Comparative study between continuous suprascapular nerve block under ultrasonic guidance, intra-articular corticosteroid injection and / or physiotherapy in relief of chronic shoulder pain

Comparison of continuous suprascapular nerve block under ultrasound guidance, intra-articular corticosteroid injection and/or physiotherapy in relieving pain and improving the range of motion in chronic shoulder pain. Fifty patients with chronic shoulder pain unresponsive to conventional treatment of at least three months duration were included in the study. Their sixty-three shoulders had first and second degrees frozen shoulder or rheumatoid arthritis. Patients who had a known allergy to the injected agents, or had such injections during last 2 months, pervious trauma or surgery to shoulder region or metabolic disorders as diabetes, thyroid disease, severe chronic airways or cardiac disease were excluded. The 63 shoulders were randomly divided into: Group I: 23 shoulders received continuous suprascapular nerve block under ultrasound guidance in addition to rehabilitation program. Group II: 20 shoulders received intra-articular injection of steroid in addition to rehabilitation program. Group III 20 shoulders received rehabilitation program alone. The patients were reviewed for pain, disability and range of movement at weeks I, 4, and 12. From weeks 1 to 12, there was marked improvement in pain score, more so in group I. Disability score showed improvement but with non-significant difference over same occasions. There was a highly significant mean change in group I versus groups II and III [p=0.001] as regard SPADIpain, disability and total SPADI score. The mean change of active movements showed highly significant difference from base line versus week 12 for all movements in group I. After 12 weeks, RA patients reported significant differences between group I as regard SPADI pain and total SPADI scores. Frozen shoulder patients showed significant difference between three groups as regard SPADI pain only. Combination of physical treatment with suprascapular nerve block is a safe and efficacious treatment for shoulder pain and stiffness in frozen and rheumatoid arthritis

Efficacy of different modalities on spasticity management of spinal cord injury: clinical and electrophysiological study

To evaluate the effectiveness of TENS [versus oral anti- spasticity drugs and physical therapy alone] on management of spinal cord injury [SCI] spasticity. Also, to study the role of the clinical and electrophysiological methods of assessment of spasticity. This study was performed on 40 patients with traumatic spinal cord injury suffering from spasticity. They were 24 males [60%] and 16 females [40%], their ages ranged from 35 to 45 years with a mean + SD of 38.9 +2.9 years. The patients were randomized into 3 treatment groups: Group[I]: included 15 patients who were taking oral anti-spasticity drugs in the form of baclofen and tizanidine and performed physical therapy program [1 session daily] for 6 weeks. Group [II]: included 15 patients who were subjected to TENS therapy applied to spastic lower limbs, lasting for 15 minutes daily and performed the same previous physical therapy program for 6 weeks. Group [III]: included 10 patients who were subjected to the same previous physical therapy program only daily for 6 weeks. Spasticity of these patients was evaluated clinically by: Lower Limb Ashworth score [LLAS], ankle clonus scale, Modified Barthel Index [MBI], and Walking Index for Spinal Cord Injury [WISCI] and electrophysiologically by: H reflex including H amplitude, H[max]/M [max] ratio and H latency. These evaluations were performed at the initial presentation and after 6 weeks of the treatment program. There was a highly significant difference [p<0.001] between the pre and post treatment assessments in group [II] in all clinical parameters and H amplitude and H [max] / M [max] ratio, the same results were obtained in group [I] except for ankle clonus scale which showed significant difference [p<0.05], while in group [III] this significant difference was shown as regards MBI, H amplitude and H [max] / M [max] ratio. There was significant difference in all clinical and electrophysiological parameters when comparing groups [II] and [III], but when comparing groups [I] and [III], this result was seen as the previous except in ankle clonus scale and MBI. But when comparing groups [I] and [II], there was non significant difference in all parameters. Also, group [I] showed significant correlation between H amplitude and all clinical parameters except WISCI [showed non significant correlation], while H max / M max ratio showed highly significant correlation between it and LLAS and significant correlation between it and ankle clonus scale and WISCI. In group [II] there were non significant correlation between both H amplitude and H max/ M max ratio and LL AS and ankle clonus scale and significant correlation between them and MBI and WISCI. But, group [III] showed significant correlation between the electrophysiological [H amplitude and H [max] / M [max] ratio] and the clinical parameters except between H max/ M max ratio and MBI, there was no significant correlation detected. TENS is an effective, economic, non- invasive and readily applicable method that has few side effects. It can be used as a supplement to other treatment methods [oral medication, TENS and physical therapy] in its management