Effect of Treatment on Trigger Points

Patients with muscle pain complaints commonly are seen by clinicians treating pain, especially pain of musculoskeletal origin. Myofascial trigger points merit special attention because its diagnosis requires examinations skills and its treatment requires specific techniques. If undiagnosed, the patients tend to be overinvestigated and undertreated, leading to chronic pain syndrome. Patients with myofascial pain syndrome present primarily with painful muscle(s) and restricted range of motion of the relevant joint. Palpable painful taut bands are named trigger points and are the main and pathognomonic finding on physical examination. Eliciting local twitch response and referred pain requires experience and examination skills. It may be useful to classify the patient as having acute or chronic, and as having primary or secondary, myofascial pain so the decision on the details of treatment can be curtailed to the needs of each patient. Effective treatment modalities are local heat and cold, stretching exercises, spray-and-stretch, needling, local injection, and high-power pain threshold ultrasound

The Effect of High-Power Pain Threshold Ultrasound Therapy on the Electrical Activity of Trigger Points and Local Twitch Response on Electromyography: A Preliminary Study

Objectives: We aimed to compare the effects of the high-power pain threshold ultrasound [HPPTUS] technique and needling on the spontaneous electrical activity [SEA] of trigger points [TrPs], local twitch response [LTR], and clinical improvement in myofascial pain syndrome. Methods: Twenty female patients presenting with acute TrPs on their upper trapezius muscles were included in this study. The patients were randomly assigned into two groups. The cases in the study group underwent HPPTUS technique and active stretching of the muscle. The cases in the control group underwent dry needling done by five adjacent electromyography [EMG] needle penetrations on the TrP [dry needling and analysis done concurrently] and did active stretching. Number of points where SEA observed were recorded. Visual analog scale [VAS], range of motion [ROM] measurement during contralateral flexion of the cervical spine, and the number of LTR were recorded. Results: Significant improvements were measured in both groups in terms of pain level and cervical ROM [P 0.05]. There were no statistically significant changes in the number of recorded SEA of both groups at the end of the treatment. However, significant reduction in the number of LTR in the HPPTUS group was found [P = 0.015]. When the two groups were compared regarding level, patients in the study group reported significantly more reduction in pain [P = 0.009]. However, there was no difference in the cervical ROM improvement between two groups [P = 0.136]. Conclusions: The HPPTUS technique combined with exercise was found to be more effective in reducing the LTRs when compared with dry needling combined with exercise

Validation of Duruoz Hand Index in patients with tetraplegia

Study design: Cross-sectional, clinical measurement

The sensitivity and specificity of the slump and the straight leg raising tests in patients with lumbar disc herniation

Background: An accurate and specific diagnosis prevents the recurrences of low back pain and chronic spinal pain. The physical examination is the most useful tool to diagnosis. The examiner must aim to determine the exact tissue that pain arises from to make the specific diagnosis. Lumbar disc herniation is I disease that physical examination, symptoms, and findings on imaging technique do not always correlate with each other. The Straight Leg Raising (SLR) test has been used as the primary test to diagnosis lumbar disc herniations and found to have high correlation with findings on operation since its sensitivity is high in only disc herniations leading to root compression that may eventually need operation. More sensitive test, like the Slump, might be used in herniations in which the SLR is negative. The Slump test is really a variant of the SLR and the Lasegue's tests performed in the seated position and is a progressive series of maneuvers designed to place the sciatic nerve roots under increasing tension. At each step in the procedure, the patient informs the examiner what is being felt and whether radicular pain is produced. As a result, the Slump test applies traction to the nerve roots by incorporating spinal and hip joint flexion into the leg raising and would warn the examiner of the presence of nerve root compression when there is a negative SLR test

Comparison of High-Power Pain Threshold Ultrasound Therapy With Local Injection in the Treatment of Active Myofascial Trigger Points of the Upper Trapezius Muscle

Unalan H, Majlesi J, Aydin FY, Palamar D. Comparison of high-power pain threshold ultrasound therapy with local injection in the treatment of active myofascial trigger points of the upper trapezius muscle. Arch Phys Med Rehabil 2011;92:657-62

Clinical evaluation during the acute exacerbation of knee osteoarthritis: the impact of diagnostic ultrasonography

We aimed to investigate (1) the probable correlation between clinical and ultrasonographic findings in chronic painful primary knee OA patients referred with acute flare-ups and (2) the impact of diagnostic ultrasonography (US) to determine the real source of pain in these patients. We included 100 patients consecutively who were admitted to our outpatient unit with a pain complaint on a single knee with the diagnosis of primary knee OA according to the ACR criteria. The control group consisted of the patients with pain-free knees at least during the last month, who were already included in the study group. The sonographic evaluation of the knee was performed by a physician who was blinded to the clinical evaluation and/or the physical and radiological evaluations. In the present study, sonographic findings were significantly more observed on the painful knees (p < 0.001). The most commonly encountered findings on the symptomatic knees were the suprapatellar effusion (55 %), the baker cyst (25 %), and the pes anserine bursitis. The distribution of the findings on the asymptomatic knees was as follows: 22 %, the suprapatellar effusion and 5 %, the Baker cyst. Effusion was detected in 55 % of the painful knees of our patients with knee OA. This finding was statistically significant compared to the painless knees of the subjects included. The results of our study also showed that there was a significant relation between the Kellgren-Lawrence grading and the frequency of suprapatellar effusion on US examination (p = 0.026). It was concluded that in chronic, primary, painful knee osteoarthritis, US is a valuable diagnostic method in the confirmation of synovitis and/or the inflammatory episode in spite of the absence of obvious clinical parameters. In advanced osteoarthritis, when we consider that the inflammatory episodes are expected findings, the early confirmation of the inflammation on US may be particularly valuable in the clinical setting

Comparison of colony performances of Anatolian, Caucasian and Carniolan honeybee (Apis mellifera L.) genotypes in temperate climate conditions

WOS: 000343702100024This study was carried out to determine the performances of Mugla and Nigde ecotypes (A. m. anatoliaca), Caucasian (A. m. caucasica) and Carniolan (A. m. carnica) honeybee genotypes in the region of central Anatolia conditions. A total of 40 colonies (each genotype group consisted of 10 colonies) were used in the study. All queens were reared at the same time and in the same apiary and were instrumentally inseminated. The average numbers of combs covered with bees were found to be 11.24 +/- 0.59, 9.51 +/- 0.42, 8.11 +/- 0.31 and 12.38 +/- 0.72 per colony respectively; the average brood areas were found to be 2825.0 +/- 240.3, 2160.6 +/- 176.8, 1701.9 +/- 129.7 and 2883.0 +/- 104.4 cm(2) per colony respectively; and the average honey yields were found to be 28.60 +/- 0.88, 15.40 +/- 0.69, 23.40 +/- 0.54 and 31.60 +/- 1.12 kg per colony in Mugla ecotype, Nigde ecotype, Caucasian and Carniolan genotypes respectively. The mean differences among the genotypes for number of combs with bees, brood area and honey yield were significant (P<0.01). These results showed that the Carniolan genotype had the best performance and Nigde ecotype had the lowest performance in temperate climate conditions. Therefore, productivity of the Nigde ecotype can be increased by a crossbreeding programme with Carniolan and Mugla genotypes

Skin thickness on bony prominences measured by ultrasonography in patients with spinal cord injury

Objective: The detailed assessment of soft tissues over bony prominences and identification of methods of predicting pressure sores would improve the quality of care for patients with spinal cord injury (SCI). Comparing skin thicknesses on bony prominences in patients with SCI to those in healthy individuals will represent, to our knowledge, the first study aimed at determining whether differences in skin thicknesses between these groups can be detected by ultrasound

Intraosseous Lipoma of the Ilium

We report a case of intraosseous lipoma of the ilium which to the best of our knowledge, has a very rare incidence. Intraosseous lipoma of bone itself has an incidence of approximately 1/1000 among all bone tumors. The most commonly involved sites are metaphyseal or epiphyseal regions of long bones such as femur, tibia, fibula, and calcaneus. First case of intraosseous lipoma involving the ilium was reported in 1988 and although the exact incidence is not known, based on the literature survey, we can suggest that this bone still seems to be among the least commonly involved bones by this tumor in humans