Poncet's disease (tuberculous rheumatism): two case reports and review of the literature.

We report two human leukocyte antigen (HLA) B27-positive cases of urogenital tuberculosis (TB) with asymmetric polyarthritis. Stained smears with Ehrlich Ziehl-Neelsen and polymerase chain reaction (PCR) tests for Mycobacterium tuberculosis complex (MTC) of the ejaculate were positive in both cases, despite negative cultures. Stained smear, culture and PCR results of the synovial fluid for mycobacteria were negative. The patients were diagnosed with Poncet's disease. Polyarthritis was resolved rapidly with anti-tuberculosis treatment. We suggest that in cases with unexplained arthritis and non-articular TB, Poncet's disease should be considered. PCR can be used in the routine diagnostic algorithm when conventional methods fail to identify MTC.

Acute brucella sacroiliitis: clinical features.

Although back pain is very common, the differential diagnosis may sometimes be very difficult. Both inflammation and infections of spinal or sacroiliac joints are examples of such causes. We report three cases of brucella sacroiliitis resembling acute low back pain or lumbar disc herniation. All patients had had a recent infection and were referred complaining of acute back pain with a suspicion of lumbar disc herniation. The complaints of all patients reduced dramatically after proper medication. Radiographs of all patients and bone scans of two patients revealed sacroiliitis. One of the patients was positive for HLA-B27; in the other two patients HLA-B27 could not be determined.

The stretch-shortening cycle of the internal rotators muscle group measured by isokinetic dynamometry.

BACKGROUND: The ability to measure the stretch-shortening cycle of isolated muscle groups has been limited. The purpose of this study was to measure the stretch-shortening cycle of the internal rotator muscle group. METHODS: Sixty-eight volunteer subjects, 35 men and 33 women, participated in one test session; eight men and eight women also participated in a retest session; to examine the reliability of the test. A concentric contraction of the dominant internal rotator was measured for peak torque, standardized peak torque, power, standardized power and acceleration time on a Cybex Norm isokinetic dynamometer under three conditions: 1) concentric contraction only, 2) isometric preload before a concentric contraction, and 3) eccentric preload before a concentric contraction. RESULTS: Condition 3 showed a significant increase in peak torque production compared to condition 1 (p=0.001). Conditions 2 and 3 showed a significant increase in power production compared to condition 1 (p=0.0001, p=0.003). A significant difference was found in all three conditions between the men and women, with the men producing greatest peak torques and powers. CONCLUSIONS: The testing protocol was found to have high reliability. This testing protocol could be used to further study the stretch-shortening cycle in the internal rotator muscle group.

The diagnostic value of dermatomal somatosensory evoked potentials in lumbosacral disc herniations: a critical approach.

In this study, we examined scalp recorded dermatomal somatosensory evoked potentials (DSEPs) to electrical stimulation of L4, L5 and S1 dermatomes in 55 patients with proven lumbosacral radiculopathy and in 22 healthy subjects. We did not observe any significant ipsilateral intertrial variations and arithmetic mean side-to-side differences in normal subjects. As for segmental latencies, the dermatomal P40 latencies were directly correlated with height. The regression equations for L4, L5 and S1 dermatomes were as follows: (L4) y = 5.8 + 21.3 (height), (L5) y = -2.09 + 28.04 (height), (S1) y = -13.9 + 36.4 (height). Maximum side-to-side latency differences and maximum P 40 latencies were obtained by adding 2 standard deviations to the arithmetic means. The abnormal latencies for L4, L5 and S1 dermatomes were 48 msec., 52 msec., and 55 msec., respectively. The abnormal side-to-side latency difference were 3 msec. for all dermatomes. DSEPs accurately predicted the lesion only in four patients (7.2%). In 20 patients (36.3%), DSEPs correctly identified the lesion but also gave misleading information on the other levels. DSEP abnormality were on the correct level but opposite side in 5 patients (9%). The findings were normal in 11 patients (20%), and misleading in 15 patients (27.2%). We conclude that the ultimate diagnostic utility of DSEPs in lumbosacral radiculopathies is doubtful and controversial needs further investigations.

Shoulder terminal range eccentric antagonist/concentric agonist strength ratios in overhead athletes.

OBJECTIVE: The agonist-antagonist strength relationship for shoulder external rotation and internal rotation was formerly described by the relatively more functional ratios of eccentric external rotator to concentric internal rotator moments, and eccentric internal rotator to concentric external rotator moments for the entire range of motion. The aim of this study was to provide descriptive data for terminal range eccentric antagonist/concentric agonist rotator cuff strength in overhead athletes. METHOD: The dominant and non-dominant shoulders of 40 asymptomatic military overhead athletes were tested through a range of 20 degrees of external rotation to 90 degrees of internal rotation using the Cybex NORM isokinetic dynamometer at a speed of 90 degrees /s. Differences between the dominant and non-dominant shoulders were assessed using the paired samples t-test. RESULTS: The terminal range ratios during external rotation (20 degrees of internal rotation - 10 degrees of external rotation) were found to be 2.09 and 1.58 for the dominant and non-dominant shoulders, respectively, whereas the terminal range ratios during internal rotation (60-90 degrees of internal rotation) were 1.03 and 1.19 for the dominant and non-dominant shoulders, respectively. These ratio differences between the dominant and non-dominant shoulders were significant (P<0.01 for external and internal rotation). CONCLUSION: The muscle torque ratios of eccentric antagonist/concentric agonist are different between dominant and non-dominant shoulders of skilled overhead athletes at terminal ranges. This functional assessment of strength testing that reflects dynamic shoulder joint stability during the throwing activity at these specific ranges may provide valuable information either during preventive exercise programs or in the evaluation of the injured shoulder of the overhead athlete. We recommended functional exercises that improve eccentric external rotation strength on the dominant shoulder during the rehabilitation and prevention programs in overhead athletes.

Peripheral nerve block with phenol to treat spasticity in spinal cord injured patients.

In this study an attempt was made to treat spinal cord injured patients with severe spasticity by peripheral nerve blocks. Thirty-six patients (5 female, 31 male) ranging in age from 20 to 71 years (mean: 29 +/- 8.2) were treated by phenol injections. A specially designed electrostimulation needle was used for the injections. The results showed that peripheral nerve blocks with phenol solution could be a remedy on a temporary basis, but are not as effective as has been described previously.

Chronic groin pain in an amateur soccer player.

Chronic groin pain is common in soccer players because of the biomechanics of kicking causing recurrent stress to the abdominal muscles, groin flexors, and adductor muscles. Myositis ossificans in adductor muscles is a rare cause of chronic groin pain in soccer players. Only two cases have been reported and the iliopsoas muscle was involved in both. This case report emphasises the importance of direct radiography for diagnosis in chronic groin pain and is a reminder that the development of myositis ossificans in the adductor muscles may be a cause.

Shoulder proprioception: a comparison between the shoulder joint in healthy and surgically repaired shoulders.

Proprioceptive mechanisms appear to play a role in stabilizing the glenohumeral joint and may serve as a means for interplay between the static stabilizers and the dynamic muscle restraints. The aim of this study was to investigate proprioception of the joint in healthy and surgically repaired shoulders. Shoulder proprioception was measured in 44 subjects who were assigned to two experimental groups: group 1, healthy subjects (n = 24); and group 2, patients who have undergone surgical reconstruction (n = 20). Joint position sense was measured with a Cybex NORM isokinetic dynamometer. The results revealed no significant differences in proprioception between the dominant and nondominant shoulders in group 1. No significant mean differences were revealed between the surgical and contralateral shoulder in group 2 under any test condition. These results imply that arm dominance in healthy individuals does not influence the proprioceptive sensibility and that reconstructive surgery appears to restore some of these proprioception characteristics.