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1.
Medicine (Baltimore) ; 98(50): e18277, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31852100

RESUMO

The aim of the study was to evaluate the clinical effect of the limited area decompression, intervertebral fusion, and pedicle screw fixation for treating degenerative lumbar spinal stenosis (DLSS) with instability. Hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation for treating DLSS with instability as the control group.Follow-up of 54 patients (26 males and 28 females; average age, 59.74 ±â€Š10.38 years) with DLSS with instability treated by limited area decompression, intervertebral fusion, and pedicle screw fixation (LIFP group), and 52 patients as control group with hemilaminectomy decompression, intervertebral fusion, and pedicle screw fixation (HIFP group). We assessed clinical effect according to the patients' functional outcome grading (good to excellent, fair, or poor), Oswestry Disability Index (ODI) and visual analogue scale (VAS) for low back pain and lower limb pain, which was administered preoperatively and at 3, 6, and 12 months postoperatively. Fusion status was assessed by radiologists at the last follow-up. Treatment satisfaction was assessed according to the subjective evaluations of the patients.At the 12-month follow-up, 96.2% (52/54) and 90.3% (47/52) of group LIFP and HIFP belonged to good to excellent outcome categories, respectively, while 3.7% (2/54) and 9.6% (5/52) of group LIFP and HIFP belonged to fair respectively, neither group belonged to poor. Satisfaction rates of patients in group LIFP and group HIFP were 98.1% (53/54) and 92.3% (48/52), respectively. The patients' functional outcome grading and satisfaction rate in group LIFP were better than that in group HIFP. The VAS for low back and lower limb pain and the ODI improved significantly during the 12 months after surgery (all P < .001) in 2 groups. The VAS for low back and lower limb pain were no difference between two groups, however, the ODI of group LIFP was lower than that of group HIFP (P < .001). All patients achieved radiological fusion.The limited area decompression, intervertebral fusion, and pedicle screw fixation had a satisfactory effect on patients with DLSS with instability.


Assuntos
Descompressão Cirúrgica/métodos , Instabilidade Articular/cirurgia , Laminectomia/métodos , Vértebras Lombares , Parafusos Pediculares , Fusão Vertebral/métodos , Estenose Espinal/cirurgia , Feminino , Fluoroscopia , Seguimentos , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Estenose Espinal/complicações , Estenose Espinal/diagnóstico , Cirurgia Assistida por Computador/métodos , Fatores de Tempo , Resultado do Tratamento
2.
J Electromyogr Kinesiol ; 48: 197-204, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31442925

RESUMO

PURPOSE: People with Joint Hypermobility Syndrome (JHS) suffer with fatigue. The purpose of this project was to investigate the contribution of central and peripheral fatigue. METHODS: Electrical stimulation of the musculocutaneous nerve to biceps brachii, and transcranial magnetic stimulation over the motor cortex supplying biceps brachii were used. Peripheral and central fatigue were assessed during a control, fatiguing and recovery phase protocol. RESULTS: JHS participants perceived greater fatigue during the protocol compared to a control group and did not recover. Central and peripheral fatigue did not occur in the control group. However, the JHS group showed central fatigue. MEP amplitude increased in the JHS group during the fatiguing protocol (p < 0.01) before recovering. Superimposed twitch amplitude increased in the JHS group during the fatiguing protocol and stayed elevated during the recovery phase (p < 0.04). Time to peak (TTP) amplitude of the torque generated by the TMS was longer in the JHS group (p < 0.05). RMS during MVCs decreased during the fatiguing protocol reaching significance during the recovery phase (p < 0.01). CONCLUSION: JHS participants suffered central but not peripheral fatigue. A modified strength programme to target this is discussed.


Assuntos
Fadiga/etiologia , Instabilidade Articular/fisiopatologia , Córtex Motor/fisiopatologia , Fadiga Muscular , Nervos Periféricos/fisiopatologia , Adulto , Fadiga/fisiopatologia , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Músculo Esquelético/inervação , Músculo Esquelético/fisiopatologia , Torque
3.
World Neurosurg ; 131: 230-233, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31425782

RESUMO

BACKGROUND: Patients with Down syndrome (DS) have an increased incidence of multisystem disorders, like cardiovascular, neurologic, gastrointestinal, respiratory, and musculoskeletal disorders. Craniovertebral junction instability is a common illness in DS patients, and they may often be affected by vertebral artery (VA) anomalies. CASE DESCRIPTION: In this paper we present neuroradiologic findings of a 34-year-old female patient affected by DS with atlantoaxial subluxation, scheduled for transoral decompression of C1-C2 and posterior occipitocervical fixation. The preoperative angio-computed tomography scan showed a peculiar anatomic variation in the entrance of the VA at the level of the C2 transverse foramen (TF). Normally, the segment of VA, named V2, becomes intraforaminal on average at the TF of C6. CONCLUSIONS: We reviewed the literature about the incidence of anatomic variations of the V2 segment in both the general population and the one affected by DS, and although numerous cases of anomalous course, none reported a C2 TF entry point. Ignoring such extremely rare anatomic variation during anterior, posterior, or lateral surgical approach to the cervical spine can lead to inadvertent injury and potentially serious complications like arterial dissection, thrombus, vascular spasm, fistula, pseudoaneurysm, cerebral ischemia, and death.


Assuntos
Articulação Atlantoaxial/cirurgia , Síndrome de Down/complicações , Luxações Articulares/cirurgia , Artéria Vertebral/anormalidades , Adulto , Angiografia por Tomografia Computadorizada , Descompressão Cirúrgica/métodos , Feminino , Humanos , Luxações Articulares/complicações , Luxações Articulares/diagnóstico , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Instabilidade Articular/cirurgia , Imagem por Ressonância Magnética , Fusão Vertebral/métodos , Tomografia Computadorizada por Raios X
4.
Medicine (Baltimore) ; 98(26): e16217, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31261576

RESUMO

BACKGROUND: Athletes with chronic ankle instability (CAI) often develop complications such as pain, instability, and reduced postural control and balance stability, all of which affect athletic performance. This study investigated the effects of a 4° medal wedge intervention on static and dynamic balance in athletes with CAI. METHODS: The participants were 24 healthy and 25 CAI athletes. Participants received a 4° medial wedge applied at the rear foot insole and completed the experiment measurements before and after the wedge intervention. The main outcome measures included the area and path length of the center of pressure when participants performed single-leg standing balance in the closed eye condition and the dynamic balance scores of a multiple single-leg hop stabilization test. RESULTS: The single-leg standing balance significantly improved in CAI (P = .027) and control groups (P = .005) after the medial wedge intervention. The dynamic balance scores significantly decreased from 53.00 ±â€Š25.22 to 41.24 ±â€Š21 48 (P = .015) in CAI group after medial wedge intervention. CONCLUSION: Wearing a 4° medial wedge applied at the rear foot insole improved static and dynamic balance immediately in athletes with CAI. We suggest that clinicians may provide the foot insole to improve balance deficit in athletes having CAI.


Assuntos
Articulação do Tornozelo , Traumatismos em Atletas/terapia , Órtoses do Pé , Instabilidade Articular/terapia , Transtornos das Sensações/terapia , Traumatismos em Atletas/complicações , Doença Crônica , Desenho de Equipamento , Feminino , Calcanhar , Humanos , Instabilidade Articular/complicações , Masculino , Transtornos das Sensações/etiologia , Resultado do Tratamento , Adulto Jovem
5.
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
6.
Phys Ther ; 99(9): 1189-1200, 2019 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-31158283

RESUMO

Hypermobility spectrum disorder (HSD) and hypermobile Ehlers-Danlos syndrome (hEDS) can cause widespread or chronic pain, fatigue, and proprioceptive and coordination deficits resulting in functional restrictions. These conditions are common and often unrecognized, and patients are likely to present in physical therapy for musculoskeletal injuries, pain, or coordination deficits. Although physical therapy is considered central to managing these conditions, many patients report pain and iatrogenic injuries due to inappropriate interventions. The diagnostic classification for these conditions was revised in 2017 to supersede previous diagnostic categories of Joint Hypermobility Syndrome and Ehlers-Danlos Syndrome-hypermobility type/type III. It is now known that these conditions affect multiple body systems and not just joints and that patients require a holistic approach. This Perspective article will describe the 2017 diagnostic classification system, clinical presentation, examination, evaluation, and management of patients with HSD/hEDS. Both adult and pediatric cases are presented to illustrate the patient management concepts discussed. This knowledge can lead to more effective management of this patient population.


Assuntos
Síndrome de Ehlers-Danlos , Instabilidade Articular , Síndrome de Ehlers-Danlos/complicações , Síndrome de Ehlers-Danlos/diagnóstico , Síndrome de Ehlers-Danlos/terapia , Fadiga/etiologia , Fadiga/terapia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/diagnóstico , Instabilidade Articular/terapia , Mastocitose/complicações , Modalidades de Fisioterapia , Síndrome da Taquicardia Postural Ortostática/complicações , Prognóstico , Avaliação de Sintomas
7.
Innovations (Phila) ; 14(4): 357-360, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31050321

RESUMO

Patients with complex aortic arch aneurysms and severe arterial tortuosity represent a unique challenge because of extreme angulations, mixed aneurysm and stenotic disease, and fragile tissues. Novel hybrid arch frozen elephant trunk techniques can expand surgical repair options to include single-stage, complete aortic reconstruction via sternotomy alone, without the need for simultaneous thoracotomy or clamshell incisions. We describe successful hybrid aortic arch reconstruction with Thoraflex Hybrid graft in a patient with complex arch aneurysm and severe arterial tortuosity.


Assuntos
Aneurisma da Aorta Torácica/cirurgia , Coartação Aórtica/cirurgia , Estenose da Valva Aórtica/cirurgia , Valva Aórtica/anormalidades , Valva Aórtica/patologia , Artérias/anormalidades , Implante de Prótese Vascular/métodos , Calcinose/cirurgia , Doenças das Valvas Cardíacas/cirurgia , Implante de Prótese de Valva Cardíaca/métodos , Instabilidade Articular/complicações , Dermatopatias Genéticas/complicações , Malformações Vasculares/complicações , Idoso , Aorta Torácica/diagnóstico por imagem , Aorta Torácica/cirurgia , Aneurisma da Aorta Torácica/complicações , Aneurisma da Aorta Torácica/diagnóstico por imagem , Coartação Aórtica/complicações , Coartação Aórtica/diagnóstico por imagem , Valva Aórtica/diagnóstico por imagem , Valva Aórtica/cirurgia , Estenose da Valva Aórtica/complicações , Estenose da Valva Aórtica/diagnóstico por imagem , Artérias/diagnóstico por imagem , Calcinose/complicações , Calcinose/diagnóstico por imagem , Feminino , Doenças das Valvas Cardíacas/complicações , Doenças das Valvas Cardíacas/diagnóstico por imagem , Humanos , Imagem Tridimensional , Instabilidade Articular/diagnóstico por imagem , Dermatopatias Genéticas/diagnóstico por imagem , Tomografia Computadorizada por Raios X , Malformações Vasculares/diagnóstico por imagem
8.
BMC Musculoskelet Disord ; 20(1): 165, 2019 Apr 11.
Artigo em Inglês | MEDLINE | ID: mdl-30975124

RESUMO

BACKGROUND: This cross-sectional study evaluated associations of joint hypermobility and multiple joint osteoarthritis (MJOA) in a community-based cohort of adults 45+ years of age. METHODS: MJOA and joint hypermobility data were from 1677 participants (mean age 69 years, 68% women) who completed research clinic visits during 2003-2010. Prevalent MJOA was defined in four ways. Radiographic OA (rOA) was defined as Kellgren-Lawrence (KL) > 2 at any included study joint; symptomatic OA (sxOA) required both symptoms and rOA in a joint. Joint hypermobility was defined as a Beighton score of > 4. Separate logistic regression models were used to estimate odds ratios (OR) between joint hypermobility and each MJOA definition, adjusting for age, sex, race, body mass index, and baseline visit. RESULTS: In this cohort, 4% had Beighton score > 4 and 63% met any definition of MJOA. Joint hypermobility was associated with significantly lower odds of radiographic and symptomatic MJOA-1 (multiple joint OA-definition 1: involvement of > 1 IP (interphalangeal) nodes and > 2 sites of hip, knee, and spine; 74 and 58% lower, respectively). However, for the other MJOA definitions (i.e., MJOA-2:involvement of > 2 IP joints, > 1 carpometacarpal [CMC] joints, and knee or hip sites; MJOA-3: involvement of > 5 joint sites from among distal interphalangeal, proximal interphalangeal, CMC, hip, knee, or spine sites; and MJOA-4:involvement of > 2 lower body sites (hip, knee, or spine), there were no statistically significant associations. For associations between site-specific hypermobility and any MJOA definition, most adjusted ORs were less than one, but few were statistically significant. CONCLUSIONS: Overall, joint hypermobility was not positively associated with any definition of prevalent MJOA in this cohort, and an inverse association existed with one definition of MJOA. Longitudinal studies are needed to determine the contribution of hypermobility to the incidence and progression of MJOA outcomes.


Assuntos
Instabilidade Articular/epidemiologia , Osteoartrite/epidemiologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Articulação do Quadril/diagnóstico por imagem , Articulação do Quadril/fisiopatologia , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/fisiopatologia , Articulação do Joelho/diagnóstico por imagem , Articulação do Joelho/fisiopatologia , Masculino , Pessoa de Meia-Idade , North Carolina/epidemiologia , Razão de Chances , Osteoartrite/diagnóstico por imagem , Osteoartrite/etiologia , Osteoartrite/fisiopatologia , Prevalência , Coluna Vertebral/diagnóstico por imagem , Coluna Vertebral/fisiopatologia
9.
Knee Surg Sports Traumatol Arthrosc ; 27(11): 3699-3704, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-30955073

RESUMO

PURPOSE: The aim of this study was to evaluate the effects of knee biomechanics with an irreparable lateral meniscus defect using the centralization capsular meniscus support procedure in the setting of the ACL-reconstructed knee in a porcine model. The hypothesis is the arthroscopic centralization will decrease the laxity and rotation of the ACL-reconstructed knee. METHODS: Twelve fresh-frozen porcine knees were tested using a robotic testing system under the following loading conditions: (a) an 89.0 N anterior tibial load; (b) 4.0 N m internal and external rotational torques. Anatomic single-bundle ACL reconstruction with a 7 mm-diameter bovine extensor tendon graft was performed. A massive, middle segment, lateral meniscus defect was created via arthroscopy, and arthroscopic centralization was performed with a 1.4 mm anchor with a #2 suture. The LM states with ACL reconstruction evaluated were: intact, massive middle segment defect and with the lateral meniscus centralization procedure. RESULTS: The rotation of the ACL reconstructed knee with the lateral meniscus defect was significantly higher than with the centralized lateral meniscus under an external rotational torque at 30° of knee flexion, and under an internal rotational torque at 30° and 45° of knee flexion. There were no systematic and consistent effects of LM centralization under anterior tibial translation. CONCLUSIONS: In this porcine model, the capsular support of middle segment of the lateral meniscus using arthroscopic centralization improved the residual rotational laxity of the ACL-reconstructed knee accompanied with lateral meniscus dysfunction due to massive meniscus defect. This study quantifies the benefit to knee kinematics of arthroscopic centralization by restoring the lateral meniscal function.


Assuntos
Lesões do Ligamento Cruzado Anterior/complicações , Lesões do Ligamento Cruzado Anterior/cirurgia , Reconstrução do Ligamento Cruzado Anterior/métodos , Artroscopia , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Meniscos Tibiais/cirurgia , Animais , Reconstrução do Ligamento Cruzado Anterior/efeitos adversos , Fenômenos Biomecânicos , Bovinos , Humanos , Modelos Animais , Complicações Pós-Operatórias/cirurgia , Amplitude de Movimento Articular , Rotação , Suínos , Tendões/transplante , Tíbia/fisiologia , Torque
10.
Bull Hosp Jt Dis (2013) ; 77(1): 33-38, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30865862

RESUMO

The Essex-Lopresti injury is caused by a high energy mechanism and consists of a characteristic triad: a comminuted radial head fracture, disruption of the distal radioulnar joint, and tearing of the interosseous membrane. These injuries are often difficult to diagnosis on initial evaluation, and the majority are missed acutely. Chronic Essex-Lopresti injuries lead to radioulnar longitudinal instability, proximal radius migration, ulnocarpal impaction, and chronic elbow pain. These injuries present a challenging problem for the treating surgeon.


Assuntos
Articulação do Cotovelo/lesões , Fraturas Cominutivas/complicações , Instabilidade Articular/complicações , Fraturas do Rádio/complicações , Traumatismos do Punho/complicações , Articulação do Punho , Fenômenos Biomecânicos , Articulação do Cotovelo/diagnóstico por imagem , Articulação do Cotovelo/fisiopatologia , Articulação do Cotovelo/cirurgia , Fraturas Cominutivas/diagnóstico por imagem , Fraturas Cominutivas/fisiopatologia , Fraturas Cominutivas/terapia , Humanos , Instabilidade Articular/diagnóstico por imagem , Instabilidade Articular/fisiopatologia , Instabilidade Articular/cirurgia , Procedimentos Ortopédicos , Valor Preditivo dos Testes , Fraturas do Rádio/diagnóstico por imagem , Fraturas do Rádio/fisiopatologia , Fraturas do Rádio/terapia , Amplitude de Movimento Articular , Recuperação de Função Fisiológica , Resultado do Tratamento , Traumatismos do Punho/diagnóstico por imagem , Traumatismos do Punho/fisiopatologia , Traumatismos do Punho/cirurgia , Articulação do Punho/diagnóstico por imagem , Articulação do Punho/fisiopatologia , Articulação do Punho/cirurgia
11.
Rev Psiquiatr Salud Ment ; 12(2): 68-76, 2019.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-30926372

RESUMO

BACKGROUND: Joint hypermobility syndrome (JHS) has been found to be associated with anxiety disorders in clinical and nonclinical populations, but to date no studies have evaluated this association in children. The main goal of this study is to evaluate JHS along with anxiety, somatic and behavioral measures in children to clarify if JHS is associated with any of these variables in this age range. METHODS: A sample of 160 children (74 girls and 86 boys) ranging from 5 to 17 o were recruited from a Child-Adolescent Mental Health clinic to participate in the study. All children underwent a diagnostic interview using the Mini International Neuropsychiatric Interview for Children and Adolescents. Instruments used include the Child Behavior Checklist (CBCL), the Screening Questionnaire to detect Hypermobility (SQ-CH) and the Children Manifested Anxiety Scale (CMAS-R). RESULTS: The prevalence of JHS in this sample was 22%, and this was significantly higher in girls (31%) than in boys (14%) (χ2=6.83; P=.001). The JHS group scored significantly higher in the CMAS-R total anxiety (F=4.51; P=.035), CMAS-R Physiological anxiety (F=7.19; P=.008) and the CBCL somatic complaints (F=8.46; 0.004) and regression analyses showed that these 3 variables were predictors of JHS (χ2=36.77; P<.001; r2=0.22). The JHS group also scored higher in some behavioral measures. CONCLUSION: Children with JHS have higher frequency of anxiety disorders and higher intensity of physiological anxiety, somatic complaints, and therefore, JHS might be used as marker for this anxiety phenotype in youngsters.


Assuntos
Transtornos de Ansiedade/etiologia , Ansiedade/etiologia , Instabilidade Articular/congênito , Adolescente , Ansiedade/diagnóstico , Ansiedade/fisiopatologia , Transtornos de Ansiedade/diagnóstico , Transtornos de Ansiedade/fisiopatologia , Estudos de Casos e Controles , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/fisiopatologia , Instabilidade Articular/psicologia , Masculino , Escalas de Graduação Psiquiátrica , Análise de Regressão , Fatores de Risco
12.
Arch Orthop Trauma Surg ; 139(8): 1111-1116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30820695

RESUMO

INTRODUCTION: Shoulder pathologies are often accompanied by rotator interval synovitis. This phenomenon is poorly described in the literature so far. The aim of the study was to analyze the occurrence of macroscopically visible synovial reaction in the rotator interval in patients with chronic shoulder pathologies and to perform a histopathological evaluation. MATERIALS AND METHODS: In this prospective cohort study, 167 consecutive patients undergoing arthroscopic shoulder surgery for chronic shoulder pathology were included (♀ = 45, ♂ = 122; [Formula: see text]54.5 years ± 12.8). Included patients were divided into subgroups according to the encountered chronic shoulder pathology: (1) impingement syndrome with or without bursal sided partial rotator cuff tear (RCT); (2) articular sided partial RCT; (3) full-thickness RCT; (4) RCT that involves at least two tendons; (5) shoulder instability; and (6) cartilage damage. Standardized soft tissue biopsies from the rotator interval were taken. The synovitis score of Krenn/Morawietz was used for histopathological examination. RESULTS: Extraarticular pathology (group 1) showed significantly decreased synovitis scores compared to all the other groups. Increased size of rotator cuff tears (group 4), as well as cartilage damage (group 6) showed significantly higher synovitis scores than group 3 (p < 0.05). Moreover, the synovitis score was significantly increased in patients with concomitant pathologies of the long head of the biceps (p = 0.001). CONCLUSIONS: This study suggests that chronic intra- and extraarticular shoulder diseases are very often accompanied by a histopathologically verifiable low-grade synovitis. Intraarticular pathologies seem to induce increased levels of synovitis. Furthermore, the increased size of rotator cuff tears is accompanied by a higher degree of synovitis. STUDY DESIGN: Cohort study, level of evidence, 2b.


Assuntos
Cartilagem Articular/lesões , Instabilidade Articular/complicações , Lesões do Manguito Rotador/complicações , Síndrome de Colisão do Ombro/complicações , Sinovite/diagnóstico , Artroscopia , Cartilagem Articular/cirurgia , Estudos de Coortes , Feminino , Humanos , Instabilidade Articular/cirurgia , Masculino , Pessoa de Meia-Idade , Lesões do Manguito Rotador/cirurgia , Índice de Gravidade de Doença , Síndrome de Colisão do Ombro/cirurgia , Articulação do Ombro/cirurgia , Sinovite/complicações
13.
Dan Med J ; 66(4)2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30910004

RESUMO

INTRODUCTION: Greater trochanteric pain syndrome (GTPS) is a common and disabling hip condition. Hypermobility has been suggested as a possible cause of GTPS. The purpose of this study was to report the prevalence of hypermobility and to investigate its impact on hip-related function and awareness in patients with GTPS. METHODS: This cross-sectional study was based on a cohort of patients diagnosed with GTPS in the 2013-2015 period. Hypermobility was investigated with the Beighton Score and defined by a cut-off score ≥ 5. Data on patients' current hip function and awareness were collected with the questionnaires the Copenhagen Hip and Groin Outcome Score and the Forgotten Joint Score. RESULTS: A total of 612 patients with GTPS were identified based on the diagnosis system; out of those, 390 patients were assessed for eligibility, and 145 (37%) were included. The prevalence of hypermobility within this cohort was estimated to be 11% (95% confidence interval (CI): 3-26%) for males and 25% (95% CI: 17-34%) for females. No significant association was found between hypermobility and self-reported hip function and awareness. CONCLUSIONS: The prevalence of hypermobility in patients with GTPS was high, but the prevalence of hypermobility did not influence hip function and awareness. The results were based on a very low response rate and should be interpreted with this in mind. FUNDING: none. TRIAL REGISTRATION: not relevant.


Assuntos
Artralgia/etiologia , Fêmur , Instabilidade Articular/complicações , Adulto , Idoso , Estudos de Coortes , Estudos Transversais , Dinamarca/epidemiologia , Feminino , Articulação do Quadril/fisiopatologia , Humanos , Instabilidade Articular/epidemiologia , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Medição da Dor , Prevalência , Autorrelato
14.
World Neurosurg ; 126: e125-e135, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30790735

RESUMO

BACKGROUND: Atlantoaxial instability (AAI) is a common cause of neurologic dysfunction and pain in patients with Down syndrome (DS), frequently requiring instrumented fusion of the upper cervical spine. Despite this, optimal treatment strategy is controversial. METHODS: A systematic review of the literature was performed according to the Preferred Reporting Items for Systemic Reviews and Meta-Analysis statement to identify patients with AAI and DS were treated with upper cervical spine fusion. Patient demographics, preoperative symptoms, fixation type, and outcome measures including complications, neurologic outcomes, and bony fusion status were gathered for patients in the included publications. Meta-analysis was performed to compare outcomes of different types of fixation constructs. RESULTS: Of the 1191 publications retrieved, 51 met inclusion criteria, yielding 137 patients. Six fixation strategies were identified: noninstrumented (n = 6), wiring (n = 77), wiring with rods (n = 14), screw fixation (n = 33), hook and rod fixation (n = 2), and screw and wire fixation (n = 5). Constructs with screws and rods had greater bony union (P = 0.003) and a lower rate of revision surgery (P = 0.047), loss of reduction or pseudoarthrosis (P = 0.009), halo utilization (P < 0.001), and early neurologic decline (P = 0.004) compared with wiring alone. Constructs with wires and rods had greater bony union (P = 0.036) than wiring alone. CONCLUSIONS: Numerous fixation strategies exist for AAI in patients with DS. Using a combination of screws, rods, and wiring in appropriately selected patients may help reduce the high rate of surgical complications in these patients.


Assuntos
Articulação Atlantoaxial/cirurgia , Síndrome de Down/complicações , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Procedimentos Neurocirúrgicos/métodos , Procedimentos Ortopédicos/métodos , Humanos , Fixadores Internos , Resultado do Tratamento
15.
Am J Case Rep ; 20: 175-178, 2019 Feb 10.
Artigo em Inglês | MEDLINE | ID: mdl-30739122

RESUMO

BACKGROUND The Say-Barber-Biesecker-Young-Simpson (SBBYS) variant of Ohdo syndrome is characterized by congenital hypothyroidism, facial dysmorphism, postaxial polydactyly, and mental retardation. The SBBYS variant of Ohdo syndrome is extremely rare with only 19 cases previously reported in the literature. A case is presented of chronic otitis media associated with cholesteatoma in a six-year-old boy with the SBBYS variant of Ohdo syndrome. CASE REPORT A 6-year-old boy presented with perforation of the tympanic membrane and a cholesteatoma in the mesotympanic-attic region associated with chronic otitis media. The child had previously been diagnosed with the SBBYS variant of Ohdo syndrome. Following computed tomography (CT) and magnetic resonance imaging (MRI), tympanoplasty was performed with removal of the lesion. CONCLUSIONS This is the first case described in the literature of chronic otitis media associated with cholesteatoma in a patient with the SBBYS variant of Ohdo syndrome. This case demonstrates the importance of specialist otolaryngology referral for patient management.


Assuntos
Blefarofimose/complicações , Colesteatoma da Orelha Média/complicações , Hipotireoidismo Congênito/complicações , Cardiopatias Congênitas/complicações , Deficiência Intelectual/complicações , Instabilidade Articular/complicações , Otite Média/complicações , Criança , Colesteatoma da Orelha Média/diagnóstico por imagem , Doença Crônica , Facies , Humanos , Imagem por Ressonância Magnética , Masculino , Doenças Raras
16.
Medicine (Baltimore) ; 98(5): e14311, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30702607

RESUMO

RATIONALE: Stress fractures are most commonly sustained in the lower extremities owing to the repetitive weight-bearing forces. They are overuse injuries that are seen often in athletes, but rare in the general population, so early diagnosis and proper treatment are important to enable athletes to return to activity. This is a rare example of successful treatment of a medial malleolar stress fracture with lateral ankle instability. PATIENT CONCERNS: A 16-year-old athlete presented with acute-onset left ankle pain. He was a baseball pitcher who had previously sprained left ankle while training. Subsequently, the ankle pain worsened, and he had tenderness on the medial aspect of his left ankle. The symptoms were mild at rest, but increased upon walking and training. Three years previously, he had sprained his ankle several times during baseball training. DIAGNOSIS: Plain standing radiographs of the left ankle showed a vertical fracture line in the medial malleolus. Computed tomography also showed the vertical fracture in the medial malleolus. Magnetic resonance imaging revealed mild bone marrow edema in the medial malleolar area and total rupture of the anterior talofibular ligament. INTERVENTIONS: Surgery was performed under general anesthesia, and we checked the instability of his ankle using a C-arm image intensifier, and the varus talar tilt angle was increased (10.3°). The medial malleolus stress fracture was fixed using tension bend wiring, and an arthroscopic modified Broström procedure was done. OUTCOMES: Two months postoperatively, the patient started walking, and raised-heel squatting. The medial malleolar fracture was completely united at the 3 months postoperatively on plain radiography, and return to full activity was achieved by 3 months postoperatively. Then the hardware was removed 1-year after operation and both the anterior drawer and external rotation stress tests were negative. LESSONS: Medial malleolar stress fractures are rare, so they can be overlooked. With these fractures, plain radiographs are frequently normal initially because the medial malleolus consists mainly of cancellous bone. Physicians require a high level of suspicion when taking the patient's history and doing the physical examination. Because most occur in athletes, early diagnosis and proper treatment are important for patients' subsequent athletic performance.


Assuntos
Fraturas do Tornozelo/diagnóstico , Fraturas do Tornozelo/etiologia , Articulação do Tornozelo , Fraturas de Estresse/diagnóstico , Fraturas de Estresse/etiologia , Instabilidade Articular/complicações , Adolescente , Fraturas do Tornozelo/cirurgia , Fraturas de Estresse/cirurgia , Humanos , Masculino
17.
J Sports Med Phys Fitness ; 59(7): 1200-1205, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30758170

RESUMO

BACKGROUND: Chronic ankle instability (CAI) is a common disease following ankle sprain and appears balance and gait problems, pain, and fatigue. This study aimed to examine the effect of therapeutic exercise performed on sea sand on pain, fatigue, and balance ability in patients with CAI. METHODS: This study was designed as a randomized controlled trial. Subjects with a Cumberland Ankle Instability Tool (CAIT) score of less than 27 were selected. 22 subjects were randomly assigned to the sea sand (SS) group (N.=11) or the self-management (SM) group (N.=11). The SS group performed the therapeutic exercise on sea sand and the SM group conducted the exercises on a firm surface at home 5 times over the course of a week. To measure static balance, center of pressure (COP) of one-leg standing on the force plate was assessed. Visual Analog Scale (VAS) was used to measure pain and fatigue. RESULTS: The SS group showed statistically significant improvements in all static balance outcomes (COP-area, COP-average velocity, minor-axis, major-axis) after the intervention (P<0.05), while the SM group did not show a significant change in all static balance parameters (P>0.05). Also, the SS group showed statistically significant improvements in pain and fatigue (P<0.05). All outcomes except major axis showed statistically significant differences between SS group and SM group at change value (P<0.05). CONCLUSIONS: Therapeutic exercise on sea sand effectively improved balance and decreased pain and fatigue. Thus, it can be considered a rehabilitation method for CAI patients.


Assuntos
Articulação do Tornozelo , Terapia por Exercício/métodos , Instabilidade Articular/terapia , Adulto , Fadiga/etiologia , Fadiga/terapia , Estudos de Viabilidade , Feminino , Humanos , Instabilidade Articular/complicações , Masculino , Dor/etiologia , Manejo da Dor/métodos , Equilíbrio Postural/fisiologia , Escala Visual Analógica
18.
Neurosurg Rev ; 42(4): 915-936, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30627832

RESUMO

A great deal of literature has drawn attention to the "complex Chiari," wherein the presence of instability or ventral brainstem compression prompts consideration for addressing both concerns at the time of surgery. This report addresses the clinical and radiological features and surgical outcomes in a consecutive series of subjects with hereditary connective tissue disorders (HCTD) and Chiari malformation. In 2011 and 2012, 22 consecutive patients with cervical medullary syndrome and geneticist-confirmed hereditary connective tissue disorder (HCTD), with Chiari malformation (type 1 or 0) and kyphotic clivo-axial angle (CXA) enrolled in the IRB-approved study (IRB# 10-036-06: GBMC). Two subjects were excluded on the basis of previous cranio-spinal fusion or unrelated medical issues. Symptoms, patient satisfaction, and work status were assessed by a third-party questionnaire, pain by visual analog scale (0-10/10), neurologic exams by neurosurgeon, function by Karnofsky performance scale (KPS). Pre- and post-operative radiological measurements of clivo-axial angle (CXA), the Grabb-Mapstone-Oakes measurement, and Harris measurements were made independently by neuroradiologist, with pre- and post-operative imaging (MRI and CT), 10/20 with weight-bearing, flexion, and extension MRI. All subjects underwent open reduction, stabilization occiput to C2, and fusion with rib autograft. There was 100% follow-up (20/20) at 2 and 5 years. Patients were satisfied with the surgery and would do it again given the same circumstances (100%). Statistically significant improvement was seen with headache (8.2/10 pre-op to 4.5/10 post-op, p < 0.001, vertigo (92%), imbalance (82%), dysarthria (80%), dizziness (70%), memory problems (69%), walking problems (69%), function (KPS) (p < 0.001). Neurological deficits improved in all subjects. The CXA average improved from 127° to 148° (p < 0.001). The Grabb-Oakes and Harris measurements returned to normal. Fusion occurred in 100%. There were no significant differences between the 2- and 5-year period. Two patients returned to surgery for a superficial wound infections, and two required transfusion. All patients who had rib harvests had pain related that procedure (3/10), which abated by 5 years. The results support the literature, that open reduction of the kyphotic CXA to lessen ventral brainstem deformity, and fusion/stabilization to restore stability in patients with HCTD is feasible, associated with a low surgical morbidity, and results in enduring improvement in pain and function. Rib harvest resulted in pain for several years in almost all subjects.


Assuntos
Malformação de Arnold-Chiari/complicações , Malformação de Arnold-Chiari/cirurgia , Doenças do Tecido Conjuntivo/complicações , Instabilidade Articular/complicações , Instabilidade Articular/cirurgia , Cifose/cirurgia , Adolescente , Adulto , Tronco Encefálico , Criança , Doenças do Tecido Conjuntivo/cirurgia , Feminino , Seguimentos , Humanos , Cifose/etiologia , Imagem por Ressonância Magnética , Masculino , Pessoa de Meia-Idade , Fusão Vertebral , Síndrome , Tomografia Computadorizada por Raios X , Resultado do Tratamento , Adulto Jovem
19.
J Man Manip Ther ; 27(1): 24-32, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30692840

RESUMO

Objective: The flexion rotation test (FRT) is used to determine C1-2 involvement in individuals with neck pain and headaches. Some individuals present with generalized joint hyperlaxity (GJH) which could influence the results of this test, which relies on a soft tissue locking mechanism. The purpose of this study was to examine the side-bend rotation test (SBRT), which utilizes osseous locking, compared to the FRT. Methods: Thirty-eight healthy individuals (25 female, 26.03 years) were assessed for GJH via the Beighton Hypermobility Index (BHI). A blinded examiner performed the FRT and SBRT bilaterally, measuring ROM using a digital goniometer device. Results: Statistically significant differences in ROM were present for the FRT based on negative (0-3) and positive (4-9) BHI score: (Right 46.4±3.6, 49.6±4.8, p=.031), (Left 45.5±3.5, 49.0±5.2, p=.023); no differences were observed for the SBRT (Right 37.6±4.3, 38.9±3.4), (Left 37.7±4.2, 37.6±3.4).  When further stratifying the groups, a one-way ANOVA and post-hoc testing revealed significant differences of FRT range of motion between the BHI 7-9 group(52.4 ± 4.4 -53.9 ± 3.4) compared to BHI 0-3 (45.4 ± 3.6-46.2 ± 3.5) and 4-6 groups (46.0 ± 3.7-46.4 ± 2.2), p < .001; there were no significant differences between the 0-3 and 4-6 groups. There were no between group differences for the SBRT, BHI 0-3 (37.5 ± 4.4-37.7 ± 4.3), BHI 7-9 (39.9 ± 3.7-39.2 ± 3.5). Discussion: Individuals with GJH demonstrated significant differences in ROM for the FRT, but not the SBRT. The SBRT may be a useful alternative to the FRT for individuals with hyperlaxity. However, further research needs to be conducted to assess the diagnostic ability of this test in individuals with cervical pathology.


Assuntos
Vértebras Cervicais , Cefaleia/diagnóstico , Instabilidade Articular/complicações , Movimento , Cervicalgia/diagnóstico , Exame Físico/métodos , Rotação , Adulto , Análise de Variância , Feminino , Humanos , Articulações/patologia , Masculino , Pescoço/patologia , Amplitude de Movimento Articular , Reprodutibilidade dos Testes
20.
Acta Neurochir Suppl ; 125: 63-70, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30610304

RESUMO

BACKGROUND: This paper reviews an experience of surgically treating ossification of the posterior longitudinal ligament (OPLL) with fixation of the involved spinal segments alone, without resorting to any bony or soft tissue decompression or attempts at direct resection of the OPLL. While in the early part of the experience, stabilization of only the involved subaxial cervical spinal segments was done, in the later part of the experience, atlantoaxial fixation was included in the multisegmental spinal fixation construct. This treatment is based on the understanding that spinal instability that includes atlantoaxial instability forms the nodal point of the pathogenesis and development of OPLL, and maturation of the presenting clinical symptoms. MATERIALS AND METHODS: Twenty-nine patients were treated in this series. There were 28 males and one female, and their ages ranged from 28 to 75 years (average 57 years). All patients presented with symptoms of neck pain, and progressive and disabling myelopathy-related quadriparesis. In the early part of the series (from 2012 to 2014), 14 patients underwent multilevel subaxial cervical spinal fixation by a transarticular technique of facetal fixation. After November 2014, atlantoaxial lateral mass fixation was included in the fixation construct in the subsequent 15 patients. Clinical assessments were done using a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scale and Goel's clinical grading scale. RESULTS: All patients' clinical symptoms improved in the immediate postoperative period, and the improvement was sustained and progressive in 28 patients. CONCLUSION: Atlantoaxial and subaxial spinal instability seems to be the nodal pathogenetic factor in OPLL. Only stabilization of spinal segments that includes the atlantoaxial joint can provide a safe, simple and rational form of treatment.


Assuntos
Articulação Atlantoaxial/cirurgia , Vértebras Cervicais/cirurgia , Instabilidade Articular/cirurgia , Ossificação do Ligamento Longitudinal Posterior/cirurgia , Fusão Vertebral/métodos , Adulto , Idoso , Articulação Atlantoaxial/fisiopatologia , Vértebras Cervicais/fisiopatologia , Feminino , Humanos , Instabilidade Articular/complicações , Instabilidade Articular/fisiopatologia , Masculino , Pessoa de Meia-Idade , Cervicalgia/etiologia , Cervicalgia/cirurgia , Ossificação do Ligamento Longitudinal Posterior/complicações , Ossificação do Ligamento Longitudinal Posterior/fisiopatologia , Quadriplegia/etiologia , Quadriplegia/cirurgia , Estudos Retrospectivos , Base do Crânio/fisiopatologia , Base do Crânio/cirurgia , Resultado do Tratamento
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