Search

Establishing the cause of unilateral leg pain is difficult in the settings of tibial diaphyseal sclerosis. This patient, a 36-year-old woman presented with unilateral pretibial leg pain for past 7 months without history of trauma, infections, systemic or metabolic disease. Besides local deep tenderness, other clinical findings and blood investigations were normal. Radiograph and CT scan showed both periosteal and endosteal cortical thickening with obliteration of medulla of the tibial midshaft. MRI scan detected marrow oedema and bone scan revealed increased tracer uptake at the affected site of tibia. She was treated by saucerisation and re-establishment of the medullary canal. Biopsy of the harvested tissue had trabecular bone without any sign of inflammation. Patient was pain free after 3 months of operation and was able to perform her activity of daily living without any difficulties. Ribbing disease is a disease of exclusion and need high degree of suspicion for its diagnosis.

BACKGROUND Abnormal foot morphology in children and adolescents is a possible risk factor for lower extremity pain. Foot posture index-6 (FPI-6) is a valid and reliable tool to assess foot morphology. However, the normative data on the age distribution for FPI-6 in Asian children and adolescents are still minimal. Further, the correlation of FPI-6 with lower extremity pain is poorly understood. We aimed to investigate the normative distribution for FPI-6 and the relationship between FPI-6 scores and knee and heel pain in Japanese children. METHODS We included 2569 Japanese children, aged 9-15 years, at a single school from 2016 to 2018. We summarized the age distribution of children and their mean bilateral FPI-6 scores. Additionally, we assessed the tenderness at the apophysis or tendon insertions at the knee and heel. We performed a cross-sectional analysis to investigate the correlations between FPI-6 scores and sex, age, and knee and heel pain for the data obtained each year. RESULTS The mean FPI-6 score was 3.1 ± 2.4, 3.4 ± 2.0, and 3.2 ± 1.9 for the left foot and 3.0 ± 2.4, 3.2 ± 1.9, and 3.1 ± 1.9 for the right foot in 2016, 2017, and 2018, respectively. Boys tended to have higher scores than girls, and the FPI-6 score of the left foot was significantly higher than that of the right foot (p

Background Irreversible pulpitis is a painful and debilitating condition. Root canal treatment (RCT) provides prompt relief and salvages the affected tooth/teeth. It has classically been performed as a multivisit procedure. A relatively newer approach constitutes performing all the steps in one single visit. This study was designed to explore if single-visit RCT could be confidently used as an effective and preferred treatment modality for irreversible pulpitis in the Indian Armed forces. Methods The study compared the incidence of postoperative pain, tenderness on percussion (TOP), flare-ups, and the analgesic drug use in 60 cases of acute irreversible pulpitis who were treated by either single or multiple visit root canal therapy. Each treatment group included 30 patients who were evaluated preoperatively and postoperatively at 24 h, one week and one month. Results The study found statistically higher incidence of postoperative pain (mild variant) and TOP in single visit therapy, 24 h after the obturation while the difference was insignificant at one week and one month after therapy. Analgesic use was significantly higher after the single visit therapy in the first 24 h. No flare-ups were recorded in either group. Significant pain and tenderness was observed after chemo-mechanical preparation (appointment 2) in multivisit regimen. Conclusion Single visit therapy is a safe, practical, and effective approach. The treatment results are similar to the multivisit regimen. It should therefore be considered for wider adoption and application.

A 62-year-old female patient presented with left radial side wrist pain for the past 4 weeks. She denied any history of trauma. On physical examination, she had swelling and tenderness to palpation in the first dorsal compartment with a positive Finkelstein’s test. On ultrasound, the first

A 40-year-old woman presented with acute-onset colicky abdominal pain. On physical examination, the patient was afebrile with a heart rate of 95 beats per minute. Abdomen was soft with tenderness in the periumbilical location. No rebound tenderness or guarding was noted. There was no palpable mass.

Purpose To describe the clinical characteristics of children and adolescents that underwent diagnostic laparoscopy for suspected adnexal torsion (AT), and to develop a prediction model for preoperative detection of AT among young women. Methods A retrospective cohort study. We included all girls ≤18 years old with clinically suspected AT who underwent a diagnostic laparoscopy between 3/2011 and 6/2020. We compared patients with AT to those without AT and constructed a prediction model. Results Overall, 120 children and adolescents with suspected AT were included in the study. Of those, AT was identified in 83 (69.2%). In a multivariate analysis, the following risk factors were independently associated with AT and included in the prediction model: absence of right lower quadrant tenderness upon examination [adjusted odds ratio (aOR) (95% Confidence interval (CI)) 3.23 (1.23–8.47), p = 0.017], platelets level >240 K [aOR (95% CI) 3.15 (1.19–8.36), p = 0.021], and neutrophils level >5.4 [aOR (95% CI) 2.71 (1.02–7.52), p = 0.046]. The rate of AT was 12.5% in cases without risk factors for AT, 56.7% with one, 68.8% with two, and 94.1% with three risk factors present, respectively. Conclusions We have identified preoperative indicators independently associated with surgically confirmed AT in a large cohort of young women. Level of evidence- III

Shoulder pain is a common symptom for non-traumatic shoulder pathologies and affects 4.7-66.7% of entire population. Even with the latest technological advantages, palpation still is a cost and time efficient tool to evaluate the shoulder pathologies. Our aim was to investigate and compare palpation findings in different shoulder pathologies.We used first assessments of impingement syndrome (IS) (n = 205), rotator cuff tear (RCT) (n = 185) and frozen shoulder (FS) (n = 210) patients who received treatment between 2010 and 2019 years. Two experienced physiotherapists palpated predefined points: long head of biceps brachii, pectoralis minor, lateral intermuscular septum, proximal tendons of extensor group. These points categorized into "proximal", "mid-proximal", "mid-distal", "distal", "irregular". We also grouped patients by their BMIs.We found RCT patients had higher BMI than IS and FS patients (p 0.001, p = 0.001); more tender intermuscular septum points and night pain than IS patients (p = 0.001, p = 0.003) and more extensor group proximal tendon points than IS and FS patients (p 0.001, p = 0.001). "No tenderness" group had lesser resting pain than distal group (p 0.001) and lesser activity and night pain than middle-proximal, middle-distal, and distal groups (all ps 0.002). Distal group had higher night pain than middle-proximal group (p = 0.003). Morbidly obese patients had higher night pain than normal and overweight patients (p = 0.003 and p = 0.009).Tender point distribution varies depending on the pathology with biceps brachii being the most common. RCT patients had higher night pain related to more distal tender points. Patients with higher night pain had increased tenderness in septum intermuscular and extensor muscles' proximal tendons.

Objective To investigate the association between clinical joint tenderness and intra- and periarticular inflammation as assessed by ultrasound and MRI in patients with active PsA and to explore if the associations differ according to patient-reported outcomes (PROs) and structural damage. Methods Forty-one patients with active PsA and hand involvement had 76/78 joints examined for swelling/tenderness and ultrasound and MRI of 24 and 12 finger joints, respectively. Synovitis, tenosynovitis, periarticular inflammation and erosions were assessed using OMERACT definitions and scoring systems. Correlation between imaging inflammation sum-scores (intra-and periarticular) and tender/swollen joint counts were calculated using Spearman’s rho, agreement at joint level was examined using prevalence and bias adjusted kappa (PABAK). Subgroup analyses explored the influence of PROs and radiographic erosive disease on these associations. Results No significant correlations were found between tender or swollen joint counts and imaging inflammation sum-scores (rho = −0.31–0.38). In patients with higher level of overall pain, disability and lower self-reported mental health, a tendency towards negative correlations were found. At joint level, intra- and periarticular imaging inflammatory lesions had slight agreement with joint tenderness (PABAK = 0.02–0.19) and slight to moderate with swelling (PABAK = 0.16–0.54). For tender joints, agreement with imaging inflammation was even weaker in patients with either high overall pain scores, high disability scores, and/or non-erosive disease. Conclusion Joint tenderness had low association with imaging signs of inflammation in PsA patients, particularly in patients with high self-reported pain, disability and low mental health, indicating that tenderness is influenced by other parameters than local inflammation.

Background Headache affects 90–99% of the population. Based on the question “Do you think that you never ever in your whole life have had a headache?” 4% of the population say that they have never experienced a headache. The rarity of never having had a headache suggests that distinct biological and environmental factors may be at play. We hypothesized that people who have never experienced a headache had a lower general pain sensitivity than controls. Methods We included 99 male participants, 47 headache free participants and 52 controls, in an observer blinded nested case-control study. We investigated cold pain threshold and heat pain threshold using a standardized quantitative sensory testing protocol, pericranial tenderness with total tenderness score and pain tolerance with the cold pressor test. Differences between the two groups were assessed with the unpaired Student’s t-test or Mann-Whitney U test as appropriate. Results There was no difference in age, weight or mean arterial pressure between headache free participants and controls. We found no difference in pain detection threshold, pericranial tenderness or pain tolerance between headache free participants and controls. Conclusion Our study clearly shows that freedom from headache is not caused by a lower general pain sensitivity. The results support the hypothesis that headache is caused by specific mechanisms, which are present in the primary headache disorders, rather than by a decreased general sensitivity to painful stimuli. Trial registration Registered at ClinicalTrials.gov (NCT04217616), 3rd January 2020, retrospectively registered.

Chest wall syndrome is the most frequent cause of chest pain complained by patients admitted to the physician’s office, in outward as well as in emergency department. It may affect all ages with sex ratio of 1:1 between man and woman. History of illness and sensibility to palpation or tenderness were the keys to the diagnostic approach. Pain was generally moderate, well localized, continuous or intermittent over a number of hours to days or weeks and was amplified by position or movement that was commonly located on the left side of the chest. Chest wall syndrome is usually a common and benign condition, but it leads to anxiety and frequent recurrence. Definitive treatment is not yet confirmed and treatment for the different condition causing isolated musculoskeletal chest pain is poor. Therefore, some options to avoid aggravating physical activities, stretching, and simple analgesics as needed are the best choices of current management.

RATIONALE, AIMS AND OBJECTIVES: The primary purpose of this study was to test both classic and novel FM pain and non-pain symptoms to determine their practical efficacy in aiding clinicians to distinguish FM pain from other chronic pain disorders. METHODS: 158 pain patients from two primary care clinics were evaluated with history, physical exam, chart review, and a questionnaire containing 26 exploratory symptoms (10 from the Symptom Impact Questionnaire (SIQR) and 16 from the FM literature)). The symptoms were rated on a 0-10 VAS for severity by those patients reporting pain over the past week. Somers' D and mean severity differences between FM and chronic pain patients without FM were used to rank the discriminatory and diagnostic contributions of symptoms. RESULTS: Fifty patients (14.2%) carried a chart diagnosis of FM, 108 (30.7%) had pain but not FM, and 192 (54.5%) who had neither pain nor FM. Comparing means between the two pain groups, the 5 best differentiating symptoms (all, P < .0001) were: a persistent deep aching over most of my body, poor balance (7.4 vs 3.1), environmental sensitivity (6.8 vs 3.0), tenderness to touch (6.8 vs 3.6) and pain after exercise (8.1 vs 4.1). Notably, VAS pain though significantly higher for FM was least discriminatory (6.5 vs 5.1, P < .001). The five best symptoms generated a ROC = 0.85 and Somers' D = 0.69, an accuracy of 81%, and an odd's ratio of 14.4. CONCLUSIONS: Our results herein suggest that clinicians may be well-served to consider symptoms in addition to those contained in current diagnostic criteria when recognizing FM in their chronic pain patients.

Introduction Pelvic congestion syndrome (PCS) may be effectively managed with conservative treatment in certain patients. Treatment with venoactive drugs is common, but supportive data are limited. This study evaluated the clinical efficacy of micronized purified flavonoid fraction (MPFF) in women with PCS. Methods In a single-blind, placebo-controlled study, women with duplex ultrasound diagnosis of pelvic varicose veins (PVV) and PCS were randomized to MPFF 1000 mg once daily or placebo for 2 months. Clinical manifestations of PCS were evaluated at baseline and end of treatment (M2) using three assessment tools: disease-specific quality of life (QoL) Pelvic Varicose Vein Questionnaire (PVVQ), Pelvic Venous Clinical Severity Score (PVCSS), and the Visual Analog Scale (VAS) for the main symptoms of the disease. Results A total of 83 women were included, 42 received MPFF and 41 received placebo. In the MPFF group, the mean global PVVQ QoL index decreased significantly from 45.1 ± 14.7 at baseline to 36.6 ± 10.6 at M2 (mean change: 8.2 ± 10.4); no significant change was observed in the control group (mean change: – 0.3 ± 4.0). The between-group difference was statistically significant (P

This study highlights the effect of a genicular nerve block (GNB) on pain, function, and inflammation outcome measures in rheumatoid arthritis (RA) knees. A total of sixty-four patients diagnosed with RA using ACR/EULAR 2010 criteria with unilateral persistent knee arthritis were recruited to the study. They were randomly assigned into two groups: group 1 received GNB and group 2 received intra-articular triamcinolone. Both groups were examined by the SOLAR scoring system, visual analog scale (VAS), and Lysholm score at 0, 2, and 12 weeks. A semi-quantitative score was used to assess the tenderness and swelling at the same intervals. Function and inflammation improved significantly in group 2 at a 2-week interval as compared to group 1, whereas pain improved in both groups with non-significant differences. After 12 weeks, group 1 showed significant improvement as compared with group 2 for the three outcome measures. Neither the disease activity nor the current medication was related to the GNB effect. Disease duration was negatively related to GNB-induced improvement. GNB is a new promising local therapy for RA to control pain, improve function, and alleviate inflammation of the knee joint. Although it has a relatively short-term effect, yet it has outperformed the steroid effect.

Background: The most common form of neck pain is non-specific which is deep, dull aching & poorly localized. Non-specific pain is associated with upper trapezius tenderness. For people who work at desks and computers, or who spend many hours driving, have poor ergonomics which causes the upper trapezius to become sore and painful. The soreness can lead to the development of tender points which can be the major reason for developing neck pain and muscle spasm. Physiotherapy techniques like muscle energy technique and Strain counterstrain has been proposed to treat tenderness in trapezius. Objective: To compare the immediate effect of Strain Counterstrain Technique & Muscle Energy Technique on pain, pain pressure sensitivity & mobility on non-specific neck pain with upper trapezius tenderness using Visual analogue scale, Pressure Algometer & Universal Goniometer respectively. Method: 60 subjects were selected as per inclusion and exclusion criteria& were randomly assigned to Group A (n=30) & Group B (n=30); Strain Counterstrain and Muscle Energy Technique respectively. Visual Analogue Scale, Pain Pressure Sensitivity & Cervical Rotation & Lateral Flexion Motion bilaterally was noted before & after application of both techniques and the data was statistically analysed. Result: Both groups showed statistical significance (p< 0.05) differences in all outcome measures between pre test and post test values of Group A and Group B but there is no statistical significant (p> 0.05) difference in the outcome measures between groups. Conclusion: The study concludes that both techniques are equally effective in treating pain, increasing lateral flexion and rotation range of motion, and improving pain pressure sensitivity. Keywords: Strain Counterstrain, muscle energy technique, upper trapezius tenderness,visual analog scale, non-specific neck pain,pain pressures sensitivity.

To validate and make evidence based changes to the Israel Defense Forces medial tibial stress fracture diagnosis and treatment protocol.Prospective cohort study.429 Elite infantry recruits were reviewed for signs and symptoms of medial tibial stress fracture during 14 weeks of basic training. Suspicion of medial tibial stress fracture was based on the presence of pain, tenderness1/3 the length of the tibia and a positive fulcrum and/or hop test. Recruits with suspected medial tibial stress fractures were initially treated with 10-14 days of rest. Bone scan was performed only when recruits failed to respond to the rest regimen or required immediate diagnosis.31 Out of 49 recruits with a suspicion of medial tibial stress fracture underwent bone scan, including 8/26 recruits whose symptoms did not resolve after being treated clinically as stress fractures. There was a significantly greater incidence of medial tibial stress fractures when a positive hop test was present in addition to tibial pain and tenderness (p=0.0001), odds ratio 52.04 (95% CL, 2.80-967.74). Medial tibial stress fracture was found to occur when the band of tibial tenderness was ≤10cm in length. Tibial pain scores were not predictive of stress fracture.This validation study provides the clinician with evidence based guidelines for the clinical diagnosis and treatment of medial stress fractures and their differentiation from shin splints. An initial treatment protocol without the use of imaging was found to be effective in more than two-thirds of the cases.

Background Tenderness on palpation of the pelvic floor muscles (PFMs) is a clinical assessment tool used alongside other tests to identify PFM involvement in pelvic complaints including pelvic pain. Although reliability of PFM tenderness has been determined, validity has yet to be established. Objectives To assess convergent validity of PFM tenderness on digital palpation with the presence of central pain mechanism, as determined by a score of greater than 40 on the Central Sensitization Inventory (CSI). A secondary objective was to assess the agreement between PFM tenderness and self-reported symptoms of PFM sensitivity. Methods Participants completed a battery of self-report questions, the CSI, and various physical assessments (blinded assessors). Convergent validity was assessed between tenderness on palpation and the CSI. Kappa statistics were used to determine agreement between tenderness on palpation and self-reported perineal pain, urinary urgency, dyspareunia, and dysmenorrhea. Results Ninety-nine female participants with hip or back pain and at least one self-reported symptom of pelvic floor dysfunction were included in the study (mean age 40.56 ± 12.72 years). Convergent validity was found between PFM tenderness on palpation and scores greater than 40 on the CSI ( X 1 2 = 4.2 , p = 0.04). There was poor agreement between tenderness on palpation with dyspareunia (agreement 62.83%, Kappa = 0.27), dysmenorrhea (agreement 55.75%, Kappa = 0.14), or perineal pain (agreement 53.04%, Kappa = 0.10). Conclusions PFM tenderness on digital palpation confirmed convergent validity with CSI scores, suggesting central pain mechanisms. Clinicians may need to consider the role of central pain mechanisms in their clinical decision making when treating PFM dysfunction.

Abdominal oblique muscle injury is characterized by acute pain and localized tenderness over the lateral trunk. This injury is particularly common among throwing athletes, and usually presents as anterolateral abdominal wall pain. Imaging evidence is scarce in regard to whether oblique muscle injury at its junction with the thoracolumbar fascia can instead present with low back pain. A high school baseball player with unilateral low back pain was referred to us with a different diagnosis. Careful palpation and magnetic resonance imaging guided our care, and the patient returned to high-level competition after 7 weeks of conservative treatment, with no report of recurrence in the subsequent 12 months. Oblique muscle injury at its junction with the thoracolumbar fascia should be added to the differential diagnosis for throwing athletes with unilateral low back pain following a torque movement.

Delayed onset of muscle soreness (DOMS) is a common finding in trained and untrained individuals post high intensity exercises which can lead to injuries. Foam rolling (FR) and neurodynamic therapy (NDT) are types of active cool-down which provides effective for treatment of DOMS. But their role in reduction of intensity of the same in cool down is not established.Crossover study.Total 60 healthy individuals participated in the study. Pre intervention readings were taken of strength and tightness by Range of motion. Subjects performed both the types of cool-down separated by 4 weeks interval with random allocation. Post intervention readings of hamstring and quadriceps tightness, grade of tenderness and stand to sit VAS score was taken post 24 h and 48 h and strength post 48 h.Analysis was done for using repeated measures ANOVA and Friedman's test. The difference of values for Straight Leg Raise and Prone knee Flexion between NDT and FR post 24 h were statistically significant (p 0.05) while that of NDT post 24 h being similar to FR post 48 h (p 0.05). There was a significant difference between strength, tenderness and VAS in NDT and FR (p 0.05). With the mean of post 24 h as well as post 48 h being less in the FR intervention.Foam rolling is a better option than Neurodynamic therapy for reduction of intensity of DOMS.

BACKGROUND Management of suspected scaphoid fractures includes repeated evaluation and casting in symptomatic patients with nondiagnostic radiographs. In this systematic review and meta-analysis, the authors compare the diagnostic accuracy of clinical examinations for scaphoid fractures and create a decision guide using Bayesian statistics. METHODS The MEDLINE, Embase, and Cumulative Index to Nursing and Allied Health Literature databases were queried for studies that evaluated clinical index tests and their diagnostic accuracies for scaphoid fracture. Summary estimates were achieved by a bivariate random effects model and used in Bayes' theorem. The authors varied the scaphoid fracture prevalence for sensitivity analysis. RESULTS Fourteen articles with 22 index tests and 1940 patients were included. Anatomical snuffbox pain/tenderness (11 studies, 1363 patients), pain with axial loading (eight studies, 995 patients), and scaphoid tubercle tenderness (five studies, 953 patients) had sufficient data for pooled analysis. Anatomical snuffbox pain/tenderness was the most sensitive test (0.93; 95 percent CI, 0.87 to 0.97), and pain with axial loading was the most specific test (0.66; 95 percent CI, 0.41 to 0.85), but all three tests had lower estimated specificities compared with sensitivities. In the base case, the probability of fracture was approximately 60 percent when a patient presented with all three findings after acute wrist injury. CONCLUSIONS The posttest probability of scaphoid fracture was sensitive to both prevalence and diagnostic accuracy of individual clinical index tests. In a population with a fracture prevalence of 20 percent, patients presenting with concurrent anatomical snuffbox pain/tenderness, pain on axial loading, and scaphoid tubercle tenderness may benefit from early advanced imaging to rule out scaphoid fractures if initial radiographs are nondiagnostic. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, II.

ObjectivesTo determine whether clinical tenderness can be considered a sign of inflammatory joint activity in patients with rheumatoid arthritis (RA), osteoarthritis (OA) or psoriatic arthritis (PsA) and to assess other possible factors associated with tenderness.MethodsPatients diagnosed with RA, PsA and OA underwent clinical and ultrasound examination of wrists and finger joints. Radiographs of the hands were scored for erosions, joint space narrowing (JSN), osteophytes and malalignment. A binary damage score (positive if ≥1 erosion, JSN and/or presence of malalignment) was calculated. Differences in grey scale signs of synovitis and power Doppler (PD) between tender non-swollen (TNS) versus non-tender non-swollen (NTNS) joints were calculated. Disease duration was assessed,5 years as long-standing arthritis.ResultsIn total, 34 patients (9 early and 14 long-standing) from patients with RA, 31 patients (7 early and 15 long-standing) with PsA and 30 with OA were included. We found equal frequencies of PD signal between TNS and NTNS joints in RA (p=0.18), PsA (p=0.59) or OA (p=0.96). However, PD had a significant association with tenderness in early arthritis both in RA (p=0.02) and in PsA (p=0.02). The radiographic damage score showed significant association with tenderness in RA (pConclusionTenderness might not always be a sign of active inflammation in RA, PsA and OA. While tenderness in early arthritis may be more related to inflammation, established disease is better explained by joint damage and malalignment.

Background Sports injuries are the second most common type of accident after domestic (3.7%) and occupational accidents (3.1%). There is an average annual estimate of 8.6 million sports and recreational related injury incidents with an age-adjusted rate of 34.1 per 1000 populations. Common sports injuries are musculoskeletal injuries i.e. Sprains, Strains, Joint injuries, soft tissue injury (STI). The sports injury in Ayurveda can be co-related within dissimilar facets of trauma related ailments. Objective To evaluate the efficacy of a protocol-based management of common sports injuries using an integrated approach. Materials and methods Integration of Ayurveda and Physiotherapy procedures was done and phase wise treatment was framed. Total 30 patients of age between 10 and 60 years ful-filling the inclusion criteria were selected for the present study. The patients were treated with Phase wise protocol consisting of three phase’s i.e. Inflammatory (1–5 days), Stabilization and recovery (6–10 days), Muscle strengthening (11–17 days). Assessments were done through various variables like pain, tenderness, swelling, local temperature, manual muscle testing (MMT) and range of motion (ROM) at different time points. Statistical analysis Wilcoxon matched pair test was used to assess within group results for subjective parameters and paired t-test (Dependent t-test) was used to assess for objective parameters. Result The study showed that integrated treatment approach has given significant results in the parameters like pain, loss of function, tenderness, local temperature, MMT and ROM. Conclusion Phase wise management through integrated protocol is effective in the management of common sports injuries.

Introduction Mammary duct ectasia is a common clinical condition characterized by abnormal dilatation of the central milk ducts with chronic inflammation and fibrosis, it may affect one or both breasts. Patients may be completely asymptomatic or have mastalgia or nipple discharge which is usually from multiple ducts. It mostly affects females and is very rare in males. Patients and methods This is a case control study which included 236 females grouped into two equal groups, the first group were patients with duct ectasia compared and the other one apparently healthy females and both groups were compared regarding different characteristics. Results Most patients were young with a mean age of 35 years, a most of them were overweight (42.4%) and obese (33.1%). Most were menstruating (86.4%) with regular cycles (79.7%). Most patients had breast pain (67.8%), tenderness (54.2%), and no nodularity (98.3%). About 47.5% had nipple discharge mostly from multiple ducts (43.2%), 52.5% had no discharge. There was a significant correlation between the development of duct ectasia and each of marital status, lactational status, coffee consumption, pain, nodularity, and breast tenderness (P values 0.026, 0.016, 0.034, 0.000, 0.000, and 0.000). Conclusion Duct ectasia is a very common complaint in females, it is commoner in overweight and obese females, married females and those with history of lactation. Coffee consumption may be a cause. The regularity of the menstruation has no correlation with its development. The presence of mastalgia, tenderness, and nodularity are highly suggestive for the disease., Highlights • The breast is a dynamic structure that undergo various stages of development. • Mammary duct ectasia is a common clinical condition. • It may affect single breast or both breasts. • It is common in obese females, married females and those with history of lactation. • Patients have mastalgia, breast tenderness, and nodularity.

Among the types of acute thyroiditis, subacute thyroiditis (SAT) is rare in children, and there is limited knowledge regarding its characteristics in pediatric cases. We present a case of SAT in a 6-yr-old boy who was brought to our hospital with high fever and pain in the front portion of the neck. Acute suppurative thyroiditis (AST), which is common in children, was suspected initially. Tenderness observed in the thyroid corresponded to a hypoechoic region on ultrasonography. The tenderness subsequently shifted to the isthmus, which was evident as a hypoechoic region on ultrasonography. Movement of hypoechoicity is typical of creeping thyroiditis, wherein the pain and tenderness can be unilateral or may start on one side and subsequently shift to the contralateral side after days or even weeks. Based on this characteristic and changes in laboratory parameters, the patient was diagnosed as a case of creeping thyroiditis. Improvement was observed in the patient without the use of anti-inflammatory drugs. At the 2-yr follow-up, the patient did not have thyrotoxicosis or relapse. Although AST is more prevalent than SAT in children, ultrasonography findings of creeping thyroiditis may be an important indicator for the diagnosis of SAT in pediatric patients.

Pelvic inflammatory disease (Waram al-Rahim)is one of the most serious gynaecological infections of the upper female genital tract with the worldwide annual rate of 10-20/1000 women of reproductive age. The objective planned for the study was to evaluate the effect of Sharbat-e-Deenar in uncomplicated Pelvic Inflammatory Disease (uPID). A pre and post observational single group clinical study was carried out in the Department of IlmulQabalatwaAmrazeNiswan, National Institute of Unani Medicine, Hospital, Bengaluru. Diagnosed cases (n=30) of uPID were included in the study. Patients with complicated PID, history of antibiotic therapy within seven days of recruitment; delivery, abortion or gynecologic surgery within the last 30 days, systemic diseases, malignancies, pregnancy & lactation were excluded. Sharbat-e-Deenarconsists of Poste baikhekasniandTukhmekasni(Cichorium intybus Linn.), Gulesurkh (Rosa damascene mill.), Tukhmekasoos(CuscutareflexaRoxb.) and Rewandchini (Rheum emodiWall. ex Meissn) were administered orally in a dose of 20 ml twice daily for 14 days. Outcome measures were 30-70% clinical improvement in Visual Analogue Scale (VAS) score for lower abdominal pain and McCormack Pain Scale (McPS) score for abdominopelvic tenderness and White Blood Cells (WBCs) count

In pes anserine bursitis patient complaint of medial side knee pain which is in inflammatory condition. The case report aims is to present evaluation & treatment of young female who’s working in the medical field which majorly involved long-standing. In addition to traditional methods of treatment, we focused on her muscle strength & biomechanical correction to improve her ADLs. A 27-year patient came to OPD with severe pain, swelling, tenderness which affected her daily functional activity. In pes anserine bursitis improvement of whole biomechanics is very important. To improve the biomechanics of the hip, knee, ankle, core we started planning 9 days strengthening program. Initial 3 days, the patient had severe pain & swelling over the inner side of the knee. We explain the effect of exercise to the patient & asked her to avoid the brace. Initially, due to this problem list, we gave her simple exercise with that cryotherapy & electrical modality to reduce the symptoms. In the next 7 days, we focused on improving the all-affected muscle strength, in this patient we had to correct the overall biomechanics to improve quality of life. We focused on strengthening core muscles, back muscles & all the weak muscles. Initially, we started with Thera Band, then with weight cuff & progress with Bosu ball training for balance & proprioception section. In addition to traditional method the strengthening exercises & biomechanical correction of lower limb showed early recovery.

A 48-year-old woman presented in February 2020 with 2 weeks of vulvar pain and swelling on the right labium minus with associated intermittent tenderness. Past medical history was significant for hypertension. Past surgical history was significant for three conizations and a bilateral

Breast engorgement is commonly encountered in lactating mothers, it is defined as the swelling and distension of breast, usually in the early days of initiation of lactation, due to vascular dilation as well as the arrival of the milk. It is the painful overfilling of the breasts with milk. This is usually caused by an imbalance between milk supply and infant demand. Early breast fullness occurs as milk supply develops and while new born has an irregular breast-feeding routine. Then normal fullness is caused by the milk and extra blood and fluids in the breasts as body uses the extra fluids to make breast milk and if baby is not breast-fed for several days then breast engorgement can occur. Twenty four-year old mother with past medical history of hypothyroid, hypertension and she complained firmness of breast. On palpation of the breast, tenderness is present. Due to pain, firm and tenderness she was not able to feed her baby. Pain and engorgement were assessed by using visual analogue scaleand6-point self-rated engorgement scale. After one week of treatment with ultrasound therapy and taping, there was decrease in breast engorgement and pain.

Objectives: This study was conducted to evaluate the effectiveness of Vaitarana Vasti along with Simhanada Guggulu and Rasna Saptak Kwatha in the Management of Amavata (Rheumatoid Arthritis). Amavata is not only a disorder of locomotor system but is a systemic disease and is named after its chief pathogenic constituents i.e. Ama and Vata. The prolonged use of modern medicines shows some side effects and therefore an attempt was made to find an effective Ayurvedic treatment modality. Methods: A single blind clinical trial was conducted at O.P.D. and I.P.D. of Post Graduate Department of Kayachikitsa, Ayurveda Mahavidyalaya Hospital, Hubli. Vaitarana Vasti was given in followed by Shamanoushadhi Simhanada Guggulu 500mg twice and Rasna Saptak Kwatha 40ml as Anupana for 45 days with 1 month follow-up period. Results: Out of 15 Patients, 8 Patients (53.33%), 9 Patients (60%) falls under Marked Relief category of Grip strength and Tenderness respectively. 01 Subject (6.66%), 3 Patients (20%) falls under Moderate Relief category of Grip strength and Tenderness respectively. 06 Patients (40%), 2 Patients (13.33%), 12 Patients (80%) falls under Mild Relief category of Grip strength, Tenderness and E.S.R respectively. 1 subject (6.66%), 3 Patients (20%) falls under No Relief category of Tenderness and E.S.R respectively. Conclusion: Vaitarana Vasti Along With Shamanoushadhi Shamanoushadhi Simhanada Guggulu and Rasna Saptak Kwatha was found to be highly effective in Amavata and showing a way out to the individual suffering from this Amavata (Rheumatoid arthritis).

A 39-year-old man with no medical history complained of right flank pain that developed 1 day prior. He reported no history of sexual activity or of travelling abroad for the past 6 months. His temperature was 38.0°C, his BP was 144/87 mm Hg and his pulse was 119 per minute. Physical examination revealed tenderness in the right flank, with no rebound tenderness. Laboratory evaluation revealed elevated white blood cell count of 12.9×109/L (neutrophils: 67.8%). A right upper quadrant ultrasound …

This case challenge describes a 75-year-old white male patient who presented to a private primary care practice with a 1-month history of right third digit numbness, tenderness, and discoloration despite there being no history of injury to the digit.

Background Over the last decade the usage of computed tomography (CT) imaging has risen dramatically in emergency department (ED) patients with abdominal pain. Recognizing the potential disadvantages of overuse of CT imaging, efforts are being made to reduce imaging. Objective We determined the operating characteristics for location of abdominal pain for the entities of acute appendicitis, diverticulitis, and intestinal obstruction. We hypothesized that patients with pain localized to the upper abdomen would be less likely to have CT abnormalities than those with lower abdominal pain. Methods This is a prospective, observational registry of ED patients with abdominal pain, performed in an academic, suburban ED with an annual census of 110,000. Presence of clinically significant CT abnormalities (e.g., appendicitis, diverticulitis, bowel obstruction) were recorded along with clinical variables including laboratory values, vital signs, reported location of pain, location of tenderness on examination, and physician pretest probability. Results A convenience sample of 1154 patients was enrolled. Of all patients, 273 cases (24%) had abnormal CT results, including appendicitis (n = 95), diverticulitis (n = 133), and bowel obstruction (n = 49). Right upper quadrant pain was negatively associated with abnormal CT (p = 0.02). Clinician gestalt was highly specific, but lacked sensitivity for the diagnosis of appendicitis, diverticulitis, and obstruction. Twenty-four percent of patients diagnosed with appendicitis had no right lower quadrant pain or tenderness, and 7% of patients with diverticulitis had no left lower quadrant pain or tenderness. Conclusions Localization of abdominal pain by history or physical examination is not sufficient to accurately diagnose intra-abdominal pathology, especially cases of acute appendicitis, diverticulitis, or intestinal obstruction.

Skin pain is increasingly recognized as an impactful symptom in atopic dermatitis (AD) because of its association with patient discomfort, disease burden, and reduced quality of life. Although the nature of skin pain in AD has not been systematically studied and is therefore not well understood, patients report soreness, discomfort, and tenderness that may reflect peripheral and central pain sensitization. The high prevalence of skin pain suggests that it is not adequately addressed by current therapies for AD and may be undertreated compared with other symptoms. This review discusses the clinical relevance of skin pain with respect to its experience, pathophysiology, relationship with itch, and treatment implications. Recent studies suggest that skin pain presents as a neuropathic symptom independent from itch and theldquo;itch-scratch cyclerdquo;, and poses a unique burden to patients. Recognition of the significant consequences of skin pain and discomfort should reinforce the need to assess and treat this symptom in patients with moderate-to-severe AD. J Drugs Dermatol. 2020;19(10)921-926. doi:10.36849/JDD.2020.5498.

O objetivo do presente estudo foi avaliar o uso da termografia infravermelha, atrelada à baropodometria para a conduta de órteses plantares em 3 D. Os testes demonstraram eficácia e possibilitaram a criação de órteses que atendessem a necessidade da paciente. A paciente fibromiálgica tinha sensibilidade e dor ao toque nas regiões onde a termografia apresentou-se hiperradiante, ou seja, mais quente. A avaliação do equilíbrio foi realizada em uma plataforma estática sensível, a baropodometria é um instrumento possível de ser utilizado para avaliação do equilíbrio, demonstrando captar minuciosamente as oscilações. Feita as análises com a termografia e o baropodômetro iniciou-se o tratamento com órteses plantares específicas, desenvolvidas para a paciente, tentando reduzir significativamente suas dores e corrigindo a forma postural, melhorando a pisada e efetuando uma melhor qualidade de vida para a paciente

A 45-year-old lady presented for a follow-up endoscopy examination for mild abdominal pain due to gastric ulcers. She experienced a severe, markedly different type of pain with labor-like contractions 3 days later. Physical examination revealed tenderness confined to a 1 × 1-cm area and positive Carnett’s sign. The pain completely resolved 10 min after a subcutaneous lidocaine injection. The patient was diagnosed with anterior cutaneous nerve entrapment syndrome. The pain returned within several hours and anterior neurectomy was performed several days later. The pain subsided immediately and no recurrence was seen during 3 years of follow-up.

Sacroiliac joint dysfunction (SIJD) is a prominent source of pain in low back pain (LBP) patients. Tenderness inferior to the posterior superior iliac spine (PSIS) is an important sign presented in SIJD. Techniques including muscle energy technique (MET) and mechanical diagnosis and therapy (MDT) have shown benefits in SIJD. However, the effects of these treatments on tenderness and pain around the PSIS are yet to be determined.Compare and examine the preliminary short-term effect of MET and MDT on tenderness and pain around the PSIS in SIJD.Twenty patients, aged between 20 and 65 years and diagnosed with unilateral, sub-acute, or chronic SIJD, were screened for the inclusion criteria and were randomly allocated to the MET or the MDT group. Both the groups received treatment for four sessions over one week. Pain pressure threshold (PPT) and visual analogue scale (VAS) were determined by a blinded assessor on pre- and post-treatment basis.Although no significant differences were observed following the treatment between the groups, some statistically significant (p 0.05) improvements were observed within each of the groups. No drop-outs and no adverse events were reported.The findings of the study suggest that both interventions may be equally effective in reducing symptoms around the PSIS. However, due to the small sample size, the results need to be interpreted cautiously. Future studies on larger sample size and long-term follow up are warranted.

Background: Objective of this study was to determine the prevalence of sign and symptoms of TMD among the patients attending Siddhpur Dental College and Hospital. Methods: 435 adult patients attending Siddhpur dental college & Hospital of Gujarat for dental treatment were included in the research. After thorough history taking and clinical examination palpation of masticatory muscles and TMJ was done. Results: 37% of the participants had sign and symptoms of TMD. Clicking was reported by 28.96%, crepitation by 4.82%, pain or tenderness by 6.20%, Deviation reported by 8.50% and limitation reported by 7.12% Conclusions: Sign and symptoms of TMD are prevalent in 37% of the patients attending siddhpur Dental college & Hospital. Most common predisposing factor identified was harmful habits and so we can conclude that more emphasis should be given to the patient education to encourage them to abstain from harmful habits.

Background: Post-operative pain is the major consequence of Kṣārasūtra, Seton technique employed in Ayurvedic management of Low anal fistula. Surgeons are forced to prescribe Opioids and NSAIDs with pronounced untoward effects. Non pharmacological measures like Balneotherapy are used to improve circulation and relieve spasm in contemporary sciences. Aim: To compare the efficacy of Khadira (Acacia catechu) and Sphaṭika (Potash alum) hot sitzbath with plain hot sitzbath in patients of low anal fistula treated with Kṣārasūtra. Method: The study was single blind, double armed; prospective, randomized control clinical trial in which 30 patients were randomly allocated into two groups of 15 each on the basis of inclusion and exclusion criteria. Group A received hot sitzbath using Acacia catechu and alum infusion twice daily for 21 days. Group B received hot sitzbath using warm water for 21 days. The assessments were made on pain, post-surgical satisfaction burning sensation, tenderness, discharge, constipation, itching and incontinence. Result: The disease was prevalent in the 4th decade of life, more in males (86.67%) involved in sedentary work (53.33%) residing in urban domicile, consuming mixed diet (100%). Both groups showed statistically significant improvement in outcome measures like pain, burning sensation, tenderness, discharge, constipation and itching. Conclusion: On comparative analysis Acacia and Alum hot sitzbath was more effective in outcomes like pain, surgical satisfaction, burning sensation and discharge. There was no difference in the effect of both interventions with respect to outcome measures like constipation, itching and incontinence. Resumo: Justificativa: A dor pós-operatória é a principal consequência da técnica que utiliza seton de Kṣārasūtra no tratamento ayurvédico de fístula anal baixa. Os cirurgiões são impelidos a prescrever opiáceos e AINEs que possuem efeitos indesejáveis pronunciados. Medidas não farmacológicas como a balneoterapia são usadas nas ciências contemporâneas para melhorar a circulação e aliviar o espasmo. Objetivo: Comparar a eficácia do banho quente de assento com Khadira (Acacia catechu) e Sphaṭika (Potash alum) com apenas banho de assento em pacientes com fístula anal baixa tratados com Kṣārasūtra. Método: Estudo clínico prospectivo, cego e controlado de dois braços randomizados, no qual 30 pacientes foram alocados aleatoriamente em dois grupos de 15 pacientes cada com base nos critérios de inclusão e exclusão. O Grupo A recebeu banho de assento com Acacia catechu e infusão de alume duas vezes ao dia por 21 dias. O Grupo B recebeu banho de assento com água morna por 21 dias. Os desfechos avaliados foram dor, satisfação pós-cirúrgica, sensação de queimação, sensibilidade, corrimento, constipação, prurido e incontinência. Resultado: A doença foi prevalente na 4ª década de vida, mais frequente no sexo masculino (86,67%), nos envolvidos em trabalho sedentário (53,33%), nos residentes em domicílios urbanos e nos que consumiam dieta mista (100%). Ambos os grupos apresentaram melhora estatisticamente significativa na avaliação dos resultados, tais como dor, sensação de queimação, sensibilidade, corrimento, constipação e prurido. Conclusão: Na análise comparativa, o banho quente de assento com acácia e alume foi mais eficaz nos desfechos de dor, satisfação cirúrgica, sensação de queimação e corrimento. Não houve diferença em relação ao efeito de ambas as intervenções sobre os desfechos de constipação, prurido e incontinência.

OBJECTIVE To examine whether joint line tenderness and patellofemoral grind from physical examination were associated with cartilage volume loss, worsening of radiographic osteoarthritis, and the risk of total knee replacement. METHODS This study examined 4,353 Osteoarthritis Initiative participants. For each measurement of joint line tenderness and patellofemoral grind, the patterns were defined as no (none at baseline and at 1 year), fluctuating (present at either time point), and persistent (present at both time points). Cartilage volume loss and worsening of radiographic osteoarthritis over 4 years were assessed using magnetic resonance imaging and radiographs, and total knee replacement over 6 years was assessed. RESULTS A total of 35.0% of participants had joint line tenderness, and 15.8% had patellofemoral grind. Baseline patellofemoral grind, but not joint line tenderness, was associated with increased cartilage volume loss (1.08% per year versus 0.96% per year; P = 0.02) and an increased risk of total knee replacement (odds ratio [OR] 1.55 [95% confidence interval (95% CI) 1.11-2.17]; P = 0.01). While the patterns of joint line tenderness were not significantly associated with joint outcomes, participants with persistent patellofemoral grind had an increased rate of cartilage volume loss (1.30% per year versus 0.90% per year; P < 0.001) and an increased risk of total knee replacement (OR 2.10 [95% CI 1.30-3.38]; P = 0.002) compared with those participants without patellofemoral grind. CONCLUSION Patellofemoral grind, but not joint line tenderness, may represent a clinical marker associated with accelerated cartilage volume loss over 4 years and an increased risk of total knee replacement over 6 years. This simple clinical examination may provide clinicians with an inexpensive way to identify those at higher risk of disease progression who should be targeted for surveillance and management.

Introduction/Purpose Currently there is little evidence supporting the use of objective tests, measures, or imaging to help predict time to return to sport (RTS) following a hamstring strain. The purpose of this study is to investigate the predictive value of tenderness to palpation (TTP) as measured by area and location following hamstring strain. Study Design Case Series. Methods Nineteen male athletes (age 28 ± 9 yr) who sustained an acute hamstring strain underwent hamstring tenderness mapping on initial evaluation. The length and width of tenderness of the hamstring was identified with manual palpation, outlined in pen, and was then calculated as a percentage of the length and width of the posterior thigh. All patients underwent the same hamstring rehabilitation protocol with remapping performed at specific stages in rehabilitation. The association between mapping tenderness indices and RTS was assessed by linear regression. Results The average length of the area of tenderness was 22 ± 12% with an average RTS of 43 ± 36 days. The length of the area of tenderness measured on initial evaluation was a strong predictor of RTS (R2 = 0.58, p

Overutilization of healthcare resources is a threat to long-term healthcare sustainability and patient outcomes. CTis a costly but efficient means of assessing abdominal pain; however, 97 per cent of ED physicians acknowledge its overutilization. This study sought to understand factors that influence ED providers’ decision regarding CT use in the evaluation of abdominal pain. After evaluating a patient for acute abdominal pain, ED providers filled in a form in which the primary diagnosis and index of suspicion were recorded. Bivariate and multivariate analyses were used to identify predictors of outcomes. The CT scan utilization rate was 54.82 per cent. Whereas 34.11 per cent of CT scans were normal, 30 per cent yielded an acute abdominal pathology. Tenderness and rebound tenderness were positive predictors of high index of suspicion [odds ratio (OR) 2.09 and 2.54, respectively]. These variables were also predictive of obtaining a CT scan [OR 2.64 and 3.41, respectively]. Compared with whites, the index of suspicion was 26 per cent and 56 per cent less likely to be high when patients were black [OR 0.73] or Hispanic [OR 0.44] respectively. Blacks and Hispanics were less likely to have CT scans performed than whites [OR 0.58 and 0.48, respectively]. Leukocytosis significantly affected the index of suspicion for acute abdominal pathology, obtaining a CTscan and the acuity of CTscan diagnosis on multivariate analysis. Patients aged ≥60 years had 2.03 odds of acute CT finding compared with those aged

Background Jowl fat overhang can reduce jawline definition. The most common treatment to reduce jowl fat is liposuction. ATX-101 (deoxycholic acid injection), a minimally invasive treatment approved for submental fat reduction, may also be an effective treatment for jowl fat. The current study evaluated the efficacy and safety of ATX-101 treatment for reducing jowl fat. Methods In this prospective single-site study, 66 adults were treated for excess jowl fat with ATX-101 (area-adjusted dose: 2 mg/cm). Eligible patients had pinchable fat on the jawline and relatively minimal skin laxity in the jowl. Depending on the size of the treatment area, ATX-101 injections of 0.2 ml spaced 1.0 cm apart or 0.1 ml spaced 0.50 to 0.75 cm apart were administered. Improvement in jowl appearance was assessed 6 months or more after the last treatment in person by the clinician. Improvement was also assessed by the patient and two independent plastic surgeons using blinded before/after treatment photographs. Safety was evaluated via adverse events. Results The mean number of ATX-101 treatments received was 1.8, with a mean injection volume of 0.8 ml per treatment per jowl. The majority of patients (98 percent) experienced an improvement in jowl appearance. Common adverse events were injection-site edema, numbness, tenderness, and bruising. Injection-site marginal mandibular nerve paresis and alopecia were experienced by three patients each; all events resolved without sequelae. Conclusions ATX-101 effectively reduced jowl fat and was well tolerated in this small cohort. Care should be taken when injecting ATX-101 into jowl fat to avoid underlying anatomic structures such as the marginal mandibular nerve. Clinical question/level of evidence Therapeutic, IV.

AIMS To analyze cervical tenderness scores (CTS) in patients with various temporomandibular disorders (TMD) and in controls and to examine associations of CTS with demographic and clinical parameters. METHODS This case-control study included 192 TMD patients and 99 controls diagnosed based on a questionnaire and a clinical examination following the Research Diagnostic Criteria for Temporomandibular Disorders (RDC/TMD) guidelines. CTS, adapted from the widely used total tenderness score, was the mean sum of the palpation scores from the suboccipital, sternocleidomastoid, and trapezius muscles. Depending on the variables, data were analyzed using Pearson chi-square, analysis of variance, t test, Bonferroni post hoc adjustment, and/or multivariate linear regression analyses. RESULTS CTS was higher in TMD compared to controls (P < .001). Across TMD subgroups, CTS was notable only in those with a myogenous TMD diagnosis, but not in arthrogenous TMD (P = .014). CTS was positively associated with: female sex (P = .03), whiplash history, higher verbal pain scores, comorbid headaches, body pain, increased pain on mouth opening, and higher masticatory muscles tenderness scores (MTS) (P < .001 for all). Sex (P < .001), MTS (P < .001), comorbid headache (P = .042), and pain on opening (mild: P = .031; moderate: P = .022) retained significant associations with CTS in the multivariate analysis, and these main effects were influenced by interactions with whiplash history and comorbid body pain. CONCLUSION CTS differentiated between TMD patients and controls and between TMD diagnoses. Specific patient and pain characteristics associated with poor outcome in terms of CTS included effects of interactions between myogenous TMD, female sex, whiplash history, comorbid body pain and headaches, and pain on opening. It can therefore be concluded that routine clinical examination of TMD patients should include assessment of the cervical region.

Objectives:To compare and evaluate the safety, efficacy and results for the treatment of adhesive capsulitis by Physiotherapy, Peri-articular injections followed by physiotherapy and Manipulation under Anaesthesia (MUA) followed by physiotherapy. Results: Adhesive capsulitis was found to be more prevalent among males. 55% of the patient in our study were Males, peak incidence of adhesive capsulitis between age group of 40 to 70 year. Maximum number of cases were found between 41-50year (50%) and 51 to 60 year (38.33%). Highest no of patients were found as daily wage worker (33) 27.5% followed by house wife (32) 26.67%. Least patients were found in student class (2)1.67%. Side of affection was majorly left shoulder. Results were evaluated on the basis of clinical improvement of certain parameters such as Pain, Tenderness, Muscular Atrophy and Range of Movement Of Shoulder. Atrophy of muscle was seen in 71 patients. Atrophy of only Deltoid muscle was observed in 36 patients. Except in 4 patients all pts had tenderness over shoulder. All the treatment modalities were found to be significant with all p values less than 0.05. Good grade was observed nearly equivalent in MUA with PT (80.43%) and Injection with PT (78.57%) with a difference of 1.86%. Poor grade was found maximum in Physiotherapy (28.12%) and minimum in MUA with PT (4.35%). Conclusion: The study conclude MUA with PT and Inj with PT showed nearly equivalent good results. Physiotherapy alone showed maximum poor results. This study supports the use of Manipulation under Anaesthesia with PT and Peri-articular injection with PT over Physiotherapy alone.

The objectives of this study was to compare palatability changes of the longissimus thoracis (LT) and vastus lateralis (VL) muscles of Hanwoo steers from different beef quality grades (1+ and 1) during 28 d of wet-aging in order to improve the utilization of the VL muscle as a steak. The VL muscle showed a higher collagen content and a lower intramuscular fat content than the LT muscle (p

Objectives A lesser known after effect of harvesting temporalis fascia is the post-surgical craniofacial pain. The aim of the study was to evaluate this pain after tympanomastoid surgeries and the effectiveness of silastic sheet interpositioning to prevent this pain. Materials and methods This pilot study that spanned one year, included patients who underwent tympanoplasty with or without mastoidectomy involving the harvesting of temporalis fascia. At the end of surgery, the wound was closed after silastic sheet was secured over the donor site in cases and without silastic sheet in controls. In the post-operative period, patients scored their temporal pain, tenderness and pain during opening of mouth and mastication on a visual analogue scale (VAS) on day 7, 15, 30 and 90. Results Visual analogue scale (VAS) scores of the silastic group were lower than the control group on day 7 and 15 after surgery and the difference was statistically significant. In the control group, temporal pain and tenderness were 74% and 81% respectively on day 7. VAS scores of both groups decreased over time and were negligible after 3 months. There were no significant postoperative complications in either group and no reaction or rejection of silastic sheet in the cases. Conclusion Post-surgical craniofacial pain secondary to the harvesting of temporalis fascia is observed in a majority of the patients. This novel technique involving silastic sheet interposition can decimate early post-operative temporal pain, tenderness and masticatory pain.

Background The efficacy of stabilization appliance therapy for masticatory muscle pain is debated. Therefore, there are currently no clear usage standards. We analyzed patient factors influencing its efficacy and characterized masticatory muscle pain subtypes to determine appropriate therapy candidates. Methods This case series study recruited patients diagnosed with local myalgia or myofascial pain and used variables related to temporomandibular disorders in the analysis. We used temporary appliance to screen patients for sleep bruxism for 2 weeks. Afterwards, we initiated therapy with stabilization appliances. Efficacy was evaluated via tenderness intensity during muscle palpation and the treatment satisfaction score after 2 months of treatment. Results We analyzed 62 (91%) patients. Tenderness upon muscle palpation was mitigated in 27 patients. Mitigated tenderness odds ratios were 0.035 for myofascial pain, 0.804 for 15‐item Patient Health Questionnaire scores, and 1.915 for facet length. Thirty‐nine patients expressed satisfaction; satisfaction odds ratios were 0.855 for 9‐item Patient Health Questionnaire scores, 1.606 for facet length, and 4.023 for awake bruxism awareness. Conclusions Stabilization appliance therapy is most effective for patients with awake bruxism awareness, local myalgia, long facets, and no psychosocial risk factors.

Tender joint count is part of most composite disease activity scores and treatment targets in rheumatoid arthritis (RA).1 Joint tenderness could represent not only synovial inflammation in the absence of clinical swelling but also factors such as erosive damage and pain sensitisation.2 Ultrasound examination can add information to the clinical evaluation of inflammation. Joint tenderness did not reflect inflammatory activity when assessed by ultrasound in patients with established RA3 but might be more related to inflammation in early arthritis.4 5 We aimed to explore joint tenderness in DMARD-naive patients with early RA and assess whether this finding was associated with ultrasound inflammation in the absence of swelling. The analyses were performed using baseline data from the ARCTIC trial,6 which included assessment of joint tenderness by Ritchie Articular Index and a 44-swollen joint count. The Ritchie Articular Index grades joint tenderness 0–3, with certain joints being treated as a single unit, for example, the metacarpal-phalangeal (MCP) joints. In the ultrasound examination, 32 joints were all dorsally scored semiquantitatively 0–3 for power Doppler (PD), with an ultrasound atlas for reference.6 The wrists were predefined as the joint area of interest since they are commonly involved in RA and were assessed both clinically and by ultrasound. Additionally, in these joints, scoring of tenderness by Ritchie Articular Index could correspond to the more commonly used tender joint count. The presence of ultrasound inflammation was defined as …

Fibromyalgia (FM) is a chronic pain disorder characterized by chronic widespread musculoskeletal pain (CWP), tenderness, and fatigue, which interferes with daily functioning and quality of life. In clinical studies, this symptomology is assessed, while preclinical models of CWP are limited to nociceptive assays. The aim of the study was to investigate the human-to-model translatability of clinical behavioral assessments for pain and muscle function in a preclinical model of CWP. We assessed correlations between pain behaviors and muscle function in a preclinical model of CWP and in women with fibromyalgia to examine whether similar relationships between outcomes existed in both settings, for usability of clinical assays in model systems. For preclinical measures, the acidic saline model of FM which induces widespread muscle pain, was used in adult female mice. Two gastrocnemius injections of acidic or physiological pH saline were given following baseline measures, five days apart. An array of adapted pain measures and functional assays were assessed for three weeks. For clinical measures, pain and functional assays were assessed in adult women with FM. For both preclinical and clinical outcomes, movement-evoked pain (MEP) was associated with mechanical pain sensitivity. Mechanical sensitivity was correlated to shifts in weight-bearing preclinically and was predictive of functionality in patients. Preclinically, it is imperative to expand how the field assesses pain behaviors when studying multi- symptom disorders like FM. Targeted pain assessments to match those performed clinically is an important aspect of improving preclinical to clinical translatability of animal models.SummaryPreclinical assessments of chronic musculoskeletal pain recapitulate several outcome measures for clinical assessment of patients with FM, particularly prolonged resting pain, and MEP.