Predictors of the effects of treatment for shoulder pain: protocol of an individual participant data meta-analysis.

Background: Shoulder pain is one of the most common presentations of musculoskeletal pain with a 1-month population prevalence of between 7 and 26%. The overall prognosis of shoulder pain is highly variable with 40% of patients reporting persistent pain 1 year after consulting their primary care clinician. Despite evidence for prognostic value of a range of patient and disease characteristics, it is not clear whether these factors also predict (moderate) the effect of specific treatments (such as corticosteroid injection, exercise, or surgery).

An 800-million-solar-mass black hole in a significantly neutral Universe at a redshift of 7.5.

Quasars are the most luminous non-transient objects known and as a result they enable studies of the Universe at the earliest cosmic epochs. Despite extensive efforts, however, the quasar ULAS J1120 + 0641 at redshift z = 7.09 has remained the only one known at z > 7 for more than half a decade.

Radiating low back pain in general practice: incidence, prevalence, diagnosis, and long-term clinical course of illness.

Objective: The aim of this study was to calculate the incidence and prevalence of radiating low back pain, to explore the long-term clinical course of radiating low back pain including the influence of radiculopathy (in a subsample of the study population) and non-radiating low back pain thereon, and to describe general practitioners' (GPs') treatment strategies for radiating low back pain.

Design: A historic prospective cohort study.

Setting: Dutch general practice.

Epidural steroids for lumbosacral radicular syndrome compared to usual care: quality of life and cost utility in general practice.

Objective: To investigate the effect of adding segmental epidural steroid injections (SESIs) to usual care compared with usual care alone on quality of life and cost utility in lumbosacral radicular syndrome (LRS) in general practice.

Design: A pragmatic randomized controlled trial. Results were analyzed using mixed models.

Steroid injections added to the usual treatment of lumbar radicular syndrome: a pragmatic randomized controlled trial in general practice.

Background: Lumbosacral radicular syndrome (LRS) is a self-limiting, benign, painful and impairing condition caused by lumbar disc herniation and inflammatory processes around the nerve root. Segmental epidural steroid injections (SESIs) are helpful to reduce radicular pain on a short-term basis. It is unknown whether SESIs are an effective addition to usual pain treatment of LRS in general practice.

Costs and cost-effectiveness of epidural steroids for acute lumbosacral radicular syndrome in general practice: an economic evaluation alongside a pragmatic randomized control trial.

Study Design: A pragmatic, randomized, controlled, single-blinded trial in Dutch general practice.

Objective: Assessing the costs and cost-effectiveness of adding segmental epidural steroid injections to care as usual in radiculopathy in general practice.

Summary Of Background Data: Lumbosacral radicular syndrome (radiculopathy) is a benign, generally self-limiting but painful condition caused by a herniated lumbar intervertebral disc, which results in an inflammatory process around the nerve root.

Guideline for diagnosis and treatment of subacromial pain syndrome: a multidisciplinary review by the Dutch Orthopaedic Association.

Treatment of "subacromial impingement syndrome" of the shoulder has changed drastically in the past decade. The anatomical explanation as "impingement" of the rotator cuff is not sufficient to cover the pathology. "Subacromial pain syndrome", SAPS, describes the condition better.

Patients with shoulder complaints in general practice: consumption of medical care.

Objective: To describe the medical consumption [general practitioner (GP) consultation, referrals, medication consumption] of patients with shoulder complaints in general practice.

Methods: Data were obtained from a primary-care medical registration network. All patients aged ≥18 years with new shoulder complaints who consulted their general practitioner in 1998 were included, and were followed 10 years beyond the initial consultation.

Randomised controlled trial of local corticosteroid injections for carpal tunnel syndrome in general practice.

Background: Carpal tunnel syndrome is caused by entrapment of the median nerve and results in pain, tingling and numbness in the wrist and hand. It is a common condition in general practice. Effectiveness of treatment by intracarpal corticosteroid injection has never been investigated in general practice.

Manipulative therapy in addition to usual care for patients with shoulder complaints: results of physical examination outcomes in a randomized controlled trial.

Objective: The purpose of this study was to examine the effect of manipulative therapy on the shoulder girdle, in addition to usual care provided by the general practitioner, on the outcomes of physical examination tests for the treatment of shoulder complaints.

Methods: This was a randomized controlled trial in a primary care setting in the Netherlands. A total of 150 participants were recruited from December 2000 until December 2002.

Randomised controlled trial of local corticosteroid injections for de Quervain's tenosynovitis in general practice.

Background: De Quervain's tenosynovitis is a stenosing tenosynovitis of the first dorsal compartment of the wrist and leads to wrist pain and to impaired function of the wrist and hand. It can be treated by splinting, local corticosteroid injection and operation. In this study effectiveness of local corticosteroid injections for de Quervain's tenosynovitis provided by general practitioners was assessed.

Corticosteroid injection for de Quervain's tenosynovitis.

Background: De Quervain's tenosynovitis is a disorder characterised by pain on the radial (thumb) side of the wrist and functional disability of the hand. It can be treated by corticosteroid injection, splinting and surgery.

Objectives: To summarise evidence on the efficacy and safety of corticosteroid injections for de Quervain's tenosynovitis.

Manipulative therapy and clinical prediction criteria in treatment of acute nonspecific low back pain.

Manipulative therapy as part of a multidimensional approach may be more effective than standard physical therapy in treating Acute Nonspecific Low Back Pain. 64 participants, 29 women and 35 men, with Acute Nonspecific Low Back Pain and a mean age of 40 yr. (SD=9.

Conservative or surgical treatment for subacromial impingement syndrome? A systematic review.

Background: Patients with subacromial impingement syndrome are often operated on when conservative treatments fail. But does surgery really lead to better results than nonoperative measures? This systematic review compared effects of conservative and surgical treatment for subacromial impingement syndrome in terms of improvement of shoulder function and reduction of pain.

Methods: A literature search for randomized controlled trials (RCTs) in PubMed, EMBASE, PEDro, and the Cochrane Central Register of Controlled Trials was conducted.

Corticosteroid injection for trigger finger in adults.

Background: Trigger finger is a disease of the tendons of the hand leading to triggering (locking) of affected fingers, dysfunction and pain. Available treatments include local injection with corticosteroids, surgery, or splinting.

Objectives: To summarize the evidence on the efficacy and safety of corticosteroid injections for trigger finger in adults using the following endpoints: treatment success, frequency of triggering or locking, functional status of the affected fingers, and severity of pain of the fingers.

Interobserver reliability of physical examination of shoulder girdle.

The object of this study was to assess interobserver reliability in 23 tests concerning physical examination of the shoulder girdle. A physical therapist and a physical therapist/manual therapist independently performed a physical examination of the shoulder girdle in 91 patients with shoulder complaints of varying severity and duration. The observers assessed 23 items in total: active and passive abductions, passive external rotation, hand in neck (HIN) test, hand in back (HIB) test, impingement test according to Neer, springing test of the first rib and joint play test of the acromioclavicular joint.

Assessment of the cervical range of motion over time, differences between results of the Flock of Birds and the EDI-320: a comparison between an electromagnetic tracking system and an electronic inclinometer.

The objective of this study was to analyse cervical range of motion, assessed over time by means of a digital inclinometer (EDI-320) and a three-dimensional electromagnetic tracking device (Flock of Birds). The maximum active cervical range of motion was assessed with two measurement devices in three sessions over time, with 6-week intervals. In total, 26 women and 24 men (mean age: 44.

A new interdisciplinary treatment strategy versus usual medical care for the treatment of subacromial impingement syndrome: a randomized controlled trial.

Background: Subacromial impingement syndrome (SIS) is the most frequently recorded shoulder disorder. When conservative treatment of SIS fails, a subacromial decompression is warranted. However, the best moment of referral for surgery is not well defined.

Patients' views on dyspepsia and acid suppressant drug therapy in general practice.

Objectives: To do an inventory on the opinion of long-term acid suppressant drug (ASD) users on their condition and drug treatment, and from that angle to reflect on possibilities to reduce usage and costs of long-term acid suppressant drug therapy.

Methods: In the year 2001, in seven general practices, patients who chronically used ASDs without proper indication were identified. A postal questionnaire based on the literature was sent to these patients (n=498).

A simple classification system was recommended for patients with restricted shoulder or neck range of motion.

Objective: To construct an empirical classification of patients with shoulder complaints, and then to investigate the relationship between the empirical classification and the setting in which the patients were recruited, their demographic and clinical characteristics, and the original diagnostic categories.

Study Design And Setting: A latent class analysis was performed on the combined data of two previous studies.

Results: Four clusters of patients emerged, one with patients who have a small chance of any restriction of the motion of the shoulder and a moderate chance of restriction of the motions of the neck, a second with patients who have a high chance of restriction of the motions of the shoulder and a moderate chance of restriction of motions of the neck, a third with patients who have a low to moderate chance of restriction of all motions, and a fourth with patients who have a high chance of restriction of all of the motions.

Interobserver reliability of neck-mobility measurement by means of the flock-of-birds electromagnetic tracking system.

Objective: To establish the interobserver reliability for measuring neck mobility in human subjects by means of an electromagnetic tracking device, the Flock-of-Birds system.

Methods: Two observers independently and in random order assessed the cervical range-of-motion in 30 subjects with a dysfunction in the neck and shoulder region (symptomatic subjects) and 30 subjects without known pathology (asymptomatic subjects). Measurements included rotation in neutral position, in flexed position and in extended position, flexion-extension, and lateral bending (all active and passive).

Variation in the cervical range of motion over time measured by the "flock of birds" electromagnetic tracking system.

Study Design: Observational longitudinal study.

Objective: To establish the normal variation over time for active and passive cervical range of motion (ROM) measured with the Flock of Birds electromagnetic tracking system (FOB).

Summary Of Background Data: Data about normal variation of cervical ROM over time are scarce but important for the interpretation of study results.

Manipulative therapy in addition to usual medical care for patients with shoulder dysfunction and pain: a randomized, controlled trial.

Background: Dysfunction of the cervicothoracic spine and the adjacent ribs (also called the shoulder girdle) is considered to predict occurrence and poor outcome of shoulder symptoms. It can be treated with manipulative therapy, but scientific evidence for the effectiveness of such therapy is lacking.

Objective: To study the effectiveness of manipulative therapy for the shoulder girdle in addition to usual medical care for relief of shoulder pain and dysfunction.

Complaint-severity and cervical spine problems successfully classified patients with shoulder complaints.

Objective: To construct a classification of patients with shoulder complaints based on their physical examination. To investigate (1) the interobserver reliability, (2) to what extent the setting in which the patients were recruited, and demographic and clinical characteristics are related to the classification.

Study Design And Setting: Data from 132 patients with shoulder complaints recruited in various health care settings in The Netherlands were examined.

Classification of shoulder complaints in general practice by means of nonmetric multidimensional scaling.

Objectives: To determine if a classification of shoulder complaints in general practice can be made from variables of medical history and physical examination with nonmetric multidimensional scaling and to investigate the reproducibility of results from an earlier hierarchical cluster analysis.

Design: A classification study performed using nonmetric multidimensional scaling.

Setting: Four general practices in the Netherlands.