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Diagnosis and Treatment of Musculoskeletal Disorders

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A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "Orthopedics".

Deadline for manuscript submissions: closed (27 December 2020) | Viewed by 40977

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Special Issue Editors

Assoc. Prof. Jos Runhaar

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Guest Editor

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Interests: muskuloskeletal disorders; early diagnosis; treatment; prevention; primary care; physiotherapy

Assoc. Prof. Marienke van Middelkoop

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Guest Editor

Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands
Interests: musculoskeletal disorders; sports medicine; children and adolescents; diagnosis; treatment; prevention; primary care

Special Issue Information

Dear Colleagues,

Musculoskeletal disorders are a serious burden for patients and modern society. In Europe alone, 100,000,000 individuals suffer from musculoskeletal disorders and 40,000,000 affected workers cause losses due to work absence and a productivity loss of €12 billion per year. Worldwide, musculoskeletal disorders are the second most common cause of pain and disability.

Adequate diagnosis and early initiation of treatment are key elements in the care for patients suffering from musculoskeletal disorders. Yet, for many musculoskeletal disorders, diagnostic tests lack appropriate accuracy. Treatment of musculoskeletal disorders is challenging the mechanisms causing the complaints and mechanisms of action for the available treatment options are largely unknown. Moreover, these mechanisms and effectiveness might depend on specific patients’ characteristics and call for personalized strategies.

This Special Issue invites researchers in the field to contribute to the state of the art in the diagnosis and treatment of musculoskeletal disorders. As many different healthcare professionals are involved in the diagnosis and treatment of musculoskeletal disorders, the Special Issue will publish high-quality studies from different areas of healthcare. Studies reporting on original research (e.g., randomized controlled trials, cohort studies), but also systematic literature reviews and meta-analyses within the scope of the Special Issue will be considered. Given recent debates around the effectiveness of surgical interventions for musculoskeletal disorders and concomitant risks for adverse side-effects, intervention studies on non-surgical treatment options will be prioritized. This Special Issue will be an open-access publication of the Journal of Clinical Medicine; ISI Web of Knowledge impact factor 5.688 (2018) and ranked 15/160 (top 10%) for General & Internal Medicine.

Assoc. Prof. Jos Runhaar
Assoc. Prof. Marienke van Middelkoop
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Musculoskeletal disorders
Pain
Disability
Diagnosis
Prognosis
Physical examination
(Non-surgical) Treatment
Physical activity
Lifestyle intervention
Personalized medicine

Published Papers (11 papers)

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Research

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10 pages, 1041 KiB

Open AccessArticle

Differences in Knee Shape between ACL Injured and Non-Injured: A Matched Case-Control Study of 168 Patients

by Koen S.R. van Kuijk, Vincent Eggerding, Max Reijman, Belle L. van Meer, Sita M.A. Bierma-Zeinstra, Ewoud van Arkel, Jan H. Waarsing and Duncan E. Meuffels

J. Clin. Med. 2021, 10(5), 968; https://doi.org/10.3390/jcm10050968 - 2 Mar 2021

Cited by 4 | Viewed by 2223

Abstract

Objective: Anterior cruciate ligament (ACL) injury prevention programs could be more effective if we could select patients at risk for sustaining an ACL rupture. The purpose of this study is to identify radiographic shape variants of the knee between patients with and patients without an ACL rupture. Methods: We compared the lateral and Rosenberg view X-rays of 168 prospectively followed patients with a ruptured ACL to a control group with intact ACLs, matched for gender, after knee trauma. We used statistical shape modeling software to examine knee shape and find differences in shape variants between both groups. Results: In the Rosenberg view X-rays, we found five shape variants to be significantly different between patients with an ACL rupture and patients with an intact ACL but with knee trauma. Overall, patients who had ruptured their ACL had smaller, flatter intercondylar notches, a lower lateral tibia plateau, a lower medial spike of the eminence, and a smaller tibial eminence compared to control patients. Conclusion: Patients with an ACL rupture have smaller intercondylar notches and smaller tibial eminences in comparison to patients with an intact ACL after knee trauma. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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12 pages, 445 KiB

Open AccessArticle

Generalized Joint Hypermobility and Injuries: A Prospective Cohort Study of 185 Pre-Professional Contemporary Dancers

by Rogier M. van Rijn and Janine H. Stubbe

J. Clin. Med. 2021, 10(5), 1007; https://doi.org/10.3390/jcm10051007 - 2 Mar 2021

Cited by 5 | Viewed by 2706

Abstract

Generalized joint hypermobility (GJH) has been mentioned as one of the factors associated with dance injuries, but the findings are inconclusive. This study aims to investigate whether GJH, based on different Beighton score cut-off points, is a potential risk factor for injuries in pre-professional dancers. Four cohorts of first-year pre-professional dancers (N = 185), mean age 19.1 ± 1.3 years, were screened on musculoskeletal functioning at the start of their academic year. The Beighton score was used to measure GJH. During the academic year, the dancers completed monthly questionnaires about their physical and mental health. Based on the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC), three injury definitions were used (i.e., all complaints, substantial injury, and time-loss injury). To examine potential risk factors for injuries, univariate and multivariate regression models were applied. The response rate of monthly completed questionnaires was 90%. The overall mean (SD) Beighton score was 2.8. The 1-year injury incidence proportion was 67.6% (n = 125), 43.2% (n = 80), and 54.6% (n = 101) for all complaint injuries, substantial injuries, and time-loss injuries, respectively. The multivariate analyses showed a significant association between a previous long lasting injury in the past year and the three injury definitions (p < 0.05). Pre-professional contemporary dancers are at high risk for injuries and hypermobility. However, these two variables are not associated with each other. Health professionals should take injury history into account when assessing dance students, because this variable is associated with increased injury risk. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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18 pages, 2290 KiB

Open AccessArticle

Estimating the Prevalence of Knee Pain and the Association between Illness Perception Profiles and Self-Management Strategies in the Frederiksberg Cohort of Elderly Individuals with Knee Pain: A Cross-Sectional Study

by Elisabeth Ginnerup-Nielsen, Robin Christensen, Berit L Heitmann, Roy D. Altman, Lyn March, Anthony Woolf, Henning Bliddal and Marius Henriksen

J. Clin. Med. 2021, 10(4), 668; https://doi.org/10.3390/jcm10040668 - 9 Feb 2021

Cited by 9 | Viewed by 4978

Abstract

Knee pain is an early sign of later incident radiographic knee osteoarthritis (OA). However, the prevalence of knee pain in the general population is unknown. Additionally, it is unknown how people with knee pain choose to self-manage the condition and if the perception of the illness affects these choices. In this study, 9086 citizens between 60–69 years old in the municipality of Frederiksberg, Copenhagen, Denmark, were surveyed, of which 4292 responded. The prevalence of knee pain was estimated, and associations between illness perceptions (brief illness perception questionnaire [B-IPQ]), self-management strategies, and knee symptoms were assessed. The prevalence of knee pain was 21.4% of which 40.5% reported to use no self-management strategies (non-users). These non-users perceived their knee pain as less threatening and reported less severe symptoms than users of self-management strategies. Further, we found that a more positive illness perception was associated with less severe knee symptoms. In conclusion, among Danes aged 60–69 years, the knee pain prevalence is 21.4%, of which 40.5% use no treatment and perceive the condition as non-threatening. These non-users with knee pain represent a subpopulation being at increased risk of developing knee OA later in life, and there is a potential preventive gain in identifying these persons. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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12 pages, 1069 KiB

Open AccessArticle

Knee Injury and Osteoarthritis Outcome Score (KOOS) Responder Criteria and Minimal Detectable Change 3–12 Years Following a Youth Sport-Related Knee Injury

by Clodagh M. Toomey, Jackie L. Whittaker, Luz Palacios-Derflingher and Carolyn A. Emery

J. Clin. Med. 2021, 10(3), 522; https://doi.org/10.3390/jcm10030522 - 1 Feb 2021

Cited by 2 | Viewed by 2932

Abstract

The applicability of thresholds that constitute an acceptable score or meaningful change on the Knee injury and Osteoarthritis Outcome Score (KOOS) in cohorts ≥ 5 years following knee injury is not well understood. The primary objective of this study was to evaluate the association between intra-articular knee injury type and two different KOOS pain thresholds (patient acceptable symptom state (PASS) and Englund symptomatic knee criteria) in the Alberta Youth Prevention of Osteoarthritis (PrE-OA) cohort, which includes participants 3–12 years following a youth sport-related knee injury and uninjured controls with similar age, sex and sport characteristics. Analyses accounted for sex, time since injury and the interaction between time since injury and injury type. Secondary objectives were to report proportions meeting thresholds for KOOS outcomes and minimal detectable change (MDC) from published test–retest reliability data, over a 1–4-year follow-up. Two hundred and fifty-three (253) participants (124 injured, 129 controls) were included in analyses, of which 153 (77 injured, 76 controls) had follow-up data. Similar odds were observed for presence of pain (below PASS threshold) in participants with anterior cruciate ligament (ACL)/meniscus injury (odds ratio (OR) 4.2 (97.5% confidence interval (CI): 1.8, 9.9)) and other knee injuries (OR 4.9 (97.5% CI: 1.2, 21.0)), while there were higher odds for presence of Englund “symptomatic knee” criteria in participants with ACL/meniscus injury (OR 13.6 (97.5% CI: 2.9, 63.4)) than other knee injuries (OR 7.3 (97.5% CI: 0.8, 63.7)) compared to controls. After a median 23.4 (8 to 42) month follow-up, 35% of previously injured participants had at least one KOOS sub-scale score that worsened by more than the MDC published threshold. Despite limited research, this study shows that individuals with youth sport knee injuries other than ACL or meniscus injury may also experience significant pain and symptoms 3–12 years following injury. Replication and further follow-up are needed to identify a possible clinical trajectory towards osteoarthritis. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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12 pages, 398 KiB

Open AccessArticle

What Is the Diagnosis in Patients with Type 2 Diabetes Who Have a Painful Shoulder? Results from a Prospective Cross-Sectional Study

by Login Ahmed S. Alabdali, Jasmien Jaeken, Nens van Alfen, Geert-Jan Dinant, Rob A. P. Borghans and Ramon P. G. Ottenheijm

J. Clin. Med. 2020, 9(12), 4097; https://doi.org/10.3390/jcm9124097 - 18 Dec 2020

Cited by 2 | Viewed by 2769

Abstract

Background: Patients with diabetes mellitus have higher risk of developing shoulder pathology. However, only adhesive capsulitis is addressed in shoulder pain guidelines as a disorder associated with diabetes. Yet, patients with diabetes are at risk of having several other shoulder disorders, including focal neuropathy. Our aim was to quantify the presence of shoulder disorders using physical examination and ultrasound imaging in patients with type 2 diabetes (T2DM) suffering from shoulder pain in general practice. Methods: In this prospective cross-sectional study, patients with T2DM who had had a painful shoulder for at least four weeks were included. Patients filled out a questionnaire and underwent a physical examination of the shoulders and feet and ultrasound imaging of the shoulder. Results: A total of 66 patients were included, of whom 40.9% (n = 27) had bilateral complaints resulting in 93 symptomatic shoulders. Subacromial pain syndrome was most frequently diagnosed by physical examination (66.6%, 95% CI 51.6–72.0%; p < 0.0001), while ultrasound imaging showed that subacromial disorders were statistically significantly the most prevalent (90.3%, 95% CI 81.9–95.2%). Only two patients (3%) were diagnosed with neuropathic shoulder pain. Conclusion: When choosing treatment, general practitioners should be aware that in patients with T2DM the subacromial region is most frequently affected. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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10 pages, 663 KiB

Open AccessArticle

Long-Term Surgical Results of Skip Pedicle Screw Fixation for Patients with Adolescent Idiopathic Scoliosis: A Minimum-Ten-Year Follow-Up Study

by Masashi Uehara, Shugo Kuraishi, Shota Ikegami, Hiroki Oba, Takashi Takizawa, Ryo Munakata, Terue Hatakenaka, Michihiko Koseki and Jun Takahashi

J. Clin. Med. 2020, 9(12), 4002; https://doi.org/10.3390/jcm9124002 - 10 Dec 2020

Cited by 5 | Viewed by 2664

Abstract

Skip pedicle screw fixation for adolescent idiopathic scoliosis (AIS) requires fewer screws and can reduce the risk of neurovascular injury as compared with segmental pedicle screw fixation. However, the long-term impact of screw number reduction on correction and clinical results is unclear. This study examined the 10-year post-operative outcomes of skip pedicle screw fixation for patients with AIS. We reviewed the outcomes of 30 patients who underwent skip pedicle screw fixation for AIS. Radiological and clinical findings were assessed before and immediately, 2 years, and 10 years after surgery in the remaining 25 patients. The mean Cobb angle of the main curve preoperatively and immediately, 2 years, and 10 years post-operatively was 59.4°, 23.4°, 25.8°, and 25.60°, respectively, and was significantly improved at all post-surgical time points (all p < 0.001). The mean correction rate immediately after surgery was 60.8%, and the correction loss rate at the observation end point was 4.8%. The Cobb angle of the lumbar curve was significantly improved immediately after surgery, and the correction persisted until 10 years post-operatively. Remarkable gains were observed for most Scoliosis Research Society-22 patient questionnaire sub-scores at the final follow-up versus preoperative assessments. In conclusion, good correction of the AIS deformity by skip pedicle screw fixation was well maintained over a long follow-up period of 10 years, with clinically meaningful gains in Society-22 patient questionnaire sub-scores. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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19 pages, 1167 KiB

Open AccessArticle

Medical Interventions for Patellofemoral Pain and Patellofemoral Osteoarthritis: A Systematic Review

by Erin M. Macri, Harvi F. Hart, David Thwaites, Christian J. Barton, Kay M. Crossley, Sita M.A. Bierma-Zeinstra and Marienke van Middelkoop

J. Clin. Med. 2020, 9(11), 3397; https://doi.org/10.3390/jcm9113397 - 23 Oct 2020

Cited by 5 | Viewed by 5023

Abstract

Patellofemoral pain (PFP) and patellofemoral osteoarthritis (PFOA) are common, persistent conditions that may lie along a pathological spectrum. While evidence supports exercise-therapy as a core treatment for PFP and PFOA, primary care physicians commonly prescribe medication, or refer for surgical consults in persistent cases. We conducted a systematic review of medical interventions (pharmaceutical, nutraceutical, and surgical) for PFP and PFOA to inform primary care decision making. Methods: Following protocol registration, we searched seven databases for randomized clinical trials of our target interventions for PFP and PFOA. Our primary outcome was pain. We assessed risk of bias, calculated standardized mean differences (SMDs) and determined the level of evidence for each intervention. Results: We included 14 publications investigating pharmaceutical or nutraceutical interventions, and eight publications investigating surgical interventions. Two randomized control trials (RCTs) provided moderate evidence of patellofemoral arthroplasty having similar pain outcomes compared to total knee arthroplasty in isolated PFOA, with SMDs ranging from −0.3 (95% CI −0.8, 0.2, Western Ontario McMaster Pain Subscale, 1 year post-surgery) to 0.3 (−0.1, 0.7, SF-36 Bodily Pain, 2 years post-surgery). Remaining studies provided, at most, limited evidence. No efficacy was demonstrated for oral nonsteroidal anti-inflammatories or arthroscopic surgery. Conclusions: Pharmaceutical and nutraceutical prescriptions, and surgical referrals are currently being made with little supporting evidence, with some interventions showing limited efficacy. This should be considered within the broader context of evidence supporting exercise-therapy as a core treatment for PFP and PFOA. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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12 pages, 1039 KiB

Open AccessArticle

The Added Value of Radiographs in Diagnosing Knee Osteoarthritis Is Similar for General Practitioners and Secondary Care Physicians; Data from the CHECK Early Osteoarthritis Cohort

by Qiuke Wang, Jos Runhaar, Margreet Kloppenburg, Maarten Boers, Johannes W. J. Bijlsma, Sita M. A. Bierma-Zeinstra and The CREDO Expert Group

J. Clin. Med. 2020, 9(10), 3374; https://doi.org/10.3390/jcm9103374 - 21 Oct 2020

Cited by 4 | Viewed by 2103

Abstract

Objective: The purpose of this study was to evaluate the added value of radiographs for diagnosing knee osteoarthritis (KOA) by general practitioners (GPs) and secondary care physicians (SPs). Methods: Seventeen GPs and nineteen SPs were recruited to evaluate 1185 knees from the CHECK cohort (presenters with knee pain in primary care) for the presence of clinically relevant osteoarthritis (OA) during follow-up. Experts were required to make diagnoses independently, first based on clinical data only and then on clinical plus radiographic data, and to provide certainty scores (ranging from 1 to 100, where 1 was “certainly no OA” and 100 was “certainly OA”). Next, experts held consensus meetings to agree on the final diagnosis. With the final diagnosis as gold standard, diagnostic indicators were calculated (sensitivity, specificity, positive/negative predictive value, accuracy and positive/negative likelihood ratio) for all knees, as well as for clinically “certain” and “uncertain” knees, respectively. Student paired t-tests compared certainty scores. Results: Most diagnoses of GPs (86%) and SPs (82%) were “consistent” after assessment of radiographic data. Diagnostic indicators improved similarly for GPs and SPs after evaluating the radiographic data, but only improved relevantly in clinically “uncertain” knees. Radiographs added some certainty to “consistent” OA knees (GP 69 vs. 72, p < 0.001; SP 70 vs. 77, p < 0.001), but not to the consistent no OA knees (GP 21 vs. 22, p = 0.16; SP 20 vs. 21, p = 0.04). Conclusions: The added value of radiographs is similar for GP and SP, in terms of diagnostic accuracy and certainty. Radiographs appear to be redundant when clinicians are certain of their clinical diagnosis. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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13 pages, 672 KiB

Open AccessArticle

Self-Assessment of Competence and Referral Behavior for Musculoskeletal Injections among Dutch General Practitioners

by Emely Spruit, Marianne F. Mol, P. Koen Bos, Sita M.A. Bierma-Zeinstra, Patrick Krastman and Jos Runhaar

J. Clin. Med. 2020, 9(6), 1880; https://doi.org/10.3390/jcm9061880 - 16 Jun 2020

Cited by 1 | Viewed by 1898

Abstract

General practitioners (GPs) are qualified and trained to administer therapeutic musculoskeletal injections when indicated. However, it is unknown to what extend Dutch GPs feel competent to administer these injections in clinical practice. Reluctance among GPs to inject might lead to unnecessary and costly referral to secondary care. An online and offline questionnaire was spread among Dutch GPs, querying demographics, GPs’ self-assessment of injection competence, the number of administered/referred injections and management strategy for musculoskeletal injections. A total of 355 GPs responded. In total, 81% of the GPs considered themselves competent in administering musculoskeletal injections. Self-assessed incompetent GPs performed less injections the last month than self-assessed competent GPs (1.2 ± 1.4 vs 4.8 ± 4.6 injections, P < 0.001). Additionally, they referred four times more often to a colleague GP (0.4 ± 1.0 vs 0.1 ± 0.6 injections per month, P < 0.001) and twice as often to secondary care (1.0 ± 1.3 vs 0.5 ± 0.9 injections per month, P = 0.001). Self-assessed incompetence was associated with female sex (OR [95% CI] = 4.94 [2.39, 10.21]) and part-time work (OR [95% CI] = 2.58 [1.43, 4.66]). The most frequently addressed barriers were a lack of confidence in injection skills, lack of practical training, and uncertainty about the effectiveness and diagnosis of musculoskeletal injections. Although most GPs considered themselves competent to administer musculoskeletal injections, the referral rate to secondary care for several injections was strikingly high. To decrease secondary care referrals, addressing some of the most frequently indicated barriers is highly recommended. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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9 pages, 1038 KiB

Open AccessFeature PaperArticle

Is Heel Height Associated with Pain Exacerbations in Hip Osteoarthritis Patients?—Results from a Case-Crossover Study

by Kai Fu, Ben R. Metcalf, Kim L. Bennell, Yuqing Zhang, K. Douglas Gross, Kathryn Mills, Leticia A. Deveza, Sarah R. Robbins and David J. Hunter

J. Clin. Med. 2020, 9(6), 1872; https://doi.org/10.3390/jcm9061872 - 16 Jun 2020

Cited by 3 | Viewed by 3491

Abstract

The etiology of osteoarthritis (OA) pain exacerbations is not well understood. The purpose of this study is to evaluate the association of heel height and duration of wearing shoes with higher heels with pain exacerbations in people with hip OA. Eligible participants with symptomatic hip OA were instructed to complete online questionnaires every 10 days over a 90-day follow-up period. They were required to complete the questionnaire whenever they were experiencing hip pain exacerbation. Of 252 participants recruited, 137 (54.4%) contributed both case and control period data, and were included in the analysis. Wearing shoes with a heel height ≥ 2.5 cm during the past 24 h was associated with lower odds of pain exacerbations (OR: 0.54, 95% CI: 0.30 to 0.99). A longer duration (>6 h) of wearing shoes with heel height ≥ 2.5 cm was also associated with a lower risk of hip pain exacerbations (p for linear trend = 0.003). Wearing shoes with heel height ≥ 2.5 cm and longer duration in the past 24 h may be protective against hip pain exacerbations in people with symptomatic hip OA. Given the observational study nature, it would be prudent for this to be replicated in an independent data set. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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Review

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21 pages, 651 KiB

Open AccessReview

Recommendations for Diagnosis and Treatment of Lumbosacral Radicular Pain: A Systematic Review of Clinical Practice Guidelines

by Ahmad Khoshal Khorami, Crystian B. Oliveira, Christopher G. Maher, Patrick J. E. Bindels, Gustavo C. Machado, Rafael Z. Pinto, Bart W. Koes and Alessandro Chiarotto

J. Clin. Med. 2021, 10(11), 2482; https://doi.org/10.3390/jcm10112482 - 3 Jun 2021

Cited by 21 | Viewed by 8670

Abstract

The management of patients with lumbosacral radicular pain (LRP) is of primary importance to healthcare professionals. This study aimed to: identify international clinical practice guidelines on LRP, assess their methodological quality, and summarize their diagnostic and therapeutic recommendations. A systematic search was performed (August 2019) in MEDLINE, PEDro, National Guideline Clearinghouse, National Institute for Health and Clinical Excellence (NICE), New Zealand Guidelines Group (NZGG), International Guideline Library, Guideline central, and Google Scholar. Guidelines presenting recommendations on diagnosis and/or treatment of adult patients with LRP were included. Two independent reviewers selected eligible guidelines, evaluated quality with Appraisal of Guidelines Research & Evaluation (AGREE) II, and extracted recommendations. Recommendations were classified into ‘should do’, ‘could do’, ‘do not do’, or ‘uncertain’; their consistency was labelled as ‘consistent’, ‘common’, or ‘inconsistent’. Twenty-three guidelines of varying quality (AGREE II overall assessment ranging from 17% to 92%) were included. Consistent recommendations regarding diagnosis are (‘should do’): Straight leg raise (SLR) test, crossed SLR test, mapping pain distribution, gait assessment, congruence of signs and symptoms. Routine use of imaging is consistently not recommended. The following therapeutic options are consistently recommended (‘should do’): educational care, physical activity, discectomy under specific circumstances (e.g., failure of conservative treatment). Referral to a specialist is recommended when conservative therapy fails or when steppage gait is present. These recommendations provide a clear overview of the management options in patients with LRP. Full article

(This article belongs to the Special Issue Diagnosis and Treatment of Musculoskeletal Disorders)

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