Develping a CPR (clinical prediction rule) for PFPS depending on Lumbopelvic manipulation.

-
Quadriceps muscle function in patients with PFPS was recently shown to improve following treatment with lumbopelvic manipulation. No previous study has determined if individuals with PFPS experience symptomatic relief of activity-related pain immediately following this manipulation technique.

Iverson CA et al tried to determine the predictive validity of selected clinical exam items and to develop a clinical prediction rule (CPR) to determine which patients with patellofemoral pain syndrome (PFPS) have a positive immediate response to lumbopelvic manipulation.

Sample & method:
1. 50 subjects (26 male, 24 female; age range, 18-45 years) with PFPS underwent a standardized history and physical examination.
2. After the evaluation, each subject performed 3 typically pain-producing functional activities (squatting, stepping up a 20-cm step, and stepping down a 20-cm step).
3. The pain level perceived during each activity was rated on a numerical pain scale (0 representing no pain and 10 the worst possible pain).
4. Following the assessment, all subjects were treated with a lumbopelvic manipulation, which was immediately followed by retesting the 3 functional activities to determine if there was any change in pain ratings.
5. An immediate overall 50% or greater reduction in pain, or moderate or greater improvement on a global rating of change questionnaire, was considered a treatment success.
6. Likelihood ratios (LRs) were calculated to determine which examination items were most predictive of treatment outcome.

Result & conclusion:
1. Out of 49 subjects who were included in the data analysis, 22 (45%) had a successful outcome.
2. Five predictor variables were identified. The most powerful predictor of treatment success was a side-to-side difference in hip internal rotation range of motion greater than 14 masculine (+LR, 4.9).
3. If this variable was present, the chance of experiencing a successful outcome improved from 45% to 80%.

Reference:
Iverson CA et al J Orthop Sports Phys Ther. 2008 Jun;38(6):297-309; discussion 309-12. Epub 2008 Jan 22.

Comments

Post a Comment

Popular posts from this blog

Entrapment of medial calcaneal nerve (MCN)

-
Image
Peripheral nerve entrapment is a rare, but important, cause of foot and ankle pain that often is underdiagnosed and mistreated. A peripheral nerve may become entrapped anywhere along its course, but certain anatomic locations are characteristic (2). The medial calcaneal nerve (MCN) The Tibial nerve is called the planter nerve in the sole. The tibial nerve passes to the sole of the foot takes a turn on the medial side of the calcaneum is called MCN. The medial calcaneal nerve arises from tibial nerve of the inner side of the ankle, perforates the laciniate ligament, travels downwards passing below the bony projection on the inner side of the ankle, and supplies the skin over the medial aspect of the heel. Hence it is the most important nerve for heel sensations. MCN have 2 branches. The anterior branch dominate the cutaneous sensation of the anterior part of the medial calcaneal and heel weight loading field, while the posterior branch dominate the sensation of the posterior an
Read more

Review of Labral Tears of shoulder

-
Image
The glenoid labrum of the shoulder has extensive anatomic variation but appears to be important for contributing to shoulder stability and for increasing the depth of contact between the glenoid labrum and the humeral head. Tears of the labrum are commonly seen in association with other pathologic entities, such as instability and rotator cuff tears, and treatment of the labral pathology may be incidental to treatment of the other more significant pathology. However, conditions isolated to the labrum do occur and can be a significant source of shoulder problems. Effective treatment of these lesions may result in significant improvement in the patient's symptoms (4). Labral lesions are difficult to diagnose, and special diagnostic studies and, frequently, arthroscopy are required. How much we can rely on clinical tests is a question. Shoulder complaints are frequently recurrent. Instability might cause some of these complaints (3). History taking and clinical tests are commonly used
Read more

Differential diagnosis of Anatomic (Radial) snuffbox pain: It is not always DeQuervain’s tenosynovitis.

-
Image
Tendon, Bone & Ligament causes: 1. DeQuervain’s tenosynovitis: Swelling of tendon of APL (Abductor pollicis longus) & extensor pollicis brevis at lateral wrist near anatomic snuff box.  The primary complaint is radial sided wrist pain that radiates up the forearm with grasping or extension of the thumb. The pain has been described as a “constant aching, burning, pulling sensation." Pain is often aggravated by repetitive lifting, gripping, or twisting motions of the hand. Swelling in the anatomical snuff box, tenderness at the radial styloid process, decreased CMC abduction ROM of the 1st digit, palpable thickening of the extensor sheaths of the 1st dorsal compartment and crepitus of the tendons moving from the extensor sheath may be found upon examination. Other possible findings include weakness and paresthesia in the hand. Finkelstein’s diagnostic test will present positive provoking the patient’s symptoms. If left untreated, the inflammation and progressive narro
Read more