Journal of clinical rheumatology : practical reports on rheumatic & musculoskeletal diseases
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An accurate and specific diagnosis prevents the recurrences of low back pain and chronic spinal pain. The physical examination is the most useful tool to diagnosis. The examiner must aim to determine the exact tissue that pain arises from to make the specific diagnosis. Lumbar disc herniation is 1 disease that physical examination, symptoms, and findings on imaging technique do not always correlate with each other. The Straight Leg Raising (SLR) test has been used as the primary test to diagnosis lumbar disc herniations and found to have high correlation with findings on operation since its sensitivity is high in only disc herniations leading to root compression that may eventually need operation. More sensitive test, like the Slump, might be used in herniations in which the SLR is negative. The Slump test is really a variant of the SLR and the Lasègue's tests performed in the seated position and is a progressive series of maneuvers designed to place the sciatic nerve roots under increasing tension. At each step in the procedure, the patient informs the examiner what is being felt and whether radicular pain is produced. As a result, the Slump test applies traction to the nerve roots by incorporating spinal and hip joint flexion into the leg raising and would warn the examiner of the presence of nerve root compression when there is a negative SLR test. ⋯ The Slump test might be used more frequently as a sensitive physical examination tool in patients with symptoms of lumbar disc herniations. In contrast, owing to its higher specificity, the SLR test may especially help identify patients who have herniations with root compression requiring surgery.
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Randomized Controlled Trial
Diffuse musculoskeletal pain is not associated with low vitamin D levels or improved by treatment with vitamin D.
Uncontrolled studies have suggested that vitamin D insufficiency causes diffuse musculoskeletal pain. ⋯ Low vitamin D levels are not associated with diffuse musculoskeletal pain, and treatment with vitamin D does not reduce pain in patients with diffuse pain who have low vitamin D levels.
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Enthesitis is inflammation at the insertion of ligaments, tendons, joint capsule, or fascia to bone, and a well-known characteristic feature of ankylosing spondylitis (AS) and related spondyloarthropathies. The clinical evaluation of enthesitis is an important outcome measure and is scored by applying pressure on entheses to elicit tenderness at these sites. ⋯ Our results indicate that algometric evaluation of entheses does not add extra information to clinical relevance of MASES, and grading with digital palpation is a more convenient, practical, and reliable examination method for the assessment of enthesitis.
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Randomized Controlled Trial
Efficacy and safety of topical nimesulide in the treatment of knee osteoarthritis.
Osteoarthritis (OA) affects mainly older people who are more sensitive to adverse effects of classic nonsteroidal anti-inflammatory drugs. Recent publications indicate that topically applied nonsteroidal anti-inflammatory drugs are effective and much safer than their oral analogues. ⋯ This study shows that topical nimesulide gel can have beneficial effects and can improve quality of life in patients with knee OA.