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A lateralised grip strength test to evaluate unilateral nigrostriatal lesions in rats.

A modified grip strength meter was designed to enable the separate measurement of lateralised grip strength in the two forelimbs of rats, in order to allow assessment of deficits in animals with unilateral lesions and grafts within the basal ganglia. Unilateral 6-hydroxydopamine lesions of the dopaminergic nigrostriatal bundle induced a significant asymmetry, marked by an increased grip strength on the side contralateral to the lesion. Lesioned animals with additional implants of embryonic nigral cell suspensions into the dopamine-denervated neostriatum showed a reduced (but not significant) deficit and did not differ from control performance. The lateralised nature of the deficit excludes explanation based on global activational changes; rather the unilateral deficit may provide a simple test of unilateral 'rigidity' in a widely used rodent model of Parkinson's disease.

Adrenergic Agents↗

Falls, sarcopenia, and growth in early life: findings from the Hertfordshire cohort study.

Recent studies have shown that people whose early growth is poor have an increased risk of sarcopenia. Sarcopenia is an important risk factor for falls, but it is not known whether poor early growth is related to falls. The authors investigated this association in the Hertfordshire Cohort Study (1998-2004), where 2,148 participants from the United Kingdom provided their history of falls. Grip strength was used as a marker of sarcopenia. Birth weight, weight at 1 year, and conditional infant growth were analyzed in relation to history of falls. The prevalence of any fall in the last year was 14.3% for men and 22.5% for women. Falls in the last year were inversely related to adult grip strength, height, and walking speed in men and women as well as to lower conditional infant growth in men (odds ratio = 1.27, 95% confidence interval: 1.04, 1.56 per standard deviation decrease in conditional infant growth; p = 0.02). This association was attenuated after adjustment for grip strength. These findings support an association between poor early growth and falls in older men that appears to be mediated partly through sarcopenia. The lack of a relation with birth weight suggests that postnatal rather than prenatal influences on muscle growth and development may be important regarding the risk of falls in later life.

Accidental Falls↗

Evaluation of movement speed and reaction time as predictors of all-cause mortality in men.

Muscle power is associated with mortality independent of strength, suggesting that movement speed and coordination convey health-related information. We hypothesized that movement speed is a marker of longevity. Our participants included 1196 men who performed a tapping and/or auditory simple (respond to a sound) and disjunctive (respond to a higher pitched sound) reaction-time tasks while participating in the Baltimore Longitudinal Study of Aging. Mortality was assessed over 40 years. Tapping time was associated with mortality (relative risk [RR] = 1.34 per minute, 95% confidence interval [CI], 1.05-1.70) adjusted for age, and persisted with adjustments for arm strength and power. Simple (RR = 1.17 per 100 ms, 95% CI, 1.03-1.32) and disjunctive (RR = 1.14 per 100 ms, 95% CI, 1.03-1.27) reaction times but not their difference (RR = 1.04 per 100 ms, 95% CI, 0.92-1.19) were associated with mortality after adjustments for age, neurological/psychiatric and neck/arm pain histories. Age-associated impairments in motor control systems but not the decision to move affects longevity.

Baltimore↗

Radiocarpal arthrodesis for osteoarthritis following fractures of the distal radius.

To compare the radioscapholunate (RSL) arthrodesis and radiolunate (RL) arthrodesis as a treatment for radiocarpal osteoarthritis following fractures of the distal radius, nine patients, 23 to 70 years old (average 41) at the time of surgery, were assessed two to 33 years after surgery. The periods between injury and surgery ranged from four months to 30 years. RSL arthrodesis was performed in three cases and RL arthrodesis in six. Post-operative wrist pain disappeared in six and was decreased in the other three. In the RSL group, the total arc of wrist flexion and extension was reduced from 50 degrees pre-operatively to 35 degrees post-operatively. In the RL group, it was increased from 72 degrees to 76 degrees after surgery. Grip strength improved in most patients, from 7 to 18 kg in the RSL group, and from 16 to 27 kg in the RL group. On roentogenogram, three patients showed arthritic changes in the adjacent joints, but there were no symptoms in two of the three patients. We concluded that partial radiocarpal arthrodesis (preferably RL arthrodesis) is a reliable procedure for radiocarpal osteoarthritis following fractures of the distal radius.

Adult↗

[Age-related changes in static maximal inspiratory and expiratory pressures].

We evaluated 240 consecutive subjects (aged 20-91) without cardiopulmonary, endocrine or, neuromuscular disease consecutively regarding pulmonary function (TLC, VC, FEV1, RV) and static maximal inspiratory (PImax) and expiratory (PEmax) pressures. PImax and PEmax declined with advancing age. PImax correlated with grip strength, VC, FEV1, height, weight, and RV/TLC. PEmax also correlated with grip strength, TLC, VC, FEV1, height, and weight. Age, height, weight, and grip strength were entered stepwise into multiple linear regression models with PImax or PEmax as the dependent variable. Stepwise regression analysis revealed that grip strength was an independent predictor for both PImax and PEmax. However, age itself was not an independent predictor for PImax or PEmax. These results suggest that static maximal respiratory pressures decrease with aging, and that age-dependent changes in respiratory muscle function may depend on other factors, including lung volume, skeletal muscle status, and body composition.

Adult↗

Continuous low-level heat wrap therapy is effective for treating wrist pain.

OBJECTIVE: To evaluate the efficacy of continuous low-level heat wrap therapy for the treatment of various sources of wrist pain including strain and sprain (SS), tendinosis (T), osteoarthritis (OA), and carpal tunnel syndrome (CTS). DESIGN: Prospective, randomized, parallel, single-blind (investigator), placebo-controlled, multicenter clinical trial. SETTING: Two community-based research facilities. PARTICIPANTS: Ninety-three patients (age range, 18-65 y) with wrist pain. INTERVENTION: Subjects with moderate or greater wrist pain were randomized and stratified to 1 of the following treatments: efficacy evaluation (heat wrap, n=39; oral placebo, n=42) or blinding (oral acetaminophen, n=6; unheated wrap, n=6). Data were recorded over 3 days of treatment and 2 days of follow-up. MAIN OUTCOME MEASURES: The primary comparison was between the heat wrap and the oral placebo group among SS/T/OA subjects for pain relief. Outcome measures included pain relief (0-5 scale), joint stiffness (101-point numeric rating scale), grip strength measured by dynamometry, and perceived pain and disability (Patient Rated Wrist Evaluation [PRWE]); subjects with CTS also completed the Symptom Severity Scale and Functional Status Scale. RESULTS: Heat wrap therapy showed significant benefits in day 1 to 3 mean pain relief (P=.045) and increased day 3 grip strength (P=.02) versus oral placebo for the SS/T/OA group. However, joint stiffness and PRWE results were comparable between the 2 treatments. For the CTS group, heat wraps provided greater day 1 to 3/hour 0 to 8 mean pain relief (P=.001), day 1 to 3 mean joint stiffness reduction (P=.004), increased day 3 grip strength (P=.003), reduced PRWE scores (P=.0015), reduced symptom severity (P=.001), and improved functional status (P=.04). In addition, the heat wrap showed significant extended benefits through follow-up (day 5) in the CTS group. CONCLUSIONS: Continuous low-level heat wrap therapy was efficacious for the treatment of common conditions causing wrist pain and impairment.

Acetaminophen↗

The impact of severe acute respiratory syndrome on the physical profile and quality of life.

OBJECTIVE: To investigate the impact of severe acute respiratory syndrome (SARS) on the physical fitness and health-related quality of life (HRQOL) among SARS survivors. DESIGN: A cohort study. SETTING: An outpatient physiotherapy department in a major hospital in Hong Kong. PARTICIPANTS: SARS patients (N=171) discharged from the hospital. Their mean age was 37.36+/-12.65 years, and the average number of days of hospitalization was 21.79+/-9.93 days. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Subjects cardiorespiratory (6-minute walk test [6MWT], Chester step test for predicting maximal oxygen uptake [Vo 2 max]), musculoskeletal (proximal/distal muscle strength and endurance test), and HRQOL status (Medical Outcomes Study 36-Item Short-Form Health Survey [SF-36]) were measured and compared with the normative data matched for age and sex. RESULTS: Seventy-eight (45.61%) patients continued to require prednisolone (< 0.5mg.kg -1 .d -1 ) for residual lung opacities when data were collected. The values of 6MWT distance, predicted Vo 2 max, proximal and distal muscle strength, and the scores from all SF-36 domains, particularly perceived role-physical, were significantly lower than the normative data ( P <.05). CONCLUSIONS: SARS survivors had deficits in cardiorespiratory and musculoskeletal performance, and their HRQOL appeared to be significantly impaired.

Adolescent↗

A pilot study of the manual force levels required to produce manipulation induced hypoalgesia.

OBJECTIVE: A pilot investigation of the influence of different force levels on a treatment technique's hypoalgesic effect. DESIGN: Randomised single blind repeated measures. BACKGROUND: Optimisation of such biomechanical treatment variables as the point of force application, direction of force application and the level of applied manual force is classically regarded as the basis of best practice manipulative therapy. Manipulative therapy is frequently used to alleviate pain, a treatment effect that is often studied directly in the neurophysiological paradigm and seldom in biomechanical research. The relationship between the level of force applied by a technique (e.g. biomechanics) and its hypoalgesic effect was the focus of this study. METHODS: The experiment involved the application of a lateral glide mobilisation with movement treatment technique to the symptomatic elbow of six subjects with lateral epicondylalgia. Four different levels of force, which were measured with a flexible pressure-sensing mat, were randomly applied while the subject performed a pain free grip strength test. RESULTS: Standardised manual force data varied from 0.76 to 4.54 N/cm, lower-upper limits 95 CI, respectively. Pain free grip strength expressed as a percentage change from pre-treatment values was significantly greater with manual forces beyond 1.9 N/cm (P=0.014). CONCLUSIONS: This study, albeit a pilot, provides preliminary evidence that in terms of the hypoalgesic effect of a mobilisation with movement treatment technique, there may be an optimal level of applied manual force. RELEVANCE: This study indicates that the level of applied manual force appear to be critical for pain relief.

Adult↗

Associations of body composition with physical performance and self-reported functional limitation in elderly men and women.

To understand how body composition relates to functional impairment, the authors examined cross-sectional associations of absolute and relative measures of fat and lean mass with physical performance and self-reported functional limitation. The sample consisted of a community-based cohort of 1,655 older women and men from Sonoma, California, who had complete baseline data in 1993-1994 on body composition, physical performance, and functional limitation. Physical performance was assessed by walking speed and grip strength, while global functional limitation, across several domains, was assessed by self-report using standard questions. Lean mass and fat mass were estimated from bioelectric impedance using population-specific prediction equations derived from dual x-ray energy absorptiometry. Higher fat mass was associated with slower walking speed and greater likelihood of functional limitation, while higher lean mass was generally associated only with increased grip strength. A higher lean mass-to-fat mass ratio, a relative measure of body composition, was associated with faster walking speed and less limitation. These findings suggest that fat mass negatively impacts some domains of physical performance and overall functioning, while lean mass is less significant in absolute terms but is important relative to amount of body fat.

Adipose Tissue↗

Computer-assisted quantitative sensorimotor testing in patients with carpal and cubital tunnel syndromes.

This study reports the use of computer-assisted sensorimotor testing in 75 patients with chronic peripheral nerve compression. Pinch and grip strength, and the cutaneous pressure threshold were measured. The reliability of this equipment for repeated measurements was excellent (r = 0.95). The pressure threshold at which a one-point static stimulus could be distinguished from a two-point static stimulus was found to be the first variable to become abnormal with computer-assisted sensorimotor testing. Criteria are suggested for screening with this equipment to detect carpal and/or cubital tunnel syndrome.

Adult↗

Oral condition and health status of elderly 8020 achievers in Aichi Prefecture.

The purpose of this study was to investigate differences in oral condition and health status between persons with 20 or more teeth at the age of 80 (8020 elderly) and persons of the same age with less than 20 teeth (non-8020 elderly). This study was conducted by a team belonging to the Aichi Dental Association. Number of remaining teeth, Community Periodontal Index of Treatment Needs (CPITN), salivary blood test, masticatory ability, bone mineral density (BMD), grip strength, balance test (length of time one can stand on one leg with eyes open), height, weight and body mass index (BMI) were all examined. The percentages of CPITN code 0, 1 and 2 were 68% in the 8020 male elderly and 72% in the 8020 female elderly. The positive percentage in the salivary blood test in the 8020 elderly was lower than that in the non-8020 elderly. Masticatory ability was 1.55 g in the 8020 male elderly, and 1.53 g in the 8020 female elderly. Relative masticatory ability in the 8020 female elderly was 20% higher than that in the non-8020 female elderly. BMD in the 8020 female elderly was significantly higher than that in the non-8020 female elderly. Grip strength in the 8020 elderly was also significantly higher than that in the non-8020 elderly. The duration of balance test in the 8020 male elderly was 2.2 times longer than that in the non-8020 male elderly. The 8020 elderly showed good oral condition and health status was found to be better in the 8020 elderly than in the non-8020 elderly.

Aged, 80 and over↗

Functional results after treatment of Volkmann's ischemic contracture: a long-term followup study.

The main objective of this retrospective study was to evaluate the long-term functional outcome in patients treated for Volkmann's ischemic contracture. In this study, functional outcome (measured as mobility, grip strength, and sensibility) and arm length difference after treatment of Volkmann's ischemic contracture were analyzed and discussed. Twenty-five patients treated between 1969 and 2001 were evaluated. The method of treatment was related to the severity of the infarction, ranging from conservative to free vascularized muscle transplantation. Although the study population was small, we could observe a wide range of functional outcome. Substantial improvement of function was obtained in patients who had free vascularized muscle transplantation. Unfortunately in one patient with an occlusion of the distal brachial artery and an insufficient flow through the collateral circulation of the radial artery, the gracilis muscle was lost. Tendon lengthening had unsatisfactory results because of recurrence of the contracture. Excision of fibrotic muscle tissue, neurolysis and tenolysis sometimes combined with a tendon transfer gave good hand function results in patients with sufficient remaining muscle tissue. In most of the patients in whom the contracture developed during childhood, a difference in forearm length was observed.

Compartment Syndromes↗

Reconstruction of the digital flexor pulley system: a retrospective comparison of two methods of treatment.

The rare injury of closed rupture of the A2 and A3 flexor pulleys was treated using two non-encircling techniques of pulley reconstruction. Thirteen patients were treated with an extensor retinaculum graft (Group A). At a mean follow-up time of 48 months, the average PIP flexion was 97%, the power grip strength 96%, the pinch grip strength 100% and the thickening 94% of the uninjured side. Ten patients were treated with a free palmaris longus tendon grafts (Group B). At a mean follow-up time of 57 months, the average PIP flexion was 94%, the power grip strength 98%, the pinch grip strength 100% and the thickening 95% of the uninjured side. In both groups, finger extension was unrestricted. The Buck Gramcko score included 10 excellent, two good and one fair result in Group A and seven excellent, two good and one fair result in Group B. Both techniques proved beneficial. All climbers returned to their previous standard and all non-climbers regained full finger dexterity in their previous job.

Adult↗

Influence of the selective ORL1 receptor agonist, Ro64-6198, on rodent neurological function.

Identification of synthetic agonists and antagonists at orphan receptors represents an important step for understanding their physiological function and therapeutic potential. Accordingly, we have recently described a non-peptide agonist at the opioid receptor like (ORL1) receptor (1S,3aS)-8-(2,3,3a,4,5,6-hexahydro-1H-phenalen-1-yl)-1-phenyl-1,3,8-triazaspiro[4.5]decan-4-one (Ro64-6198; Jenck et al., PNAS 94 (2000) 4938; Wichmann et al., Eur. J. Med. Chem. 35 (2000) 839). We have investigated the effects of this compound in various tests of rodent neurological function, utilising ORL1 knockout mice to examine the pharmacological specificity of Ro64-6198. In male C57BL/6J mice, effects on balance and motor co-ordination were detected following low doses (0.3-1mg/kg IP) of Ro64-6198. At higher doses (1-3mg/kg IP), effects on swim behaviour and hypothermia was observed. At 10mg/kg, each effect became more profound and a severe neurological disturbance appeared, including loss of righting reflex. These effects of Ro64-6198 (10mg/kg IP) were absent in ORL1 receptor knockout mice. In male, hooded Lister rats, Ro64-6198 (6-10mg/kg IP), produced some disturbance of neurological function, including hypoactivity, rotarod performance, grip strength and mild hypothermia. An impairment of food responding under a variable interval (VI) 20s schedule of reinforcement was noted at 3mg/kg. These results confirm Ro64-6198 to be a highly selective pharmacological tool to investigate ORL1 receptor function in vivo and, furthermore, that activation of this receptor is accompanied by a variety of effects on neurological function.

Animals↗

Clinical disorders and pressure-pain threshold of the forearm and hand among automobile assembly line workers.

The prevalence of forearm and hand disorders was examined by questionnaire and clinical examination in 199 automobile assembly line workers and in 186 controls. The pressure-pain threshold, hand grip force and hand anthropometry were also studied. There was an increased prevalence of de Quervain's disease for male automobile assembly line workers, and of carpal tunnel syndrome in female workers. The prevalence of symptoms in the forearm and hand during the last 7 days were twice as high among automobile assembly line workers than controls for both men and women. The occurrence of symptoms in the last 7 days was associated with de Quervain's disease, carpal tunnel syndrome and sick-leave due to forearm or hand problems, and it also influenced activities of daily living. Hand grip strength and anthropometrics were not associated with findings in the clinical examination or the occurrence of symptoms in the last 7 days. Low pressure-pain threshold was not associated with findings in the clinical examination, except for reported occurrence of symptoms in the last 7 days for women. Pressure-pain threshold as an indicator of tissue damage is discussed.

Adolescent↗

Arthroscopic debridement alone for intercarpal ligament tears.

This study examined the role of arthroscopic debridement alone for complete and incomplete intercarpal ligament tears of the wrist. Forty-three wrists underwent arthroscopic evaluation for persistent wrist pain and were identified as having isolated scapholunate or lunotriquetral ligament tears treated by arthroscopic debridement alone of the torn ligament edges. At follow-up examination at an average of 27 months, 29 (66%) wrists having a complete scapholunate ligament tear and 36 (85%) wrists having a limited scapholunate ligament tear had either complete symptom resolution or improved symptomatology. Thirty-three (78%) wrists with a complete lunotriquetral ligament tear and 43 (100%) wrists having a limited lunotriquetral ligament tear had complete symptom resolution or improvement. No wrists were noted to have static intercarpal instability pattern changes on follow-up radiographs. Grip strength improved 23% postoperatively. These findings suggest that intercarpal ligament tears, in a majority of patients, may be treated from a symptomatic standpoint by debridement alone for at least several years. The long-term ability of this approach to maintain a pain-free wrist has yet to be determined. No statistically significant difference was noted in the symptomatic improvement rate of scapholunate compared to lunotriquetral ligament debridement.

Adult↗

Percutaneous Herbert screw fixation for fractures of the scaphoid: review of 30 cases.

INTRODUCTION: The purpose of this study was to evaluate the results of percutaneous fixation of undisplaced or minimally displaced fractures of the scaphoid using the first generation Herbert screw in terms of union, functional results and scaphoid mobility. METHODS: 30 of the 50 patients operated on in our department between 1995 and 2000 were available for evaluation by an independent observer. Wrist mobility, grip strength and key pinch were measured. Scaphoid mobility was evaluated by measuring radioscaphoid angles in flexed and extended positions on dynamic X-rays. RESULTS: The union rate was comparable to that achieved by non-operative management (90%). Resumption of professional activities was possible long before bony union because immobilization was short. Grip strength, wrist and scaphoid mobilities were comparable to the controlateral sides except for scaphoid flexion. Persistent symptoms were found in 30% of the patients despite union of their fracture. DISCUSSION: Our results demonstrate that percutaneous stabilization of undisplaced or minimally displaced fractures of the scaphoid preserves the mobility of the wrist and minimally alters the normal dynamics of the carpus. The duration of work inability is short.

Adult↗

Continuous axillary brachial plexus analgesia with low dose morphine in patients with complex regional pain syndromes.

In this prospective pilot study, nine patients suffering from complex regional pain syndrome of the arm were treated with morphine 0.16 mg h-1 (3.84 mg day-1) applied continuously through an axillary brachial plexus catheter. In all of them an oral analgesic medication including the less potent opioid tramadol had not provided sufficient pain relief. During regional treatment, patients were kept in hospital and physiotherapy was carried out frequently in order to improve strength and function of the affected arm. Pain at rest and during movement as well as grip strength were assessed at first visit, during morphine infusion and at a long-term follow-up visit. All assessments improved significantly during plexus analgesia. There were no major opioid related side-effects. The results from this pilot study indicate that continuous axillary brachial plexus analgesia with low dose morphine might be beneficial in patients suffering from complex regional pain syndrome of the arm.

Adult↗