Efficacy of Adding Kampo Medicine for Rheumatoid Arthritis / 日本東洋医学雑誌

We added Kampo medicine (Japanese traditional herbal medicine) to disease-­modifying anti-­rheumatic drugs (DMARDs) to treat rheumatoid arthritis (RA) in 41 patients. After 1 year, disease activity assessments showed improvement in the number of tender joints and DAS 28-­CRP, and Boolean remission increased from 3 cases to 6 cases. However, 16 of 41 patients had an insufficient therapeutic effect with Kampo medicine ; therefore, their DMARD treatment was strengthened. Disease activity in the 16 patients with strengthened DMARD therapy (Western group) was compared with that in the 25 patients who did not require strengthened DMARD therapy (Kampo group). The Western group had high disease activity at the beginning of Kampo medicine, and a year later CRP and DAS 28­-CRP improved. In the Kampo group, disease activity was relatively good at the beginning of Kampo medicine, and patient global assessment (PGA) improved. We believe that combination therapy, with DMARDs controlling synovitis and Kampo medicine improving PGA, is an effective way to achieve Boolean remission.

Trial of the contraction method for transversus abdominal muscle with taping: focusing on the muscle thickness of external oblique, internal oblique and transversus abdominal muscles / 体力科学

Abdominal draw-in is a functional transversus abdominal muscle exercise to acquire the contraction. However, it is difficult for even healthy subjects to selectively contract the deep transversus abdominal and internal oblique muscles without over-contraction of the superficial rectus abdominis and the external oblique muscles. This study examined whether the transversus abdominal muscle is selectively contracted by our taping method. The subjects were 20 healthy males. Using ultrasound, we compared the thickness of external oblique, internal oblique, and transversus abdominal muscle among no taping, kinesio taping and abdominal muscle activation taping in the standing position. The thickness of transversus abdominal muscle significantly increased in the activation taping more than the other methods. This study showed that abdominal musculature activation taping made it possible to contract the transversus abdominal muscle selectively.

Arthroscopic Pullout Fixation for a Small and Comminuted Avulsion Fracture of the Posterior Cruciate Ligament from the Tibia

We describe a patient who underwent arthroscopic pullout fixation for a posterior cruciate ligament (PCL) avulsion fracture. A 46-year-old female, injured in a fall while riding a motorcycle, was diagnosed with a right knee PCL tibial attachment avulsion fracture and underwent arthroscopic osteosynthesis. A Kirschner wire was drilled to a point just medial to the medial border of the anterior tibial bony bed. A suture wire was folded into a loop and introduced into the posteromedial compartment via the bone tunnel. A fixation thread was inserted from the posteromedial portal, through the medial and lateral loop wires, and into the posteromedial compartment. The lateral and medial loop wires attached to the thread were pulled to the outside, and the thread was fixed onto the tibia. Three months post-surgery, she returned to her job. This procedure represents a minimally invasive method of treating avulsion fractures of the tibial attachment of the PCL.

Radiographic Measurement of Joint Space Width Using the Fixed Flexion View in 1,102 Knees of Japanese Patients with Osteoarthritis in Comparison with the Standing Extended View

PURPOSE: The fixed flexion view (FFV) of the knee is considered useful for evaluating the joint space when assessing the severity of osteoarthritis (OA) of the knee. To clarify the usefulness of FFV for evaluation of the joint space and severity of knee OA, this study evaluated changes in the joint space on the FFV and standing extended view (SEV) in patients with knee OA. MATERIALS AND METHODS: The SEV and FFV images were acquired in 567 patients (1,102 knees) who visited the hospital with a chief complaint of knee joint pain. Medial joint space width (MJSW) and Kellgren-Lawrence (K-L) classification assessed using the SEV and FFV images were compared. RESULTS: Mean MJSW was significantly smaller when assessed on the FFV than on the SEV (3.02±1.55 mm vs. 4.31±1.30 mm; p<0.001). The K-L grade was the same or higher on the FFV than on the SEV. CONCLUSIONS: The FFV is more useful than the SEV for evaluating the joint space in OA knees. Treatment strategies in patients with knee OA should be determined based on routinely acquired FFV images.

Medial and Lateral Discoid Menisci of Both Knees

Discoid menisci on both the medial and lateral sides are rare, and there are very few reports on cases involving both sides. We report a case of a 52-year-old female with medial and lateral discoid menisci in both knees. Arthroscopy revealed the lateral menisci of both knees were complete discoid menisci, and partial meniscectomy was performed. The medial menisci were incomplete discoid menisci, but there were no findings of abnormal mobility or injury; therefore, the medial menisci were observed without treatment. At six months postoperatively, her pain and range of motion restrictions disappeared.

Comparative Effects of Periarticular Multimodal Drug Injection and Single-Shot Femoral Nerve Block on Pain Following Total Knee Arthroplasty and Factors Influencing Their Effectiveness

PURPOSE: This study compared the analgesic effects of local infiltration analgesia (LIA) and femoral nerve block (FNB) after total knee arthroplasty (TKA) and assessed factors associated with analgesia obtained by these two methods. MATERIALS AND METHODS: Study subjects included 66 patients (72 knees) who underwent TKA for osteoarthritis of the knee. Pain visual analogue scale (VAS), the amount of analgesics used, number of days to achieve 90° of flexion of the knee joint, date of initiating parallel-bar walking, range of motion of the knee joint at discharge, and adverse events were investigated. RESULTS: The VAS scores did not differ significantly between two groups, whereas the amount of analgesics used was significantly lower in the LIA group. Preoperative flexion contracture was significantly more severe in the LIA group with high VAS compared with low VAS. No serious adverse event occurred in the LIA or FNB group. CONCLUSIONS: The lower analgesic usage in the LIA group than the FNB group indicates that the analgesic effect of LIA was greater than that of singleshot FNB after TKA. There were no serious complications in either group. The postoperative analgesic effect of LIA was smaller in patients with severe than less severe preoperative flexion contracture.

Comparison with Magnetic Resonance Three-Dimensional Sequence for Lumbar Nerve Root with Intervertebral Foramen

STUDY DESIGN: Prospective study based on magnetic resonance (MR) imaging of the lumbar spinal root of the intervertebral foramen. PURPOSE: This study was to compare MR three-dimensional (3D) sequences for the evaluation of the lumbar spinal root of the intervertebral foramen. OVERVIEW OF LITERATURE: The diagnosis of spinal disorders by MR imaging is commonly performed using two-dimensional T1- and T2-weighted images, whereas 3D MR images can be used for acquiring further detailed data using thin slices with multi-planar reconstruction. METHODS: On twenty healthy volunteers, we investigated the contrast-to-noise ratio (CNR) of the lumbar spinal root of the intervertebral foramen with a 3D balanced sequence. The sequences used were the fast imaging employing steady state acquisition and the coherent oscillatory state acquisition for the manipulation of image contrast (COSMIC). COSMIC can be used with or without fat suppression (FS). We compared these sequence to determine the optimized visualization sequence for the lumbar spinal root of the intervertebral foramen. RESULTS: For the CNR between the nerve root and the peripheral tissue, these were no significant differences between the sequences at the entry of foramen. There was a significant difference and the highest CNR was seen with COSMIC-FS for the intra- and extra-foramen. CONCLUSIONS: In this study, the findings suggest that the COSMIC-FS sequences should be used for the internal or external foramen for spinal root disorders.

The Clinical Basis of Osteoarthritis / The Japanese Journal of Rehabilitation Medicine

Osteoarthritis (OA) is a non-inflammatory joint disease that is characterized by cartilage degeneration. OA can develop in any joint with synovium and articular cartilage. OA is a very common disease in old age which can cause patients to become housebound or to require nursing care. Epidemiological research in Japan showed that the estimated number of patients with radiographic knee OA was 25 million and those with radiographic lumbar OA was 38 million. OA induces pain, contracture, hydrarthrosis and joint deformity. These in turn lead to gait disturbance in the lower limb and disorders of ADL in the upper limb. On plain radiography, joint space narrowing, osteophyte formation and bone cysts are observed. Several treatment guidelines for OA were published by several academies associated with OA. Various conservative treatments and surgical treatments are often applied to OA. Patient education, exercise and orthoses are effective in improving pain and functional impairment. As a drug therapy, acetaminophen, NSAIDs and opioids are used to reduce pain in OA. Additionally, steroid and hyaluronic intra-articular injection are widely used in the treatment of OA. If the conservative therapies are not effective, surgical therapies are considered. Surgical therapies are categorized into osteotomy, arthroplasty, arthrodesis and replacement arthroplasty. Recently, total knee and hip arthroplasties are becoming very common. Since exercise and orthosis therapy are effective for OA, rehabilitation doctors should have an understanding of the pathology and treatment of OA. In addition, rehabilitation is very important before and after surgery.

Trial of a new lower limbs and trunk functional evaluation for pitcher -physical characteristic of the baseball player with throwing disorder- / 体力科学

Pitching motion is made up by three-dimensional whole body movement. Pelvic and trunk rotation movement is important for the prevention of throwing injuries. Throwing is not a simple rotation movement. Evaluation should reflect muscle strength, coordination, and pitching motion characteristics. We have devised throwing rotational assessment (TRA) similar to throwing as the new evaluation of total rotation angle required for throwing. The purpose of this study was to introduce the new method and to examine the characteristics of players with throwing disorders. The subjects were 76 high school baseball pitchers who participated in the medical check. Pain-induced tests were elbow hyperextension test and intra-articular shoulder impingement test. Pitchers who felt pain in either test were classified as disorder group. TRA evaluation was performed as follows. In the positions similar to the foot contact phase, rotation angles of the pelvis and trunk were measured. In the position similar to follow through phase, the distance between the middle finger and the second toe was measured. All tests were performed in the throwing and opposite direction. Twenty five pitchers were classified as disorder group. All TRA tests in healthy group were significantly higher in the throwing direction than in the opposite direction, but there was no significant difference in the disorder group. Disorder group had significantly lower average rotation angles of the pelvis and trunk in the throwing direction and rotation angle of trunk in the opposite direction than the healthy group. Restrictions on TRA reflecting the complex whole body rotation movement may be related to the throwing disorder. This evaluation is a simple method. It would be useful early detection of throwing disorder and systematic evaluation in medical check, as well as self-check in the sports field.

The prediction of pitching injuries of the shoulder and elbow by comparing the ROM between dominant and non-dominant side on neck/trunk rotations and hip internal rotation / 体力科学

The pitching motion requires neck, trunk and hip rotations. The purpose of this study was to investigate the relationship between pitching injuries and dominant versus non-dominant differences of the ranges of these motions. The subjects were 66 high school baseball pitchers who received medical checkup during baseball classes in Kyoto prefecture. During medical checkup, physical therapists measured the ranges of neck/trunk rotations, and internal rotation of the bilateral hips. Then orthopaedic doctors did special tests such as shoulder internal impingement test, subacromial impingement test, elbow valgus stress test and elbow hyper extension test. Fourteen pitchers (21.2%) who were positive in one or more special tests were judged to require second screening (injured group). In normal group, average neck/trunk rotations toward the non-dominant side were significantly wider than rotations toward the dominant side. Average hip internal rotation was significantly wider on the non-dominant side than on the dominant side. In injured group, a larger number of pitchers had wider neck and trunk rotation ranges toward the dominant side than toward the non-dominant side, and had wide hip internal rotation range on the dominant side compared to the non-dominant side. Comparing the ranges of the neck/trunk rotations and hip internal rotation between dominant and non-dominant sides might be useful for the prediction of pitching injuries of the shoulder and the elbow.

Hydrostatic Pressure Induces Cytokine Production in Human Periodontal Ligament Cells / Oral Science International

Periodontal tissue has a unique structure in that the human periodontal ligament (hPDL) lies between the hard tissues of cementum and alveolar bone. Although the role of cytokines in hPDL function is not clearly understood, we investigated the effect of mechanical stress as hydrostatic pressure (HP) on cytokine expression in hPDL cells.The hPDL cells were obtained from a healthy maxillary third molar. After the 3rd to 4th passage, the cells were exposed to HP ranging from 1 MPa to 6 MPa as previously described. The expression of cytokine mRNA was determined by RT-PCR and cytokines in the culture supernatants were assessed by enzyme-linked immunosorbent assay (ELISA).The exposure to 6 MPa of HP caused no morphological changes of hPDL cells, and did not affect cellular viability. No expression of IL-1β, IL-6, IL-8, TNF-α, RANK, RANKL or OPG mRNA was observed in the control cells under atmospheric pressure, whereas in hPDL cells treated with HP, enhancement of IL-6, IL-8, RANKL and OPG mRNA expression was observed between 10 and 60 minutes after the exposure to HP. After the exposure to HP, the production of IL-6 and TNF-α were induced significantly in hPDL cells, but IL-1β and IL-8 were not produced.These results suggest that hPDL cells may play a role in the production of cytokines in response to mechanical stress <i>in vivo</i>.