The Journal of bone and joint surgery. American volume
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J Bone Joint Surg Am · Nov 2002
A comprehensive study of patients with surgically treated lumbar spinal stenosis with neurogenic claudication.
The relationship between objective measurements and subjective symptoms of patients with spinal stenosis and the degree of narrowing of the spinal canal is not clear. The purpose of this study was to evaluate patients undergoing surgery for lumbar spinal stenosis and intermittent neurogenic claudication with functional testing, quantitative imaging, and patient self-assessment. ⋯ A positive treadmill test was consistent with a diagnosis of spinal stenosis and neurogenic claudication in >90% of the patients preoperatively. Following surgical decompression of the lumbar spinal stenosis, more functional improvement was demonstrated by the treadmill test than by the bicycle test. The scores on the Oswestry Disability Index and visual analog pain scale also improved postoperatively. The severity of central canal narrowing at a single level does not appear to limit the postoperative improvement in either functional ability or patient self-assessment. Patients with multilevel central stenosis were, on the average, older and walked a shorter distance preoperatively and postoperatively, although the improvement in their postoperative self-assessment scores was similar to that of patients with single-level stenosis.
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J Bone Joint Surg Am · Nov 2002
Randomized Controlled Trial Multicenter Study Clinical TrialExtracorporeal shock wave therapy in the treatment of lateral epicondylitis : a randomized multicenter trial.
On the basis of observational trials, numerous investigators have recommended extracorporeal shock wave therapy as an alternative treatment for chronic lateral epicondylitis of the elbow. However, there has been no evidence of its efficacy from well-designed randomized clinical trials. The objective of this study was to find out whether extracorporeal shock wave therapy in combination with local anesthesia was superior to placebo therapy in combination with local anesthesia. ⋯ Extracorporeal shock wave therapy as applied in the present study was ineffective in the treatment of lateral epicondylitis. The previously reported success of this therapy appears to be attributable to inappropriate study designs. Different application protocols might improve clinical outcome. We recommend that extracorporeal shock wave therapy be applied only in high-quality clinical trials until it is proved to be effective.
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J Bone Joint Surg Am · Nov 2002
Comparative StudyPulley plasty versus resection of one slip of the flexor digitorum superficialis after repair of both flexor tendons in zone II: a biomechanical study.
The outcome of repair of zone-II lacerations of the flexor digitorum superficialis and flexor digitorum profundus tendons remains suboptimal. We investigated the effects of two strategies to improve postoperative gliding in a human cadaveric hand. ⋯ Both pulley plasty and resection of one slip of the flexor digitorum superficialis reduce gliding resistance after tendon repair in zone II of the hand.