ABSTRACT
OBJECTIVE: To analyze whether a corticosteroid injection in combination with rehabilitation early in the course of lateral epicondylitis (LE) alters the outcome up to 6 months after injection compared with a control injection and rehabilitation. DESIGN: Randomized, controlled, double-blind study. SETTING: Sports medicine center in a tertiary care center. PARTICIPANTS: Subjects with a diagnosis of LE whose symptoms had been present less than 4 weeks were included. Subjects were recruited by word of mouth and through advertising. The 39 subjects who were recruited were 18 to 65 years old. INTERVENTIONS: 19 subjects were randomized to receive rehabilitation and a sham injection, and 20 were randomized to receive rehabilitation and a corticosteroid injection. At 4 and 8 weeks, they were reevaluated and their treatment programs were modified, if indicated. MAIN OUTCOME MEASURES: Outcome measurements were performed at baseline, 4 weeks, 8 weeks, and 6 months, and included a functional pain questionnaire and a visual analogue pain scale. Painless grip strength on the affected side and maximal grip strength bilaterally were measured at baseline, 4 weeks, and 8 weeks. RESULTS: There were no significant differences in outcome between the two groups with the exception of an improvement in the visual analogue pain scale in the corticosteroid group from 8 weeks to 6 months. Outcome measurements in both groups improved significantly over time; more than 80% of subjects reported improvements from baseline to 6 months for all scales. CONCLUSION: A corticosteroid injection does not provide a clinically significant improvement in the outcome of LE, and rehabilitation should be the first line of treatment in patients with a short duration of symptoms.
Subject(s)
Anti-Inflammatory Agents/administration & dosage , Athletic Injuries/drug therapy , Betamethasone/administration & dosage , Tennis Elbow/drug therapy , Adolescent , Adult , Aged , Anesthetics, Local/administration & dosage , Athletic Injuries/rehabilitation , Bupivacaine/administration & dosage , Cryotherapy/methods , Double-Blind Method , Exercise Therapy/methods , Female , Functional Laterality , Hand Strength , Humans , Injections, Intramuscular , Injections, Subcutaneous , Male , Middle Aged , Pain Measurement/methods , Tennis Elbow/rehabilitation , Time , Treatment OutcomeABSTRACT
OBJECTIVE: Few studies have concomitantly examined shoulder subluxation and other potential causes of shoulder pain in persons who have had a stroke. This study explores whether shoulder pain after stroke is related to shoulder subluxation, age, limitations in shoulder range of motion, and upper extremity motor impairment. METHOD: Shoulder pain was measured with a visual analog scale in 20 subjects admitted to a rehabilitation hospital within 6 weeks of onset of their first stroke. Degree of shoulder pain was correlated with vertical, horizontal, and total asymmetries of glenohumeral subluxation; age; shoulder flexion, abduction, and external rotation; and the upper extremity subscore of the Fugl-Meyer Motor Assessment. RESULTS: Shoulder pain after stroke was not correlated with age (rk = .019, p = .916); vertical (rk = .081, p = .324), horizontal (rk = .126, p = .241), or total asymmetry (rk = -.098, p = .288); shoulder flexion (rk = .049, p = .390) or abduction (rk = -.074, p = .337); or Fugl-Meyer scores (rk = -.123, p = .257). In contrast, shoulder pain was strongly correlated with degree of shoulder external rotation (rk = -.457, p = .006). CONCLUSION: These results do not support a strong relationship between shoulder subluxation and pain after stroke. Appropriate precautions should be taken to prevent range of motion limitations that may result in shoulder pain.
Subject(s)
Arthralgia/etiology , Cerebrovascular Disorders/complications , Shoulder Dislocation/complications , Shoulder Joint , Adult , Aged , Aged, 80 and over , Cerebrovascular Disorders/rehabilitation , Female , Humans , Male , Middle Aged , New Jersey , Pain Measurement , Radiography , Range of Motion, Articular , Shoulder Dislocation/diagnostic imagingABSTRACT
OBJECTIVE: Shoulder subluxation is a well-known sequela of stroke. This study quantitatively compares the reduction of shoulder subluxation using four supports: the single-strap hemisling, the Bobath roll, the Rolyan humeral cuff sling, and the Cavalier support. DESIGN/SETTING: Anteroposterior shoulder radiographs of 20 consecutive first-time stroke survivors in a freestanding rehabilitation hospital were taken within 6 weeks of stroke onset. Vertical, horizontal, and total asymmetries of glenohumeral subluxation compared with the unaffected shoulders were measured before and after fitting of each support. MAIN OUTCOME MEASURES: Group means were compared to find which supports altered subluxation asymmetries and approximated the unaffected shoulder. Individual data were tallied to detect how often each support best reduced subluxation asymmetries. RESULTS: The single-strap hemisling eliminated the vertical asymmetry of subluxation over the entire study group, but each support corrected the vertical asymmetry best in some subjects (55%, 20%, 40%, and 5%, respectively). The Bobath roll and the Cavalier support produced lateral displacements of the humeral head of the affected shoulder (p = 0.005, 0.004, respectively). The Rolyan humeral cuff sling significantly reduced total subluxation asymmetry (p = 0.008), whereas the single-strap hemisling, Bobath roll, and Cavalier support did not alter total asymmetry (p = 0.091, 0.283, 0.502, respectively). CONCLUSION: When treating shoulder subluxation, several different types of supports should be evaluated to optimize the function of the affected extremity and the reduction of the shoulder subluxation.
