Joint diseases Research Papers - Academia.edu (original) (raw)

The book features increased coverage of ultrasound, PET, and the diabetic foot and upgraded MR and CT images. New syndromes such as impingement have been added to the chapter on soft tissue trauma and overuse. The fractures and dislocations chapter includes OTA classifications and additional MR and CT scans of complications. Other highlights include up-to-date information on new fixation devices and prostheses and state-of-the-art interventional and vascular techniques including use of MRA.

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- Tendon and Ligament injuries, Diagnostic Imaging, Clinical Sciences, Foot Diseases

This article describes diagnostic arthroscopy and arthroscopic management of selected lesions in the standing equine patient. Details on case selection, patient and operating room preparation, and surgical technique are presented. This... more

- by Janik Gasiorowski
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- Arthroscopy, Horses, General Anesthesia, Veterinary Sciences

This article presents an overview of physical therapy management for patients with pathological musculoskeletal conditions of the shoulder. The importance of a thorough physical examination is stressed because proper treatment is based on this information. The primary goals of management should include the alleviation of acute inflammation and pain and the avoidance of subsequent soft tissue shortening. Medical and surgical treatments for common shoulder disorders also are discussed.

- by Arthur Nitz
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- Exercise therapy, Physical Therapy, Tendinopathy, Clinical Sciences
- by Russell Travis
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- Nursing, Pain, Chronic Pain, Occupational Medicine

Patient reported outcome (PRO) questionnaires are increasingly used to measure treatment effect in patients with knee pathology. PROs commonly used to assess outcome in patients with knee conditions can be generic, knee-specific, or condition-specific. Most PROs have been created based on clinician-based consensus and are not patient-centered. Items (questions plus their response options) in PROs can be generated by clinicians or through patient interviews. Items created by clinicians possess face validity. The objective of this study was to find all existing PRO items with potentially relevant content for patients with knee pathology. An exhaustive literature search was conducted for PRO questionnaires in English, German, and Scandinavian languages used to assess outcome in patients with knee pathology. The items from the collected PROs were assessed for content redundancy and item reduction was carried out to isolate items of unique content. These items were grouped into one of the components of the ICF classification system. Thirty-one PROs used for assessment of patients with knee problems were identified, yielding 539 items. Approximately 70% of these items consisted of redundant content matter. The item pool was reduced to a pool of 157 items. The search yielded 157 items of unique content. The identified items can be used to build condition-specific PRO questionnaires for patients with knee pathology.

- by Jonathan Comins
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- Biomedical Engineering, Medicine, ICF, Clinical Sciences

BackgroundArthropathy is one of the earliest and most common manifestations of hereditary haemochromatosis with a significant impact on quality of life. Although its radiographic features are well known, there is no assessment tool for their evaluation.ObjectiveTo develop and validate a novel scoring system for the evaluation of radiographic features of haemochromatosis arthropathy.MethodsA dichotomous scoring system assessing four radiographic features of haemochromatosis arthropathy and a 4-grade scale reflecting severity of radiographic change have been developed. Standard radiographs (hand, wrist, knee and ankle) of 170 subjects (116 male, 54 female) with genetically confirmed haemochromatosis and laboratory signs of iron overload were assessed by three readers and construct validity, feasibility and cross-sectional reliability (intrareader and inter-reader) were assessed.ResultsIntrareader and inter-reader reliability as assessed by percentage pairwise agreement and Cohen's...

- by Alexander Cavallaro
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- Genetics, Immunology, Global Health, Quality of life

This article presents the recommendations of the European Society of Musculoskeletal Radiology Arthritis Subcommittee regarding the standards of the use of MRI in the diagnosis of musculoskeletal rheumatic diseases. The recommendations discuss (1) the role of MRI in current classification criteria of musculoskeletal rheumatic diseases (including early diagnosis of inflammation, disease follow-up, and identification of disease complications); (2) the impact of MRI on the diagnosis of axial and peripheral spondyloarthritis, rheumatoid arthritis, and juvenile spondyloarthritis; (3) MRI protocols for the axial and peripheral joints; (4) MRI interpretation and reporting for axial and peripheral joints; and finally, (5) methods for assessing MR images including quantitative, semiquantitative, and dynamic contrast-enhanced MRI studies.

- by Iris Eshed
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- Magnetic Resonance Imaging, Medicine, Europe, Ultrasonography
- by Ron Diercks
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- Pain, Inclusion, Natural History, Comparative Study

Domestication of the donkey from the African wild ass transformed ancient transport systems in Africa and Asia and the organization of early cities and pastoral societies. Genetic research suggests an African origin for the donkey, but pinpointing the timing and location of domestication has been challenging because donkeys are uncommon in the archaeological record and markers for early phases of animal domestication are hard to determine. We present previously undescribed evidence for the earliest transport use of the donkey and new paleopathological indicators for early phases of donkey domestication. Findings are based on skeletal data from 10 ≈5,000-year-old ass skeletons recently discovered entombed in an early pharaonic mortuary complex at Abydos, Middle Egypt, and a concurrent study of 53 modern donkey and African wild ass skeletons. Morphometric studies showed that Abydos metacarpals were similar in overall proportions to those of wild ass, but individual measurements varied...

- by Matthew D Adams
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- Genetics, Paleontology, Morphometrics, Egyptian Archaeology

OBJECTIVE Thyroid dysfunction may cause musculoskeletal symptoms. We have evaluated the prevalence of adhesive capsulitis, Dupuytren's contracture, trigger finger, limited joint mobility and carpal tunnel syndrome in a series of patients with various thyroid diseases and differing levels of function. DESIGN AND PATIENTS Patients with euthyroid (diffuse and /or nodular) goitre, Hashimoto's thyroiditis, Graves' disease, toxic nodular goitre, toxic diffuse goitre and patients with goitre who had partial thyroidectomy were included in the study (n = 137). Neurological and musculoskeletal examinations were performed after a standardized symptom questionnaire. The prevalence of musculoskeletal problems was analysed with respect to thyroid function and thyroid autoantibody status. MEASUREMENTS Serum concentrations of free T3, free T4, TSH and thyroglobulin and thyroperoxidase antibodies were determined. Serum levels of creatine kinase, lactate dehydrogenase, calcium and phosphate along with erythrocyte sedimentation rate were measured to exclude other causes of musculoskeletal complaints. RESULTS When the study group (n = 137) was divided according to thyroid status, 30•6% (n = 42) were thyrotoxic, 16•8% (n = 23) had subclinical thyrotoxicosis, 28•5% (n = 39) were euthyroid, 7•3% (n = 10) had subclinical hypothyroidism and 16•8% (n = 23) were hypothyroid. Overall, adhesive capsulitis was found in 10•9% (n = 15), Dupuytren's contracture in 8•8% (n = 12), limited joint mobility in 4•4% (n = 6), trigger finger in 2•9% (n = 4) and carpal tunnel syndrome in 9•5% (n = 13) of the patients. The prevalence of adhesive capsulitis was highest in patients with subclinical thyrotoxicosis (17•4%); Dupuytren's contracture, limited joint mobility and carpal tunnel syndrome were commonest in hypothyroid patients (21•7%, 8•7% and 30•4%, respectively). Trigger finger occurred in 10% of patients with subclinical hypothyroidism. When these prevalences were analysed with respect to thyroid status, carpal tunnel syndrome was significantly more prevalent in the hypothyroid group (P = 0•004). When thyroperoxidase antibody-positive and-negative patients were compared, adhesive capsulitis negatively (P = 0•03, r = − − − −0•18) and trigger finger positively correlated with (P = 0•03, r = 0•21) thyroperoxidase antibody existence. CONCLUSIONS These results demonstrate that musculoskeletal disorders often accompany thyroid dysfunction. In addition to the well-known observation that these disorders are common in patients with hypothyroidism, they are also observed in patients with thyrotoxicosis. Patients with thyroid dysfunction should be questioned for musculoskeletal complaints and referred to a specialist if necessary.

S houlder dysfunction is the second most common musculoskeletal problem seen in physical therapy 42 and affects approximately 16% to 21% of the population. 22,43 It is a leading cause of sick days among young adults, 21 and its prevalence in persons 65 years and older is 34%. 24 The direct cost for the treatment of shoulder dysfunction in the United States exceeds $7 billion annually. 30 There are numerous underlying musculoskeletal causes of shoulder dysfunction. These include tendinopathy, bursitis, rotator cuff tear, adhesive capsulitis, avascular necrosis, shoulder impingement syndrome, glenohumeral osteoarthritis, and trauma from injury. Shoulder dysfunction results in a variety of impairments such as pain, stiffness, weakness, postural deviations, and altered glenohumeral rhythm. These impairments, in turn, lead to limitation of activities of daily living such as reaching, lifting, overhead movements, carrying, pushing, pulling, grooming, and sleep. Common approaches to treating individuals with shoulder dysfunction are corticosteroid injections, nonsteroidal anti-inflammatory drugs, manipulation under general anesthesia, arthroscopic surgery, and physical therapy intervention, including therapeutic exercises, manual therapy, and various modalities. Prior studies have shown that medical and surgical interventions are not superior to physical therapy interventions for patients with shoulder dysfunction. 11,15,42 Therapeutic exercise is defined as "the systematic performance or execution of T T LEVEL OF EVIDENCE: Therapy, level 1a- .

- by Tracy Brudvig
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- Exercise therapy, Medicine, Shoulder, The
- by Arlan Rosenbloom
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- Adolescent, Child, Clinical Sciences, Joints

Systematic literature review. To assess the efficacy of deep friction massage (DFM) in the treatment of tendinopathy. Anecdotal evidence supports the efficacy of DFM for the treatment of tendinopathy. An advanced understanding of the etiopathogenesis of tendinopathy and the resultant paradigm shift away from an active inflammatory model has taken place since the popularization of the DFM technique by Cyriax for the treatment of "tendinitis." However, increasing mechanical load to the tendinopathic tissue, as well as reducing molecular cross-linking during the healing process via transverse massage, offers a plausible explanation for observed responses in light of the contemporary understanding of tendinopathy. The authors surveyed research articles in all languages by searching PubMed, Scopus, Pedro, CINAHL, PsycINFO, and the Cochrane Library using the terms deep friction massage, deep tissue massage, deep transverse massage, Cyriax, soft tissue mobilization, soft tissue m...

- by craig denegar
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- Evidence Based Medicine, Massage, Tendinopathy, Friction
- by Ramon Sanchez
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- Magnetic Resonance Imaging, Adolescent, Child, Incidental Findings
- by James Talmage
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- Nursing, Pain, Chronic Pain, Occupational Medicine

Lipoma arborescens is a rare benign intra-articular lesion of unknown etiology that usually in-volves the suprapatellar pouch of the knee joint. Clinically, the most com-mon finding is a slow-growing pain-less swelling, accompanied by... more

Introduction This cross-sectional study examined the effect of structural changes caused by rheumatoid arthritis (RA) on computer keyboarding style to provide insights on how changes may affect worker performance. Method Computer keyboarding styles, as measured by the keyboard-personal computer style instrument, were compared between 45 keyboard operators with RA and 29 without. A severity of structural changes score (SSCS) was assigned after recruitment by observing subjects' hands while operating a keyboard. Significant differences between each item of keyboarding style by diagnosis were identified through Chi square analyses. Logistic regression models with age, diagnosis, SSCS, and touch typing training as the predicators further evaluated the effect of structural changes on each item of personal keyboarding style. Results Significantly more keyboard operators with RA used high force keystrokes, did not use a wrist rest, moved their hands to strike keys, maintained their wrists and fingers in a fixed position and used fewer than two fingers to activate keys. The amount of variance explained by each model varied from 8 to 56%. SSCS was the most common predictor of keyboarding style (54% of significant models), followed by age (35% of significant models), diagnosis (19% of significant models), and touch typing training (15% of significant models). Conclusion Severity of structural changes and age are significant predictors of keyboarding style for computer operators with RA. The keyboarding styles used by computer operators with RA appear to reduce typing productivity and have the potential to put stress on joints already affected by RA. Computer operators with RA may benefit from worksite modifications that address keyboarding style such as alternate keyboards.

- by Joan Rogers
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- Biomechanics, Multivariate Analysis, Confidence intervals, Efficiency
- by Shih-chang Wang
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- Wrist joint, Clinical Sciences, Elbow Joint, Joints

The successful treatment of chondral and osteochondral defects of the weightbearing surfaces is a challenge for orthopaedic surgeons. Autologous osteochondral transplantation is one method that can be used to create a hyaline or hyaline-like repair in the defect area. Ten years of clinical experience with autologous osteochondral mosaicplasty are described. Clinical scores, imaging techniques, arthroscopy, histological examination of biopsy samples, and cartilage stiffness measurements were used to evaluate the clinical outcomes and quality of the transplanted cartilage in a total of 831 patients who underwent mosaicplasty. According to our investigations, good-to-excellent results were achieved in 92% of the patients treated with femoral condylar implantations, in 87% of those treated with tibial resurfacing, in 79% of those treated with patellar and/or trochlear mosaicplasties, and in 94% of those treated with talarprocedures. Long-term donor-site disturbances, which were assessed...

- by Imre Szerb
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- Cartilage, Weight Bearing, Orthopedic Procedures, Joint diseases

The coracoid process is a hook-shaped bone structure projecting anterolaterally from the superior aspect of the scapular neck. Surgeons often refer to the coracoid process as the "lighthouse of the shoulder" given its proximity to major neurovascular structures such as the brachial plexus and the axillary artery and vein, its role in guiding surgical approaches, and its utility as a landmark for other important structures in the shoulder. The coracoid also serves as a critical anchor for many tendinous and ligamentous attachments. These include the tendons of the pectoralis minor, coracobrachialis, and short head of the biceps brachii muscles, and the coracoclavicular, coracohumeral, coracoacromial, and transverse scapular ligaments. Consequently, the coracoid and its associated structures are linked to numerous shoulder pathologic conditions. This article will detail the anatomy of the coracoid and its associated structures and review the clinical and radiologic findings of corresponding pathologic conditions in this region with original illustrations and multimodality imaging examples. Highlighted in this article are the coracoclavicular joint, the classification and management of coracoid fractures, subcoracoid impingement, the coracoacromial arch and subacromial impingement, the coracohumeral ligament and the biceps pulley, the coracoclavicular ligament and its surgical reconstruction, adhesive capsulitis, the suprascapular notch and suprascapular notch impingement, subcoracoid bursitis, coracoid transfer procedures, and coracoid tumors. A brief summary of the pathophysiology, potential causes, and management options for each of the pathologic entities will also be discussed. ©

Imaging of the wrist with MR imaging can be difficult because of the small size of this joint, its complex anatomy, and its sometimes poorly understood pathologic lesions. A recent study by Hobby and coworkers [1] of 98 patients revealed that MR imaging of the wrist influences clinicians' diagnoses and management plans in most patients. This article summarizes the current diagnostic criteria that can be useful in interpreting abnormalities of the wrist ligaments and triangular fibrocartilage complex (TFCC) of the wrist in this difficult topic in joint MR imaging. Anatomy Ligamentous anatomy The carpal ligaments may be classified as either extrinsic or intrinsic. The extrinsic ligaments link the carpal bones to the radius and ulna. The intrinsic or intercarpal ligaments connect the individual carpal bones.

Statin use may be associated with increased musculoskeletal adverse events, especially in physically active individuals. To determine whether statin use is associated with musculoskeletal conditions, including arthropathy and injury, in a military health care system. A retrospective cohort study with propensity score matching. San Antonio Military Multi-Market. Tricare Prime/Plus beneficiaries evaluated from October 1, 2003, to March 1, 2010. Statin use during fiscal year 2005. On the basis of medication fills, patients were divided into 2 groups: statin users (received a statin for at least 90 days) and nonusers (never received a statin throughout the study period). Using patients' baseline characteristics, we generated a propensity score that was used to match statin users and nonusers; odds ratios (ORs) were determined for each outcome measure. Secondary analyses determined adjusted ORs for all patients who met study criteria and a subgroup of patients with no comorbidities i...

- by Mary Jo Pugh
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- Pain, Skeletal muscle biology, Medicine, Dislocations
- by John Vanore
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- Foot and Ankle Surgery, Arthroplasty, Clinical Sciences, Foot Diseases

The pafient self-evaluafion section contains visual analog scales for pain and a series of questions relating to function of the extremity. The responses to the questions are scored on a 4-point ordinal scale. The physician assessment section has 4 parts: motion, stability, strength, and physical findings. It is hoped that adoption of this method of data cokcfion WII sfimulate m&center studies and improve communication between professionals who assess and treat patients with elbow disorders.

- by J. Iannotti
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- Activities of Daily Living, Shoulder, Data Collection, Clinical Sciences
- by James Teh
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- Magnetic Resonance Imaging, Adolescent, Anterior Cruciate Ligament, Child

Ultrasonography of the elbow is a very helpful and reliable diagnostic procedure for a broad spectrum of rheumatic and orthopedic conditions, representing a possible substitute to magnetic resonance imaging for evaluation of soft tissues of the elbow. Musculoskeletal ultrasound (US) shows many advantages over other imaging modalities, probably the most important being its capability to perform a dynamic assessment of musculoskeletal elements with patient's partnership and observation during examination. In addition, ultrasonography is cost effective, easy available, and has excellent and multiplanar capability to visualize superficial soft tissue structures. Among all imaging procedures, US is highly accepted by patients. US assessment of the elbow requires good operator experience in the assessment of normal anatomy, and suitable high-quality equipment. US of the elbow provides detailed information including joint effusions, medial and lateral epicondylitis, tears of the distal...

- by Francesco Porta
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- Medicine, Ultrasonography, Elbow Joint, Rheumatic diseases

Wrist arthroscopy is a commonly used procedure that has undergone many modifications and improvements since it was first described. The advent of new portals (both dorsal and volar) means that the wrist joint can be viewed from virtually any perspective ("box concept"). Indications for wrist arthroscopy have continued to expand and include diagnostic and reparative procedures and, more recently, reconstructive, soft-tissue, and bony procedures. Arthroscopic grading of Kienböck's disease better describes articular damage compared with plain radiographs and can help guide surgical treatment options. Triangular fibrocartilage complex injury diagnosis, classification, and treatment can be performed arthroscopically, including distal ulna resection (wafer procedure). Assessment of fracture reduction of the distal radius and scaphoid is superior to that obtained with fluoroscopy, with the advantage of being able to look for associated soft-tissue and chondral injuries. Arthroscopic assessment of intercarpal ligament injuries and instability is now considered the gold standard by many authors. Arthroscopy can also aid us in the management of post-traumatic capsular contraction, resection of ganglia, and the relatively rare isolated ulna styloid impaction. Complications of wrist arthroscopy are relatively uncommon. With the ever-expanding list of indications and procedures that can be performed with this technique, it exists as an essential diagnostic and therapeutic tool for the orthopaedic surgeon.

- by Gregory Bain
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- Medicine, Arthroscopy, Wrist joint, Clinical Sciences

The inference of the state of wealth, or poverty, from human skeletal remains is a difficult task as the limited number of skeletal changes is mediated by numerous other physiological, biomechanical and pathological events. In recent years, identified skeletal collections have become valuable resources in enabling aetiologies of these changes to be understood while controlling for some known causative factors, e.g. age, sex and occupation. This has favoured more rigorous data analysis and interpretation. This study compares the presence of osteological makers of occupation - specifically degenerative joint changes (DJC) - between socio-economically framed occupational groups whilst controlling for age-at-death. A total of 603 individuals were distributed into 7 occupational groups used as a proxy for their socio-economic status. The results demonstrated that age was a contributing factor for DJC. Differences between occupational groups were only found for the hips, right shoulder an...

- by Francisca Alves Cardoso
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- Archaeology, Poverty, Anthropometry, Physical Anthropology

Bone marrow edema syndrome (BMES) refers to transient clinical conditions with unknown pathogenic mechanism, such as transient osteoporosis of the hip (TOH), regional migratory osteoporosis (RMO), and reflex sympathetic dystrophy (RSD). BMES is primarily characterized by bone marrow edema (BME) pattern. The disease mainly affects the hip, the knee, and the ankle of middle-aged males. Many hypotheses have been proposed to explain the pathogenesis of the disease. Unfortunately, the etiology of BMES remains obscure. The hallmark that separates BMES from other conditions presented with BME pattern is its self-limited nature. Laboratory tests usually do not contribute to the diagnosis. Histological examination of the lesion is unnecessary. Plain radiographs may reveal regional osseous demineralization. Magnetic resonance imaging is mainly used for the early diagnosis and monitoring the progression of the disease. Early differentiation from other aggressive conditions with long-term sequelae is essential in order to avoid unnecessary treatment. Clinical entities, such as TOH, RMO, and RSD are spontaneously resolving, and surgical treatment is not needed. On the other hand, early differential diagnosis and surgical treatment in case of osteonecrosis is of crucial importance.

- by Alain Blum
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- Nuclear medicine, Medicine, Osteoporosis, Orthopedics

Transcutaneous electric nerve stimulation (TENS) is a non-pharmacological method which is widely used by medical and paramedical professionals for the management of acute and chronic pain in a variety of conditions. Similarly, it can be utilized for the management of pain during various dental procedures as well as pain due to various conditions affecting maxillofacial region. This review aims to provide an insight into clinical research evidence available for the analgesic and non analgesic uses of TENS in pediatric as well as adult patients related to the field of dentistry. Also, an attempt is made to briefly discuss history of therapeutic electricity, mechanism of action of TENS, components of TENs equipment, types, techniques of administration, advantages and contradictions of TENS. With this we hope to raise awareness among dental fraternity regarding its dental applications thereby increasing its use in dentistry.

- by Anjum Farooqui
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- Dentistry, Pain, Pain Management, Chronic Disease

With an improvement in the temporal and spatial resolution, computed tomography (CT) is indicated in the evaluation of a great many osteoarticular diseases. New exploration techniques such as the dynamic CT and CT bone perfusion also provide new indications. However, CT is still an irradiating imaging technique and dose optimisation and reduction remains primordial. In this paper, the authors first present the typical doses delivered during CT in osteoarticular disease. They then discuss the different ways to optimise and reduce these doses by distinguishing the behavioural factors from the technical factors. Among the latter, the optimisation of the milliamps and kilovoltage is indispensable and should be adapted to the type of exploration and the morphotype of each individual. These technical factors also benefit from recent technological evolutions with the distribution of iterative reconstructions. In this way, the dose may be divided by two and provide an image of equal quality...

- by Alain Blum
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- Spine, Magnetic Resonance Imaging, Radiologic Technology, Three Dimensional Imaging

SummaryObjectives: To investigate the possibilities and limitations of arthroscopy to detect flexor enthesopathy in dogs and to distinguish the primary from the concomitant form.Materials and methods: Fifty dogs (n = 94 elbow joints) were prospectively studied: dogs with primary flexor enthesopathy (n = 29), concomitant flexor enthesopathy (n = 36), elbow dysplasia (n = 18), and normal elbow joints (n = 11). All dogs underwent an arthroscopic examination of one or both elbow joints. Presence or absence of arthroscopic characteristics of flexor enthesopathy and of other elbow disorders were recorded.Results: With arthroscopy, several pathological changes of the enthesis were observed in 100% of the joints of both flexor enthesopathy groups, but also in 72% of the joints with elbow dysplasia and 25% of the normal joints. No clear differences were seen between both flexor enthesopathy groups.Clinical significance: Arthroscopy allows a sensitive detection of flexor enthesopathy characte...

- by B. Van Ryssen
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- Dogs, Arthroscopy, Veterinary Sciences, Joints

Treatment of femoracetabular impingement to prevent or delay the development of secondary osteoarthritis of the hip. Improvement of the mechanical limitation of the range of motion of the hip joint. Pain-free movement of the hip. Femoroacetabular impingement including a cam impingement, a pincer impingement, as well as mixtures of both types. Osteoarthritis of the hip joint grades 1-3 according to Kellgren induced by a femoroacetabular impingement. Pincer impingement with the necessity of an osteotomy in acetabula malaligned in retroversion. Severe osteoarthritis grade 4 according to Kellgren. Hip infection. Supine position of the patient. Longitudinal incision of 5-6 cm in line with the medial border of the anterior superior iliac spine at the level of the greater trochanter, two thirds cranially and one third distally of the tip of greater trochanter. Minimally invasive anterior approach in a modified technique of the Smith-Petersen approach with cutting of the fascia and preserva...

- by Bernd Fink
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- Treatment Outcome, Femur, Arthroplasty, Minimally Invasive

Intraoperative joint-line determination during revision TKA is difficult and no method exists to plan the position preoperatively. Two questions need to be answered: to which extent does the joint line differ from its anatomic position after revision TKA if it has only been determined intraoperatively, and can the joint line be calculated preoperatively based on the transepicondylar width. Of 22 consecutive patients with complete preoperative (before and after primary TKA) and postoperative (after revision TKA) radiograph documentation, the joint-line position was measured on plane radiographs using the medial epicondyle as a reference. On another set of 45 consecutive patients with no knee disorders other than meniscal lesions, the transepicondylar axis width (TEAW) and the perpendicular distance from the medial and lateral epicondyles to the joint line were measured twice by two independent observers on plane AP radiographs of the knee. Significant joint-line alterations were observed after primary and revision TKA, implicating that a method for preoperative planning is needed. Because a linear correlation between the TEAW and the perpendicular distance from the epicondyles to the joint-line tangent was found, the ratio is useful to calculate the true joint-line position from the TEAW before revision TKA. Level of Evidence: Level III, therapeutic study. See Guidelines for Authors for a complete description of levels of evidence. Each author certifies that he or she has no commercial associations (eg, consultancies, stock ownership, equity interest, patent/licensing arrangements, etc) that might pose a conflict of interest in connection with the submitted article. Each author certifies that his or her institution approved the human protocol for this investigation, that all investigations were conducted in conformity with ethical principles of research.

- by jose antonio eyzaguirre romero
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- Orthopedic Surgery, Adolescent, Medicine, Femur

Soft tissue pain is, by default, an entity of most of the other structures in the body besides bone. This includes muscle, fascia, tendons, ligaments, cartilage, synovium, fibrous capsules, organs, and nerves. Soft tissue pain is often overlooked because it is not as easy to diagnose as pain involving bony structures. However, soft tissue pain can be just as debilitating as pain from bony structures. Treatment of soft tissue pain includes a variety of pharmacologic and nonpharmacologic techniques, and these are discussed in this article.

- by Bonnie Wright
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- Pain, Medicine, Pain Management, Cats

The shoulder is one of the most complex joints in the human body and, as such, presents an evaluation and diagnostic challenge. The fi rst steps in its evaluation are obtaining an accurate history and physical examination and evaluating conventional radiography. The use of other imaging modalities (eg, ultrasound, magnetic resonance imaging and computed tomography) should be based on the type of additional information needed. The goals of this study were to review the current limitations of evidence-based medicine with regard to shoulder examination and to assess the rationale for and against the use of diagnostic physical examination tests.

- by Pingal Desai
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- Engineering, Education, Computed Tomography, Evidence Based Medicine
- by Marco Zanetti
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- Radiology, Diagnostic Imaging, Biomechanical Phenomena, Joint diseases

The purpose of this study is to evaluate the ability of proton density (PD)-BLADE sequences in reducing or even eliminating motion and pulsatile flow artifacts in knee magnetic resonance imaging examinations. Eighty consecutive patients, who had been routinely scanned for knee examination, participated in the study. The following pairs of sequences with and without BLADE were compared: (a) PD turbo spin echo (TSE) sagittal (SAG) fat saturation (FS) in 35 patients, (b) PD TSE coronal (COR) FS in 19 patients, (c) T2 TSE axial in 13 patients and (d) PD TSE SAG in 13 patients. Both qualitative and quantitative analyses were performed based on the signal-to-noise ratio (SNR), contrastto-noise ratio (CNR) and relative contrast (ReCon) measures of normal anatomic structures. The qualitative analysis was performed by experienced radiologists. Also, the presence of image motion and pulsation artifacts was evaluated. Based on the results of the SNR, CRN and ReCon for the different sequences and anatomical structures, the BLADE sequences were significantly superior in 19 cases, whereas the corresponding conventional sequences were significantly superior in only 6 cases. BLADE sequences eliminated motion artifacts in all the cases. However, motion artifacts were shown in (a) six PD TSE SAG FS, (b) three PD TSE COR FS, (c) three PD TSE SAG and (d) two T2 TSE axial conventional sequences. In our results, it was found that, in PD FS sequences (sagittal and coronal), the differences between the BLADE and conventional sequences regarding the elimination of motion and pulsatile flow artifacts were statistically significant. In all the comparisons, the PD FS BLADE sequences (coronal and sagittal) were significantly superior to the corresponding conventional sequences regarding the classification of their image quality. In conclusion, this technique appears to be capable to potentially eliminate motion and pulsatile flow artifacts in MR images.

Skeletal abnormalities, affecting posture and walking pattern, increase with motor impairment in children with cerebral palsy (CP). However, it is not known whether these skeletal malalignments occur in children with slight motor impairment. Our aim was to evaluate skeletal malalignment at the level of the pelvis and lower limbs in ambulant children with CP, with slight motor impairment, using a low dose biplanar X-ray technique. Twenty-seven children with spastic CP (mean age: 10.9 AE 4 years, 7 Hemiplegia, 20 Diplegia, GMFCS levels I:17, II:10), with no previous treatments at the hips and knees, underwent EOS 1 biplanar X-rays. A control group consisting of 22 typically developing children was also included. Three-dimensional reconstructions of the pelvis and lower limbs were performed in order to calculate 11 radiological parameters related to the pelvis, acetabulum and lower limbs. Pelvic incidence and sacral slope were significantly increased in children with CP compared to TD children (48 AE 7 vs. 43 AE 8 , 42 AE 7 vs. 38 AE 5 , respectively, p = 0.003). Acetabular parameters did not significantly differ between the two groups. Femoral anteversion and neck shaft angle were significantly increased in children with CP (25 AE 12 vs. 14 AE 7 , p < 0.001; 134 AE 5 vs. 131 AE 5 , p = 0.005 respectively). No difference was found for tibial torsion. This study showed that even slightly impaired children with CP have an anteverted and abducted femur and present positional and morphological changes of the pelvis in the sagittal plane. The orientation of the acetabulum in 3D seems to not be affected when children with CP present slight motor impairment. 2016 Elsevier B.V. All rights reserved.

- by Ayman Assi
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- Mechanical Engineering, Cerebral Palsy, Adolescent, Child

Patellofemoral disorders are among the most common clinical conditions managed in the orthopaedic and sports medicine setting. Nonoperative intervention is typically the initial form of treatment for patellofemoral disorders; however,... more

- by Terry Malone
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- Pain, Knee, Femur, Classification

Invalidating elbow contractures, a frequent problem after injury, are commonly treated by physical therapy or surgical release. In both cases, results can be frustrating: physical therapy is often not sufficient to gain functional range of motion, and after surgical release it is common to lose part of the motion gained in operating room. Thanks to the viscous-elastic properties of the soft tissue, the mobilization elbow braces can stretch the retracting or retracted tissues inducing a biological lengthening of collagen fibres. In post-traumatic contracture, mobilization braces are effectively employable in two main critical situations: to treat recent onset contractures which do not respond to simple physical therapy and to help in preserving range of motion gained after surgical release. We report our experience with mobilization brace used in 42 patients, 5 for post-traumatic contracture, 4 for contracture following articular fracture fixation and 33 after surgical release. Classification, indications and treatment protocols of the mobilization braces utilized are reported.

- by Alessandro Marinelli
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- Physical Therapy, Operating Room, Braces, Musculoskeletal

contributed equally to this article.

- by Gerard Rongen
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- Atherosclerosis, Medicine, England, Adenosine

Bedside ultrasound is an extremely valuable and rapidly accessible diagnostic and therapeutic modality in potentially life- and limb-threatening situations in the emergency department. In this report, the authors discuss the role of ultrasound in quick assessment of pathologic conditions and its use to aid in diagnostic and therapeutic interventions.

- by Teresa Wu
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- Procedures, Ultrasound, Medicine, Drainage

Background: Reverse shoulder prostheses are increasingly used in recent years for treatment of glenohumeral arthropathy with deficient rotator cuff. Bone preservation is becoming a major goal in shoulder replacement surgery. Metaphyseal humeral components without a stem were developed to minimize bone resection and preserve bone. This study evaluated the clinical and radiologic outcomes at 2 to 7 years using a novel short metaphyseal reverse total shoulder arthroplasty (rTSA) prosthesis without a diaphyseal stem. Methods: Between 2005 and 2010, 102 consecutive patients underwent rTSA with this implant, and 98 (20 men, 78 women) were available for follow-up. Mean age was 74.4 years (range, 38-93 years). Indications were cuff tear arthropathy, 65; fracture sequelae, 12; rheumatoid arthritis, 13; failed rotator cuff repair, 3; cuff deficiency with loosening of anatomic prosthesis, 3; and acute trauma, 2; with 17 of these as revisions. Results: Patients' satisfaction (Subjective Shoulder Value) improved from 8 of 100 to 85 of 100. The Constant score improved from 14 to 59 (age-and sex-adjusted, 86; P < .0001). Range of motion improved from 47°to 129°in elevation, 10°to 51°in external rotation, and 21°to 65°in internal rotation. Radiographic analysis showed no lucencies, subsidence, or stress shielding around the humeral or glenoid components. Glenoid notching was found in 21 patients (18 grade 1-2; 3 grade 3). Conclusions: The short metaphyseal rTSA design without a diaphyseal stem shows encouraging short-to midterm results, with excellent pain relief and shoulder function, restoration of good active range of motion, and high patient satisfaction scores. The design of this implant seems to result in improved rotational movements, low incidence of glenoid notching, and no implant loosening, subsidence, or stress shielding.

- by Ofer Levy
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- Treatment Outcome, Medicine, Prospective studies, Follow-up studies

We have analysed the Constant-Murley (1987) assessment for 25 patients with shoulder pathology. We found the score easy to use, with low inter-and intraobserver errors, but sufficiently imprecise in repeated measurements to give concern in its use for clinical follow-up of patients. We have calculated 95% confidence limits for a single assessment to be within 16 to 20 points in most cases. In addition, we found that all our subjects with instability as their main problem scored within five points of the maximum; this suggests that the scoring method may need to be revised for use on these patients.

- by Tyler Cymet
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- Sound, Osteoarthritis, Noise, Cervical Spine

In recent years there has been an increase in interest in issues related to the enhancement of the performance of the masters athlete. Many of the changes in health status that have been thought to be the normal result of aging have been found to be actually the result of a long-standing sedentary lifestyle. Thus, masters athletes may be able to increase their athletic performance to higher levels than what was once thought. Decreases in muscle strength thought to be the result of aging do not appear to be so. The masters athlete may be able to maintain and increase strength in situations where strength training has not been previously

- by Heidi Skolnik
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- Mechanical Engineering, Nutrition, Aging, Sports