Journal of Back and Musculoskeletal Rehabilitation - Volume 15, issue 2-3
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Journal of Back and Musculoskeletal Rehabilitation is a journal whose main focus is to present relevant information about the interdisciplinary approach to musculoskeletal rehabilitation for clinicians who treat patients with back and musculoskeletal pain complaints. It will provide readers with both 1) a general fund of knowledge on the assessment and management of specific problems and 2) new information considered to be state-of-the-art in the field. The intended audience is multidisciplinary as well as multi-specialty.
In each issue clinicians can find information which they can use in their patient setting the very next day. Manuscripts are provided from a range of health care providers including those in physical medicine, orthopedic surgery, rheumatology, neurosurgery, physical therapy, radiology, osteopathy, chiropractic and nursing on topics ranging from chronic pain to sports medicine. Diagnostic decision trees and treatment algorithms are encouraged in each manuscript. Controversial topics are discussed in commentaries and rebuttals. Associated areas such as medical-legal, worker's compensation and practice guidelines are included.
The journal publishes original research papers, review articles, programme descriptions and cast studies. Letters to the editors, commentaries, and editorials are also welcomed. Manuscripts are peer reviewed. Constructive critiques are given to each author. Suggestions for thematic issues and proposed manuscripts are welcomed.
Abstract: Although once perceived as an unimportant vestigial structure, the menisci of the knee are now known to be a common source of knee pain and disability. The medial meniscus is more vulnerable to injury to due to its intimate attachment to the medial collateral ligament. The moveable lateral meniscus is less prone to tear except when the ACL is injured. The medial and lateral menisci are usually injured as a result of sudden knee flexion with a component of knee internal or external rotation. However, older patients may present without a specific mechanism of injury as their meniscal injuries are…often due to degenerative processes. Most meniscal injuries can be diagnosed with a thorough physical examination utilizing the McMurray, Apley, and “bounce home” maneuvers. Joint line tenderness and the presence of a knee effusion aid in the diagnosis. Magnetic Resonance Imaging (MRI) has become the test of choice in confirming injury. MRI also defines the type, location, and severity of meniscal injury. Some meniscal injuries, particularly peripheral, well-vascularized tears, may be more prone to healing with nonsurgical management. Typical initial management includes reduction of swelling and pain. Rehabilitation stresses tri-planar functional retraining. The final phases of rehabilitation incorporate a functional progression to sports or work specific activities. Arthroscopic knee surgery has become a prevalent treatment method for bucket handle tears and non-vascularized meniscal injuries. Meniscal repair is currently preferred over partial menisectomy to avoid premature osteoarthritis. In sum, clinicians can return patients with meniscal pain to a high level of function with appropriate recognition of injury and functional rehabilitation.
Abstract: Skeletal muscle relaxants (SMR) are commonly used drugs prescribed for the treatment of muscle spasm and discomfort. Although many have been in use for decades, physicians may be unaware of the accumulating evidence of their risks, benefits, safety and side effects. This review examines the efficacy, side effects, and safety of three commonly prescribed SMRs: metaxalone, cyclobenzaprine, and carisoprodol. All three appear to have equal efficacy, but their side effects vary considerably. Metaxalone has the fewest reports of side effects, and no reports of major safety issues. Cyclobenzaprine, closely related to the tricyclic antidepressants, causes the expected lethargy and anticholinergic…side effects, and may have some toxicity in overdose and in combination with other substances. Carisoprodol raises the greatest concern. Reports in the literature suggest a significant potential for physical and psychological dependence perhaps suggesting a potential for misuse. It also has, perhaps, the greatest toxicity. A secondary goal of this review is to stimulate more discourse about these commonly used, but poorly understood compounds.
Abstract: Sweden has seen a sharp increase in sick-listing recently. A new rehabilitation programme was tested for patients with musculoskeletal pain applying the experiences from sports injury rehabilitation. In this programme, the danger of inactivity was emphasised, and the staff accepted that the process of restoring physical fitness may be accompanied by a temporary increase in pain. During an 11 month period, 101 patients began a 4-week rehabilitation programme. This programme was in action 5 days a week from 9AM to 4PM. Six patients broke off the programme. The remainder were called back for a follow-up 6 months later, a total…of 83 patients attending. This follow-up showed that only 22% benefit. Significantly more men than women returned to work. After rehabilitation the patients perceived better health and their living habits normalized. In patients sick-listed for long periods, an intensive period of exercise based largely on sports medicine can lead to return-to-work, also in Sweden.
Abstract: Objective: To evaluate the neurobiological effect of constant, subthreshold magnetic field exposure on symptomatic median nerve compression symptoms, neurophysiology and assess the role of placebo. Background: Conservative treatment of moderate and severe CTS has been variable and often results in surgical decompression at the wrist. Design/methods: Eight moderately symptomatic and intractable CTS hands constantly wore identical Elastomag wrist support wraps (unmagnetized vs. magnetized 350 gauss) for one month intervals. Identical wraps were then switched at the second month. Baseline assessments included the neurological exam, VAS scores for burning, numbness and tingling twice a day on a…10 point ordinal scale. CMAP/SNAP was determined at baseline and monthly intervals. Clinical follow-up at end of fourth and eighth weeks was compared to baseline. Results: The mean pain scores improved in four patients (57%) which also correlated with clinical benefit. Improvement in Tinel and Phalen sign as well as sensory changes was similarly noted. Placebo effect was detected in one patient (13%). Electrophysiological improvement in distal latencies in 5/8 hands using magnetic treatment was noted compared to no change or worsening in all placebo cases. Conclusions: Percutaneous magnetic stimulation induced palliative pain relief, presumably via modulation of the unmyelinated C-fibers. Prior studies have suggested an influence on K+ inward rectification excitability. These observations suggest that wearing magnetized wrist wraps appears to be a novel therapeutic agent. However, the underlying neuropathology tends to be progressive.
Abstract: Purpose: The purpose of this retrospective, pilot study was to assess changes in dizziness, pain and function in subjects undergoing an outpatient rehabilitation program focusing on cervical pain. Methods: Fifteen subjects with chronic cervical myofascial pain and concurrent dizziness of suspected cervical origin completed a retrospective questionnaire. Improvement in pain, dizziness and function were recorded on a visual analog scale (VAS) in response to a non-standardized rehabilitation program involving modalities, stretching, strengthening, trigger point injections and aerobic conditioning. Results: Subjects reported an average VAS improvement in dizziness of 59% (± 29), pain 69% (± 21%) and…function 71% (± 19). Seven subjects experienced reproduction of their dizziness and pain during trigger point injections. Overall, twenty seven percent reported no further episodes of dizziness. All subjects experienced a decrease in the frequency of episodes of dizziness. There was a correlation between dizziness and pain (r=0.58), dizziness and function (r=0.60), and pain and function (r=0.74). Conclusion: Subjects with dizziness and cervical myofascial pain of suspected cervical origin may experience symptomatic and functional improvement through a rehabilitative program addressing their cervical pain. Future prospective, randomized controlled studies are needed to address which intervention is the most effective.
Abstract: A case of isolated post-traumatic sciatic nerve contusion is reported, sustained after direct blunt trauma to the region of the buttock after a fall. Evaluation of this nerve injury not only included an EMG/ NCS, but also confirmatory evidence was obtained using the Minor's iodine-starch test to detect disturbances of sweat secretion. This case of sciatic nerve contusion responded to stimulator-guided local steroid injections. Cross-sectional anatomy of the sciatic nerve and various etiologies of sciatic nerve neuropathy is revisited.
Keywords: traumatic sciatic nerve contusion, Minor's iodine-starch test
Abstract: Objective: To evaluate the efficacy of pain management in a clinical pathway for rehabilitation after hip and knee arthroplasty, in which scheduled medications are rapidly tapered and prn medications are continued throughout the inpatient stay. Study design: A prospective cross-sectional study. Setting: General rehabilitation unit of a regional acute rehabilitation center. Patients: Twenty-nine patients admitted consecutively to the rehabilitation unit in three months. Outcome measures: Number of pills/day of prn pain medication, pain scores at admission and discharge, frequency of constipation and nausea, Functional Independence Measure (FIM) gain, and length of stay…(LOS). Results: For all patients, prn pain medication use was 2.4 pills/day/patient; the mean FIM gain was 22.1; and the average LOS was 9.8 days. In comparison to the Vicodin group, patients on Darvocet N-100 had significantly fewer requests for prn pain medication each day (3.1 vs. 1.1, p < 0.01), significantly better FIM gains better (18.9 vs. 24.1, p < 0.05), and fewer side effects (nausea and constipation). Conclusion: Choosing the right pain medication is imperative for achieving optimal efficiency in clinical pathways for orthopedic rehabilitation. In this pilot study, Darvocet N-100 is the preferred narcotic over codeine and its derivatives.