Background: Extracorporeal shock wave therapy (ESWT) is an intervention treatment in

Background: Evidence-based practice (EBP) has become increasingly popular as a

This paper explores the concept of an early intervention management system for the treatment of playing-related musculoskeletal disorders (PRMDs) among orchestral musicians through the provision of on-site medical and rehabilitative services. This model of health care delivery, promoted in the occupational and sports rehabilitation literature, has been reported to significantly reduce costs and rehabilitation times. An on-site physiotherapy clinic was made available during the 1998 performance of Wagner’s Ring Cycle by the Adelaide Symphony Orchestra. Questionnaire assessment of orchestra members highlighted a high incidence of PRMDs among the 50 respondents (86% reported neck symptoms, 70% upper back symptoms, 76% shoulder symptoms). The questionnaire highlighted a number of ergonomic issues that the respondents felt aggravated symptom development. One hundred fifteen treatments were administered during the clinic, of which 72% were to the small string section members, reflecting the high demands on this section of the orchestra during Wagner’s Ring Cycle. The cost to the orchestral management over the six-week period was approximately $12.00 per treatment, representing a significant savings. Indirect cost savings include reduced time and travel costs, and potentially reduced lost time because of injuries. This model of health care delivery was shown in this case to be cost-effective for the management of PRMDs during a major orchestral production.

Introduction: The literature suggests that abnormal sonographic findings of the common extensor origin (hypoechogenicity, neovascularity, calcifications, irregular margin, presence of adjacent fluid, irregular fibrillar pattern, thickness, tear) and of the lateral epicondyle (cortical irregularities) can be used to confirm the presence of Lateral Epicondylalgia (LE) in elbows which have been initially diagnosed using the clinical diagnosis for LE. The association of these abnormal sonographic findings and the initial clinical diagnosis for LE were studied. Methodology: The participants were recruited in Metro Manila (Philippines) through advertisements and referral by doctors and physiotherapists. LE was determined if participants reported lateral elbow pain on one elbow which was replicated by any of the Cozen’s, Mill’s, or Maudsley’s tests. Acuity of elbow symptoms was determined using six weeks since symptom onset as the time differentiating acute from chronic LE. A prospective blinded sonographic assessment of both elbows of participants was performed using a valid and reliable scanning protocol. Results: Fifty-one participants provided 55 symptomatic and 46 asymptomatic elbows (one elbow ineligible due to congenital shortening). Duration of elbow pain ranged from a day (acute) to 36 months (chronic). The hypoechogenicity of the common extensor origin was moderately associated with acute LE (sensitivity=67%, specificity=38%) and strongly associated with chronic LE (sensitivity=81%, specificity=64%). The calcifications of the CEO were found to be significantly associated with acute LE (DOR: 14.62) and chronic LE (DOR: 7.26) with p<0.05. Conclusion: Sonographic measures of hypoechogenicity and calcifications of the common extensor origin may complement the findings from the elbow provocation tests in confirming a diagnosis of acute or chronic LE.