BackgroundPressure sores are important and common complications of spinal cord injury. Many preventive and therapeutic approaches have been tried and new trials are evolving. One relatively recent method is application of a hydrocolloid dressing (HD). In this study we compared the therapeutic effects of HD on pressure ulcer healing with two other topical applications, phenytoin cream (PC) and simple dressing (SD).MethodsNinety-one stage I and stage II pressure ulcers of 83 paraplegic male victims of the Iran-Iraq war were randomly allocated to three treatment groups. Mean age and weight of the participants were 36.64 ± 6.04 years and 61.12 ± 5.08 kg, respectively. All the patients were managed in long term care units or in their homes for 8 weeks by a team of general practitioners and nurses, and the ulcer status was recorded as "Complete healing", "Partial healing", "Without improvement" and "Worsening".ResultsComplete healing of ulcers, regardless of location and stage, was better in the HD group than the PC [23/31(74.19%) vs 12/30(40%); difference: 34.19%, 95% CI = 10.85–57.52, (P < 0.01)] or the SD [23/31(74.19%) vs 8/30(26.66%); difference: 47.53%, 95% CI = 25.45–69.61, (P < 0.005)] groups. Complete healing of stage I ulcers in the HD group [11/13(85%)] was better than in the SD [5/11(45%); difference: 40%, 95% CI = 4.7–75.22, (P < 0.05)] or PC [2/9 (22%); difference: 63%, 95% CI = 29.69–96.3, (P < 0.005)] groups. Complete healing of stage II ulcer in the HD group [12/18 (67%)] was better than in the SD group [3/19(16%); difference: 51%, 95% CI = 23.73–78.26, (P < 0.005)], but not significantly different from the PC group [10/21 (48%); difference: 19%, 95% CI = -11.47–49.47, (P > 0.05)]. We performed a second analysis considering only one ulcer per patient (i.e. 83 ulcers in 83 patients). This "per patient" analysis showed that complete ulcer healing in the HD group was better than in the PC [20/28(71.4%) vs 11/28 (39.3%); difference: 32.1%, 95% CI = 7.4–56.7, (P < 0.01)] or SD [20/28(71.4%) vs 8/27 (29.6%); difference: 41.8%, 95% CI = 17.7–65.8, (P < 0.005)] groups.ConclusionWe deduced that HD is the most effective method investigated for treating stage I and II pressure ulcers in young paraplegic men.

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BackgroundTennis elbow (TE) is a common musculotendinous degenerative disorder of the extensor origin at the lateral humeral epicondyle. Different modes of treatment are used for management of tennis elbow.ObjectivesThis study investigated the effect of the taping technique (TT) on pain, grip strength and wrist extension force in treatment of tennis elbow.Patients and MethodsThirty patients (16 men /14 women with a mean age of 32.2 years) with tennis elbow of their dominant arm participated in this study. Outcome measures were assessment of pain at the lateral aspect of the elbow, grip strength and wrist extension force before and five to ten minutes after application of elbow tape on the affected and unaffected arms. A Visual Analog Scale was used to assess pain. A dynamometer and a hand-held dynamometer were used for evaluation of grip strength and wrist extension force, respectively.ResultsAmong the variables, significant differences were found in wrist extension forces between effected and unaffected arms (P = 0.02). Changes in grip strength showed statically significant improvements in the affected arm compared to the unaffected arm (P = 0.03). Also, in assessment of pain at the lateral epicondyle, the mean change between affected and unaffected arms was significant, with P = 0.001.ConclusionsThe taping technique, as applied in this study demonstrates an impressive effect on wrist extension force and grip strength of patients with TE. Elbow taping also reduces pain at the lateral aspect of the elbow in these patients.

Context: Use of a handrim wheelchair could force the wrist into extreme excursions and encroachment of the median nerve.Objective: We performed a study of the prevalence of carpal tunnel syndrome in prolonged wheelchair users. Design and setting: A cross-sectional study was conducted for one year in an outpatient clinic of spinal cord injury. Participants: Patients had traumatic injury at the first thoracic level and below, with time since injury of at least 5 years. Outcome measure: The prevalence of carpal tunnel syndrome by history taking, clinical examinations and motor and sensory nerve conduction studies of median nerve performed for both hands. Results: Participants (N = 297) were all male. Mean (SD) age and duration since injury were 48 (8.5) and 23 (6.6) years, respectively. A significant difference in median duration of injury based on the severity of the syndrome (P < 0.001), and a significant trend in time since injury for the severity (P (one tailed) < 0.001) were seen. There was a significant difference in the median age among the groups (P = 0.009), and the median increased with the severity (P (one tailed) = 0.001). Conclusions: Carpal tunnel syndrome is a common side effect of the long time use of wheelchair, and its severity is associated with duration of wheelchair use and age. Alternative methods for wheelchair propulsion should be developed to diminish the likelihood of the syndrome.

Background and aims: Carpal tunnel syndrome is the most prevalent peripheral neuropathy and has a considerable burden on health services. We tried to compare the therapeutic effects of local corticosteroid injection, low-level laser, and corticosteroid phonophoresis in the treatment of carpal tunnel syndrome. Subjects and methods: We performed a randomized clinical trial with three parallel groups. The study was carried out at a University Hospital. In total, 42 participants including 31(73.8%) women were randomly allocated to the treatment groups with equal sizes. We assessed pain, symptom severity and functional status with Boston Carpal Tunnel Questionnaire, and performed median nerve conduction velocity studies. Evaluations were done before the interventions and in the fourth week of study. For the group corticosteroid, under the guidance of sonography, methylprednisolone with lidocaine was injected into the carpal tunnel. For laser therapy, we administered 10 sessions, each lasting 10 seconds. We used topical hydrocortisone acetate gel 10% as the anti-inflammatory agent with phonophoresis, 3 times per week for 10 sessions. Results: Within-group analyses with paired t-test showed that local corticosteroid, laser, and phonophoresis are all effective treatments. Between-group analyses with ANOVA indicated that there were significant differences among the groups after four weeks in terms of pain (p = 0.004), in favor of corticosteroid; and in sensory delay (p = 0.001), in favor of laser. For the Boston Carpal Tunnel Questionnaire and median nerve motor latency, the results were not significant. There was no important side-effect after four weeks of follow-up. Conclusion:The three treatments are comparable and beneficial for carpal tunnel syndrome.