Frequency and Interrelations of Risk Factors for Chronic Low Back Pain in a Primary Care Setting

INTRODUCTION: Many risk factors have been identified for chronic low back pain (cLBP), but only one study evaluated their interrelations. We aimed to investigate the frequency of cLBP risk factors and their interrelations in patients consulting their general practitioners (GPs) for cLBP. METHODS: A cross-sectional, descriptive, national survey was performed. 3000 GPs randomly selected were asked to include at least one patient consulting for cLBP. Demographic, clinical characteristics and the presence of cLBP risk factors were recorded. The frequency of each cLBP risk factor was calculated and multiple correspondence analysis (MCA) was performed to study their interrelations. RESULTS: A total of 2068 GPs (68.9%) included at least 1 patient, for 4522 questionnaires analyzed. In the whole sample of patients, the 2 risk factors most commonly observed were history of recurrent LBP (72.1%) and initial limitation of activities of daily living (66.4%). For working patients, common professional risk factors were beliefs, that LBP was due to maintaining a specific posture at work (79.0%) and frequent heavy lifting at work (65.5%). On MCA, we identified 3 risk-factor dimensions (axes) for working and nonworking patients. The main dimension for working patients involved professional risk factors and among these factors, patients' job satisfaction and job recognition largely contribute to this dimension. DISCUSSION: Our results shed in light for the first time the interrelation and the respective contribution of several previously identified cLBP risk factors. They suggest that risk factors representing a "work-related" dimension are the most important cLBP risk factors in the working population

Accouchement différé dans les grossesses gémellaires et multiples (à propos d'une série multicentrique de 35 cas)

NICE-BU Médecine Odontologie (060882102) / SudocPARIS-BIUM (751062103) / SudocSudocFranceF

A new description of scapulothoracic motion during arm movements in healthy subjects.

International audienceThe participation of scapula motion in arm movement is clinically well known and recent three dimensional (3D) analyses using kinematic techniques have confirmed its importance. Scapular motion relative to the thorax has a theoretical maximum of 6 degrees of freedom (DoF), resulting from rotations at both clavicular joints (3 rotational DoF each). However, most recent kinematic studies have only analysed the 3D rotations of the scapula relative to the thorax. In the present study, the 3D translations of the barycentre of the scapula were considered in order to complete the description of movement at the shoulder complex. Eight healthy subjects performed arm elevation in the sagittal and frontal planes, simulated activities of daily living (hair combing and back washing) and maximum voluntary scapula movement (forward and backward rolling). Measurements were recorded using a 6 DoF electromagnetic device and the acromial method of analysis was used. The results showed that 3D scapular rotations and translation of its barycentre were functionally consistent for all tasks. A principal component analysis (PCA) yielded three factors, explaining 97.6% of the variance. The first two factors (protraction and shrug, according to clinical descriptions) combined rotations and translations, consistent with the hypothesis that the scapula rolls over the curved thoracic surface. The third factor related to lateral-medial rotation, thus representing rotation in the plane tangential to the thorax. The PCA suggested that scapular motion can be described using these 3 DoF. This should be studied in a larger group of individuals, including patients with pathological conditions

Disability induced by hand osteoarthritis: are patients with more symptoms at digits 2–5 interphalangeal joints different from those with more symptoms at the base of the thumb?

AbstractBackground: The contribution of osteoarthritis (OA) at the base of the thumb (BT) and digits 2–5 interphalangeal joints (IP) to disability in the hand has never been assessed.Objectives: To evaluate and compare disability in patients with clinical hand OA and more severe symptoms at BT or IP.Design: Observational, prospective, correlational.Setting: Rheumatology and rehabilitation departments in two tertiary care teaching hospitals.Participants: One hundred and sixteen patients (107 women, mean age 62±7 years) fulfilling the American College of Rheumatology criteria for OA in the hand, with more symptomatic BT (67 patients) or IP (49 patients).Main outcome measure: Disability assessment with Cochin hand functional scale (CHFS) was the primary outcome. Assessment of impairment by the visual analog scale of pain (VAS pain), Ritchie articular index (RAI), modified Kapandji index (mKI), Kallman radiological classification and handicap assessment with visual analog scale (VASHd) was the secondary outcome. Group comparisons were assessed by use of Student’s t-test for quantitative variables and Chi-square test for categorical variables. Results of the CHFS analysis were assessed by factorial analysis followed by Varimax rotation. Correlation between scores of disability, impairment, and handicap measures were calculated with use of Spearman rank correlation coefficient.Results: Demographic data, disease duration, and level of global pain were similar between the BT and IP groups. The BT and IP groups did not differ significantly according to disability and handicap level (P=0.42 and P=0.94 for CHFS total score and VASHd, respectively). Factor analysis of the CHFS revealed similar results for the two groups of patients, especially for the first extracted factor. Disability scores correlated best with global hand pain (r=0.65) in the BT group and with RAI scores (r=0.71) in the IP group.Conclusions: Disability and perceived handicap levels are comparable in clinical hand OA patients with more symptomatic BT or IP. These two groups should not be considered different during trials assessing treatments for hand OA when the primary outcome measure assesses disability

Three-dimensional scapular kinematics and scapulohumeral rhythm in patients with glenohumeral osteoarthritis or frozen shoulder.

International audienceWe aimed to describe 3D scapular kinematics and scapulohumeral rhythm (SHR) in glenohumeral (GH) osteoarthritis shoulders compared to unaffected shoulders and to compare the abnormal scapular kinematic schema for GH osteoarthritis with that for frozen shoulder. Thirty-two patients with stiff shoulder (16 with GH osteoarthritis and 16 with frozen shoulder) performed maximal arm elevation in two planes, sagittal and frontal. Scapular rotations and humeral elevation of the affected and unaffected shoulders were measured by the Polhemus Fastrak electromagnetic system. Patients with GH osteoarthritis were older, had longer disease duration (p<0.001) and less restricted humeral elevation in the frontal plane (p=0.01). Protraction was significantly lower for the affected shoulders except for arm elevation in the frontal plane in the GH osteoarthritis group. Furthermore, protraction was lower with frozen shoulder than GH osteoarthritis during arm elevation in the frontal plane. Scapular lateral rotation and SHR were significantly higher for the affected shoulders in both groups whatever the plane of elevation. SHR showed a fair to moderate negative correlation with maximal humeral elevation in both groups and appears to be higher with frozen shoulder than GH osteoarthritis. In addition, SHR of the affected shoulder showed a fair to moderate correlation with disease duration only with GH osteoarthritis. Scapular tilt did not differ between affected and unaffected sides and was not influenced by type of disease. In conclusion, the increased scapular lateral rotation described in frozen shoulder is also observed in GH osteoarthritis. SHR of the affected shoulder is inversely related to severity of limitation of shoulder range of motion, which suggests a compensatory pattern

Modified 3D scapular kinematic patterns for activities of daily living in painful shoulders with restricted mobility: a comparison with contralateral unaffected shoulders.

International audienceThere is a lack of studies of 3D scapular kinematic patterns for patients with shoulder conditions comparing affected and contralateral nonaffected shoulders during self-care activities of daily living (ADL). In this study, we compared 48 patients - 11 with glenohumeral osteoarthritis (GHOA), 20 with frozen shoulder (FS) and 17 with rotator cuff tendinopathies (RCT) - as they performed two ADL: hair combing and back washing. 3D scapular rotations and humerothoracic elevation (HTE) of the affected and contralateral nonaffected shoulders were recorded with use of a 6 degrees-of-freedom electromagnetic device. The HTE of affected and nonaffected shoulders were compared for each pathology group at rest and at the HTE used to perform the ADL: 30°, 45° and 60° of HTE for hair combing, and 30° of HT elevation for back washing. For hair combing, mean peak HTE was significantly lower for affected than nonaffected shoulders. Mean scapular lateral rotation was significantly greater at each HTE degree for GHOA and RCT groups, and mean scapular posterior tilt was significantly lower at 30° of HTE for the FS group. For back washing, mean peak HTE was lower for affected than nonaffected shoulders for the FS group only. Mean scapular medial rotation was significantly lower at 30° of HTE for the RCT group. 3D scapular kinematics appear to be specific to the shoulder pathology and to the task studied. Specific scapular kinematic patterns must be considered for appropriate therapeutic management

High-sensitivity C-reactive protein in chronic low back pain with vertebral end-plate Modic signal changes.

International audienceOBJECTIVE: To assess high-sensitivity C-reactive protein (hsCRP) level as a measure of low-grade inflammation in relation to Modic vertebral end-plate marrow signal change on magnetic resonance imaging (MRI) in patients with chronic low back pain. METHODS: All patients hospitalized for chronic low back pain in our institution were prospectively enrolled in this pilot study. Serum hsCRP concentration was measured by immunoturbidimetric assay. MR images were evaluated independently by a panel of 2 spine specialists and a radiologist. Recording of clinical parameters, MRI evaluation, and hsCRP level of each patient was blinded. RESULTS: Three groups of 12 consecutive patients (Modic 0, Modic I, and Modic II signal changes on MRI) were prospectively selected. Serum hsCRP level was significantly different in the 3 groups (P = 0.002) and especially high in the Modic I group (P = 0.002 compared with Modic 0 and II groups): mean +/- SD 1.33 +/- 0.77 mg/liter in the Modic 0 group, 4.64 +/- 3.09 mg/liter in the Modic I group, and 1.75 +/- 1.30 mg/liter in the Modic II group. The only difference in clinical parameters among the 3 groups (P = 0.001) was that the worst painful moment during the previous 24 hours occurred during the late night and morning for all Modic I patients (P = 0.001 compared with Modic 0 and P = 0.002 compared with Modic II). CONCLUSION: Low-grade inflammation indicated by high serum hsCRP level in patients with chronic low back pain could point to Modic I signal changes. This result could help physicians predict the patients with Modic I signals to more precisely prescribe the correct imaging procedure and local antiinflammatory treatment in such patients

Specific scapular kinematic patterns to differentiate two forms of dynamic scapular winging

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Kinematic analysis of the shoulder complex after anatomic and reverse total shoulder arthroplasty: A cross-sectional study

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