Comparison of the long-term effectiveness of physiotherapy programs with low-level laser therapy and pulsed magnetic field in patients with carpal tunnel syndrome.

PURPOSE: The aim of the study was to compare the long term effects of low - level laser therapy (LLLT) and pulsed magnetic field (PMF) in the rehabilitation of patients with carpal tunnel syndrome (CTS). METHODS: The study included 38 patients with idiopathic CTS, confirmed by electroneurographic (ENG) examination. All patients were randomly assigned to 2 groups: group L (18 patients) treated with LLLT and group M (20 patients) with PMF therapy. Clinical assessment, including day and night pain, the presence of paresthesia, functional tests (Phalen, Tinel, armband tests) and pain severity according to the Visual Analogue Scale (VAS) was conducted before treatment, after the first series of 10 sessions, after a two-week break, after the second series of 10 sessions and six months after the last series. RESULTS: After LLLT a significant reduction of day and night pain was observed at each stage of treatment and 6 months after the last series (p<0.05). However, in group M, a significant reduction of both day and night pain was demonstrated only after the second series (p<0.05). A reduction of the incidence of Phalen's symptoms were noticed in both groups, however, only in group L the improvement was significant (p<0.05). In groups L and M a significant reduction of pain intensity was observed at every stage of treatment (p<0.05). CONCLUSIONS: Although after LLL as well as PMF therapy clinical improvement was observed, the most significant differences were registered after the second series and persisted for up to 6 months in both groups.

The value of iontophoresis combined with ultrasound in patients with the carpal tunnel syndrome.

PURPOSE: The purpose of the study was the evaluation of usefulness of iontophoresis with hydrocortisone combined with ultrasounds in conservative treatment of the carpal tunnel syndrome (CTS). PATIENTS AND METHODS: Forty patients (35 women and 5 men), aged 30-72 years, with unilateral CTS confirmed by electromyographic examination were included. The patients were divided into 3 groups based on clinical symptoms according to Whitley. Subjective complaints and objective symptoms were recorded in all patients. The character of the pain, its frequency and intensity (VAS scale) as well as paresthesies was determined. Physical examination consisted of clinical tests according to Phalen and Tinnel, sensation discriminatory test, pressure test and estimation of muscular atrophy of the thenar. All the patients underwent combined physiotherapeutic procedures: iontophoresis with hydrocortisone acetate (25 mg per procedure; galvanic current up to 5 mA, the active electrode--50 cm2, time--20 min) and ultrasounds with direct coupling (the dose of 0.5-0.8 W/cm2, 1 MHz, PIP 1:4, 48 Hz; the time 3-6 min). The number of procedures was 10--one per day. RESULTS: Decrease of pain and paresthesia were observed in 36 patients (out of 40) with mild and moderate stage of CTS. Objective parameters (Phalen test, Tinnel test, and sensation discriminatory test) significantly improved only in 24 patients with moderate stage of CTS. There was no improvement in 4 patients with advanced form of CTS. CONCLUSIONS: The use of combined procedures of iontophoresis with hydrocortisone and the ultrasound diminishes subjective complaints of patients with the carpal tunnel syndrome. The procedure is most effective in the treatment of mild and moderate stages of the disease.

Interleukin-6, soluble interleukin-2 receptor and soluble interleukin-6 receptor in the sera of patients with different histological patterns of rheumatoid synovitis.

OBJECTIVE: The present study was conducted to investigate whether the serum levels of interleukin 6 (IL-6), soluble IL-2 receptor (sIL-2R) and sIL-6R are associated with the morphological appearance of rheumatoid arthritis (RA). METHODS: Using the ELISA technique we measured the IL-6, sIL-2R and sIL-6R concentrations in the serum of 34 patients with RA and 28 patients with osteoarthritis (OA). Histological analysis of synovial samples distinguished 2 types of rheumatoid synovitis. Twenty-one RA specimens presented diffuse infiltrates of mononuclear cells without any specific microanatomical organization. In remaining 13 samples the formation of lymphocytic follicles with germinal center-like structures was found. RESULTS: Serum levels of IL-6, sIL-2R and sIL-6R were elevated in patients with RA compared to the OA control group (p < 0.001, p < 0.001 and p < 0.05 respectively). Concentrations of IL-6 and sIL-2R were highest in the serum of RA patients with follicular synovitis in comparison to patients with diffuse synovitis (p < 0.001 and p < 0.01 respectively) and could distinguish RA patients with these two histological variants of the disease. Serum levels of IL-6 and sIL-2R correlated with markers of disease activity such as ESR and CRP levels. In addition, the clinical data suggest a more severe disease among RA patients with follicular synovitis. CONCLUSION: Distinct histological types of rheumatoid synovitis associated with unique serum concentrations of IL-6 and sIL-2R reflect levels of disease activity and confirm the concept of RA heterogeneity.

Circulating tumour necrosis factor alpha and soluble tumour necrosis factor receptors in patients with different patterns of rheumatoid synovitis.

OBJECTIVE: To examine the relation between the serum levels of tumour necrosis factor alpha (TNFalpha), soluble tumour necrosis factor receptors (sTNF-R), and the histological pattern of rheumatoid synovitis. METHODS: An enzyme linked immunosorbent assay (ELISA) was used to measure TNFalpha, p55 sTNF-R, and p75 sTNF-R concentrations in the serum of 43 patients with rheumatoid arthritis (RA) and 34 patients with osteoarthritis (OA). RESULTS: Upon histological analysis two variants of rheumatoid synovitis emerged. Twenty six RA specimens presented only diffuse infiltrates of mononuclear cells. In the remaining 17 samples the formation of lymphocytic follicles with germinal centre-like structures was found. Serum concentrations of TNFalpha, p55 and p75 sTNF-R were raised in patients with RA compared with the OA control group (p<0.001 for all comparisons). Levels of TNFalpha, p55 and p75 sTNF-R were higher in the serum of patients with RA with follicular synovitis than in patients with diffuse synovitis (p<0.001, p<0.01, and p<0.05, respectively). Serum concentrations of TNFalpha, p55 and p75 sTNF-R correlated with markers of disease activity. CONCLUSION: Different histological types of rheumatoid synovitis associated with distinct serum levels of TNFalpha and sTNF-R reflect varying clinical activity of the disease and support the concept of RA heterogeneity.

Soluble adhesion molecules (ICAM-1, VCAM-1, and E-selectin) and vascular endothelial growth factor (VEGF) in patients with distinct variants of rheumatoid synovitis.

BACKGROUND: Cell adhesion molecules and endothelial growth factors have an important role in the infiltrating of rheumatoid synovium with mononuclear cells, leading to the initiation and progression of the disease. OBJECTIVE: To investigate whether the serum profile of soluble adhesion molecules and of vascular endothelial growth factor (VEGF) is associated with the histological appearance of rheumatoid arthritis (RA). METHODS: Serum levels of soluble intercellular adhesion molecule-1 (sICAM-1), vascular cell adhesion molecule-1 (sVCAM-1), E-selectin (sE-selectin), and VEGF were assessed by enzyme linked immunosorbent assay (ELISA) in 40 patients with RA and 32 patients with osteoarthritis (OA). RESULTS: Histological analysis of synovium specimens distinguished two types of rheumatoid synovitis. Twenty four RA samples presented diffuse infiltrates of mononuclear cells without any further microanatomical organisation, whereas in the remaining 16 samples lymphocytic follicles with germinal centre-like structures were identified. In comparison with patients with OA, constituting a control group, higher serum concentrations of sICAM-1 (p<0.001), sVCAM-1 (p<0.001), sE-selectin (p<0.01), and VEGF (p<0.001) were detected in patients with RA. Raised concentrations of sICAM-1, sVCAM-1, and VEGF dominated in the serum of patients with RA with follicular synovitis compared with those with diffuse synovitis (p<0.01 for all comparisons). The serum concentrations of sICAM-1, sVCAM-1, and VEGF correlated with markers of disease activity such as the erythrocyte sedimentation rate and C reactive protein levels. Furthermore, the clinical data analysed in our study indicated that patients with RA with follicular synovitis tend to have more severe disease. CONCLUSIONS: The distinct histological appearances of rheumatoid synovitis associated with different serum profiles of sICAM-1, sVCAM-1, and VEGF reflect varied clinical activity of the disease and confirm RA heterogeneity. Patients with different histological forms of synovitis may respond differently to the treatment regimens.

Serum matrix metalloproteinases and tissue inhibitors of metalloproteinases in different histological variants of rheumatoid synovitis.

OBJECTIVE: Rheumatoid synovitis is characterized by an invasive and tissue-destructive infiltrate of lymphocytes, macrophages and synoviocytes. Matrix metalloproteinases (MMPs) and tissue inhibitors of metalloproteinases (TIMPs) produced by these cells are important in the remodelling of the articular tissues in rheumatoid arthritis (RA). The aim of this study was to explore whether the serum concentrations of MMPs and their inhibitors were correlated with the histological appearance of the disease. METHODS: Tissue and serum samples were obtained from 37 patients with clinically active RA and 30 with osteoarthritis (OA). Morphological analysis allowed the division of RA synovial specimens into two distinct types. In 22 samples only diffuse infiltrates of mononuclear cells without further microanatomical organization were found. In 15 specimens we observed lymphocytic conglomerates with germinal centre-like structures. Serum concentrations of interstitial collagenase (MMP-1), stromelysin-1 (MMP-3), gelatinase B (MMP-9), TIMP-1 and TIMP-2 were measured with an ELISA technique. RESULTS: Unique serum profiles of MMPs and TIMPs were identified in each of the two histological types of RA synovitis. The serum concentrations of MMP-1, MMP-3 and MMP-9 were higher in RA patients than in OA patients used as a control group (P<0.001 for all comparisons). These three MMPs dominated in the serum of RA patients with follicular synovitis compared with those with diffuse synovitis (P<0.05, P<0.01 and P<0.001 respectively). The analysis of the serum concentrations of TIMP-1 and TIMP-2 showed that their levels were also elevated in RA patients compared with OA patients (P<0.001 and P<0.01 respectively). Only TIMP-1 was found in a significantly higher concentration in the serum of RA patients with follicular synovitis than in those with diffuse synovitis (P<0.05). The serum concentrations of MMPs and TIMP-1 clearly identified patients with two different histological types of rheumatoid synovitis and with OA. Additionally, the analysis of clinical data showed that the rheumatoid disease in patients with follicular synovitis seemed to be more active than in those with diffuse synovitis. CONCLUSION: The morphological appearance of rheumatoid synovitis and the serum MMP and TIMP-1 profile were correlated with the clinical activity of the disease, confirming the heterogeneity of RA. These associations also suggest that patients with different histological forms of RA might require different treatment regimens.

Serum cytokines in different histological variants of rheumatoid arthritis.

OBJECTIVE: Rheumatoid arthritis (RA) is characterized by an invasive and tissue destructive infiltrate of lymphocytes, macrophages, and synoviocytes formed in the joints. Its etiopathogenesis and the role of the particular morphological components of synovitis remain unclear. There is evidence that its histological heterogeneity is correlated with synovium cytokine transcription. We investigated whether the serum cytokine profile is associated with the morphological appearance of the disease. METHODS: Tissue and serum samples were collected from 25 patients with clinically active RA and 25 with osteoarthritis (OA) as a control group. After histological analysis RA synovial biopsies were divided into 2 distinct types; 16 samples were characterized by diffuse lymphocyte infiltrates with no additional microanatomical organization. Lymphocytic aggregates with germinal center-like structures were found in 9 specimens. Serum concentrations of interferon-gamma (IFN-gamma), interleukin 12 (IL-12, p70 heterodimer), tumor necrosis factor-alpha (TNF-alpha), and IL-15 were measured by ELISA. RESULTS: Low concentrations of IFN-gamma (p < 0.01) and IL-12 (NS) were found in RA patients' serum compared with OA controls. RA patients with follicular synovitis had lower serum concentration of IFN-gamma (p < 0.05) and IL-12 (p < 0.05) than patients with diffuse infiltrates. High concentration of TNF-alpha and IL-15 characterized RA patient serum in comparison with controls (respectively, p < 0.001 and p < 0.01). In the serum of RA patients with follicular synovitis TNF-alpha was a dominant cytokine (p < 0.01) compared to patients with diffuse disease. At TNF-alpha level > or = 44 pg/ml, 5 (56%) of 9 patients with follicular RA had such elevated values vs one of 16 diffuse patients (< 10%; p < 0.02). Only serum concentrations of TNF-alpha could effectively differentiate between patients with OA and subgroups of RA. Analysis of clinical data suggested that activity of rheumatoid disease in patients with follicular synovitis was more severe than in those with diffuse infiltrates. CONCLUSION: The association between distinct histological appearance of rheumatoid synovitis and serum cytokine profile and diverse clinical activity of disease seems to confirm its heterogeneity.

[MRNA activity in synovial fluid after anterior cruciate ligament reconstruction]. / Aktywnosc mRNA w plynie stawowym kolana po zabiegach rekonstrukcji wiezadla krzyzowego przedniego.

The authors present the results of studies on the transcription level of mRNA (poly A + mRNA) in patients in whom anterior cruciate ligament reconstruction was performed. In a group of 9 patients who underwent this procedure an average increase of the concentration of mRNA was noted--from 1.5 micrograms/ml to 67 micrograms/ml in the first week following surgery. This was followed by a decrease of concentration in the third week to 37 micrograms/ml and 7.8 micrograms/ml in the fifth week. In the control group (16 patients who underwent arthroscopy with partial meniscectomy) an average increase in mRNA concentration from 1.3 micrograms/ml to 4.8 micrograms/ml in the first week after the procedure was noted. It was followed by a decrease to 1.6 micrograms/ml in the third week after surgery. The authors believe the marked increase of mRNA is a result of stimulation of synovial cells and an increase of the number of mononuclear cells in the synovial fluid. The small concentration increase of mRNA in the control group seems to be related only the increase in number of mononuclear cells in synovial fluid.

[Rotatory instability of the ankle: an experimental investigation of tibio-fibular syndesmosis function]. / Niestabilnosc rotacyjna stawu skokowego--doswiadczalna ocena funkcji wiezozrostu piszczelowo-strzalkowego.

The influence of sectioning of different parts of tibiofibular syndesmosis on stability of the ankle in 10 anatomical preparations is presented. Sectioning of the anterior tibiofibular ligament increased rotational potential of the talus from 0.3 degree to 2.8 degrees. Sectioning of the tibiofibular syndesmosis allowed for further increase of rotation from 1.8 degrees to 4.9 degrees.

[Clinical significance of arthroscopic synovial biopsy in the diagnosis of knee synovitis]. / Przydatnosc kliniczna artroskopowej biopsji blony maziowej w diagnostyce wysiekowych zapalen stawów kolanowych.

Eighty-two patients (49 females and 33 males, mean age 38.2 years) underwent arthroscopic synovial biopsy in the course of treatment for chronic knee synovitis. After histopatological analysis of the samples Fritz et al. criteria were used for their classification. In 16 cases of specific synovitis clinical diagnosis was always confirmed by histopathology. In 66 patients with nonspecific synovitis lymphoplasmatic and serofibrous type prevailed. In 8 cases with dominant non-specific synovitis histological features of specific synovitis have been also found and correct clinical diagnosis has been established. Arthroscopic synovial biopsy increases diagnostic potential in the synovitis of unclear etiology.

[The influence of operative methods on biomechanics of tibio-fibular syndesmosis]. / Rozwiazania operacyjne a biomechanika wiezozrostu piszczelowo-strzalkowego.

Ten cadaver anatomical preparations of the ankle served to assess selected parameters of movement within this joint. Measurements were done in uninjured joint and after transfixation with tension wiring band, staples and screws. Wiring band provided better biomechanical results than screws or staples.

[Arthroscopic anatomy and diagnosis of posterior cruciate ligament injuries]. / Artroskopowa anatomia i diagnostyka uszkodzen wiezadla krzyzowego tylnego.

Basic problems of arthroscopically assisted diagnostics of posterior cruciate ligament injuries are presented. Anatomic "three-part" concept and arthroscopic postero-medial approach are recommended in visual judging of ligament competence. "Sloppy ACL" is considered as most valuable sign in diagnosis of posterior cruciate ligament injuries.

[Cyclops type changes--a specific complication after anterior cruciate reconstruction--a clinical and histopathologic study]. / Zmiana typu cyklopa--specyficzne powiklanie po rekonstrukcji wiezadlla krzyzowego przedniego--obraz kliniczny i histopatologiczny.

Four cases of specific complication following 15 anterior cruciate ligament reconstructions using isometric vascularized patellar tendon tendon graft are presented. During "second-look" arthroscopy in all 4 cases a nodule in anterior knee compartment was found. The consistent microscopic finding within the nodule was the presence of disorganized dense fibroconnective tissue. Small bone debris were found in all cases. Arthroscopic debridement was performed resulting in proper joint function.

[Posterolateral rotation instability of the knee. I. Reconstruction methods, personal results]. / Tylno-boczna rotacyjna niestabilnosc stawu kolanowego. Czesc II--Sposoby rekonstrukcji, wyniki wlasne.

This article presents suggested ways of treatment for posterolateral knee joint instability. Detailed technique of posterolateral tenodesis using part of biceps femoris tendon is presented. In conclusions it was stated, that anatomical reconstruction and restoration of the tension of all damaged structures is mandatory.

[Posterolateral rotatory knee joint instability. I. Anatomy of injuries and diagnosis]. / Tylno-boczna rotacyjna niestabilnosc stawu kolanowego. Czesc I--anatomia uszkodzen, diagnostyka.

Posterolateral rotatory knee joint instability is an uncommon but debilitating injury. Its pathomorphology as well as basic principles of clinical and instrument aided diagnosis are presented.

Bilateral knee gunshot wounds successfully treated with arthroscopic bullet retrieval: a case report.

One unusual case of bilateral knee joint gunshot wounds caused by a low-velocity low-energy missile is presented. Arthroscopic retrieval of the bullets was performed resulting in recovery within 5 days.

[Lateral release of the patella. I--Diagnostics, indications]. / Boczne uwolnienie rzepki. Czesc I--Diagnostyka, wskazania.

Basic principles of diagnostics of the patello-femoral joint are presented. Indications for arthroscopic subcutaneous patellar lateral release are discussed.

[Lateral release of the patella. II. Arthroscopic technique of subcutaneous lateral release, complications]. / Boczne uwolnienie rzepki. Czesc II--Technika artroskopowego podskórnego przeciecia troczka bocznego rzepki, powiklania.

Principles of operative technique of arthroscopic patellar lateral release are presented. The most common complications and measures to avoid them are discussed.

Arthroscopic knee joint synovectomy in the treatment of early stages of rheumatoid arthritis.

Clinical results of 14 arthroscopic knee joint synovectomies are presented. They were done in grade II and III rheumatoid arthritis. Good and moderate results (according to Ogilvie-Harris) were obtained in 79% cases. Operative technique and postoperative management is presented. It was stated that arthroscopic synovectomy is most useful in II degree RA.

Vascularised patellar tendon graft in anterior cruciate ligament reconstruction.

Clinical results of 13 anterior cruciate ligament reconstructions by use of vascularised patellar tendon graft are presented. In all patients improvement was achieved resulting in good results in 62% cases (according to Lysholm score). Technical merits, fate of the graft and rehabilitation program are discussed. Described operation is recommended as the procedure of choice for the symptomatic anterior cruciate-deficient knee.