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BackgroundEvidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS).AimTo investigate the efficacy of SWT on pain and function in the management of GTPS.MethodsA systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow‐up were considered for inclusion. Meta‐analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria.ResultsTwelve articles (n = 1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non‐RCTs. No statistical differences were observed for pain over time f(1,5) = 1.349 (p = 0.298) or between SWT and control f(1,5) = 1.782 (p = 0.238). No significant differences in functional outcomes in short‐ (H = 2.591, p = 0.181) and medium‐term follow‐up (H = 0.189, p = 0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges‐G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow‐up time‐points in SWT groups compared to control.ConclusionModerate‐quality evidence demonstrated no statistically significant improvements in pain and function post‐SWT compared to control. Low‐quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta‐analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.
BackgroundEvidence is lacking for the efficacy of shockwave therapy (SWT) in the treatment of greater trochanteric pain syndrome (GTPS).AimTo investigate the efficacy of SWT on pain and function in the management of GTPS.MethodsA systematic search of electronic databases and grey literature was conducted up to May 2023. Studies utilising SWT on adults for GTPS, providing measures of pain and/or function at baseline and at follow‐up were considered for inclusion. Meta‐analysis was undertaken using converted pain and functional outcomes. Studies were assessed for quality and risk of bias, and assigned a level of evidence as per the Grading of Recommendations, Assessment, Development and Evaluations criteria.ResultsTwelve articles (n = 1121 subjects) were included, including five randomised controlled trials (RCTs) and seven non‐RCTs. No statistical differences were observed for pain over time f(1,5) = 1.349 (p = 0.298) or between SWT and control f(1,5) = 1.782 (p = 0.238). No significant differences in functional outcomes in short‐ (H = 2.591, p = 0.181) and medium‐term follow‐up (H = 0.189, p = 0.664) were identified between SWT and control. Moderate magnitude treatment effects for pain (Hedges‐G [HG] 0.71) favouring SWT groups over control was identified, decreasing to low for function (HG 0.20). Further pain and functional treatment effects were identified at higher magnitudes across follow‐up time‐points in SWT groups compared to control.ConclusionModerate‐quality evidence demonstrated no statistically significant improvements in pain and function post‐SWT compared to control. Low‐quality evidence established clinical improvements throughout all included studies favouring SWT over control. Consequently, owing to relatively low incidence of side effects, SWT should be considered a viable option for the management of GTPS. Issues with both clinical and statistical heterogeneity of studies and during meta‐analysis require consideration, and more robust RCTs are recommended if the efficacy of SWT for the management of GTPS is to be comprehensively determined.
BackgroundThe deltoid is a common site for intramuscular injections, but guidelines for administration lack standardization. Global researchers propose various techniques, and recent study reports indicate a 1.5-15% incidence of nerve palsies due to injections. Our cadaveric study is aimed to standardize the deltoid intramuscular injection sites in the Southeast-Asian population.MethodsA cadaveric study of a 2-year duration was conducted in the Department of Anatomy in which twelve upper extremity specimens were dissected by the end of the pilot phase. Anthropometric measurements of deltoid muscle along with the distance of underlying neuro-vascular structures like the Axillary nerve and Posterior Circumflex Humeral Artery were measured from neighboring bony landmarks.ResultsIn adults, in anatomical position, the mean distances of the Axillary nerve, and Posterior Circumflex Humeral Artery from the mid-acromial point are 8.19 ± 0.616 cm; and 8.66 ± 0.968 cm respectively. The deltoid thickness at 3, 5, and 7 cm from mid-acromial point was observed to be 1.079 ± 0.13 cm (0.5 cm to 1.78 cm), 1.599 ± 0.12 cm (1 cm to 2.96 cm), 1.815 ± 1.0 cm (1.2 cm to 2.5 cm) respectively. The acquired qualitative and quantitative data were tabulated, graphically represented, and statistically analyzed.ConclusionsThe deltoid IMI must be given at or below the level of the midpoint of the deltoid muscle, but never in the upper half. We recommend a site, 4 fingerbreadths / 9cm below the mid-acromion point as the safest site to avoid injury to any underlying neurovascular structures.
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