Alaselkäkivun tutkiminen ja hoito perusterveydenhuollossa

Vertaisarvioitu• Alaselkäkipu on erittäin tavallinen vaiva, mutta hyvin harvoin taustalla on vakava syy. • Uusiutumistaipumus on vahva ja monet psykososiaaliset tekijät lisäävät alaselkäkivun pitkittymisen riskiä. Lääkärin rohkaiseva ja pelkoa vähentävä kommunikaatio on tärkeää. • Yksilölliset biopsykososiaaliset tekijät huomioiva lääkkeetön hoito on ensisijainen. Sairauslomien tulee olla lyhyitä. • Potilas on syytä ohjata herkästi fysioterapeutin arvioon

Association of Abdominal Obesity with Lumbar Disc Degeneration - A Magnetic Resonance Imaging Study

Peer reviewe

Association of Abdominal Obesity with Lumbar Disc Degeneration - A Magnetic Resonance Imaging Study

Peer reviewe

Body mass index is associated with lumbar disc degeneration in young Finnish males: subsample of Northern Finland birth cohort study 1986

Peer reviewe

Genetic susceptibility of intervertebral disc degeneration among young Finnish adults

<p>Abstract</p> <p>Background</p> <p>Disc degeneration (DD) is a common condition that progresses with aging. Although the events leading to DD are not well understood, a significant genetic influence has been found. This study was undertaken to assess the association between relevant candidate gene polymorphisms and moderate DD in a well-defined and characterized cohort of young adults. Focusing on young age can be valuable in determining genetic predisposition to DD.</p> <p>Methods</p> <p>We investigated the associations of existing candidate genes for DD among 538 young adults with a mean age of 19 belonging to the 1986 Northern Finland Birth Cohort. Nineteen single nucleotide polymorphisms (SNP) in 16 genes were genotyped. We evaluated lumbar DD using the modified Pfirrmann classification and a 1.5-T magnetic resonance scanner for imaging.</p> <p>Results</p> <p>Of the 538 individuals studied, 46% had no degeneration, while 54% had DD and 51% of these had moderate DD. The risk of DD was significantly higher in subjects with an allele G of <it>IL6 </it>SNPs rs1800795 (OR 1.45, 95% CI 1.07-1.96) and rs1800797 (OR 1.37, 95% CI 1.02-1.85) in the additive inheritance model. The role of <it>IL6 </it>was further supported by the haplotype analysis, which resulted in an association between the GGG haplotype (SNPs rs1800797, rs1800796 and rs1800795) and DD with an OR of 1.51 (95% CI 1.11-2.04). In addition, we observed an association between DD and two other polymorphisms, <it>SKT </it>rs16924573 (OR 0.27 95% CI 0.07-0.96) and <it>CILP </it>rs2073711 in women (OR 2.04, 95% CI 1.07-3.89).</p> <p>Conclusion</p> <p>Our results indicate that <it>IL6</it>, <it>SKT </it>and <it>CILP </it>are involved in the etiology of DD among young adults.</p

Degenerative findings on MRI of the lumbar spine:prevalence, environmental determinants and association with low back symptoms

Abstract Earlier studies on lumbar degenerative imaging findings in magnetic resonance imaging (MRI) have been done mainly in adult populations and the associations of degenerative findings with low back pain (LBP) are controversial. Only a few studies have involved adolescents and young adults. Heritability has been acknowledged as the only explicit risk factor of disc degeneration (DD). This study investigated the prevalence and environmental determinant of lumbar degenerative findings in MRI and their association with low back symptoms among young adults. The data were based on two physical assessments, three questionnaires and one lumbar MRI that were executed on members of the Oulu Back Study (n=558), a subsample of Northern Finland Birth Cohort 1986, between 16 and 21 years of age. Prevalences of lumbar DD (54%), bulging (25%), protrusion (18%) and Schmorl’s node (17%) were high, whereas other degenerative findings were rare among young adults. Males had higher prevalence of DD and Schmorl’s nodes than females. DD and herniations were associated with low back symptoms. On the other hand, symptoms were present among subjects without DD or other abnormal findings on MRI. Of the environmental determinants, high body mass index and MRI-based obesity measurements of visceral adiposity were associated with lumbar DD among males. Waist circumference and smoking showed a comparable association with DD among males, but the level of physical activity was not associated with DD in either gender. Low back symptoms are more common among young adults with a higher degree of DD or presence of disc herniation. Smoking and overweight are associated with lumbar DD among young male adults.Tiivistelmä Aikaisempia tutkimuksia magneettikuvantamisella (MK) todetuista lannerangan rappeumamuutoksista ja niiden yhteyksistä alaselkäkipuun on tehty lähinnä aikuisväestöllä ja tulokset ovat ristiriitaisia. Vain muutamia tutkimuksia on tehty alle 25-vuotiailla. Välilevyrappeuman mahdollisista riskitekijöistä vain perimästä on vahvaa näyttöä. Tässä tutkimuksessa tarkasteltiin MK:lla todettujen lannerangan rappeumamuutosten esiintyvyyttä, niihin vaikuttavia ympäristötekijöitä ja yhteyttä alaselkäoireisiin nuorilla aikuisilla. Tutkimuksen aineisto perustui kahteen kliiniseen tutkimukseen, kolmeen kyselyyn ja yhteen MK:een, jotka toteutettiin Pohjois-Suomen syntymäkohortti 1986:een kuuluville Oulun selkätutkimuksen koehenkilöille (n=558) 16-21 vuoden iässä. Lannerangan välilevyrappeumalla (54 %), välilevyn pullotuksilla (bulge; 25 %), sellaisilla välilevyn pullistumilla jotka eivät läpäisseet selkärangan takimmaista pitkittäissidettä (protruusio; 18 %) sekä päätelevyn läpi suuntautuvilla välilevyn pullistumilla (Schmorlin keräset; 17 %) oli korkea esiintyvyys nuorilla aikuisilla, kun taas muut kuvantamislöydökset olivat harvinaisia. Välilevyrappeuma ja Schmorlin keräset olivat yleisempiä miehillä. Sekä välilevyrappeuma että pullistumat olivat yhteydessä alaselkäoireisiin molemmilla sukupuolilla, mutta kaikilla oireisilla ei todettu poikkeavia löydöksiä MK:ssa. Ympäristötekijöistä korkea kehon painoindeksi ja MK:sta mitatut rasvan määrää mittaavat muuttujat olivat miehillä yhteydessä välilevyrappeumaan. Miehillä vyötärönympärys ja tupakointi olivat heikommin yhteydessä välilevyrappeumaan, kun taas liikunta-aktiivisuus ei ollut kummallakaan sukupuolella yhteydessä rappeumaan. Alaselkäoireet ovat yleisempiä nuorilla aikuisilla, joilla on vaikea-asteisempi välilevyrappeuma tai välilevyn pullistuma. Tupakointi ja ylipaino ovat yhteydessä lannerangan välilevyrappeumaan nuorilla aikuisilla miehillä

Bursiitit:diagnostiikka ja hoito

Tiivistelmä Syvät limapussit ovat synnynnäisiä rakenteita, kun taas pinnalliset bursat kehittyvät kuormituksen ­seurauksena. Pinnallisten infektiivisten bursiittien hoitona on ripeä antibioottihoidon aloitus limapussin punktion ja ­bakteeriviljelyn jälkeen. Pinnallisten inflammatoristen bursiittien hoitona on punktio ja lepo. Kuormitusperäisiin syviin bursiitteihin käytetyt kortikosteroidi-injektiot voivat lievittää oireita, ­mutta niistä ei ole pitkävaikutteista hyötyä. Syvissä bursiiteissa tulee huomioida usein taustalla vaikuttava lisääntynyt tai poikkeava epäsuora ­mekaaninen kuormitus, tarvittaessa kuntoutuksen avulla.English summary Diagnosis and treatment of bursitis A bursa is a structure that reduces friction between soft tissues and bony structures. Bursitis can be either aseptic or septic. Aseptic bursitis is more frequent. Septic bursitis occurs mainly in superficial bursae. Infection in deep bursae is less frequent. The diagnosis of superficial bursitis is fairly straightforward based on clinical examination, but imaging can be useful in some cases. Treatment consists of aspiration of the bursa and relative rest. The diagnosis of deep bursitis is more challenging and ultrasound or magnetic resonance imaging can be helpful in reaching the diagnosis. Indirect mechanical loading is a common contributing factor in deep bursitis, and tendinopathy findings are frequent in adjacent tendons. The treatment in the acute phase consists of relative rest and medication. However, when aiming for long-term effects, improvement in the loading tolerance of the bursa and the loading capacity of the adjacent tendons should be targeted in rehabilitation. Corticosteroid injections can be useful in the short-term, but they do not have any long-term benefit and, thus, the use of injections should be considered carefully. Surgery is required infrequently

Intra- and inter-rater reliability of thoracic spine mobility and posture assessments in subjects with thoracic spine pain

Background: The thoracic spine (TS) has been neglected in the study of the spine despite its essential role in the stability and posture of the entire spinal complex. Therefore, there is an inevitable need to investigate the reproducibility of different thoracic spinal posture measures used in subjects with TS pain. Methods: Thirty-two subjects (16 females and 16 males, mean age 39 years) were evaluated by two physiotherapists on the same day to gauge inter-rater reliability and on two consecutive days to gauge intra-rater reliability. TS posture was assessed by observation, and thoracic spine mobility was measured by manual assessment of segmental flexion and extension mobility in a seated position. Additionally, posterior-to-anterior accessory mobility in a prone position was assessed manually. Moreover, cervicothoracic flexion in a seated position, thoracic posture, and thoracic flexion and extension mobility in a standing position were assessed with a tape measure, and flexion and extension mobility in a seated position and TS posture in seated and standing positions were measured with an inclinometer. The intraclass correlation coefficient (ICC), standard error of measurement (SEM), mean difference (MD), Bland-Altman (B&A) plot features and coefficient of repeatability (CR) were calculated. Results: The mean and standard deviation (SD) of the duration of TS pain was 22 (SD 45) months, with the intensity of pain being rated at 27 (SD 21) mm on a visual analogue scale (VAS). Intra-rater reliability was very strong (ICC ≥ 0.80) for the evaluation of seated and standing upper TS posture, standing whole TS posture and seated lower TS posture with an inclinometer. Moreover, TS posture evaluation with a measuring tape, posture inspection in a seated position, and manual assessment of segmental extension were found to have very strong intra-rater reliability. Inter-rater reliability was very strong for inclinometer measurements of standing and seated upper TS posture as well as standing whole TS posture. Conclusion: Intra-rater reliability was higher than inter-rater reliability in most of the evaluated measurements. Overall, posture measurements with an inclinometer were more reliable than mobility measurements with the same instrument. The manual assessments can be used reliably when same evaluator performs the examination.peerReviewe

Lower thoracic spine extension mobility is associated with higher intensity of thoracic spine pain

Objectives: To evaluate the association of thoracic spine (TS) posture and mobility with TS pain. Methods: Participants with TS pain reported maximum, average, and night pain in TS area, and pain summary score was calculated. Upright and sitting TS postures were evaluated by inspection. TS posture and mobility (flexion and extension) were recorded using an inclinometer and a tape measure, respectively. Correlations between posture and mobility assessments were calculated using Spearman rank correlation, the association of TS posture and mobility with TS pain by logistic regression analysis. Results: The participants’ (n = 73, 52 females, age range 22–56) TS pain duration was 12 weeks on average. The correlations for measurements of TS posture and flexion mobility were higher than correlations of other TS measurements being between 0.53 and 0.82. Decreased extension mobility of the upper (from 1st to 6th TS segments; Th1–Th6) TS was associated with higher worst pain (OR 1.04, 95% CI 1.00–1.07) and whole TS with pain sum score (OR 1.05, 95% CI 1.01– 1.08). Less kyphotic whole TS was associated with lower pain sum score (OR 0.96, 95% CI 0.92– 1.00). Greater flexion mobility of upper and lower (Th6–Th12) TS were associated with lower pain sum score (OR 0.96, 95% CI 0.91–1.00, and OR 0.96, 95% CI 0.91–1.00, respectively). Conclusions: Reduced thoracic extension mobility was associated with higher pain scores and the greater flexion mobility with lower pain scores. Future research is warranted to evaluate if treatments geared toward TS extension mobility improvements would result in lower TS pain.peerReviewe