The effect of intra-articular hyaluronate and tramadol injection on patients with adhesive capsulitis of the shoulder.

BACKGROUND: Local administration of opioids causes effective analgesia without adverse effects related to the central nervous system. After the beneficial demonstration of peripheral opioid receptors in joint synovia, intra-articular opioid injections were used for pain treatment. Clinical studies have reported the safety and efficacy of hyaluronate injection in the shoulder joint of patients with osteoarthritis, periarthritis, rotator cuff tears, and adhesive capsulitis. OBJECTIVES: To estimate the efficacy of intra-articular hyaluronate and tramadol injection for adhesive capsulitis of the shoulder compared with that of intra-articular hyaluronate injection alone. METHODS: Thirty patients with adhesive capsulitis of the shoulder were randomized to the hyaluronate group (n= 16) or the tramadol group (n= 14). Hyaluronate group members were administered five weekly intra-articular hyaluronate injections; tramadol group members were administered three weekly intra-articular hyaluronate and tramadol injections and then two weekly intra-articular injections of hyaluronate. Visual Analog Scale (VAS), passive range of motion (PROM) of the shoulder joint, and Shoulder Pain and Disability Index (SPADI) scores were assessed at baseline and weeks 1, 2, 3, 4, and 6 after the initial injection. RESULTS: A significant improvement was observed in VAS, PROM, and SPADI scores between time points in both groups. In comparison in both groups at weeks 1 and 2 after the initial injection the VAS scores of the tramadol group were significantly lower than those of the hyaluronate group. CONCLUSIONS: Intra-articular hyaluronate with tramadol showed more rapid and strong analgesic effects than intra-articular hyaluronate alone and did not induce any adverse effects.

Clinical applications of therapeutic phlebotomy.

Phlebotomy is the removal of blood from the body, and therapeutic phlebotomy is the preferred treatment for blood disorders in which the removal of red blood cells or serum iron is the most efficient method for managing the symptoms and complications. Therapeutic phlebotomy is currently indicated for the treatment of hemochromatosis, polycythemia vera, porphyria cutanea tarda, sickle cell disease, and nonalcoholic fatty liver disease with hyperferritinemia. This review discusses therapeutic phlebotomy and the related disorders and also offers guidelines for establishing a therapeutic phlebotomy program.

Validation of the Hanyang Pain Scale for clerical workers with musculoskeletal pain.

PURPOSE: The visual analog scale (VAS) is the most widely used scale for pain assessment. However, its reflection of time-, sleep-, work-, psychological-, and reward-related pain characteristics is limited. Therefore, this study aimed to develop a new pain scale, the Hanyang Pain Scale (HPS), evaluate its reliability, and assess its agreement with currently used scales. SUBJECTS AND METHODS: The HPS comprises a 10 cm long visual vertical bar, similar to the VAS, with eleven simple evaluation sentences related to pain frequency, work, and sleep. We selected 1,037 clerical workers as study subjects and conducted medical examinations through interviews, physical examinations, and musculoskeletal pain assessments tools including the VAS, HPS, and McGill pain questionnaire (MPQ). The reliability of the HPS and its agreement with VAS and MPQ were statistically analyzed. RESULTS: HPS test-retest reliability was very high (Pearson correlation coefficient =0.902). In particular, HPS test-retest reliability in the weak pain group (<4 points for both VAS and HPS) was greater (Pearson correlation coefficient =0.863) than that of VAS (0.721). Therefore, the HPS showed consistent pain assessment results in cases of relatively weak pain. Correlation was high between HPS and VAS scores (Spearman's ρ =0.526) and satisfactory between HPS and MPQ scores (Spearman's ρ =0.367). CONCLUSION: The newly developed HPS has high reliability and strong agreement with other currently widely used scales. In particular, HPS was more consistent than the VAS for relatively weak pain. Based on these findings, the HPS can be considered a useful pain assessment tool for clerical workers. Further clinical research on musculoskeletal diseases and on workers in other fields is required.

Ischemic compression after trigger point injection affect the treatment of myofascial trigger points.

OBJECTIVE: To investigate the effects of trigger point injection with or without ischemic compression in treatment of myofascial trigger points in the upper trapezius muscle. METHODS: SIXTY PATIENTS WITH ACTIVE MYOFASCIAL TRIGGER POINTS IN UPPER TRAPEZIUS MUSCLE WERE RANDOMLY DIVIDED INTO THREE GROUPS: group 1 (n=20) received only trigger point injections, group 2 (n=20) received trigger point injections with 30 seconds of ischemic compression, and group 3 (n=20) received trigger point injections with 60 seconds of ischemic compression. The visual analogue scale, pressure pain threshold, and range of motion of the neck were assessed before treatment, immediately after treatment, and 1 week after treatment. Korean Neck Disability Indexes were assessed before treatment and 1 week after treatment. RESULTS: We found a significant improvement in all assessment parameters (p<0.05) in all groups. But, receiving trigger point injections with ischemic compression group showed significant improvement as compared with the receiving only trigger point injections group. And no significant differences between receiving 30 seconds of ischemic compression group and 60 seconds of ischemic compression group. CONCLUSION: This study demonstrated the effectiveness of ischemic compression for myofascial trigger point. Trigger point injections combined with ischemic compression shows better effects on treatment of myofascial trigger points in the upper trapezius muscle than the only trigger point injections therapy. But the duration of ischemic compression did not affect treatment of myofascial trigger point.

Comparison of manual balance and balance board tests in healthy adults.

OBJECTIVE: To investigate the correlations of scores on the Timed Up and Go (TUG) test and the Single Leg Stance (SLS) test with stability scores on the Biodex Balance System (BBS) in healthy adults. METHOD: The postural balance of 73 participants was measured on the TUG and SLS tests and with the Overall Stability Index (OSI) on the BBS. The participants were divided into groups by age and by times on the TUG and SLS. The correlations between TUG or SLS and OSI scores were analyzed by groups. RESULTS: TUG scores were significantly correlated with OSI scores in age under 65 years, TUG over 10 seconds and SLS over 30 seconds groups (level 12). TUG scores were also correlated with OSI in total (level 10) and TUG under 10 seconds groups (level 2). However, there were no significant relationships between SLS and OSI scores. CONCLUSION: OSI scores on the BBS are significantly correlated with TUG scores, especially at the easy levels. According to the findings of present study, relatively easy BBS levels are considered to assess the postural balance in healthy adults.