Blind IAI proved safe and accurate when performed by a trained professional. Significant improvement was seen in the VAS for pain at rest and during movement, VAS for oedema and morning stiffness.

Both treatments were effective, with a slight superiority of the intra-articular injection of steroids over intramuscular injection.

Objective: To compare the effectiveness of intra-articular injection (IAI) with Botulinum toxin type A (BTA), triamcinolone hexacetonide (TH), and saline in primary knee osteoarthritis. Design: A randomized controlled trial, with blinded patients and assessor. Setting: Outpatient rheumatology service. Subjects: Patients with knee osteoarthritis grades II and III. Interventions: Patients received IAI with 100 IU BTA, 40 mg TH, or isotonic saline solution (SS) 0.9%. Main measures: Patients were assessed at baseline and at 4, 8, and 12 weeks with the following instruments: visual analog scale for pain during movement (VASm; primary outcome) and visual analog scale for pain at rest (VASr), Western Ontario & McMaster Universities Osteoarthritis Index (WOMAC) questionnaire, 6-minute walk test, Timed Up and Go test, Short Form (SF)-36 questionnaire, range of motion of knee, and ultrasound (US) measurement of synovial hypertrophy. Results: In total, 105 patients were randomized, with 35 in each group; 96 were female (91.4%) and 9 were male (8.6%), with a mean age of 64.2 years (±6.9). At 12 weeks, the TH group showed better results only for VASm. At four weeks, the TH group showed better results than the BTA and SS groups for VASm (–68.9% (37.8) vs. –35.3% (40.3) vs. –35.9% (51.4)), WOMAC pain (–56.0% (30.7) vs. –30.8% (34.3) vs. –30.0% (39.9)), WOMAC stiffness (–53.4% (38.4) vs. –17.2% (59.3) vs. –17.3% (78.1)), WOMAC function (–48.2% (34.6) vs. 30.8% (33.6) vs. –13.6% (64.9)), WOMAC total score (–51.2% (31.0) vs. –30.9% (30.0) vs. –18.8% (54.8)), and US measurement of synovial hypertrophy (–11.6% (44.9) vs. –1.5% (47.9) vs. +28.6% (81.3)). Conclusion: IAI with TH had a higher effectiveness than that with TBA or SS in the short-term assessment (four weeks) for pain in movement, WOMAC, and US measurement of synovial hypertrophy.

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INTRODUÇÃOA síndrome do túnel do carpo (STC) resulta da compressão do nervo mediano no túnel do carpo, sendo a neuropatia mais comum da extremidade superior.O túnel do carpo é um espaço restrito, elíptico, confinado ventralmente pelo retináculo dos flexores, inelástico e resistente e, dorsalmente, pela superfície anterior dos ossos do carpo. As maiores estruturas que passam pelo túnel são: quatro tendões flexores superficiais dos dedos e quatro tendões flexores profundos, tendão do flexor longo do polegar, e o nervo mediano.A incidência de STC na população geral é menor do que 1%, podendo ser encontrados, entretanto, valores acima de 15% em trabalhadores de risco, sendo a tendinite o achado mais comum.A compressão da STC é causada pela discrepância entre a capacidade rígida do canal e o volume de seu conteúdo. Dado que o volume do conteúdo e a capacidade do canal variam com a posição do punho em relação ao eixo do antebraço, os períodos de compressão podem ser inconstantes, e os sintomas resultantes tendem a flutuar (Tabela 1).A STC ocupacional é causa de absenteísmo no trabalho e de disputas legais. Como a incidência de STC continua a aumentar, a avaliação acurada desses pacientes torna-se de fundamental importância. DIAGNÓSTICOO diagnóstico é clínico e determinado pela história e exame físico. Setenta por cento dos pacientes têm entre 40 e 70 anos de idade, e as mulheres são afetadas de três a cinco vezes mais do que os homens. Os sintomas da STC são fraqueza, hiperestesia ou parestesia no território do nervo mediano.O exame físico do paciente com suspeita de STC inclui dois sinais: Tinel e Phalen. O sinal de Tinel é pesquisado com a percussão do punho, sendo positivo com dor ou formigamento no polegar e no indicador ou entre os dedos médios. O sinal de Phalen é pesquisado com a flexão a 90°d o punho; se os sintomas forem reproduzidos em 60 segundos, é considerado positivo.

Objective: To assess the effectiveness of customized insole in patients with Morton’s neuroma. Design: Double-blind randomized controlled trial with intent-to-treat analysis. Setting: Outpatients, University Hospital. Subjects: A total of 72 patients with Morton’s neuroma met the inclusion criteria and were randomly allocated to either the study group ( n = 36) or the control group ( n = 36). Interventions: The study group was assigned to use a customized insole with metatarsal and arch support made of ethyl vinyl acetate and the control group received a flat insole of the same material, color, and density. Main measures: The primary outcome measure was walking pain intensity measured by the visual analogue scale. The secondary outcomes were as follows: pain at rest, palpation, and paresthesia (visual analogue scale); functional disability (6-minute walk test, Foot Function Index, and Foot Health Status Questionnaire); quality of life (Health Survey Short Form-36 (SF-36)); and foot pressure (AM Cube FootWalk Pro program). Results: In the comparison between the groups over time, a statistically significant difference, with improvement in favor of the experimental group, was found for pain during walking ( P = 0.048); in the general health domains ( P < 0.001) and physical activity ( P = 0.025) of the Foot Health Status Questionnaire; in the general Foot Function Index score ( P = 0.012); and in the functional capacity domain of the SF-36 questionnaire ( P = 0.046). For the other parameters, no difference was found between groups. Conclusion: The study demonstrated that customized insole with metatarsal and arch support relieved walking pain and improved patient-reported measures of function in patients with Morton’s neuroma.

Background The peritrochanteric corticosteroid injections with anesthesics is one of the suggested treatments for the refractory case of the Greater Throcanteric Pain Syndrome and this therapeutic intervention can be guided or not. Objectives To compare the effectiveness of both injections in the Greater Trochanteric Pain syndrome treatment: The blinded corticosteroid injections and the ultrasound-guided corticosteroid injections. Methods A prospective, randomised, double – blind, controlled study was made involving 60 patients (from 19 – 65 years old) who were diagnosed with GTPS for at least 30 days. The patients were randomised in two groups. Both groups were infiltraded once. Group 1 (n=30) was infiltraded blindly. Group 2 (n=30) was infiltrated with the ultrasound guidance. In both groups betamethasone (6 mg) and lidocaine (2 cc) were used in a same syringe. Two blinded observers evaluated the experiment during week 0, 1, 4 and 8 after the procedure, using a visual analogue scale (VAS: 0-10). The patients were followed according: Spontaneous pain, painfull palpation, global health, external rotation pain, pain when testing against resistance, repositioning functional testing, “time up and go” (time in minutes), test six-minute walk (distance in meters), Lequesne hip; goniometry hip (flexion, extension and abduction), and ultrasound qualitative and quantitative (in mm) measurements of the gluteus medium tendon, minimum tendon and trochanteric bursa. Side effects were observed and evaluated during the research. Results We studied 60 patients with a mean age of 54 years (10.1), mean duration of pain peritrochanteric of 32.2 months (35.8), with 98% of women, 90% white and 61.66% sedentary. After 8 weeks of follow-up, there was improvement over the initial time (intra-group evaluation) in both groups. Using repeated measures ANOVA, there was no significant difference between the groups for local pain VAS (p=0.347), VAS of pain on palpation (p=0.873), EVA external rotation (p=0.215), test repositioning against resistance (p=0.855), test “time up and go” (p=0.062), test the six-minute walk (p=0.537), Lequesne hip (p=0.802). There was also no statistical difference in the sonographic assessment (p>0.1). The variable VAS global health, was the only one that evolved differently between groups over time (p=0.023) with better intergroup evaluation for group 2. There were no significant adverse effects. Conclusions There are benefits when it comes to the patient's general perception, but according to this study, there is no benefit (intermediate-term) when ultrasound-guided infiltration is used in GTPS patients. References Cohen SP, Strassels SA, Foster L, et al. Comparison of fluoroscopically guided and blind corticosteroid injections for greater trochanteric pain syndrome: multicentre randomized controlled trial. BMJ 2009; 338:b1088 Labrosse JM, Cardinal E, Leduc BE, et al. Effectiveness of ultrasound-guided corticosteroid injection for the treatment of gluteus medius tendinopathy. AJR 2010; 194:202–206 ...