Background:Knee pain, is one of the most common causes of patients’ referring to physiatric clinics, and several factors, are involved in its creation. One of these factors is pes anserine bursitis (PAB) for which various treatment methods are used. This study aims to investigate the effect of this method on reducing chronic pain in these patients.Materials and Methods:This clinical trial was conducted in 2013- 2014 on patients with PAB referring to academic, physical medicine clinics. The patients with chronic PAB (pain duration more than 3 months), who were refractory to conservative treatments, were randomly divided into two 20-member experimental groups (extracorporeal shock wave therapy [ESWT] and sham ESWT). Pain scores of all patients were measured using the Visual Analog Scale (VAS) and McGill Pain Questionnaire (MPQ) (total and present pain indexes [TPIs and PPIs]) before intervention, immediately after intervention (3rd week), and after 8 weeks. The pain scores were then compared and statistically analyzed.Results:In the ESWT group, the mean patient pain score of the VAS and TPI in MPQ were significantly lower than in the sham ESWT group immediately after intervention (3rd week): P =0.02, P = 0.04 respectively; and 8 weeks after the end of treatment: P =0.01, P = 0.000. Moreover, the PPI in both groups had significantly decreased over time, although in ESWT group this decrement was significantly more than sham ESWT group (P < 0.001).Conclusion:The results showed that ESWT could be effective in reducing the pain and treating PAB.

Local steroid injections are common for treatment of impingement syndrome. Corticosteroid injections methods are basically in two formats, blind or with image guidance. The aim of this study is to compare the effect of ultrasound-guided in comparison with blind corticosteroid injections in patients with impingement syndrome. This study is a randomized clinical trial study undertaken in patients with diagnosis of impingement syndrome done in Isfahan University of Medical Science clinics from February 2014 to February 2015. The number of all patients registered in the study is 48; and then 40 patients were allocated to either control group randomly which received blind steroid injection or case group that underwent ultrasound-guided steroid injection. The clinical symptoms were assessed using Shoulder Pain and Disability Index (SPADI) questionnaire, Visual Analogue Scale (VAS) and shoulder range of motion (ROM) using goniometer at baseline and six weeks after the injection. Data analysis revealed a significant difference in the mean of the VAS, SPADI and shoulder ROM in both groups 6 weeks after intervention (P < 0.05). Patients with ultrasound guided corticosteroid injection had statistically significant improvements in function and shoulder ROM (abduction, flexion) compared to blind injection group after 6 weeks (P<0.05). There was not significant differences in pain (VAS) and internal and external rotation between these two groups (p>0.05). Our findings suggest that US image guided can improve the shoulder function of patients with impingement syndrome, and thus can be considered in comprehensive care programs of these patients for fast speed of rehabilitation.

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Background:In this study, we aimed to evaluate the effectiveness of extracorporeal shockwave treatment (ESWT) on pain and ankle-hindfoot scale of the American Orthopedic Foot and Ankle Society (AOFAS) score of patients with chronic Achilles tendinopathy (AT).Materials and Methods:In this double-blind clinical trial, 43 patients with chronic AT were selected and randomly allocated in two groups to receive a basic treatment with ESWT or sham SWT (radial and focused shock waves, four sessions once a week for 4 weeks). AOFAS and pain scores for each patient were recorded at baseline (before intervention), immediately after intervention, and 4 and 16 weeks after intervention using AOFAS and visual analog scale (VAS) scaling method.Results:A total of 43 patients (22 ESWT and 21 sham SWT) were participated in this study. Both groups improved during the treatment and follow-up period. The mean VAS score decreased from 7.55 to 3 in the intervention group and from 7.70 to 4.30 in the sham SWT group. Mean AOFAS and VAS scores were significantly different between ESWT and no ESWT groups at 16 weeks of follow-up (P = 0.013) (P = 0.47). There was no significant difference in terms of AOFAS and VAS scores between both the groups in the other follow-up times.Conclusion:Overall, ESWT causes decrease in VAS score and increase in AOFAS score. However, due to the small sample size, the results were not statistically significant. It is recommended to plan more interventional studies with larger sample size in the future.

Objectives: This study aimed to assess the effects of using Extracorporeal Shock Wave Therapy (ECSWT) and phonophoresis therapy on pain and neck disability in patients with neck myofascial pain syndrome (MPS). Methods: Forty eligible patients were randomly divided into two groups of ECSWT (received three sessions of ECSWT, once a week for three weeks) and phonophoresis (received ultrasound using hydrocortisone gel 1% over the trigger point on trapezius muscle, three times a week for three weeks). Patients in both groups received the same stretching exercise program and drug regimen during the intervention. Results: Pain and NDI scores in both groups were significantly improved at the end of the treatment and four weeks later. At the end of the treatment, the pain score was similar between the groups. Four weeks after the treatment, the pain score in the ECSWT group was significantly lower than in the phonophoresis group (P-value = 0.030). The NDI score was not significantly different between the groups at the end of the treatment. However, four weeks after the treatment, the NDI score was significantly lower in the ECSWT group than in the phonophoresis group (P-value=0.032). The trend of changes in the pain and NDI scores was not significantly different between the groups. Conclusions: Both phonophoresis and ECSWT groups effectively decreased pain and neck disability in patients with MPS, with the superiority of ECSWT with a more lasting effect for a month after the end of the treatment.

Introduction: Trigger finger disorder is a sudden release or locking of a finger during flexion or extension. Regarding the complications and disadvantages mentioned for the methods used in the treatment of trigger finger disorder, the aim of this study was to investigate the effect of extracorporeal shock wave therapy in the treatment of patients with trigger finger. Methods: This study was an interventional study recruiting 19 patients with trigger finger disorder. Evaluation of pain severity, severity of triggering, and functional impact of triggering was carried out using the Visual Analogue Scale, Trigger Finger Score suggested by Quinnell, and Quick-Disabilities of the Arm, Shoulder, and Hand (DASH) questionnaire, respectively, before intervention, immediately after intervention, and in 6 and 18 weeks after intervention. Each patient was treated with extracorporeal shock wave therapy in three sessions with a 1-week interval. Data were analyzed in Statistical Package for the Social Sciences (SPSS) software using ANOVA to monitor changes in pain severity, severity of triggering, and functional impact of triggering during follow-ups. Results: There were statistically significant differences with regard to reduction of the pain severity, severity of triggering, and functional impact of triggering before intervention, immediately after intervention, and in 6 and 18weeks after intervention (P<0.01). However, the effect of extracorporeal shock wave therapy on reducing severity of triggering immediately after intervention did not yield a statistically significant difference compared to before intervention (P>0.01). Conclusion: It seems that extracorporeal shock wave therapy leads to a reduction in pain severity, severity of triggering, and functional impact of triggering. These effects persisted until the 18th week after the intervention. It is recommended to use extracorporeal shock wave therapy in terms of a non-invasive intervention with no significant complications for patients with trigger finger.

Background:To determine the effects of knee taping in combination with exercise and medical treatment on functional outcome and pain of patients with knee osteoarthritis (OA).Materials and Methods:In a randomized single-blinded clinical trial, 36 patients with knee OA were randomly assigned to two study groups. Both groups received exercise and medical therapy for 6 weeks. In addition, the first group (20 patients) received taping in the first 3 weeks. Pain severity (assessed by visual analog scaling), weekly amount of analgesics consumption, timed get up and go test (TUG), and step tests were recorded at baseline, 3 and 6 weeks after the treatment and were further compared between two study groups.Results:There was no significant difference between two groups in pain severity score (P = 0.228), step test score (P = 0.771), TUG test score (P = 0.821) and weekly amount of analgesics consumption (P = 0.873) at baseline. After 3 weeks, weekly amount of analgesics consumption (P = 0.006), pain severity (P < 0.001) was significantly lower in taping group whereas step test score (P = 0.006) was significantly higher in the taping group. After 6 weeks, patients in taping group had significantly lower pain severity (P = 0.011) and higher step test score (P = 0.042). However, there was no significant difference in TUG test score (P = 0.443) and weekly amount of analgesics consumption (P = 0.270) between two groups.Conclusion:Therapeutic knee taping may be an effective method for short-term management of pain and disability in patients with knee OA.

Background:The aim of this study is to compare the effects of laser therapy and shock wave therapy for symptoms treatment among patients with MPS in the upper trapezius muscle.Materials and Methods:In a clinical trial study, 46 patients were selected based on the clinical criteria and physiathrist diagnosis. Subjects were randomized into two groups as follows: Twenty individuals were assigned to exercise-medication-laser therapy group, and 26 to exercise-medication-shock wave therapy group. The pain was assessed based on visual analog scale (VAS), neck disability index (NDI), and SPADI in three stages: Before treatment, subsequently after treatment, and a month after treatment.Results:One man and 19 women, age group of 45.3 ± 7.7 years, were assigned into laser therapy group. Two men and 24 women, average age group of 42.3 ± 10.4 were assigned into shock wave therapy group. A significant difference was found among our study groups before treatment and after starting treatment for VAS, NDI, and SPDI indices, that is, two methods of treatments were effective (P < 0.001). However, among these two treatment methods, laser therapy provided higher effect on VAS and NDI as compared to the radial shock wave method (P < 0.05) in 2 weeks from starting the treatment (consequent to treatment).Conclusion:According to this study results, we can conclude that shock wave and laser therapy results on similar effect in long-term for relieve of pain and eliminating symptoms in patients with myofascial but laser provides a faster optimal results.