Background and Objectives

Triangular fibrocartilaginous complex (TFCC) tears are common sources of ulna sided wrist pain and resultant functional disability. Diagnosis is based on history, clinical examination and radiological evidence of a TFCC central perforation or radial/ulna tear. The purpose of this study is therefore to evaluate the diagnostic accuracy of Magnetic Resonance Imaging (MRI) and Magnetic Resonance Arthrography (MRA) in the detection of TFCC injury in the adult population.

Background and Purpose: There is a high prevalence of self reported back pain in the adolescent population. A randomised controlled trial (RCT) was undertaken to determine the effects of a high density foam seating wedge on back pain intensity.

Methods: The study took part in a large predominantly rural county in Eastern England. 185 students with back pain were recruited from 12 schools. Randomisation was stratified by school, and resulted in 92 students in the control and 93 in the intervention groups, respectively. The primary outcome measure was pain intensity (numerical rating 0–10 scale) recorded in pain diaries over 4 weeks. Following a one week baseline at the beginning of week 2, the intervention group were given a wedge to use on their school chairs. Linear effects models were used to analyse the pain intensity data.

Results: 97 students (46 control, 51 intervention) completed the RCT. For the intervention group, pain intensity was significantly reduced during the 3 weeks when the wedge was used (0.013 point reduction per half day, 95%CI −0.025 to −0.001, p=0.04). Evening pain was significantly less for the intervention group (0.324 reduction, 95%CI −0.543 to −0.104, p≤0.01).

Conclusion: The introduction of the wedge significantly reduced back pain intensity especially in the evenings. Despite its benefits some students found carrying the wedge a nuisance. It is therefore only suitable to relieve back pain in the short term. The results suggest that further research into the longer-term effect of alternative, permanent, seating on pain intensity in adolescents should be completed.

Locognosia, the ability to localise touch, is one aspect of tactile spatial discrimination which relies on the integrity of peripheral end-organs as well as the somatosensory representation of the surface of the body in the brain. The test presented here is a standardised assessment which uses a protocol for testing locognosia in the zones of the hand supplied by the median and/or ulnar nerves.

The test-retest reliability and discriminant validity were investigated in 39 patients with injuries to the median or ulnar nerve. Intraclass correlation coefficients were used to calculate the test-retest reliability. Discriminant validity was assessed by comparing the injured with the unaffected hand.

Excellent test-retest reliability was demonstrated for the injuries to the median (intraclass correlation coefficient 0.924, 95% confidence interval 0.848 to 1.00) and the ulnar nerves (intraclass correlation coefficient 0.859, 95% confidence interval 0.693 to 1.00). The magnitude of the difference in scores between affected and unaffected hands showed good discriminant validity. For injuries to the median nerve the mean difference was 11.1 points (1 to 33; sd 7.4), which was statistically significant (p < 0.0001, paired t-test) and for those of the ulnar nerve it was 4.75 points (1 to 13.5; sd 3.16), which was also statistically significant (paired t-test, p < 0.0001).

The locognosia test has excellent test-retest reliability, is a valid test of tactile spatial discrimination and should be included in the evaluation of outcome after injury to peripheral nerves.