BACKGROUND Myofascial Pain Syndrome (MPS) is a major cause of musculoskeletal pain in the shoulder neck region in modern era, originating from Myofascial Trigger Points (MTrPs) in skeletal muscle, either alone or in combination with other pain generators. The objectives of this study were-1. to compare the efficacy and outcome of 3 different treatment modalities namely ultrasound therapy (UST), transcutaneous electrical nerve stimulation (TENS) and steroid mixed with local anaesthetics injection to trigger points, in the clinical outcome of MPS and 2. to propose steps for early rehabilitation after identifying area needing clinical research. MATERIALS AND METHODS Based on the Travell and Simon's criteria, 109 patients diagnosed to have MPS in the cervical and peri scapular region were recruited for this study. They were randomly divided into 3 groups. Group A received ultrasound therapy (UST), group B received transcutaneous electrical nerve stimulation (TENS) and group C received depot form of steroid (Triamcinolone 20 mg) injection with local anaesthetics (lidocaine 2%) at trigger points (TPI). All patients also received therapeutic exercises (Stretching exercises of trapezius muscle, strain/ counter strain exercise of cervical and upper back), hot packs application and tablet amitriptyline (10 mg) daily at night for 6 weeks. They were followed up after initial visit, at 2nd week, 6th week, 12th week and at 24th week. Pain and result of the treatment were assessed with visual analogue scale (VAS) scores, number of trigger points, index of MTrPs and neck disability index (NDI) questionnaire method. RESULTS Pain scores improved in the patients of all the 3 groups, in the early visits but gradually worsened in later visits. Group C showed significant improvement (p value <0.01) in the pain scores by VAS scale and other scores like number of trigger points, MTrP index score and neck disability index score as compared to group A and B. But no group could show significant improvement in outcome measures at long term follow up. CONCLUSION MPS can be effectively managed by TPI. UST and TENS are also approved methods of treatment, but their efficacy is not as remarkable as TPI. But the improvements were sustained for a short term only.
BACKGROUND:The study was to evaluate the surgical outcomes of arthroscopic repair of post-traumatic Bankart lesions with the use of suture anchors. Patients with >20% bony lesions, SLAP (superior labral tear from anterior to posterior) lesions and multi-directional instability were excluded. The patients were followed up for a period of minimum 4 years. MATERIALS AND METHODS: We evaluated the results of arthroscopic Bankart repair with use of suture anchors in 35 patients with traumatic recurrent anterior instability of the shoulder. The mean age at operation was 25.71 years. The patients were evaluated pre-operatively and at follow-up using the UCLA (University of California Los Angeles) shoulder scoring system and the modified Rowe scores, which were 6.2 and 29.3 respectively pre-operatively. RESULTS: The UCLA shoulder scoring system and the modified Rowe scores at follow-up were 32 and 72.57 respectively and both improvements were significant. The Modified Rowe Shoulder Scoring System showed 14 patients having excellent results, 12 patients good, 6 patients fair and 3 patients with poor results. One patient had subluxation and another had positive apprehension test. Five patients had discomfort/pain with arm in abducted and externally rotated position but negative apprehension test. Remaining 28 patients had negative apprehension test; no subluxation. Significant improvements occurred for each motion tested for each follow up visit. CONCLUSION: We conclude that arthroscopic Bankart lesion repair with suture anchors is an effective surgical technique for the treatment of an isolated Bankart lesion having good results with respect to pain relief, stability and function. KEYWORDS: Arthroscopic Bankart repair, Anterior shoulder instability, UCLA (University of California Los Angeles) shoulder rating scale. INTRODUCTION:The shoulder, by virtue of its anatomy and biomechanics, is one of the most unstable and frequently dislocated joints in the body, accounting for nearly 50% of all dislocations. According to one estimate, up to 96% of acute shoulder dislocations were traumatic in origin. (1) Anterior instability is the most common form of shoulder instability. (2) Recurrent anterior shoulder instability results in a functional disability for the patient, in terms of both shoulder function and general health status. (3) The use of arthroscopy has improved the recognition of pathologic findings in shoulder instability and allowed a better understanding of the etiology of instability and the correlation between symptom and lesion patterns.Arthroscopic treatment of shoulder instability due to Bankart lesion introduced some advantages compared with open Bankart lesion repair procedure. The Arthroscopic method offers a less invasive technique of Bankart repair.
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