Background: Although the current nonsurgical treatment for trigger digits is corticosteroid (CS) injection, it often comes with adverse effects that may cause some limitations. Currently, Hyaluronic acid (HA) has been successfully used in tendinopathy and may be used in stenosing tenosynovitis. The aim of this study is to compare the efficacy of ultrasound-guided injection between the HA and CS in trigger digits treatment. Methods: Double-blind randomized controlled trial was conducted. Fifty patients with 66 trigger digits were randomly assigned into an intervention group (1 ml of low-molecular weight HA) and a control group (1 ml of 10mg/ml triamcinolone acetate). The ultrasound-guided injection and local anesthesia (0.5 ml of 1% lidocaine without adrenaline) were used. The Quinnell grading, Visual Analog Scale (VAS) score of pain, Disabilities of the Arm, Shoulder and Hand (DASH) score and complications were collected at 1-, 3-and 6-month follow-up. Results: The mean age of HA group (33 digits) and CS group (33 digits) were 58.3 years and 54.7 years respectively. Nine patients were loss of follow-up (7 in HA group and 2 in CS group). The Quinnell grades have shown an improvement in both group. The CS group had a significant better improvement at 1-month (p-value < 0.001) and there was no significant difference at 3-and 6-month follow-up between the two groups. The median of VAS and DASH score were significantly improved by time in both groups (p-value < 0.01). The CS group showed a better significant improvement in early period of follow-up (p-value < 0.05). However, there was no significant difference between the two groups in the last follow-up. Conclusions: HA and CS injection has a comparable therapeutic effect in treatment of trigger digits. However, CS injection has higher efficacy of pain and inflammation reduction in the early phase of the disease.
Introduction The early rehabilitation and mobilization after hip arthroplasty (HA) in elderly femoral neck fracture (FNF) patients significantly reduces the postoperative morbidity and mortality. The direct anterior approach (DAA) without the muscle detachment has been shown to improve the early postoperative functional outcomes in coxarthrosis patients. However, the application of DAA on elderly FNF and the most suitable surgical technique have rarely been investigated. This study aimed to report the short-term outcome after our anterior-based muscle-sparing approach (ABMS) in elderly FNF. Materials and methods A prospective study, in 40 elderly unilateral FNF patients who underwent HA with ABMS, was conducted. The primary outcomes were hip flexion and abduction power at each follow-up period. The contralateral muscle power, measured at 3 and 6 months, was used as the control value. The perioperative data and complications were recorded. Results Thirty-two patients underwent bipolar hemiarthroplasty (BHA), while eight other patients received total hip arthroplasty (THA). The hip abduction power returned to control value at 6 weeks (99.0% ± 6.1%; 95% CI: 86.1–111.8). The hip flexion power returned to control at 3 months (108.5% ± 5.6%, 95% CI: 96.8–120.2). No iatrogenic nerve injury was found. The intraoperative femoral fracture (IFF) was found in 7 patients (17.5%), and was significantly related to the early period of learning skill (first 11 cases; p <0.01). BHA had nonsignificant higher IFF than THA (8 vs. 0; p =0.31). Conclusion After ABMS, the hip muscle could recover to the baseline value within 3 months without iatrogenic nerve injury. The ABMS-related complication, which was IFF, could be significantly improved with the learning skill. The adequate posterior soft tissue release and gentle manipulation of the hip joint might play important roles for IFF prevention. BHA might relate to higher risk of IFF because of difficult reduction from large femoral head diameter.
Background UCLA Shoulder Scale is a useful evaluation tool to assess the functional outcome of shoulder after treatments. It has been translated into several languages. The objectives of this study were to translate UCLA Shoulder Scale into Thai language and validate the translated version in patients with rotator cuff tear. Methods This study consists of 2 phases: 1) Development of the Thai version of UCLA Shoulder Scale and 2) Validation of the translated version. The UCLA Shoulder Scale was translated into Thai according to the international guideline. Seventy-eight subjects with a mean age of 71 ± 11.5 took part in the study. All had shoulder pain and rotator cuff tear according to MRI from 2019 to 2020. Four patients were excluded due to incomplete questionnaires. The data from 21 patients whose symptoms in shoulder joint had not changed within 14 days were analyzed with the UCLA Shoulder Scale test-retest using intraclass correlation (ICC), Standard Error of Measurement (SEM) and Minimal Detectable Change (MDC). The Thai version of UCLA Shoulder Scale was compared to the validated Thai versions of American Shoulder and Elbow Surgeons (ASES), Western Ontario Rotator Cuff (WORC) and Shortened version of The Disability of the Arm, Shoulder and Hand (QuickDASH) shoulder scores. Results Thai version of UCLA Shoulder Scale was developed following the guideline. Moderate to strong correlations were found using Spearman’s correlation coefficient between pain, function and total score of Thai version of UCLA Shoulder Scale. The reliability of total UCLA Shoulder Scale was excellent (ICC = 0.99, 95% CI 0.97–1.00), whereas agreement assessed with SEM and MDC (0.18 and 0.50 respectively) demonstrated a positive rating. The validity analysis of total UCLA Shoulder Scale (Thai version) showed moderate to strong correlations with total ASES, total WORC and QuickDASH (Thai versions). The Thai version of UCLA Shoulder Scale showed no floor and ceiling effects from the results. Conclusion The Thai version of UCLA Shoulder Scale is a reliable and valid tool for assessing the function and disability of the shoulder in Thai patients who have rotator cuff tear.
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