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For individuals with temporomandibular joint (TMJ) disc displacement without reduction with limited mouth opening (closed lock), interventions vary from minimal treatment to surgery. In a single-blind trial, 106 individuals with TMJ closed lock were randomized among medical management, rehabilitation, arthroscopic surgery with post-operative rehabilitation, or arthroplasty with post-operative rehabilitation. Evaluations at baseline, 3, 6, 12, 18, 24, and 60 months used the Craniomandibular Index (CMI) and Symptom Severity Index (SSI) for jaw function and TMJ pain respectively. Using an intention-to-treat analysis, we observed no between-group difference at any follow-up for CMI (p ≥ 0.33) or SSI (p ≥ 0.08). Both outcomes showed within-group improvement (p < 0.0001) for all groups. The findings of this study suggest that primary treatment for individuals with TMJ closed lock should consist of medical management or rehabilitation. The use of this approach will avoid unnecessary surgical procedures.

Background/aimTo compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery.MethodsFrom August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year.ResultsQuick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred.ConclusionsEarly active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year.Trial registration numberNTR 2025.

Objective To observe the effect of warming needle moxibustion combined with rehabilitation techniques on clinical symptoms and quality of life of patients with anterior disc displacement without reduction (ADDwoR). Methods This randomized controlled trial included 66patients, with ADDwoR, attending the Hangzhou Hospital of Traditional Chinese Medicine. Patients were assigned to the Experimental (12 sessions of warming needle moxibustion combined with rehabilitation manipulation therapy) and Control (rehabilitation therapy only) group ( n  = 33, each). Duration of treatment was 4 weeks, with 3 times a week. Outcomes included VAS pain score, maximum mouth opening (MMO), mandibular function impairment score (MFIQ), oral health impact scale (OHIP-14 scale), and mandibular dysfunction index (Fricton score). Safety assessments during treatment included incidence of fainting, broken needle, bleeding, hematoma and scalding. Results After treatment, the VAS scores, mandibular function impairment scores, oral health impact degree scale, and the scores of Dysfunction index (DI), palpation index (PI) and craniomandibular index (CMI) in the two groups were significantly decreased compared with before. While the maximum mouth opening was increased in both groups, the clinical efficacy evaluation showed the total significant rate of the control group was 59%, and the total significant rate of the experimental group was 83%, demonstrating a significant clinical efficacy difference between the two groups. Conclusion Compared to targeted rehabilitation exercises only, warming needle moxibustion combined with rehabilitation manipulation can not only improve the pain and maximum mouth opening, but also mandibular function impairment, mandibular joint disorder and oral health of patients with ADDwoR. Clinical trial registration http://www.chictr.org.cn/index.aspx , identififier: ChiCTR2200059039.

Objective to compare the combined effect of Prolotherapy and Deep Dry Needling (DDN) versus DDN effect on relieving the symptoms of Temporomandibular joint (TMJ) anterior disc displacement. Patients and methods The clinical trial randomly allocated forty patients. The (control group) patients received four intraarticular and masseteric DDN sessions, while the (study group) patients were subjected to the exact technique followed by Prolosolution injection. The baseline preoperative measurements included Maximal interincisal opening (MIO), auscultation of the presence of clicking, and Visual Analogue Scale (VAS), which were repeated for postoperative measurements after one, two, five, and eight months. Results By the end of the study, all patients expressed apparent improvement in pain MIO and clicking. The inter- and intragroup comparison revealed that the pain score values of the control group after five and eight months were significantly higher than those of the study group. The study group demonstrated more significant MIO calibration than the control group, with insignificant differences between both groups regarding the presence of clicking at any time interval. The associations between clicking and VAS values, between clicking and MIO, and between VAS values and increased MIO were positive in the test group and negative in the control group. Conclusions Dextrose Prolotherapy and DDN were beneficial. However, Prolotherapy demonstrated more significant, sustained, and correlated long-term alleviation of symptoms and increased MIO. Clinical relevance The study assesses the sole effect of dextrose prolotherapy on relieving the signs of TMJ anterior disc displacement apart from the impact of the penetrating needle. Clinical trial registration The study was registered on www.clinicaltrials.gov (#: NCT05821985) by Ahmed Nagi Alghandour.

This randomized controlled trial aimed to compare the effectiveness of supination/flexion (SF) and hyperpronation (HP) maneuvers in the management of radial head subluxation (RHS) in children ≤6 years old presenting to the emergency department. Patients were randomly allocated to one of two treatment arms. Following the application of the respective reduction maneuver, maneuver success was assessed after 10 min. If unsuccessful, the maneuver was repeated up to three times. Patients failing to achieve reduction after three attempts were classified as experiencing ultimate failure. Treatment failure rates were compared between groups for each reduction attempt. Additionally, procedural pain, side effects, and recurrence within 72 h were compared between treatment groups. In this study involving 119 patients, first attempt failure rates were 9.8 % in the HP group and 24.2 % in the SF group, indicating a statistically significant advantage for HP (Risk ratio 0.41 (95 % confidence interval 0.19 to 0.98)). No statistically significant differences were observed between groups regarding second-attempt success, ultimate failure, procedural pain, side effects, or recurrence rates within 72 h. Among children ≤6 years old presenting with RHS, the HP maneuver demonstrated significantly superior first-attempt success rates compared to SF. Therefore, we recommend the HP maneuver as the preferred initial treatment option for managing these patients. The trial was registered on clinicaltrials.gov with registration number NCT05828641 (Url= https://classic.clinicaltrials.gov/ct2/show/NCT05828641).

The clinical diagnosis of atlantoaxial joint subluxation (AJS) in traditional Chinese medicine (TCM) is characterized by an unequal distance between the lateral mass of the atlas and the odontoid process on imaging, resulting in neck pain accompanied by symptoms such as dizziness, headache, and limited cervical mobility. In Shanghai, Shi cervical rotational manipulation (SCRM) is a commonly employed TCM manual therapy for treating this condition. Nevertheless, there is a lack of evidence-based medical information regarding the clinical efficacy and safety of this technique. The principal aim of this study is to evaluate the efficacy and safety of SCRM in patients diagnosed with AJS. This study is a prospective randomized controlled clinical trial that will be conducted at a single center and that has a follow-up period of 24 weeks. A total of 96 patients diagnosed with AJS will be recruited from outpatient and inpatient clinics at Shanghai Baoshan Hospital of Integrated Traditional Chinese and Western Medicine. These patients will be randomly assigned to either the experimental group (SCRM) or the comparison group (basic cervical manipulation [BCM]). Treatment sessions consisting of SCRM or BCM will be administered twice a week for a duration of 4 weeks. Clinical monitoring indicators include the presence or absence of clinical symptoms as recorded on a symptom recording form, cervical imaging examination findings using cervical computed tomography, degree of neck pain measured by a visual analog scale (VAS), cervical range of motion assessed through cervical mobility measurement, degree of vertigo evaluated using the Vertigo Symptoms Scale-Chinese Version (VSS-C), and adverse events that may occur during the follow-up period. The time points for data collection and follow-up are baseline and postintervention (weeks 4, 8, 12, 16, 20, and 24). This paper presents an overview of the reasoning and structure of a prospective randomized controlled trial with the objective of investigating the clinical efficacy and safety of SCRM in patients with AJS by assessing improvements in clinical symptoms, neck pain severity, and vertigo severity and evaluating changes in cervical imaging findings. Recruitment was started in March 2023. By the end of May 2024, 76 patients were included in this project. The last follow-up data are predicted to be collected by the end of February 2025. This investigation will yield dependable evidence regarding the efficacy and safety of SCRM in patients with AJS. Chinese Clinical Trial Registry ChiCTR2300068510; https://www.chictr.org.cn/showprojEN.html?proj=186883. DERR1-10.2196/57865.

Purpose Reduction of cervical facet dislocation should be performed as soon as possible to depressurize neuron cells although some randomized control studies defined early reduction as over 24 h after trauma. The purpose of this study was to define the actual time limit for early reduction in patients with complete motor paralysis. Methods Cervical spine dislocation patients with complete motor paralysis admitted between April 2007 and December 2014 were analyzed as retrospective cohort study. We separated the patients into three groups according to the number of hours lapsed between the trauma and reduction, within 4 h (very early group), >4–6 h (early group), and >6 h (delayed group). We compared the neurological outcomes, patient injury patterns, the arrival time at the hospital, and the injury severity score (ISS). Results Of 30 patients who enrolled, 8 (27%) were recovered to American Spinal Injury Association Impairment Scale Grades C-E. The delayed group had poorer neurological outcomes than the very early group and early group, although no significant differences were noted in the recovery rate between the very early group and early groups. The injury pattern, arrival time, and ISS were not found to be associated with the neurological outcome. Conclusion Our data suggest that early (<6 h) reduction of cervical spine dislocation is associated with favorable neurological outcome as compared with those performed after 6 h.

Background Ultrasound-guided supraclavicular block (UGSCB) is an emerging technique gaining interest amongst emergency physicians that provides regional anaesthesia to the upper limb to tolerate painful procedures. It offers an alternative to the more traditional technique of a Bier block (BB). However, the effectiveness or safety of UGSCB when performed in the emergency department (ED) is unclear. Methods SUPERB (SUPraclavicular block for Emergency Reduction versus Bier block) is a prospective open-label non-inferiority randomised controlled trial comparing the effectiveness of UGSCB versus BB for closed reduction of upper limb fractures and/or dislocations. Adult patients presenting with upper limb fracture and/or dislocation requiring closed reduction in ED were randomised to either UGSCB or BB. Once regional anaesthesia is obtained, closed reduction of the injured part was performed and immobilised. The primary outcome is maximal pain experienced during closed reduction measured via a visual analogue scale (VAS). Secondary outcomes include post-reduction pain, patient satisfaction, total opioid requirement in ED, ED length of stay, adverse events and regional anaesthesia failure. Results Primary outcome analysis will be performed using both the intention-to-treat and per-protocol populations. The between-group difference in maximum pain intensity will be assessed using linear regression modelling with trial group allocation (UGSCB vs BB) included as a main affect. A pre-specified non-inferiority margin of 20 mm on the VAS scale will be used to establish non-inferiority of UGSCB compared to BB. Conclusion SUPERB is the first randomised controlled trial to investigate the effectiveness and safety of UGSCB in the ED. The trial has the potential to demonstrate that UGSCB is an alternative safe and effective option for the management of upper extremity emergencies in the ED.

IntroductionUp to 30% of patients with a dislocated distal radial fracture (DRF) treated with closed reduction and cast immobilisation suffer from long-term functional restrictions. It remains unclear, whether duration of cast immobilisation influences functional outcome. The aim of this study is to evaluate whether the functional outcome of dislocated DRFs could be improved by shortening the period of immobilisation.Methods and analysisA single blinded multicentre randomised controlled trial is initiated. Four weeks of plaster cast immobilisation is compared with six week plaster cast immobilisation in adult patients with adequate reduced DRFs. Primary outcome parameters are functional outcome measured with the Patient Rated Wrist Evaluation after 1 year of follow-up (FU). Secondary outcomes are: Disability of Arm, Shoulder and Hand Score after 1 year, 36-Item Short Form Health Survey after 1 year, functional outcome earlier in FU (6 weeks, 12 weeks and 6 months), range of motion, pain level and complications: number of re-interventions, secondary dislocation, delayed and non-union.Ethics and disseminationThe medical ethical committee VUmc approved the study protocol (2018.004, NL62861.029.17). The expectation of this study is that a shorter duration of plaster cast immobilisation is beneficial. This risk of specific complications is low and generally similar in both treatment options. FU is standardised according to current trauma guidelines. Present literature indicates that both treatment options that are used within this study are accepted protocols for treatment of dislocated DRFs. This trial will provide Level-I evidence for the comparison of functional outcome between the two treatment options for dislocated DRFs. Results of this study are expected to be published as a prospective, multicentre, randomised controlled trial article in 2021.Trial registrationThe Netherlands National Trial Register: NTR 6600, ABR: NL62861.029.17. Medical Ethical Committee VUmc registration number: 2018.004.

Context, Aim, and Objectives: Diagnosis of temporomandibular joint (TMJ) disc displacement with reduction (DDR) is difficult. Literature combining different subjective parameters of TMJ function with an objective evaluation of TMJ function using joint vibration analysis (JVA) is limited. Hence, the study was planned to diagnose temporomandibular disorder accurately, to do a subjective and objective evaluation of TMJ function, and to assess the effectiveness of different types of splint therapy over the conventional anterior repositioning appliance (ARA) group. Design: Single-blind, randomized, comparative clinical trial conducted in thirty patients, 18-55 years of age, allocated to three groups, i.e., ARA conventional group, centric stabilization splint (CSS), and Soft splint (SS) groups. Subjects and Methods: Preoperative values of comfortable mouth opening (CMO) in mm, maximum mouth opening (MMO) in mm, TMJ clicking and tenderness (grading 0-3), visual analog scale pain score (0-10 cm), and total energy (TE) integral values of both TMJs using JVA were recorded. Postoperative values were taken at the time of delivery of splint at 1st , 2nd , 6th , and 10th week. Statistical Analysis and Results: Intergroup comparison - Kruskal-Wallis test showed no statistically significant difference in CMO, MMO, and TE values of right TMJs among three groups at any point. No significant difference was seen in TMJ clicking and tenderness among groups at any point of time except at 10 weeks and at 2 weeks, respectively, by Chi-square test. Intragroup comparison - Wilcoxon signed-rank test showed the significance of difference (P < 0.05*) in postoperative visits for CMO, MMO, pain score, and TE values. Clinical effect size, extent, consistency, and percentage of cases showing improvement were maximum for CSS group. Conclusions: The study concludes that the use of JVA for diagnosis along with history and clinical examination increases the accuracy of the diagnosis of DDR. ARA group was used as a conventional treatment option. Although statistically significant difference in pre- and post-treatment values was obtained in all the three groups, CSS group patients showed consistent clinically effective responses and more significant improvement in the subsequent follow-up visits than SS group. Hence, it is advisable to start therapy with CSS splint in TMJ DDR patients to get sooner and effective results without minimum side effects.