***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVE Since 2002 , an epidemiologic surveillance system of work-related , upper-limb musculoskeletal disorders ( MSDs ) has been implemented in France 's Pays de la Loire region to assess the prevalence of MSDs and their risk factors in the working population . METHODS The surveillance was based on a network of occupational physicians ( OPs ) and used the recommendations of a group of European experts ( criteria document consensus ) . In 2002 - 2003 , 80 of 400 OPs volunteered to participate . All underwent a training program to st and ardize the physical examination .  Health status was assessed by self-administered question naire and physical examination . Occupational risk factors were assessed by self-administered question naire .  Exposure scores were computed for each anatomic zone by summing the risk factors taken into account by the criteria document . RESULTS More than 50 % of the 2,685 men and women r and omly included in 2002 - 2003 experienced nonspecific musculoskeletal symptoms during the preceeding 12 months and approximately 30 % experienced them in the preceeding week . The prevalence of clinical ly diagnosed MSDs was high : approximately 13 % of workers experienced at least 1 of the MSDs . The most frequent disorder was rotator cuff syndrome followed by carpal tunnel syndrome and lateral epicondylitis . The prevalence of MSDs increased with age and varied widely across economic sectors and occupations . More than half of the workers were exposed to at least 2 risk factors of MSDs . Exposure varied according to industrial activity and occupation . According to the criteria document , a high percentage of MSD cases could be classified as probably work related ( 95 % in men and 89 % in women age < 50 , and 87 % in men and 69 % in women age > 50 ) . CONCLUSION Nonspecific upper-limb symptoms and specific upper-limb MSDs are common in the working population . These results show the need to implement prevention programs in most sectors to reduce the prevalence of MSDs Ninety-eight patients were admitted to a single-blind parallel study comparing the efficacy of naproxen sodium with a paracetamol/dextropropoxyphene combination in the treatment of soft-tissue disorders . The two study groups were well matched in all respects . After seven days of treatment patients in the naproxen sodium group had less residual symptoms and more of them were considered cured . These patients also had a significantly lower mean-pain-score , tended to have less daily symptoms and recorded a significantly greater initial improvement in their condition . Fewer side-effects were recorded by the naproxen sodium-treated patients . One patient from each group withdrew from the study because of side-effects . It was concluded that in the treatment of non-articular soft-tissue disorders the use of a rapidly-acting withdrew anti-inflammatory drug , naproxen sodium , gave a better clinical response than did treatment with a simple analgesic combination Introduction Gastrointestinal upset and local pain commonly limit the use of oral nonsteroidal anti-inflammatory drugs and corticosteroid injection as treatments for lateral epicondylitis . Transdermal administration of an anti-inflammatory drug could avoid these adverse effects . Purpose To determine the effectiveness of topical diclofenac as a treatment of lateral epicondylitis . Methods A convenience sample of 14 subjects meeting clinical criteria of chronic lateral epicondylitis participated in this r and omized , double blind , crossover study . Each subject applied a plutonic lecithin liposomal organo-gel ( PLO ) over the affected lateral elbow three times daily for 1 week , followed by a 1-week “ washout ” period of no gel . A second topical PLO gel was then applied similarly for 1 week . Both gels were identical , but only one gel contained 2 % diclofenac . Treatment order was r and omized , and both the subject and tester were blinded . Pain and isometric wrist extension strength were measured using a visual analog pain scale ( VAS ) and a mounted manual muscle testing dynamometer , respectively , at the following time periods : just before application of the first gel , the last day of using the first gel , the last day of the washout week , and the last day of using the second gel . Analysis was performed using repeated measures analysis of variance . Results When subjects used diclofenac PLO , pain was significantly less than that during the pretreatment , washout , and placebo PLO periods ( mean VAS ; diclofenac PLO , 2.1 ; pretreatment , 3.5 ; washout , 3.4 ; placebo PLO , 3.6 ) . Average wrist extension strength was significantly greater when subjects used diclofenac PLO ( 8.4 kg ) than it was before treatment ( 5.9 kg ) . One subject developed a local rash while using diclofenac PLO . Conclusion Topical 2 % diclofenac in PLO appears to provide effective short-term reduction in elbow pain and wrist extensor weakness associated with chronic lateral epicondylitis Abstract Objective : To compare the clinical effectiveness of local corticosteroid injection , st and ard non-steroidal anti-inflammatory drugs , and simple analgesics for the early treatment of lateral epicondylitis in primary care . Design : Multicentre pragmatic r and omised controlled trial . Setting : 23 general practice s in North Staffordshire and South Cheshire . Participants : 164 patients aged 18 - 70 years presenting with a new episode of lateral epicondylitis . Interventions : Local injection of 20 mg methylprednisolone plus lignocaine , naproxen 500 mg twice daily for two weeks , or placebo tablets . All participants received a st and ard advice sheet and co-codamol as required . Main outcome measures : Participants ' global assessment of improvement ( five point scale ) at four weeks . Pain , function , and “ main complaint ” measured on 10 point Likert scales at 4 weeks , 6 months , and 12 months . Results : Over 2 years , 53 subjects were r and omised to injection , 53 to naproxen , and 58 to placebo . Prognostic variables were similar between groups at baseline . At 4 weeks , 48 patients ( 92 % ) in the injection group were completely better or improved compared with 30 ( 57 % ) in the naproxen group ( P<0.001 ) and 28 ( 50 % ) in the placebo group ( P<0.001 ) . At 12 months , 43 patients ( 84 % ) in the injection group had pain scores ≤3 compared with 45 ( 85 % ) in the naproxen group and 44 ( 82 % ) in the placebo group ( P>0.05 ) . Conclusions : Early local corticosteroid injection is effective for lateral epicondylitis . Outcome at one year was good in all groups , and effective early treatment does not seem to influence this . Key messages Most lateral epicondylitis is managed by general practitioners , but optimum treatment is unclear This large pragmatic r and omised trial showed that corticosteroid injection was significantly better than non-steroidal anti-inflammatories or placebo tablets at four weeks A two week course of a st and ard non-steroidal anti-inflammatory was no better than placebo A few patients who respond well initially to injection relapse by six months . Long term outcome was good , irrespective of initial treatment Summary A prospect i ve , r and omized , multicentre , open , crossover study of the comparative efficacy , tolerability and acceptability of two topical nonsteroidal anti-inflammatory drug ( NSAID ) therapies , flurbiprofen local-action transcutaneous ( LAT ) patch ( 40 mg b.d . ) and piroxicam gel ( 3 cm , 0.5 % q.d.s ) , was conducted in general practice in the UK in 137 men and women with soft-tissue rheumatism of the shoulder or elbow ( e.g. epicondylitis , tendinitis , bursitis and adhesive capsulitis ) . Patients received one therapy for 4 days before crossing over to the other NSAID for a further 4 days , followed by 6 days of their preferred therapy . Clinical assessment of severity of pain , tenderness and overall clinical condition was carried out at baseline and after 4 , 8 and 14 days . Patients self-assessed the severity of pain during the day and at night , and also the quality of their sleep during each treatment phase . More patients showed a greater improvement in all of the clinical assessment s of efficacy following treatment with flurbiprofen LAT during the crossover phase . There was a statistically significant reduction in the severity of pain , the principal measure of efficacy , in favour of flurbiprofen LAT : 42 % of patients showed greater improvement with flurbiprofen LAT compared with 26 % who showed a greater improvement with piroxicam gel ( p=0.012 ; n=131 , intent-to-treat ) . Eligible data set ( n=126 ) analysis revealed statistically significant differences in favour of flurbiprofen LAT in the severity of lesion tenderness ( p=0.03 ) and the overall change in clinical condition ( p=0.04 ) compared with baseline status . Superior efficacy for flurbiprofen LAT was also indicated in the patients ' assessment at the end of the crossover phase ( day 8) , at which 69 % chose to continue treatment with flurbiprofen LAT compared with only 31 % of patients who chose piroxicam gel ( n=126 ; p<0.001 ) . There were , in addition , statistically significant differences in favour of flurbiprofen LAT in assessment s for night pain ( p<0.001 ) , quality of sleep ( p=0.004 ) and the patients ' overall opinion of treatment ( p<0.001 ) . Both treatments were well tolerated with a low incidence of mainly local adverse events . These results showed that flurbiprofen LAT had a greater efficacy than piroxicam gel , and was also preferred by patients in the treatment of painful soft-tissue rheumatism of the shoulder and elbow Four treatments for soft-tissue rheumatism -- sham ionisation , placebo ionisation , and pharmacological ionisation with pirprofen ( two-dose levels)--were assessed in a r and omized double-blind , between-patient controlled trial in 73 out patients affected by scapulo-humeral periarthritis or elbow epicondylitis . Treatment lasted two weeks ( 5 sessions a week ) . Progress was measured by patient 's assessment on pain at rest and on movement and by physician 's assessment on functional impairment . At two weeks each treatment was associated with a significant degree of improvement ; however , pharmacological ionisation produced a significantly higher improvement in symptoms . No differences were detected between sham ionisation and placebo ionisation . These results suggest that the ionisation procedure displays per se a moderate therapeutic effect which seems to be due more to a simple placebo effect than to the biological effect of electricity OBJECTIVE To determine the prevalence , interrelation , and impact of musculoskeletal disorders of the upper limb in the general population . METHODS A total of 9,696 r and omly selected adults of working age were surveyed in a 2-stage cross-sectional study involving a screening question naire and a st and ardized physical examination in symptomatic subjects . Age- and sex-specific prevalence rates were estimated for several musculoskeletal disorders and for nonspecific pain in the upper limbs . The overlap and impact on daily activities and healthcare utilization were explored . RESULTS Among 6,038 first-stage responders , 3,152 reported upper limb symptoms and 1,960 were subsequently examined . Of subjects with pain , 44.8 % had 1 or more specific soft-tissue disorders . Site-specific prevalence rates were as follows : shoulder tendinitis 4.5 % among men and 6.1 % among women ; adhesive capsulitis 8.2 % among men and 10.1 % among women ; lateral epicondylitis 1.3 % among men and 1.1 % among women ; de Quervain 's disease 0.5 % among men and 1.3 % among women ; other tenosynovitis of the h and or wrist , 1.1 % among men and 2.2 % among women . Specific disorders tended to cluster ( P < 0.001 ) in individuals , with particular overlap at the shoulder . Compared with subjects with nonspecific pain , those with specific disorders more often reported inability to perform everyday tasks ( P < 0.05 ) , consultation with a doctor ( P < 0.05 ) , and use of prescribed medication ( P < 0.05 ) . CONCLUSION Upper limb pain is common in the general population and is often associated with physical signs suggestive of specific upper-limb disorders . These disorders have a substantial impact on physical function and use of health care An open , parallel trial was conducted to compare the efficacy and toleration of piroxicam 0.5 % gel and diclofenac 1.16 % topical gel preparations in the treatment of 173 patients with well-defined , acute sprains and tendinitis of the ankle , shoulder , or elbow . Therapy was begun within three to five days of the injury and continued for up to 14 days . Piroxicam gel was applied to the injured area four times daily by 84 patients and diclofenac gel was similarly applied by 89 patients . Pain , tenderness , and restriction of joint movement were markedly improved with both drugs after three days of treatment . Further improvement was noted after 14 days of treatment and patients generally resumed normal activities in nine days . There was no difference in the response to treatment or in the global impressions of efficacy between piroxicam and diclofenac .  Toleration was regarded as good or excellent by 
    Output:
    
Transient pain may occur following injection .
There remains limited evidence from which to draw firm conclusions about the benefits or harms of topical or oral NSAIDs in treating lateral elbow pain .
Some people may expect a mild transient skin rash .
Evidence about the benefits of oral NSAIDs has been conflicting , although oral NSAID use may result in gastrointestinal adverse effects in some people .