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2.
Pan Afr Med J ; 33: 169, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31565130

RESUMO

Introduction: hepatitis C virus (HCV) has several extra-hepatic manifestations including cryoglubulinemia. Cryoglobulinemia is defined as the abnormal presence in the blood of one or several proteins (cryoglobulins) that can precipitate at low temperatures. Method: We conducted a cross-sectional analytical study in the Laboratory of Biology and in the Unit of Hepatology of the General Hospital in Douala (HGD) over a period of 6 months. All patients agreeing to participate to the study and with anti-hepatitis-C antibodies under treatment or not were enrolled. Cryoglobulins were detected using biuret method and the classification was performed using Brouet immunoelectrophoresis. A multivariate analysis was conducted, confounding factors such as age, sex and the length of time after Hepatitis C Virus screening were adjusted. Results: The study enrolled 116 patients. The average age of patients was 58.47±9.95 years. Male sex accounted for 50.86% of cases. Arthralgia was found in 69.80% of cases. Cryoglobulin was found in 63.80% of patients. After adjustment, female sex (OR =2.18; CI 95% [0,97-4,90]; p= 0.059), asthenia alone (OR =2.45;CI 95% [1,04-5,80]; p= 0.041), asthenia combined with arthralgia (OR =2.84;CI 95% [1,13-7, 10]; p= 0.026) and the presence of HCV RNA (OR =2.84;CI 95% [1,13-7,10]; p= 0.028) were factors independently associated with the presence of cryoglobulin. Conclusion: The prevalence of cryoglobubin is high in patients with anti-hepatitis-C antibodies at the HGD. Simple biological methods are used to detect it. Cryoglobulin test in patients with HCV is essential in resource-limited countries.


Assuntos
Crioglobulinemia/epidemiologia , Crioglobulinas/análise , Anticorpos Anti-Hepatite C/sangue , Hepatite C/complicações , Idoso , Artralgia/epidemiologia , Artralgia/etiologia , Camarões , Estudos Transversais , Crioglobulinemia/virologia , Feminino , Humanos , Imunoeletroforese , Masculino , Pessoa de Meia-Idade , Análise Multivariada , Prevalência , RNA Viral/análise
3.
Medicine (Baltimore) ; 98(41): e17464, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31593103

RESUMO

Osteoarthritis (OA) is a common condition of the hip. Patients with hip OA often report nocturnal pain, yet little is known how it affects sleep quality. The purpose of this paper was to assess how hip arthritis affects sleep quality. We hypothesized that hip pain caused by hip OA affects sleep quality in adult patients.This is a prospective, cross-sectional study of patients who were diagnosed with hip OA. Patients were evaluated using Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), hip outcome score (HOS), and modified Harris hip score (mHHS). Sleep quality was assessed using Pittsburgh Sleep Quality Index (PSQI). A multiple regression model was used to assess factors associated with poor sleep quality.A total of 106 patients were analyzed. All patients had a Tonnis grade of 2 or 3 and American Society of Anesthesiologists (ASA) classification of 2. WOMAC, HOS, and mHHS were significantly and negatively correlated with PSQI. The multiple regression model, WOMAC, short form health survey vitality, ASA classification, and history of obstructive sleep apnea were associated with poor sleep quality (R = 0.60, P < .001).Patients with hip OA, who report a symptomatic hip, are susceptible to reduced sleep quality. There is a correlation between worsening HOSs and sleep quality. The WOMAC score is a significant predictor of poor sleep quality. Patients with poor hip metrics should be screened for sleep disturbance.


Assuntos
Artralgia/fisiopatologia , Osteoartrite do Quadril/fisiopatologia , Transtornos do Sono-Vigília/fisiopatologia , Sono , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/etiologia , Estudos Transversais , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Osteoartrite do Quadril/complicações , Medição da Dor , Estudos Prospectivos , Transtornos do Sono-Vigília/etiologia , Adulto Jovem
4.
Life Sci ; 236: 116860, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31518605

RESUMO

AIMS: Intrathecal injection of morphine presents analgesic and antiedematogenic effects in rats. However, it is unknown whether tramadol, which possess a mixed mechanism of action, can also produce analgesic and antiedematogenic effects similarly. MAIN METHODS: Male Wistar rats received carrageenan and LPS in the right knee joint. Tramadol (10 µg) was injected intrathecally 20 min before articular LPS injection. Incapacitation and articular edema were measured 5 h after LPS stimulation. Synovial fluid was collected for leukocyte counting and western blot analysis. Whole joint and lumbar spinal cord were also collected for histology and immunohistochemistry, respectively. Intrathecal pretreatments groups were with the NKCC1 blocker bumetanide, TRPV1 agonist resiniferatoxin, µ-opioid receptor antagonist CTOP and serotonergic neurotoxin 5,7-DHT, all previously to tramadol. KEY FINDINGS: Tramadol treatment caused the reduction of incapacitation and edema. It also reduced c-Fos protein expression in the spinal cord dorsal horn and slightly reduced TNF-α levels in synovial fluid, but neither reduced cell migration nor tissue damage. Bumetanide and resiniferatoxin prevented the analgesic and antiedematogenic effects of tramadol. CTOP prevented the analgesic and the antiedematogenic effects, but 5,7-DHT prevented only tramadol-induced analgesia. SIGNIFICANCE: Spinal NKCC1 cotransporter and peptidergic peripheral afferents seem to be important for the analgesic and antiedematogenic effects of tramadol, as well as µ-opioid receptor. However, the monoamine uptake inhibition effect of tramadol seems to be important only to the analgesic effect.


Assuntos
Analgésicos Opioides/administração & dosagem , Artralgia/prevenção & controle , Artrite Experimental/complicações , Artrite Reativa/complicações , Edema/prevenção & controle , Lipopolissacarídeos/toxicidade , Tramadol/administração & dosagem , Animais , Artralgia/etiologia , Artralgia/patologia , Artrite Experimental/induzido quimicamente , Artrite Experimental/fisiopatologia , Artrite Reativa/induzido quimicamente , Artrite Reativa/fisiopatologia , Modelos Animais de Doenças , Edema/etiologia , Edema/patologia , Injeções Espinhais , Masculino , Ratos , Ratos Wistar
5.
Wien Klin Wochenschr ; 131(21-22): 558-566, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31535221

RESUMO

BACKGROUND: Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center. METHODS: The online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet. RESULTS: The program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia. CONCLUSION: As hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability.


Assuntos
Artralgia/terapia , Hemofilia A , Aptidão Física , Adulto , Artralgia/etiologia , Criança , Exercício/fisiologia , Terapia por Exercício , Hemofilia A/complicações , Humanos , Qualidade de Vida
6.
Bone Joint J ; 101-B(9): 1138-1143, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31474148

RESUMO

AIMS: The aim of this study was to compare the incidence of anterior knee pain after antegrade tibial nailing using suprapatellar and infrapatellar surgical approaches. PATIENTS AND METHODS: A total of 95 patients with a tibial fracture requiring an intramedullary nail were randomized to treatment using a supra- or infrapatellar approach. Anterior knee pain was assessed at four and six months, and one year postoperatively, using the Aberdeen Weightbearing Test - Knee (AWT-K) score and a visual analogue scale (VAS) score for pain. The AWT-K is an objective patient-reported outcome measure that uses weight transmitted through the knee when kneeling as a surrogate for anterior knee pain. RESULTS: A total of 53 patients were randomized to a suprapatellar approach and 42 to an infrapatellar approach. AWT-K results showed a greater mean proportion of weight transmitted through the injured leg compared with the uninjured leg when kneeling in the suprapatellar group compared with the infrapatellar group at all timepoints at all follow-up visits. This reached significance at four months for all timepoints except 30 seconds. It also reached significance at six months at 0 seconds, and for one year at 60 seconds. CONCLUSION: The suprapatellar surgical approach for antegrade tibial nailing is associated with less anterior knee pain postoperatively compared with the infrapatellar approach Cite this article: Bone Joint J 2019;101-B:1138-1143.


Assuntos
Artralgia/prevenção & controle , Fixação Intramedular de Fraturas/efeitos adversos , Fixação Intramedular de Fraturas/métodos , Dor Pós-Operatória/prevenção & controle , Patela/cirurgia , Fraturas da Tíbia/cirurgia , Adolescente , Adulto , Idoso , Artralgia/etiologia , Pinos Ortopédicos/efeitos adversos , Feminino , Fixação Intramedular de Fraturas/instrumentação , Humanos , Joelho/cirurgia , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Dor Pós-Operatória/etiologia , Medidas de Resultados Relatados pelo Paciente , Tíbia/lesões , Tíbia/cirurgia , Adulto Jovem
7.
Medicine (Baltimore) ; 98(28): e16301, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31305415

RESUMO

BACKGROUND: Knee osteoarthritis (KOA), known as severe degenerative arthritis, commonly occurs in middle-aged and elderly people all over the world. Acupuncture as traditional oriental intervention is getting widely used and several systematic reviews (SRs) have reported the effectiveness of acupuncture on pain relief and functional recovery in patients with KOA. OBJECTIVE: Conducting an overview of SRs to provide more reliable evidence-based medical references for clinical practitioners and researchers of the effectiveness and safety of acupuncture for KOA. DATA SOURCES: EMBASE, Medline, Web of science, the Cochrane library, China National Knowledge Infrastructure, the Chinese Science and Technology Periodical Database, China Biology Medicine, Wan Fang Digital Journals, and PROSPERO databases from inception to December 2018, magazines, websites, and unpublished sources. SELECTION CRITERIA: Potential SRs were independently selected by 2 reviewers following a predetermined protocol. DATA EXTRACTION: Data information of included SRs were independently extracted by 2 reviewers following a predetermined standardized data extraction form. REVIEW APPRAISAL: The risk of bias and reporting quality of included SRs were evaluated by the Risk of Bias in Systematic reviews (ROBIS) tool and the Preferred Reporting Item for Systematic Review and Meta-analysis (PRISMA) statement. The quality of evidence of outcomes was evaluated by the Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: A total of 12 SRs were included. All the SRs were published in recent 12 years, ranging from 2006 to 2017. According to ROBIS, 4 SRs were in low risk in domain 1 and 7 in domain 3 of phase 2, and 2 SRs were low risk in phase 3. Among 27 items of PRISMA, 19 items were reported over 70% of compliance. Using GRADE assessment, of 34 outcomes, high quality of evidence was found in 5 outcomes, 17 outcomes were rated moderate quality, and 11 outcomes were low quality. According to high-quality outcomes, acupuncture had more total effective rate, short-term effective rate, and less adverse reactions than western medicine in treating KOA. In terms of Lequesne index and Lysholm knee score scale score, the effectiveness of electroacupuncture was better than that of western medicine. LIMITATIONS: There might be missing information. There may be duplicated clinical trials included by each SR that might have impact on the synthetic findings. CONCLUSIONS: According to the high-quality evidence, we concluded that acupuncture may have some advantages in treating KOA. However, there are some risk of bias and reporting deficiencies still needed to be improved.


Assuntos
Terapia por Acupuntura , Osteoartrite do Joelho/terapia , Terapia por Acupuntura/efeitos adversos , Artralgia/etiologia , Artralgia/terapia , Humanos , Osteoartrite do Joelho/complicações , Segurança do Paciente , Revisão Sistemática como Assunto
8.
J Shoulder Elbow Surg ; 28(8): 1431-1440, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31327393

RESUMO

BACKGROUND: The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs) 6-9 months after elbow fractures in adults from a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. METHODS: We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. RESULTS: There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. CONCLUSIONS: Developing effective coping strategies to overcome fears related to movement and reinjury and finding ways of persevering with activity despite pain within a month of injury may enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.


Assuntos
Adaptação Psicológica/fisiologia , Artralgia/psicologia , Articulação do Cotovelo/lesões , Fraturas Ósseas/psicologia , Medidas de Resultados Relatados pelo Paciente , Amplitude de Movimento Articular , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Artralgia/diagnóstico , Artralgia/etiologia , Articulação do Cotovelo/fisiopatologia , Feminino , Fraturas Ósseas/complicações , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Medição da Dor , Adulto Jovem
9.
Acta Chir Orthop Traumatol Cech ; 86(3): 216-219, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31333187

RESUMO

PURPOSE OF THE STUDY The purpose of this study is to investigate the acute and long term effectiveness of kinesio taping applied following shoulder arthroscopy in relieving pain and reducing swelling. MATERIAL AND METHODS This study included 50 patients undergone shoulder arthroscopy between June 2016 and December 2017 in our clinic. Patients were randomly assigned into two groups. Group I consisted of patients who had kinesiotherapy; while Group II consisted of control patients whom we applied sham taping with no effect. Pre and postoperative pain and swelling status of patients were recorded and groups were compared. RESULTS Comparing two groups, we found that kinesio taping significantly reduced pain levels in the early post-operative period. However, we didn't detect any significant difference in reduction of shoulder swelling between two groups. CONCLUSIONS Kinesio taping could be an alternative treatment in relieving pain after shoulder arthroscopy. However, we didn't find a significant reduction in swelling in shoulder. Key words:kinesio taping, arthroscopy, shoulder.


Assuntos
Artroscopia/efeitos adversos , Fita Atlética , Edema/terapia , Dor Pós-Operatória/terapia , Articulação do Ombro/cirurgia , Dor de Ombro/terapia , Artralgia/etiologia , Artralgia/terapia , Artroscopia/métodos , Edema/etiologia , Humanos , Dor Pós-Operatória/etiologia , Dor de Ombro/etiologia
10.
Medicine (Baltimore) ; 98(26): e16060, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261513

RESUMO

The purpose of this study was to investigate the association between objectively-measured lifestyle factors and health factors in patients with knee osteoarthritis (OA).In this cross-sectional study, 52 patients with knee OA were examined. Lifestyle factors were measured using a wearable smartwatch (step counts, walking distance, calorie consumption, sleep hours) and by self-report (eating speed). Body mass index (BMI), waist circumference, blood pressure, muscle strength of knee extensor and hip abductor, knee pain, symptoms, daily living function, sports recreation function, quality of life by knee injury and OA outcome score (KOOS) were measured to obtain data on health factors. Correlations and regression analysis were used to analyze the relationship between lifestyle factors and health factors.KOOS subscales (pain, symptom, daily living function) and hip abductor strength were positively correlated with daily step count, which was the only independently contributing lifestyle factor. Additionally, knee pain duration and diastolic blood pressure were negatively correlated with daily step count. BMI and waist circumference showed no correlation with physical activity data, but were negatively correlated with sleep duration and eating speed.The findings of this study contribute to expanding the knowledge on how lifestyle habits of older patients with knee OA contribute to their health status. Daily step counts were associated with knee OA-related pain, symptom, function in daily living, duration of knee pain, blood pressure, and strength of hip abductor. BMI and waist circumference were associated with sleep duration and eating speed.


Assuntos
Nível de Saúde , Estilo de Vida , Osteoartrite do Joelho/epidemiologia , Acelerometria , Idoso , Artralgia/epidemiologia , Artralgia/etiologia , Artralgia/fisiopatologia , Pressão Sanguínea , Índice de Massa Corporal , Estudos de Casos e Controles , Estudos Transversais , Exercício , Comportamento Alimentar , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Força Muscular , Osteoartrite do Joelho/complicações , Osteoartrite do Joelho/fisiopatologia , Sono , Circunferência da Cintura
11.
J Athl Train ; 54(6): 662-670, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31184959

RESUMO

OBJECTIVE: To identify the prevalence of pain in people with chronic ankle instability (CAI) and how pain is related to the impairments of CAI. DATA SOURCES: We searched the databases of AMED, CINAHL, EMBASE, MEDLINE, PubMed, Scopus, SPORTDiscus, and Web of Science from inception to March 2017. STUDY SELECTION: Eligible studies were peer-reviewed research in which investigators reported the presence of ankle pain or assessed the effects of pain on impairments in participants with CAI. Age and language were not restricted. Studies that included only surgical interventions were excluded. DATA EXTRACTION: Studies identified by the search strategy were screened according to the eligibility criteria, and 2 independent reviewers extracted the data. Outcome measurements were (1) pain ratings using measures such as a visual analog scale and (2) other residual impairments, such as feelings of weakness, giving way, or deficits in functional performance. DATA SYNTHESIS: Of the 5907 records identified through the database search, 14 studies were included in this review. All authors assessed ankle pain by self-report questionnaires or physical examination, or both. Pain was self-reported by 23% to 79% of participants and present on physical examination in 25% to 75% of participants, depending on the test applied. Among these studies, the highest reported pain level was 4.9 on the 11-point visual analog scale. Studies were heterogeneous for pain measures, participant groups, interventions, and follow-up periods. The relationship between pain and the structural and functional impairments associated with CAI was not investigated in the included studies. CONCLUSIONS: Pain was present in a large proportion of people who had CAI, but pain levels were low. Information about the effects of pain was not reported, so researchers should examine the association between pain and function, balance, or other activities in people with CAI.


Assuntos
Traumatismos do Tornozelo/complicações , Artralgia/epidemiologia , Instabilidade Articular/complicações , Autorrelato , Traumatismos do Tornozelo/fisiopatologia , Artralgia/etiologia , Doença Crônica , Saúde Global , Humanos , Instabilidade Articular/epidemiologia , Prevalência
12.
Int J Surg ; 67: 37-46, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31128316

RESUMO

OBJECTIVE: To compare the clinical efficacy of platelet-rich plasma (PRP) injections with that of corticosteroids in patients with lateral epicondylitis (LE). METHODS: We searched for relevant studies on the comparison of PRP and corticosteroids in the management of lateral epicondylitis in electronic databases, including PubMed, Embase, Ovid, Cochrane Library, Web of Science, Wan Fang and China National Knowledge Internet, up to March 2019. The outcomes were pain score, elbow joint function and adverse effects after local injection. For continuous data, the weighted mean difference (WMD) and 95% confidence intervals (CIs) was used. Risk difference (RD) with a 95% CI were calculated for dichotomous outcomes. Cochrane Collaboration's tool was used to assess the risk of bias. The data were collected and input into the STATA software. RESULTS: A total of seven randomized controlled trials (RCTs) involving 515 patients were finally included in our study. The present meta-analysis indicated that PRP injection yielded statistically significant superior in pain scores and elbow joint function at a 6-month follow up compared with local corticosteroid injection. No significant difference was identified between two groups regarding the post-injection adverse events. CONCLUSION: Local PRP injections was associated with superior outcomes for reducing pain and improving elbow joint function compared with local corticosteroids treatment for LE at a follow-up of 6 months.


Assuntos
Corticosteroides/uso terapêutico , Transfusão de Plaquetas/métodos , Plasma Rico em Plaquetas , Cotovelo de Tenista/terapia , Artralgia/etiologia , Artralgia/fisiopatologia , Artralgia/terapia , Articulação do Cotovelo/fisiopatologia , Humanos , Injeções , Medição da Dor , Ensaios Clínicos Controlados Aleatórios como Assunto , Recuperação de Função Fisiológica , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento
13.
Medicine (Baltimore) ; 98(22): e15937, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145366

RESUMO

BACKGROUND: The aim of this study was to compare the short-term and intermediate-term efficacy of acupuncture plus fire needle therapy with that of acupuncture alone in the treatment of lateral epicondylitis (LE). METHODS: Thirty-eight patients with LE who had persisted for at least 2 months were enrolled in this prospective, assessor-blinded, randomized controlled pilot trial. Twenty-one patients were randomized to the acupuncture plus fire needle group and 17 to the acupuncture-only group. The primary outcome was the visual analog scale pain score for the previous 24 hours and the secondary outcomes were the maximum grip strength, Patient-rated Forearm Evaluation Questionnaire score, and Medical Outcomes Study 36-Item Short-form Health Survey score. The values at baseline (pretreatment), at the end of treatment, and at 3 months after treatment were used to assess the short-term and intermediate-term effects of treatment. The data were analyzed using the Chi-square test and t test. RESULTS: Within-group analyses showed better results for acupuncture plus fire needle therapy in the short term and intermediate term. Differences in the severity of pain and secondary outcomes were significant in the intermediate term in the acupuncture group. At the end of treatment, none of the differences in outcome scores were significant, except for maximum grip strength in the affected hand in the acupuncture group. No significant between-group differences in short-term or intermediate-term outcomes were observed. CONCLUSION: Acupuncture plus fire needle therapy was effective in the short term in patients seeking improvement of LE. Twelve treatments were effective for relieving pain and improving disability in the intermediate term in patients with chronic LE in both study groups. The findings of the pilot study confirm the feasibility of proceeding to a larger randomized controlled study of the longer-term effects of acupuncture plus fire needle therapy in patients with LE.


Assuntos
Terapia por Acupuntura/métodos , Artralgia/terapia , Agulhas , Manejo da Dor/métodos , Cotovelo de Tenista/terapia , Terapia por Acupuntura/instrumentação , Adulto , Artralgia/etiologia , Artralgia/fisiopatologia , Estudos de Casos e Controles , Avaliação da Deficiência , Articulação do Cotovelo/fisiopatologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/instrumentação , Medição da Dor , Projetos Piloto , Estudos Prospectivos , Método Simples-Cego , Cotovelo de Tenista/complicações , Cotovelo de Tenista/fisiopatologia , Resultado do Tratamento , Adulto Jovem
14.
BMC Musculoskelet Disord ; 20(1): 180, 2019 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-31039774

RESUMO

BACKGROUND: Osteoarthritis (OA) in the thumb carpometacarpal joint (CMCJ) is a prevalent disease which may lead to structural damage, severe pain and functional limitations. Evidence-based treatment recommendations state that all patients with hand OA should be offered non-pharmacological treatment. Surgery should be considered only when other treatment has proven insufficient in relieving pain. The purpose of this study was to investigate prior treatment and characteristics of patients referred to specialist health care surgical consultation due to CMCJ OA. The study includes exploring differences in pain and function between referred and non-referred hand, between men and women, and between patients with and without OA affection of other finger joints than CMCJ. METHODS: Patients in this cross-sectional study reported prior non-pharmacological treatment for CMCJ OA. Patient demographics, disease and functional variables were assessed based on hand radiographs, patient-reported and observer-based outcome measures. Differences in pain and function between referred and non-referred hand, men and women, and between patients with and without additional affection of finger joints other than CMCJ, were analysed using Paired-samples T-tests, Wilcoxon Signed Rank, or Chi-Square tests. RESULTS: One hundred and eighty patients were included. The mean age was 63 years and 79% were women. Only 21% reported having received non-pharmacological treatment before referral to surgical consultation. The results show a statistically significant worse function for referred hands, women and involvement of additional interphalangeal joints. Most patients reported no pain or mild pain in their referred hand. CONCLUSIONS: The results of this study show a non-pharmacological treatment gap in OA care. Most patients report no pain or mild pain, and that they had not received non-pharmacological treatment prior to being referred to CMCJ OA surgical consultation. The results furthermore show that CMCJ OA negatively affects all aspects of function. Strategies need to be developed to improve OA care, including educating general practitioners in evidence-based treatment recommendations and in the assessment of hand pain, and encourage the routine referral of patients with symptomatic hand OA to occupational therapy before considering surgery.


Assuntos
Artralgia/diagnóstico , Terapia Ocupacional/estatística & dados numéricos , Procedimentos Ortopédicos , Osteoartrite/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Idoso , Artralgia/etiologia , Articulações Carpometacarpais/fisiopatologia , Articulações Carpometacarpais/cirurgia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Terapia Ocupacional/normas , Osteoartrite/complicações , Osteoartrite/diagnóstico , Guias de Prática Clínica como Assunto , Amplitude de Movimento Articular , Fatores Sexuais , Polegar/fisiopatologia , Polegar/cirurgia
15.
BMC Musculoskelet Disord ; 20(1): 196, 2019 May 07.
Artigo em Inglês | MEDLINE | ID: mdl-31064359

RESUMO

BACKGROUND: High molecular weight (HMW) hyaluronic acid (HA) is a treatment option for knee osteoarthritis (OA). The efficacy of HMW-HA in knee OA is investigated extensively, but the effectiveness in patients in the working age is unknown. Nevertheless, the number knee OA patients in the working age is increasing. Surgical treatment options are less eligible in these patients and productivity losses are high. In this study the effectiveness of intra-articular HMW-HA added to regular non-surgical usual care in everyday clinical practice (UC) compared to UC over 52 weeks in symptomatic knee OA patients in the working age was investigated. METHODS: In this open labelled randomized controlled trial, subjects aged between 18 and 65 years with symptomatic knee OA (Kellgren and Lawrence I-III) were enrolled and randomized to UC + 3 weekly injections with HMW-HA (intervention) or UC only (control). The primary outcome was the between group difference in responders to therapy according to OMERACT-OARSI criteria after 52 weeks. These criteria include the domains pain, knee related function and patient's global assessment (PGA). Function was evaluated with the KOOS questionnaire. Pain was assessed with the Numeric Rating Scale. Secondary outcome comprised the between group difference on the individual responder domains, as analysed with a random effects model. Odds Ratios (OR) were calculated by logistic regression analysis. Sensitivity analyses were performed. RESULTS: In total, 156 subjects were included (intervention group 77, control group 79). Subjects in the intervention group (HMW-HA + UC) were more often responder compared to the controls (UC). Depending on whether pain during rest or pain during activity was included in the responder domains, 57.1% versus 34.2% (p = 0.006) and 54.5% versus 34.2% (p = 0.015) was responder to therapy respectively. The results of the secondary outcome analyses show that scores on individual responder domains over all follow-up moments were statistically significant in favour of the intervention group in the domains pain during rest (δ 0.8, 95%CI 0.2; 1.4, p = 0.010), knee related function (δ - 6.8, 95%CI -11.9; - 1.7, p = 0.010) and PGA (δ - 0.7, 95%CI -0.9; - 0.4, p < 0.0001). CONCLUSIONS: Intra-articular HMW-HA added to usual care is effective for knee OA in patients in the working age. TRIAL REGISTRATION: www.trialregister.nl , NTR1651, registered 2009-3-3.


Assuntos
Artralgia/terapia , Ácido Hialurônico/administração & dosagem , Osteoartrite do Joelho/terapia , Viscossuplementos/administração & dosagem , Adulto , Artralgia/diagnóstico , Artralgia/etiologia , Feminino , Seguimentos , Humanos , Ácido Hialurônico/química , Injeções Intra-Articulares , Articulação do Joelho/efeitos dos fármacos , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , Peso Molecular , Países Baixos , Osteoartrite do Joelho/complicações , Medição da Dor , Qualidade de Vida , Resultado do Tratamento , Viscossuplementos/química , Adulto Jovem
16.
Orthop Clin North Am ; 50(3): 269-279, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31084828

RESUMO

Arthrofibrosis is the pathologic stiffening of a joint caused by an exaggerated inflammatory response. As a common complication following total knee arthroplasty (TKA), this benign-appearing connective tissue hyperplasia can cause significant disability among patients because the concomitant knee pain and restricted range of motion severely hinder postoperative rehabilitation, clinical outcomes, and basic activities of daily living. The most effective management for arthrofibrosis in the setting of TKA is prevention, including preoperative patient education programs, aggressive postoperative physical therapy regimens, and anti-inflammatory medications. Operative treatments include manipulation under anesthesia, arthroscopic debridement, and quadricepsplasty.


Assuntos
Artroplastia do Joelho/efeitos adversos , Artropatias/patologia , Artropatias/terapia , Articulação do Joelho/patologia , Atividades Cotidianas , Anti-Inflamatórios não Esteroides/uso terapêutico , Artralgia/etiologia , Artroscopia , Desbridamento , Fibrose , Humanos , Artropatias/diagnóstico , Artropatias/fisiopatologia , Articulação do Joelho/fisiopatologia , Articulação do Joelho/cirurgia , Manipulação Ortopédica , Modalidades de Fisioterapia , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/patologia , Complicações Pós-Operatórias/fisiopatologia , Complicações Pós-Operatórias/terapia , Amplitude de Movimento Articular , Reoperação , Fatores de Risco
17.
Medicine (Baltimore) ; 98(18): e15497, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31045835

RESUMO

Synovial plica is rarely diagnosed as cause of elbow pain. Impingemnt of posterolateral plicae in the radiocapitellar joint tends to be usually overlooked. The purpose of this study was to present outcomes of arthroscopic treatment in relatively large number of cases and propose reliable diagnostic test for posterolateral plicae of the radiocapitellar joint.From January 2000 to December 2010, 24 cases diagnosed with pathologic posterolateral radiocapitellar plica on arthroscopic finding were retrospectively reviewed. Magnetic resonance imaging (MRI) evaluation and preoperative physical examination were performed. The posterolateral radiocapitellar plica test newly proposed by the present study was also conducted. To measure postoperative clinical outcomes, the disabilities of the arm, shoulder, and hand (DASH) score and Mayo elbow performance score (MEPS) were employed. Minimum duration of follow up was 24 months.According to the preoperative MRI, pathologic radiocapitellar plica was identified in 17 cases (70.8%). Preoperatively, maximal tender point was present on the radiocapitellar joint line in 20 cases (83.3%) and mechanical symptoms were observed in 9 cases (37.5%). 6 cases (25%) demonstrated pain at terminal extension and limitation of extension. 20 (83.3%) cases tested positive for posterolateral radiocapitellar plica test. The sensitivity and specificity of the posterolateral radiocapitellar plica test were 83.3% and 87.5%, respectively. The accuracy value was 86.3%. Arthroscopic debridement of pathologic plica in the radiocapitellar joint demonstrated clinical improvements: DASH score was from 36.6 to 8.9 and MEPS was from 56.9 to 95.6 at the latest follow-up.Symptomatic impingement by the pathologic posterolateral plica of the radiocapitellar joint should be considered when posterolateral elbow pain which is refractory to conservative treatment, and other prevalent diseases are excluded. The posterolateral radiocapitellar plica test and radiocapitellar joint line tenderness could be recommended as reliable examination maneuvers to obtain accurate diagnosis. Arthroscopic debridement was an effective method for treating symptomatic plicae.


Assuntos
Artroscopia/métodos , Desbridamento/métodos , Artropatias/diagnóstico , Artropatias/cirurgia , Adolescente , Adulto , Artralgia/etiologia , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/patologia , Articulação do Cotovelo/cirurgia , Feminino , Humanos , Artropatias/complicações , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Membrana Sinovial/diagnóstico por imagem , Membrana Sinovial/patologia , Adulto Jovem
20.
Acta Orthop ; 90(2): 179-186, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30973090

RESUMO

Background and purpose - Up to 20% of patients are dissatisfied after total knee arthroplasty (TKA), mainly because of pain and restricted physical function. We developed a prediction model for 6-month knee range of motion, knee pain, and walking limitations in patients undergoing TKA surgery. Patients and methods - We performed a prospective cohort study of 4,026 patients who underwent elective, primary TKA between July 2013 and July 2017. Candidate predictors included demographic, clinical, psychosocial, and preoperative outcome measures. The outcomes of interest were (i) knee extension and flexion range of motion, (ii) knee pain rated on a 5-point ordinal scale, and (iii) self-reported maximum walk time at 6 months post TKA. For each outcome, we fitted a multivariable proportional odds regression model with bootstrap internal validation. Results - At 6 months post TKA, around 5% to 20% of patients had a flexion contracture ³ 10°, range of motion < 90°, moderate to severe knee pain, or a maximum walk time £â€¯15 minutes. The model c-indices (the probabilities to correctly discriminate between 2 patients with different levels of follow-up TKA outcomes) when evaluating these patients were 0.71, 0.79, 0.65, and 0.76, respectively. Each postoperative outcome was strongly influenced by the same outcome measure obtained preoperatively (all p-values < 0.001). Additional statistically significant predictors were age, sex, race, education level, diabetes mellitus, preoperative use of gait aids, contralateral knee pain, and psychological distress (all p-values < 0.001). Interpretation - We have developed models to predict, for individual patients, their likely post-TKA levels of knee extension and flexion range of motion, knee pain, and walking limitations. After external validation, they can potentially be used preoperatively to identify at-risk patients and to help patients set more realistic expectations about surgical outcomes.


Assuntos
Artralgia , Artroplastia do Joelho , Articulação do Joelho/fisiopatologia , Limitação da Mobilidade , Osteoartrite do Joelho , Complicações Pós-Operatórias , Amplitude de Movimento Articular , Idoso , Artralgia/diagnóstico , Artralgia/etiologia , Artroplastia do Joelho/efeitos adversos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Humanos , Articulação do Joelho/cirurgia , Masculino , Pessoa de Meia-Idade , Osteoartrite do Joelho/epidemiologia , Osteoartrite do Joelho/cirurgia , Avaliação de Resultados (Cuidados de Saúde) , Período Perioperatório/métodos , Período Perioperatório/estatística & dados numéricos , Complicações Pós-Operatórias/diagnóstico , Complicações Pós-Operatórias/epidemiologia , Complicações Pós-Operatórias/fisiopatologia , Prognóstico , Medição de Risco/métodos , Taiwan/epidemiologia
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