analysis of two months effects of muscle stretching. Immediately following injection of methyl prednisolon in the treatment of trigger points patients

Trigger points have been described as causing pain in clinical practice and are a common source of musculoskeletal pain. Trigger point injection can effectively inactivate the trigger points and provide symptomatic relief. Efficacy of injection in the treatment of trigger points depends strongly on the technique of trigger point injection. This study compares muscle stretching immediately after injection of methyl prednisolon vs. injection without stretching in the treatment of trigger points. Patients with trigger point pain in the gluteal muscles were recruited using strict inclusion and exclusion criteria from Shiraz Medical School Clinic. Subjects under went two office visits and two phone follow-ups. All patients received injection of lidocaine and methyl prednisolon. In group A, injection was without stretching. In group B, stretching of muscle was done immediately after injection. Evaluation measure tools were 0-10 NRS, VAS and BPI. In respect to VAS, there was a significant statistical difference between both groups one month following injection. In respect to NRS, there was a significant statistical difference between both groups 1 month and 2 months after injection. However, there was no significant statistical difference between both groups in all measurement aspect of BPI, except mood. Muscle stretching immediately after injection was more effective up to two months, than without muscle stretching in the symptomatic treatment of gluteal trigger points

[Prevalence of shoulder pain after stroke and associated factors]

Shoulder pain is a common complication of stroke that can cause some rehabilitation limits to achieve functional goals. The information about its prevalence and associated factors is limited. This study was conducted to detect more details about its associated factors. This study was performed on 191 stroke patients at Physical Medicine and Rehabilitation ward at Shiraz-Medical School from 2001 to 2004. Each patient was followed up for one year. A questionnaire was prepared containing information about shoulder pain compliant, thorough history and physical examination previous history of open heart surgery, scoliosis, limited neck range of motion, type of stroke [based on MRI and brain CT], osteoporosis [based on bone mineral density and X ray], shoulder adductor muscles and biceps spasticity [based on ashworth scale]. In the follow-up visits bi-monthly for one year, the questionnaire was filled out again and if present, shoulder pain was recorded. Most patients developed shoulder pain between 2 and 6 months following their stroke. Forthy-nine patients [32.2%] developed shoulder pain, 39[79.6%] of whom had spastic tone and 8 [16.3%] had flaccid tone. In both groups, with shoulder pain and without shoulder pain respectively, 6.7% and 1.9% had a history of open heart surgery, 6.1% and 1% had scoliosis, 67.3% and 35.1% had Intracranial hemorrhage, 73.5% and 23.3% had limited neck range of motion and 24.5% and 35% had osteopenia. Spasticity was significantly more common in the shoulder pain group, which can be due to capsulitis, soft tissue inflammation [especially ligament and rotator cuff muscle] and anteroinferior subluxation of the shoulder. There was a significant statistical correlation between Intracranial hemorrhage, reduced neck range of motion, and hemiplegic shoulder pain. It appears that treatment and rehabilitation of spasticity and underlying cervical area problems are helpful in preventing hemiplegic shoulder pain