Intra-articular triamcinolone acetonide injection in patients with capsulitis of the shoulder: a comparative study of two dose regimens.

BACKGROUND AND PURPOSE: Although corticosteroid injections have been reported to be effective in capsulitis of the shoulder, the optimal dose has not been established. The purpose of this study was to compare relief of symptoms following a lower dose with that following a higher dose of triamcinolone acetonide given intra-articularly. SUBJECTS: Thirty-two patients were given low dose suspension; 25 patients were given high dose suspension. METHOD: Randomized, double-blind clinical trial. Each patient was given a course of three injections. Pain, sleep disturbance, functional impairment and passive range of motion (ROM) were assessed at intake and at one, three and six weeks after the initial injection. Data were analysed by independent sample t-tests and nonparametric Mann-Whitney U-tests. RESULTS: The group which received the 40 mg dose showed significantly greater improvement than the group receiving the 10 mg dose. CONCLUSIONS: The study shows that in the treatment of frozen shoulder greater symptom relief is obtained with a dose of 40 mg triamcinolone acetonide intra-articularly than with a dose of 10 mg. The effect on pain and sleep disturbance was more marked than on ROM. Intra-articular injections with triamcinolone acetonide appear to be an effective method to obtain symptom relief for patients with painful capsulitis of the shoulder.

The influence of site of stimulation, age, and gender on pain threshold in healthy children.

BACKGROUND AND PURPOSE: Factors influencing mechanical pain thresholds (MPThs) in children are not understood. Reports conflict on whether MPThs increase with age. The purposes of this study were to determine whether MPTh values change with age in children and to investigate the influence of the site of stimulation and gender. SUBJECTS: Sixty-nine children of both genders, aged 6 to 17 years, were divided into two age groups: 6 to 11 years and 12 to 17 years. METHODS: Mechanical pain thresholds were determined by applying pressure three times on both sides of the body at the elbow, wrist, knee, and ankle and paraspinally at C-6, T-1, T-3, T-6, T-10, L-1, L-3, and L-5. The influence of body site, gender, and age on MPThs was analyzed by multivariate analysis of variance. The relationship between MPThs at different sites was analyzed by correlations and factor analysis. RESULTS: There was a trend for the paraspinal MPThs to be greater the more caudally they were located. The MPThs increased with age in the paraspinal region, but they did not increase with age at the extremities. The MPThs of the male subjects did not differ from those of the female subjects. CONCLUSION AND DISCUSSION: Measurements of MPTh can be reproducibly performed in children. The level of MPThs is reliant on age and body site. In MPTh studies in children, age- and site-matched controls seem to be more relevant than gender-matched controls.

Soft-tissue compliance measurements in the spinal region of children with juvenile chronic arthritis compared with healthy children and adults.

OBJECTIVE: Study 1. To compare paraspinal soft-tissue compliance in asymptomatic (healthy) adults with children and to define reference values in children. Study 2. To determine whether the reference values in asymptomatic children differ from children with juvenile chronic arthritis (JCA). STUDY DESIGN: A tissue-pressure-compliance meter (TPCM) was used in the paraspinal region of 69 asymptomatic children, 28 asymptomatic adults and in 57 children with JCA. The tissue compliance was assessed paraspinally at level C6, T1, T3, T6, T10, L3 and L5. MAIN FINDINGS: Study 1: Differences between asymptomatic children and adults were not significant, except for the thoracolumbar junction, i.e., area T10, L1 and L3. Asymptomatic men showed a greater amount of displacement at area C6; adult asymptomatic women at area L3 and L5. The cervical and lumbar areas were shown to have the greatest amount of displacement and the thoracic area the least. Study 2. No significant differences were found between the compliance of the JCA group and the asymptomatic group, except for paraspinal area L3. CONCLUSION: Study 1. The curvature within the spinal region in adults and children may have influenced the amount of soft-tissue displacement; sexual maturation may have affected soft-tissue displacement as well. Study 2. Paraspinal soft-tissue compliance exhibited no alterations in JCA that could be segmentally related to inflamed joints.

The pain threshold in juvenile chronic arthritis.

An algometer was used to study the pain threshold (PT) on pressure at the joint capsules of the wrists, elbows, knees, ankles and at paravertebral soft tissues in 57 patients with juvenile chronic arthritis (JCA) and 69 healthy controls, aged 6-17 yr. The PTs were correlated to visual analogue scales (VAS) and values of articular disease activity, to define their relation with pain perception and joint inflammation. The PTs in JCA patients were significantly lower than in their healthy peers, both in children with active inflammation as well as in children without detectable inflammation. The JCA group with active inflammation showed significant lower PTs than without detectable inflammation. Disease activity and VAS correlated significantly with PT (r = -0.5). There is an enhanced sensitivity to noxious stimuli in all measured body areas, suggesting a change in the pain processing system in JCA. The sensitivity endures in JCA patients without clinically active disease, probably due to prolonged central sensitization after periods of active disease.

Algometry. Measuring pain threshold, method and characteristics in healthy subjects.

A pressure algometer was tested using a specially designed protocol in 28 healthy adult males and females. Two observers examined the pressure threshold (PT) of local tenderness at the joints of the wrists, elbows, knees, ankles, and at the paravertebral tissues. Several characteristics of the instrument were found. There were no significant differences in PT's between the same points on either side of the body (r = 0.738-0.934). A large source of variance was the measurement of one area within short time intervals. No significant differences in means were found between the two observers for the paravertebral points, while significant differences were found at the peripheral joints. Male subjects had significantly higher PT's than females. The PT's of the paravertebral tissues decreased in a cranial direction, while PT's of the peripheral joints showed similar levels. There was no significant influence on observing PT's on different dates or in a different order.