Manual therapy
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Methods of assessing functional impairment in arthritic hands include pain assessments and disability scoring scales which are subjective, variable over time and fail to take account of the patients' need to adapt to deformities. The aim of this study was to evaluate measures of functional strength and joint motion in the assessment of the rheumatoid (RA) and osteoarthritic (OA) hand. Ten control subjects, ten RA and ten OA patients were recruited for the study. ⋯ In the RA there were demonstrable relationships between ROM measurements and disability (R2=0.31) as well as disease duration (R2=0.37). Intra-patient measures of strength were robust whereas inter-patient comparisons showed variability. In conclusion, pinch/grip strength and ROM are clinically reproducible assessments that may more accurately reflect functional impairment associated with arthritis.
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Case Reports
Mechanical Diagnosis and Therapy approach to assessment and treatment of derangement of the sacro-iliac joint.
This case report describes the clinical reasoning and management of the sacroiliac joint, utilising the McKenzie Method of Mechanical Diagnosis and Therapy (MDT). A patient with a 2 year history of buttock and thigh pain demonstrates a directional preference for repeated anterior SIJ rotation. The MDT approach is discussed and is an ideal method for emphasising the patients involvement in managing their own back problem.
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The objective of the study was to assess inter-rater reliability of one palpation and six pain provocation tests for pain of sacroiliac origin. The sacroiliac joint (SIJ) is a potential source of low back and pelvic girdle pain. Diagnosis is made primarily by physical examination using palpation and pain provocation tests. ⋯ In conclusion this study has shown the reliability of the pain provocation tests employed were moderate to good, and for the palpation test, reliability was poor. Clusters out of three and five pain provocation tests were found to be reliable. The cluster of tests should now be validated for assessment of diagnostic power.
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The purpose of this study was to determine the accuracy of manipulative physiotherapists in palpating radiologically identified lumbar spinous processes (SPs). Five experienced manipulative physiotherapists were each allocated a cohort of 15 consecutive low back pain (LBP) patients presenting for X-rays and were asked to use surface palpation to identify the L1, L3 and L5 SPs. Spherical radio-opaque markers were taped to the skin over these palpated points and standard lateral radiographs taken. ⋯ The strongest effect on accuracy was between-therapist variability. The manipulative physiotherapists used in this study appear to be moderately successful in either palpating a nominated SP or being no more than one spinal level in error. Further research will focus on the choice of palpation procedure and a larger sample.
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The aim of this study was to describe the differences in the presence of myofascial trigger points (TrPs) in the upper trapezius,sternocleidomastoid, levator scapulae and suboccipital muscles between patients presenting with mechanical neck pain and control healthy subjects. Twenty subjects with mechanical neck pain and 20 matched healthy controls participated in this study. TrPs were identified, by an assessor blinded to the subjects' condition, when there was a hypersensible tender spot in a palpable taut band, local twitch response elicited by the snapping palpation of the taut band, and reproduction of the referred pain typical of each TrP. ⋯ Moreover, differences in the distribution of TrPs within the analysed cervical muscles were also significant (P < 0.01) for all muscles except for both levators capulae. All the examined muscles evoked referred pain patterns contributing to patients' symptoms. Active TrPs were more frequent in patients presenting with mechanical neck pain than in healthy subjects.