Scientific Abstracts
Saturday, 15 June 2013 725
Conclusions: Despite slight clinical differences, the outcome of radiculalgia
induced by lateral lumbar disk herniations seems even better than the
outcome of those induced by median disk herniations. Previous claims of
poorer outcomes in foraminal herniations might be explained by the inclusion
of patients with associated foraminal stenosis. Thus, surgery should not be
requested earlier just because the disk herniation is more lateral, moreover as
motor weakness had disappeared in all cases at the end of follow-up.
References: Lejeune JP, et al. Spine (Phila Pa 1976) 1994:19:1905-8.
Disclosure of Interest: None Declared
SAT0422 INCREASED SUPRASPINATUS THICKNESS WITH
REDUCED ACROMOHUMERAL DISTANCE IN PEOPLE
WITH MILD AND MODERATE ROTATOR CUFF
TENDINOPATHY: A RELIABILITY AND COMPARATIVE
STUDY
K. Mccreesh1, S. Anjum2, J. Crotty3, J. Lewis4. 1Dept of Clinical Therapies,
University of Limerick, Limerick, Ireland, 2Dept of Rheumatology, 3Dept of
Radiology, University Hospital Limerick, Limerick, Ireland, 4Musculoskeletal
Services, Central Health at the Stowe, London Community Healthcare,
London, United Kingdom
Background: Background: Subacromial impingement syndrome has
historically been ascribed to extrinsic compression of the supraspinatus
tendon (SsT) due to altered acromial morphology. More recently intrinsic
tendon pathology has been proposed as an important mechanism, leading
to degenerative changes in the tendon, superior translation of the humeral
head occurs due to rotator cuff (RC) failure and subsequent narrowing of
the subacromial space, measured as the acromiohumeral distance (AHD).
The continuum model of RC pathology proposes that people in the reactive
or disrepair stage may have a swollen SsT, which further compromises the
subacromial space (Lewis 2010).
Objectives: Objectives: The aims of this study were to (i) examine the
intra and inter-rater reliability of ultrasound measurements of AHD and SsT
thickness in healthy controls, and people with RC tendinopathy (RCT) of
varying degrees. (ii) to compare AHD and SsT thickness between shoulders in
controls and in people with unilateral RCT
Methods: Methods: A total of 25 healthy controls (mean age=50), 21
swimmers with mild unilateral RCT (mean age=53) and 21 patients with
moderate-severe unilateral RCT (mean age=61) were recruited. Repeated
ultrasound measurements of AHD and SsT thickness were obtained in a single
session, with the shoulder in a neutral position, by one experienced rater in the
controls and mild RCT group, and by two raters in the third group.
Results: Results: Intra-rater reliability for AHD and SsT thickness
measurement was excellent, with all intra-class correlation (ICC) values >0.9,
and small standard error of measurement (SEM) values (0.1-0.4mm). Inter-
rater reliability for AHD and SsT thickness measurement was also excellent for
the mod-severe RCT group, with ICC values >0.9, and small SEM values (0.3-
0.5mm). There was no difference between shoulders for AHD or SST thickness
measures for the control group (p>0.05). There was a significantly smaller AHD
in the painful shoulder for both the mild (p=0.014), and mod-severe RCT groups
(p=0.009). There was also a significantly larger SsT thickness in both the mild
(p=0.001), and mod-severe RCT groups in the painful shoulder (p=0.009).
Conclusions: Conclusion: The results support the reliability of ultrasound for
the measurement of AHD and SsT thickness in RCT. People with RCT in this
study had significantly smaller AHD and larger SsT thickness in their painful
shoulder compared to non-painful side. While the finding of reduced AHD in
people with RCT supports the work of other studies, the concurrent increase in
SsT thickness in the painful shoulders is an important additional finding which
may further compromise the subacromial space. The results of this study
provide support for the continuum model of rotator cuff tendon pathology.
References: LewisJS (2010) Rotator cuff tendinopathy: a model for the
continuum of pathology and related management. Br J Sports Med. 44, 918
Acknowledgedments:   exercises at home. The pathology that had a higher average number of days
Disclosure of Interest: None Declared
SAT0423 BENEFITS OF REHABILITATION PROGRAM IN
PATIENTS WITH L5-S1 DEGENERATIVE FORAMINAL
STENOSIS
M. R. Traistaru1, O. Rogoveanu1, R. Popescu1. 1University of Medicine and
Pharmacy of Craiova, Craiova, Romania
Background: Degenerative foraminal stenosis (DFS) is one the three
anatomically locations of degenerative lumbar spinal stenosis (1) and more
frequently involves the L5 nerve root (L5 – S1 foramen is the one with the
smaller foramen / root area ratio) (2). The treatment options are adapted to
clinical and functional status, generated by the severity of pressure on the
nerve root complex by the degenerative changes (1, 3).
Objectives: The purpose of our randomized controlled study was to compare
outcomes between the conservative therapies (activity modifications,
medications and physical treatments) and the pharmacotherapy in patients
with moderate symptomatic DFS (L5-S1 foramen).
Methods: 66 patients with L5 – S1 DFS were randomly assigned to a
conservative treatment group – CG (n=36; 23 males, 13 females; mean age
[±SD] = 54 ± 8 years) or a pharmacotherapy group – PG (n=28, 15 males, 13
females; mean age [±SD] = 56 ± 7 years). All patients were completely assessed
Ann Rheum Dis: first published as 10.1136/annrheumdis-2013-eular.2146 on 23 January 2014. Downloaded from http://ard.bmj.com/ on 5 May 2018 by guest. Protected by copyright.
(patient’s description of their symptoms - Konno self-administered diagnostic
tool, physical and radiological examinations and functional assessment - The
Roland-Morris Disability Questionnaire). Subjects in the CG received activity
modifications, medications (similar to PG) and physical therapy (supervised
exercise - twice daily stretching and adapted strengthening for lumbar spine, 
over a 6-week period;  in addition we recommended lumbar bracing and 
performed ultrasounds, TENS and hot packs for 2 weeks). Measured outcomes
were the generic QoL scale SF-MOS (Short Form Medical Outcomes Study)
and the Roland-Morris Disability Questionnaire (RMDQ) score. Differences
parameter values between groups were tested by ANOVA test.
Results: Both groups showed clinically and statistically significant
improvements in SF-MOS and RMDQ scores at 6 weeks (SF-MOS scores
had improved by 43% in the CG and by 21% in the PG; RMDQ scores had
improved over 25% in both groups). At 3 months, patients in the CG clinic
were more satisfied with the overall outcome of their rehabilitative treatment
compared with subjects in the PG.
Conclusions: Although both groups improved by 6 weeks, subjects in the
CG achieved about twice as much improvement in SF-MOS scores than
subjects in PG. The results indicate that a conservative treatment in moderate
symptomatic DFS patients had not only effect on pain and function lumbar
status but also a long term effect on perceived recovery. More randomly
studies investigating conservative an surgical treatments in all degenerative
spinal stenosis are required.  
References:         
1. Genevay S., Atlas S.J., Best Practice and Research Clinical Rheumatology
24 (2010): 253 – 265.
2. Jenis L.G., An H.S., Spine 2000; 25 (3):389 – 394.
3. Konno S., Kikuchi S., tanaka Y., et.al., BMC Musculoskeletal Disord 2007;
8:102
Disclosure of Interest: None Declared
SAT0424 PRELIMINARY RESULTS OF THE EARLY
INTERVENTION IN PATIENTS BEING OFF WORK BY
MUSCULOSKELETAL CAUSES IN THE HUP LA FE
AREA
M. D. Garcia-Armario1, C. Molina1, J. Ivorra1, I. Martinez-Cordellat1, J. L.
Valero1, E. Grau1, I. Chalmeta1, R. Negueroles1, L. Gonzalez-Puig1, M. L.
Muñoz1, C. Nuñez-Cornejo1, C. Alcañiz1, J. A. Roman-Ivorra1. 1Department Of
Rheumatology, Hospital Universitario Y Politécnico La Fe, Valencia, Spain
Background: In March 2012, a new project was started in the HUP La Fe,
following the pilot project performed in San Carlos Clinical Hospital in Madrid,
where patients off work for musculoskeletal causes were referred to us from
Primary Care.
Objectives: The aim of the study is to analyze the variation in days off work in
those individuals included in this program with respect to the normal average
of days off.
Methods: Cohort, observational, cross-sectional study from April to December
2012, which included patients from the HUP La Fe area, for the first time
referred to the Rheumatology Early Intervention consultation because of
temporary disability due to musculoskeletal origin. These patients are referred
to medical appointment with a maximum waiting time of one week and were
provided of medical treatment, ultrasound articular injections and directed
exercises  if needed. The patient is reviewed continuously until discharge.
We excluded patients whose disabilities were traumatic or surgical, or their
situation can cause  a permanent disability.
Results: We included a total of 116 patients with a mean age of 49 years
and 58% were women. The most frequently reported diseases were: back
pain (34%), neck pain (12%), shoulder pain syndrome (9%) and other
tendinopathies (10%). The 44.8% of cases had a history of sick leave. 100% of
the patients received medical treatment, 31% underwent articular ultrasound,
25% of them with infiltration and 61% were trained to perform physical therapy
from the first visit to the medical discharge were lumbociatalgia (34 days), neck
pain (21 days), painful shoulder syndrome (17 days) and low back pain (14
days). Comparing these data with the population controlled pilot study there
is a decrease of the days off, being in the control group lumbociatalgia (57.6
days), neck (37.4 days), back pain (34.5 days) and tendinitis (36.7 days).
Conclusions: Preliminary results obtained in our study show that early
intervention by rheumatologists in patients with temporary incapacity
pathology with musculoskeletal origin decreases the number of days off work,
compared to patients treated regularly, and can incorporate to work early and
consequently, save all costs resulting from such temporary disability.
Disclosure of Interest: None Declared
SAT0425 MANAGEMENT OF CARPAL TUNNEL SYNDROME IN
MUSCULOSKELETAL DISEASE DEPARTMENT: ARE WE
ADHERING TO THE GUIDELINE?
M. Y. Md Yusof1, C. Chattopadhyay1, E. Gladston Chelliah1, N. Sathi1.
1
Rheumatology, Wrightington, Wigan & Leigh NHS Foundation Trust, Greater
Manchester, United Kingdom
Background: Carpal tunnel syndrome (CTS) is a common nerve entrapment
neuropathy caused by compression of median nerve as it travels through
the anatomic carpal tunnel. It is a clinical diagnosis, hence identifying the