Biomedical subjects

Scott F Nadler

Publications and source records attributed to Scott F Nadler.

31 records · Page 2Linked to original sources

PubMed2003

Physical examination of the knee: a review of the original test description and scientific validity of common orthopedic tests.

OBJECTIVES: To present the original descriptions of common orthopedic physical examination maneuvers of the knee and then to review the literature to support the scientific validity of these tests. DATA SOURCES: MEDLINE (1970-2000) searches were performed, as were reviews of various musculoskeletal examination textbooks that describe physical examination maneuvers of the knee. These references were then reviewed for additional references and crossed back to the original description (when possible) of these named tests. STUDY SELECTION: All articles that discussed the sensitivity and specificity of the physical examination maneuvers were extracted. This information was reviewed for accuracy and then summarized. DATA EXTRACTION: Multiple MEDLINE and text searches were performed by using the terms of the test maneuver, the joint tested, and the term physical examination. Any article with this information was reviewed until the article describing the original description was found. Articles dating from that original article to the present were reviewed for information on the sensitivity and specificity of the test. DATA SYNTHESIS: Literature reviewing the sensitivity and specificity of the tests reviewed is summarized in text and table form. The Lachman test seems to be very sensitive and specific for the detection of anterior cruciate ligament tears. For posterior cruciate ligament tears, the posterior drawer test is also very sensitive and specific and is enhanced with other tests, such as the posterior sag sign. For meniscal tears, the McMurray test is very specific but has a very low sensitivity, whereas joint line tenderness has fairly good sensitivity but lacks good specificity. Although collateral ligament testing seems to be sensitive and specific, there is a lack of well-designed studies that scientifically validate the sensitivity and specificity of these tests. Common tests for patellofemoral pain and patellar instability lack sensitivity when correlated with pathologic operative findings. CONCLUSIONS: Most physical examination tests could be referenced back to an original description, with variable information on the sensitivity and specificity along with other information about the validity of these tests in clinical practice. To standardize how physical examinations are performed and compared, they should follow the original description or agreed-on standards. In addition, the significance of a physical examination finding must be understood to ensure that patients with knee complaints are accurately diagnosed and properly treated.

Biomechanical Phenomena↗

PubMed2003

Continuous low-level heatwrap therapy for treating acute nonspecific low back pain.

OBJECTIVE: To evaluate the efficacy of 8 hours of continuous low-level heatwrap therapy for the treatment of acute nonspecific low back pain (LBP). DESIGN: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. SETTING: Five community-based research facilities. PARTICIPANTS: Two-hundred nineteen subjects, aged 18 to 55 years, with acute nonspecific LBP. INTERVENTION: Subjects were stratified by baseline pain intensity and gender and randomized to one of the following groups: evaluation of efficacy (heatwrap, n=95; oral placebo, n=96) and blinding (oral ibuprofen, n=12; unheated back, wrap n=16). All treatments were administered for 3 consecutive days with 2 days of follow-up. MAIN OUTCOME MEASURES: Primary: day 1 mean pain relief (0- to 5-point verbal response scale). Secondary: muscle stiffness (101-point numeric rating scale), lateral trunk flexibility (fingertip-floor distance), and Roland-Morris Disability Questionnaire over 3 days of treatment and 2 days of follow-up. RESULTS: Heatwrap therapy was shown to provide significant therapeutic benefits when compared with placebo during both the treatment and follow-up period. On day 1, the heatwrap group had greater pain relief (1.76+/-.10 vs 1.05+/-.11, P <.001), less muscle stiffness (43.1+/-1.21 vs 47.6+/-1.21, P=.008), and increased flexibility (18.6+/-.44 cm vs 16.5+/-.45 cm, P=.001) compared with placebo. Disability was also reduced in the heatwrap group (5.3 vs 7.4, P=.0002). Adverse events were mild and infrequent. CONCLUSION: Continuous low-level heatwrap therapy was shown to be effective for the treatment of acute, nonspecific LBP.

Acute Disease↗

PubMed2003

Overnight use of continuous low-level heatwrap therapy for relief of low back pain.

OBJECTIVE: To evaluate of the efficacy and safety of 8 hours of continuous, low-level heatwrap therapy administered during sleep. DESIGN: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. SETTING: Two community-based research facilities. PARTICIPANTS: Seventy-six patients, aged 18 to 55 years, with acute, nonspecific low back pain. INTERVENTIONS: Subjects were stratified by baseline pain intensity and gender and randomized to one of the following treatments: evaluation of efficacy (heatwrap, n=33; oral placebo, n=34) or blinding (unheated wrap, n=5; oral ibuprofen, n=4). All treatments were administered for 3 consecutive nights with 2 days of follow-up. MAIN OUTCOME MEASURES: Primary: morning pain relief (hour 0) on days 2 through 4 (0-5-point verbal response scale). Secondary: mean daytime pain relief score (days 2-4, hours 0-8), mean extended pain relief score (day 4, hour 0; day 5, hour 0), muscle stiffness, lateral trunk flexibility, and disability (Roland-Morris Disability Questionnaire). RESULTS: Heatwrap therapy was significantly better than placebo at hour 0 on days 2 through 4 for mean pain relief (P=.00005); at hours 0 through 8 on days 2 through 4 for pain relief (P<.001); at hour 0 on day 4 and at hour 0 on day 5 for mean pain relief (P<.001); on day 4 in reduction of morning muscle stiffness (P<.001); for increased lateral trunk flexibility on day 4 (P<.002); and for decreased low back disability on day 4 (P=.005). Adverse events were mild and infrequent. CONCLUSIONS: Overnight use of heatwrap therapy provided effective pain relief throughout the next day, reduced muscle stiffness and disability, and improved trunk flexibility. Positive effects were sustained more than 48 hours after treatments were completed.

Acute Disease↗

PubMed2003

Muscular control of the lumbar spine.

The lumbar spine has been the object of investigation since the era of Hippocrates. The lumbar spine consists of bone, cartilage, ligament, nerve, and muscle. The muscles provide the functional mechanism for movement and stability of the spine. They provide range of motion allowing for performance of many essential activities of daily living, work, and leisure. These muscles serve a secondary role protecting the underlying lumbar spinal components by absorbing axial forces. This role can have serious implications in the development of lumbar spinal pain syndromes. In this article we will discuss the attachments of the lumbar muscles and their direct and indirect action on the lumbar spine.

Journal Article↗

PubMed2003

Provocative tests in cervical spine examination: historical basis and scientific analyses.

The majority of the provocative tests described for physical examination of the neck and cervical spine relate to identification of radiculopathy, spinal cord, or brachial plexus pathology. These tests are often performed routinely by many providers with variable methods and interpreted in a variety of ways. Several commonly performed provocative tests include Spurling's Neck Compression Test, Shoulder Abduction (Relief) Test, Neck Distraction Test, L'hermitte's Sign, Hoffmann's Sign and Adson's Test. This review describes some specialized provocative tests with comprehensive literature review. The goal of this review is to develop standardization in the performance and clinical use of these tests. Each of the tests described in this manuscript apparently originated from the anecdotal observations of experienced, well respected clinicians. However, only few studies have been performed addressing the interexaminer reliability or validity of these tests. The existing literature appears to indicate high specificity, low sensitivity, and good to fair interexaminer reliability for Spurling's Neck Compression Test, the Neck Distraction Test, and The Shoulder Abduction (Relief) Test when performed as described. For Hoffman's Sign, the existing literature does not address interexaminer reliability but appears to indicate fair sensitivity and fair to good specificity. For L'hermitte's Sign and Adson's Test, not even tentative statements can be made with regard to interexaminer reliability, sensitivity, and specificity, based on the existing literature. It is concluded that more research is indicated to understand the clinical utility of all the provocative tests employed in the physical examination of the neck and cervical spine.

Journal Article↗

PubMed2002

Continuous low-level heat wrap therapy provides more efficacy than Ibuprofen and acetaminophen for acute low back pain.

STUDY DESIGN: A prospective, randomized, single (investigator) blind, comparative efficacy trial was conducted. OBJECTIVE: To compare the efficacy of continuous low-level heat wrap therapy (40 C, 8 hours/day) with that of ibuprofen (1200 mg/day) and acetaminophen (4000 mg/day) in subjects with acute nonspecific low back pain. SUMMARY OF BACKGROUND DATA: The efficacy of topical heat methods, as compared with oral analgesic treatment of low back pain, has not been established. METHODS: Subjects (n = 371) were randomly assigned to heat wrap (n = 113), acetaminophen (n = 113), or ibuprofen (n = 106) for efficacy evaluation, or to oral placebo (n = 20) or unheated back wrap (n = 19) for blinding. Outcome measures included pain relief, muscle stiffness, lateral trunk flexibility, and disability. Efficacy was measured over two treatment days and two follow-up days. RESULTS: Day 1 pain relief for the heat wrap (mean, 2) was higher than for ibuprofen (mean, 1.51; P = 0.0007) or acetaminophen (mean, 1.32; P = 0.0001). Extended mean pain relief (Days 3 to 4) for the heat wrap (mean, 2.61) also was higher than for ibuprofen (mean, 1.68; P = 0.0001) or acetaminophen (mean, 1.95; P = 0.0009). Lateral trunk flexibility was improved with the heat wrap (mean change, 4.28 cm) during treatment (P </= 0.009 vs acetaminophen [mean change, 2.93 cm], P </= 0.001 vs ibuprofen [mean change, 2.51 cm]). The results were similar on Day 4. Day 1 reduction in muscle stiffness with the heat wrap (mean, 16.3) was greater than with acetaminophen (mean, 10.5; P = 0.001). Disability was reduced with the heat wrap (mean, 4.9), as compared with ibuprofen (mean, 2.7; P = 0.01) and acetaminophen (mean, 2.9; P = 0.0007), on Day 4. None of the adverse events were serious. The highest rate (10.4%) was reported in the ibuprofen group. CONCLUSION: Continuous low-level heat wrap therapy was superior to both acetaminophen and ibuprofen for treating low back pain.

Acetaminophen↗

PubMed2002

Misinterpretation of regional sensory loss in an injured worker: a case report.

Regional patterns of motor or sensory loss are considered indicators of a behavioral component to the complaints of an injured worker. This assumption may lead to a discounting of signs and symptoms with premature return to work and discharge from care. We present the case of a 25-year-old airline baggage handler with an 8-month history of unresolved neck and shoulder complaints who had been returned to work after a lack of objective findings on physical examination. On physiatric evaluation, his unusual pattern of insensitivity to pinprick led to prompt magnetic resonance imaging that revealed a focus of increased intramedullary signal at C6 consistent with a syrinx. This case report shows the importance of a detailed neuromuscular examination coupled with appropriate diagnostic imaging in the assessment of individuals with regional sensory or motor loss so as not to miss more serious spinal cord pathology.

Adult↗

PubMed2002

Functional deficits in athletes with a history of low back pain: a pilot study.

OBJECTIVE: To evaluate whether athletes with a history of low back pain (LBP) would, on average, perform slower on a timed 20-m shuttle run as compared with a normal athletic population. DESIGN: A timed shuttle run to evaluate residual functional limitations in college athletes with resolved LBP. SETTING: National College Athletic Association (NCAA) division I college. PARTICIPANTS: NCAA division I athletes (161 men, 50 women). INTERVENTION: A timed 20-m shuttle run. MAIN OUTCOME MEASURE: Each athlete was timed in a divided 20 m (66 ft) run in which 2 taped lines were positioned 6.7 m (22 ft) apart. RESULTS: Of 211 athletes evaluated, 27 had been treated for LBP during the previous year. Currently asymptomatic athletes with a recent history of LBP were slower (6.3s vs 5.8s) during performance of the timed 20-m shuttle run than athletes without LBP (P=.0002). CONCLUSIONS: Athletes with resolved LBP were slower than a matched group of normal athletes without LBP in the timed 20-m shuttle run. Further research is needed to support these findings and to understand fully the influence of the kinetic chain and the effects of both gender and sport on the observed findings.

Adult↗

PubMed2002

Pain, dizziness, and central nervous system blood flow in cervical extension: vascular correlations to beauty parlor stroke syndrome and salon sink radiculopathy.

OBJECTIVE: Professional shampoos have previously been implicated in beauty parlor stroke syndrome and salon sink radiculopathy. The purpose of this study was to record pain, dizziness, and cervical blood flow while subjects were specifically placed into the salon sink position and to determine whether an additional cervical support would alter these symptoms and measurements. DESIGN: In 25 volunteers who reported previous dizziness from salon shampoos, we recorded subjective levels of pain and dizziness and objective measurements of blood flow within the vertebral and carotid arteries at baseline and then during cervical extension into a salon sink, with and without additional cervical support. RESULTS: When the additional cervical support was not used, there was significantly greater dizziness, neck pain, and carotid blood flow. No statistically significant differences were seen in the vertebral artery blood flow when comparing the three positions. CONCLUSIONS: Pain and dizziness were commonly reproduced in this previously symptomatic population but significantly less frequently when a supplemental cervical support was used. Individuals with a history of such symptoms should probably exercise caution when deciding whether to receive a salon sink shampoo.

Aged↗

PubMed2002

Central post-stroke pain syndrome: yet another use for gabapentin?

Although gabapentin was originally developed for treating partial seizures, it has been used mainly to treat various peripheral neuropathic pain conditions; however, there is very limited experience with gabapentin for the treatment of pain conditions of the central nervous system like central post-stroke pain syndrome. We report the case of a 45-yr old man with central post-stroke pain syndrome who failed to respond to a variety of oral analgesics, but within 2 wk of the inception of gabapentin therapy, his average pain was significantly reduced and his level of function improved. We conclude that gabapentin may be an effective medication for the treatment of central post-stroke pain syndrome.

Acetates↗

PubMed2002

Hip muscle imbalance and low back pain in athletes: influence of core strengthening.

PURPOSE: The influence of a core-strengthening program on low back pain (LBP) occurrence and hip strength differences were studied in NCAA Division I collegiate athletes. METHODS: In 1998, 1999, and 2000, hip strength was measured during preparticipation physical examinations and occurrence of LBP was monitored throughout the year. Following the 1999-2000 preparticipation physicals, all athletes began participation in a structured core-strengthening program, which emphasized abdominal, paraspinal, and hip extensor strengthening. Incidence of LBP and the relationship with hip muscle imbalance were compared between consecutive academic years. RESULTS: After incorporation of core strengthening, there was no statistically significant change in LBP occurrence. Side-to-side extensor strength between athletes participating in both the 1998-1999 and 1999-2000 physicals were no different. After core strengthening, the right hip extensor was, on average, stronger than that of the left hip extensor (P = 0.0001). More specific gender differences were noted after core strengthening. Using logistic regression, female athletes with weaker left hip abductors had a more significant probability of requiring treatment for LBP (P = 0.009) CONCLUSION: The impact of core strengthening on collegiate athletes has not been previously examined. These results indicated no significant advantage of core strengthening in reducing LBP occurrence, though this may be more a reflection of the small numbers of subjects who actually required treatment. The core program, however, seems to have had a role in modifying hip extensor strength balance. The association between hip strength and future LBP occurrence, observed only in females, may indicate the need for more gender-specific core programs. The need for a larger scale study to examine the impact of core strengthening in collegiate athletes is demonstrated.

Adult↗

PubMed2002

Functional performance deficits in athletes with previous lower extremity injury.

OBJECTIVE: To evaluate the influence of previously treated, though clinically resolved, lower extremity injury on performance in a timed 20-meter shuttle run. DESIGN: Case control study. SETTING: National Collegiate Athletic Association (NCAA) Division I college during the 2000/2001 preparticipation physicals. PARTICIPANTS: NCAA Division I athletes (n = 213) participated in this research study. Athletes were excluded if they presently had an unresolved lower extremity injury or low back pain. MAIN OUTCOME MEASURES: Time to complete a 20-meter shuttle run was recorded. Previous lower extremity injury and college year were recorded via a short questionnaire. RESULTS: A significantly slower response time on the 20-meter shuttle run was observed in freshman athletes with a history of a lower extremity injury, as compared with freshmen without a previous injury (p = 0.01). No significant difference was noted in non-freshman collegiate athletes regardless of injury history (p = 0.98). CONCLUSION: Kinetic chain deficits may exist long after symptomatic recovery from injury resulting in functional deficits, which may be missed on a standard physical assessment. The slower shuttle run times observed in freshmen with previous lower extremity injury may be a manifestation of insufficient treatment received at the high school level or the benefit of a mandatory core strengthening program in returning athletes. Further study is necessary to identify and validate the cause-and-effect relationship. CLINICAL RELEVANCE: This study may support residual functional deficits in incoming college athletes, which may be related to inadequate care in the high school setting.

Adolescent↗

PubMed2002

Assessing physicians' interpersonal skills: do patients and physicians see eye-to-eye?

OBJECTIVE: To determine the level of agreement between standardized patient ratings and resident physician self-ratings of physician interpersonal skills and the level of agreement between faculty observer and standardized patient ratings of resident physicians' interpersonal skills. DESIGN: Structured clinical evaluation. A total of 25 resident physicians in physical medicine and rehabilitation conducted a 10-min interview of a standardized patient to obtain a history. A resident physician, a standardized patient, and a faculty observer rated the resident physician's interpersonal skills immediately after the interview. The main outcome measure was a modification of the patient assessment measure from the American Board of Internal Medicine, a 9-item rating scale assessing communication (score range, 9-45). RESULTS: There was a low level of agreement between standardized patient ratings and the resident physicians' self-ratings of interpersonal skills (Lin's concordance coefficient, rc = 0.11, P = 0.58). Conversely, there was a statistically significant degree of agreement between the standardized patient and faculty observer ratings of resident physician interpersonal skills (rc = 0.50, P = 0.006). CONCLUSIONS: Some resident physicians have significant difficulty accurately assessing how well they communicate with patients. Physicians in training rarely get feedback regarding their interpersonal skills and may have difficulty using social comparison. Conversely, standardized patients and faculty observers may have insight into interpersonal skills about which resident physicians are unaware.

Communication↗