Major increase in creatine kinase after intensive exercise. / Kraftig stigning i kreatinkinase etter intensiv trening.

BACKGROUND: Exercise-induced rhabdomyolysis is an increasingly frequent cause of hospitalisation and is much debated in the media. The real incidence of the condition is unknown. We wanted to investigate changes in creatine kinase (CK) levels in healthy students following intensive exercise and to look for a correlation between CK, pain and previous exercise history. METHOD AND MATERIAL: Twenty-four healthy students performed a single intensive workout and acted as their own controls with testing before and after the exercise session. RESULTS: All participants displayed an increase in CK levels after the workout, 58 % to above 5 000 IU/l. CK rose from a median of 104 IU/l (72-212) to a median of 6 071 IU/l (2 815-12 275) on day 4, p < 0.001. A negative Spearman's rank correlation was observed between the frequency of strength training prior to the experiment and the CK increase, rho = -0.477 (p = 0.021). INTERPRETATION: A major increase in CK levels is a normal phenomenon after intensive exercise, and the amount of the increase is related to previous exercise history. Further studies should evaluate whether patients with exercise-induced rhabdomyolysis should receive the same treatment as those with rhabdomyolysis caused by other mechanisms.

A new surgical method for treating patients with refractory external snapping hip: Pedersen-Noor operation.

The technical description of a new surgical method (Pedersen-Noor operation) to treat refractory external snapping hip [coxa saltans externa (CSE)] is presented. The method consists of distal lengthening of the iliotibial band by Z-plasty under local anesthesia and on an outpatient basis. Five patients with refractory CSE were treated with the new method. Postoperatively, the outcome was evaluated by phone interview and physical examination, 3 to 4 months and 1 year postoperatively, respectively. The snapping disappeared in all five patients. No postoperative complications were reported. Three patients were very satisfied and two patients were satisfied with the result of the operation. All five patients would recommend the operation to another patient with similar symptoms. The described method is simple, economic, and effective and can be recommended in the treatment of refractory CSE.

Distal lengthening of ilio-tibial band by Z-plasty for treating refractory greater trochanteric pain after total hip arthroplasty (Pedersen-Noor operation).

INTRODUCTION: The development of greater trochanteric pain (GTP) after total hip arthroplasty (THA) represents a special category. Despite that treatment is mainly conservative, some patients show poor response and surgical intervention should be considered. We propose a new method consisting of distal lengthening of ilio-tibial band (ITB) by Z-plasty. MATERIAL AND METHODS: Between March 2004 and June 2006, 12 women with refractory GTP after THA were operated on using distal ITB lengthening. The procedure was done under local anaesthesia on an outpatient basis. The patients were followed up 3-4 months postoperatively by phone interview and at 1-3 years by EQ-5D questionnaire and clinical examination including tenderness evaluation with algometer. RESULTS: All patients improved significantly (EQ-5D = 0.26 preoperatively vs. 0.67 postoperatively; P < 0.005) except one patient who experienced no change in GTP symptoms. No postoperative complications were reported. CONCLUSION: We believe that treating patients with GTP after THA by the technique described offers a simple, safe and reliable method.