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Background: Knee osteoarthritis (KOA) is the most expected diagnosis for an arthropathy that causes discomfort and disability in older adults. Radiography is frequently used to assess patients with KOA and there have been few prior research evaluating the diagnostic efficacy of ultrasonography (US). The current study sought to assess the diagnostic efficacy of the US in identifying various characteristics of KOA in the scientific literature. Materials and Methods: This study was conducted following the Preferred Reporting Items for Systematic Reviews and Meta Analyses statement. A systematic search in PubMed, Web of Science, Scopus, and Embase databases was completed in March 2023. This study focused on the diagnostic value of US in KOA, including sensitivity, specificity, positive predictive value, and negative predictive value. The quality assessment was conducted using the Joanna Briggs Institute critical appraisal tools. Results: Out of 552 records of database searches, finally, two studies met this systematic review's eligibility criteria and were included in the study. Both of the included studies were cross sectional studies. US demonstrated remarkable sensitivity with adequate specificity for the detection of radiographic knee OA; however, it was found not to be an appropriate method for the detection of early KOA. Conclusion: This study as the first systematic review aims to evaluate the diagnostic performance of US in detecting KOA. These findings shed light on the importance of investigating the different US features in the evaluation of KOA to reach appropriate sensitivity and specificity in the diagnosis [ABSTRACT FROM AUTHOR]

Background & Objective: High power laser therapy (HPLT) seems to be a new modality to possibly manage rotator cuff tendinitis. The purpose of this study was to investigate the effects of HPLT on clinical and sonographic findings in people with chronic rotator cuff tendinitis. Materials & Methods: thirty-two people suffering from rotator cuff tendinitis participated in this study. The patients were randomly assigned to the control group (n=16) that received routine physiotherapy including Transcutaneous electrical nerve stimulation (TENS), ultrasound, hot pack, exercise consisting range of motion, pendulum, strengthening, and stability exercises, or the treatment group (n=16) that received routine physiotherapy and HPLT in the painful area of the shoulder (12 sessions) Clinical and functional findings including pain, shoulder range of motion, shoulder disability, and sub-acromial liquid were measured using the visual analog scale, goniometry, questionnaire, and sonography, respectively before and after treatment. Results: Pain, active and passive range of motion, shoulder disability and subacromial fluid accumulation were significantly different in both groups and improved, but no difference was reported in the thickness of the rotator cuff tendon, especially the supraspinatus tendon. The improvement was more significant (pain reduction and sub-acromial liquid, increase in range of motion and level of function) in the treatment group than in the control group (p<0.05). Conclusion: HPLT combined with the routine physiotherapy improve the clinical as well as sonography findings including supraspinatus tendon thickness and accumulation of sub-acromial fluid in people with rotator cuff tendinitis compared with those in the control group. [ABSTRACT FROM AUTHOR]

Objectives: The objective of this trial was to compare the efficacy of acromioclavicular joint mobilization and standard physical-therapy versus physical-therapy alone in the treatment of the frozen shoulder. Design: Single-blind randomized clinical trial. Setting: Outpatient setting. Subjects: Patients with frozen shoulder. Intervention: Participants were randomly allocated into mobilization + physical-therapy (n = 28), and physical-therapy alone (n = 28) groups for one month. Main Measures: The primary outcomes were the shoulder pain and disability index and the shoulder range of motion. The secondary outcome was the visual analogue scale. Measures were performed at the baseline, immediately and one month after the beginning of the treatment. Results: Visual analogue scale and the shoulder pain and disability index improved more significantly in the mobilization group compared to the physical-therapy group immediately [−4.63 (−5.58–−3.67) vs. −2.22 (−2.96–−1.47), P < 0.001 and −23.08 (−28.63–−17.53) vs. −13.04 (−17.93–−8.16), P = 0.008, respectively] and one month after the beginning of the treatment [−5.58 (−6.45–−4.72) vs. −3.61 (−4.60–−2.62), P < 0.001 and −33.43 (−40.85–−26.01) vs. −20.03 (−26.00–−14.07), P = 0.001, respectively]. Active abduction range of motion was also improved more significantly immediately after the treatment in the mobilization group compared to the physical-therapy group [25.83 (11.45–40.13) vs. 10.17 (1.02–19.15), P = 0.025], however there were no significant differences between two groups concerning other measured range of motions. Conclusions: Adding acromioclavicular mobilization to standard physical-therapy was more efficient in decreasing pain and disability and improving active abduction range of motion compared to standard physical-therapy in frozen shoulder patients. [ABSTRACT FROM AUTHOR]

Objectives: Neck roots lesions are among the etiologies of cervical and arm pain. A detailed patient evaluation could assist the diagnosis, reduce imaging requests, and promote the treatment of cervical pain. We tried to estimate the value of pronator teres reflex in C6 and C7 roots irritation. Methods: The present study comprises 118 participants, including 56 patients with C6 and C7 lesions and 62 normal controls. The reliability and usefulness of this reflex in C6 and C7 roots lesions were compared to positive electromyography and imaging with magnetic resonance. Results: The sensitivity, specificity, positive predictive value, and negative predictive value for pronator teres reflex were 36.4%, 13.6%, 64.8%, and 4.6%, respectively. Discussion: This reflex can be considered an additional reflex during the physical examination for C6 and C7 nerve roots injury, but its diagnostic value for C6 and C7 radiculopathy is unreliable to be used for screening purposes. [ABSTRACT FROM AUTHOR]

Objectives: Extracorporeal shockwave therapy (ESWT) has recently been evaluated for knee osteoarthritis (KOA) treatment. The present study aimed to investigate the therapeutic effects of ESWT for the treatment of patients with moderate KOA compared with conventional physiotherapy (PT). Materials and Methods: In this randomized controlled clinical trial, a total of 75 adult patients (70 females and 5 males) with moderate KOA were randomly assigned to ESWT with exercise, PT with exercise, and exercise-only groups. Finally, patients were evaluated using the visual analogue scale (VAS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), knee range of motion (ROM), Timed Up and Go (TUG) test, and high sensitivity C-reactive protein. Results: In either treatment group, VAS, WOMAC, and TUG significantly improved toward 3 weeks and this improvement sustained until the 7-week follow-up session. In addition, patients' knee ROM significantly improved in the ESWT group throughout the course of the study. Based on the results, no significant difference was observed between the ESWT and PT after 3 weeks and both were superior to exercise alone. In the 7-week evaluation, patients in the ESWT group reported lower pain (50.42% improvement in VAS compared to 30.31%; P < 0.001 and 28.26%; P = 0.008 in PT and exercise groups, respectively) and better improvement in knee extension ROM (P = 0.004 and <0.001, respectively). Conclusions: In general, although PT and ESWT seem to be more effective than exercise alone in the short-term treatment of patients suffering from KOA, medium intensity ESWT is better than PT and exercise in the medium-term rehabilitation of these patients resulting in better pain-relieving and knee ROM improvements. [ABSTRACT FROM AUTHOR]

Objectives: The aim of this study was to assess the efficacy of balance training in combination with physical modalities in patients with knee OA. Materials and Methods: In this single-blinded randomized clinical trial, 60 patients (mean age: 56.5±0.90 years) with primary knee osteoarthritis were recruited. Participants were assigned to two groups. Physiotherapy (PT) group received routine physical therapy (hot pack, ultrasound, transcutaneous electrical nerve stimulation (TENS), and exercise) while balance training group (BT) received conventional physical therapy plus balance training using Biodex balance system (BBS). Results: The comparison between two groups revealed significant differences with regard to the visual analogue scale (VAS) pain score (P = 0.023), Western Ontario and McMaster Universities Osteoarthritis (WOMAC) pain score (P = 0.018), WOMAC total score (P = 0.042), Lequesne index (P=0.015) as well as the score of Timed Up and Go (TUG) test (P = 0.003). Similar results were observed for the fall risk score (P < 0.001). The WOMAC stiffness score in the BT group significantly decreased from 2.80±0.34 to 1.70±0.32 (P < 0.0 1), but it did not decrease in the PT group (P = 0.096). Conclusions: The combination of balance training and physical therapy provided more pain relief and development of functional abilities in patients with knee OA. [ABSTRACT FROM AUTHOR]

Objective Plantar fasciitis (PF) is one of the most common causes of heel pain. The affected area is often close to the attachment of plantar fascia to calcaneus bone. The purpose of this study was to compare the effects of ozone (O2-O3) injection to corticosteroid injection under ultrasound guidance for the treatment of chronic PF. Design Randomized clinical trial. Setting Academic University and Neuromusculoskeletal Research Center. Subjects Thirty patients with chronic PF. Methods The patients were randomly divided into two groups receiving methylprednisolone (15 subjects) vs ozone (O2-O3; 15 subjects). The following outcome measures were assessed before injection and then two weeks and 12 weeks after the injection in each group; morning and daily pain via visual analog scale, daily life and exercise activities via the Foot and Ankle Ability Measure, and plantar fascia thickness at insertion and 1 cm distal to its insertion into the calcaneus via ultrasound imaging. Results Intragroup changes showed significant improvement in pain, functional parameters, and sonographic findings in both groups (P  < 0.05). Pain reduction (both daily and morning) and daily activity improvement were better in the corticosteroid group two weeks after injection; however, at 12 weeks, the ozone (O2-O3) group had significantly more improvement (P  = 0.003, P  = 0.001, and P  = 0.017, respectively). Conclusions Both methods were effective in the treatment of chronic PF. Steroid injection provided a more rapid and short-term therapeutic effect. However, ozone (O2-O3) injection led to a slow and longer-lasting treatment outcome. Ozone (O2-O3) injection can be an effective treatment, with slow onset and a longer durability in the treatment of chronic PF. [ABSTRACT FROM AUTHOR]

Osteoarthritis (OA) is a chronic multifactorial disease characterized by progressive joint degeneration. The purpose of this study was to compare the effects of ultrasound-guided corticosteroid injection with oxygen-ozone injection in patients with knee OA. This double-blind randomized clinical trial was performed on 62 patients with knee OA. The patients were randomly divided into two groups. In the first group 40 mg triamcinolone (1 cc) and in the second group 10 cc (15 μg/ml) oxygen-ozone (O2-O3) were injected into the knee joint under ultrasound guidance. Outcome measures included the Western Ontario and McMaster Universities Osteoarthritis (WOMAC), knee flexion range of motion (ROM), effusion in ultrasound images of the suprapatellar recess, and visual analog scale (VAS), which were evaluated before injection, 1 week, 1 month, and 3 months after the treatment. Sixty-two patients (10 men and 52 women) were enrolled with mean age of 57.9 years. VAS improved in both groups (steroid P value = 0.001, oxygen-ozone P value > 0.001). The improvements seen in VAS and WOMAC scores 3 months after treatment were in favor of the oxygen-ozone group when compared to the steroid group (P = 0.041 vs P = 0.19). There was no significant difference between the two groups in ROM and joint effusion seen under ultrasound (ROM p = 0.880, effusion p = 0.362). However, in the oxygen-ozone-receiving group, joint effusion was decreased significantly (p < 0.001). Both steroid and oxygen-ozone injections are effective in patients with knee osteoarthritis. Our study showed that the effects of oxygen-ozone injection last longer than those of steroid injection to the knee joint. [ABSTRACT FROM AUTHOR]

Familial amyloid polyneuropathy (FAP) type IV (FINNISH) is a rare clinical entity with challenging neuropathy and cosmetic deficits. Amyloidosis can affect peripheral sensory, motor, or autonomic nerves. Nerve lesions are induced by deposits of amyloid fibrils and treatment approaches for neuropathy are challenging. Involvement of cranial nerves and atrophy in facial muscles is a real concern in daily life of such patients. Currently, diagnosis of neuropathy can be made by electrodiagnostic studies and diagnosis of amyloidosis can be made by genetic testing or by detection of amyloid deposition in abdominal fat pad, rectal, or nerve biopsies. It is preferable to consider FAP as one of the differential diagnosis of a case presented with multiple cranial nerves symptoms. The authors present a case of familial amyloid polyneuropathy (FAP) type IV with severe involvement of multiple cranial nerves, peripheral limb neuropathy, and orthostatic hypotension. [ABSTRACT FROM AUTHOR]

Background: This study examined the effects of dry needling on chronic heel pain due to plantar fasciitis. Methods: During this single-blinded clinical trial, 20 eligible patients were randomized into two groups: A case group treated with dry needling and a control group. Patients' plantar pain severity, (using modified visual analog scale [VAS] scoring system), range of motion of ankle joint in dorsiflexion [ROMDF] and plantar extension [ROMPE] and foot function index (using standard questionnaires of SEM5 and MDC7) were assessed at baseline, four weeks after intervention and four weeks after withdrawing treatment. Independent sample t-test, Mann-Whitney U test, paired t-test, Wilcoxon signed rank tests, and chi square test were used for data analysis. Results: The mean VAS scores in the case group was significantly lower than the control group after four weeks of intervention (p<0.001). Comparison of the ROMDF and ROMPE did not reveal any significant changes after four weeks of intervention in the case and control groups (p=0.7 and p=0.65, respectively). The mean of MDC7 and SEM5 scores in the case group were significantly lower than the control group following four weeks of intervention (p<0.001). Conclusion: Despite the insignificant effect on ROMDF and ROMPE, trigger point dry needling, by improving the severity of heel pain, can be used as a good alternative option before proceeding to more invasive therapies of plantar fasciitis. [ABSTRACT FROM AUTHOR]

Carpal tunnel syndrome (CTS) is a neuropathy due to the compression of the median nerve. It is shown that gabapentin in high doses is effective in treatment of CTS patients. In this study we evaluated the efficacy of low doses of gabapentin in treatment of CTS patients. Ninety patients with CTS were randomly assigned to groups A, B and C. Gabapentin was administered to group A with dose of 100 mg/day and to group B with dose of 300 mg/day for 2 months. Group C received no treatment. Before and after treatment, patients were evaluated using Visual analogue scale (VAS) for pain and parasthesia, Boston carpal tunnel questionnaire (BCTQ) including Symptom Severity Scale (SSS) and Functional Status Scale (FSS) to evaluate the efficacy of the treatment. The pinch and grip strength was also measured. There was significant improvement in VAS, grip strength, pinch strength, SSS, FSS and BCTQ score in all three groups (p < 0.05), but the changes in CMAP and SNAP was not significant. Groups A and B in comparison to group C had significantly better improvement in VAS, pinch strength, SSS, FSS and BCTQ total score (p < 0.05). There was significantly more improvement in pinch strength and SSS score in group B compared to group A (p < 0.05). Gabapentin in low doses is a useful drug in treatment of CTS symptoms with no side effects and intolerance. Gabapentin with dose of 300 mg/day is more effective than the dose of 100 mg/day. [ABSTRACT FROM AUTHOR]

Background: Determining the validity of current median sensory nerve conduction techniques for diagnosis of carpal tunnel syndrome (CTS). Methods: Eighty five patients with clinical diagnosis of CTS were compared with the same number of healthy people. The validity of electrodiagnostic tests were compared in a case-control manner. These electrodiagnostic techniques included long-segment, short-segment, 2-segment and relative slowing studies; as well as distoproximal ratio. Receiver Operating Characteristic (ROC) curve employed for comparison, determining the optimal cut-off points for each test. Validity was evaluated with likelihood ratio. Results: Likelihood ratio (LHR) for Radial-median sensory latency difference was ∞, while LHR for ulnarmedian sensory latency difference was 16.9. Sensitivity of Two-segment method was 98.8% and mixed palmwrist median Nerve Conduction Velocity (NCV) study showed a sensitivity and specificity of 97.6%, 83.5% respectively. Conclusions: Radial-median latency difference study (optimal cut-off point ≥0.5) and study of wrist-segment NCV (optimal cut-off point <50.45) were the most valuable techniques in diagnosis of CTS, respectively. Median- ulnar latency difference study and disto-proximal ratio study had more diagnostic implication than long and short (mixed) segment technique in this regard. [ABSTRACT FROM AUTHOR]

Background and Objectives: Diminished bone mineral density can be a problem in cerebral palsied children. The underlying pathophysiology is complex and variable risk factors have been proposed. This study aimed at assessing BMD in children with CP. Materials and Methods: In this analytic-descriptive cross-sectional study, 85 children with CP were recruited in Tabriz Children's Teaching Hospital in a 12-month period. Bone mineral density (BMD) of three lumbar vertebrae (L2-L4) and hip were accessed by Dual energy X-ray Absorptiometry. CP types and subtypes, history previous physiotherapy, standing and walking conditions, nutritional status and anti-seizure medication history and functional status were determined by the Gross Motor Functional Classification (GMFC) scale. Results: Eighty five patients, 44 males and 41 females with mean age of 5.79±2.39 years were enrolled in the study. Osteopenia and osteoporosis were present in 48.2% and 30.6% of the patients, respectively. Standing ability and its duration was directly associated with increased lumbar vertebral BMD. There was no significant inverse correlation between the BMD and GMFC. Conclusion: Osteopenia and osteoporosis are frequent in children with CP. The relating pathophysiology is multifactorial and complex. [ABSTRACT FROM AUTHOR]