Are Passive Physical Modalities Effective for the Management of Common Soft Tissue Injuries of the Elbow?: A Systematic Review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

OBJECTIVE: To evaluate the effectiveness of passive physical modalities for the management of soft tissue injuries of the elbow. METHODS: We systematically searched MEDLINE, EMBASE, CINAHL, PsycINFO, and Cochrane Central Register of Controlled Trials from 1990 to 2015. Studies meeting our selection criteria were eligible for critical appraisal. Random pairs of independent reviewers critically appraised eligible studies using the Scottish Intercollegiate Guidelines Network criteria. We included studies with a low risk of bias in our best evidence synthesis. RESULTS: We screened 6618 articles; 21 were eligible for critical appraisal and 9 (reporting on 8 randomized controlled trials) had a low risk of bias. All randomized controlled trials with a low risk of bias focused on lateral epicondylitis. We found that adding transcutaneous electrical nerve stimulation to primary care does not improve the outcome of patients with lateral epicondylitis. We found inconclusive evidence for the effectiveness of: (1) an elbow brace for managing lateral epicondylitis of variable duration; and (2) shockwave therapy or low-level laser therapy for persistent lateral epicondylitis. DISCUSSION: Our review suggests that transcutaneous electrical nerve stimulation provides no added benefit to patients with lateral epicondylitis. The effectiveness of an elbow brace, shockwave therapy, or low-level laser therapy for the treatment of lateral epicondylitis is inconclusive. We found little evidence to inform the use of passive physical modalities for the management of elbow soft tissue injuries.

The effectiveness of passive physical modalities for the management of soft tissue injuries and neuropathies of the wrist and hand: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) collaboration.

OBJECTIVE: The purpose of this systematic review was to determine the effectiveness of passive physical modalities compared to other interventions, placebo/sham interventions, or no intervention in improving self-rated recovery, functional recovery, clinical outcomes and/or administrative outcomes (eg, time of disability benefits) in adults and/or children with soft tissue injuries and neuropathies of the wrist and hand. METHODS: We systematically searched MEDLINE, EMBASE, PsycINFO, and the Cochrane Central Register of Controlled Trials, accessed through Ovid Technologies, Inc, and CINAHL Plus with Full Text, accessed through EBSCO host, from 1990 to 2015. Our search strategies combined controlled vocabulary relevant to each database (eg, MeSH for MEDLINE) and text words relevant to our research question and the inclusion criteria. Randomized controlled trials, cohort studies, and case-control studies were eligible. Random pairs of independent reviewers screened studies for relevance and critically appraised relevant studies using the Scottish Intercollegiate Guidelines Network criteria. Studies with low risk of bias were synthesized following best evidence synthesis principles. RESULTS: We screened 6618 articles and critically appraised 11 studies. Of those, 7 had low risk of bias: 5 addressed carpal tunnel syndrome (CTS) and 2 addressed de Quervain disease. We found evidence that various types of night splints lead to similar outcomes for the management of CTS. The evidence suggests that a night wrist splint is less effective than surgery in the short term but not in the long term. Furthermore, a night wrist splint and needle electroacupuncture lead to similar outcomes immediately postintervention. Finally, low-level laser therapy and placebo low-level laser therapy lead to similar outcomes. The evidence suggests that kinesio tape or a thumb spica cast offers short-term benefit for the management of de Quervain disease. Our search did not identify any low risk of bias studies examining the effectiveness of passive physical modalities for the management of other soft tissue injuries or neuropathies of the wrist and hand. CONCLUSIONS: Different night orthoses provided similar outcomes for CTS. Night orthoses offer similar outcomes to electroacupuncture but are less effective than surgery in the short term. This review suggests that kinesio tape or a thumb spica cast may offer short-term benefit for the management of de Quervain disease.

Is bone tenderness, as measured by manual algometry, associated with vitamin D deficiency?

OBJECTIVE: To explore the relationship between serum 25-hydroxycholecalciferol (25[OH]D3) and pressure-pain thresholds, as measured by algometer, in advance of a main study to determine whether PPT is a potentially cost-effective proxy measure of 25[OH]D3 status in the general population. METHODS: The cross-sectional pilot study involved a convenience sample of twenty-two subjects (10 males, 12 females), aged 18 to 67 years. All subjects consented to three trials of pressure-pain threshold readings on both tibiae and the manubrium. Serum 25[OH]D3 levels were determined from blood samples drawn post-algometry. RESULTS: The average pressure pain thresholds were 14.92 (±6.03), 15.07(±6.07), 11.10 (±6.68) for the left and right tibia and sternum, respectively. The stability between the measurements was very high with the interclass correlation coefficient (95% CI) calculated as 0.94 (0.62-1.00), 0.9 (0.81-1.00), 0.96(0.93-1.00). The Pearson correlation coefficients were 0.03 for the left tibia, 0.17 for the right tibia and 0.20 for the sternum, J Dresser, M MacIntyre, B Chisholm, GE Lawson showing a negligible correlation for the left and right tibia, but a low positive correlation for the sternum. CONCLUSION: We did not find preliminary evidence of a strong or otherwise clinically meaningful correlation between bone tenderness and manual algometry in this pilot study. Only a weak linear relationship between PPT in the sternum and serum 25[OH]D3 concentrations was found. Replication of this study is warranted in larger and more representative study populations of interest. Discussion on a number of feasibility issues is provided to inform those future studies.

OBJECTIF: Étudier la relation entre le taux sérique de 25-hydroxycholécalciférol (25 [OH] D3) et les seuils de tolérance à la pression, tels que mesurés par un algésimètre, en préparatif d'une étude principale pour déterminer si le STP pourrait être une mesure de remplacement économique de l'état de 25[OH]D3 dans la population générale. MÉTHODOLOGIE: L'étude pilote transversale a porté sur un échantillon pratique de vingt-deux sujets (10 hommes, 12 femmes), âgés de 18 à 67 ans. Tous les sujets ont consenti à trois essais lecture des seuils de tolérance à la pression sur le tibia et le manubrium. Les taux sériques de 25[OH]D3 ont été déterminés à partir d'échantillons de sang prélevés après la mesure par l'algésimètre. RÉSULTATS: Les seuils moyens de tolérance à la pression étaient 14,92 (±6,03), 15,07(±6,07), 11,10 (±6,68) pour respectivement les tibias gauche, droit et le sternum. La stabilité entre les mesures était très élevée avec le coefficient de corrélation interclasse (IC à 95 %) calculée comme 0,94 (0,62 à 1,00), 0,9 (0,81 à 1,00), 0,96 (0,93 à 1,00). Les coefficients de corrélation de Pearson ont été de 0,03 pour le tibia gauche, 0,17 pour le tibia droit et 0,20 pour le sternum, montrant une corrélation négligeable pour les tibias gauche et droit, mais une faible corrélation positive pour le sternum. CONCLUSION: Nous n'avons pas relevé dans cette étude pilote des preuves préliminaires d'une corrélation forte ou cliniquement significative entre la sensibilité des os et l'algométrie manuelle. Seule une faible relation linéaire entre le SPT dans le sternum et les taux sériques de 25[OH]D3 a été constatée. Une reproduction de cette étude est recommandée dans de plus grandes populations cibles qui seraient plus représentatives. Une discussion portant sur plusieurs questions de faisabilité est offerte pour renseigner ces futures études.