Prof. Leonid Kalichman completed his Physical Therapy studies at Tel Aviv University in 1995. Since then, he has been working as a physiotherapist in a community of various HMOs. He completed a Ph.D. in the Department of Anatomy and Anthropology, Tel Aviv University in 2004. He studied post-doc at Boston University in the United States between 2006 and 2009. Since 2008 began an academic career as a lecturer in the Physical Therapy department at Ben-Gurion University of the Negev. Since 2010 he has served as head of the Master's degree program in Physical Therapy and from 2017 serves as head of the Physical Therapy department at Ben-Gurion University of the Negev. Leonid is the director of a Musculoskeletal Medicine Clinical Research Unit and has established a South Israel Interdisciplinary Academic Forum of Musculoskeletal Medicine (SIMM).
American Journal of Physical Medicine & Rehabilitation, Aug 1, 2007
To evaluate the influence of patient&... more To evaluate the influence of patient's weight on rehabilitation results after first stroke. Retrospective, comparative study. The sample comprised 84 males and females, first-time stroke patients, who had been hospitalized in the department of rehabilitation at the Hartzfeld Geriatric Hospital, Gedera, Israel for a full 3 mos and who, on admission, had scored between 40 and 60 on the total Functional Improvement Measure (FIM) test. We evaluated the difference in total FIM improvement between normal-weight, overweight, and obese patients. The relative improvement of FIM score was significantly higher in normal-weight patients than in overweight patients, and improvement in overweight patients was significantly higher than in obese ones. We also found a statistically significant negative correlation (r = -0.27, P = 0.014) between relative improvement of FIM score and body mass index (BMI) in the total sample. Our study revealed that during the first 12 wks, rehabilitation is statistically significantly less effective in overweight and, particularly, in obese patients (evaluated by BMI). We also found a statistically significant negative association between the individual's BMI and relative improvement of the FIM score, representing the functional status of the stroke patient.
Journal of Back and Musculoskeletal Rehabilitation, Jan 26, 2015
Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatme... more Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice. To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis. PubMed, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological quality of interventional studies was evaluated inter alia by the PEDro score. Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping. We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.
The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral j... more The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral joints (UVJs) found on computed tomography (CT) scans, and assess the intra‐ and inter‐rater reliability of this scale. The study included 50 subjects (average age 55.12 ± 13.76 years) referred for CT examinations due to cervical complaints. Three researchers developed a reading protocol using a semiquantitative grading scale of UVJ degenerative changes. CTs were read and reread several times to refine the protocol. Subsequently, the reader read and reread 20 CTs (C3–C7 bilateral, altogether 200 UVJs) 2 weeks apart in order to assess the intra‐rater reliability. The second reader, after the training, read the same 20 CTs (yet, C4–C6 bilateral, altogether 120 UVJs) in order to assess the inter‐rater reliability. The additional 30 CTs were evaluated to analyze the prevalence and associations between the studied parameters. The final grading scale included joint space narrowing, osteophyte, subchondral sclerosis, subchondral cyst, hypertrophy, cortical erosion, and vacuum phenomenon. The intra‐rater agreement ranged from very good in joint space narrowing (k = 0.757), osteophyte grade (k = 0.748), subchondral cyst (k = 0.716), hypertrophy (k = 0.728), vacuum phenomenon (k = 0.712) to good (k = 0.544) in subchondral sclerosis, and fair in cortical erosion (k = 0.36). For the overall UVJ degeneration grade, the intra‐rater agreement was very good (k = 0.616) and the inter‐rater reliability was good (k = 0.468). 77.6% of the evaluated UVJs exhibited some degenerative changes. Our grading scale is the first to evaluate UVJs presenting good‐very good intra‐rater and inter‐rater reliability which can be utilized in further clinical studies and assess degenerative changes in UVJs.
International journal of therapy and rehabilitation, Nov 1, 2014
Background: A critical review of the literature shows that very few objective methods for clinica... more Background: A critical review of the literature shows that very few objective methods for clinically evaluating Achilles tendinopathy have been described. Aim: To evaluate the validity and reliability of common digital and skinfold calipers in measuring the Achilles tendon width. Methods: Reliability study of ten healthy adult volunteers (five males and five females) was performed at the Rheumatology Unit of Barzilai Medical Center, Ashkelon, Israel. Achilles tendon width was measured by ultrasound at two points of both legs (the tendon attachment and 5 cm proximally). Using regular and skinfold calipers, two further measurements were made, three hours apart, at the same sites. Results: Test-retest reliability was high for the skinfold caliper at both the upper (intraclass correlation coefficient (ICC)=0.863, p<0.001) and lower (ICC=0.931, p<0.001) points, and moderate for the regular caliper at upper (ICC=0.730, p<0.001) and lower (ICC=0.641, p<0.001) points. Moderate association was found between ultrasound and caliper measurements at the lower point (Spearman's rank correlation coefficient (rho)=0.721, p=0.019 for regular calipers; rho=0.646, p=0.043 for skinfold calipers). At the upper point, the associations were high (rho=0.778, p=0.008 for regular calipers; rho=0.960, p<0.001 for skinfold calipers). Conclusions: The skinfold caliper showed a higher correlation with ultrasound measurements and higher intraobserver reliability than the regular caliper. Therefore, the skinfold caliper can be recommended in clinics and trials when repeated measurements need to be performed.
Disclosures: D. Benton, None. Objective: The purpose of the proposed research is to empirically e... more Disclosures: D. Benton, None. Objective: The purpose of the proposed research is to empirically explore the effectiveness of standard clinical intervention for Veterans with chronic low back pain (CLBP) and posttraumatic stress disorder (PTSD) given multiple medical and psychiatric comorbidities, particularly in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/ OIF) Veterans. Design: Retrospective chart review. Setting: Outpatient PM&R clinic setting. Participants: Veteran subjects with CLBP cleared for active participation in a group setting of education and lumbar stabilization exercises. A total of 318 veteran charts from Back School Log over 18 months were examined and divided into 4 groups based on the diagnosis of PTSD and OEF/OIF status. Main Outcome Measures: Visual numerical pain scale, self-reported functional activities, ie, sitting and walking, compliance. Results: The mean overall age was 55.86 years (SD 13.88) with a significant difference (P .001), between non-OEF/ OIF Groups 1 and 2 (59.34 years, SD11.4) and OEF/ OIF groups 3 and 4 (35.24 years, SD 8.08). While men were the overall majority (95.6%), a significant number of women constituted the OEF/OIF groups 3 and 4 (20%, P .0001). Further, a significantly higher percentage of OEF/OIF veterans were exposed to combat (34.8%, P .02). The majority of those with PTSD were from the Army (65.28%, P .0026). There was no difference among groups with race or marital status. The majority of veterans completed Back School I with an average VNS 4.9 with a significantly greater improvement (P .0024) in those without PTSD. Those who continued on to Back School II demonstrated a significant difference (P .05) with only a 50% completion rate in OEF/OIF veterans with PTSD. Conclusions: Overall, those with a diagnosis of PTSD reported lower improvements in functional activities, ie, sitting and walking (P .04, and .03, respectively). Education alone (Back School I) may have impact on perceived pain in General CLBP. PTSD may have a negative influence on outcomes in OEF/OIF veterans with CLBP. Poster 96 Accuracy of the Clinical Examination for the Diagnosis of Symptomatic Lumbar Spinal Stenosis. Pradeep Suri, MD (Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA); Leonid Kalichman, PT, PhD; Jeffrey N. Katz, MD; James Rainville, MD.
Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifical... more Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifically in the bladder detrusor muscle. We reviewed the current literature on the association between vitamin D deficiency and urinary incontinence (UI), and whether vitamin D supplementation plays a role in the treatment of UI symptoms. We performed a scoping review of all available studies. PubMed, Google Scholar, and PEDro databases were searched from inception until August 2020 with the keywords “urinary incontinence,” “pelvic floor disorders,” “lower urinary tract symptoms,” “overactive bladder,” and various terms for vitamin D. No language restrictions were imposed. The reference lists of all retrieved articles were also searched. The search revealed 12 studies of different research methodologies after elimination. In 6 out of the 7 cross-sectional studies reviewed, a significant association between vitamin D deficiency or insufficiency and the onset and severity of UI was found. In 2 out of the 3 prospective studies included, no association between vitamin D intake and UI was found; however, both randomized controlled trials that were reviewed found that vitamin D supplementation is effective for the treatment of UI. The existing literature supports an association between low levels of serum vitamin D and UI. Initial evidence regarding the effect of vitamin D supplementation on UI is accumulating, yet additional, comprehensive research is warranted to establish these findings.
Journal of Bodywork and Movement Therapies, Jul 1, 2019
BACKGROUND Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-relate... more BACKGROUND Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases. AIMS To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS. METHODS A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test. RESULTS The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ2 = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ2 = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ2 = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls. CONCLUSION There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.
Journal of Back and Musculoskeletal Rehabilitation, Jun 10, 2009
To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone inject... more To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone injection in patients with carpal tunnel syndrome (CTS) over a 6-months period. Twenty one patients, of whom 7 were lost for follow-up (mean age 57.9 +/- 8.4) with clinical and electrophysiological evidence of CTS were treated by injection of depo-methylprednisolone 40 mg proximal to the carpal tunnel. Severity of pain (VAS), rates of numbness/paresthesias and nocturnal awakening, motor and sensory nerve conduction studies were used as outcomes. All tests were performed before, 1, 3 and 6 months after the injection. Severity of pain was significantly reduced at all follow-up time points (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Prior to injection all patients complained of night pain and awakening. On the first, third and sixth months, 0(0%), 4 (29%) and 7 (50%) of the patients, respectively, had night awakening. All patients complained of numbness before the treatment. This symptom disappeared in 81% of the patients after one month and reappeared in all after three months. Significant improvement was shown in the mean distal motor latency (DML) of the median nerve: 5.2 +/- 0.9 msec. before, 4.6 +/- 0.6 msec. and 4.7 +/- 0.6 msec. 1 and 3 months after the injection, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Mean values of motor muscle potential amplitudes, sensory latency and sensory amplitude did not change significantly after the treatment. Local corticosteroid injection for the treatment of CTS provides significant symptom improvement for three months. No electrophysiological parameters were improved after injection, except the improvement in distal motor latency of the median nerve.
American Journal of Physical Medicine & Rehabilitation, Aug 1, 2007
To evaluate the influence of patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;... more To evaluate the influence of patient&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s weight on rehabilitation results after first stroke. Retrospective, comparative study. The sample comprised 84 males and females, first-time stroke patients, who had been hospitalized in the department of rehabilitation at the Hartzfeld Geriatric Hospital, Gedera, Israel for a full 3 mos and who, on admission, had scored between 40 and 60 on the total Functional Improvement Measure (FIM) test. We evaluated the difference in total FIM improvement between normal-weight, overweight, and obese patients. The relative improvement of FIM score was significantly higher in normal-weight patients than in overweight patients, and improvement in overweight patients was significantly higher than in obese ones. We also found a statistically significant negative correlation (r = -0.27, P = 0.014) between relative improvement of FIM score and body mass index (BMI) in the total sample. Our study revealed that during the first 12 wks, rehabilitation is statistically significantly less effective in overweight and, particularly, in obese patients (evaluated by BMI). We also found a statistically significant negative association between the individual&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39;s BMI and relative improvement of the FIM score, representing the functional status of the stroke patient.
Journal of Back and Musculoskeletal Rehabilitation, Jan 26, 2015
Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatme... more Plantar fasciitis is considered the most common cause of foot pain. Numerous non-surgical treatments have been used to relieve symptoms. Taping is one of the most widespread treatments, with several techniques utilized in clinical practice. To evaluate, based on existing literature, the efficacy of different taping techniques in relieving symptoms and dysfunction caused by plantar fasciitis. PubMed, CINAHL, PEDro, ISI Web of Science, and Google Scholar databases were searched from inception until December 2012, using a predefined search strategy. Controlled trials of any methodological quality were included, without any language restrictions. The methodological quality of interventional studies was evaluated inter alia by the PEDro score. Five randomized control trials, one cross-over study and two single group repeated measures studies met the inclusion criteria. Two studies were high quality; two were moderate quality and four were of poor methodological quality. All eight studies favored the use of different taping techniques. The most common technique was low dye taping. We found that in the short-term, taping is beneficial in treating plantar fasciitis. The best evidence exists for low dye taping and calcaneal taping. More research is needed to investigate long-term effect and effectiveness of specific taping techniques.
The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral j... more The study aimed to develop a grading scale for evaluating degenerative changes in uncovertebral joints (UVJs) found on computed tomography (CT) scans, and assess the intra‐ and inter‐rater reliability of this scale. The study included 50 subjects (average age 55.12 ± 13.76 years) referred for CT examinations due to cervical complaints. Three researchers developed a reading protocol using a semiquantitative grading scale of UVJ degenerative changes. CTs were read and reread several times to refine the protocol. Subsequently, the reader read and reread 20 CTs (C3–C7 bilateral, altogether 200 UVJs) 2 weeks apart in order to assess the intra‐rater reliability. The second reader, after the training, read the same 20 CTs (yet, C4–C6 bilateral, altogether 120 UVJs) in order to assess the inter‐rater reliability. The additional 30 CTs were evaluated to analyze the prevalence and associations between the studied parameters. The final grading scale included joint space narrowing, osteophyte, subchondral sclerosis, subchondral cyst, hypertrophy, cortical erosion, and vacuum phenomenon. The intra‐rater agreement ranged from very good in joint space narrowing (k = 0.757), osteophyte grade (k = 0.748), subchondral cyst (k = 0.716), hypertrophy (k = 0.728), vacuum phenomenon (k = 0.712) to good (k = 0.544) in subchondral sclerosis, and fair in cortical erosion (k = 0.36). For the overall UVJ degeneration grade, the intra‐rater agreement was very good (k = 0.616) and the inter‐rater reliability was good (k = 0.468). 77.6% of the evaluated UVJs exhibited some degenerative changes. Our grading scale is the first to evaluate UVJs presenting good‐very good intra‐rater and inter‐rater reliability which can be utilized in further clinical studies and assess degenerative changes in UVJs.
International journal of therapy and rehabilitation, Nov 1, 2014
Background: A critical review of the literature shows that very few objective methods for clinica... more Background: A critical review of the literature shows that very few objective methods for clinically evaluating Achilles tendinopathy have been described. Aim: To evaluate the validity and reliability of common digital and skinfold calipers in measuring the Achilles tendon width. Methods: Reliability study of ten healthy adult volunteers (five males and five females) was performed at the Rheumatology Unit of Barzilai Medical Center, Ashkelon, Israel. Achilles tendon width was measured by ultrasound at two points of both legs (the tendon attachment and 5 cm proximally). Using regular and skinfold calipers, two further measurements were made, three hours apart, at the same sites. Results: Test-retest reliability was high for the skinfold caliper at both the upper (intraclass correlation coefficient (ICC)=0.863, p&lt;0.001) and lower (ICC=0.931, p&lt;0.001) points, and moderate for the regular caliper at upper (ICC=0.730, p&lt;0.001) and lower (ICC=0.641, p&lt;0.001) points. Moderate association was found between ultrasound and caliper measurements at the lower point (Spearman's rank correlation coefficient (rho)=0.721, p=0.019 for regular calipers; rho=0.646, p=0.043 for skinfold calipers). At the upper point, the associations were high (rho=0.778, p=0.008 for regular calipers; rho=0.960, p&lt;0.001 for skinfold calipers). Conclusions: The skinfold caliper showed a higher correlation with ultrasound measurements and higher intraobserver reliability than the regular caliper. Therefore, the skinfold caliper can be recommended in clinics and trials when repeated measurements need to be performed.
Disclosures: D. Benton, None. Objective: The purpose of the proposed research is to empirically e... more Disclosures: D. Benton, None. Objective: The purpose of the proposed research is to empirically explore the effectiveness of standard clinical intervention for Veterans with chronic low back pain (CLBP) and posttraumatic stress disorder (PTSD) given multiple medical and psychiatric comorbidities, particularly in Operation Enduring Freedom/Operation Iraqi Freedom (OEF/ OIF) Veterans. Design: Retrospective chart review. Setting: Outpatient PM&R clinic setting. Participants: Veteran subjects with CLBP cleared for active participation in a group setting of education and lumbar stabilization exercises. A total of 318 veteran charts from Back School Log over 18 months were examined and divided into 4 groups based on the diagnosis of PTSD and OEF/OIF status. Main Outcome Measures: Visual numerical pain scale, self-reported functional activities, ie, sitting and walking, compliance. Results: The mean overall age was 55.86 years (SD 13.88) with a significant difference (P .001), between non-OEF/ OIF Groups 1 and 2 (59.34 years, SD11.4) and OEF/ OIF groups 3 and 4 (35.24 years, SD 8.08). While men were the overall majority (95.6%), a significant number of women constituted the OEF/OIF groups 3 and 4 (20%, P .0001). Further, a significantly higher percentage of OEF/OIF veterans were exposed to combat (34.8%, P .02). The majority of those with PTSD were from the Army (65.28%, P .0026). There was no difference among groups with race or marital status. The majority of veterans completed Back School I with an average VNS 4.9 with a significantly greater improvement (P .0024) in those without PTSD. Those who continued on to Back School II demonstrated a significant difference (P .05) with only a 50% completion rate in OEF/OIF veterans with PTSD. Conclusions: Overall, those with a diagnosis of PTSD reported lower improvements in functional activities, ie, sitting and walking (P .04, and .03, respectively). Education alone (Back School I) may have impact on perceived pain in General CLBP. PTSD may have a negative influence on outcomes in OEF/OIF veterans with CLBP. Poster 96 Accuracy of the Clinical Examination for the Diagnosis of Symptomatic Lumbar Spinal Stenosis. Pradeep Suri, MD (Harvard Medical School/Spaulding Rehabilitation Hospital, Boston, MA); Leonid Kalichman, PT, PhD; Jeffrey N. Katz, MD; James Rainville, MD.
Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifical... more Vitamin D receptors are found in skeletal and smooth muscle cells throughout the body, specifically in the bladder detrusor muscle. We reviewed the current literature on the association between vitamin D deficiency and urinary incontinence (UI), and whether vitamin D supplementation plays a role in the treatment of UI symptoms. We performed a scoping review of all available studies. PubMed, Google Scholar, and PEDro databases were searched from inception until August 2020 with the keywords “urinary incontinence,” “pelvic floor disorders,” “lower urinary tract symptoms,” “overactive bladder,” and various terms for vitamin D. No language restrictions were imposed. The reference lists of all retrieved articles were also searched. The search revealed 12 studies of different research methodologies after elimination. In 6 out of the 7 cross-sectional studies reviewed, a significant association between vitamin D deficiency or insufficiency and the onset and severity of UI was found. In 2 out of the 3 prospective studies included, no association between vitamin D intake and UI was found; however, both randomized controlled trials that were reviewed found that vitamin D supplementation is effective for the treatment of UI. The existing literature supports an association between low levels of serum vitamin D and UI. Initial evidence regarding the effect of vitamin D supplementation on UI is accumulating, yet additional, comprehensive research is warranted to establish these findings.
Journal of Bodywork and Movement Therapies, Jul 1, 2019
BACKGROUND Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-relate... more BACKGROUND Patients suffering from complex regional pain syndrome (CRPS) endure myofascial-related pain in at least 50% of cases. AIMS To evaluate the association of upper limb CRPS with myofascial pain in muscles that might influence arm or hand pain, and to evaluate whether the paraspinal skin and subcutaneous layers' tenderness and allodynia are associated with CRPS. METHODS A case-control study comprising 20 patients presenting with upper limb CRPS, and 20 healthy controls matched for sex and age, were evaluated in the thoracic paraspinal area and myofascial trigger points (MTrPs) (infraspinatus, rhomboids, subclavius, serratus posterior superior and pectoralis minor) via a skin rolling test. RESULTS The prevalence of MTrPs in the affected extremity of the subjects was significantly higher than in the right limb of the controls: 45% exhibited active and latent MTrPs in the infraspinatus muscle (χ2 = 11.613, p = 0.001); 60% in active and latent MTrPs in the subclavius muscle (χ2 = 17.143, p < 0.001); and in the pectoralis minor muscle (χ2 = 13.786, p < 0.001). In addition, 55% of the cases exhibited active and latent MTrPs in the serratus posterior superior muscle (χ2 = 15.172, p < 0.001). Significant differences between the groups in skin texture and pain levels (p = 0.01, p < 0.001, respectively) demonstrated that CRPS patients felt more pain, and their skin and subcutaneous layers were much tighter than in the healthy controls. CONCLUSION There is a high prevalence of MTrPs in the shoulder and upper thoracic area muscles in subjects who suffer from CRPS. We recommend adding an MTrPs evaluation to the standardized examination of these patients.
Journal of Back and Musculoskeletal Rehabilitation, Jun 10, 2009
To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone inject... more To evaluate the clinical and electrophysiological effects of local depo-methylprednisolone injection in patients with carpal tunnel syndrome (CTS) over a 6-months period. Twenty one patients, of whom 7 were lost for follow-up (mean age 57.9 +/- 8.4) with clinical and electrophysiological evidence of CTS were treated by injection of depo-methylprednisolone 40 mg proximal to the carpal tunnel. Severity of pain (VAS), rates of numbness/paresthesias and nocturnal awakening, motor and sensory nerve conduction studies were used as outcomes. All tests were performed before, 1, 3 and 6 months after the injection. Severity of pain was significantly reduced at all follow-up time points (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.001). Prior to injection all patients complained of night pain and awakening. On the first, third and sixth months, 0(0%), 4 (29%) and 7 (50%) of the patients, respectively, had night awakening. All patients complained of numbness before the treatment. This symptom disappeared in 81% of the patients after one month and reappeared in all after three months. Significant improvement was shown in the mean distal motor latency (DML) of the median nerve: 5.2 +/- 0.9 msec. before, 4.6 +/- 0.6 msec. and 4.7 +/- 0.6 msec. 1 and 3 months after the injection, respectively (p &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt; 0.05). Mean values of motor muscle potential amplitudes, sensory latency and sensory amplitude did not change significantly after the treatment. Local corticosteroid injection for the treatment of CTS provides significant symptom improvement for three months. No electrophysiological parameters were improved after injection, except the improvement in distal motor latency of the median nerve.
Uploads