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1.
Curr Sports Med Rep ; 20(7): 359-365, 2021 Jul 01.
Article in English | MEDLINE | ID: mdl-34234091

ABSTRACT

ABSTRACT: This article discusses the "bidirectional" relationship between inflammatory bowel disease (IBD) and physical activity. Intestinal symptoms and extraintestinal manifestations of IBD negatively impact a patient's ability to participate in sports. IBD also impacts athletic performance via its effects on muscle mass, muscle function, bone density, and fatigue. Surveys of IBD patients consistently show that IBD interferes with athletic participation. While IBD negatively affects physical activity, there is growing evidence that physical activity can be beneficial for IBD patients. Prospective studies have revealed that structured physical activities may positively influence inflammatory markers, disease activity, muscle strength, bone density, fatigue, stress, anxiety, and quality of life. This suggests that physical activity may be a simple and safe adjuvant therapy for IBD patients. Future studies assessing the optimal activity regimen are warranted. Finally, a cohort of professional athletes with IBD are described for the first time - football players in the National Football League.


Subject(s)
Athletes , Athletic Performance/physiology , Exercise/physiology , Inflammatory Bowel Diseases/physiopathology , Sports/physiology , Anxiety/therapy , Bone Density/physiology , Erythema Nodosum/etiology , Fatigue/physiopathology , Football/physiology , Football/statistics & numerical data , Humans , Inflammatory Bowel Diseases/complications , Inflammatory Bowel Diseases/epidemiology , Inflammatory Bowel Diseases/prevention & control , Joint Diseases/classification , Joint Diseases/etiology , Muscle, Skeletal/physiology , Physical Functional Performance , Pyoderma Gangrenosum/etiology , Quality of Life , Scleritis/etiology , Skin Diseases/etiology , Stress, Physiological/physiology , Uveitis/etiology
2.
Skeletal Radiol ; 49(6): 823-836, 2020 Jun.
Article in English | MEDLINE | ID: mdl-31993687

ABSTRACT

The knee is a complex joint with its function dependent on a combination of osseous and soft tissue structures. Alteration in the relationship of these tissues, due to either acute or chronic repetitive injury with possible underlying congenital predisposing factors, can result in impingement between the structures resulting in pain, particularly on activity. The purpose of this article is to provide a comprehensive review of the MRI features of various impingement syndromes around the knee.


Subject(s)
Joint Diseases/diagnostic imaging , Knee Injuries/diagnostic imaging , Knee Joint/diagnostic imaging , Magnetic Resonance Imaging/methods , Friction , Humans , Joint Diseases/classification , Knee Injuries/classification , Syndrome
3.
Arch Orthop Trauma Surg ; 140(1): 129-137, 2020 Jan.
Article in English | MEDLINE | ID: mdl-31696320

ABSTRACT

INTRODUCTION: While numerous classifications of hip arthritis have been proposed, none considered the magnitude and direction of femoral head translation relative to the native acetabulum. A more precise classification of architectural hip deformities is necessary to improve preoperative templating and anticipate surgical challenges of total hip arthroplasty (THA). The purpose of the present study was to introduce a classification system to distinguish different types of architectural hip deformities, based on femoral head translation patterns, and to evaluate its repeatability using plain radiographs (qualitative) and Computed Tomography (CT) measurements (quantitative). MATERIALS AND METHODS: We studied pre-operative frontal and lateral hip radiographs and CT scans of 191 hips (184 patients) that received primary THA. The distance between the femoral head center (FC) and the acetabular center (AC) was measured, as well as femoral offset, acetabular offset, head center height, acetabular floor distance and femoral neck angle. The hips were classified qualitatively using frontal plain radiographs, and then quantitatively using CT scans (with an arbitrary threshold of 3 mm as Centered, Medialized, Lateralized, Proximalized or Proximo-lateralized. The agreement between qualitative and quantitative classification methods was compared for applying the same classification. RESULTS: Qualitative classification identified 120 centered (63%), 8 medialized (4%), 49 lateralized (26%), 3 proximalized (2%), and 11 proximo-lateralized (6%) hips, while quantitative classification identified 116 centered (61%), 8 medialized (4%), 51 lateralized (27%), 5 proximalized (3%), and 11 proximo-lateralized (6%) hips. The agreement between the two methods was excellent (0.94; CI 0.90-0.98). Medialization reached 9.7 mm, while lateralization reached 10.9 mm, and proximalization reached 8.5 mm. Proximalized and proximo-lateralized hips had more valgus necks, while medialized hips had more varus necks (p = 0.003). CONCLUSIONS: The classification system enabled repeatable distinction of 5 types of architectural hip deformities. The excellent agreement between quantitative and qualitative methods suggests that plain radiographs are sufficient to classify architectural hip deformities.


Subject(s)
Acetabulum , Arthroplasty, Replacement, Hip/methods , Femur Head , Hip Joint , Joint Diseases , Acetabulum/diagnostic imaging , Acetabulum/surgery , Cohort Studies , Femur Head/diagnostic imaging , Femur Head/surgery , Hip Joint/diagnostic imaging , Hip Joint/surgery , Humans , Joint Diseases/classification , Joint Diseases/diagnostic imaging , Joint Diseases/surgery , Preoperative Care , Radiography , Tomography, X-Ray Computed
4.
Arch Orthop Trauma Surg ; 139(8): 1045-1049, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30770995

ABSTRACT

INTRODUCTION: Impingement of the prominent anterior inferior iliac spine (AIIS) against the femoral neck has recently been described as another type of impingement. The purpose of this study is to provide a distribution of AIIS types using the classification proposed by Hetsroni and thus report on the prevalence of prominent types. MATERIALS AND METHODS: A total of 400 patients were included in the study with an average age 27.3 ± 6.9 years (range 18-40). All patients received a whole-body polytrauma computer tomography (CT) scan in the emergency room (ER) upon arrival. The classification of AIIS proposed by Hetsroni et al., which describes three morphological types, was used. Type II and III were grouped as prominent types. The measurements were performed in all three planes by two examiners. RESULTS: Male to female ratio was 71:29. Type I was observed in 367 (91.7%) patients. Type II was observed in 31 (7.8%) patients and type III was observed in 2 (0.5%) patients, unilaterally. Prominent types were much more prevalent in men (10.5%) than in women (2.6%). The CT assessment demonstrated excellent intra- and interreliability (overall: 0.926, I/II: 0.906, III: 1.000). CONCLUSION: A young population demonstrates a prevalence of a prominent AIIS of 11.5%. Prominent AIIS is more common in men than in women.


Subject(s)
Arthralgia/physiopathology , Femur Neck/physiopathology , Ilium/physiopathology , Joint Diseases/physiopathology , Adolescent , Adult , Female , Femur Neck/diagnostic imaging , Hip Joint/diagnostic imaging , Hip Joint/physiopathology , Humans , Ilium/diagnostic imaging , Imaging, Three-Dimensional , Joint Diseases/classification , Joint Diseases/diagnostic imaging , Male , Prevalence , Sex Factors , Tomography, X-Ray Computed , Whole Body Imaging , Young Adult
5.
Eur J Orthop Surg Traumatol ; 29(6): 1217-1221, 2019 Aug.
Article in English | MEDLINE | ID: mdl-30963323

ABSTRACT

OBJECTIVE: Plain radiographs of the sternoclavicular joint (SCJ) are difficult to interpret, and a CT or MRI scan is the usual investigation of choice. At our hospital, we use digital SCJ tomograms as our first-line investigation for all SCJ pathologies. We wanted to ascertain whether this is a safe and appropriate first-line imaging investigation. MATERIALS AND METHODS: We retrospectively reviewed every patient who had undergone an SCJ digital tomogram (DT) over a 4-year period. We cross-referenced each patient with their records to assess the reason for referral, result, requirement for further investigation, diagnosis and management. RESULTS: We identified 132 SCJ tomograms over the study period. Twelve patients were referred from other hospitals with pre-existing imaging and were excluded. The reasons for radiological investigation in the remaining 120 patients were pain/lump without trauma (54.2%), pain/lump with trauma (30.8%) and post-operative review (15%). Of the 102 patients who had DT as their initial investigation, the most common diagnoses identified included osteoarthritis, normal SCJ, fracture and dislocation among others. Only 18 (17.6%) of these patients required further investigation with CT and/or MRI. CONCLUSION: Our study is the first to assess digital tomography in SCJ pathology. We have shown that digital tomograms are an accurate and economically beneficial investigation for SCJ pathology and propose that it should be used as a first-line imaging investigation.


Subject(s)
Joint Diseases/diagnosis , Sternoclavicular Joint , Tomography, X-Ray Computed , Adult , Cost-Benefit Analysis , Female , Humans , Joint Diseases/classification , Magnetic Resonance Imaging/methods , Male , Referral and Consultation/standards , Referral and Consultation/statistics & numerical data , Reproducibility of Results , Retrospective Studies , Sternoclavicular Joint/diagnostic imaging , Sternoclavicular Joint/injuries , Tomography, X-Ray Computed/economics , Tomography, X-Ray Computed/methods , United Kingdom
6.
J Orthop Sci ; 22(5): 898-904, 2017 Sep.
Article in English | MEDLINE | ID: mdl-28595800

ABSTRACT

BACKGROUND: The number of hemodialysis patients has been progressively increasing in our country. On the other hand, chronic hip arthropathy associated with long-term hemodialysis is a devastating problems affecting patients' quality of life. In our previous study, we proposed a classification system for radiological abnormalities seen in hemodialysis-related hip lesions. The purpose of the study was to propose the surgical strategy for hip disorders caused by long-term hemodialysis. METHODS: Patients with a history of hemodialysis for more than 10 years, 191 hip lesions in 165 consecutive patients who visited our institute due to hip symptoms. Various abnormalities were identified in 116 out of 191 hips. A retrospective assessment of the patient record and radiographs was performed for the included subjects examining the natural course of the disease process as well as the results of surgical treatment. RESULTS: Seventy-six hip lesions (69.0%) were conservatively managed at the time of the initial visit. Surgeries were performed for 75 hips (64.7%) during the study period. Among those, surgical treatment was indicated for 40 hips at the time of the initial visit. On the other hand, surgeries were performed for 35 hips during the subsequent follow-up period due to progression of the disease process. CONCLUSIONS: Based on the analysis of our surgical experiences by the retrospective chart review, we have established a flowchart of the treatment strategy for chronic hip arthropathy in long-term hemodialysis patients. STUDY DESIGN: This study is retrospective clinical study.


Subject(s)
Amyloidosis/etiology , Amyloidosis/surgery , Hip Joint , Joint Diseases/etiology , Joint Diseases/surgery , Renal Dialysis/adverse effects , Adult , Aged , Amyloidosis/classification , Chronic Disease , Humans , Joint Diseases/classification , Middle Aged , Retrospective Studies , Time Factors
7.
Instr Course Lect ; 65: 109-26, 2016.
Article in English | MEDLINE | ID: mdl-27049185

ABSTRACT

Advances in shoulder replacement surgery have allowed for the successful treatment of various shoulder conditions. As the elderly population increases and the surgical indications for shoulder replacement surgery continue to expand, the number of shoulder replacements performed annually will continue to increase. Accordingly, the number of complications also will be expected to increase. Successful shoulder replacement outcomes require surgeons to have a thorough understanding of the surgical indications, surgical technique, and potential complications of the procedure. By reviewing the key aspects of shoulder replacement surgery and focusing on the surgical technique and common complications for both anatomic and reverse total shoulder arthroplasty, surgeons can help improve outcomes and minimize complications.


Subject(s)
Arthroplasty, Replacement , Joint Diseases/surgery , Postoperative Complications , Shoulder Joint , Aged , Arthroplasty, Replacement/adverse effects , Arthroplasty, Replacement/instrumentation , Arthroplasty, Replacement/methods , Humans , Intraoperative Care/methods , Joint Diseases/classification , Joint Diseases/diagnosis , Joint Prosthesis/standards , Outcome Assessment, Health Care , Postoperative Complications/etiology , Postoperative Complications/prevention & control , Quality Improvement , Shoulder Joint/anatomy & histology , Shoulder Joint/pathology , Shoulder Joint/surgery
8.
J Hand Surg Am ; 41(4): 532-540.e1, 2016 Apr.
Article in English | MEDLINE | ID: mdl-26826947

ABSTRACT

PURPOSE: To determine whether simplification of the Eaton-Glickel (E-G) classification of trapeziometacarpal (TMC) joint arthrosis (eliminating evaluation of the scaphotrapezial [ST] joint) and information about the patient's symptoms and examination influence interobserver reliability. We also tested the null hypotheses that no patient and/or surgeon factors affect radiographic rating of TMC joint arthrosis and that no surgeon factors affect the radiographic rating of ST joint arthrosis. METHODS: In an on-line survey, 92 hand surgeons rated TMC joint arthrosis and ST joint arthrosis separately on 30 radiographs (Robert, true lateral, and oblique views) according to the (modified) E-G classification. We randomly assigned 42 observers to review radiographs alone and also informed 50 of the patient's symptoms and examination. Information about symptoms and examination was randomized. Interobserver reliability was determined with the s* statistic. Because of the hierarchical data structure, cross-classified ordinal multilevel regression analyses were performed to identify factors associated with the severity of arthrosis. RESULTS: Shortening the E-G classification to the first 3 stages significantly improved the interobserver reliability, which approached substantial agreement. Providing clinical information to observers marginally improved interobserver reliability. Factors associated with a lower E-G stage for TMC joint arthrosis, among observers who rated the severity of TMC joint arthrosis based on radiographs and clinical information, included female surgeon, practice setting, supervising surgical trainees in the operating room, self-reported number of patients with TMC joint arthrosis typically treated annually, male patient, higher patient age, pain limiting daily activities, and shoulder sign. A self-reported larger number of patients with TMC joint arthrosis treated annually was the only variable associated with a higher modified E-G classification to rate ST joint arthrosis. CONCLUSIONS: Our findings suggest that simpler classifications that focus on a single anatomical area are reliable and that surgeon and patient factors can bias interpretation of objective pathophysiology such as radiographic findings. TYPE OF STUDY/LEVEL OF EVIDENCE: Diagnostic III.


Subject(s)
Carpometacarpal Joints/diagnostic imaging , Joint Diseases/classification , Joint Diseases/diagnostic imaging , Adult , Female , Humans , Joint Diseases/complications , Male , Observer Variation , Reproducibility of Results , Severity of Illness Index
9.
Vestn Khir Im I I Grek ; 175(3): 35-9, 2016.
Article in English, Russian | MEDLINE | ID: mdl-30444091

ABSTRACT

The hip arthroplasty in case of destructive - dystrophic affection is considered as the most effective method, which provided social and home reintegration. A modern science development facilitates to this technique. However, specialists noted that the rate of endoprosthesis complication increased in the patients after osteosynthesis of proximal femur. The authors compared the results of patient's treatment that applied hip arthroplasty methods after osteosynthesis of proximal femur. The main group consisted of 38 patients who underwent hip arthroplasty after osteosynthesis of proximal femur. The control group had 43 patients with hip idiopathic osteoarthrosis, who underwent primary arthroplasty. The endoprothesis replacement was associated with increase of the rate of intraoperative and postoperative complications in the main group of patients. According to the results, given group of patients requires a special approach to diagnostics and treatment.


Subject(s)
Arthroplasty, Replacement, Hip , Fracture Fixation, Internal/adverse effects , Hip Joint , Joint Diseases/surgery , Postoperative Complications , Aged , Arthroplasty, Replacement, Hip/adverse effects , Arthroplasty, Replacement, Hip/methods , Female , Femoral Fractures/surgery , Fracture Fixation, Internal/methods , Hip Joint/physiopathology , Hip Joint/surgery , Humans , Joint Diseases/classification , Male , Middle Aged , Postoperative Complications/diagnosis , Postoperative Complications/epidemiology , Postoperative Complications/etiology , Postoperative Complications/physiopathology , Reoperation , Treatment Outcome
10.
Arch Orthop Trauma Surg ; 135(3): 427-37, 2015 Mar.
Article in English | MEDLINE | ID: mdl-25575720

ABSTRACT

The TFCC is a crucial stabilizer of the DRUJ. Based on its superficial and deep fibers, the TFCC guarantees unrestricted pronation and supination which is essential for performing sophisticated tasks. The ability to perform complex movements is of uppermost importance for hand function. Therefore, a functional intact TFCC is a prerequisite in this context. The articular disc of the TFCC is a fibrocartilaginous extension of the superficial zone of hyaline articular cartilage which arises from the radius. The peripheral 10-40 % of the TFC is vascularized. Degeneration of the articular disc is common with increasing age. Even though the central part of the articular disc is avascular, potential regeneration of lesions could be detected. The Palmer and Atzei classifications of TFCC lesions are complementary. TFCC innervation is based on different nerves. There is a high variability. A diligent clinical examination facilitates specific tests which help to allocate symptoms to the pathology. Therefore, a thorough clinical examination is not dispensable. Wrist arthroscopy remains the "gold standard" for diagnosing TFCC pathologies despite technical progress in imaging modalities. MR arthrography may have the potential to become a real alternative to wrist arthroscopy for diagnosing TFCC pathologies with technical progress in the future.


Subject(s)
Joint Diseases/diagnosis , Triangular Fibrocartilage , Wrist Injuries/diagnosis , Arthroscopy , Humans , Joint Diseases/classification , Joint Diseases/surgery , Physical Examination , Pronation , Radius/anatomy & histology , Radius/pathology , Radius/physiology , Radius/physiopathology , Supination , Triangular Fibrocartilage/anatomy & histology , Triangular Fibrocartilage/pathology , Triangular Fibrocartilage/physiology , Triangular Fibrocartilage/physiopathology , Wrist Injuries/classification , Wrist Injuries/surgery , Wrist Joint/anatomy & histology , Wrist Joint/pathology , Wrist Joint/physiology , Wrist Joint/physiopathology
11.
Arthroscopy ; 30(2): 271-8, 2014 Feb.
Article in English | MEDLINE | ID: mdl-24485119

ABSTRACT

Optimal treatment for the unstable acromioclavicular (AC) joint remains a highly debated topic in the field of orthopaedic medicine. In particular, no consensus exists regarding treatment of grade III injuries, which are classified according to the Rockwood classification by disruption of both the coracoclavicular and AC ligaments. The ISAKOS Upper Extremity Committee has provided a more specific classification of shoulder pathologies to enhance the knowledge on and clinical approach to these injuries. We suggest the addition of grade IIIA and grade IIIB injuries to a modified Rockwood classification. Grade IIIA injuries would be defined by a stable AC joint without overriding of the clavicle on the cross-body adduction view and without significant scapular dysfunction. The unstable grade IIIB injury would be further defined by therapy-resistant scapular dysfunction and an overriding clavicle on the cross-body adduction view.


Subject(s)
Acromioclavicular Joint/injuries , Joint Diseases/classification , Orthopedics , Wounds and Injuries/classification , Humans , Trauma Severity Indices , Wounds and Injuries/diagnosis
12.
BMC Geriatr ; 13: 18, 2013 Feb 21.
Article in English | MEDLINE | ID: mdl-23432774

ABSTRACT

BACKGROUND: Joint contractures are frequent in older individuals in geriatric care settings. Even though they are used as indicator of quality of care, there is neither a common standard to describe functioning and disability in patients nor an established standardized assessment to describe and quantify the impact of joint contractures on patients' functioning. Thus, the aim of our study is (1) to develop a standard set for the assessment of the impact of joint contractures on functioning and social participation in older individuals and (2) to develop and validate a standardized assessment instrument for describing and quantifying the impact of joint contractures on the individuals' functioning. METHODS: The standard set for joint contractures integrate the perspectives of all potentially relevant user groups, from the affected individuals to clinicians and researchers. The development of this set follows the methodology to develop an International Classification of Functioning Disability and Health (ICF) Core Set and involves a formal decision-making and consensus process. Evidence from four preparatory studies will be integrated including qualitative interviews with patients, a systematic review of the literature, a survey with health professionals, and a cross sectional study with patients affected by joint contractures. The assessment instrument will be developed using item-response-theory models. The instrument will be validated. DISCUSSION: The standard set for joint contractures will provide a list of aspects of functioning and health most relevant for older individuals in geriatric care settings with joint contractures. This list will describe body functions, body structures, activities and participation and related environmental factors. This standard set will define what aspects of functioning should be assessed in individuals with joint contractures and will be the basis of the new assessment instrument to evaluate the impact of joint contractures on functioning and social participation.


Subject(s)
Contracture/classification , Disability Evaluation , Health Status , International Classification of Diseases/classification , Joint Diseases/classification , Social Participation , Activities of Daily Living/classification , Aged , Aged, 80 and over , Contracture/diagnosis , Contracture/epidemiology , Cross-Sectional Studies , Female , Humans , Joint Diseases/diagnosis , Joint Diseases/epidemiology , Male
13.
Knee Surg Sports Traumatol Arthrosc ; 21(11): 2548-56, 2013 Nov.
Article in English | MEDLINE | ID: mdl-23328988

ABSTRACT

PURPOSE: Researchers from 11 countries (Austria, England, Estonia, Finland, France, Germany, Ireland, Netherlands, Poland, Spain, and Sweden) compared how their Diagnosis-Related Group (DRG) systems deal with knee replacement cases. The study aims to assist knee surgeons and national authorities to optimize the grouping algorithm of their DRG systems. METHODS: National or regional databases were used to identify hospital cases treated with a procedure of knee replacement. DRG classification algorithms and indicators of resource consumption were compared for those DRGs that together comprised at least 97 % of cases. Five standardized case scenarios were defined and quasi-prices according to national DRG-based hospital payment systems ascertained. RESULTS: Grouping algorithms for knee replacement vary widely across countries: they classify cases according to different variables (between one and five classification variables) into diverging numbers of DRGs (between one and five DRGs). Even the most expensive DRGs generally have a cost index below 2.00, implying that grouping algorithms do not adequately account for cases that are more than twice as costly as the index DRG. Quasi-prices for the most complex case vary between euro 4,920 in Estonia and euro 14,081 in Spain. CONCLUSIONS: Most European DRG systems were observed to insufficiently consider the most important determinants of resource consumption. Several countries' DRG system might be improved through the introduction of classification variables for revision of knee replacement or for the presence of complications or comorbidities. Ultimately, this would contribute to assuring adequate performance comparisons and fair hospital reimbursement on the basis of DRGs.


Subject(s)
Arthroplasty, Replacement, Knee/economics , Diagnosis-Related Groups , Joint Diseases/surgery , Algorithms , Databases, Factual , Europe , Humans , Joint Diseases/classification , Reimbursement Mechanisms , Retrospective Studies
14.
Z Rheumatol ; 72(4): 383-92, 2013 May.
Article in German | MEDLINE | ID: mdl-23446461

ABSTRACT

The revised classification of the periprosthetic membrane (synovial-like interface membrane SLIM) encompasses all pathological alterations which can occur as a result of endoprosthetic replacement of major joints and lead to a reduction in durability of prostheses. This also includes the established consensus classification of SLIM by which aseptic and septic prosthetic loosening can be subdivided into four histological types and histopathological criteria for additional pathologies: endoprosthesis-associated arthrofibrosis, immunological/allergic alterations and osseous pathologies. This revision represents the foundation for the histopathological diagnostics of the total spectrum of diseases associated with joint prostheses, is a suitable basis for a standardized diagnostic procedure and etiological clarification of endoprosthesis failure and also as a data standard for endprosthesis registers, in particular for registers based on routine data (e.g. German endoprosthesis register).


Subject(s)
Joint Diseases/classification , Joint Diseases/diagnosis , Joint Prosthesis/adverse effects , Practice Guidelines as Topic , Terminology as Topic , Germany , Humans , Joint Diseases/etiology
15.
Scott Med J ; 58(2): 109-12, 2013 May.
Article in English | MEDLINE | ID: mdl-23728757

ABSTRACT

BACKGROUND: Coding of patients' diagnosis and surgical procedures is subject to error levels of up to 40% with consequences on distribution of resources and financial recompense. Our aim was to explore and address reasons behind coding errors of shoulder diagnosis and surgical procedures and to evaluate a potential solution. METHODS: A retrospective review of 100 patients who had undergone surgery was carried out. Coding errors were identified and the reasons explored. A coding proforma was designed to address these errors and was prospectively evaluated for 100 patients. The financial implications were also considered. RESULTS: Retrospective analysis revealed the correct primary diagnosis was assigned in 54 patients (54%) had an entirely correct diagnosis, and only 7 (7%) patients had a correct procedure code assigned. Coders identified indistinct clinical notes and poor clarity of procedure codes as reasons for errors. The proforma was significantly more likely to assign the correct diagnosis (odds ratio 18.2, p < 0.0001) and the correct procedure code (odds ratio 310.0, p < 0.0001). Using the proforma resulted in a £28,562 increase in revenue for the 100 patients evaluated relative to the income generated from the coding department. CONCLUSION: High error levels for coding are due to misinterpretation of notes and ambiguity of procedure codes. This can be addressed by allowing surgeons to assign the diagnosis and procedure using a simplified list that is passed directly to coding.


Subject(s)
Arthroscopy/classification , Clinical Coding , Joint Diseases/classification , Shoulder Joint/surgery , Diagnostic Errors , Humans , International Classification of Diseases , Joint Diseases/surgery , Retrospective Studies
16.
J Pediatr Orthop ; 32(1): 5-8, 2012.
Article in English | MEDLINE | ID: mdl-22173380

ABSTRACT

BACKGROUND: In previous studies, 5% to 20% of patients with a discoid lateral meniscus eventually require surgery bilaterally for symptomatic discoid menisci. However, there are little published data specifically on children who require treatment for discoid menisci in both knees. The purpose of this study is to identify differences in clinical and arthroscopic findings between children who require bilateral versus unilateral treatment for symptomatic discoid lateral menisci. METHODS: We retrospectively reviewed the records of all patients aged 18 years or younger requiring treatment of discoid lateral meniscus between 1998 and 2007. Data were collected on 16 patients (32 knees) with symptomatic bilateral discoid menisci and 60 patients treated unilaterally with an asymptomatic contralateral knee. RESULTS: At initial presentation, children who were treated bilaterally for discoid menisci were younger than those treated unilaterally (10.4 vs. 12.5 y; P=0.021). Patients under 12 years of age were 4.6 times more likely to eventually require surgery on both knees (P=0.015). Watanabe classification was as follows: complete, 65% bilateral versus 30% unilateral; incomplete, 22% bilateral versus 68% unilateral; and Wrisberg, 13% bilateral versus 2% unilateral (P<0.001). The odds of current or future bilateral symptoms requiring treatment were 4.5 times higher in patients with a complete discoid meniscus (P=0.0017) and 8.4 times higher in those with a Wrisberg type (P=0.048). A tear of the lateral meniscus was more likely to be found intraoperatively in unilateral knees than bilateral (90% vs. 72%; P=0.037). CONCLUSIONS: Patient education and long-term follow-up are important for children who present with a discoid meniscus at a young age or with a complete or Wrisberg type, as these patients may be at increased odds of symptomatic discoid meniscus in the contralateral knee, even several years later. Furthermore, evaluation and treatment of discoid lateral meniscus requires vigilance for meniscal tears. LEVEL OF EVIDENCE: Prognostic study, level III.


Subject(s)
Arthroscopy/methods , Joint Diseases/pathology , Knee Joint/pathology , Menisci, Tibial/abnormalities , Adolescent , Age Factors , Child , Child, Preschool , Female , Follow-Up Studies , Humans , Joint Diseases/classification , Joint Diseases/surgery , Knee Joint/surgery , Male , Patient Education as Topic , Retrospective Studies
17.
Osteoarthritis Cartilage ; 19(11): 1323-9, 2011 Nov.
Article in English | MEDLINE | ID: mdl-21884810

ABSTRACT

OBJECTIVE: To evaluate the levels of plasmatic and synovial Coll2-1, Coll2-1NO(2) and myeloperoxidase (MPO) in horses with osteochondral lesions of the tarsocrural joint and to investigate how these levels relate to arthroscopic findings of inflammation and degeneration. MATERIALS AND METHODS: Venous blood and synovial fluid samples were collected from 63 horses presented for arthroscopic removal of osteochondral fragments in the tarsocrural joint. Prior to removal of the osteochondral fragment, an exploration of the joint was performed and an inflammatory and degenerative score was determined. The blood and synovial levels of Coll2-1, Coll2-1NO(2) and MPO were also measured. The effects of the arthroscopic evaluation (inflammatory and degenerative classes) on the blood and synovial markers were evaluated using a linear model (GLM procedure), and correlations between biochemical markers in the blood and synovial fluid and the arthroscopic evaluation (inflammatory and degenerative classes) were established (Pearson's correlations). RESULTS: Significantly higher levels of Coll2-1 were detected in synovial fluid of higher degenerative classes. There was a significant correlation between the degenerative score and the synovial levels of Coll2-1 (r=0.27). According to the logistic regression model, there was a significant effect of the degenerative class on synovial levels of Coll2-1. CONCLUSIONS: Coll2-1 correlates well with the degenerative state of tarsocrural joints as evaluated by arthroscopy. This marker can therefore be classified as a burden-of-disease marker in the assessment of joint disease in horses.


Subject(s)
Horse Diseases/metabolism , Joint Diseases/veterinary , Osteochondrosis/veterinary , Tarsal Joints/metabolism , Animals , Arthroscopy , Biomarkers/metabolism , Collagen Type II/metabolism , Hindlimb/metabolism , Horse Diseases/classification , Horse Diseases/diagnosis , Horses , Joint Diseases/classification , Joint Diseases/diagnosis , Joint Diseases/metabolism , Osteochondrosis/classification , Osteochondrosis/diagnosis , Osteochondrosis/metabolism , Peptide Fragments/metabolism , Peroxidase/metabolism , Synovial Fluid/chemistry , Tarsal Joints/pathology
19.
J Arthroplasty ; 25(4): 607-13, 2010 Jun.
Article in English | MEDLINE | ID: mdl-20022454

ABSTRACT

The use of large metal on metal bearings has led to a reduction in the risk of dislocation post hip arthroplasty. Because of this, and also because of the technical difficulties associated with resurfacing surgery in particular, it could be argued that a less meticulous approach to acetabular cup placement has developed in comparison with conventional metal on polyethylene arthroplasty. Resurfacing cups may produce significant clinical problems when placed at the extremes of version, including increased production of metal debris and psoas tendonitis. Presented in this article is evidence that EBRA software (Einzel-Bild-Roentgen-Analysis, University of Innsbruck, Austria) can be used to reliably assess the version of resurfacing cups, when radiographs are of sufficient quality. The cups have characteristic appearances when placed at the extremes of version. These characteristics can allow the surgeon to identify poorly positioned cups without the use of software.


Subject(s)
Acetabulum/surgery , Arthroplasty, Replacement, Hip/adverse effects , Hip Prosthesis/adverse effects , Joint Diseases/surgery , Humans , Joint Diseases/classification , Prosthesis Failure , Prosthesis Fitting , Software
20.
J Am Osteopath Assoc ; 120(1): 25-29, 2020 Jan 01.
Article in English | MEDLINE | ID: mdl-31904771

ABSTRACT

Lateral strain is a type of nonphysiologic cranial dysfunction that occurs at the sphenobasilar synchondrosis. In this dysfunction, the sphenoid and occiput rotate in the same directions along 2 vertical axes. There is currently no consensus on the nomenclature for this cranial dysfunction. In this article, the authors provide a standard nomenclature for lateral strains using the historical writings of pioneers in osteopathic medicine, including William Gardner Sutherland, DO, Anne L. Wales, DO, and Harold Magoun, DO. The authors establish the following consensus: (1) Lateral strains are named for the side to which the basisphenoid shifts; (2) The more prominent greater wing of the sphenoid is on the same side to which the basisphenoid shifts; (3) In vault and fronto-occipital holds, the holds form a parallelogram shape, with the index fingers pointing to the same side as the more prominent greater wing; and (4) The hand that is on the side of the prominent greater wing will shift anteriorly while the hand on the opposite side will shift posteriorly.


Subject(s)
Joint Diseases/classification , Joint Diseases/therapy , Manipulation, Osteopathic , Occipital Bone/physiopathology , Skull Base/physiopathology , Humans
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