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Affected Joints (affected + joint)
Selected AbstractsDomiciliary application of CryoCuff in severe haemophilia: qualitative questionnaire and clinical auditHAEMOPHILIA, Issue 4 2008A. I. D'YOUNG Abstract., The acute management of haemophilic bleeding episodesin the home setting is based on the concept of immediate factor replacement therapy and the PRICE regime , an acronym representing the concepts of Protection, Rest, Ice, Compression and Elevation [1,2]. Integral to this regime is the application of cold therapy, and yet little is known regarding the safe periods of application, or the relative safety of cryotherapy devices such as the CryoCuffÔ when used in the home setting by patients suffering from severe haemophilia and related bleeding disorders. This study examines the subjective patient response to the application of the CryoCuffÔ device in the home setting in terms of the effect on pain, joint swelling and the return to ,pre-bleed status' of the knee, ankle or elbow in patients with severe haemophilia A/B or type III von Willebrand's disease (VWD) immediately following haemarthrosis, and any potential adverse effects related to the device or recommended duration of application as stated in the PRICE guideline (Fig. 1). Twelve patients, either with severe haemophilia A/B or with VWD were recruited and asked to use the CryoCuffÔ device as part of the PRICE regime immediately following the onset of knee-, ankle- or elbow bleeds for the next one year. Each subject was then sent a qualitative questionnaire to determine subjective responses to the device. All patients reported that the application protocol was easy to follow, they were able to apply the device as per the PRICE regime and they were able to tolerate it for the recommended period. Whereas, all the patients felt that the device had a significant impact on alleviation of pain and return to pre-bleed status, 78% of the patients felt that the device led to a significant reduction in swelling around the affected joint. There was no conclusive evidence that the device resulted in any reduction in the amount of factor used to treat the acute bleeding episode, however, no patients reported any perceived delay in achieving haemostasis or required extra factor replacement therapy consequent to the usage of the device. No other adverse effects were reported by participants in this study. Figure 1. ,The qualitative participant questionnaire, given following 1 year of unsupervised use in the home setting immediately following the onset of the symptoms of haemarthroses. [source] Body posture during sleep and disc displacement in the temporomandibular joint: a pilot studyJOURNAL OF ORAL REHABILITATION, Issue 2 2005H. HIBI summary, ,Many possible factors associated with internal derangement of the temporomandibular joint (TMJ) have been discussed, but the causal factors remain unproven. The present study aimed to investigate habitual body posture during sleep (HBP) of patients with anterior disc displacement (ADD) in the TMJ. The sample comprised 87 patients (12 males, 75 females) aged 13,68 years (mean 25 years) and diagnosed by magnetic resonance imaging as having unilateral or bilateral ADD in the TMJ. The HBPs were classified into five categories: supine, prone, right lateral, left lateral, and no-dominant positions. Of the 50 patients with the unilateral ADD, 33 (66%) had the ipsilateral HBP to the affected joint while none (0%) had the contralateral HBP. This contrast showed that the HBP was a possible contributing factor to the ADD. It was suggested that HBP allows the ipsilateral condyle to displace posteriorly and this posterior position causes relative ADD. [source] Expression of interleukin-1,, cyclooxygenase-2, and prostaglandin E2 in a rotator cuff tear in rabbitsJOURNAL OF ORTHOPAEDIC RESEARCH, Issue 1 2007Hiroshi Koshima Abstract We investigated the specific factors related to shoulder pain due to a rotator cuff tear using a model in rabbits. A rotator cuff tear was surgically created, and the expression of interleukin-1, (IL-1,), prostaglandin E2 (PGE2), and cyclooxygenase-2 (COX-2) was analyzed. In the supernatant of the tissue culture of the torn tendon, IL-1, production was detected. The amount of IL-1, was highest 1 day after injury, and then decreased gradually to 21 days. PGE2, the mediator of pain and the product of COX-2, was also detected in the supernatant of the tissue culture. The production of PGE2 significantly increased to 7 days after injury, and then decreased to 21 days. RT-PCR analysis confirmed the mRNA expression of IL-1, and COX-2 in the torn tendon. Immunohistochemical study demonstrated that cells in the tendon stump were immunopositive for IL-1, and COX-2. Furthermore, in the affected joint, articular chondrocytes in the remote area from the tear expressed COX-2 strongly. When the rotator cuff is torn, IL-1, is produced in the torn tendon, and stimulates the expression of COX-2 in not only the torn tendon but also in articular chondrocytes. The COX-2 then produces PGE2, which would mediate shoulder pain. © 2006 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res 25:92,97, 2007 [source] Patterns of intraneural ganglion cyst descentCLINICAL ANATOMY, Issue 3 2008Robert J. Spinner Abstract On the basis of the principles of the unifying articular theory, predictable patterns of proximal ascent have been described for fibular (peroneal) and tibial intraneural ganglion cysts in the knee region. The mechanism underlying distal descent into the terminal braches of the fibular and tibial nerves has not been previously elucidated. The purpose of this study was to demonstrate if and when cyst descent distal to the articular branch-joint connection occurs in intraneural ganglion cysts to understand directionality of intraneural cyst propagation. In Part I, the clinical records and MRIs of 20 consecutive patients treated at our institution for intraneural ganglion cysts (18 fibular and two tibial) arising from the superior tibiofibular joint were retrospectively analyzed. These patients underwent cyst decompression and disconnection of the articular branch. Five of these patients developed symptomatic cyst recurrence after cyst decompression without articular branch disconnection which was done elsewhere prior to our intervention. In Part II, five additional patients with intraneural ganglion cysts (three fibular and two tibial) treated at other institutions without disconnection of the articular branch were compared. These patients in Parts I and II demonstrated ascent of intraneural cyst to differing degrees (12 had evidence of sciatic nerve cross-over). In addition, all of these patients demonstrated previously unrecognized MRI evidence of intraneural cyst extending distally below the level of the articular branch to the joint of origin: cyst within the proximal most portions of the deep fibular and superficial fibular branches in fibular intraneural ganglion cysts and descending tibial branches in tibial intraneural ganglion cysts. The patients in Part I had complete resolution of their cysts at follow-up MRI examination 1 year postoperatively. The patients in Part II had intraneural recurrences postoperatively within the articular branch, the parent nerve, and the terminal branches, although in three cases they were subclinical. The authors demonstrate that cyst descent distal to the take-off of the articular branch to the joint of origin occurs regularly in patients with fibular and tibial intraneural ganglion cysts. The authors believe that parent terminal branch descent follows ascent up the articular branch from an affected joint of origin. This mechanism for bidirectional flow explains cyst within terminal branches of the fibular and tibial nerves and is dependent on pressure fluxes and resistances. This new pattern is consistent with principles previously described in a unified (articular) theory, is generalizable to other intraneural ganglion cysts arising from joints, and has important implications for pathogenesis and treatment of these intraneural cysts. Clin. Anat. 21:233,245, 2008. © 2008 Wiley-Liss, Inc. [source] Arthroscopic reattachment of osteochondritis dissecans lesions using resorbable polydioxanone pinsEQUINE VETERINARY JOURNAL, Issue 5 2004A. J. NIXON Summary Reasons for performing study: Debridement of osteochondritis dissecans (OCD) cartilage lesions results in fibrocartilage and imperfect hyaline repair tissue, and forms a permanent irregularity to the subchondral bone plate. Objective: To evaluate the clinical, radiographic and outcome effects of OCD cartilage flap reattachment for select lesions as an alternative to OCD debridement. Hypothesis: Separated cartilage flaps resulting from OCD lesions may be re-incorporated into the hyaline cartilage surface by reattachment rather than debridement and removal. Methods: Resorbable polydioxanone pins were used to reattach OCD flap lesions in 16 joints of 12 horses. Criteria for attachment, rather than removal, included an unmineralised cartilage flap on preoperative radiographs and a relatively smooth surface with some residual perimeter attachment at surgery. Results: There were 12 subjects, 6 males and 6 females, 7 Thoroughbred or Standardbred weanlings, 3 Warmbloods, 1 Arabian and 1 Quarter Horse, mean age at surgery 6.8 months. All horses had effusion of the affected femoropatellar joint (n = 9), tarsocrural joint (n = 1) or fetlock (n = 2). Radiographic lesions varied in length between 1.8,6.3 cm; reattachment was used in 16 of 18 affected joints and the OCD cartilage was not satisfactory for salvage in 2 stifles. Number of pins required was 2,10. One horse was subjected to euthanasia due to a tendon laceration 8 weeks after surgery; of the remaining 11 horses, mean duration of follow-up was 3.9 years (range 4 months-8 years). Nine of these were sound and had entered work, while 2 were sound but remained unbroken 4 and 6 months post operatively, respectively. Radiographic resolution of the OCD lesion occurred in 14 of 16 pinned joints in the 9 horses with long-term follow-up. The 2 remaining joints had a 3 and a 5 mm mineralised flap in the original defect sites. Conclusions: This study indicated cartilage flap reattachment was an alternative to removal in selected OCD lesions. Potential relevance: Relatively smooth OCD cartilage flaps may be salvaged by reattachment and can result in normal radiographic subchondral contour and a high likelihood of athletic performance. Further case numbers are required to determine which lesions are too irregular or contain too much mineral for effective incorporation after reattachment. [source] The co effect of prophylaxis and radiosynovectomy on bleeding episodes in haemophilic synovitisHAEMOPHILIA, Issue 3 2008J. BRECELJ Summary., Prophylactic substitution treatment and radiosynoviorthosis have a leading role in preventing irreversible haemophilic arthropathy. The aim of the study was to evaluate the effects of prophylaxis treatment and radiosynovectomy on the length of intervals between subsequent haemorrhages in haemophilic patients. Thirty-three joints were treated with radiosynovectomy in 28 patients with bleeding disorders. 90Y colloid was used in knees and 186Re colloid for elbows, shoulders and ankles. Twenty patients were on prophylaxis. Joint X-rays were evaluated on the Pettersson scale between 0 (normal) and 13 (severe joint destruction). During an observation period (range 6,44 months) bleeding episodes were recorded and data statistically analysed. Before radiosynovectomy, increasing intensity of the prophylaxis 10% lengthens intervals between two haemorrhages by 1% (P < 0.05). In patients with a Pettersson score higher than nine, intervals between bleedings are shorter by 73% (P < 0.05), in comparison with patients with lower Pettersson scores of 0,5. After radiosynovectomy, the length of the first non-bleeding interval increased by 120% (to 60 days) in comparison with the intervals before the procedure (P < 0.001). But, in the following year and half, every subsequent non-bleeding interval was 8% shorter (P < 0.1). In that period, prophylaxis shortened the non-bleeding interval by 1.7% (P < 0.05) per 10% increase of its intensity. Radiosynovectomy is more efficient in patients with less affected joints and is less efficient in younger patients. Prophylaxis reduced time between the bleedings episodes after isotope application. Before radiosynovectomy, prophylaxis reduces the number of haemorrhages. Our findings support data previously published by Rodriguez-Merchan et al. [J Thromb Haemost, 5 (2007) P-W-126]. [source] Clinical and radiographic scores in haemophilic arthropathies: how well do these correlate to subjective pain status and daily activities?HAEMOPHILIA, Issue 6 2002T. Wallny Summary. Haemophilic patients who reached adulthood before the establishment of prophylactic treatment frequently show multiple and substantial arthropathies. The aim of this study was to determine to what extent haemophiliac's subjective impairment due to arthropathies correlates with objective clinical and radiographic parameters. By means of a questionnaire and a visual analogue scale, we consulted 79 haemophiliacs concerning their joint-pain status, how these were treated and to what extent their daily activities had been affected. Using a scoring system suggested by the Advisory Committee of the World Federation of Haemophilia, clinical evaluation was performed. Radiographs of 60 patients were assessed by means of the Petterson scale. The results were statistically compared. We found a significant correlation between pain intensity and clinical pathology as well as between pain intensity and radiographic joint damage for both knees and for the right ankle. The number of painful joints correlated well with the number of clinically/radiographically affected joints. The more pronounced the objective damage to joints, the more frequently patients claimed to have constant pain, depressive episodes and a dependency on pain-relieving medication. The more pronounced the objectively assessed damage to the knee and ankle joint, the higher the likelihood that the patient suffers from severe joint pain and reduction of activity. Treatment of painful symptoms from arthropathies is often insufficient. Scores and questionnaires may help to define the haemophiliacs pain status more clearly, thereby offering a possibility of assessment and long-term observation. [source] Neurorehabilitation of Upper Extremities in Humans with Sensory-Motor ImpairmentNEUROMODULATION, Issue 1 2002Dejan B. Popovic PhD Abstract Today most clinical investigators agree that the common denominator for successful therapy in subjects after central nervous system (CNS) lesions is to induce concentrated, repetitive practice of the more affected limb as soon as possible after the onset of impairment. This paper reviews representative methods of neurorehabilitation such as constraining the less affected arm and using a robot to facilitate movement of the affected arm, and focuses on functional electrotherapy promoting the movement recovery. The functional electrical therapy (FET) encompasses three elements: 1) control of movements that are compromised because of the impairment, 2) enhanced exercise of paralyzed extremities, and 3) augmented activity of afferent neural pathway. Liberson et al. (1) first reported an important result of the FET; they applied a peroneal stimulator to enhance functionally essential ankle dorsiflexion during the swing phase of walking. Merletti et al. (2) described a similar electrotherapeutic effect for upper extremities; they applied a two-channel electronic stimulator and surface electrodes to augment elbow extension and finger extension during different reach and grasp activities. Both electrotherapies resulted in immediate and carry-over effects caused by systematic application of FET. In studies with subjects after a spinal cord lesion at the cervical level (chronic tetraplegia) (3,5) or stroke (6), it was shown that FET improves grasping and reaching by using the following outcome measures: the Upper Extremity Function Test (UEFT), coordination between elbow and shoulder movement, and the Functional Independence Measure (FIM). Externally applied electrical stimuli provided a strong central sensory input which could be responsible for the changes in the organization of impaired sensory-motor mechanisms. FET resulted in stronger muscles that were stimulated directly, as well as exercising other muscles. The ability to move paralyzed extremities also provided awareness (proprioception and visual feedback) of enhanced functional ability as being very beneficial for the recovery. FET contributed to the increased range of movement in the affected joints, increased speed of joint rotations, reduced spasticity, and improved functioning measured by the UEFT, the FIM and the Quadriplegia Index of Function (QIF). [source] The melanocortin system in articular chondrocytes: Melanocortin receptors, pro-opiomelanocortin, precursor proteases, and a regulatory effect of ,-melanocyte,stimulating hormone on proinflammatory cytokines and extracellular matrix componentsARTHRITIS & RHEUMATISM, Issue 10 2009Susanne Grässel Objective The pro-opiomelanocortin (POMC),derived neuropeptide ,-melanocyte,stimulating hormone (,-MSH) mediates its effects via melanocortin (MC) receptors. This study was carried out to investigate the expression patterns of the MC system and the effects of ,-MSH in human articular chondrocytes. Methods Articular chondrocytes established from human osteoarthritic joint cartilage were analyzed by reverse transcription,polymerase chain reaction (RT-PCR) and Western blotting for the expression of MC receptors, POMC, and prohormone convertases (PCs). MC-1 receptor (MC-1R) expression in articular cartilage was further studied by immunohistochemistry. Ca2+ and cAMP assays were used to monitor ,-MSH signaling, while studies of ,-MSH function were performed in cultures with chondrocyte micromass pellets stimulated with ,-MSH. Expression of cytokines and extracellular matrix (ECM) components was determined by real-time RT-PCR, Western immunoblotting, and enzyme-linked immunosorbent assays. Results MC-1R expression was detected in articular chondrocytes in vitro and in articular cartilage in situ. In addition, expression of transcripts for MC-2R, MC-5R, POMC, and PCs was detected in articular chondrocytes. Stimulation with ,-MSH increased the levels of intracellular cAMP, but not Ca2+, in chondrocytes. Both messenger RNA and protein expression of various proinflammatory cytokines, collagens, matrix metalloproteinases (MMPs), and SOX9 was modulated by ,-MSH. Conclusion Human articular chondrocytes are target cells for ,-MSH. The effects of ,-MSH on expression of cytokines and MMPs suggest that this neuropeptide plays a role in inflammatory and degenerative processes in cartilage. It is conceivable that inflammatory reactions can be mitigated by the induction of endogenous MCs or administration of ,-MSH to the affected joints. The induction pattern of regulatory and structural ECM components such as collagens as well as SOX9 and anabolic and catabolic cytokines points to a function of ,-MSH as a trophic factor in skeletal development during endochondral ossification rather than as a factor in homeostasis of permanent cartilage. [source] Gamma/delta T cells are the predominant source of interleukin-17 in affected joints in collagen-induced arthritis, but not in rheumatoid arthritisARTHRITIS & RHEUMATISM, Issue 8 2009Yoshinaga Ito Objective Although interleukin-17 (IL-17),producing ,/, T cells were reported to play pathogenic roles in collagen-induced arthritis (CIA), their characteristics remain unknown. The aim of this study was to clarify whether ,/, T cells or CD4+ T cells are the predominant IL-17,producing cells, and to determine what stimulates ,/, T cells to secret IL-17 in mice with CIA. The involvement of IL-17,producing ,/, T cells in SKG mice with autoimmune arthritis and patients with rheumatoid arthritis (RA) was also investigated. Methods IL-17,producing cells in the affected joints of mice with CIA were counted by intracellular cytokine staining during 6 distinct disease phases, and these cells were stimulated with various combinations of cytokines or specific antigens to determine the signaling requirements. Similar studies were performed using SKG mice with arthritis and patients with RA. Results Gamma/delta T cells were the predominant population in IL-17,producing cells in the swollen joints of mice with CIA, and the absolute numbers of these cells increased in parallel with disease activity. IL-17,producing ,/, T cells expressed CC chemokine receptor 6, were maintained by IL-23 but not by type II collagen in vitro, and were induced antigen independently in vivo. Furthermore, IL-17 production by ,/, T cells was induced by IL-1, plus IL-23 independently of T cell receptor. In contrast to what was observed in mice with CIA, IL-17,producing ,/, T cells were nearly absent in the affected joints of SKG mice and patients with RA, and Th1 cells were predominant in the joints of patients with RA. Conclusion Gamma/delta T cells were antigen independently stimulated by inflammation at affected joints and produced enhanced amounts of IL-17 to exacerbate arthritis in mice with CIA but not in SKG mice with arthritis or patients with RA. [source] Early elevation in circulating levels of C-telopeptides of type II collagen predicts structural damage in articular cartilage in the rodent model of collagen-induced arthritisARTHRITIS & RHEUMATISM, Issue 9 2006Svetlana Oestergaard Objective To investigate changes in the circulating levels of the C-telopeptide of type II collagen (CTX-II) with relation to disease onset and structural damage of cartilage in a rodent model of collagen-induced arthritis (CIA), and to investigate immunolocalization of the CTX-II epitope in the articular cartilage of affected joints. Methods Seven-week-old female Lewis rats were immunized with type II collagen and monitored using blood sampling at weekly intervals. At study termination (day 23), the animals were killed, synovial fluid was collected, and the affected joints were scored macroscopically for disease severity and underwent immunohistochemical evaluation. Results At the time of disease onset (day 15), which was characterized by redness and swelling of the affected joints (mean ± SD macroscopic severity score 9.1 ± 1.6), there was a 355% increase in serum CTX-II levels. The early change in serum CTX-II from day 0 to day 15 showed a significant association with the severity of cartilage damage (r = 0.61, P < 0.01). Immunostaining revealed extensive presence of the CTX-II epitope in the damaged, uncalcified cartilage tissue. Conclusion The elevation in serum CTX-II concomitant with the onset of disease and proportional to cartilage damage demonstrates that CTX-II is a sensitive diagnostic tool for monitoring joint disease in the rodent model of CIA. Furthermore, the immunohistochemical findings are consistent with the concept that the major source of serum CTX-II is the damaged articular cartilage. [source] | |||||||||||||