Joint diseases

Systematic literature review. To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy. Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy. An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of "tendinitis." However, increasing mechanical load to the tendinopathic tissue, as well as reducing molecular cross-linking during the healing process via transverse massage, offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy. The authors surveyed research articles in all languages by searching PubMed, Scopus, Pedro, CINAHL, PsycINFO, and the Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage, Cyriax, soft tissue mobilization, soft tissue m...

Invalidating elbow contractures, a frequent problem after injury, are commonly treated by physical therapy or surgical release. In both cases, results can be frustrating: physical therapy is often not sufficient to gain functional range of motion, and after surgical release it is common to lose part of the motion gained in operating room. Thanks to the viscous-elastic properties of the soft tissue, the mobilization elbow braces can stretch the retracting or retracted tissues inducing a biological lengthening of collagen fibres. In post-traumatic contracture, mobilization braces are effectively employable in two main critical situations: to treat recent onset contractures which do not respond to simple physical therapy and to help in preserving range of motion gained after surgical release. We report our experience with mobilization brace used in 42 patients, 5 for post-traumatic contracture, 4 for contracture following articular fracture fixation and 33 after surgical release. Classification, indications and treatment protocols of the mobilization braces utilized are reported.

Galectin-3 is expressed in various tissues, including the bone, where it is considered a marker of chondrogenic and osteogenic cell lineages. Galectin-3 protein was found to be increased in the differentiated chondrocytes of the metaphyseal plate cartilage, where it favors chondrocyte survival and cartilage matrix mineralization. It was also shown to be highly expressed in differentiating osteoblasts and osteoclasts, in concomitance with expression of osteogenic markers and Runt-related transcription factor 2 and with the appearance of a mature phenotype. Galectin-3 is expressed also by osteocytes, though its function in these cells has not been fully elucidated. The effects of galectin-3 on bone cells were also investigated in galectin-3 null mice, further supporting its role in all stages of bone biology, from development to remodeling. Galectin-3 was also shown to act as a receptor for advanced glycation endproducts, which have been implicated in age-dependent and diabetes-associ...

Soft tissue pain is, by default, an entity of most of the other structures in the body besides bone. This includes muscle, fascia, tendons, ligaments, cartilage, synovium, fibrous capsules, organs, and nerves. Soft tissue pain is often overlooked because it is not as easy to diagnose as pain involving bony structures. However, soft tissue pain can be just as debilitating as pain from bony structures. Treatment of soft tissue pain includes a variety of pharmacologic and nonpharmacologic techniques, and these are discussed in this article.

Digital templating is an accurate method of assessing femoral and acetabular component sizes. This allows surgeons to foresee potential problems and also recognize an intraoperative error when a large discrepancy exists between a trial component and the templated size. Preoperative templating data of pelvic radiographs from 100 consecutive patients receiving uncemented implants were templated with Orthoview software (version 2.0CEN; Meridian Technique Ltd, Southampton, United Kingdom). Seventy-five percent of stems were templated to within 0.5 size, and 98%, to within 1 size. Eighty percent of cups were templated to within 2 mm, and 98%, to within 4 mm, and 62% of head length was accurately template. Seven patients were converted from a templated 132°t o a 127°femoral prosthesis neck angle. The mean lower limb length discrepancy was + 0.05 mm (SD, 5.1 mm) postoperatively.

Wrist arthroscopy is a commonly used procedure that has undergone many modifications and improvements since it was first described. The advent of new portals (both dorsal and volar) means that the wrist joint can be viewed from virtually any perspective ("box concept"). Indications for wrist arthroscopy have continued to expand and include diagnostic and reparative procedures and, more recently, reconstructive, soft-tissue, and bony procedures. Arthroscopic grading of Kienböck's disease better describes articular damage compared with plain radiographs and can help guide surgical treatment options. Triangular fibrocartilage complex injury diagnosis, classification, and treatment can be performed arthroscopically, including distal ulna resection (wafer procedure). Assessment of fracture reduction of the distal radius and scaphoid is superior to that obtained with fluoroscopy, with the advantage of being able to look for associated soft-tissue and chondral injuries. Arthroscopic assessment of intercarpal ligament injuries and instability is now considered the gold standard by many authors. Arthroscopy can also aid us in the management of post-traumatic capsular contraction, resection of ganglia, and the relatively rare isolated ulna styloid impaction. Complications of wrist arthroscopy are relatively uncommon. With the ever-expanding list of indications and procedures that can be performed with this technique, it exists as an essential diagnostic and therapeutic tool for the orthopaedic surgeon.

SummaryObjectives: To investigate the possibilities and limitations of arthroscopy to detect flexor enthesopathy in dogs and to distinguish the primary from the concomitant form.Materials and methods: Fifty dogs (n = 94 elbow joints) were prospectively studied: dogs with primary flexor enthesopathy (n = 29), concomitant flexor enthesopathy (n = 36), elbow dysplasia (n = 18), and normal elbow joints (n = 11). All dogs underwent an arthroscopic examination of one or both elbow joints. Presence or absence of arthroscopic characteristics of flexor enthesopathy and of other elbow disorders were recorded.Results: With arthroscopy, several pathological changes of the enthesis were observed in 100% of the joints of both flexor enthesopathy groups, but also in 72% of the joints with elbow dysplasia and 25% of the normal joints. No clear differences were seen between both flexor enthesopathy groups.Clinical significance: Arthroscopy allows a sensitive detection of flexor enthesopathy characte...

Post-arthroplasty infections represent a devastating complication of total joint replacement surgery, resulting in multiple reoperations, prolonged antibiotic use, extended disability and worse clinical outcomes. As the number of arthroplasties in the U.S. will exceed 3.8 million surgeries per year by 2030, the number of post-arthroplasty infections is projected to increase to over 266,000 infections annually. The treatment of these infections will exhaust healthcare resources and dramatically increase medical costs. To evaluate novel preventative therapeutic strategies against post-arthroplasty infections, a mouse model was developed in which a bioluminescent Staphylococcus aureus strain was inoculated into a knee joint containing an orthopaedic implant and advanced in vivo imaging was used to measure the bacterial burden in real-time. Mice inoculated with 5x10(3) and 5x10(4) CFUs developed increased bacterial counts with marked swelling of the affected leg, consistent with an acut...

Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however, there is no consensus on the most effective method ...

The investigation reported in this paper is concerned with an experimental and theoretical study conducted to explain the changes of the knee joint mechanics m degenerative joint disease. The major thrust of the study is to determine the resultants of the pressure distribution on both lateral and medial plateaus in normal and abnormal knee joint configurations. Up to 5" of varus and valgus deformity is applied to a normal femorotibial angle of a strain-gaged test specimen which is connected through the femur and the tibia IO the jaws of a specially designed loading apparatus. Strains are obtained for various loads and deviated femorotibial angles from the strain gages impfanted on the femur and the tibia. Utilization of these strains as data for a three-dimensional theoretical analysis yielded the following results for the normal and abnormal knee joint configurations: la) contact forces on both lateral and medial plateaus; (b) medial and lateral collateral ligament forces; (c) anteroposterior and lateral-medial moments.

This investigation compared differences in the occurrence of symptoms in participants with CFS, melancholic depression, and no fatigue (controls). The following Fukuda et al. [Ann. Intern. Med. 121 (1994) 953] criteria symptoms differentiated the CFS group from controls, but did not differentiate the melancholic depression group from controls: headaches, lymph node pain, sore throat, joint pain, and muscle pain. In addition, participants with CFS uniquely differed from controls in the occurrence of muscle weakness at multiple sites as well as in the occurrence of various cardiopulmonary, neurological, and other symptoms not currently included in the current case definition. Implications of these findings are discussed.

Objective: To compare screw fixation strength for subtalar arthrodesis. Methods: Eight matched pairs of cadaver feet underwent subtalar joint arthrodesis with two 7.3mm cannulated screws. Randomization was used to assign screw orientation, such that one foot in each pair was assigned dorsal to plantar screw orientation (DP Group), and the other foot, plantar to dorsal orientation (PD Group). Standard surgical technique with fluoroscopy was used for each approach. Following fixation, each specimen was loaded to failure with a Bionix® 858 MTS device, applying a downward axial force at a distance to create torque. Torque to failure was compared between DP and PD Groups using Student’s t test, with p=0.05 used to determine statistical significance. Results: Statistical analysis demonstrated that the mean torque to failure slightly favored the DP Group (37.3Nm) to the PD Group (32.2Nm). However, the difference between the two groups was not statistically significant (p=0.55). Conclusion: In subtalar arthrodesis, there is no significant difference in construct strength between dorsal-to-plantar and plantar-to-dorsal screw orientation. The approach chosen by the surgeon should be based on factors other than the biomechanical strength of the screw orientation.

In 2009, GRAPPA published their first evidence-based recommendations for the treatment of psoriasis and psoriatic arthritis (PsA). Since then, new information has been published and drugs developed. We summarize evidence for the efficacy of available treatments for peripheral joint involvement in PsA. We performed a systematic review of current literature on the efficacy of different therapies, management, and therapeutic strategies for peripheral arthritis involvement in PsA, in order to provide information for the development of the new GRAPPA treatment recommendations.

Objective. The glycoprotein lubricin (encoded by the gene Prg4) is secreted by surface chondrocytes and synovial cells, and has been shown to reduce friction in vitro. In contrast to man-made bearings, mammalian diarthrodial joints must endogenously produce frictionreducing agents. This study was undertaken to investigate whether friction is associated with wear. Methods. The lubricating ability of synovial fluid (SF) samples from humans with genetic lubricin deficiency was tested in vitro. The coefficient of friction in the knee joints of normal and lubricin-null mice was measured ex vivo; these joints were also studied by light and electron microscopy. Atomic force microscopy was used to image and measure how lubricin reduces friction in vitro. Results. SF lacking lubricin failed to reduce friction in the boundary mode. Joints of lubricin-null mice showed early wear and higher friction than joints from their wild-type counterparts. Lubricin self-organized and reduced the work of adhesion between apposing asperities. Conclusion. These data show that friction is coupled with wear at the cartilage surface in vivo. They imply that acquired lubricin degradation occurring in inflammatory joint diseases predisposes the cartilage to damage. Lastly, they suggest that lubricin, or similar biomolecules, will have applications in man-made devices in which reducing friction is essential.

Imaging of the wrist with MR imaging can be difficult because of the small size of this joint, its complex anatomy, and its sometimes poorly understood pathologic lesions. A recent study by Hobby and coworkers [1] of 98 patients revealed that MR imaging of the wrist influences clinicians' diagnoses and management plans in most patients. This article summarizes the current diagnostic criteria that can be useful in interpreting abnormalities of the wrist ligaments and triangular fibrocartilage complex (TFCC) of the wrist in this difficult topic in joint MR imaging. Anatomy Ligamentous anatomy The carpal ligaments may be classified as either extrinsic or intrinsic. The extrinsic ligaments link the carpal bones to the radius and ulna. The intrinsic or intercarpal ligaments connect the individual carpal bones.

This article presents an overview of physical therapy management for patients with pathological musculoskeletal conditions of the shoulder. The importance of a thorough physical examination is stressed because proper treatment is based on this information. The primary goals of management should include the alleviation of acute inflammation and pain and the avoidance of subsequent soft tissue shortening. Medical and surgical treatments for common shoulder disorders also are discussed.

Objective The aim of this study was to describe the magnetic resonance imaging (MRI) findings in patients with ischiofemoral impingement (IFI) and to evaluate the reliability of these MRI findings. Materials and methods Seventy hips of 50 patients with hip pain and quadratus femoris muscle (QFM) edema and 38 hips of 30 control cases were included in the study. The QFM edema and fatty replacement were assessed visually. Ischiofemoral space (IFS), quadratus femoris space (QFS), inclination angle (IA), hamstring tendon area (HTA), and total quadratus femoris muscle volume (TQFMV) measurements were performed independently by two musculoskeletal radiologists. The intra-and interobserver reliabilities were obtained for quantitative variables. Results IFS, QFS, and TQFMV values of the patient group were significantly lower than those of controls (P<0.001). HTA and IA measurements of the patient group were also significantly higher than in controls (P<0.05). The QFM fatty replacement grades were significantly higher in the patient group than in the control group (P<0.001). Inter-and intra-observer reliabilities were strong for all continuous variables. Conclusion Clinicians and radiologists should be aware of IFI in patients with hip or groin pain, and MRI should be obtained for the presence of the QFM edema/fatty replacement, narrowing of the IFS-QFS, and other features that may help in the clinical diagnosis of IFI for the proper diagnosis and treatment of the disease.

Introduction This cross-sectional study examined the effect of structural changes caused by rheumatoid arthritis (RA) on computer keyboarding style to provide insights on how changes may affect worker performance. Method Computer keyboarding styles, as measured by the keyboard-personal computer style instrument, were compared between 45 keyboard operators with RA and 29 without. A severity of structural changes score (SSCS) was assigned after recruitment by observing subjects' hands while operating a keyboard. Significant differences between each item of keyboarding style by diagnosis were identified through Chi square analyses. Logistic regression models with age, diagnosis, SSCS, and touch typing training as the predicators further evaluated the effect of structural changes on each item of personal keyboarding style. Results Significantly more keyboard operators with RA used high force keystrokes, did not use a wrist rest, moved their hands to strike keys, maintained their wrists and fingers in a fixed position and used fewer than two fingers to activate keys. The amount of variance explained by each model varied from 8 to 56%. SSCS was the most common predictor of keyboarding style (54% of significant models), followed by age (35% of significant models), diagnosis (19% of significant models), and touch typing training (15% of significant models). Conclusion Severity of structural changes and age are significant predictors of keyboarding style for computer operators with RA. The keyboarding styles used by computer operators with RA appear to reduce typing productivity and have the potential to put stress on joints already affected by RA. Computer operators with RA may benefit from worksite modifications that address keyboarding style such as alternate keyboards.

SummaryObjective: Assessment of the effect of intraarticular anaesthesia on lameness caused by medial coronoid disease.Methods: This study included 90 dogs that were evaluated for the complaint of unilateral forelimb lameness. All dogs were suspected of having an elbow problem for which orthopaedic examination and radiographs showed inconclusive findings. Following a short sedation, mepivacaine was injected intra-articularly to determine whether lameness was caused by a suspected elbow problem. This effect was compared with the final diagnosis based on computed tomography and arthroscopy.Results: Out of 90 dogs, 78 (87%) dogs had an improvement of lameness after injection of the local anaesthetic, which confirmed the elbow joint as the primary source of lameness. A positive response was seen in all types of medial coronoid lesions. A false negative result was observed in 12 dogs (13%).Clinical relevance: Medial coronoid disease is represented by different types of pathologic lesions...

The purpose of this study was to evaluate the outcome of implant arthroplasty according to subjective, biomechanic, and radiographic parameters over a long period of time. Implants in 40 feet (27 patients) were analyzed at an average follow-up time of 8.25 years and a mean patient age of 63. The results were consistent with the subjective findings of previous studies that demonstrated that most patients were satisfied with the procedure. Ninety-six percent of the patients in this study confirmed they would undergo the procedure a second time. The radiographic results did not demonstrate a high incidence of implant fracture as previously reported. This review suggests that implants can be effective when used with patients who are carefully selected according to age, activity level, and diagnosis.

The aim of this study was to evaluate the prevalence of hip and elbow dysplasia in a group of growing Labrador retrievers fed a fish-based diet enriched with nutraceuticals with chondroprotective properties. The puppies ranged from 3 to 12 mo of age and were divided into 2 groups, each fed a different diet. The control diet consisted of a high quality, chicken-based dog food, while the test diet was a fish-based dog food, enriched with nutraceuticals. Hip and elbow joints were radiographed and scored at 6 and 12 mo of age. Overall, 42 dogs completed the study. At 12 mo of age, no differences were found between the groups in the prevalence of hip and elbow dysplasia, although dogs fed the fish-based food enriched with nutraceuticals had a less severe grade of osteoarthritis at 12 mo. It was concluded that the fish-based diet with nutraceuticals did have beneficial effects on the development of severe osteoarthritis.

Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance.

The use of knee-ankle-foot orthoses with drop locked knee joints produces some limitations for walking in subjects with quadriceps muscle weakness. The development of stance control orthoses can potentially improve their functionality. The aim of this review was to compare the evidence of the effect of stance control orthoses to knee-ankle-foot orthoses with drop locked knee joints in improving kinematic variables and energy efficiency of walking by subjects with quadriceps muscle weakness caused by different pathologies. Literature review. Based on selected keywords and their composition, a search was performed in Google Scholar, PubMed, ScienceDirect, and ISI Web of Knowledge databases. In total, 18 articles were finally chosen for review. The results of this study demonstrated that this type of orthosis can improve the walking parameters of subjects with quadriceps muscle weakness and spinal cord injury patients when compared to a locked knee-ankle-foot orthosis. There is evidenc...

Planning has been hypothesized to operate as a mediator linking intentions to health behaviors. To explore the temporal variation of these constructs and their interrelationships, a long-term study of intentions, planning, and physical activity was conducted. Method: A sample of 328 individuals in orthopedic rehabilitation provided data at five measurement occasions over 3 years after their discharge from rehabilitation. A process-oriented approach combining mediation analysis and latent growth curve (LGC) modeling was applied. Results: The orthopedic rehabilitation led to an initial increase in planning and behavior, followed by a decrease after 6 months and stabilization for the next 2.5 years. Intention revealed a slight but constant decrease for 6 months and remained stable up to 3 years after rehabilitation. The mediation model confirmed planning as mediator between intention and physical activity in former rehabilitation participants. Conclusions: Prior evidence on the mediating role of planning in the intention-behavior relation is corroborated and extended by the present findings at the level of long-term processes. Planning can and should be integrated in rehabilitation treatment programs to facilitate sustainable recovery.

Background and Aims: The reported frequency of extraintestinal manifestations in inflammatory bowel disease varies from 6% to 47%. We evaluated extraintestinal manifestations of inflammatory bowel disease patients who were followed up in our clinic. Materials and Methods: The epidemiological findings, disease duration, extraintestinal manifestations, and complications were evaluated between April 1998 and April 2008, retrospectively. Results: Four hundred and ninety-four patients (254 males; mean age, 38,63±13,32 years; range, 16-78) were evaluated: 283 (57,3%) with ulcerative colitis, 194 (39,3%) with Crohn's disease and 17 (3.4%) with indeterminate colitis. The mean disease duration was 70,66±75,93 months (1-1008 months), and the mean follow-up was 36,40±45,09 months (1-288 months). The extraintestinal manifestation rate was 19.2% (95/494) in the whole group, and included arthritis in 32 (6,5%), hepatobiliary in 13 (2,6%), skin in 13 (2,6%), multiple extraintestinal manifestations in 16 (3,2%), renal calculus in 12 (2,4%), thromboembolic events in 5 (1%), and eye involvement in 4 (0,8%). Complications were observed in a total of 78 patients (15,8%). Complication rates were as follows: 29 (5,9%) abscess, 15 (3%) perforation, 5 (1%) malignancy, 1 (0,2%) toxic megacolon, and 15 (2,6%) others. The complication rate was higher in Crohn's disease than ulcerative colitis (29,3% vs 3,6%). There was a positive correlation between extraintestinal manifestations and the complication rate in ulcerative colitis (p=0,007, r=0,173), and a positive correlation was observed between colonic involvement and extraintestinal manifestations in Crohn's disease (p=0,04, r=0,144). Conclusions: The most common extraintestinal manifestation was arthritis, and the most frequently seen complications were abscess and perforation. The complication rate was higher in Crohn's disease than ulcerative colitis. Extraintestinal manifestations may enhance the complication rate in UC. In Crohn's disease, the extraintestinal manifestations rate is higher in colonic involvement than in ileocolonic and ileal involvement. Colonic involvement in Crohn's disease is a predictive factor for extraintestinal manifestations.

Background: Intra-articular injections of the glenohumeral joint are an important tool for orthopedic surgeons who treat the spectrum of shoulder disorders. Previous studies, however, have suggested that these injections may not be reliably placed intra-articularly in the glenohumeral joint when performed in the office setting and that radiographic assistance may be necessary. This study assessed the accuracy of a glenohumeral injection through an anterior approach with arthroscopic confirmation. Materials and methods: The study included 75 consecutive patients who were undergoing routine shoulder arthroscopy for a variety of shoulder disorders. All underwent anterior placement of a 1.5-inch, 21-gauge needle using a location just lateral to the coracoid and angled 45 toward the glenohumeral joint. After injection of sterile saline, a diagnostic arthroscopy was initiated through a standard posterior portal. The needle was considered intra-articular if fluid was expressed from the eyelet of the needle when the arthroscopy pump was turned on or with direct visualization of the needle with the arthroscope, or both. Results: The needle was visualized with the arthroscope in all 75 patients (100%). In 70 patients (93.3%), fluid was expressed through the eyelet of the needle when the arthroscopy pump was turned on. Conclusions: The results of this study show that an anterior injection into the glenohumeral joint can be accurately placed without radiographic assistance using standard landmarks. The technique used is similar to making a standard rotator interval portal during shoulder arthroscopy; therefore, it is most successful in the hands of experienced shoulder arthroscopists.

Children with cerebral palsy (CP) have many neurological deficits that interfere with motor function and daily activities. These impairments include neuromuscular and musculoskele-tal problems such as spasticity, muscle contractures, dyscoordi-nation, loss of selective motor control, ...

S houlder dysfunction is the second most common musculoskeletal problem seen in physical therapy 42 and affects approximately 16% to 21% of the population. 22,43 It is a leading cause of sick days among young adults, 21 and its prevalence in persons 65 years and older is 34%. 24 The direct cost for the treatment of shoulder dysfunction in the United States exceeds $7 billion annually. 30 There are numerous underlying musculoskeletal causes of shoulder dysfunction. These include tendinopathy, bursitis, rotator cuff tear, adhesive capsulitis, avascular necrosis, shoulder impingement syndrome, glenohumeral osteoarthritis, and trauma from injury. Shoulder dysfunction results in a variety of impairments such as pain, stiffness, weakness, postural deviations, and altered glenohumeral rhythm. These impairments, in turn, lead to limitation of activities of daily living such as reaching, lifting, overhead movements, carrying, pushing, pulling, grooming, and sleep. Common approaches to treating individuals with shoulder dysfunction are corticosteroid injections, nonsteroidal anti-inflammatory drugs, manipulation under general anesthesia, arthroscopic surgery, and physical therapy intervention, including therapeutic exercises, manual therapy, and various modalities. Prior studies have shown that medical and surgical interventions are not superior to physical therapy interventions for patients with shoulder dysfunction. 11,15,42 Therapeutic exercise is defined as "the systematic performance or execution of T T LEVEL OF EVIDENCE: Therapy, level 1a- .

Impingement is defined as a painful limitation of motion. Impingement lesions as identified on MR imaging of the ankle may relate to a range of soft tissue or bony pathologies that can be interpreted as predisposing to painful limitation of motion, accepting that the diagnosis of impingement remains clinical and not radiological. Typically, impingement lesions are classified according to their location and whether the underlying pathology is osseous or soft tissue in nature. Most commonly, impingement lesions relate to posttraumatic synovitis and intra-articular fibrous bands-scar tissue, capsular scarring, or bony prominences, the latter either developmental or acquired. Well-recognized sites of impingement around the ankle include the anterolateral, centroanterior, anteromedial, posteromedial, and posterior sites. This article reviews the anatomy in these regions and focuses on common causes of impingement around the ankle; their pathogenesis, clinical features, and management; th...

To explore the relationship between human immunodeficiency virus (HIV) infection and soft tissue rheumatic lesions in HIV-positive black Zambians. We performed a prospective study of all patients over 18 years of age attending a rheumatic clinic in a teaching hospital. All patients underwent routine blood tests, and radiographs were performed when indicated. HIV status was determined by ELISA, and clinical staging was determined by World Health Organization criteria. Patients with isolated sacroiliac pain, enthesitis, or a soft tissue lesion were selected for analysis. For HIV-positive patients, only those in clinical stage 1 (asymptomatic or persistent generalized lymphadenopathy) were selected. Our study cohort comprised 120 patients (41 men, 79 women, age 23-70 yrs). Diagnosis and number (% HIV positive) were distributed as follows: sacroiliitis, 14 (100%); heel pain, 14 (100%); costochondritis, 3 (100%); polyenthesitis (&gt; or = 4 sites), 20 (100%); carpal tunnel syndrome, 8 (6...

We report the case of a professional baseball pitcher who achieved complete relief of an anterior knee pain after resection of a complete type of suprapatellar plica under arthroscopy. The 27-year-old male professional baseball pitcher had complained of right anterior knee pain while pitching for more than 2 years. On physical examination, the mobility of his patella was limited and he complained of tenderness along the joint line of his lateral patellofemoral joint. The preoperative patellofemoral axial radiograph showed osteophyte formation on the lateral edge of the patella. On preoperative magnetic resonance imaging, a septum dividing the suprapatellar pouch was found. Arthroscopy revealed obvious cartilaginous damage on the lateral facet of the patella and facing trochlea of the femoral condyle. There was a complete type of suprapatellar plica. The suprapatellar plica seemed to be anchoring the patella, which reduced the mobility of the patella. After resecting the complete type of suprapatellar plica under arthroscopy, the mobility of the patella was improved. Because his anterior knee pain while pitching reduced rapidly postoperatively, he could return to regular baseball. We consider that the main cause of his anterior knee pain was cartilaginous damage on the patella and the trochlea, which might be accelerated by the existence of the suprapatellar plica that reduced the mobility of the patella.

OUTINE radiographic technique has severe limitations in the assessment of bone and joint pathology.' Identification of pathology at a reversible or treatable stage is a goal that has proven elusive. Identification of alterations, with radiologic dimensions c I mm in size. is not possible using routine technology.'.' Xeroradiology had been used as an interim technique because of higher resolution than routine radiography. but the requirement for specialized equipment and processing has limited its general use. As Talbott et al pointed out over 25 years ago, magnification techniques offer a mechanism to achieve the necessary radiographic definition." Basically, two forms of magnification are currently available: optical and geometrical. The information provided by either technique is comparable.' OPTICAL MAGNIFICATION The optical method" uses nonradiographic techniques (ie, photographic or magnifying glass enlargement) on the original radiograph. Use of routine x-ray film is not practical as enlargement results in a very "grainy" picture that does not provide any additional information.' It is the size of the grain that most limits any benefits derived by enlargement. Since the speed of film is inversely related to grain sire, the use of finer grain film has been explored. Fine-grain x-raq films, however, require prolonged exposure time. increased radiation exposure, and special hand processing. The requirement for a prolonged From /he Menorah Medical Crnrcr. Kansas <'in,. MO,

Methods A primary care database with an average population of 30,000 patients per year aged 18 or older was used to select patients who consulted their general practitioner (GP) with shoulder complaints in the year 1998. Information about consultations for shoulder complaints was ...

Seventy-seven patients with idiopathic frozen shoulder syndrome were included in a prospective study to compare the effect of intensive physical rehabilitation treatment, including passive stretching and manual mobilization (stretching group) versus supportive therapy and exercises ...

This study evaluated the effect of notchplasty (enlargement of the intercondylar fossa) in stable and unstable canine stifles. Bilateral notchplasty and unilateral cranial cruciate ligament (CrCL) transection were performed in 6 dogs. Exercise, consisting of walking 1.5 miles three times a week, began 1 month after surgery and continued until euthanasia 6 months after surgery. EvaIuation methods included orthopedic examination, serial radiographs, thin section radiography, histopathology, and gross pathology. Notchplasty in the stable stifle did not cause lameness beyond 3 weeks, joint instability, or degenerative joint disease. In the stable stifle, smooth resurfacing of the notchplasty site with fibrous and osseous tissue occurred. Stifles with notchplasty and CrCL transection exhibited persistent lameness, instability, and degenerative joint disease. In CrCL deficient stifles osteophytes formed within the notchplasty site, resulting in a rough surface. Our observations indicated significant refilling in notchplasties of both stable and unstable stifles (P < .05). However, the intercondylar fossa (ICF) width 6 months after notchplasty was significantly smaller in unstable stifles compared with stable stifles (P < .05) indicating that greater refilling of the notchplasties occurred in the unstable stifles. In clinical cases, notchplasty should be larger than the desired final result to accomodate the partial refilling that occurs even in stable stifles.

The B-B Score is a straightforward kinematic shoulder function score including only two movements (hand to the Back + lift hand as to change a Bulb) that demonstrated sound measurement properties for patients for various shoulder pathologies. However, the B-B Score results using a smartphone or a reference system have not yet been compared. Provided that the measurement properties are comparable, the use of a smartphone would offer substantial practical advantages. This study investigated the concurrent validity of a smartphone and a reference inertial system for the measurement of the kinematic shoulder function B-B Score. Sixty-five patients with shoulder conditions (with rotator cuff conditions, adhesive capsulitis and proximal humerus fracture) and 20 healthy participants were evaluated using a smartphone and a reference inertial system. Measurements were performed twice, alternating between two evaluators. The B-B Score differences between groups, differences between devices, r...

Background Understanding acetabular pathomorphology is necessary to correctly treat patients with hip complaints. Existing radiographic parameters classify acetabular coverage as deficient, normal, or excessive but fail to quantify contributions of anterior and posterior wall coverage. A simple, reproducible, and valid measurement of anterior and posterior wall coverage in patients with hip pain would be a clinically useful tool. Questions/Purposes We (1) introduce the anterior wall index (AWI) and posterior wall index (PWI), (2) report the intra-and interobserver reliability of these measurements, and (3) validate these measurements against an established computer model. Methods We retrospectively reviewed 87 hips (63 patients) with symptomatic hip disease. A validated computer model was used to determine total anterior and posterior acetabular coverage (TAC and TPC) on an AP pelvis radiograph. Two independent observers measured the AWI and PWI on each film, and the intraclass correlation coefficient (ICC) was calculated. Pearson correlation was used to determine the strength of linear dependence between our measurements and the computer model. Results Intra-and interobserver ICCs were 0.94 and 0.99 for the AWI and 0.81 and 0.97 for the PWI. For validation against the computer model, Pearson r values were 0.837 (AWI versus TAC) and 0.895 (PWI versus TPC). Mean AWI and PWI were 0.28 and 0.81 for dysplastic hips, 0.41 and 0.91 for normal hips, 0.61 and 1.15 for hips with a deep acetabulum. Conclusions Our data suggest these measures will be helpful in evaluating anterior and posterior coverage before and after surgery but need to be evaluated in asymptomatic individuals without hip abnormalities to establish normal ranges. Level of Evidence Level III, diagnostic study. See Instructions for Authors for a complete description of levels of evidence.

Pain and functional impairment associated with joint disease are major problems for people with hemophilia, and impact on health-related quality of life (HRQoL) may vary across groups defined by demographic and treatment-related characteristics. To evaluate differences in overall HRQoL, pain, function, and joint status between P-FiQ study subgroups. Adult males with hemophilia and a history of joint pain/bleeding completed a pain history and the patient-reported outcome instruments EQ-5D-5L, Brief Pain Inventory v2 Short Form (BPI), International Physical Activity Questionnaire (IPAQ), and Hemophilia Activities List (HAL); optionally, joint status was assessed (Hemophilia Joint Health Score v2.1 [HJHS]). Scores were analyzed between subgroups across sets of participant characteristics. A total of 381 adult males with hemophilia were enrolled, with median age of 34 years. Worse scores on EQ-5D-5L index, BPI pain severity/interference, HAL overall score, and HJHS were generally associ...

A retrospective analysis was undertaken of 30 consecutive THA performed in 25 patients with hypoplastic proximal femurs, who had received a 9-mm uncemented modular S-ROM stem. The mean patient age was 42 years (17-69 years), mean height was 152.5cm (130-170.5 cm), mean weight was 63 kg (39-90 kg), and mean follow-up period was 19 years (range, 12-23 years). Subsidence was seen in 2 hips, with asymptomatic femoral osteolysis present in 11 hips; overall survival of the femoral stem was 93.3%, with two revisions of the femoral component required for aseptic loosening. After a mean follow-up of 19 years, the use of the S-ROM 9 mm femoral stem in the patient with the small femur was associated with a low revision rate due to aseptic loosening of the stem.