Background: There are no controlled studies testing the efficacy of various nonoperative strategies for treatment of greater trochanter pain syndrome. Hypothesis: The null hypothesis was that local corticosteroid injection, home training, and repetitive low-energy shock wave therapy produce equivalent outcomes 4 months from baseline. Study Design: Randomized controlled clinical trial; Level of evidence, 2. Methods: Two hundred twenty-nine patients with refractory unilateral greater trochanter pain syndrome were assigned sequentially to a home training program, a single local corticosteroid injection (25 mg prednisolone), or a repetitive low-energy radial shock wave treatment. Subjects underwent outcome assessments at baseline and at 1, 4, and 15 months. Primary outcome measures were degree of recovery, measured on a 6-point Likert scale (subjects with rating completely recovered or much improved were rated as treatment success), and severity of pain over the past week (0–10 points) at 4-month follow-up. Results: One month from baseline, results after corticosteroid injection (success rate, 75%; pain rating, 2.2 points) were significantly better than those after home training (7%; 5.9 points) or shock wave therapy (13%; 5.6 points). Regarding treatment success at 4 months, radial shock wave therapy led to significantly better results (68%; 3.1 points) than did home training (41%; 5.2 points) and corticosteroid injection (51%; 4.5 points). The null hypothesis was rejected. Fifteen months from baseline, radial shock wave therapy (74%; 2.4 points) and home training (80%; 2.7 points) were significantly more successful than was corticosteroid injection (48%; 5.3 points). Conclusion: The role of corticosteroid injection for greater trochanter pain syndrome needs to be reconsidered. Subjects should be properly informed about the advantages and disadvantages of the treatment options, including the economic burden. The significant short-term superiority of a single corticosteroid injection over home training and shock wave therapy declined after 1 month. Both corticosteroid injection and home training were significantly less successful than was shock wave therapy at 4-month follow-up. Corticosteroid injection was significantly less successful than was home training or shock wave therapy at 15-month follow-up.

Study Design: Descriptive, prospective, longitudinal single-cohort study. Objective: To investigate the rate of force development to 30% (RFD₃₀), 50% (RFD₅₀), and 90% (RFD₉₀) of maximal voluntary isometric contraction (MVIC) as an adjunct outcome measure for determining readiness for return to sport following an anterior cruciate ligament (ACL) reconstruction. Background: One criterion of full recovery following an ACL reconstruction is the ability to achieve 85% or 90% of the maximal strength of the contralateral limb. However, the time required to develop muscular strength in many types of daily and sports activities is considerably shorter than that required to achieve maximal strength. Therefore, in addition to maximal strength, neuromuscular functions such as RFD should also be considered in the definition of recovery. Methods: Forty-five male professional soccer players who underwent an ACL reconstruction were recruited. Assessment with the International Knee Documentation Committee (IKDC) Subjective Knee Evaluation Form, Tegner score, and KT1000 instrumented arthrometer was performed postinjury/prereconstruction and at 6 and 12 months after ACL reconstruction. MVIC, RFD₃₀, RFD₅₀, and RFD₉₀ testing was performed preinjury, as part of standard preseason assessment, and at 6 and 12 months post-ACL reconstruction. Results: The average MVIC value 6 months postreconstruction was 97% of the preinjury average value. In contrast, at 6 months, the RFD₃₀, RFD₅₀, and RFD₉₀ values were 80% (P = .04), 77% (P = .03), and 63% (P = .007), respectively, of the preinjury values. The mean RFD values for the reconstructed knee attained or exceeded 90% of the preinjury mean values only at the 12-month post-ACL reconstruction assessment (RFD₃₀, P = .86; RFD₅₀, P = .51; RFD₉₀, P = .56). Conclusion: Despite the near recovery of MVIC strength to preinjury levels, there were still significant deficits in RFD at 6 months post-ACL reconstruction. An RFD similar to the preinjury RFD was achieved at 12 months post-ACL reconstruction, following a rehabilitation program focusing on muscle power. These results suggest that, following an ACL reconstruction, RFD criteria may be a useful adjunct outcome measure for the decision to return athletes to sports. J Orthop Sports Phys Ther 2012;42(9):772–780, Epub 19 July 2012. doi:10.2519/jospt.2012.3780

Background. Complex regional pain syndrome type 1 (CRPSt1) of the upper limb is a painful and debilitating condition, frequent after stroke, and interferes with the rehabilitative process and outcome. However, treatments used for CRPSt1 of the upper limb are limited. Objective. This randomized controlled study was conducted to compare the effectiveness on pain and upper limb function of mirror therapy on CRPSt1 of upper limb in patients with acute stroke. Methods. Of 208 patients with first episode of unilateral stroke admitted to the authors’ rehabilitation center, 48 patients with CRPSt1 of the affected upper limb were enrolled in a randomized controlled study, with a 6-month follow-up, and assigned to either a mirror therapy group or placebo control group. The primary end points were a reduction in the visual analogue scale score of pain at rest, on movement, and brush-induced tactile allodynia. The secondary end points were improvement in motor function as assessed by the Wolf Motor Function Test and Motor Activity Log. Results. The mean scores of both the primary and secondary end points significantly improved in the mirror group (P < .001). No statistically significant improvement was observed in any of the control group values (P > .001). Moreover, statistically significant differences after treatment (P < .001) and at the 6-month follow-up were found between the 2 groups. Conclusions. The results indicate that mirror therapy effectively reduces pain and enhances upper limb motor function in stroke patients with upper limb CRPSt1.

Complex regional pain syndrome type 1 is characterized by pain, sensory disturbances (e.g., pain evoked by light brushing of the skin [allodynia]), motor impairment (e.g., weakness), and sympathetic dysfunction (e.g., edema). Pain in this syndrome may be induced by a mismatch between proprioceptive feedback and motor action.¹ Visual feedback as a substitute for inappropriate proprioceptive feedback may reduce pain.^1,2

Background and Purpose. Radial shock-wave therapy (RSWT) is a pneumatically generated, low- to medium-energy type of shock-wave therapy. This single-blind, randomized, “less active similar therapy”-controlled study was performed to evaluate the effectiveness of RSWT for the management of calcific tendinitis of the shoulder. Subjects. Ninety patients with radiographically verified calcific tendinitis of the shoulder were tested. Methods. Subjects were randomly assigned to either a treatment group (n=45) or a control group (n=45). Pain and functional level were evaluated before and after treatment and at a 6-month follow-up. Radiographic modifications in calcifications were evaluated before and after treatment. Results. The treatment group displayed improvement in all of the parameters analyzed after treatment and at the 6-month follow-up. Calcifications disappeared completely in 86.6% of the subjects in the treatment group and partially in 13.4% of subjects; only 8.8% of the subjects in the control group displayed partially reduced calcifications, and none displayed a total disappearance. Discussion and Conclusion. The results suggest that the use of RSWT for the management of calcific tendinitis of the shoulder is safe and effective, leading to a significant reduction in pain and improvement of shoulder function after 4 weeks, without adverse effects.

Background: Chronic proximal hamstring tendinopathy is an overuse syndrome that is usually managed by nonoperative methods. Shockwave therapy has proved to be effective in many tendinopathies. Hypothesis: Shockwave therapy may be more effective than other nonoperative treatments for chronic proximal hamstring tendinopathy. Study Design: Randomized controlled clinical study; Level of evidence, 1. Methods: Forty professional athletes with chronic proximal hamstring tendinopathy were enrolled between February 1, 2004, and September 30, 2006. Patients were randomly assigned to receive either shockwave therapy, consisting of 2500 impulses per session at a 0.18 mJ/mm ² energy flux density without anesthesia, for 4 weeks (SWT group, n = 20), or traditional conservative treatment consisting of nonsteroidal anti-inflammatory drugs, physiotherapy, and an exercise program for hamstring muscles (TCT group, n = 20). Patients were evaluated before treatment, and 1 week and 3, 6, and 12 months after the end of treatment. The visual analog scale (VAS) score for pain and Nirschl phase rating scale (NPRS) were used as primary outcome measures. Results: The patients were observed for a mean of 10.7 months (range, 1-12 months). Six patients were lost to follow-up because they underwent a surgical intervention: 3 (all in TCT group) were lost at 3 months; 2 (1 in each group), at 6 months; and 1 (in the TCT group), at 12 months. Primary follow-up was at 3 months after the beginning of treatment. The VAS scores in the SWT and TCT groups were 7 points before treatment ( P = .84), and 2 points and 5 points, respectively, 3 months after treatment ( P < .001). The NPRS scores in the SWT and TCT groups were 5 points in either group before treatment ( P = .48), and 2 points and 6 points, respectively, 3 months after treatment ( P < .001). At 3 months after treatment, 17 of the 20 patients (85%) in the SWT group and 2 of the 20 patients (10%) in the TCT group achieved a reduction of at least 50% in pain ( P < .001). There were no serious complications in the SWT group. Conclusion: Shockwave therapy is a safe and effective treatment for patients with chronic proximal hamstring tendinopathy.