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.

Challenges surrounding return-to-play (RTP) for the sports clinician: a case highlighting the need for a thorough three-step RTP model.

Return-to-play (RTP) is a multifactorial process of retuning an injured athlete back to competition when risk for re-injury is minimized. Traditionally, these decisions are made by medical practitioners based on experience or anecdotal evidence. RTP decisions continue to be a challenging task for the medical practitioner. In the interest of advancing sports medicine for the betterment of athletes, improving the RTP decision-making process with a new paradigm has been suggested.1 It stands to clarify the intricacies used by clinicians when making RTP decisions by providing insight into the multiple factors that must be considered; not only by the athlete and medical practitioner, but all relevant parties (i.e., coaches, trainers, and organizations). This case describes a 19-year-old Ontario Junior Hockey League (OJHL) player who fractured his left clavicle during game play and consequently, suffered a more severe injury to the same clavicle 5½ weeks later by returning to competition against medical advice. This case highlights the potential issues that present when a RTP protocol is poorly executed and addresses the need to adopt a thorough decision-based RTP model proposed by Creighton et al.1 Further, the discussion will draw on current literature and issues surrounding RTP, and the potential legal implications associated with premature return to competition. Given the lack of consensus among sport medicine experts in regards to RTP criteria, the presented model stands to provide a pivotal framework upon which future research can be conducted, while improving the current criteria in place when returning an athlete to competition to aid medical practitioners.

Le retour au jeu (RTP) est un processus multifactoriel du retour d'un athlète blessé à la compétition lorsque les risques d'une nouvelle blessure ont été réduits. D'habitude, ces décisions sont prises par des médecins selon leur expérience ou des données empiriques. Les décisions relatives au RTP continuent d'être une tâche difficile pour le médecin. Dans l'intérêt de l'avancement de la médecine sportive pour le mieux-être des athlètes, l'amélioration du processus décisionnel relatif au RTP avec un nouveau paradigme a été suggérée1. Cela vise à clarifier les subtilités auxquelles ont recours les cliniciens dans leur prise de décision relative au RTP en offrant un aperçu des multiples facteurs qui doivent être tenus en compte non seulement par l'athlète et le médecin, mais aussi par toutes les parties concernées (c.-à-d. les entraîneurs et les organisations). Ce cas décrit un joueur du Ligue de hockey junior de l'Ontario (OJHL) de 19 ans qui a fracturé la clavicule gauche pendant le jeu et a subi une blessure plus grave à la même clavicule 5½ semaines plus tard lorsqu'il est retourné à la compétition contre l'avis médical. Ce cas met en évidence les problèmes potentiels qui se posent lorsqu'un protocole RTP est mal appliqué et répond à la nécessité d'adopter un modèle RTP décisionnel proposé par Creighton et autres1. En outre, on y discute des publications scientifiques actuelles et des questions entourant le RTP, ainsi que les conséquences juridiques potentielles associées à un retour prématuré à la compétition. Compte tenu de l'absence de consensus parmi les experts en médecine sportive en ce qui concerne les critères du RTP, le modèle présenté vise à offrir un cadre essentiel à partir duquel des recherches futures peuvent être menées, tout en améliorant les critères actuels dans la décision du retour de l'athlète à la compétition pour aider les médecins.

The effectiveness of manual therapy for the management of musculoskeletal disorders of the upper and lower extremities: a systematic review by the Ontario Protocol for Traffic Injury Management (OPTIMa) Collaboration.

BACKGROUND: Musculoskeletal disorders (MSDs) of the upper and lower extremities are common in the general population and place a significant burden on the health care system. Manual therapy is recommended by clinical practice guidelines for the management of these injuries; however, there is limited evidence to support its effectiveness. The purpose of our review was to investigate the effectiveness of manual therapy in adults or children with MSDs of the upper or lower extremity. METHODS: Randomized controlled trials (RCTs), cohort studies, and case-control studies evaluating the effectiveness of manual therapy were eligible. We searched MEDLINE, EMBASE, PsycINFO, CINAHL, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired 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. Where available, we computed mean changes between groups, relative risks and 95 % CI. RESULTS: We screened 6047 articles. Seven RCTs were critically appraised and three had low risk of bias. For adults with nonspecific shoulder pain of variable duration, cervicothoracic spinal manipulation and mobilization in addition to usual care may improve self-perceived recovery compared to usual care alone. For adults with subacromial impingement syndrome of variable duration, neck mobilization in addition to a multimodal shoulder program of care provides no added benefit. Finally, for adults with grade I-II ankle sprains of variable duration, lower extremity mobilization in addition to home exercise and advice provides greater short-term improvements in activities and function over home exercise and advice alone. No studies were included that evaluated the effectiveness of manual therapy in children or for the management of other extremity injuries in adults. CONCLUSIONS: The current evidence on the effectiveness of manual therapy for MSDs of the upper and lower extremities is limited. The available evidence supports the use of manual therapy for non-specific shoulder pain and ankle sprains, but not for subacromial impingement syndrome in adults. Future research is needed to determine the effectiveness of manual therapy and guide clinical practice. SYSTEMATIC REVIEW REGISTRATION NUMBER: CRD42014009899.

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.

The effectiveness of exercise for the management of musculoskeletal disorders and injuries of the elbow, forearm, 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 evaluate the effectiveness of exercise compared to other interventions, placebo/sham intervention, or no intervention in improving self-rated recovery, functional recovery, clinical, and/or administrative outcomes in individuals with musculoskeletal disorders and injuries of the elbow, forearm, wrist, and hand. METHODS: We searched MEDLINE, EMBASE, CINAHL, PsycINFO, and the Cochrane Central Register of Controlled Trials from 1990 to 2015. Paired reviewers independently screened studies for relevance and assessed the risk of bias using the Scottish Intercollegiate Guidelines Network criteria. We synthesized the evidence using the best evidence synthesis methodology. RESULTS: We identified 5 studies with a low risk of bias. Our review suggests that, for patients with persistent lateral epicondylitis, (1) adding concentric or eccentric strengthening exercises to home stretching exercises provides no additional benefits; (2) a home program of either eccentric or concentric strengthening exercises leads to similar outcomes; (3) home wrist extensor strengthening exercises lead to greater short-term improvements in pain reduction compared to "wait and see"; and (4) clinic-based, supervised exercise may be more beneficial than home exercises with minimal improvements in pain and function. For hand pain of variable duration, supervised progressive strength training added to advice to continue normal physical activity provides no additional benefits. CONCLUSION: The relative effectiveness of stretching vs strengthening for the wrist extensors remains unknown for the management of persistent lateral epicondylitis. The current evidence shows that the addition of supervised progressive strength training does not provide further benefits over advice to continue normal physical activity for hand pain of variable duration.

Meniscal allograft transplant in a 16-year-old male soccer player: A case report.

Meniscal allograft transplantation (MAT) is a relatively new procedure that has gained popularity in the last couple of decades as a possible alternative to a meniscectomy to provide significant pain relief, improve function, and prevent the early onset of degenerative joint disease (DJD). As of present, evidence is limited and conflicting on the success of such procedures. In this case, a 16-year old male athlete underwent numerous surgical procedures to correct a left anterior cruciate ligament (ACL) rupture with associated medial and lateral meniscal damage that occurred as a result of a non-contact mechanism of injury. Following multiple procedures, including repair of both menisci and follow-up partial meniscectomy of the lateral meniscus, the patient continued to experience symptoms on the left lateral knee, making him a candidate for MAT. This case is used to highlight what a MAT is, what makes someone a candidate for this type of procedure, the current evidence surrounding the success of this intervention, and some rehabilitation considerations following surgery. The role of chiropractors and primary clinicians is to ensure that young athletes undergo early intervention to offset any degenerative changes that would be associated with sustained meniscal lesions.

L'allogreffe méniscale (AM) est une procédure relativement nouvelle qui s'est répandue au cours des dernières décennies comme une solution de remplacement possible à une méniscectomie afin de soulager de façon significative la douleur, d'améliorer la fonction, et d'empêcher l'apparition précoce de l'arthrose. À l'heure actuelle, il y a peu de données probantes, qui sont d'ailleurs contradictoires, sur le succès de ces procédures. Dans ce cas, un athlète de 16 ans a subi de nombreuses interventions chirurgicales pour corriger la rupture d'un ligament croisé antérieur (LCA) gauche ainsi que les lésions associées au ménisque médial et latéral qui se sont produites à la suite d'un mécanisme de blessure sans contact. Après plusieurs procédures, y compris la réparation des deux ménisques suivie d'une méniscectomie partielle du ménisque latéral, le patient a continué à ressentir des douleurs latérales au genou gauche, ce qui a fait de lui un candidat pour l'AM. Ce cas est utilisé pour mettre en évidence ce qu'est un AM, ce qui rend quelqu'un un candidat idéal pour ce genre de procédure, les preuves actuelles relatives à la réussite de cette intervention, et certains enjeux liés à la réadaptation après la chirurgie. Le rôle des chiropraticiens et des médecins traitants est d'assurer que les jeunes athlètes subissent une intervention rapide pour compenser les changements dégénératifs qui seraient associés à des lésions méniscales soutenues.