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At least 19 recordsLinked to original sources
PubMed2002

Limited joint mobility in selected hand and foot joints in patients with type 1 diabetes mellitus: a methodology comparison.

OBJECTIVES: First to determine the range of motion (ROM) of selected foot and hand joints with a goniometer, 2.) to determine joint limitation by prayer sign and 3.) to compare both methods used. METHODS: Maximal active ROM was measured by goniometry (Method 1) in 50 patients with Type 1 diabetes and in 44 healthy controls, respectively. The lower limits for normal ranges were defined as mean minus 2 SD. To elicit the prayer sign (Method 2) subjects were asked to put their hands together in a praying position with the fingers fanned. The number of missing joint contacts between the fingers was counted and correlated to ROM. RESULTS: The ROM of all joints measured, except that of the thumb, was significantly smaller in diabetic patients than in control subjects. The degree of the prayer sign was well correlated to the ROM of most hand joints, but was solely correlated in feet to ankle ROM. In diabetic patients the prevalence of limited joint mobility (LJM) measured by goniometry ranged from 2 to 20% in hand joints and from 10 to 14% in foot joints. By the prayer sign 33% of the diabetic patients had LJM. CONCLUSION: With both methods, diabetic patients had more limitations in joint motion than control subjects, as was their prevalence of LJM higher. Since the prayer sign was correlated to exactly measured ROMs, we would suggest using the prayer sign as a simple clinical indicator for LJM in diabetic subjects.

Adult↗
PubMed2001

Lymph draining from foot joints in rheumatoid arthritis provides insight into local cytokine and chemokine production and transport to lymph nodes.

OBJECTIVE: Rheumatoid arthritis (RA) is characterized by inflammatory reactions in joints and adjacent tissues unaccompanied by clinically evident changes in lymphatics and lymph nodes draining the inflamed areas. The explanation for this phenomenon, which contrasts with infectious processes in joints and soft tissues that evoke major changes in the lymphatic system, is unclear. To determine which inflammatory factors produced in the joints of RA patients are transported in lymph to lymph nodes, we measured levels of immunoglobulins, cytokines, and chemokines in prenodal lymph from the foot joints of RA patients and quantified their rate of transport to regional lymph nodes. METHODS: Lymph was collected from the cannulated lymphatics draining the foot joints, tendons, fascia, and skin of 20 RA patients. Lymph flow rate and concentrations of proteins and immunoglobulins were measured. Cytokine and chemokine levels were quantified by enzyme-linked immunosorbent assays. Results were compared with those obtained in 20 control subjects. RESULTS: In the cannulated vessel, the mean +/- SEM lymph flow rate in RA patients was almost 2-fold that in control subjects (22.6 +/- 3.2 ml/24 hours versus 13.2 +/- 1.1 ml/24 hours; P < 0.01). Lymph concentrations of total protein, IgG, and IgM were 1.80 +/- 0.14 gm/dl, 384 +/- 45 mg/dl, and 32.0 +/- 1.5 mg/dl, respectively, in RA patients and 1.66 +/- 0.14 gm/dl, 238 +/- 32 mg/dl, and 15.0 +/- 1.3 mg/dl, respectively, in control subjects. The corresponding lymph:serum (L:S) ratios were 0.21 +/- 0.02, 0.22 +/- 0.02, and 0.15 +/- 0.02, respectively, in RA patients and 0.22 +/- 0.02, 0.19 +/- 0.02, and 0.11 +/- 0.02, respectively, in control subjects. The L:S ratios of <1 and the absence of significant differences between groups suggested a lack of local production of immunoglobulins. In RA patients, lymph concentrations (in pg/ml) were as follows: interleukin-1beta (IL-1beta) 14.8 +/- 3.9, IL-6 511 +/- 143, tumor necrosis factor alpha (TNFalpha) 9.9 +/- 1.1, IL-1 receptor antagonist (IL-1Ra) 4,274 +/- 737, IL-10 13.3 +/- 4.4, IL-8 846 +/- 174, IL-15 6.2 +/- 0.9, granulocyte-macrophage colony-stimulating factor (GM-CSF) 2.30 +/- 0.15, vascular endothelial growth factor (VEGF) 80.4 +/- 8.6, and macrophage inflammatory protein 1alpha (MIP-1alpha) 171 +/- 34. In control subjects, these values were as follows: IL-1beta 1.50 +/- 0.25, IL-6 79.0 +/- 14.6, TNFalpha 4.4 +/- 1.1, IL-1Ra 208 +/- 52, IL-10 0.0, IL-8 216 +/- 83, IL-15 5.00 +/- 0.45, GM-CSF 0.40 +/- 0.05, VEGF 42.0 +/- 2.4, and MIP-1alpha 3.4 +/- 1.7 (P < 0.05 versus RA patients for all except IL-15). The L:S ratio was >1 in all RA patient samples for IL-1beta, IL-6, IL-1Ra, IL-8, GM-CSF, IL-10, IL-15, TNFalpha, and MIP-1alpha, indicating local production of cytokines. Great variability in lymph cytokine concentrations, presumably reflecting differences in the intensity of local inflammation, was not reflected in serum cytokine concentrations. Intravenously infused methylprednisolone decreased lymph cytokine levels to normal within 12 hours. In contrast, their concentrations in serum showed little or no change. CONCLUSION: High lymph concentrations of cyto kines and chemokines, exceeding those in serum, were found in RA patients. The L:S concentration ratios of > 1 indicate the local production of these cytokines and chemokines in the inflamed tissues. High flow rates of lymph containing high cytokine concentrations through the regional lymph nodes are likely to affect node lymphocytes and dendritic cells. Analysis of cytokines in lymph should provide insight into events in inflamed tissues in RA and in regional lymph nodes.

Adult↗
PubMed1991

Radiologic changes in temporomandibular, hand, and foot joints of patients with rheumatoid arthritis.

Radiologic changes in the temporomandibular joint (TMJ) and in the joints of the hand and foot were recorded for 90 adult patients with rheumatoid arthritis. The severity of the changes was graded according to the Larsen classification of six grades (O to V), and mainly erosive changes were recorded. The assessment of the radiographs was performed with the aid of reference films. The radiologic changes in the TMJs corresponded to grade II (definite early abnormality) and paralleled those of most of the metacarpophalangeal and metatarsophalangeal joints. The most severe changes were localized to the wrists, with a median grade of III (moderate destructive abnormality). The severity of the changes was similar on the right and left sides of the TMJ. We conclude that TMJ involvement in patients with rheumatoid arthritis is severe and warrants a thorough initial clinical examination. Such a strategy will facilitate the diagnosis and treatment of TMJ changes in the early stages of the disease.

Adolescent↗
PubMed2002

[Technique and value of arthrosonography in rheumatologic diagnosis--3: Ultrasound diagnosis of the ankle joint, foot and toes].

The clinical investigation of ankles, feet, and toes is frequently equivocal in rheumatology. Sonography can distinguish between underlying pathologies. We suggest following standard scans: 1) anterior longitudinal scan to diagnose effusions in the ankle and talonavicular joints, to display erosive and osteoarthrotic pathologies, and to diagnose tenosynovitis of the extensor tendons; 2) anterior transverse scan to document the findings in an additional dimension; 3) lateral transverse scan and 4) lateral longitudinal scan to diagnose tenosynovitis of the peroneus tendons; 5) medial transverse scan and 6) medial longitudinal scan to diagnose tenosynovitis of the flexor tendons; 7) posterior longitudinal scan and 8) posterior transverse scan to evaluate the Achilles tendon, the retrocalcaneal bursa, and the posterior recess of the ankle joint. Additionally we suggest optional scans: 9) plantar longitudinal scan for the plantar fascia and the plantar calcaneal surface; 10) distal anterior longitudinal scan to evaluate the midtalar joints; 11) distal anterior longitudinal scan to evaluate the toes; and 12) plantar, distal transverse scan to evaluate the flexor tendons of the toes. Additionally, the correlating longitudinal and transverse scans can be used to confirm the findings. The frequency of the transducer should be about 7.5 MHz for ankles and the peroneus, flexor, and extensor tendons. Ten to over 20 MHz are possible for more superficially located structures. Using modern equipment with higher resolution a hypoechoic border may be normal up to 3 mm in the ankle joints, the MTP joints, and around the peroneus tendons, and up to 4 mm around the tibialis posterior tendons.

Ankle Joint↗
PubMed1993

[Diagnostic possibilities of sonography: ankle joint, foot and Achilles tendon].

In patients with soft tissue swelling and pain of the foot and ankle, ultrasonography is a simple and reliable diagnostic procedure to demonstrate joint effusions or a tendovaginitis which may have caused the symptoms of the patient. The diagnostic puncture of a joint is only necessary to determine the kind of effusion. The diagnostic workup of patients with acute and chronic instability of the proximal ankle joint benefits from the sonographic measurement of the talus tilt and of the anterior drawer. As the diagnostic performance is equal to the radiologic stress test, X-ray exposure can be avoided. As the anatomic structure of the achilles tendon causes the typical fibrillary sonographic pattern, structural changes due to tendinitis or tendon rupture can easily be diagnosed.

Achilles Tendon↗
PubMed1976

[Method of compression arthrodesis of the ankle and foot joints].

A modified F.R. Bogdanov arthrodesis of the talocrural joint is described. The authors employed an external compression with three Kirschner pins, inserted in the tibial, calcanial and scaphoid bones. Late results of the operation were followed up in 20 patients. A complete correction, osteoankylosis of arthrodesized joints and rehabilitation of the weight-bearing function of the foot and extremity, as a whole, were gained in all patients.

Adolescent↗
PubMed1977

[Arthordesis of foot joints with the Cloward-technique (author's transl)].

The Cloward instruments can be used not only for the interbody cervical fusion, but also for the arthrodesis of the talo-crural and talo-navicular joints. By exact pinning with autolog spongiosa pins while the joints are distracted further internal is not necessary. In contrast to other methods the arthrodesis of the talo-crural joint is not accompanied by a shortening of the leg. Technical details of the method are described and the first results of 15 cases are reported.

Ankle Joint↗