and prognosis.
Abstract: Calf strains are common injuries seen in primary care and sports medicine clinics. Differentiating strains of the gastrocnemius or soleus is important for treatment and prognosis. Simple clinical testing can assist in diagnosis and is aided by knowledge of the anatomy and common clinical presentation.
77 citations
TL;DR: The purpose of this article is to review published literature regarding conservative treatment options for MTSS and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.
Abstract: Medial tibial stress syndrome (MTSS), commonly known as "shin splints," is a frequent injury of the lower extremity and one of the most common causes of exertional leg pain in athletes (Willems T, Med Sci Sports Exerc 39(2):330-339, 2007; Korkola M, Amendola A, Phys Sportsmed 29(6):35-50, 2001; Hreljac A, Med Sci Sports Exerc 36(5):845-849, 2004). Although often not serious, it can be quite disabling and progress to more serious complications if not treated properly. Often, the cause of MTSS is multi-factorial and involves training errors and various biomechanical abnormalities. Few advances have been made in the treatment of MTSS over the last few decades. Current treatment options are mostly based on expert opinion and clinical experience. The purpose of this article is to review published literature regarding conservative treatment options for MTSS and provide recommendations for sports medicine clinicians for improved treatment and patient outcomes.
73 citations
TL;DR: An overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain is provided.
Abstract: Low back pain is the most common pain symptom experienced by American adults and is the second most common reason for primary care physician visits. There are many structures in the lumbar spine that can serve as pain generators and often the etiology of low back pain is multifactorial. However, the facet joint has been increasingly recognized as an important cause of low back pain. Facet joint pain can be diagnosed with local anesthetic blocks of the medial branches or of the facet joints themselves. Subsequent radiofrequency lesioning of the medial branches can provide more long-term pain relief. Despite some of the pitfalls associated with facet joint blocks, they have been shown to be valid, safe, and reliable as a diagnostic tool. Medial branch denervation has shown some promise for the sustained control of lumbar facet joint-mediated pain, but at this time, there is insufficient evidence that it is a wholly efficacious treatment option. Developing a universal algorithm for evaluating facet joint-mediated pain and standard procedural techniques may facilitate the performance of larger outcome studies. This review article provides an overview of the anatomy, pathophysiology, diagnosis, and treatment of facet joint-mediated pain.
58 citations
TL;DR: Coracoid impingement syndrome is a less common cause of shoulder pain, and the possibility of the coexistence of the two conditions must be taken into consideration before treatment of either as an isolated process.
Abstract: Coracoid impingement syndrome is a less common cause of shoulder pain. Symptoms are presumed to occur when the subscapularis tendon impinges between the coracoid and lesser tuberosity of the humerus. Coracoid impingement should be included in the differential diagnosis when evaluating a patient with activity-related anterior shoulder pain. It is not thought to be as common as subacromial impingement, and the possibility of the coexistence of the two conditions must be taken into consideration before treatment of either as an isolated process. If nonoperative treatment fails to relieve symptoms, surgical decompression can be offered as an option.
57 citations
TL;DR: Osteoid osteoma and osteoblastoma are rare primary bone tumors that usually do not arise in the spine and with the help of modern imaging modalities, a complete removal and cure may be achieved for most of these rare tumors.
Abstract: Osteoid osteoma and osteoblastoma are rare primary bone tumors that usually do not arise in the spine. Histologically, osteoid osteoma and osteoblastoma are similar, containing osteoblasts that produce osteoid and woven bone. Osteoblastoma, however, is larger, tends to be more aggressive, and can undergo malignant transformation, whereas osteoid osteoma is small, benign, and self-limited. With the help of modern imaging modalities that aid in diagnosis and surgical planning, a complete removal and cure may be achieved for most of these rare tumors. We document a brief review of the literature.
TL;DR: Radiofrequency thermal ablation is considered the treatment of choice for osteoid osteomas, in which it has long been safely used, and an option for the palliation of localized, painful osteolytic metastatic and myeloma lesions.
Abstract: Radiofrequency thermal ablation (RFTA) is considered the treatment of choice for osteoid osteomas, in which it has long been safely used Other benign conditions (chondroblastoma, osteoblastoma, giant cell tumour, etc) can also be treated by this technique, which is less invasive than traditional surgical procedures RFTA ablation is also an option for the palliation of localized, painful osteolytic metastatic and myeloma lesions The reduction in pain improves the quality of life of patients with cancer, who often have multiple morbidities and a limited life expectancy In some cases, these patients are treated with RFTA because conventional therapies (surgery, radiotherapy, chemotherapy, etc) have been exhausted In other cases, it is combined with conventional therapies or other percutaneous treatments, eg, cementoplasty, offering faster pain relief and bone strengthening A multidisciplinary approach to the management of these patients is recommended to select the optimal treatment, including orthopaedic surgeons, neurosurgeons, medical and radiation oncologists and interventional radiologists
TL;DR: This paper will review the authors’ experience, indications, clinical outcomes, and complications of viscosupplementation therapy in patients with ankle OA.
Abstract: Viscosupplementation refers to the concept of synovial fluid replacement with intra-articular injections of hyaluronic acid (HA) for the relief of pain associated with osteoarthritis (OA). Intra-articular viscosupplementation was approved by the Food and Drug Administration (FDA) in 1997. It is currently indicated only for the treatment of pain associated with knee OA. However, OA can occur in several of the weight-bearing joints of the foot and ankle. Ankle OA produces chronic disability that directly impacts the quality of life. There is only limited published literature relating to the use of HA in the ankle. This paper will review the authors’ experience, indications, clinical outcomes, and complications of viscosupplementation therapy in patients with ankle OA.
TL;DR: In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4–6 weeks, while more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis.
Abstract: In patients with non specific acute low back pain, without the red flags, a conservative approach is preferable, with assessment in 4–6 weeks. The natural history of low back pain is favorable with improvement over time, thus reassurance to such patients is very important. However, a plain radiograph or more advanced imaging techniques like MRI/CT may be ordered in back pain associated with radiculopathy or spinal stenosis and back pain associated with progressive neurologic deficits. There is limited role of imaging in non specific acute low back pain without the red flags, as the findings correlate poorly with symptoms.
TL;DR: It is necessary to have an understanding of the appearance of the ossification centers seen on the pediatric elbow when evaluating the elbow for fractures, in particularly supracondylar fractures owing to their high propensity for complications.
Abstract: The pediatric and adolescent elbow is subject to both acute and chronic overuse injuries. The practitioner should develop a classification system to evaluate all such injuries, with first focusing on whether the injury represents an acute episode or rather it represents a more chronic problem. In addition, localizing the area of pain as being either medial, lateral, or posterior can better help differentiate the diagnosis. Youth baseball pitchers and throwers are particularly at risk for overuse injuries of the elbow, most of which are related to an injury mechanism termed “valgus extension overload”. The most common entity related to this is termed “Little Leaguer’s Elbow.” Treatment is usually conservative, but for some injuries surgery may be required, especially for displaced medial epicondylar avulsion fractures. Other acute injuries also should be easily recognizable by the general clinician including annular ligament displacement (nursemaid’s elbow) which represents one of the most common upper extremity injuries presenting to emergency rooms in youngsters under the age of 6. Most studies seem to indicate a hyperpronation reduction technique may be more successful then the flexion/supination technique. It is also important to have an awareness of some of the common elbow fractures seen in the younger patient, in particularly supracondylar fractures owing to their high propensity for complications. When evaluating the elbow for fractures, it is necessary to have an understanding of the appearance of the ossification centers seen on the pediatric elbow.
TL;DR: Observing the pathologic mechanism of MN injury during common prehensile hand movements could help better understand how to treat and prevent CTS.
Abstract: Median nerve (MN) compression is a recognized component of carpal tunnel syndrome (CTS). In order to document compressive changes in the MN during hand activity, the carpal tunnel was imaged with neuromuscular ultrasound (NMUS). Ten patients with CTS and five normal controls underwent NMUS of the MN at rest and during dynamic stress testing (DST). DST maneuvers involve sustained isometric flexion of the distal phalanges of the first three digits. During DST in the CTS patients, NMUS demonstrated MN compression between the contracting thenar muscles ventrally and the taut flexor tendons dorsally. The mean MN diameter decreased nearly 40%, with focal narrowing in the mid-distal carpal canal. Normal controls demonstrated no MN compression and a tendency towards MN enlargement, with an average diameter increase of 17%. Observing the pathologic mechanism of MN injury during common prehensile hand movements could help better understand how to treat and prevent CTS.
TL;DR: It is shown that radiofrequency neurotomy has been shown to have limited evidence in treating sacroiliac joint syndrome, and future studies will be needed to focus on the type of radio frequencies used and positioning of electrodes to better evaluate efficacy.
Abstract: We review here the latest studies on efficacy of and techniques employed in radiofrequency neurotomy of the sacroiliac joint. Radiofrequency neurotomy has been shown to have limited evidence in treating sacroiliac joint syndrome. Variability in results has been attributed to individual nerve patterns, improper diagnosis, and selection of patients, as well as variability in the procedure itself. Future studies will be needed to focus on the type of radiofrequency neurotomy and positioning of electrodes to better evaluate efficacy.
TL;DR: This study will attempt to discuss pathological commonalities of low-back pain in athletes and how these can be applied to an evidence-based rehabilitation approach.
Abstract: Back pain in athletes is common. Proper management of an athlete with back pain who is trying to return to competition must take into account the probable biomechanical contributors and incorporate these into a comprehensive rehabilitation program that moves steadily forward towards defined goals. This study will attempt to discuss pathological commonalities of low-back pain in athletes and how these can be applied to an evidence-based rehabilitation approach.
TL;DR: This article reviews the reported injuries to both leisure and elite athletes in snowboarding and musculoskeletal ultrasound is an accurate and portable technology that can be used for real time, mountainside diagnoses of these injuries.
Abstract: Snowboarding has become a popular recreational and professional sport. Participants suffer a variety of injuries, especially of the extremities, that require medical evaluation. This article reviews the reported injuries to both leisure and elite athletes. To many, an injured extremity requires travel to a medical facility for accurate evaluation. Musculoskeletal ultrasound is an accurate and portable technology that can be used for real time, mountainside diagnoses of these injuries.