No abstract

Despite the fact that both methods yielded similar results and have statistically similar number of complications, the type of postoperative complications was different between groups. The plate group had more postoperative pain and worse function but both aspects improved after plate removal. The rope group had more complex complications including deep infection and recurrence of deformity and fracture. These differences should be taken into consideration when consenting the patient regarding possible treatment.

The results provide early, exploratory evidence that patients with persistent shoulder pain treated by physiotherapists using palpation-guided SSNBs achieve clinically important changes in pain and function in the short and medium term.

Wide variations in treatment approaches were identified. There was no consistency in the choice of modality used, the type of exercise or the dose of exercise prescribed. The use of passive modalities and corticosteroid injections was found to remain commonplace, despite a lack of supporting research evidence. There is a clear need for evidence-based guidance for physiotherapists treating patients with tennis elbow.

Objectives: To investigate the long-term efficacy of lateral glide mobilisation for patients with chronic Cervicobrachial Pain (CP). Methods: A randomised controlled trial which involved ninetynine participants with chronic CP. Participants were randomised to receive either the lateral glide with self-management (n = 49) or self-management alone (n = 50). Four assessments were made (at baseline and 6, 26 and 52 weeks post intervention). The primary outcome measure was the Visual Analogue Scale (VAS) for pain. Patient perceived recovery used the Global Rating of Change score (GROC). Functional outcomes included the Neck and Upper Limb Index score (NULI) and the Short-From 36 (SF36). Costs and reported number of harmful effects in response to intervention were evaluated. An intention to treat approach was followed for data analysis. Results: No statistically significant between-group differences were found for pain (using VAS) in the short-term at six weeks (p = 0.52; 95% CI −14.72 to 7.44) or long-term at one year (p = 0.37; 95% CI −17.76 to 6.61) post-intervention. The VAS outcomes correlated well with GROC scores (p < 0.001). There was a statistically significant difference in NULI scores favouring self-management alone (p = 0.03), but no between-group differences for SF36 (p = 0.07). The cost of providing lateral glide and self-management was twice that of providing self-management alone. Minor harm was reported in both groups, with 11% more harm being associated with the lateral glide. Conclusion: In patients with chronic CP, the addition of a lateral-glide mobilization to a self-management program did not produce improved outcomes and resulted in higher health-care costs.

Background: Sub-acromial shoulder pain (SASP) is a common clinical presentation with much diagnostic uncertainty. Some of this uncertainty relates to the involvement of the cervical spine as a source or contribution to SASP. Currently, there is no accepted method of screening of the cervical spine in the presence of SASP, which risks patients receiving misguided and/or ineffective interventions.Objective : To evaluate approaches used to screen the cervical spine in patients with SASP.Design: Systematic review of randomized controlled trials (RCTs). Methods:Electronic searches of PEDro and MEDLINE to December 2016 were conducted. RCTs evaluating the effectiveness of interventions within the current scope of physiotherapy comprising of adult patients complaining of SASP were included. Data relating to the method of cervical spine screening was extracted and synthesized categorically.Results: 102 studies were included. 26 (25.5%) were categorized as "No method of screening undertaken or reported", 49 (48.0%) were categorized as "Localized cervical spine symptoms and/or radiculopathy/radicular pain", 9 (8.8%) were categorized as "Cervical examination", 2 (2.0%) were categorized as "Manual testing", 2 (2.0%) were categorized as 'History of cervical surgery", and 14 (13.7%) were categorized as using "Combined approaches" Conclusion: Examination of the cervical spine in patients with SASP is variable in RCTs. In many instances, no or minimal attempts to screen were made/reported. This has potential research and management implications and further research is indicated to facilitate development of this aspect of examination.

No abstract

No abstract