Research Report Abstracts - Gesundheit

eS1320
sured using a dynamometer. Secondary outcomes were TMS
and fMRI measures of cortical activity.
Analysis: Stimulation groups (n = 3) were compared across
time (n = 3) using a general linear model for repeated measures.
TMS and fMRI measures of cortical activity were
explored to assess whether they could predict functional outcome
and/or provide surrogate markers of clinical benefit.
Results: Daily TBS was safe and well tolerated. Preliminary
analyses prior to full recruitment (n = 12 in each group) with
one-factor ANOVAs looking at the main effect of TIME (pre,
post1 and post2), showed a significant effect for outcomes of
function and strength (p < 0.05) in all groups. The type of
TBS (excitatory, inhibitory or sham) did not appear to make
a difference at this stage.
Conclusions: At preliminary analysis, all three groups
improved from a stable baseline with physical therapy treatment,
and maintained that improvement at one month follow
up, regardless of stimulation type. Final analysis, including
TMS and fMRI measures of cortical excitability, will answer
this question and may also identify subgroups of patients that
such treatments could effectively target.
Implications: Our results so far do not support the hypothesis
that non-invasive brain stimulation enhances the benefits
from physical therapy in chronic stroke patients with residual
hand weakness. They could however, help plan future
research to identify subgroups of patients that may be targeted
by this or similar interventions.
Keywords: Adjuncts to physiotherapy treatment; Rehabilitation;
standardisation of intervention
Funding acknowledgements: Medical Research Council
(Grant Number G0401353) and the Rosetrees Foundation.
Ethics approval: Approval was given by the joint UCL
Institute of Neurology and National Hospital for Neurology
and Neurosurgery ethics committee.
Research Report Poster Display
Number: RR-PO-205-5-Tue Tuesday 21 June 13:00
RAI: Exhibit Halls 2&3
POWER DOPPLER ULTRASOUND IN THE EARLY
DIAGNOSIS OF PRIMARY/IDIOPATHIC ADHESIVE
CAPSULITIS: A PILOT STUDY
Walmsley S., Rivett D.A., Osmotherly P.G.
The University of Newcastle, School of Health Sciences, Newcastle,
Australia
Purpose: The purpose of this pilot study was to determine if
power Doppler ultrasound could identify an area of increased
vascularity in the rotator interval area of the glenohumeral
joint capsule in subjects in the early stage of adhesive capsulitis.
Relevance: Adhesive capsulitis is a disorder of the shoulder
that is reported to occur in 2–3% of the population. It has
been described as difficult to diagnose in its early stage and
differentiate from other commonly presenting shoulder disorders.
Anatomically the rotator interval has been identified
as the area predominantly involved in adhesive capsulitis.
Arthroscopic and histological studies of this region have
demonstrated synovial inflammation in the early stage followed
by fibrous contracture in the later stages. Macroscopic
examination of the rotator interval has shown high vascularity
consistent with the presence of inflammation. It has
been suggested that ultrasound may be able to assist in the
early diagnosis of adhesive capsulitis by assessing the rotator
interval for vascular soft tissue.
Participants: Ten participants diagnosed as having adhesive
capsulitis by health care practitioners including physiotherapists
and medical practitioners participated in the study. In
order to ensure the early stage of adhesive capsulitis was
being assessed, participants were required to have had shoulder
pain for less than nine months. As primary/idiopathic
adhesive capsulitis was being investigated potential participants
with episodes of major trauma or surgery were
excluded. Further, potential participants with evidence of
glenohumeral osteoarthritis, calcification or full thickness
rotator cuff tears on radiological investigations were also
excluded.
Methods: The anterior shoulder of participants was imaged
using a portable diagnostic ultrasound system in the clinic
prior to undergoing intra-articular injection of corticosteroid
and local anaesthetic as part of routine clinical care.
Analysis: Ultrasound images were recorded and reviewed
by two musculoskeletal radiologists to determine whether
an increase in vascularity was evident in the rotator interval
as measured by power Doppler ultrasound. Consensus was
established between the two radiologists with a third radiologist
consulted in the event of a disagreement between the
two radiologists.
Results: The ten participants with a provisional diagnosis
of adhesive capsulitis undergoing power Doppler ultrasound
reported shoulder pain ranging between three and six months.
None of the participants demonstrated any area of increased
vascularity in the rotator interval area of the shoulder.
Conclusions: These results provide preliminary evidence
that identifying an increase in vascularity in the rotator interval
of the shoulder using power Doppler ultrasound in patients
suspected as having adhesive capsulitis may not be possible.
Ongoing research involving a larger number of participants
at varying times from onset of pain will determine if these
early findings remain consistent.
Implications: It has been suggested that early treatment of
adhesive capsulitis may decrease the morbidity of the disorder.
With the increase in the availability and use of ultrasound
in the physiotherapy clinic coupled with the technological
advances of equipment and skills of physiotherapists, the
early diagnosis of adhesive capsulitis using power Doppler
ultrasound may be facilitated should reproducible findings be
demonstrated.
Keywords: Adhesive capsulitis; Diagnosis; Ultrasound