Of76 patients with lateral epicondylitis, 38 were randomly allocated to receive ultrasound treatment and 38 placebo. All 76 were given 12 treatments each over four to six weeks. The conditions of 24 patients (63%) treated with ultrasound and 11 (29%) given placebo improved, the difference being significant at the 1% level. Improvement in particular clinical variables (pain score, weight lifting, grip strength) also showed an advantage for the patients given ultrasound treatment. A simple underwater radiation balance showed considerable fluctuation in ultrasonic output, and frequent checks of output were shown to be necessary.Ultrasound enhances recovery in most patients with lateral epicondylitis.
Computerised temperature assessments showed statistically significant side to side temperature differences when 17 active tennis elbows were compared with the opposite normal elbows for spot temperatures, proximal and distal forearm gradients. Similar temperature assessments in 18 bilateral tennis elbows compared with 17 normal elbows showed significant temperature differences for elbow spot temperatures and distal forearm gradients, but not for proximal gradients.
Acupuncture is widely used for pain relief in many musculoskeletal disorders, and evidence suggests that modulation of the sympathetic nervous system responses which play an integral part in somatic pain, is an important mechanism of acupuncture action. This prospective study of 20 patients with neck and arm pain measured finger temperature, controlled by somatic sympathetic vasomotor activity before and after needle acupuncture. Responses were correlated with visual analogue scale (VAS) of pain severity. An association was found between pain relief and reduced sympathetic vasomotor activity. In 10 patients with significant reduction in visual analogue scale (VAS) pain (p less than .05), the mean change in temperature (delta t degrees C) was 0.55 (SD +/- 0.86) with significant difference in pre to post treatment temperatures (p less than .01). In 10 patients without significant pain relief on VAS scoring (p greater than .05), the mean t degrees C was 0.20 (SD +0.72) without significant difference in pre to post treatment temperatures (p greater than .05). The relevance of somatic sympathetic influences on musculoskeletal pain and modulation of sympathetic activity by acupuncture will be discussed.
Although these results confirmed the correlation of interleukin 1 concentrations with disease activity in rheumatoid arthritis, they suggest that a rethinking of the role of the 'inflammatory' cytokines tumour necrosis factor a and interferon gamma in the pathology of joint destruction in rheumatoid arthritis may be necessary. In contrast, these data might rather suggest that a relative lack of these cytokines is associated with the disease process, and, further, imply that therapeutic interventions aimed at increasing tumour necrosis factor a and interferon gamma concentrations may be more appropriate than those aimed at decreasing them. This would be consistent with some reports showing decreased interferon gamma and tumour necrosis factor a production in patients with rheumatoid arthritis3 and the possible therapeutic benefit of interferon gamma treatment,4as well as the fact that antirheumatic drugs may stimulate immune responses rather than inhibiting them, even to the extent of enhancing interleukin 2 production.5
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