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At least 1,045 records · Page 58Linked to original sources

PubMed2006

Problematic bone fixation with pyrocarbon implants in proximal interphalangeal joint replacement: short-term results.

Seventeen pyrocarbon PIP prostheses were implanted into 14 patients, followed prospectively and reviewed clinically. The patients were assessed after a mean follow-up of 20.5 months subjectively by a VAS pain scale and radiographically. Significant pain relief was noted in all patients from a mean of 7.6 pre-operatively to 1.3 at final follow-up. Migration of one, or both, components was observed radiographically in eight joints and radiolucent lines were evident in three more cases. The clinical results of the implants which had migrated were less favourable for range of motion and grip strength than the stable joints of this series, although, statistically, the results were not significant. The number of possibly unstable prostheses in this series raises the question as to whether pyrocarbon is suitable for uncemented pressfit fixation in combination with early functional rehabilitation.

Aged↗

PubMed2005

Complications of free radial forearm flap transfers for head and neck reconstruction.

Free tissue transfer using microvascular anastomosis has been established as an accepted maxillofacial reconstructive procedure. The free radial forearm flap (FRFF) has become a workhorse flap as a means of reconstructing surgical defects in the head and neck region. Since 1992, we have carried out 38 FRFF transfers in 37 patients for reconstruction after head and neck cancer ablative surgery. We present our clinical experience with head and neck reconstruction using the FRFF and the morbidity of the donor sites. Of the 38 FRFFs, 35 FRFFs were performed successfully. The survival rate of FRFF was 92%. Donor site complications included partial loss of skin graft in 4 donor sites (11%), abnormal sensations in 10 (26%), poor appearance in 3 (8%), and reduced grip strength in 4 (11%). Therefore, we believe that, because of the reliability, functional characteristics, and low donor site morbidity, the FRFF is a useful and versatile flap for reconstruction of head and neck defects.

Adult↗

PubMed2003

The Erlangen Fitness Osteoporosis Prevention Study: a controlled exercise trial in early postmenopausal women with low bone density-first-year results.

OBJECTIVE: To investigate the effect of a 2-year vigorous, combined high-impact, strength, and endurance training program on bone mineral density (BMD) determined by dual-energy x-ray absorptiometry (DXA), quantitative computed tomography (QCT), and ultrasound in early postmenopausal women with osteopenia. DESIGN: Nonrandomized controlled trial, reporting 1-year data. SETTING: Community. PARTICIPANTS: Early postmenopausal (1-8y postmenopausal) osteopenic women (DXA T score at lumbar spine or total hip between -1 and -2.5 standard deviations). The exercise group (n=59; mean age, 55.1+/-3.4y) and control group (n=41; mean age, 55.9+/-3.1y) were recruited from community registers. INTERVENTION: Fourteen months of exercise training, with 2 joint sessions and 2 additional home training sessions. Exercise and control groups were supplemented individually with calcium and cholecalciferol up to 1500mg of calcium and 500IU of vitamin D per day. MAIN OUTCOMES MEASURES: BMD at the lumbar spine and total hip measured by DXA, isometric maximum strength, and maximal oxygen consumption (VO2max) during a stepwise running test to exhaustion. RESULTS: Bone density increased significantly at the lumbar spine for the exercise group (1.3%, P<.001) and decreased in the control group (-1.2%, P<.01). Differences at the total hip (-0.3%, not significant vs -0.8%, P<.05) and the femoral neck (-0.8%, P<.05 vs -1.8%, P<.001) were nonsignificant. Changes in isometric maximum strength were significant for each region (grip strength, trunk flexors and extensors, hip flexors, leg adductors and abductors, arm flexors and extensors) in the exercise group (11%-39%) compared with nonrelevant changes (-1.1% to 3.9%) in the control group. Between-group differences were significant (P<.01-.001) for all strength parameters. VO2max increased significantly by 11% (P<.001) in the exercise group but decreased in the control group by 4% (P<.05) while showing significant between-group differences. CONCLUSION: High-intensity exercise training can have a positive influence on bone density in early postmenopausal osteopenic women.

Absorptiometry, Photon↗

PubMed2003

The strength-dexterity test as a measure of dynamic pinch performance.

We have developed a method to quantify the dynamic interaction between fingertip force magnitude (strength) and directional control (dexterity) during pinch with a novel strength-dexterity (S-D) test based on the principle of buckling of compression springs. The test consists of asking participants to use key and opposition pinch to attempt to fully compress springs, in random order, with a wide range of combinations of strength and dexterity requirements. The minimum force required to fully compress the spring and the propensity of the spring to buckle define the strength and dexterity requirements, respectively. The S-D score for each pinch style was the sum of the strength values of all springs successfully compressed fully. We tested 3 participant groups: 18 unimpaired young adults ( 40yr), and 14 adults diagnosed with carpo-metacarpal osteoarthritis (CMC OA) (>or = 36yr). We investigated the repeatability of the S-D test with 74 springs by testing 14 young adults twice on different days. The per-spring repeatability across subjects was >or = 94%. A minimum performance score for young adults was found as they all could compress a subset of 39 springs. Using this subset of springs, we compared the ability of the S-D score vs. maximal pinch force values to distinguish unimpaired hands from those with CMC OA of the thumb. The score for this 39-spring S-D test distinguished between CMC OA and asymptomatic older adults, whereas pinch meter readings did not (p<0.05). We conclude that the S-D test is repeatable and applicable to clinical research. We propose including the S-D test in studies aiming to quantify impairment and compare treatment outcomes in orthopaedic and neurological afflictions that degrade dynamic manipulation.

Adolescent↗

PubMed2001

[Reconstruction of the distal radius for primary bone tumors using a non-vascularized fibular graft (report of 4 cases)].

We report four cases of primary bone tumour of the distal radius. Follow-up averaged ten years with a range of four to 13. Each case underwent excision of the tumour followed by reconstruction with a non-vascularised fibular graft. The aim of our study was to investigate the carcinologic, functional and radiological results at an average of ten years after the initial surgery. There were three high grade osteosarcomas and one giant cell tumour of bone. The mean postoperative wrist flexion was 45 degrees, extension was 20 degrees, pronation 30 degrees and supination 50 degrees. Radial tilt was a mean 10 degrees and ulnar tilt 15 degrees. All the patients had satisfactory function so as to be able to perform activities of daily living and to work. Grip strength was normal in three cases and reduced in one. Bone graft healing occurred at a mean of six months with a range of from four to nine months. Resection followed by a non-vascularised fibular graft is an effective way to managing these patients.

Adolescent↗

PubMedDate not supplied

[Therapy for chronic radial epicondylitis with botulinum toxin A].

AIM: Chronic radial epicondylitis (tennis elbow) is not a serious disease but patients may suffer greatly. If standard conservative and possibly operative treatment modalities have not been effective, patients need further therapy. First trials with injection of Botulinum toxin A (Btx A) have shown promising results. The purpose of the study was to clarify if a single injection of Btx A could be an efficient therapy for chronic radial epicondylitis. METHODS: In this study 16 patients received injections into the forearm extensors. The site of injection was determined by local tenderness and pain provocation on finger and wrist extension. RESULTS: A significant clinical improvement was already seen at 2 weeks following injection. The effect was noted up to the last follow-up at 2 years. Continuous and maximal pain during the last 48 h, as self-assessed on a visual analogue scale, was also significantly reduced. In a few cases a significant decrease of muscle strength was seen for the third finger two weeks after injection. It slowly returned thereafter. CONCLUSION: A single injection of Btx A was effective as therapy for chronic tennis elbow. It can be carried out in an out-patient setting, and allows the patient to continue working.

Ambulatory Care↗

PubMed2005

Botulinum toxin injection in the treatment of tennis elbow. A double-blind, randomized, controlled, pilot study.

BACKGROUND: A recent report has suggested that local injection of botulinum toxin type A is an effective method of treatment for chronic tennis elbow. The toxin is thought to provide temporary paralysis of the painful common extensor origin, thereby allowing a healing response to occur. To test this theory, we performed a double-blind, randomized, controlled, pilot trial comparing injections of botulinum toxin type A with those of a placebo (normal saline solution) in the treatment of chronic tennis elbow. METHODS: Forty patients with a history of chronic tennis elbow for which all conservative treatment measures, including steroid injection, had failed were randomized into two groups. Half the patients received 50 units of botulinum toxin type A, and the remainder received normal saline solution. The intramuscular injections were performed 5 cm distal to the maximum point of tenderness at the lateral epicondyle, in line with the middle of the wrist. The two solutions used for the injections were identical in appearance and temperature. The results of a quality-of-life assessment with the Short Form-12 (SF-12), the pain score on a visual analogue scale, and the grip strength measured with a validated Jamar dynamometer were recorded before and three months after the injection. RESULTS: Three months following the injections, there was no significant difference between the two groups with regard to grip strength, pain, or quality of life. CONCLUSIONS: With the numbers studied, we failed to find a significant difference between the two groups; thus, we have no evidence of a benefit from botulinum toxin injection in the treatment of chronic tennis elbow.

Botulinum Toxins, Type A↗

PubMed2004

Decreased isometric neck strength in women with chronic neck pain and the repeatability of neck strength measurements.

OBJECTIVES: To evaluate neck flexion, extension, and, especially, rotation strength in women with chronic neck pain compared with healthy controls and to evaluate the repeatability of peak isometric neck strength measurements in patients with neck pain. DESIGN: Cross-sectional. SETTINGS: Rehabilitation center and physical and rehabilitation medicine department at a Finnish hospital. PARTICIPANTS: Twenty-one women with chronic neck pain and healthy controls matched for sex, age, anthropometric measures, and occupation. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Peak isometric strength of the cervical muscles was tested in rotation, flexion, and extension. RESULTS: Significantly lower flexion (29%), extension (29%), and rotation forces (23%) were produced by the chronic neck pain group compared with controls. When the repeated test results were compared pairwise against their mean, considerable variation was observed in the measures on the individual level. Intratester repeatability of the neck muscle strength measurements was good in all the 4 directions tested in the chronic neck pain group (intraclass correlation coefficient range,.74-.94). The coefficient of repeatability was 15N, both in flexion and extension, and 1.8 Nm in rotation. On the group level, improvement up to 10% due to repeated testing was observed. CONCLUSIONS: The group with neck pain had lower neck muscle strength in all the directions tested than the control group. This factor should be considered when planning rehabilitation programs. Strength tests may be useful in monitoring training progress in clinical settings, but training programs should be planned so that the improvement in results is well above biologic variation, measurement error, and learning effect because of repeated testing.

Adult↗

PubMed2001

Tendon interposition arthroplasty versus arthrodesis for the treatment of trapeziometacarpal arthritis: a retrospective comparative follow-up study.

Long-term subjective and objective outcomes of 24 tendon interposition arthroplasties in 17 patients and 32 trapeziometacarpal (TMC) arthrodeses in 26 patients were compared retrospectively in a standardized manner. Tendon interposition arthroplasty led to complications less often (27%) than TMC arthrodesis (39%). Patients in the tendon interposition arthroplasty group reported significantly less pain, less temperature intolerance, and better thumb mobility and were more satisfied with pain symptoms than patients in the arthrodesis group. Patients undergoing tendon interposition arthroplasty had better thumb opposition, interphalangeal joint mobility, and radial and palmar TMC joint range of motion. No statistically significant differences were found in tip pinch, key pinch, and grip strength between the 2 groups. Proximal first metacarpal collapse occurred in the tendon interposition patients without affecting subjective or objective outcome. Seven of 25 patients with TMC arthrodesis had pseudarthrosis. Tendon interposition arthroplasty seems to be preferable to TMC joint arthrodesis for the treatment of TMC arthritis.

Aged↗

PubMed1997

Fractionated reaction time as a function of magnitude of force in simple and choice conditions.

The present study examined whether varying magnitude of force required to perform an isometric response influences fractionated reaction time in simple and choice conditions and whether reaction time and premotor time to initiate the response are shorter when force is selected freely by the subject than when it is selected by the experimenter. 20 subjects were required to react and produce a designated peak force as quickly and accurately as possible by squeezing a handle after a reaction signal. Four different magnitudes of force were 30, 50, and 70% of the maximum grip strength of the subjects and subject-selected magnitude of force. Reaction time and premotor time did not change across the range of forces examined in both simple and choice reaction-time conditions regardless of whether a desired force was selected by the experimenter or by the subject. These findings suggest that programming an isometric response may require a constant amount of time.

Adult↗

PubMed2004

Timing of improvement after carpal tunnel release.

This prospective study of 52 patients from the authors' institutional carpal tunnel database investigated which patient subpopulations were most likely to benefit from carpal tunnel release and documented the time course of recovery. Preoperatively and postoperatively at 6 and 12 months, patients completed a Levine-Katz questionnaire, and NC-Stat studies and clinical parameters were recorded by a certified occupational therapist. For individual parameters from preoperative to 6 months postoperative, statistical improvements were found in Tinel's and Phalen's signs, pinch strength, delayed motor latency, and symptom severity and functional scores. None of these parameters changed significantly from 6 to 12 months. Grip strength did not change significantly postoperatively. Analysis based on age or carpal tunnel release technique showed no differences postoperatively. Preoperative symptom and functional scores correlated statistically with postoperative scores, peaking at 6 months postoperatively. The study concluded that most clinical signs and symptoms of carpal tunnel release fail to improve after 6 months postoperatively.

Adult↗

PubMed1995

Salvage of the failed Darrach procedure.

Six patients (5 post-traumatic, 1 rheumatoid) underwent a three-component reconstruction for correction of dorsal instability and radioulnar impingement following failure of a Darrach resection of the entire distal end of the ulna. The technique was devised to prevent simultaneous coronal and sagittal instability. The procedure used longitudinal intramedullary tenodesis of the extensor carpi ulnaris tendon, dorsal transfer of the pronator quadratus through the interosseous space, and temporary percutaneous pinning to maintain corrected distal radioulnar relationship. The were evaluated for 11 to 39 months (average, 20 months) following reconstruction. The preoperative wrist extension-flexion arc was preserved following surgery; there was a minimal loss of radial and ulnar deviation. The arc of forearm rotation increased 24 degrees to a range equal to 95% of the rotational arc of the opposite, unoperated wrist. Postoperative grip strength improved to an average value of 65 lb., two and one half times the preoperative value, representing 80% of the value for the opposite extremity. Four patients were able to return to their previous employment. All patients achieved pain-free forearm rotation and relief of their preoperative complaints of painful mechanical popping, clicking, and catching.

Adult↗

PubMed1998

A placebo controlled investigation of the effects of tryptophan or placebo on subjective and objective measures of fatigue.

OBJECTIVE: To examine the effect of L-tryptophan administration on subjective and objective measures of fatigue in healthy volunteers. SUBJECTS: Six healthy volunteers (4M:2F) were recruited from staff and students at the College. SETTING: Department of Human Nutrition, St. Bartholomews and the Royal London School of Medicine and Dentistry. DESIGN: Subjects were tested for central and peripheral fatigue using a visual analogue scale, flicker fusion frequency, grip strength, reaction time and wrist ergometry. In addition, plasma free tryptophan concentrations and Trp:LNAA ratio were determined. Measurements were made before, and at 1, 2, 3 and 4 h after drinking one of two test drinks. The drinks were of either caffeine free diet Coca-Cola (placebo) or caffeine free diet Coca-Cola plus L-tryptophan (30 mg/kg: active drink). Each of the six subjects was tested after placebo and active drink with a one week washout period between test days. RESULTS: Subjective fatigue was significantly increased following tryptophan compared to placebo (P < 0.002), and objective measures of central fatigue were significantly increased by tryptophan compared to placebo (flicker fusion frequency: P < 0.001; reaction time P < 0.001). No significant changes in grip strength were found following tryptophan compared to placebo, but a significant increase in ergometric work output was seen (P < 0.001). CONCLUSION: Tryptophan ingestion in the quantity 30 mg/kg leads to increased subjective and central fatigue. Increases in work output observed following tryptophan may be as a result of a reduced perception of discomfort during ergometry.

Adult↗

PubMed1999

Comparative results of resection of the distal ulna in rheumatoid arthritis and post-traumatic conditions.

The purpose of this study was to determine whether the results of resection of the distal ulna differed depending upon the underlying aetiology of the condition. Patients with rheumatoid arthritis were compared with patients with post-traumatic wrist complaints. Fifty resections in 40 patients (eight male, 32 female) were assessed with respect to pain, range of motion, and grip strength. Of the 23 rheumatoid wrists, 86% were pain-free following surgery; however, only 36% of the patients in the trauma group reported pain relief postoperatively. Pain relief in post-traumatic patients was more predictable when distal radioulnar joint arthrosis was identified as the sole cause of wrist pain.

Adolescent↗

PubMed1997

Manual muscle test score and force comparisons after cervical spinal cord injury.

Manual muscle test scores (MMTS) and maximum voluntary contraction (MVC) force measurements were made from triceps brachii muscles of 70 individuals with chronic cervical spinal cord injury (SCI). Both MMTS and strength assessments showed that asymmetrical motor deficits were common. Muscles with MMTS of 3 generated an average of nine percent MVC force produced by control muscles. In this SCI population, little residual voluntary force is apparently needed for triceps brachii to work against gravity. Only 24 percent of muscles tested had this strength, however, indicating the need to develop strategies to alleviate this muscle weakness. MMTS and force were related positively but each MMTS was not associated with a unique force range. MVC force generating capacity is therefore only one factor that determines whether or not a muscle can work with or against gravity and against resistance.

Adult↗

PubMed2004

A meta-analysis of randomized controlled trials comparing endoscopic and open carpal tunnel decompression.

Controversy exists regarding the benefit of endoscopic carpal tunnel release versus open carpal tunnel release in terms of grip/pinch strength, scar tenderness, pain, return to work, reversible/irreversible nerve damage, and adverse effects. Although a number of randomized controlled trials and systematic reviews have been published on the subject, to date, no large definitive randomized controlled trial or meta-analysis has been performed comparing endoscopic to open carpal tunnel release. This meta-analysis was undertaken to address the effectiveness of endoscopic carpal tunnel release relative to open carpal tunnel release. Key outcome measures from 13 randomized controlled trials were extracted and statistically combined. Heterogeneity was observed in three of the outcomes (i.e., grip strength, pain, and return to work), but the causes of heterogeneity could not be explained because of insufficient detail in the reported studies. Using the Jadad et al. scale, nine of 13 studies were of low methodologic quality. The effect sizes were compared between the studies that were rated as high quality and the studies that were rated as low quality on the Jadad et al. scale. Similarly, the studies that were rated as high quality on the Gerritsen et al. scale were compared with those that were rated as low quality. No clinically significant difference in effect sizes was apparent between studies of high and low methodologic quality. This meta-analysis supports the conclusion that endoscopic carpal tunnel release is favored over the open carpal tunnel release in terms of a reduction in scar tenderness and increase in grip and pinch strength at a 12-week follow-up. With regard to symptom relief and return to work, the data are inconclusive. Irreversible nerve damage is uncommon in either technique; however, there is an increased susceptibility to reversible nerve injury that is three times as likely to occur with endoscopic carpal tunnel release than with open carpal tunnel release.

Absenteeism↗

PubMed2004

Fitness levels of middle aged martial art practitioners.

OBJECTIVES: To quantify and compare fitness levels of middle aged practitioners of soo bahk do (SBD; a Korean martial art similar to karate) with those of sedentary subjects. METHODS: Eighteen volunteers, 14 men and four women (aged 40-60 years), participated. Nine sedentary subjects (mean age 46.7 years) and nine SBD practitioners (mean age 46.8 years) were matched for sex and age. All subjects participated in a one day battery of fitness tests. The following dependent variables were tested: body composition, balance, flexibility, quadriceps strength, grip strength, muscle endurance, and aerobic capacity. RESULTS: All dependent variables were analysed using paired t tests. Body composition (% body fat) for the SBD group was 18.9% v 30.8% for the sedentary group (p = 0.004). The SBD group was able to balance for 61.8 seconds v 26.2 seconds for the sedentary group (p = 0.02). The result for the sit and reach flexibility test was 22.3 cm for the SBD group v 10.4 cm for the sedentary group (p = 0.01). The number of push ups performed in one minute was 47.0 for the SBD group v 18.6 for the sedentary group (p = 0.0003), and the number of sit ups performed was 66.1 for the SBD group and 37.3 for the sedentary group (p = 0.00006). Aerobic capacity was 41.0 ml/kg/min v 31.1 ml/kg/min for the sedentary group (p = 0.04). Quadriceps strength was 99.5% (peak torque/body weight) v 83.0% for the sedentary group (p = 0.02). Only grip strength was not significantly different. CONCLUSIONS: There were significant differences between the groups for most of the physical fitness tests. The SBD practitioners displayed greater aerobic capacity, balance, flexibility, muscle endurance, and strength, and less body fat than the sedentary controls matched for age and sex. SBD can be considered an excellent form of exercise for the promotion of fitness in adults. Health professionals should be aware that there are alternative methods to traditional exercise that can increase the physical fitness and health of the middle aged population.

Adult↗

PubMed2000

Health implications of musculoskeletal fitness.

Although it is well documented that physical activity participation can bring about improvements in musculoskeletal fitness, related health implications have only been substantiated in the elderly. Currently, interpretations of the results of musculoskeletal fitness appraisals for the general population are based largely on an intuitive belief that enhanced musculoskeletal fitness is associated with higher levels of health throughout adulthood. Musculoskeletal fitness was measured in 312 females and 259 males aged 15-69 years. Health levels were determined using two previously validated questionnaires and expressed as composite health scores derived from principal components analysis. Grip strength, push strength, pull strength, push-ups, and trunk forward flexion were significant predictors of health scores after controlling for the potentially confounding effects of gender age, aerobic fitness, waist circumference, and smoking status. These findings indicate that musculoskeletal fitness is related to health in males and females aged 15 to 69 years.

Adolescent↗