Peter Nicolakis

Ultrasound Therapy for Calcific Tendinitis of the Shoulder

BACKGROUND AND METHODS Although ultrasound therapy is used to treat calcific tendinitis of the shoulder, its efficacy has not been rigorously evaluated. We conducted a randomized, double-blind comparison of ultrasonography and sham insonation in patients with symptomatic calcific tendinitis verified by radiography. Patients were assigned to receive 24 15-minute sessions of either pulsed ultrasound (frequency, 0.89 MHz; intensity, 2.5 W per square centimeter; pulsed mode, 1:4) or an indistinguishable sham treatment to the area over the calcification. The first 15 treatments were given daily (five times per week), and the remainder were given three times a week for three weeks. Randomization was conducted according to shoulders rather than patients, so a patient with bilateral tendinitis might receive either or both therapies. RESULTS We enrolled 63 consecutive patients (70 shoulders). Fifty-four patients (61 shoulders) completed the study. There were 32 shoulders in the ultrasound-treatment group and 29 in the sham-treatment group. After six weeks of treatment, calcium deposits had resolved in six shoulders (19 percent) in the ultrasound-treatment group and decreased by at least 50 percent in nine shoulders (28 percent), as compared with respective values of zero and three (10 percent) in the sham-treatment group (P=0.003). At the nine-month follow-up visit, calcium deposits had resolved in 13 shoulders (42 percent) in the ultrasound-treatment group and improved in 7 shoulders (23 percent), as compared with respective values of 2 (8 percent) and 3 (12 percent) in the sham-treatment group (P=0.002). At the end of treatment, patients who had received ultrasound treatment had greater decreases in pain and greater improvements in the quality of life than those who had received sham treatment; at nine months, the differences between the groups were no longer significant. CONCLUSIONS In patients with symptomatic calcific tendinitis of the shoulder, ultrasound treatment helps resolve calcifications and is associated with short-term clinical improvement.

Relationship between craniomandibular disorders and poor posture.

ABSTRACT The purpose of this research was to show that a relationship between craniomandibular disorders (CMD) and postural abnormalities has been repeatedly postulated, but still remains unproven. This study was intended to test this hypothesis. Twenty-five CMD patients (mean age 28.2 years) were compared with 25 gender and age matched controls (mean age 28.3 years) in a controlled, investigatorblinded trial. Twelve postural and ten muscle function parameters were examined. Measurements were separated into three subgroups, consisting of those variables associated with the cervical region, the trunk in the frontal plane, and the trunk in the sagittal plane. Within these subgroups, there was significantly more dysfunction in the patients, compared to control subjects (Mann-Whitney U test p<0.001, p<0.05, p<0.01). Postural and muscle function abnormalities appeared to be more common in the CMD group. Since there is evidence of the mutual influence of posture and the craniomandibular system, control of body posture in CMD patients is recommended, especially if they do not respond to splint therapy. Whether poor posture is the reason or the result of CMD cannot be distinguished by the data presented here.

An investigation of the effectiveness of exercise and manual therapy in treating symptoms of TMJ osteoarthritis.

ABSTRACT The background and purpose of this investigation was to evaluate the use of a treatment protocol which included active and passive jaw movements, manual therapy techniques, correction of body posture, and relaxation techniques for the treatment of temporomandibular joint (TMJ) osteoarthrosis (OA). Twenty consecutive patients suffering from TMJ OA participated in this study. Inclusion criteria: a. pain in the temporomandibular region; b. symptoms lasting at least three months; and c. radiologically proven OA. All patients were assigned to a waiting list, serving as a no treatment control period. Nineteen patients completed the study. No adverse effects occurred. During the control period (mean duration 35 days), the parameters did not change significantly. After treatment (mean duration 46 days) pain, impairment, and incisal edge clearance improved significantly (Wilcoxon test p < 0.001). At follow-up, pain and impairment were further reduced. The number of patients experiencing no pain at rest (80%), chi-square test p = 0.02) and stress (47%), chi-square test p = 0.03), and no impairment (37%), chi-square test p = 0.05) increased significantly. This therapeutic treatment protocol seems to be useful treatment for the symptoms of clinical dysfunction in OA of the TMJ.

Long-term outcome after treatment of temporomandibular joint osteoarthritis with exercise and manual therapy.

ABSTRACT In a previous study, exercise and manual therapy demonstrated a 90% success rate in patients with osteoarthrosis of the temporomandibular joints in the short-term. The aim of this follow-up study was to assess the long-term effect of these treatment modalities. Seventeen patients were evaluated. All patients suffered from osteoarthrosis of the temporomandibular joints with pain in the temporomandibular joint at baseline and were treated successfully in a prior short-term study. The parameters were pain at rest and at chewing, impairment in daily life, and mouth opening. At follow-up, 11 patients (65%) experienced no pain and 13 patients (76%) had no pain at rest (Fishers Exact Test: p<0.02). Thirteen patients (76%) had a normal incisal edge clearance, and ten patients (59%) felt no impairment due to the disease (Fishers Exact Test: p=0.01). Thirteen patients (76%), who had been treated once successfully, have not needed treatment within the three years after cessation of their therapy. Exercise therapy is an effective tool to treat osteoarthrosis of the temporomandibular joints.

Oefentherapie voor craniomandibulaire stoornissen

Exercise therapy for craniomandibular disorders [Archives of Physical Medicine & Rehabilitation 2000;81(10):1137-42]

Rehabilitation der Arthrosen

Arthrosen sind die haufigsten Gelenkserkrankungen (Oliveria et al. 1995; Felson et al. 1995) und betreffen den Grosteil der Bevolkerung. Die Inzidenz und Pravalenz der Erkrankung steigt ab dem 50. Lebensjahr (Olive-ria et al. 1995; Felson et al. 1995). Arthrosen sind eine wichtige Ursache fur Langzeiterkrankungen und eine der haufigsten Ursachen fur Langzeitbehinderung (Badley 1995). Die Ursachen der Arthrose sind mannigfaltig, wobei entweder eine Uberlastung gesunden Knorpels, oder normale Belastung geschwachten Knorpels (Buckwalter 1995) letztendlich zu einer Zerstorung des Knorpels und in der Folge zu knochernen Veranderungen im Sinne von Knochenanbauten an den Gelenksrandern und subchondraler Sklerosierung fuhrt.