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At least 1,099 records · Page 61Linked to original sources

Scaphotrapeziotrapezoid arthrodesis: a follow-up study.

PURPOSE: The purpose of this study was to review the results of 800 scaphotrapeziotrapezoid fusions performed over a 27-year period. METHODS: The patients were evaluated for postoperative range of motion, grip and pinch strength, pain, return to work, arthritis, and complications. RESULTS: The overall range of motion was 70% to 80% of the nonoperated side and strength was 69% to 89%. Of the patients 88% returned to previous employment. Arthritis developed in 1.8% of the patients. The overall complication rate was 13.4%. CONCLUSIONS: Scaphotrapeziotrapezoid fusion is a viable treatment option especially for a high-functional-demand young population with significant wrist pathology. Complications, specifically nonunion, can be minimized with careful technique.

Adult↗

CPH-82 (Reumacon) versus auranofin (Ridaura): a 36-week study of their respective onset of action rates in RA.

The onset of action rate of CPH-82 (Reumacon), was compared with that of auranofin (AUR; Ridaura) in a 36-week randomised, double-blind, multicentre study of 60 patients with rheumatoid arthritis (RA). As compared with respective baseline values, the CPH-82 group manifested significant improvement in grip strength, Ritchie's articular index (RAI), pain ratings, and HAQ (health assessment questionnaire) scores after 8, 12, 24, and 36 weeks of treatment, with the exception of the 24-week HAQ score. The AUR group manifested corresponding improvement in RAI after 8, 12, 24, and 36 weeks. Significant differences in changes from baseline values in favour of the CPH-82 group were found for grip strength at 12 and 24 weeks, RAI score at 8 weeks, VAS score at 8 and 12 weeks, and HAQ score at 8 weeks. The findings suggest CPH-82 to manifest a more rapid onset of action than AUR. The two drugs were similar in tolerance and safety.

Adult↗

Performance-based measures of physical function for high-function populations.

OBJECTIVES: To improve and broaden the applicability of performance-based measures of function for use in clinical and research settings. DESIGN: Cross-sectional repeated-measures study. SETTING: Research clinic. PARTICIPANTS: Population-based sample of Japanese Americans without significant functional impairments aged 35 to 55 and 56 to 71 (N=203). MEASUREMENTS: Performance-based measures of physical function, including range of standard tests, newer automated measures of balance and strength and data on cognitive function, lifestyle, medical history, and physical activity. RESULTS: Of the nonplatform balance measures, only the one-leg stand was reliable (reliability coefficient (rc) =0.69) and able to discriminate between functional levels. Combining the Fourth National Health and Nutrition Examination Survey protocol of folded arm position while standing on a foam pad with the more-sophisticated balance platform test had the highest reliability and discrimination. With the strength chair, high rcs (0.88-0.96) were found for upper and lower extremity tests. Timed chair stands, a test of lower extremity and central strength were reliable. The 6-minute walk had a high rc (0.90). CONCLUSION: Many performance tests used today are not reliable. Only a few discriminate between the most highly functioning individuals and individuals with good function. Thus, a new recommended battery includes unassisted single-leg stand, balance platform "foam pad, eyes closed," elbow flexion and knee extension strength (strength chair), grip strength, timed chair stands, and the 6-minute walk. These simple performance-based tests have good reliability and discrimination across the range of function and can be used in most clinical and research settings to quickly assess global functional level.

Adult↗

Characteristics of frail older adult drivers.

OBJECTIVES: To determine the prevalence of driving in older adults with mild to moderate physical frailty and to compare characteristics of current frail older adult drivers with those of former drivers in the sample. DESIGN: Retrospective study of frail older adults enrolled in randomized trials of exercise and hormone replacement therapy. SETTING: Urban, academic medical center. PARTICIPANTS: One hundred eighty-three sedentary community-dwelling men and women aged 75 and older with mild to moderate physical frailty, as defined by two of the following three criteria: modified Physical Performance Test (PPT) score between 18 and 32, peak oxygen uptake (VO2) between 10 and 18 mL/kg per minute, and self-report of difficulty or assistance with one activity of daily living (ADL) or two instrumental ADLs. Participants were classified as current or former drivers. MEASUREMENTS: Demographic characteristics, medical diagnoses, medication use, modified PPT score, and psychometric tests. RESULTS: The majority (85%) of the participants were drivers. Former drivers were more likely to be older, be female, reside in congregate independent living for the elderly, have a higher incidence of arthritis and congestive heart failure, take sedating medications, have lower total ADL scores, have lower VO2 peak scores, and have more impairment on tests of cognition and physical strength, although only age, type of residence, and grip strength were independent predictors of driving cessation in the regression analysis. CONCLUSION: Despite the presence of physical frailty, many older adults choose to continue to drive. Further studies are needed to better understand the driving behaviors of frail older adults and explore opportunities for optimizing driving abilities.

Activities of Daily Living↗

Bilateral sensorimotor abnormalities in unilateral lateral epicondylalgia.

OBJECTIVE: To evaluate impairments in motor function of the upper limb in unilateral lateral epicondylalgia. DESIGN: Assessor-blinded, case-controlled study. SETTING: University laboratory. PARTICIPANTS: Forty participants with lateral epicondylalgia and 40 age- and sex-matched controls were recruited from the general community. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Wrist posture adopted during a grip test, grip strength force, as well as upper-limb reaction times and speed of movement. RESULTS: Participants with unilateral lateral epicondylalgia adopted wrist postures that were on average 11 degrees less extended, bilaterally, than controls (P<.000). This was paralleled by increased upper-limb reaction times and reduced speed of movement (mean differences, 2%-15%) in both affected and unaffected limbs. Pain-free grip strength was reduced on the involved side (mean difference, 170N; 95% confidence interval, 144-195N). CONCLUSIONS: Motor deficits may be modifiable through exercise and postural retraining. Although further work is required to evaluate the clinical efficacy of such an approach, health care practitioners have an emerging evidence base on which to base their management of lateral epicondylalgia.

Adult↗

Dorsal capsulodesis for scapholunate instability--effect on patient disability and wrist pain.

Twenty cases of scapho-lunate instability have been reviewed, to determine the effect of dorsal capsulodesis on disability and wrist pain. The average follow-up was 41 (range 13-63) months. There was a significant improvement in the pre-operative Patient Rated Wrist Evaluation score from 108 (range 18-150) to a postoperative score of 60 (range 0-132). All wrist movements and grip strength were reduced postoperatively but only the reductions in flexion and radial deviation were statistically significant. Seventeen (85%) patients were satisfied with the operation. One patient remained unemployed after surgery. Five patients returned to their normal jobs. This study shows that dorsal capsulodesis should remain an important option in the treatment of scapholunate instability.

Adolescent↗

Muscle performance in patients with fibromyalgia.

OBJECTIVES: To compare muscle performance in women with fibromyalgia and in healthy women. PATIENTS AND METHODS: Sixteen women with fibromyalgia syndrome (FMS) and 85 healthy women who were physically inactive or engaged in recreational sports underwent measurements of four parameters: maximal concentric isokinetic muscle strength of the knee extensors and flexors in the dominant limb, isometric grip strength on a Colin dynamometer, muscle fatigue resistance during 30 maximal concentric isokinetic contractions of the dominant knee flexors and extensors at 180 degrees angular velocity, and static endurance during posture maintenance. RESULTS: All muscle variables were decreased in the FMS patients as compared to the controls. The decreases were more marked during aerobic than during anaerobic exercise. Mean decreases were 39% (P<0.001) for muscle strength, 40% (P<0.0001) for fatigue resistance, and 81% (P<0.0001) for static endurance. Pain during exercise as evaluated using a visual analog scale was more marked in the FMS patients. CONCLUSION: This study of the three pathways supplying energy to muscle confirms that muscle function is globally impaired in FMS patients. The results suggest that the impairment predominates on aerobic processes.

Adult↗

Shared age-related influences on cognitive and noncognitive variables.

Analyses of new data and of previously published data were conducted to examine the degree to which age-related variance was shared across cognitive and noncognitive variables and to investigate possible alterations in the composition of a factor common to all variables as a function of age. The results indicated that measures of visual acuity, grip strength, and blood pressure shared age-related variance with measures of perceptual speed, episodic memory, spatial visualization, and inductive reasoning. However, although the cognitive variables shared similar amounts of variance in age-restricted and age-partialed analyses, the variance shared between cognitive and noncognitive variables was substantially reduced after controlling the influence of age.

Adolescent↗

Changes in physical capacity among middle-aged municipal employees over 16 years.

The purpose of the present study was to identify changes in different components of physical capacity among middle-aged women and men employed in the municipal branch for 16 years. The data were obtained by laboratory measurements and postal questionnaires. The study group consisted of 45 middle-aged subjects, who were on average 51.5 years old at the beginning of the follow-up in 1981 and 67.3 years in 1997. During the 16-year follow-up period, the average physical capacity of these workers decreased by approximately 20%. The study showed that the greatest changes occurred in isometric trunk muscle strength and in the flexibility of the spine, whereas smaller changes were noted in anthropometrics. The decrease of physical capacity was greater among men (range 11.6% to 33.7%) than among women (range 3.3% to 26.7%), although women had more individual variations. On average, people without disease or who were physically active displayed better physical capacity than people with disease or who were physically passive.

Aged↗

1-Bromopropane, an alternative to ozone layer depleting solvents, is dose-dependently neurotoxic to rats in long-term inhalation exposure.

1-Bromopropane has been newly introduced as an alternative to ozone layer-depleting solvents. We aimed to clarify the dose-dependent effects of 1-bromopropane on the nervous system. Forty-four Wistar male rats were randomly divided into 4 groups of 11 each. The groups were exposed to 200, 400, or 800 ppm of 1-bromopropane or only fresh air 8 h per day for 12 weeks. Grip strength of forelimbs and hind limbs, maximum motor nerve conduction velocity (MCV), and distal latency (DL) of the tail nerve were measured in 9 rats of each group every 4 weeks. The other 2 rats of each group were perfused at the end of the experiment for morphological examinations. The rats of the 800-ppm group showed poor kicking and were not able to stand still on the slope. After a 12-week exposure, forelimb grip strength decreased significantly at 800 ppm and hind limb grip strength decreased significantly at both 400 and 800 ppm or after a 12-week exposure. MCV and DL of the tail nerve deteriorated significantly at 800 ppm. Ovoid or bubble-like debris of myelin sheaths was prominent in the unraveled muscular branch of the posterior tibial nerve in the 800-ppm group. Swelling of preterminal axons in the gracile nucleus increased in a dose-dependent manner. Plasma creatine phosphokinase (CPK) decreased dose-dependently with significant changes at 400 and 800 ppm. 1-Bromopropane induced weakness in the muscle strength of rat limbs and deterioration of MCV and DL in a dose-dependent manner, with morphological changes in peripheral nerve and preterminal axon in the gracile nucleus. 1-Bromopropane may be seriously neurotoxic to humans and should thus be used carefully in the workplace.

Administration, Inhalation↗

Redisplaced unstable fractures of the distal radius. A randomised, prospective study of bridging versus non-bridging external fixation.

A randomised, prospective study was carried out on 60 patients with unstable fractures of the distal radius to compare bridging with non-bridging external fixation using pins placed in the distal fragment of the radius. The radiological results showed significant improvement in the non-bridging group at all stages of review. In particular, normal volar tilt and carpal alignment were regained and maintained. The functional results at six weeks, three months, six months and one year showed statistically better grip strength and flexion in the non-bridging group at all stages of review. Other ranges of movement showed an early advantage in the non-bridging group. Non-bridging external fixation is the treatment of choice for unstable fractures of the distal radius which have sufficient space for the placement of pins in the distal fragment.

Adult↗

Kienböck's disease: conservative management versus radial shortening.

Avascular necrosis of the lunate, first described by Kienbock, can be treated either conservatively or by various surgical procedures. We compared the results of 18 conservatively treated patients, all of whom had stage-2 or stage-3 disease, with those of 15 who underwent a radial shortening procedure. We evaluated pain, range of movement, grip strength and functional disability, and determined the progression of the disease by assessing radiologically carpal height, the width and flattening of the lunate, the radioscaphoid angle, the pattern of the fracture and sclerosis and cysts. The mean follow-up was for 3.6 years (1.5 to 9). Patients treated by radial shortening had less pain and better grip strength than those managed conservatively. In some patients with stage-3 disease treated conservatively there was rapid deterioration to carpal collapse. Although radial shortening did not reverse or prevent carpal collapse, it slowed down the process in patients with stage-3 disease. We recommend a radial shortening procedure for patients with severe pain and radiological signs of progressive carpal collapse.

Activities of Daily Living↗

Minimizing fatigue during repetitive jobs: optimal work-rest schedules.

Twenty women were asked to generate forces using a dynamometer that were consistent with one of three different work-rest schedules (a low-, medium-, and high-force schedule). Each work-rest schedule consisted of 6 identical blocks of 10 work-rest cycles. Each of the 10 work-rest cycles lasted 1 min. The first work-rest cycle in each block consisted of a 6-s maximal voluntary contraction and a 54-s rest. The remaining 9 work-rest cycles in each block consisted of a submaximal contraction and a rest period. The desired force of the submaximal contraction, the length of this contraction, and the duration of the rest period remained constant within schedules but varied across schedules. The amount of physiological work was kept constant among schedules. The fatigue that developed in the medium-force schedule was significantly lower than that developed in either the low- or high-force schedule. A model was developed that predicted the amount of fatiguable strength at the beginning and end of each contraction of a work-rest cycle. When fit to the results from the experiment, the model explained 94% of the variance. The model can be used to predict the work-rest schedule that minimizes fatigue in a given repetitive job, thereby potentially increasing productivity and reducing the incidence of cumulative trauma disorders.

Adult↗

Initial effects of elbow taping on pain-free grip strength and pressure pain threshold.

STUDY DESIGN: Single-blind, placebo control, randomized, crossover, experimental study with repeated measures. OBJECTIVE: To determine the initial effects of a taping technique on grip strength and pain in individuals with lateral epicondylalgia. BACKGROUND: Taping techniques are advocated for chronic musculoskeletal conditions such as lateral epicondylalgia, a prevalent disorder with significant impact on the individual and community. Little evidence exists supporting the effects of taping techniques on musculoskeletal pain. METHODS AND MEASURES: Sixteen participants (mean age +/- SD, 45.8 +/- 10.2 years) with chronic lateral epicondylalgia (mean duration +/- SD, 13.1 +/- 9.9 months) participated in a placebo control study of an elbow taping technique. Outcome measures were pain-free grip strength and pressure pain threshold taken before, immediately after, and 30 minutes after application of tape. RESULTS: The taping technique significantly improved pain-free grip strength by 24% from baseline (P = .028). The treatment effect was greater than that for placebo and control conditions. Changes in pressure pain threshold (19%), although positive, were not statistically significant. CONCLUSION: This preliminary study demonstrated an initial ameliorative effect of a taping technique for lateral epicondylalgia and suggests that it should be considered as an adjunct in the management of this condition.

Adult↗

Ligament reconstruction basal joint arthroplasty without tendon interposition.

The necessity of tendon interposition for the maintenance of joint space after basal joint resection arthroplasty with ligament reconstruction has not been established. A prospective, randomized study was performed. In Group I (nine patients), ligament reconstruction was performed to suspend the first metacarpal in addition to placement of a rolled tendon interposition to fill the void created by resection of the trapezium. In Group II (11 patients), ligament reconstruction alone was performed, with use of a Mitek suture anchor. No tendon interposition was performed. This allowed use of a more limited incision and shorter length of tendon graft. Average followup was 23 months. There was no difference between the two groups in range of motion of the thumb, grip strength, lateral pinch strength, the ability to perform activities of daily living, or subjective satisfaction with the procedure. Two- and three-point pinch strength was statistically significantly greater in Group II. Lateral radiographs of the basal joint at followup, at rest and with pinch, showed maintenance of the joint space, and no difference between the two groups. Tendon interposition is not necessary for maintenance of joint space after basal joint resection arthroplasty if ligament reconstruction is performed.

Activities of Daily Living↗

[Results of surgical treatment of radio-humeral epicondylopathy].

We examined extent and affection of an assumed neuromuscular transmission disorder by performing a prospective clinical study on 75 patients with therapy-resistant radiohumeral epicondylopathy. Before operation, we electromyographically diagnosed an increased rate of polyphasic potentials of the long wrist extensors as well as a prolonged motor latency of the respective muscles. Corresponding to a hereby implied damage to the distal part of the motor neuron, disordered neuromuscular recruitment combined with a reduced maximum strength and -elasticity could be proven. Both effects were significantly reversible (p < 0.001) through operative intervention. We found a significant correlation (corr < 0.90) between the normalization of the motor latency and increased strength. Subgroups were formed depending on different pre-operative diagnostic efforts and differing redicality regarding the performed soft-tissue operation, thus the clinical validity of the findings diagnosed in the anatomic and neurophysiologic part of the study was additionally examined. It was proven that the failure rate varies between 10% and 30%, depending on the radicality of tenotomy, which could be interpreted as a general indication for complete extensor carpi radialis brevis tendon release. In this connection it is remarkable that the clinical result of an electromyographically localized damage in the area between epicondyle and arcade of Frohse could not be improved through open neurolysis. Dealing with strictures located on the proximal side of the epicondyle on the other hand, this technique seems to play an important role for recurrence prophylaxis.

Adult↗

The development of a battery of measures for assessing physical functioning of chronic pain patients.

The physical performance of chronic pain patients is of major concern both for their assessment and for treatment evaluation. However, there are few widely used physical tests, a shortage of reliability and validity data on published tests, and an over-reliance on self-report or on clinical measures of dubious generalisability. A set of tests was designed to cover speed and endurance in walking, stair climbing, standing up from a chair, sit-ups, arm endurance, grip strength, and peak flow. Standard instructions and testing conditions were used by a trained tester on a population of chronic pain patients before and after a cognitive-behavioural chronic pain management programme. Reliability, validity, and acceptability of each test was examined, and recommendations made for their relative utility.

Adult↗

Low grip strength, impaired tongue force and hyperactivity induced by overexpression of neurotrophin-3 in mouse skeletal muscle.

Transgenic mice overexpressing neurotrophin-3 (NT-3) in skeletal muscle (mlc/NT-3 mice) develop abnormal muscle spindles in skeletal muscle and display abnormal motor function in the form of gait and locomotive disturbances. The purpose of this work was to characterize the functional consequences of NT-3 overexpression in skeletal muscle with further behavioral assessments that permitted inferences about muscle weakness in the tongue or forelimbs as well as potential central nervous system (CNS) abnormalities compared to wild-type controls. Wild-type (n=12) and mlc/NT-3 (n=12) male mice were tested in five procedures (in chronological order): lick dynamics, locomotor activity, grid ataxia, go-no-go discrimination procedure, and grip strength. Relative to wild-type mice, the mlc/NT-3 mice exhibited lower tongue force, hyperactivity, slowed limb retrieval in the grid ataxia test, similar discrimination performance, and lower grip strength. Overall, the data suggest that chronically elevated levels of NT-3 in mouse skeletal muscle cause muscle weakness in the mlc/NT-3 mice. Surprisingly, mlc/NT-3 mice also exhibited significant hyperactivity, suggesting that NT-3 overexpression in the periphery may have caused abnormalities in the CNS that are related to the cortical processing of proprioceptive afferent information.

Afferent Pathways↗