Fibromyalgia
· Chronic non-inflammatory diffuse pain disorder, associated with fatigue, sleeping difficult, cognitive dysfunction, depression
· Prevalence is 1.1% in the USA, 2.1% in Germany
· Risk factors of trauma in last 6 months, and history of physical or sexual abuse
· Unknown cause, with abnormal processing in peripheral, sympathetic and central nervous system.
· Diagnosed with the American College of Rheumatology 2010 criteria
Widespread pain index (WPI) ≥ 7 and symptom severity (SS) scale score ≥ 5 or WPI 3-6 and SS scale score ≥ 9
Symptoms present at similar level for ≥ 3 months
Absence of disorder that would otherwise explain pain
· Treatment strategy should incorporate principles of self-management using multimodal approach, including non-pharmacological strategies with active patient participation
· Encourage patients to identify specific goals regarding health status and quality of life and to pursue as normal a life pattern as possible
· Patients with fibromyalgia should participate in a graduated exercise program
· Psychological evaluation and counseling may be helpful for patients with fibromyalgia, which is often associated with psychological distress
· Pharmacologic management should be guided by symptoms and may require combination of medications
· Revised guidelines in February 2017
· 2979 titles, 275 full papers were selected for review and 107 reviews eligible
· Based on meta-analyses, the only 'strong for' therapy-based recommendation in the guidelines was exercise
· Initial management should involve patient education and focus on non-pharmacological therapies
· Non-response, further therapies (all of which were evaluated as 'weak for' based on meta-analyses) should be tailored to the specific needs of the individual and may involve psychological therapies (for mood disorders and unhelpful coping strategies), pharmacotherapy (for severe pain or sleep disturbance) and/or a multimodal rehabilitation programs (for severe disability)
Hip Labral Tear
• Hip labral tears occur in approximately 22-55% of patients with groin pain. Retroverted acetabulum or coxa valga have been found in 87% of those patients with labral tears. It is usually detected clinically through demonstration of the “C” sign, mobility restriction within the hip joint, and weakness within the surrounding musculature such as hip flexors, adductors, and external rotators. Various orthopedic tests can be used such as FADIR, flexion internal rotation test, FABER, impingement and Thomas test. Of these orthopedics tests the highest sensitivity and specificity can be found with the Thomas test.
• MRI and MRA is the gold standard for imaging to detect hip labral tears with studies showing 94% and 95% accuracy between two radiologists
• Surgical intervention includes repair or debridement of the hip labrum. Other options include femoroplasty and aceatbuloplasty reshaping of the osseous structure
• Further research is needed on if the labrum is a pain generating structure, in a study of asymptomatic patients (n=45) the follow were found on MRI, labral tears 69%, chondral defects 24%, fibrocystic changes 22%, osseous bumps 20% etc
• Surgical candidate should have positive MRI findings with signs and symptoms lasting over four weeks. Little evidence exists on rehabilitation procedures after arthroscopic labral surgery. Both debridement and repair have specific guidelines and phase based progressions
• Phase 1 – reduce pain and protect surgery, early motion including isometrics
• Phase 2 – progressive ROM, increasing flexibility and strengthening
• Phase 3 – symmetrical ROM and functional strength
• Phase 4 – safe RTP, eccentric control and endurance work
References
https://www-ncbi-nlm-nih-gov.ezproxy.cmcc.ca/pubmed/27377815
http://pamw.pl/en/issue/article/28075425
http://www.sciencedirect.com.ezproxy.cmcc.ca/science/article/pii/S1360859215002636
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Dr. Mike Hadbavny
Chiropractor, Sports Sciences Resident RCCSS(C)
If you are interested in learning more about how chiropractic care can be effective for your particular condition or health goals, contact Dr. Mike Hadbavny at 250-881-7881 today to make an appointment and discover the many benefits of chiropractic care in Victoria, BC. Contact us today.
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