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Comparison of the effectiveness between manual acupuncture and electro-acupuncture on patients with tennis elbow.

This is a single-blinded randomized controlled trial to compare the relative effectiveness between manual acupuncture (MA) and electro-acupuncture (EA) on the patients with chronic tennis elbow. Twenty patients recruited in the study were first introduced into control group for 2 weeks waiting period. Then, they were randomly assigned into either MA or EA group for acupuncture treatment. The acupuncture points of GB34 and ST38 were used in both treatment groups. In the MA group, the needle was retained for 20 minutes after the Deqi sensation obtained. In the EA group, electrical stimulation with 4 pulses/second frequency was applied and treatment lasted for 20 minutes. After 6 treatments within 2 weeks duration, significant differences were observed between groups favoring the electro-acupuncture in relation to pain relief (Pain visual analogue scale) and pain free hand grip strength (PFG). This study showed that electro-acupuncture is superior to manual acupuncture in treating patients with tennis elbow.

Acupuncture↗

Single-portal endoscopic carpal tunnel release compared with open release : a prospective, randomized trial.

BACKGROUND: Carpal tunnel syndrome is a common condition causing hand pain and numbness. Endoscopic carpal tunnel release has been demonstrated to reduce recovery time, although previous studies have raised concerns about an increased rate of complications. The purpose of this prospective, randomized study was to compare open carpal tunnel release with single-portal endoscopic carpal tunnel release. METHODS: A prospective, randomized, multicenter center study was performed on 192 hands in 147 patients. The open method was performed in ninety-five hands in seventy-two patients, and the endoscopic method was performed in ninety-seven hands in seventy-five patients. All of the patients had clinical signs or symptoms and electrodiagnostic findings consistent with carpal tunnel syndrome and had not responded to, or had refused, nonoperative management. Follow-up evaluations with use of validated outcome instruments and quantitative measurements of grip strength, pinch strength, and hand dexterity were performed at two, four, eight, twelve, twenty-six, and fifty-two weeks after the surgery. Complications were identified. The cost of the procedures and the time until return to work were recorded and compared between the groups. RESULTS: During the first three months after surgery, the patients treated with the endoscopic method had better Carpal Tunnel Syndrome Symptom Severity Scores, better Carpal Tunnel Syndrome Functional Status Scores, and better subjective satisfaction scores. During the first three months after surgery, they also had significantly (p < 0.05) greater grip strength, pinch strength, and hand dexterity. The open technique resulted in greater scar tenderness during the first three months after surgery as well as a longer time until the patients could return to work (median, thirty-eight days compared with eighteen days after the endoscopic release). No technical problems with respect to nerve, tendon, or artery injuries were noted in either group. There was no significant difference in the rate of complications or the cost of surgery between the two groups. CONCLUSION: Good clinical outcomes and patient satisfaction are achieved more quickly when the endoscopic method of carpal tunnel release is used. Single-portal endoscopic surgery is a safe and effective method of treating carpal tunnel syndrome.

Adult↗

[Treatment of scaphoid waist fractures by shape memory staples. Retrospective evaluation on 60 cases].

OBJECTIVES: In carpal scaphoid fractures, treatment with screws is considered the gold standard: ostheosynthesis with mini-staples is not the usual choice of treatment. The authors report a study on fractures of the middle third of the scaphoid treated by mini shape memory staples, in order to test the quality of reduction and ostheosynthesis, functional results, time of union and complications. MATERIALS AND METHODS: A retrospective analysis of 60 patients, with average age 39 years old and follow-up 36 months, was performed. Evaluation criteria were: the grade of pain, flexion-extension and pronation-supination wrist range, hand grip strength, radiographic consolidation of fractures and lateral intrascaphoid angle of flexion as described by Amadio. RESULTS: Pain was absent in 86% of the cases, the average flexion-extension range achieved was 107 degrees and the average pronation-supination range 171 degrees. Hand grip strength values achieved were comparable to those of the controlateral wrist in 85% of cases. Radiographic consolidation of the fracture was achieved in all patients within three months of surgery and the average value of the lateral intrascaphoid angle of flexion was 37 degrees. No cases of algodystrophy were observed. CONCLUSIONS: Our results show the safety and the practicality of ostheosynthesis with mini shape memory staples in fresh unstable fractures of the middle third of the scaphoid. Stable fixation, continuous compressive force on fragments and the ability to allow early active movement, are the main advantages.

Adolescent↗

Body cooling in human males by cold-water immersion after vigorous exercise.

Five male subjects were immersed to neck level in a whole-body water calorimeter (water temperature 19 degrees C) on two occasions. One immersion was preceded by 30 min of exercise on a treadmill at 80% of the subjects' maximum heart rate, while the other was preceded by no exercise (control). Ventilation, oxygen consumption, hand-grip strength, and heat loss (measured by calorimetry) results showed no significant differences between resting and exercise trials. Minute ventilation and oxygen consumption increased during the immersion but the magnitude of the increase varied among subjects. There was a significant decrease is isometric hand-grip strength after 30 min of immersion. Rectal temperatures fell faster (0.031 degree C +/- 0.004 degree C/min) for exercised subjects than for controls (0.019 degree C +/- 0.005 degree C/min) between 10 and 45 min of immersion (P less than 0.01). It appears that vigorous preimmersion exercise may shorten survival time in cold water due to an increase in cooling rate.

Adult↗

Effects of testosterone replacement therapy in old hypogonadal males: a preliminary study.

OBJECTIVE: To examine the effects of testosterone administration to older hypogonadal males (bioavailable testosterone less than 70 ng/dL). DESIGN: Alternate-case controlled trial. SETTING: St. Louis University. PATIENTS: Eight males (mean age 77.6 +/- 2.3 years) who received testosterone and six males (mean age 76 +/- 2.3 years) who served as controls. Selected from alumni of the SHEP trial and attendees at the St. Louis University Impotence Clinic. INTERVENTIONS: Testosterone enanthate (200 mg/mL) was administered intramuscularly to the treatment group every 2 weeks for 3 months. MEASUREMENTS: Serum testosterone, bioavailable testosterone and estradiol, weight, % body fat, right hand muscle strength, balance, cholesterol, HDL-cholesterol, hematocrit, BUN, creatinine, albumin, calcium, PTH, 25(OH) vitamin D, 1,25(OH)2 vitamin D, osteocalcin, prostate-specific antigen, and fructosamine. RESULTS: Males who received testosterone had a significant increase in testosterone and bioavailable testosterone concentration, hematocrit, right hand muscle strength and osteocalcin concentration. They had a decrease in cholesterol (without a change in HDL-cholesterol) levels and decreased BUN/Creatinine ratios. CONCLUSION: These preliminary findings support the need for long term studies of testosterone therapy in older hypogonadal males.

Aged↗

The effect of starvation on skeletal muscle function in man.

Measuring skeletal muscle function may be a diagnostic aid to detect malnutrition. To evaluate this hypothesis 11 lean women were studied before and after 5 days of total starvation. Skeletal muscle function was assessed as hand grip strength and as adductor pollicis muscle function after electrical stimulation of the ulnar nerve. The muscle function variables were force of contraction at 5, 10, 20 and 50 Hz stimulation, relaxation rate and endurance. In addition some currently used anthropometric and biochemical nutritional indices were serially determined. Hand grip strength was decreased (p < 0.05) and the function of the adductor pollicis muscle was altered with a higher contraction force at 10 Hz (p < 0.01), a slower relaxation rate (p < 0.05) and a reduced endurance (p < 0.05). These changes were all within the normal ranges. Triceps skin fold and arm muscle circumference were not changed after a mean weight loss of 3.3 kg (p < 0.05). However blood glucose, insulin and triiodothyronine all decreased (p < 0.01) indicating a metabolic adaptation to starvation. Prealbumin (p < 0.05) and fibronectin (p < 0.01) were also lowered. In conclusion, skeletal muscle function was significantly altered after five days of total starvation. However, to identify short term nutritional depletion in clinical practice the changes in muscle function were too small to be diagnostically useful.

Journal Article↗

Sex-dependent relations of grasp-reflex strengths from right and left hands to serum gonadotropin (FSH and LH) levels in human neonates with regard to cerebral lateralization.

The relation of grasp-reflex strength to serum FSH and LH levels were studied in human neonates. The grasp-reflex strengths from the right and left hands were found to be negatively linearly correlated with serum FSH level in males without familial sinistrality (-FS), but there was no significant correlations between these parameters in females. Serum LH levels were not correlated with grasp reflex in -FS neonates. The grasp-reflex strength from the right hand showed a significant negative linear correlation with LH only in +FS males. The right minus left (R-L) grasp-reflex strength decreased linearly with serum LH levels only in +FS males. These results did not support the testosterone hypothesis of cerebral lateralization. It was suggested that FSH and LH may indirectly influence the brain development according to sex and genetically pre-determined cerebral organization.

Female↗

Construct validity of the physical Self-Efficacy Scale for a black sample: implications for health educators.

Principal components factor analysis of the Physical Self-efficacy Scale and measures of cardiorespiratory function, flexibility, muscle strength and endurance, and a rating of perceived health were calculated for a sample of 138 black undergraduates. Physical Self-efficacy Scale scores were organized into a factor that represented outcomes of fitness in support of the construct validity of the test. Additional evidence of validity was found in application of multiple regression analysis which indicated that nondominant hand-grip strength and sit and reach were significant physical predictors of efficacy scores. We discuss implications of this research for health educators.

Adolescent↗

Circadian variation of physiological functions related to physical work capacity.

The circadian variation of selected physiological functions related to physical work capacity was studied in four trained young male subjects. The twofold objective was to describe, in parametric terms, the variation of these functions and estimate the times and values of their maximum and minimum responses. Statistically significant periodic regression effects were found for the following functions: oral temperature; systolic blood pressure; heart rate at rest, during work (245 and 270 W) and after a 5-min recovery; ratings of perceived exertion; strength of hand grip; and neuromuscular coordination measured with a seesaw board balance test. The Fourier curve (sine curve) accounted for 63 % of the variation in oral temperature and from 13 to 38 % of the variation in the other significant harmonic intensities. In phase with the rhythm of oral temperature, but with larger amplitude, were systolic blood pressure, heart rate at rest and heart rate during work; roughly in phase were strength of hand grip and neuromuscular coordination. Ratings of perceived exertion and heart rate after a 5-min recovery showed a rhythm which was out of phase with the oral temperature. The number of disturbances in neuromuscular coordination was greatest at 2400 and smallest at 1200, the difference being as large as 44 %. The results suggest that the measured capacities of muscle strength and neuromuscular coordination are the lowest, that physical work is perceived as the heaviest, and recovery after work is the slowest at night. These findings appear to support the notion that performance capacity is reduced during the night.

Adult↗

A cross-cultural comparison of neuromuscular performance, functional status, and falls between Japanese and white women.

BACKGROUND: Previous studies have reported that the incidence of falls among Japanese women is about half that of white women. The difference in incidence might result from differences in neuromuscular performance, such as muscle strength, mobility, and balance. This hypothesis was tested by comparing two community-dwelling populations: Japanese women in the Hawaii Osteoporosis Study, and Caucasian women in the Study of Osteoporotic Fractures. METHODS: Neuromuscular performance was assessed for women in the two cohorts using standardized procedures. Falls were monitored longitudinally, using surveys mailed at 4-month intervals. RESULTS: The Japanese and white women differed substantially in their neuromuscular performance. The Japanese women had faster walking speeds and chair stands, and performed better on a series of balance tests. The white women had greater strength, particularly at the quadriceps, and faster hand and foot reaction times. The white women also reported fewer functional disabilities, including fewer difficulties in climbing steps, doing heavy housework, and shopping for groceries. In age-adjusted analyses, the risk of falls was greater for the white women [odds ratio (OR) = 1.8; 95% confidence interval (CI) = 1.6, 2.0]. After adjusting for the neuromuscular test results and the number of functional disabilities, the odds ratio for the risk of falls remained essentially the same (OR = 1.8; 95% CI = 1.5, 2.1). CONCLUSIONS: The Japanese and white women had different advantages and limitations in neuromuscular performance. These differences, however, did not explain the lower risk of falls among Japanese women.

Accidental Falls↗

The effect of botulinum toxin on hand function after incomplete spinal cord injury at the level of C5/6: a case report.

OBJECTIVE: To investigate the benefits of the focal use of botulinum toxin in spasticity in the forearm seen after incomplete spinal cord injury. DESIGN: A single case study with standardized assessment before and at three-week intervals after injection. INTERVENTION: EMG-guided selective injection of botulinum toxin. SUBJECT: A 23-year-old man, 18 months post injury. MEASURES: Rivermead Motor Assessment; grip strength; Jebsen hand tests; visual analogue scale; Ashworth spasticity scale. RESULTS: Weakness was seen as expected with some functional losses, but the patient made gains in the areas of concern: shaking hands, typing, using the hand to drink. These gains were sustained at 12 weeks. CONCLUSION: Selective use of botulinum toxin to weaken muscles can lead to functional benefit.

Adult↗

Muscle strength as a predictor of onset of ADL dependence in people aged 75 years.

The aim of this prospective study over 5 years was to examine maximal isometric strength of multiple muscle groups as a predictor of losing independence in activities of daily living (ADL). The participants were from the Nordic Research on Aging (NORA75). These analyses are restricted to 567 people who at baseline were independent in ADL and participated in strength tests, and who five years later participated in follow-up ADL assessments. Tests on maximal isometric strength of hand grip, elbow flexion, knee extension and trunk flexion and extension were done using adjustable dynamometers. For each muscle group tested, three equal groups were formed for men and women separately based on distributions of results. Those who reported being unable or needing help for eating, dressing, bathing, toileting, walking indoors or transferring from a bed or a chair were rated as ADL dependent. Of the 227 initially ADL independent men, 21 (9.3%) became dependent in ADL. In women, the figures were 30 (8.8%) of 340. Multiple logistic regression models were used to predict the risk of ADL dependence in groups based on strength tertiles. After confirming that the association of muscle strength and incident ADL-dependence was similar in men and women, both genders were included in the same analyses adjusted for body weight and height, gender and research locality. Gender specific cut-offs were used for strength tertiles. All the strength tests predicted ADL dependence, with those being in the lowest tertile having two to three times greater risks than those in the highest tertile of strength. Further adjustments for chronic diseases did not materially change the results. Strength tests could be used to identify people who are still independent in ADL but who are at increased risk of becoming dependent because of poor muscle strength, and who could reduce their risk by strengthening exercises.

Activities of Daily Living↗

New insight of amino acid-based dialysis solutions.

Malnutrition is a major complication of peritoneal dialysis (PD) and is associated with increased morbidity and mortality. Daily losses of proteins and amino acids (AAs) into dialysate contribute to this problem. Previous metabolic balance study demonstrated that treatment with 1.1% AA-based dialysis solution is safe and may improve protein malnutrition in continuous ambulatory peritoneal dialysis (CAPD) patients ingesting low protein intake. Other prospective studies also showed that AA solution can provide nutritional benefit for malnourished PD patients resulting in a significant improvement in some biochemical and/or anthropometric nutritional parameters. However, there are other studies showing no particular improvement in nutritional parameters after long-term use of AA solution. This may be related to the differences in the study design, sample size, methods used to assess nutritional status, and other factors such as dietary intake and comorbidities of study subjects. Published data will be reviewed to further emphasize the nutritional benefit of long-term use of AA solution in malnourished PD patients along with a brief discussion on the various reasons that may partly explain the different study results. We will also present the results of a longitudinal observational study evaluating changes in nutritional parameters following use of one exchange of 1.1% AA solution in malnourished Korean PD patients. A significant improvement of somatic protein status such as lean body mass (LBM) and hand grip strength was observed. No significant change in serum albumin level was noted. Patients with a positive estimated coefficient for LBM in the fitted regression model to the repeated observations over 1 year were classified as responders and patients with neutral or negative coefficient were considered as non-responders. Thirty-one out of 43 malnourished patients (72%) showed nutritional benefit based on the change of LBM. Hand grip strength and back lift strength were significantly higher in responders at baseline. Other baseline parameters did not differ between the two groups.

Amino Acids↗

Low serum calcidiol concentration in older adults with reduced muscular function.

OBJECTIVE: To examine the association between muscular function and the serum concentrations of 25-hydroxyvitamin D (calcidiol) and 1,25-dihydroxyvitamin D (calcitriol). DESIGN: A randomized population survey. Baseline measurements of serum calcidiol and calcitriol concentrations and assessment of muscular function (hand grip strength, ability to climb stairs, outdoor activity, and fall occurrence). SETTING: The Medical department, Aker University Hospital, Oslo, and subjects' homes. PARTICIPANTS: Two hundred forty-six recently hospitalized older patients and 103 randomly selected older people living at home. MEASUREMENTS: Serum concentration of calcidiol and calcitriol in relation to muscle function. MAIN RESULTS: Reduced muscle function was associated with low calcidiol levels. In both the hospital group and the home group, calcidiol concentrations correlated positively to arm muscle strength (r = .22, P < .001; r = .37, P < .001), ability to climb stairs (r = -.16, P < .05; r = -.42, P = < .001), physical activity (r = -.27, P < .001; r = -.31, P < .001), and the absence of fall occurrences (r = -.27, P < .001; r = -.31, P = .004). Calcitriol showed an association with physical activity in the hospital group (r = -.19, P < .05), and with fall last month in the home group (r = -.22, P < .05). CONCLUSIONS: Older people with reduced muscle function often had reduced levels of calcidiol serum concentration. Low levels of calcidiol were not associated with signs of general undernutrition, such as low body mass, or with reduced arm-muscle circumference or triceps skinfold thickness. This finding may suggest a physiological role for calcidiol in muscle function. Reduced muscle strength increased disability in our older subjects, which may be improved by vitamin D supplementation in vitamin D-deficient subjects.

Activities of Daily Living↗

Familial aggregation of 7-year changes in musculoskeletal fitness.

The purpose of this study was to determine the degree of familial resemblance in baseline and 7-year changes in musculoskeletal fitness. Data from the 1981 Canada Fitness Survey and the Campbell's Survey 7-year follow-up were used. The sample consisted of 1264 people (635 males and 629 females) between the ages of 7 and 69 years for whom measurements of musculoskeletal fitness were available at baseline. A subsample of 834 people had measurements at both baseline and 7-year follow-up. Sit-and-reach trunk flexibility, number of push-ups without time limit, number of sit-ups in 60 seconds, and hand-grip strength were used as indicators of musculoskeletal fitness. The data were adjusted for the effects of age and body mass index (and baseline level of the variable for changes) by using regression procedures, and they were standardized to zero mean and unit variance within each of the four sex-by-generation groups (fathers, mothers, sons, and daughters). Familial correlation models were fitted to the data by using the computer software SEGPATH. The results indicate significant familial resemblance for all indicators of musculoskeletal fitness for baseline measures and 7-year changes. The heritabilities, or the percentages of the total variance attributable to heredity, were 64% for trunk flexibility, 37% for push-ups, 59% for sit-ups, and 48% for grip strength. Similarly, heritabilities for the change scores were 48% for trunk flexibility, 52% for push-ups, 41% for sit-ups, and 32% for grip strength. The results suggest that familial, and perhaps genetic, factors are important in explaining the variance in musculoskeletal fitness not only cross-sectionally but also for changes over time.

Adolescent↗

Relationship of physical characteristics and life habits to treadmill exercise capacity.

Apparently healthy middle-aged men (n = 175) were recruited from a population sample and completed questionnaires about habitual physical activity, smoking, beverage consumption and sleep habits. Body mass index (BMI), heart rate and blood pressure were measured at rest and during submaximal exercise; frequency of ventricular premature beats (VPB) on an ECG rhythm strip; hand grip strength; and serum cholesterol. These characteristics were correlated with duration of treadmill exercise by the Bruce protocol. Univariate analysis indicated that treadmill performance was significantly and positively correlated with leisure-time physical activity and personal reports of sweating and/or dyspnea occurring regularly during such physical activity. Performance was negatively correlated with age, BMI, resting heart rate, cigarette smoking, and consumption of caffeine-containing beverages, but was insignificantly related to job physical activity, hand grip strength, alcohol consumption, sleep habits, blood pressure, cigar smoking, serum cholesterol, and the frequency of VPB. A 0.75 multiple correlation coefficient was found between treadmill performance and 11 of the above variables and the r is increased to 0.81 by adding heart rate during submaximal exercise. It is concluded that substantial prediction of work capacity and physical fitness of population is achieved by questionnaires and easily obtained, noninvasive physical measures.

Adult↗

A simple and inexpensive pinch meter to detect subclinical weakness among leprosy patients.

This paper describes the use of a neonatal sphygmomanometer cuff as a simple, inexpensive pinch meter. Normal values for key pinch, pulp pinch and side pinch in the dominant hand of healthy Nepali people are provided. The pinch meter was also used to test pinch strength in hands affected by leprosy and normal hands. Some patients with leprosy who have no objective weakness on voluntary muscle testing (VMT) have less pinch strength than people without leprosy. The pinch meter is a useful tool for the early detection of motor function loss.

Adolescent↗

A comparison of elderly patients with proximal femoral fractures and a normal elderly population: a case control study.

AIM: To assess the importance of bone density and other risk factors in elderly subjects with hip fractures. METHOD: Thirty-six subjects with femoral neck fracture were compared with 72 community controls in this case control study. Variables compared included: history of falls, previous fracture, body mass index, hand grip strength, blood pressure, medication use, cigarette smoking, alcohol intake, visual acuity, age at menopause, mental status quotient, mobility index and mid thigh circumference. Bone mineral density was measured at the hip (DPA absorptiometer) in the 36 subjects with hip fracture and 36 community controls. RESULTS: Fracture patients had significantly (p < 0.01) reduced bone mineral density at femoral neck (0.64 vs 0.74 g/cm2) and trochanteric regions (0.55 vs 0.66 g/cm2). They also had significantly (p < 0.05) lower body mass index, weaker hand grip strength, smaller mid thigh circumference, reduced mobility and more previous fractures. After controlling for age and sex stepwise logistic regression identified handgrip strength, mobility status and falls in that ranking as risk factors for fracture. Bone mineral density was correlated with mobility status and grip strength. CONCLUSION: Patients with hip fracture have lower bone mineral density than controls. Mobility, grip strength and muscle bulk appear to be important in fracture aetiology and could operate either through bone density or risk of falling.

Accidental Falls↗