Complex regional pain syndrome in pediatric sports: a case series of three young athletes.

SETTING: Outpatient Sports Medicine Clinic. PATIENTS: Three adolescent young female athletes who developed clinical findings compatible with complex regional pain syndrome (CRPS) after lower extremity trauma. INTERVENTION: Based on the clinical picture, the patients were identified and treated with physical therapy, which included desensitization techniques, stress loading, edema control, early mobilization and electrical stimulation. It was combined with pharmacotherapeutic measures such as non-steroidal anti-inflamatories, oral corticosteroids and gabapentin. One of the patients required serotonin selective reuptake inhibitors, opioid analgesics and acupuncture as an adjunctive treatment. RESULTS: All three patients had involvement of the lower extremities, with a degree of pain and edema exceeding the expected for the nature of their injury. They exhibited a good response to conservative treatment, with physical therapy playing a significant role on the treatment plan. One of the patients, whose diagnosis and treatment was delayed due to late referral, had a more severe presentation and protracted recovery. CONCLUSION: CRPS is a challenging disease that may affect young active and athletic patients. In this population, early clinical suspicion and aggressive treatment may lead to excellent clinical results and the avoidance of invasive procedures or long-term disability. Laboratory and imaging studies should be used to discard other conditions with clinical presentations similar to CRPS.

Chronic lateral epicondylitis: comparative effectiveness of a home exercise program including stretching alone versus stretching supplemented with eccentric or concentric strengthening.

The objective of this study was to evaluate the effectiveness of eccentric strengthening. Ninety-four subjects (50 men) with chronic lateral epicondylitis were allocated randomly into three groups: stretching, concentric strengthening with stretching, and eccentric strengthening with stretching. Subjects performed an exercise program for six weeks. All three groups received instruction on icing, stretching, and avoidance of aggravating activities. The strengthening groups received instruction on isolated concentric and eccentric wrist extensor strengthening, respectively. At six weeks, significant gains were made in all three groups as assessed with pain-free grip strength, Patient-rated Forearm Evaluation Questionnaire, Disabilities of the Arm, Shoulder, and Hand questionnaire, Short Form 36, and visual analog pain scale. No significant differences in outcome measures were noted among the three groups. Although there were no significant differences in outcome among the groups, eccentric strengthening did not cause subjects to worsen. Further studies are needed to assess the unique effects of a more intense or longer eccentric strengthening program for patients with lateral epicondylitis.

Sensitivity of the Patient-rated Forearm Evaluation Questionnaire in lateral epicondylitis.

The purpose of this study was to examine the sensitivity, reliability, and concurrent validity of the Patient-rated Forearm Evaluation Questionnaire (PRFEQ). Reliability on three consecutive days was evaluated with 22 of 94 subjects who had chronic lateral epicondylitis (LE) and who concomitantly participated in an outcome study. The PRFEQ results were compared with results of the Visual Analogue Scale; the Disabilities of the Arm, Shoulder, and Hand questionnaire; the Medical Outcomes Study 36-Item Short Form Health Survey; and the pain-free grip strength measurement. Questionnaires were completed at baseline, six weeks, and 12 weeks. Reliability was excellent using variance components and interclass correlation coefficients (PRFEQ function subscale, 0.92; PRFEQ pain subscale, 0.96; PRFEQ total scale, 0.96). Generally, correlations were moderate between the PRFEQ subscales and total scale and the other outcome scales. Effect size and standardized response mean were good in many outcome scales, being slightly higher in the PRFEQ than in the other outcome measures. The PRFEQ is reliable, reproducible, and sensitive for assessment of LE. It is at least as sensitive to change as the other outcome tools tested. The PRFEQ should be a standard primary outcome measure in LE research.