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Effect of anodyne therapy versus traditional physiotherapy in treating de quervain tenosynovitis

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To compare Anodyne Therapy effect and the traditional physiotherapy effect on de Quervain tenosynovitis present study was performed. Thirty two patients with de Quervain tenosynovitis with mean age 48.29 ± 11.29 years were divided equally into experimental group 1 and experimental group 2. Each subject in the experimental group 1 performed 12 session of traditional physical therapy program which include low frequency ultrasound, and Kinesio taping in addition to stretching exercises as a home program, while each subject in the experimental group 2 perform 12 sessions of anodyne therapy (day after day)in addition to stretching exercises as a home program. Evaluation of Intensity of pain and degree of functional ability prior to the treatment, immediately at the end of the 12 sessions and later on after 90 days. Experimental group 1 and 2 showed reduction in the repetitions of pain attaches through the week as well as reduction in numbers of pain hours during the days. Both treatment methods showed reduction in the general pain intensity and during ulnar deviation of wrist joint as evaluated using the VAS. Both anodyne therapy and conventional physical therapy reduce the pain intensity and improve function in the de Quervain tenosynovitis patients. Anodyne therapy alone reduced the frequency of analgesic intake by de Quervain tenosynovitis patients at the last evaluation which was done on 90 days after the last session.
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Bioscience Research
Print ISSN: 1811-9506 Online ISSN: 2218-3973
Journal by Innovative Scientific Information & Services Network
RESEARCH ARTICLE BIOSCIENCE RESEARCH, 2018 15(4):3254-3261. OPEN ACCESS
Effect of Anodyne Therapy versus Traditional
Physiotherapy in Treating de Quervain Tenosynovitis
Ahmed Ebrahim Elerian1, Mahmoud Mohamed Ewida1, Noran Ahmed Elbehary2,
Gada Ismail Mohamed2, Nabil Mahmoud Abdel-Aal2 Ayman Mohmed Elmakaky 3
and Fatma Elfeky 4
1 Assistance professor, Physical Therapy Department for Basic Science, Physical Therapy Faculty, Cairo University,
Egypt.
2 Lecturer, Physical Therapy Department for Basic Science, Physical Therapy Faculty, Cairo University, Egypt.
3 Lecturer, Physical Therapy Department for Surgery, Physical Therapy Faculty, South Valley University, Egypt.
4 Lecturer, Physical Therapy Department for Basic science, Physical Therapy Faculty, South Valley University,
Egypt.
*Correspondence: dr_ahmed_elerian77@yahoo.com Accepted: 02 Nov. 2018 Published online: 03Dec. 2018
To compare Anodyne Therapy effect and the traditional physiotherapy effect on de Quervain
tenosynovitis present study was performed. Thirty two patients with de Quervain tenosynovitis with
mean age 48.29 ± 11.29 years were divided equally into experimental group 1 and experimental group
2. Each subject in the experimental group 1 performed 12 session of traditional physical therapy
program which include low frequency ultrasound, and Kinesio taping in addition to stretching exercises
as a home program, while each subject in the experimental group 2 perform 12 sessions of anodyne
therapy (day after day)in addition to stretching exercises as a home program. Evaluation of Intensity of
pain and degree of functional ability prior to the treatment, immediately at the end of the 12 sessions and
later on after 90 days. Experimental group 1 and 2 showed reduction in the repetitions of pain attaches
through the week as well as reduction in numbers of pain hours during the days. Both treatment
methods showed reduction in the general pain intensity and during ulnar deviation of wrist joint as
evaluated using the VAS. Both anodyne therapy and conventional physical therapy reduce the pain
intensity and improve function in the de Quervain tenosynovitis patients. Anodyne therapy alone reduced
the frequency of analgesic intake by de Quervain tenosynovitis patients at the last evaluation which was
done on 90 days after the last session.
Keywords: De Quervain tenosynovitis, Anodyne therapy, Physiotherapy.
INTRODUCTION
Monochromatic infrared energy (MIRE) which
was known as Anodyne Therapy is a device that
approved in 1994 by the U.S Food and Drug
Administration (FDA) 1. Various musculoskeletal
disorders and soft tissues injuries and trauma
were treated by anodyne therapy as it leads to
increasing circulation and decreasing pain2.
Anodyne therapy was established as a treatment
method of many conditions as peripheral
neuropathy especially diabetic one, different types
of ulcers, and soft tissue injuries, including
Temporo mandibular joint dysfunction, also
different types of repetitive trauma and over use
inflammation and localized myofascial pain 3.
Anodyne therapy convey its array to therapy
energy which involve 60 super luminous Gallium
Aluminum Arsenide diodes4, anodyne therapy
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3255
device has a control segment that attached to this
Gallium Aluminum Arsenide diodes to pulse the
MIRE at 292 times/second1.
The Monochromatic infrared energy (MIRE)
device is a conservative treatment methods that
doesn’t include any medication induction, but
produce its effect though producing photo energy
with a wavelength of 890nm5. The diode array
should be applied directly over the affected skin,
for increasing the monochromatic infrared photo
array that energizing cell effect in the epidermis
and the most superficial portion of the dermis,
through its warming effect on the skin6.
The monochromatic infrared photo energy
with a wavelength of 890nm penetrates the skin
and be absorbed by hemoglobin in the rete
capillary loops in the papillary dermis5.The
benefits of the MIRE depend on contact with skin
contact, pulse power , length of the wave , power,
and energy density6. The power density per diode
array of monochromatic infrared photo energy of
up to ten mille watts for each cm2, with density of
photon energy up to 1.6 joules for each in one
minute and pulsed adjustable radiant power of up
to 10 mille watts for each diode 7. Therefore,
treatment duration of 20-30 minutes of
monochromatic infrared photo energy when
applied directly over the skin produces up to 48
joules/cm2. The monochromatic infrared photo
energy topical heat effect and a transient increase
of local release of nitric oxide describe the
mechanism of anodyne therapy in pain relieving6,
8. Because any type of light either visible or
nonvisible, developed by photons, and the
photons size or mass depends on the special
wavelength of this light, specific skin area should
first absorb light to stimulate the photons
biological effect. For best absorption, the light
should be placed perpendicularly and in direct
contact over the targeted tissue. Also
homogenous wavelength photo energy is more
effective than light composed of several
wavelengths9.
The de Quervain tenosynovitis is one of the
most common tendinitis in the hand and wrist10.
Compression on the abductor pollicis longus
(APL) and the extensor pollicis brevis (EPB)
tendons caused by narrowed tenosynovitis of the
first dorsal compartment of the wrist is the main
cause of de Quervain tenosynovitis11. Wrist
dorsolateral aspect pain which referred toward the
thumb along the lateral aspect of the forearm is
the main complain of the patient with this
condition12.
Many studies concluded that women have
greater incidence of de Quervain tenosynovitis,
with a male -to-female ratio as low as 1:813,
14.Pregnancy or the postpartum period is the
significant period of more suffering from de
Quervain tenosynovitis 14.Rheumatoid arthritis
also in some cases leads to de Quervain
tenosynovitis due to mal alignment and
deformities that result from Rheumatoid arthritis, a
positive Finkelstein test is the standard and usual
finding which represent the de Quervain
tenosynovitis clinically15.
De Quervain tenosynovitis symptoms and
pain usually relieved by thump and wrist splinting,
however the splinting restriction to the normal
movement of the thump and wrist prevent most of
the patients from wearing it for the adequate
period16. Reducing the inflammation and
thickening of abductor pollicis longus and the
extensor pollicis brevis is the aim of corticosteroid
injection in first dorsal compartment sheath17.
Another method to alleviate the compression
on abductor pollicis longus and the extensor
pollicis brevis tendons is a release of the first
dorsal compartment surgically 18. Although
deQuervain tenosynovitis surgical release is a fast
process and straightforward, but its complications
may be profound and permanent17, 18 .The most
common complication of surgical release are
superficial radial nerve injury, neuritis resulted
from sharp injury or adhesion and subluxation of
released tendons, also if the tendon slips of the
abductor pollicis longus are mistaken during the
release, the persistent entrapment symptoms are
possible 19. Many Physical and occupational
therapy modalities were used in de Quervain
tenosynovitis treatment such as cryo therapy,
ultrasound, low intensity laser, iontophoresis and
phonophersis 20.
There is no adequate researches that
investigate the use of the monochromatic infrared
photo energy in patients with de Quervain
Tenosynovitis21. So the purpose of current study
was to investigate the influence of anodyne
therapy versus traditional physical therapy on de
Quervain tenosynovitis:
Experimental group 1 low intensity
ultrasound application on radial dorsal zone in
addition to stretching of the thenar eminence
muscles into thumb extension and abduction as
well as active stretching the thenar eminence
muscles which was performed by the patient as a
home program .Experimental group 2
application of anodyne therapy pads on radial and
ulnar zone, together plus stretching of the thenar
eminence muscles actively as a home program.
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3256
MATERIALS AND METHODS
Study design: a clinical randomized,
comparative and prospective study.
Subjects of the study:
32 subjects suffered from de Quervain
tenosynovitis were included in this study. Patients'
histories as well as physical examination and
positive Finkelstein test were used for patient
diagnosis.
Local Ethics Committee approved the protocol
of this research work, also at the beginning of this
study each patient applied an informed written
consents.
Subjects inclusive criteria: patients with de
Quervain tenosynovitis were diagnosed by
special orthopedic physician, their age were from
21 to 67 years; persisting pain for more than 90
days.; patients using pacemaker or on
anticoagulant medication were excluded from this
study also patients with coagulation disease,
other musculoskeletal disorders in the upper
limbs, central or peripheral neuropathy, systemic
inflammatory disease, metabolic and endocrine
diseases and any psychiatric disorders were
excluded from this study . Patients mean age was
48.29 ± 10.29 years with range from 24 to 67.
Four patients (12.5%) from the thirty two patients
included in this study were male, while the
remaining twenty eight patients (87.5 %) were
female. Only fourteen patients (43.99%) were
unilaterally affected, only 8 patients (25%) didn’t
use analgesics while the remaining twenty four
patients (75%) were on medication for reducing
pain. Most of the patient included in this study
were overweight (26) also eleven patient (34%)
didn’t participate in regular exercise.
All Participants were divided randomly to
anodyne therapy group and conventional therapy
group using 1 to 100 numbered blank folders.
Only one independent investigator, blinded to
group allocation, conducted the testing
procedures at both the initial and final sessions.
After initial testing, participants began the
treatment on the same day. Another licensed
physical therapist performed all interventions with
participants in both groups. All participants
received three sessions per week for four weeks.
Instrumentation:
The monochromatic infrared photo energy
intervention was administered using the
Anodyne® Therapy System, model 480 (Anodyne
Therapy, LLC, and Tampa, FL), which consists of
a power basic unit with eight treatment pads, each
one has a sixty diodes from gallium aluminum
arsenide. The anodyne LEDs area for each
therapy pad equal 22.5 cm2, to produce a total
area of treatment with one hundred and eighty
cm2. So the instrument yielding a monochromatic
infrared photo energy with 292 Hz and its
wavelength is 890 nm through each diodes. The
energy density for the active unit was 62.4 Joules
per each cm2.
Figure 1. Anodyne therapy units and diodes
2. Therapeutic ultrasound unit: It was used for
treatment of groups B &C, therapeutic ultrasound
Figure 2.Therapeutic ultrasound unit with its
transducers (ProSound ULS-1000-Medserve
Limited. Prior Hall Business Center. United
Kingdom)
Procedure of Treatment
The selected 32 patients divided randomly into
anodyne therapy group and conventional physical
therapy groups each one contain sixteen patients
according to the drawn numbers:
(1) Conventional physiotherapy group:
Low intensity 1.5 watts/ cm2 ultrasound at
frequency of 1 MHz for 12 session (3 session in
each week) were applied to the 16 patients in this
group as well as passive stretching of the thenar
eminence muscles into thumb extension and
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3257
abduction and performing resisted exercise for
finger and thumb extension, and abduction, radial
deviation, supination, and thump opposition. The
same physiotherapist followed up and guided the
all patients in this group all over the study. Active
stretching of thenar eminence were performed by
the patient as a home program.
(2) Anodyne therapy group:
In this group the patients were received the
monochromatic infrared photo energy for 30
minutes in addition to thenar eminence active
stretching as a home program . Application of
anodyne therapy for each patient was in a
comfortable sitting position with room temperature
240 C. To ensure compliance with the procedure
of infection control, a plastic wrap was used to
cover the treated area as a barrier between the
diodes and the skin. Anodyne therapy pads were
applied at either side of the wrist (radial and ulnar
zone). The energy setting on the device was
preset automatically. By the end of each session,
the diodes were removed from the patient's wrist
then the plastic wrap. Intervention with the
monochromatic infrared photo energy was
followed by active stretching exercise instructions
as in group 1
Evaluation
All treated patients in each groups were
evaluated by the same physiotherapist in the
following patterns
First time evaluation which was performed before
starting the treatment procedures.
Second time evaluation which was performed at
the end of the all treatment sessions in each
group.
Third time evaluation which was performed
following the end of treatment sessions by three
months. The evaluations consisted of Pain
assessment through:
Pain periodicity, i.e. the repetition of pain attaches
per week.
Pain duration, i.e. the duration in hours in which
the patient experiences the pain all over the day.
Assessment of general pain as well as pain during
wrist range of motion by Visual analog scale
(VAS).Analgesics dependency during treatment.
RESULTS
Both experimental groups showed no
significant difference in patient's age, gender,
functional activity, affected limb and body mass
index (BMI). Reduction of pain symptoms were
shown in the two experimental groups. As shown
in Table (1) in both groups, the repetitions of pain
attaches per week were significantly reduced also
there were significant reduction in pain hours per
day in both groups as shown in Table (2). While
table (3) showed that there were significant
reduction in general pain intensity in both
experimental groups and table (4) showed that
there were significant reduction in pain with ulnar
deviation of wrist joint in the two experimental
groups as evaluated using the VAS. Although
there were significant reduction of the frequency
of analgesic intake by patients at the third
evaluation session at 90 days after treatment by
anodyne therapy and the conventional physical
therapy program as shown in Table 5.
Table (1) Pain periodicity per week in both treated groups
Number of
pain attaches
per week
Conventional Physiotherapy Group
Anodyne Therapy Group
Second
time
evaluation
Third
time
evaluation
First
Time
evaluation
Second
time
evaluation
Third
Time
evaluation
No pain
0(0%)
4 (25%)
6 (37.5%)
0 (0%)
7 (44%)
6 (37.5%)
One episode
of Pain in
week
0 (0%)
3 (18.75%)
3 (19%)
0 (0%)
0 (0%)
4 (25%)
twice or more
episode of
pain in the
week
16 (100%)
9 (56%)
7 (44%)
16 (100%)
9 (56%)
7 (44%)
p*
0.001
0.008
ANOVA intergroup evaluation and Friedman test intragroup evaluation p > 0.05
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3258
Table (2) Pain duration in the day in both groups
Pain
Duration
along the day
Conventional Physiotherapy Group
Anodyne therapy Group
First
Time
evaluation
Second
Time
evaluation
Third
time
evaluation
First
time
evaluation
Second
time
evaluation
Third
time
evaluation
No pain
0 (0%)
6 (37%)
8 (50%)
0 (0%)
6 (37%)
7 (44%)
1, 2 , 3 hours of pain
7 (44%)
8 (50%)
7 (44%)
8 (50%)
9 (56%)
8 (50%)
4 hours of pain or more
9 (56%)
2 (13%)
1 (6%)
8 (50%)
1 (6%)
1 (6%)
p*
0.000
0.001
ANOVA intergroup evaluation and Friedman test intragroup evaluation p > 0.05
Table (3) patients frequency according to general pain intensity on visual analog scale (VAS) in
both groups
VAS
Conventional Physiotherapy Group
Anodyne therapy Group
First
time
evaluation
Second
time
evaluation
Third
time
evaluation
First
time
evaluation
Second
time
evaluation
Third
time
evaluation
Good (0-1)
2 (13%)
8 (50%)
10 (62%)
2 (13%)
10 (62%)
11 (69%)
Regular (25)
2 (13%)
3 (19%)
3 (19%)
3 (19%)
3 (19%)
3 (19%)
Poor (610)
12 (75%)
5 (31%)
3 (19%)
11 (69%)
3 (19%)
2 (13%)
p*
0.001
0.002
ANOVA intergroup evaluation and Friedman test intragroup evaluation p > 0.05
Table (4) Patients frequency according to pain intensity during wrist movement on visual analog
scale (VAS) in both groups
VAS
Conventional Physiotherapy Group
Anodyne therapy Group
First
time
evaluation
Second
time
evaluation
Third
time
evaluation
First
time
evaluation
Second
time
evaluation
Third
time
evaluation
0-1 Good
1 (6%)
7 (44%)
8 (50%)
2 (13%)
6 (37%)
8 (50%)
2-5 Regular
2 (13%)
3 (19%)
5 (31%)
2 (13%)
6 (37%)
5 (31%)
6-10Poor
13 (81%)
6 (37%)
3 (19%)
12 (75%)
4 (25%)
3 (19%)
p*
0.000
0.3000
ANOVA intergroup evaluation and Friedman test intragroup evaluation p > 0.05
Table (5) patients Frequency according to using analgesics three months after treatment.
Analgesics using
stopping following
the treatment by 90 days
Number of patients
using analgesics
before treatment
p
Stopping
Didn’t stop
Conventional Physiotherapy
Group
9 (69.23%)
4 (30.7%)
0.42
Anodyne
therapy Group
10 (76.9%)
3 (23.1%)
13
p> 0.5
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3259
DISCUSSION
Usually de Quervain tenosynovitis Patients
complain from pain with thumb and wrist motion,
also localized pressure aver radial styloid process
associated with severe pain and tightness , also
direct blow to the area of the first dorsal
compartment can lead to de Quervain
tenosynovitis 11.
De Quervain tenosynovitis can be found in
both sex with greater incidence in female more
than male13. Percent of female Patients included
in this study were (80.8%), and the whole patient
mean age was 48.29 ± 11.29 years.87% of the
patients included in this study were considered to
be overweight
Professions and activities that require hand
working is related to the occurrence of de
Quervain tenosynovitis11. Lactating mothers
usually suspected to de Quervain tenosynovitis
due to lifting of their infants aged from six to
twelve months, also they usually affected
bilaterally, so any other worker who lift infants
frequently may be affected as well as lactating
mothers13. Persons who perform repetitive hand
activity as fine hand worker and Secretaries also
were more likely to develop de Quervain
tenosynovitis.21Most individuals in the present
study (63%) were hand dependent working while
standing (nurses, cleaners and computer users),
On the other hand, pain with thump and wrist
movement by 72% which was reported by many
previous study13. Fourteen patients in each group
in this study had score less than 5 in VAS scale at
the end of the treatment, this indicate that
anodyne therapy as well as conventional physical
therapy were useful in reduction of pain in de
Quervain tenosynovitis11.
In many cases, de Quervain tenosynovitis is
bilateral12. In current study 18 subjects suffered
from de Quervain tenosynovitis bilaterally.
Anodyne therapy was more effective in treatment
of chronic cases, in which the symptoms persists
for more than 3 months8, 9. Patients in this study
were chronic cases of de Quervain de Quevain
tenosynovitis.
Non-surgical conservative approach is always
the best and first method of treatment in de
Quervain tenosynovitis because of surgical
treatment complication which may be serious and
common in thirty percent of total cases18, 19.Low
frequency ultrasound application associated with
stretching exercises usually used as a physical
therapy to de Quervain tenosynovitis 20.
In this study both treatment groups had a
significant reduction in pain and improvement in
functional activity just after the end of the
treatments sessions where the main purpose of
this is to investigate the anodyne therapy effect
versus the traditional physical therapy program
effect on de Quervain tenosynovitis. In
experimental group 1 low frequency ultrasound
application on radial dorsal zone , the same
physiotherapist followed up and guided the all
patients in this group all over the study at all
treatment sessions in addition to stretching of the
thenar eminence muscles into thumb extension
and abduction with reinforcement of instructions
by the physical therapist for active stretching of
the same muscle to be performed at home in each
one of the 12 treatment session, which might had
a role in the significant improvement in this group.
Also this continuous guidance during the
stretching exercise leads to good permanent
change in the habitual use of hand and wrist
during the daily activity, more ever the good result
in this treatment protocol is dependent on the
physiotherapist, who apply the treatment
procedure carefully and judiciously11, 13.
While in the second experimental group
(anodyne treated), the patients were treated with
the monochromatic infrared photo energy for 30
minutes and instruction for active stretching of the
thenar eminence muscles to be performed at
home, without kinesiotherapy , the guidance was
given during the assessments only .This result
was in agreement of many studies that concluded
that the anodyne therapy has a beneficial effect in
treating many musculoskeletal disorders and soft
tissues injuries 8, 9.
So the anodyne therapy might be a physical
therapist method that need less effort for treating
the de Quervain tenosynovitis but traditional
physical therapy programs which are performed
carefully to improve patient functional habit that
lead to pain reduction and functional
improvement.
Two experimental groups in this study
presented reduction in general pain and pain with
movement either thumb or wrist movement when
measured at three months after treatment, this
reduction in pain in the form of decreased hours
of pain along the day, and decrease of attacks of
pain in the week, and reduction of analgesics
use. For both treatment protocol more
improvement and long lasting effect, it must be
accompanied by the use of splint for movement
limitation17.
Application of simplified and accurate
implemented program of physiotherapy along with
perfect diagnosis of de Quervain tenosynovitis
Elerian et al., Anodyne therapy vs Traditional Physiotherapy in Treating deQuervain Tenosynovitis
Bioscience Research, 2018 volume 15(4): 3254-3261 3260
could provide an ideal approach to treat the de
Quervain tenosynovitis11, 12. So it is not almost
necessary to use more sophisticated devices to
gain the best improvements7, 16.
CONCLUSION
Anodyne therapy and conventional physical
therapy showed reduction the pain intensity and
improve function in the de Quervain tenosynovitis
patients.
CONFLICT OF INTEREST
The authors declared that present study was
performed in absence of any conflict of interest.
ACKNOWLEGEMENT:
Time saving support by the Department of
physical therapy for Basic science, Faculty of
physical therapy, Cairo University. Thanks also to
Professor Doctor Mohsen El-sayaad for his
respectable consultation about technical
applications.
AUTHOR CONTRIBUTIONS
AE and ME designed and performed the
experiments and also wrote the manuscript. NE,
FE and GI performed the assessment follow up
procedures. NM and AE performed the data
analysis procedure. AE, ME designed
experiments and reviewed the manuscript. All
authors read and approved the final version.
Copyrights: © 2017 @ author (s).
This is an open access article distributed under the
terms of the Creative Commons Attribution License
(CC BY 4.0), which permits unrestricted use,
distribution, and reproduction in any medium,
provided the original author(s) and source are
credited and that the original publication in this
journal is cited, in accordance with accepted
academic practice. No use, distribution or
reproduction is permitted which does not comply
with these terms.
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Article
OBJECTIVE This study investigated and compared the efficacy of dextrose phonophoresis and Pulsed Electromagnetic Field (PEMF) on pain, range of motion (ROM) and function in patients with Temporomandibular Dysfunction (TMD). METHODS 45 patients with TMD aging from 25–45 years, with mean age 29 ± 2.5 years were included in this study, they were assigned randomly into 3 equal groups each contain fifteen TMJ dysfunction patients. Group (A) in which each patient received 50 % dextrose phonophoresis for 5 min and therapeutic ultrasound for 5 min , Group (B) in which each patient received Pulsed Electromagnetic Field (PEMF) with frequency of 50 HZ for 50 min, and traditional physiotherapy ultrasound for 5 min , while in the control group (C) the patients received traditional physiotherapy ultrasound for 5 min only , the frequency of treatment session in the three groups was 3 days per week for 4 weeks. The assessment tools were visual analog scale (VAS) for pain evaluation, plastic ruler for TMJ ROM measurements while Fonseca's questionnaire was used for evaluation of TM function at baseline and 4 weeks later. RESULTS Paired t test for comparison between pre and post treatment measurements in each group showed significant decrease pain as well as improvement of ROM and Fonseca's questionnaire in group A and B than placebo group. CONCLUSIONS The results found that both dextrose phonophoresis and PEMF have beneficial effects considering pain, ROM and function in patients with (TMD).
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This study compared the use of a mixed steroid/lidocaine injection alone, an immobilization splint alone, and the simultaneous use of both in improving symptoms in de Quervain's disease. Ninety-three wrists were included in the study, with an average follow-up examination of 13 months. Complete relief of symptoms was noted in 28 of 42 wrists receiving an injection alone, 8 of 14 wrists receiving both an injection and splint, and 7 of 37 wrists receiving a splint alone. No significant difference was noted between the injection alone and injection plus splint groups. A significant difference was seen between the injection alone and splint alone groups and the injection/splint and splint alone groups. Twenty of 45 wrists that underwent operative release demonstrated a septum at the first dorsal compartment. When the need for operative release was used as an outcome result for treatment failure, the injection alone and splint alone groups demonstrated significance. We recommend the use of a mixed steroid/lidocaine injection alone as the initial treatment of choice in this condition. No additional benefit is appreciated by the addition of splint immobilization and, in fact, patients are less restricted with a lower financial burden without its use.
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The results presented in this paper document healing of different types of extremity wounds with 890 nanometer (nm) monochromatic infrared energy. Recalcitrant dermal lesions, including venous ulcers, diabetic ulcers, and a wound related to scleroderma, were treated with a Food and Drug Administration-cleared infrared device. The infrared protocol was instituted after conventional management protocols were shown to be ineffective. The rate and quality of healing of these previously refractory wounds, following use of monochromatic infrared energy, may be related to local increases in nitric oxide concentration. Increases in nitric oxide previously have been demonstrated to correlate with vasodilatory and anabolic responses. Further research is needed to confirm the results found in these patients.
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Study design: Randomized, double-blind, placebo-controlled study. Objectives: To examine the short-term therapeutic effects of monochromatic infrared energy (MIRE) on participants with knee osteoarthritis (OA). Patients were assessed according to the International Classification of Functioning, Disability and Health. Background: MIRE is commonly used in therapy for patients with peripheral neuropathies. However, research has not focused intensively on the therapeutic effects of MIRE in patients with knee OA. Methods: This study enrolled 73 participants with knee OA. Participants received six 40-minute sessions of active or placebo MIRE treatment (890-nm wavelength; power, 6.24 W; energy density, 2.08 J/cm2/min; total energy, 83.2 J/cm2) over the knee joints for 2 weeks. International Classification of Functioning, Disability and Health-related outcomes were collected weekly over 4 weeks using the Knee injury and Osteoarthritis Outcome Score, Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire. Data were analyzed by repeated-measures analysis of variance. Results: No statistically significant differences were found for the interaction of group by time for Knee injury and Osteoarthritis Outcome Score scores, including pain, other symptoms, function in daily living, function in sport and recreation, and knee-related quality of life. Scores on the Lysholm Knee Scale, Hospital Anxiety and Depression Scale, Multidimensional Fatigue Inventory, Chronic Pain Grade questionnaire, World Health Organization Quality of Life-brief version, and OA Quality of Life Questionnaire also showed no significant differences between the 2 groups at any of the 4 follow-up assessments. Conclusion: Short-term MIRE therapy provided no beneficial effects to body functions, activities, participation, and quality of life in patients with knee OA.
Article
The aims of the present study were to characterize the thumb active range of motion (AROM) and strength impairments resulting from unilateral de Quervain's disease; to verify the adequacy of standard clinical assessment tools to quantify impairments resulting from this pathology; and to validate the utilization of the asymptomatic thumb as a reference to quantify the symptomatic thumb's deficits by comparing the performances of asymptomatic to control thumbs. The thumb's AROM and strength were evaluated bilaterally in 31 participants with unilateral de Quervain's disease and 18 control participants using clinical assessments involving the flexors and adductors of the thumb and experimental assessment devices measuring strength and mobility in several directions of the thumb's movements. A comparison was made between the results obtained from the symptomatic, asymptomatic, and control thumbs. The AROM performance of symptomatic thumbs was found to be reduced when compared to the asymptomatic and control thumbs for maximal thumb flexion (p=0.008 and 0.003, respectively) and total circumduction displacement (p<0.001). The strength performance of the symptomatic thumb was also found to be reduced when compared to the asymptomatic and control thumbs for palmar pinch strength (p<0.001 and 0.002, respectively) and for maximal voluntary effort in all directions (p<0.001). Differences in performance were also found between the asymptomatic and control thumbs, reaching the significance level for some movement parameters of the thumb circumduction evaluations and when palmar pinch strength results are normalized (p<0.001 and 0.009, respectively). This study revealed bilateral impairments of thumb AROM and strength for participants with de Quervain's disease, the impairments being more pronounced on the symptomatic side. This finding may question the validity of using the asymptomatic thumb as a standard measure to identify the symptomatic thumb's impairments associated with de Quervain's disease. The study also demonstrated the validity of using clinical evaluations when assessing impairments associated with this disease.
Article
De Quervain's tenosynovitis is thought to occur most frequently in women, with presentation of pain and swelling in the first dorsal extensor sheath. The epidemiology of this extensor tendinitis is not well described. We evaluated the incidence and demographic risk factors for de Quervain's tenosynovitis using a large database of military personnel. The Defense Medical Epidemiology Database (DMED) collects International Classification of Diseases, 9th Revision, and Clinical Modification (ICD-9-CM) coding information for every patient encounter occurring for United States military personnel. We queried the DMED system by race, gender, military service, rank, and age for the years 1998-2006 using the ICD-9 code 727.04, limiting data to first presentations. Multivariate Poisson regression was used to estimate the rate of de Quervain's tenosynovitis per 1000 person-years, as well as incidence rate ratios and 95% confidence intervals. There were 11,332 cases of de Quervain's tenosynovitis in the population at risk of 12,117,749 person-years. Women had a significantly higher rate of de Quervain's tenosynovitis at 2.8 cases per 1000 person-years, compared to men at 0.6 per 1000 person-years. Age greater than 40 was also a significant risk factor, with this age category showing a rate of 2.0 per 1000 person-years compared to 0.6 per 1000 in personnel under 20 years. There was also a racial difference, with blacks affected at 1.3 per 1000 person-years compared to whites at 0.8. In analysis of a large population, we have described the epidemiology of stenosing tenosynovitis of the first extensor compartment. Risk factors for de Quervain's in our population include female gender, age greater than 40, and black race. Prognostic II.
Article
The purpose of this study was to describe the sonographic appearance of the first annular (A1) pulley-flexor tendon complex in patients with trigger fingers. Thirty-three trigger fingers in 33 patients were examined with a 7- to 15-MHz probe. A control group consisted of 20 patients without trigger fingers. The study included systematic measurement of the thickness of the A1 pulley and a power Doppler assessment of the pulleys, tendons, and tendon sheaths. Thickening and hypoechogenicity of the A1 pulley were found in all patients with trigger fingers. Measurements of A1 pulley thickness were significantly different (P < .0001) between the groups without trigger fingers (mean, 0.5 mm; range, 0.4-0.6 mm) and with trigger fingers (mean, 1.8 mm; range, 1.1-2.9 mm). Hypervascularization of the A1 pulley on power Doppler imaging was found in 91% of the trigger fingers but was never found in the healthy control group. Flexor tendinosis was found in 48% of the trigger fingers; tenosynovitis was found in 55%; and both were found in 39%. In the control group, tenosynovitis and tendinosis were not found. Thickening and hyper-vascularization of the A1 pulley are the hallmarks of trigger fingers on sonography. Other frequently observed features include distal flexor tendinosis and tenosynovitis.
Article
Volar subluxation of the tendons of the first dorsal compartment of the wrist occurred in two patients after surgery for treatment of de Quervain's stenosing tenosynovitis. In both patients a painful tenosynovitis of the extensor pollicis brevis and abductor pollicis longus developed, which was unresponsive to conservative therapy as the tendons prolapsed over the prominence of the first dorsal compartment. A distally based flap of the brachioradialis tendon was used to prevent tendon prolapse, with both patients asymptomatic and free of subluxation one and five years after operation.
Article
Examination of a series of 16 consecutively referred women patients who have had a de Quervain's release revealed 23 associated diagnoses and 14 complications. Also, 11 consecutive women patients were referred preoperatively and, even in this small group, there were eight associated diagnoses. The complexities of de Quervain's tendinitis and the diagnosis and treatment of associated diseases and complications are described to help prevent surgical failures and prolonged disabilities in these groups of working women.
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DeQuervain tenosynovitis, which involves the abductor pollicis longus and extensor pollicis brevis tendons, is much more common in women than men and is due to repetitive movements of the hand such as grasping and twisting. Housewives and persons involved in manual occupations using the hands and wrists account for most cases in previous series. In this series, six of 24 female patients (25%) were pregnant or postpartum at the time of onset. In five of the six, activities of infant care aggravated symptoms. Both pregnancy, per se, and mechanical factors appear to play a role in causing this condition.
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Recently, there has been an increase in the clinical application of low-level laser irradiation (LLLI) in various fields. The present study was conducted to explore the effects of LLLI on microcirculation. We investigated the effects of LLLI on rat mesenteric microcirculation in vivo, and on cytosolic calcium concentration ([Ca2+]i) in rat vascular smooth muscle cells (VSMCs) in vitro. LLLI caused potent dilation in the laser-irradiated arteriole, which led to marked increases in the arteriolar blood flow. The changes were partly attenuated in the initial phase by the superfusion of 15 microM L-NAME, but they were not affected by local denervation. Furthermore, LLLI caused a power-dependent decrease in [Ca2+]i in VSMCs. The circulatory changes observed seemed to be mediated largely by LLLI-induced reduction of [Ca2+]i in VSMCs, in addition to the involvement of NO in the initial phase.