Radiology case of the month. Growing pains. Slipped capital femoral epiphysis.
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Adolescent↗
Biomedical subjects
J Monu
Publications and source records attributed to J Monu.
A randomized trial comparing aerobic exercise and resistance exercise with a health education program in older adults with knee osteoarthritis. The Fitness Arthritis and Seniors Trial (FAST).
OBJECTIVE: To determine the effects of structured exercise programs on self-reported disability in older adults with knee osteoarthritis. SETTING AND DESIGN: A randomized, single-blind clinical trial lasting 18 months conducted at 2 academic medical centers. PARTICIPANTS: A total of 439 community-dwelling adults, aged 60 years or older, with radiographically evident knee osteoarthritis, pain, and self-reported physical disability. INTERVENTIONS: An aerobic exercise program, a resistance exercise program, and a health education program. MAIN OUTCOME MEASURES: The primary outcome was self-reported disability score (range, 1-5). The secondary outcomes were knee pain score (range, 1-6), performance measures of physical function, x-ray score, aerobic capacity, and knee muscle strength. RESULTS: A total of 365 (83%) participants completed the trial. Overall compliance with the exercise prescription was 68% in the aerobic training group and 70% in the resistance training group. Postrandomization, participants in the aerobic exercise group had a 10% lower adjusted mean (+/- SE) score on the physical disability questionnaire (1.71 +/- 0.03 vs 1.90 +/- 0.04 units; P<.001), a 12% lower score on the knee pain questionnaire (2.1 +/- 0.05 vs 2.4 +/- 0.05 units; P=.001), and performed better (mean [+/- SE]) on the 6-minute walk test (1507 +/- 16 vs 1349 +/- 16 ft; P<.001), mean (+/-SE) time to climb and descend stairs (12.7 +/- 0.4 vs 13.9 +/- 0.4 seconds; P=.05), time to lift and carry 10 pounds (9.1 +/- 0.2 vs 10.0 +/- 0.1 seconds; P<.001), and mean (+/-SE) time to get in and out of a car (8.7 +/- 0.3 vs 10.6 +/- 0.3 seconds; P<.001) than the health education group. The resistance exercise group had an 8% lower score on the physical disability questionnaire (1.74 +/- 0.04 vs 1.90 +/- 0.03 units; P=.003), 8% lower pain score (2.2 +/- 0.06 vs 2.4 +/- 0.05 units; P=.02), greater distance on the 6-minute walk (1406 +/- 17 vs 1349 +/- 16 ft; P=.02), faster times on the lifting and carrying task (9.3 +/- 0.1 vs 10.0 +/- 0.16 seconds; P=.001), and the car task (9.0 +/- 0.3 vs 10.6 +/- 0.3 seconds; P=.003) than the health education group. There were no differences in x-ray scores between either exercise group and the health education group. CONCLUSIONS: Older disabled persons with osteoarthritis of the knee had modest improvements in measures of disability, physical performance, and pain from participating in either an aerobic or a resistance exercise program. These data suggest that exercise should be prescribed as part of the treatment for knee osteoarthritis.
Activities of Daily Living↗
The evaluation of pain in patients with knee osteoarthritis: the knee pain scale.
OBJECTIVE: To develop and validate a knee pain scale (KPS) for use with osteoarthritis (OA) of the knee. METHODS: Patients with documented evidence of knee OA completed the KPS and a test battery including measures of physical functioning, physical performance, and depression. Analyses were conducted to confirm the 4-factor structure of the measure, determine alpha reliabilities, assess the test-retest reliability, and examine the construct validity of the KPS. RESULTS: Confirmatory factor analysis revealed that the KPS has 4 subscales, including frequency and intensity of pain experienced during both ambulation/climbing and transfer activities. All reliabilities were in excess of 0.80 and the subscales of the KPS shared expected variance with both self-reported and objective indices of dysfunction. CONCLUSION: The KPS has good psychometric properties for assessing pain experienced in conjunction with the performance of activities of daily living. Although at present it is a research tool, with further study it should prove valuable in clinical practice as well.
Activities of Daily Living↗
Dermatomyositis with normal muscle enzyme concentrations. A single-blind study of the diagnostic value of magnetic resonance imaging and ultrasound.
BACKGROUND AND METHODS: It is well documented that the cutaneous lesions of dermatomyositis may precede clinical myositis or may occur in the absence of any muscle disease detectable by current diagnostic criteria. In this single-blind study, we used magnetic resonance imaging (MRI) and ultrasound to evaluate five patients who presented with classical clinicopathologic dermatomyositis, but with normal levels of serum muscle enzymes. This patients group has not been previously studied with these techniques. Patients who served as positive and negative control subjects were also examined. RESULTS: Ultrasonography revealed hyperechogenicity, and MRI revealed high signals on T2-weighted images in several muscle groups of the patient with active myositis (positive control). Increased echogenicity was also noted in the deltoid region of one patient who had previously had a normal muscle biopsy finding. In the same patient, MRI revealed inflammatory changes in the lumbar paraspinal muscles. Another patient, with all previous study results being normal, had MRI evidence of T2 high signals in the gluteus minimus. CONCLUSIONS: Noninvasive examinations such as MRI and ultrasound are beneficial as adjunctive means of examination in the evaluation of patients with dermatomyositis sine myositis or dermatomyositis. Future studies may suggest additional uses for these tests, including serial evaluation of patients, noninvasive confirmation of diagnosis in pediatric patients, or in directing muscle biopsy, thus increasing sensitivity. Ultrasound appears to be the more cost-effective and simple test; but MRI, although more expensive, may be more sensitive and specific.
Adult↗
Some upper cervical spine norms.
Lateral cervical spine films from 175 normal examinations of adults performed in the emergency room of North Carolina Baptist Hospital were analyzed to establish some norms and relationships in the upper cervical spine. The predens angle was found to be between 0 degree-13 degrees (mean 5.57 degrees) in neutral position and 0-18 degrees (mean 9.27 degrees) in flexion in most persons. Ninety-two percent of persons have angles greater than 3 degrees in flexion. A V-shaped predens space is not indicative of injury to the cruciate ligament. Virtually every person has posterior slanting or tilting of the dens and the range of values is up to 35 degrees (mean 17.43 degrees). Ninety-eight percent of persons have an angle greater than 6 degrees. A tilted dens does not indicate acute or remote trauma. No relationship was identified between the predens angle and the dens tilt angle. The posterior arch of the atlas can be found at any position between the occiput and spinous process of C2 in all positions of the head and neck. Hence, fanning or widening of the C1-C2 interspinous distance is not a reliable index of ligamentous injury in the upper cervical spine.
Adolescent↗