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By: John Walter Krakauer, M.A., M.D.

  • Director, the Center for the Study of Motor Learning and Brain Repair
  • Professor of Neurology

https://www.hopkinsmedicine.org/profiles/results/directory/profile/9121870/john-krakauer

Strength of Evidence  Recommended symptoms 4 dpo bfp 2 mg kytril sale, Insufficient Evidence (I) Rationale for Recommendations There are few quality studies evaluating efficacy for treatment of trigger points/myofascial pain symptoms vaginal yeast infection buy discount kytril online. Overall medicine hat jobs order kytril discount, the quality of the available studies is not particularly high due to bad medicine 1 generic kytril 1 mg overnight delivery combinations of exercises and lack of detailed descriptions of exercise programs (one study used wait-listed controls). Aerobic and strengthening exercises are also believed to be important, but quality studies are not available to support those beliefs. Stretching, aerobic, and strengthening exercises are not invasive, have low risk for adverse effects, and are low to moderate cost depending on the extent to which supervised exercise is required while transitioning to a home-based program. Inclusion of these principles in the course of exercise training or supervision appears highly desirable. This would also strengthen the education of the patient about these problems that should be a message in unison with other members of the team treating the patient. Use of massage in first 2 groups is co-intervention and limits conclusions regarding utility of ultrasound or massage. Recommendation: Aquatic Therapy for Myofascial Pain/Trigger Points Aquatic therapy is not recommended for myofascial pain/trigger points as other therapies are likely more efficacious. Strength of Evidence  Not Recommended, Insufficient Evidence (I) Rationale for Recommendation Aquatic exercise may be beneficial for the rehabilitation of chronic pain conditions in which it is advantageous to reduce the effects of gravity. It is not recommended other than for the few, select patients who are unable to tolerate land-based therapies. Aquatic therapy is moderate cost, not invasive, and has little potential for adverse effects. Traditional yoga also involves rules for personal conduct, sense withdrawal, concentration, meditation, and self realization” (Taimini 86; Williams 05) and different versions are practiced. This review focuses on the exercise aspects of yoga and does not endorse nor support spiritual elements or specific religious beliefs, nor does it cover non-occupational conditions such as chronic pancreatitis. There is much self-selection in the above studies – evidence suggests that patient motivation must be high, otherwise compliance and adherence reportedly is poor. Evidence for the Use of Yoga There are no quality studies evaluating the use of yoga for myofascial pain/trigger points. Follow-up appointments are required every 2 to 4 weeks until resolution or an end-of improvement plateau is reached. However, there are no quality trials of efficacy (see Chronic Pain Guidelines for gastrointestinal protection. Frequency/Duration – Per manufacturer recommendations; as needed use reasonable for many patients. Indications for Discontinuation – Resolution, lack of efficacy, or development of adverse effects that necessitate discontinuation. At-risk patients include those with a history of prior gastrointestinal bleeding, elderly, diabetics, and cigarette smokers. Strength of Evidence – Strongly Recommended, Evidence (A) – Proton pump inhibitors, misoprostol Strength of Evidence – Moderately Recommended, Evidence (B) – Sucralfate Strength of Evidence – Recommended, Evidence (C) – H2 Blockers 3. Strength of Evidence – Recommended, Insufficient Evidence (I) Acetaminophen or aspirin as the first-line therapy appear to be the safest regarding cardiovascular adverse effects to use for patients with cardiovascular disease risk factors. Imipramine is less sedating, thus if there is carryover daytime sedation, it may be a better option. Duration of use may be indefinite, although most patients do not require indefinite treatment as the condition usually either resolves or improves, particularly if compliant with functional restoration program elements. Indications for Discontinuation – Resolution of pain, intolerance, or development of adverse effects. Recommendation: Selective Serotonin Reuptake Inhibitors, Bupropion, or Trazodone for Trigger Points/Myofascial Pain Selective serotonin reuptake inhibitors, bupropion, or trazodone are not recommended for the treatment of trigger points/myofascial pain. Recommendation: Duloxetine for Muscle Tenderness and Trigger Points There is no recommendation for or against the use of duloxetine for the treatment of muscle tenderness and trigger points. A trial of duloxetine may be considered after other treatments with documented efficacy. Strength of Evidence – No Recommendation, Insufficient Evidence (I) Rationale for Recommendations There are no quality trials evaluating treatment of these patients. Norepinephrine reuptake inhibitor antidepressants are not invasive, have low to moderate, dose-dependent adverse effects, and are not costly in their generic formulations. The degree to which depression or dysthymia is present necessitates understanding of these complex issues and may impact these recommendations. Strength of Evidence  Not Recommended, Insufficient Evidence (I) Rationale for Recommendations There are no quality studies evaluating these medications for treatment of trigger points/myofascial pain. There is some evidence of efficacy for treatment of radicular or neuropathic pain symptoms. However, this condition is not analogous and thus these agents are not recommended. Evidence for the Use of Anti-convulsants There are no quality studies evaluating the use of anti-convulsant agents for trigger points/myofascial pain. Strength of Evidence  No Recommendation, Insufficient Evidence (I) Rationale for Recommendation There are no quality trials for treatment of these patients. Gabapentin and pregabalin appear useful for selected patients with severe fibromyalgia (see Appendix 2 in Chronic Pain Guidelines) which might suggest they would be useful in patients with severe myofascial pain; however, there is no evidence to support use in this context. Gabapentin and pregabalin are not invasive, but have significant adverse effects in some patients, largely central nervous system-related which are of concern in employed populations. Release of a generic form of gabapentin has reduced its cost, though pregabalin remains moderately costly. Evidence for the Use of Gabapentin and Pregabalin There are no quality studies evaluating the use of gabapentin and pregabalin for trigger points/myofascial pain. Recommendation: Glucocorticosteroids for Trigger Points/Myofascial Pain Glucocorticosteroids administered by systemic or topical routes are not recommended. However, there is no quality evidence to support treatment for trigger points/myofascial pain. These agents are not invasive if prescribed for oral administration, are low cost, but have considerable adverse effects. Evidence for the Use of Oral Glucocorticosteroids © Copyright 2016 Reed Group, Ltd. This risk appears to be substantially lower than with opioids; however, there are patients in whom abuse has been reported involving some if not all of these agents. Strength of Evidence  Not Recommended, Insufficient Evidence (I) Rationale for Recommendation There are no quality trials for treatment of these patients. Skeletal muscle relaxants have been widely used for the treatment of tender and trigger points on the supposition that prescription of the muscle relaxant will directly treat the disorder. These agents are not invasive, have significant adverse effects, and are low to moderately costly. Skeletal muscle relaxants have largely been used in the setting of acute pain and there is much less evidence for their efficacy for the treatment of chronic pain, especially trigger points/myofascial pain. Evidence for the Use of Skeletal Muscle Relaxants There are no quality studies evaluating the use of skeletal muscle relaxants for trigger points/myofascial pain. Regardless, all types of taping are utilized to attempt to treat musculoskeletal disorders. Difficulty with tolerating the various types of tape may be problematic for some patients. Recommendation: Taping and Kinesiotaping for Trigger Points/Myofascial Pain © Copyright 2016 Reed Group, Ltd. Strength of Evidence  No Recommendation, Insufficient Evidence (I) Rationale for Recommendation There is one high-quality trial of kinesiotaping for treatment of shoulder pain, of short-term duration that failed to show improvements in pain (Thelen 08); there are no other quality trials. As use and movement are thought to be helpful for treating trigger points/ myofascial pain, the rationale for taping the shoulder and back for myofascial pain/trigger points seems limited. When the fees for both the tape and its application are considered, taping is costly, especially since there are alternative interventions that have been shown to be effective. Evidence for the Use of Taping and Kinesiotaping There are no quality studies evaluating the use of kinesiotaping and taping for trigger points/myofascial pain. Recommendation: Magnets and Magnetic Stimulation for Trigger Points/Myofascial Pain Magnets and magnetic stimulation are not recommended for the treatment of trigger points/myofascial pain. Strength of Evidence  Not Recommended, Insufficient Evidence (I) Rationale for Recommendation There is no significant evidence base from which to draw conclusions on the utility of magnets as a treatment of these patients. Evidence for the Use of Magnets and Magnetic Stimulation There are no quality studies evaluating the use of magnets and magnetic stimulation to treat trigger points/myofascial pain.

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Vascular Access: Umbilical Venous Cannula and Intra Osseous Access: Volume replacement in resuscitation is rarely needed medicine for nausea order 1mg kytril fast delivery. Inserting a Acknowledgements: We would like to medicine 7 year program 1mg kytril otc thank Sabrina Bhandari and small nasogastric tube 5cms into an umbilical vein is probably the Sophie Bunce symptoms intestinal blockage generic 1 mg kytril visa, medical students medicine for stomach pain 1mg kytril free shipping, Queens University, Belfast for their quickest method of establishing venous access at birth. Levels and the use of an intraosseous needle, you may fnd the 25 minute video trends in Child Mortality 2017. In order to provide safe anaesthesia for mother and fetus, it is essential for the anesthetist to have thorough understanding of the physiological and pharmacological changes that characterize the three trimesters of pregnancy. A multidisciplinary team approach involving the anesthetist, obstetrician, neonatologist and surgeon is highly recommended to ensure an adequate standard of care. Anaesthesia management, including post-operative analgesia, should be planned well to preserve the pregnancy and to ensure the safety of the mother as well as the foetus. Regional anaesthesia minimizes fetal drug exposure, airway management is simplifed, blood loss may be decreased, and overall risks to the mother and fetus are less. Tese patients do The anaesthetist has the following goals:5 present with surgical illness requiring surgery under (i) Optimize and maintain normal maternal general or regional anaesthesia. With advances in physiological function; fetal surgeries the number is only likely to increase in future. Incidence of non-obstetric surgery being (ii) Optimize and maintain utero-placental blood 1-2%. In the largest single series concerning (iv) Avoid stimulating the myometrium surgery and anaesthesia during pregnancy, 42% of (oxytocic efects); surgery during pregnancy occurred during the frst (v) Avoid awareness during general anaesthesia; trimester, 35% during the second trimester, and 23% during the third. The incidence of Appendicitis is around 1 3 regardless of trimester, pregnant woman should in 1500-2000 pregnancies. Elective surgery Non-obstetric surgery during pregnancy presents should be postponed until after delivery. The anaesthetist nonurgent surgery should be performed in the second has to take care of two lives. The goal being safe trimester when preterm contractions and spontaneous Madhusudan Upadya anaesthesia for both pregnant woman and the fetus. The choice of anaesthetic Kasturba Medical College To ensure maternal safety, the anaesthetist must technique(s), and the selection of appropriate drugs of Mangalore have a thorough understanding of the physiological anaesthesia should be guided by maternal indications Karnataka and pharmacological adaptations to pregnancy. Tese problems can occur during anaesthesia and surgery (2mg/kg iv titrated doses may be used. However, in cases of failed intubation, Concerns about anaesthetic efects on the developing human fetus laryngeal mask airway has been used to ventilate successfully and have been considered for many years Anaesthetic drugs afect intra safely in the reverse Trendelenburg’s position for brief periods. Terefore, all anaesthetic agents can hold great potential in the management of the obstetric airway. Despite years of animal studies and can be used in carefully selected patients to maintain the airway. As observational studies in humans, no anaesthetic drug has been shown changes in maternal position can have profound haemodynamic to be clearly dangerous to the human fetus and there is no optimal efects, positioning during anaesthesia should be carried out slowly. Tough all volatile on pregnant patients and no animal model perfectly mimics human agents (<1. Low concentration sevofurane would be the preferred 10 administering high concentrations for prolonged periods. Ephedrine has traditionally been the vasopressor of choice for However, some recommend avoiding nitrous oxide in pregnant hypotension. However, many recent controlled studies catecholamine surge with resulting impaired uteroplacental have countered this association. Positive avoid benzodiazepine use throughout gestation and most especially pressure ventilation should be used with care and end-tidal carbon during the frst trimester. However, it may be appropriate to provide dioxide levels should be maintained within the limits. Hyperventilation should be avoided as this adversely opioids, muscle relaxants, and local anaesthetics have been widely afects uterine blood fow. Oxygenation should be optimized to used during pregnancy with a good safety record. Pregnant surgical patient Fetal safety Depending on the dose administered, the timing of exposure with Elective Essential Emergency respect to development, and the route of administration of any drug surgery surgery surgery given during pregnancy can potentially jeopardise the development of the foetus. Until date, no anaesthetic drug has been proven to Delay until First trimester Second/third postpartum trimester be clearly hazardous to the human foetus. It may be noted that no animal model perfectly simulates human gestation and a randomised If no or minimal increased trial on pregnant patients in this regard would be defnitely unethical. Teratogenicity of anaesthetic drugs If greater than minimal Proceed with optimal anesthetic for mother, increased risk to mother modifed by considerations for maternal A teratogen is defned as a substance that causes an increase in the proceed with surgery physiologic changes and fetal well-being Consult a perinatologist or an obstetrician incidence of a particular defect in a foetus that cannot be attributed Intraopertaive and postoperative fetal and to chance. The teratogen must be given in a sufcient dose for a uterine monitoring may be useful substantial period at a critical developmental point to produce the defect. When considering the possible teratogenicity of various Figure 1: Decision-Making Algorithm for Non-Obstetric Surgery During anaesthetic agents, several important points must be kept in mind. The 2012 days of human gestation an all or nothing phenomenon occurs: the American College of Chest Physicians clinical practice guideline on fetus is lost or the fetus is preserved fully intact. During the time prevention and treatment of thrombosis recommends mechanical of organogenesis (15-56 days) structural abnormalities may occur. Prophylactic tocolytics: Tere is no proven beneft to routine Decision-Making Algorithm for Non-Obstetric Surgery During administration of prophylactic perioperative tocolytic therapy. Pregnancy Minimising uterine manipulation may reduce the risk of development of uterine contractions and preterm labour. Tocolytics Whenever a pregnant woman undergoes nonobstetric are indicated for the treatment of preterm labour until resolution surgery, consultations among her obstetrical team, surgeon(s), of the underlying, self-limited condition that may have caused the anesthesiologist(s), and neonatologist(s) are important to coordinate contractions. Conduct of Anaesthesia General principles of anaesthesia management No studies have shown a benefcial efect on the outcome of pregnancy Pre-operative preparation after regional compared with general anaesthesia. However, regional this should always involve close liaison with the obstetricians anaesthesia minimizes fetal drug exposure, airway management and include ultrasound assessment of the fetus when delivery is is simplifed, blood loss may be decreased, and overall risks to the anticipated. The largest risk of regional anaesthesia signs and symptoms often associated with cardiac disease, such as is hypotension resulting from sympathetic nerve blockade, which dyspnoea, heart murmurs and peripheral oedema are common reduces uterine blood fow and perfusion to the fetus. Pregnant After 6–8 weeks gestation, cardiac, haemodynamic, respiratory, patients who require surgery should be evaluated pre-operatively metabolic and pharmacological parameters are considerably altered. Laboratory and With the increase in minute ventilation and oxygen consumption other testing should be performed as indicated by the patient’s and a decrease in oxygen reserve (decreased functional residual comorbidities and the proposed surgery. In addition to standard capacity and residual volume), pregnant women become hypoxaemic pre-operative procedures, preparation of pregnant women takes into more rapidly. Supplementary oxygen must always be given during account risks of aspiration, difcult intubation, thromboembolism, vulnerable periods to maintain oxygenation. Aortocaval compression is a major hazard from 20 weeks onwards Aspiration prophylaxis: The gastric emptying has recently been (and sometimes even earlier); this compromises uterine blood fow shown to be normal during pregnancy until the onset of labour. This efect However, the risk of aspiration is still higher due to reduced gastric may be exacerbated by regional or general anaesthesia when normal barrier pressure and lower oesophageal sphincter tone (a progesterone 17 compensatory mechanisms are attenuated or abolished. The presence of additional risk for regurgitation and compression is only efectively avoided by the use of the 150 lateral aspiration, including active refux or obesity should be surveyed. It can be decreased by uterine displacement through Prophylaxis against aspiration pneumonitis should be administered wedging or manual displacement. Venacaval compression results from 16 weeks gestation with H2-receptor antagonists and non in distension of the epidural venous plexus, increasing the risk of particulate antacids. The capacity of Antibiotic prophylaxis: The need for antibiotic prophylaxis depends the epidural space is reduced, which probably contributes to the on the specifc procedure. However, attention should be paid in enhanced spread of local anaesthetics in pregnancy. Pregnancy is associated with a hypercoagulable state because of Prophylactic glucocorticoids: Administration of a course of antenatal increased pro-coagulant factors. The incidence of thromboembolic glucocorticoids 24-48hrs before surgery between 24 and 34 weeks complications is at least fve times greater during pregnancy; of gestation can reduce perinatal morbidity/mortality if preterm thromboprophylaxis is essential. Despite the potential benefts to the foetus, however, During third trimester, delivery by caesarean section before major antenatal glucocorticoids are best avoided in the setting of systemic surgery is often recommended. Where possible, surgery should infection (such as sepsis or a ruptured appendix), because they may be delayed 48hr to allow steroid therapy to enhance fetal lung impair the ability of the maternal immune system to contain the maturation.

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Improvement patients reported outcomes based s yu symptoms meningitis purchase online kytril, Chien-chen; compared with pre significant on hypnotic 0 treatment 20 initiative kytril 2mg low cost. No tendinitis Both groups improved Both groups meaningful and Group I received 10 with respect to medicine used to induce labor purchase kytril mastercard showed difference showed treatments of manual passive movement significant between groups symptoms 10dpo buy 2 mg kytril. Indications for Discontinuation – Non-tolerance, including exacerbation of shoulder pain. Strength of Evidence  Recommended, Insufficient Evidence (I) Rationale for Recommendation There are no quality trials for treatment of shoulder pain patients. There is one moderate-quality trial for post-operative treatment; however, there were no clinical results. Self applications of cryotherapies using towels or reusable devices are non-invasive, minimal cost, and without complications. Other forms of cryotherapy can be considerably more expensive, including chemicals or cryotherapeutic applications in clinical settings and are not recommended. Author/Title Scor Sample Comparison Results Conclusion Comments Study Type e (0 Size Group 11) © Copyright 2016 Reed Group, Ltd. The depth of penetration of some heating agents is minimal since transmission is via conduction or convection, but other modalities have deeper penetration. Not surprisingly, some of these heat-related modalities have been shown to reduce pain ratings more than placebo for low back pain patients (see Low Back Complaints). In chronic pain settings, use of heat should be minimized to self-treatments of flare-ups with primary emphasis on functional restoration elements. Recommendation: Self-application of Heat Therapy for Acute, Subacute, or Chronic Shoulder Pain Self-application of low-tech heat therapy is recommended for acute, subacute, or chronic shoulder pain. Applications should be home-based as there is no evidence for superiority of provider-based heat treatments. Primary emphasis should generally be on functional restoration program elements, rather than on passive treatments in patients with chronic pain. Strength of Evidence  Recommended, Insufficient Evidence (I) Rationale for Recommendation Self applications of heat using towels or reusable devices are non-invasive, minimal cost and without complications. Other forms of heat can be considerably more expensive, including chemicals or cryotherapeutic applications in clinical settings and are not recommended. There is one moderate quality study suggesting hyperthermia is superior to ultrasound for patients with supraspinatus tendinopathies in athletes, although that did not involve self-application of heat. Author/Titl Score Sample Comparison Results Conclusion Comments e (0-11) Size Group Study Type Rotator Cuff Tendinopathies: Hyperthermia vs. None of these modalities other than ultrasound have demonstrated major efficacy for any disorder, however, there have been limited uses for treatment of specific disorder with a specific intervention (see Hand, Wrist, and Forearm Complaints, Elbow Disorders, Low Back Complaints, and Chronic Pain Guidelines). Recommendation: Diathermy or Infrared Therapy for Acute, Subacute, or Chronic Shoulder Pain There is no recommendation for or against the use of diathermy or infrared therapy for the treatment of acute, subacute, or chronic shoulder pain. Strength of Evidence  No Recommendation, Insufficient Evidence (I) Rationale for Recommendation There are no quality studies evaluating the use of diathermy or infrared for shoulder pain patients. While they are not invasive and have low complication rates, diathermy and infrared therapy are moderate to high cost depending on the number of treatments. Evidence for the Use of Diathermy and Infrared Therapy There are no quality studies evaluating the use of diathermy or infrared therapy for shoulder pain. Recommendation: Ultrasound for Acute, Subacute, or Chronic Shoulder Tendinopathies Ultrasound is not recommended for the treatment of acute, subacute, or chronic shoulder tendinopathy. Recommendation: Ultrasound for Calcific Tendinitis Ultrasound is recommended for the treatment of calcific tendinitis. Strength of Evidence  Recommended, Evidence (C) Rationale for Recommendations the largest, highest quality blinded study of shoulder soft tissue disorders found a lack of efficacy of ultrasound vs. It is recommended for treatment of calcific tendinitis as the highest quality, largest sample sized-study documents efficacy. However, it is not recommended for shoulder pain to include tendinopathies other than calcific tendinitis, as there is not clear documentation of efficacy for other than patients with calcific tendinitis. Author/Title Scor Sample Comparison Group Results Conclusion Comments Study e (0 Size Type 11) Shoulder Tendinopathies: Interferential vs. As chronic apparently mixed and stratified results not presented, utility of study is limited. It is theorized that the mechanism of action is through photoactivation of the oxidative chain and has been used for treatment of rotator cuff tendinopathies. Strength of Evidence  Not Recommended, Evidence (C) Rationale for Recommendation There are six sham-controlled trials, nearly all assessing additive benefit to exercise programs. In Cochrane Library, we found and reviewed 4 articles, and considered 1 for inclusion. Of the 15 articles considered for inclusion, 7 randomized trials and 3 systematic studies met the inclusion criteria. Author/Title Score Sample Comparison Group Results Conclusion Comments Study Type (0-11) Size Shoulder Tendinopathies: Laser vs. Short including anterior, abduction, mean alone in relieving follow-up time posterior and lateral (°)/active external pain and in of 2 weeks were irradiated per rotation, mean improving the without longer session for 2 mins (n (°)/passive external shoulder joint follow-up. Age tubercululum and and percent changes shown better groups range of 39 minus, bicipital groove after treatment results in improved, but 80. Thus, pulsed electro is not recommended for treatment of rotator cuff tendinopathies. Strength of Evidence  Recommended, Insufficient Evidence (I) Rationale for Recommendation There is sparse quality evidence of efficacy of manual therapy, manipulation, or mobilization for treatment of rotator cuff tendinopathies. There is one moderate-quality trial assessing a specific mobilization (Mulligan’s mobilization) compared to sham which suggested modest benefit (Teys 08); however, patients are not well described and it is unclear for whom the treatment would be effective. A study assessing efficacy found modest benefits, comparing the potential additive benefits of manual therapy in addition to an exercise program. Author/ Scor Sample Comparison Results Conclusion Comments Title e (0 Size Group Study 11) Type Shoulder Tendinopathies: Manipulation, Mobilization, Manual Therapy vs. For the description of appointments Patients who were synovial disorders, exercise therapy or (mobilization and “cured” 8. Pain scores in injection seems the Number of cervical spine, synovial group: best treatment. Data triamcinolone suggest acetonide 40mg corticosteroid plus 9mL 10mg/mL superior for lignocaine; up to 3 synovial pain. Physiotherapy group “The positive results Brief report of 2 1999 same as manipulation vs. It is most typically used for treatment of spine and torso pain (see Chronic Pain Gudeilines and Low Back Complaints). Strength of Evidence  No Recommendation, Insufficient Evidence (I) Rationale for Recommendation Massage is a commonly used treatment for musculoskeletal pain, but few studies evaluated disorders other than low back pain. Author/ Scor Sample Size Comparison Results Conclusion Comments Title e (0 Group Study 11) Type Shoulder Tendinopathies: Massage vs. It entails the physical act of applying pressure to the feet and hands with specific thumb, finger and hand techniques without the use of oil or lotion. Reflexology is based on a system of zones and reflex areas that reflect an image of the body on the feet and hands with a premise that such work effects a physical change to the body. Recommendation: Reflexology for Shoulder Pain Reflexology is not recommended for treatment of shoulder pain including rotator cuff tendinopathies. Strength of Evidence  Not Recommended, Insufficient Evidence (I) Rationale for Recommendation There are no quality studies of reflexology. Evidence for the Use of Reflexology There are no quality studies evaluating reflexology for shoulder pain including rotator cuff tendinopathies. Recommendation: Interferential Therapy for Treatment of Rotator Cuff Tendinopathies Interferential therapy is not recommended for treatment of rotator cuff tendinopathies. Recommendation: Other Electrical Stimulation Therapies for Treatment of Rotator Cuff Tendinopathies There is no recommendation for or against the use of other electrical therapies outside of research settings for treatment of rotator cuff tendinopathies. Strength of Evidence  No Recommendation, Insufficient Evidence (I) Rationale for Recommendations There is one moderate-quality study suggesting interferential therapy is ineffective for treating rotator cuff tendinopathies. These therapies are mostly non-invasive with low adverse effects, but are moderate to high cost when © Copyright 2016 Reed Group, Ltd. Author/Title Score Sample Comparison Group Results Conclusion Comments Study Type (0-11) Size Shoulder Tendinopathies: Interferential vs. However, there have been some challenges noted in interpreting studies of efficacy including amount of energy delivered, method of focusing shock waves, treatment frequency, timing, and use of anesthetics. Recommendation: Extracorporeal Shockwave Therapy for Calcific Rotator Cuff Tendinitis Extracorporeal shockwave therapy is strongly recommended for treatment of calcific rotator cuff tendinitis. Indications – Symptomatic calcific rotator cuff tendinitis that has been diagnosed with imaging.

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