The anatomy of the lateral branches of the sacral dorsal rami: implications for radiofrequency ablation.

Background: The sacroiliac joint (SIJ) is a major source of pain in patients with chronic low back pain. Radiofrequency ablation (RFA) of the lateral branches of the dorsal sacral rami that supply the joint is a treatment option gaining considerable attention. However, the position of the lateral branches (commonly targeted with RFA) is variable and the segmental innervation to the SIJ is not well understood.

Environmental conditions and performance outcomes: a preliminary report of implications for patient outcomes.

Background: Whereas a host of studies have established various forms of experimental bias, few clinical investigations have examined the relationship of the behavior of the observer or examiner to a subject's physical performance.

Objective: To measure the grip strength of volunteers in 2 distinct clinical "environments."

Methodology: Twenty subjects were randomized in a crossover design to undergo grip strength testing in positive and negative environments as created by the distinctly different behavioral/communication approaches of the research staff.

Does opioid use for pain management warrant routine bone mass density screening in men?

Background: Although opioids are known to inhibit testosterone production and bone formation, no prior study has investigated the relationship between opioid use in male subjects and bone mass density measurements.

Method: Eighty-one male patients who had been using opioids for a period of time from a few weeks to 20 years were included in this study. Blood samples were obtained to examine the total testosterone level of these subjects and each patient also had a bone mass density scan.

Current applications of electrotherapeutics in collagen healing.

Electrical current flow appears to be integral to the healing of collagen containing tissue, i.e., bone, cartilage, ligaments, tendons and skin.

No clear winner in differing imaging modalities for cervical radiculopathy.

We review the literature pertaining to the strengths and limitation of myelography, computerized tomography (CT) and magnetic resonance imaging (MRI) relative to developing a diagnostic algorithm in the evaluation of cervical radiculopathy. To obtain the relevant literature, a Medline search was conducted using selected keywords and phrases. In addition, the bibliography of all retrieved articles was searched and pertinent articles were obtained and evaluated.

An algorithm for understanding spine imaging.

The presentation of a patient with primary spine pathology may be confounded by a myriad of symptoms that span many organ systems. Likewise, imaging findings are often diverse and may be as subtle as slight posterior joint asymmetry combined with paravertebral myofascial strain or as goss as fracture-dislocation with neurological sequelae. A systematic approach to selecting and applying the appropriate imaging study combined with a careful clinical history and examination will insure a more accurate diagnosis and proper treatment.

Clinical evaluation of ankylosing spondylitis in Switzerland.

The purpose of this study was to identify the socioeconomic conditions and clinical history of ankylosing spondylitis patients in Switzerland. Data collected from 1177 ankylosing spondylitis patients, through a mail-in questionnaire, was analyzed for epidemiological factors, clinical presentation, musculoskeletal related surgical history and socioeconomic impact. The results showed that the sex ratio, average age at onset of symptoms, latent period until diagnosis, signs and symptoms, peripheral joint involvement and the prevalence of extraarticular organ affection of our patient group all conform with the majority of the published literature.

Thoracolumbar syndrome in athletes.

The thoracolumbar syndrome is a potential cause of back pain in athletes whose sport involves prolonged posturing with the hips flexed and the head extended upward. This syndrome may be overlooked and athletes are sometimes inappropriately treated for an incidental finding in the lower lumbar spine disclosed on conventional imaging studies. The clinical presentation involves point tenderness over the affected motion segment (T12 through L3) with pain radiating along a segmental nerve distribution (anterior or posterior rami divisions) of thoracolumbar origin.

Competitive figure skating injuries.

The nature, type and frequency of injuries occurring at a national figure skating competition were examined. Data was compiled from the medical history form of all 208 participants and the on-site evaluations of the 55 skaters who presented for treatment. Twenty-six percent of all the skaters were injured during the competition.

Sacroiliac arthrograms and post-arthrography computerized tomography.

Sacroiliac joint (SIJ) injection and arthrography have been described, yet no study has specifically categorized the morphological characteristics of SIJ arthrograms versus post arthrogram computerized tomography (CT). Forty-three patients with a mean age of 33 years (range 20-48 years) and an equal male to female distribution were studied radiographically for SIJ pathology. A total of 74 SIJ injections were performed using Image-intensifier-control and a posterior-inferior approach.

Can the sacroiliac joint cause sciatica?

In this brief study we provide evidence that earlier and more recent findings pertaining to the anatomy and physiology of the sacroiliac joint suggest that dysfunction in this joint could, similar to a herniated lumbar disc, produce pain along the sciatic nerve. These observations might explain some of the cases of sciatica in which no disc pathology can be found.

Thoracic facet blocks: bent needle technique.

Thoracic posterior joints are putative pain generators; yet there is a paucity of information to assist the clinician in the diagnosis and treatment of dorsal spine pain. A safe and effective bent needle injection/arthrography technique is described which can assist in the diagnosis of some patients with thoracic zygapophyseal joint dysfunction.

Minimally invasive options to disc surgery.

Consumer consciousness, the evolution of non-operative specialties involved in pain management, a continuing trend toward outpatient versus inpatient procedures and cost concerns have all generated interest in minimally invasive options to spine surgery. Accompanying this movement are the aspirations of reduced convalescence, loss of functional limitations, lowered complications and diminished costs. Although new therapies offer future promise, there is currently a paucity of randomized controlled trials on these options.

The fundamentals of musculoskeletal imaging.

Pain management physicians need to understand the basic diagnostic tools for their profession, including the major musculoskeletal imaging modalities for joint and muscle disorders. This article serves to review the indications and limitations for musculoskeletal imaging modalities with particular attention to how altered anatomy may reflect injury mechanisms.

Imaging in lumbar spinal stenosis.

Lumbar spinal stenosis is a common condition seen in patients presenting to physicians who specialize in pain management or perform spine surgery. The designation of "spinal stenosis" without other qualifiers is vague and as such holds little practical value. Classifications have been created in order to more specifically describe the various etiologies as well as the site(s) of narrowing.

The sacroiliac joint: anatomy, physiology and clinical significance.

The sacroiliac joint (SIJ) is a putative source of low back pain. The objective of this article is to provide clinicians with a concise review of SIJ structure and function, diagnostic indicators of SIJ-mediated pain, and therapeutic considerations. The SIJ is a true diarthrodial joint with unique characteristics not typically found in other diarthrodial joints.

Histologic analysis of neural elements in the human sacroiliac joint.

Study Design: The posterior ligament of the human sacroiliac joint was examined for nerves and nerve endings using histologic and immunohistochemical techniques.

Objective: To identify nerve fibers and mechanoreceptors in the posterior ligament.

Summary Of Background Data: According to the findings of previous studies, the human sacroiliac joint receives myelinated and unmyelinated axons that presumably conduct pain and proprioceptive impulses derived from mechanoreceptors and free nerve endings in the human sacroiliac joint.