Ultrasonography of shoulders in spondyloarthritis and rheumatoid arthritis: A case-control study

IntroductionShoulders are often involved in spondyloarthritis (SpA) and rheumatoid arthritis (RA). The diagnosis of peripheral SpA and its differential diagnosis with RA could be challenging. A recent ultrasound study showed that ultrasonography (US) of the hands might differentiate psoriatic arthritis to RA. The aim of the study was to compare different US features in SpA, RA and healthy controls.MethodsA total of 38 SpA and 43 RA patients with clinical involvement of shoulders were included and compared to 33 controls. One blinded rheumatologist performed US examinations. The following items were assessed: gleno-humeral effusion, long-head biceps tendon tenosynovitis, subacromial and subdeltoid bursitis, acromio clavicular (AC) synovitis and humeral bone erosion.ResultsThirty-eight SpA (mean age: 49.9 ± 15.4 years, 58% of male), 43 RA patients (52.9 ± 16.6 years, 26% of male) and 33 controls (55.2 ± 16.9 years, 42% of male) were assessed. In comparison to RA, SpA patients had higher frequency of AC synovitis (66% vs 5%, P < 0.0001) but lower prevalence of subacromial and subdeltoid bursitis (39% vs 67%, P = 0.015), gleno-humeral effusion (5% vs 28%, P = 0.008) and humeral bone erosion (10% vs 56%, P < 0.0001). Unilateral abnormalities were found more frequently in SpA patients than in RA (64% vs 26%, P < 0.0001).ConclusionOur results suggest that AC synovitis is highly evocative of SpA in patients with inflammatory painful shoulders. Thus, US might help to diagnose SpA and to differentiate with RA.     

Combining robotic exoskeleton and body weight unweighing technology to promote walking activity in tetraplegia following SCI: A case study

Context: To investigate the feasibility of combining the lower-limb exoskeleton and body weight unweighing technology for assisted walking in tetraplegia following spinal cord injury (SCI).

Findings: A 66-year-old participant with a complete SCI at the C7 level, graded on the American Spinal Injury Association Impairment Scale (AIS) as AIS A, participated in nine sessions of overground walking with the assistance from exoskeleton and body weight unweighing system. The participant could tolerate the intensity and ambulate with exoskeleton assistance for a short distance with acceptable and appropriate gait kinematics after training.

Conclusion: This report showed that using technology can assist non-ambulatory individuals following SCI to stand and ambulate with assistance which may promote general physical and psychological health if used in the long term.     

Nerve transfer rehabilitation in tetraplegia: Comprehensive assessment and treatment program to improve upper extremity function before and after nerve transfer surgery,a case report

ContextA 28-year-old male, sustained a traumatic Spinal Cord Injury (SCI) in January 2015, and was classified as AIS A, neurological level of injury (NLI) C4. As an inpatient at the SCI rehabilitation unit, he underwent multidisciplinary assessment involving SCI specialists, peripheral nerve surgeons, psychologists, occupational and physical therapists. Team consensus determined he was a candidate for nerve transfer surgery to improve upper extremity function. The patient undertook a pre-surgical neurorehabilitation program of 3 months duration. Surgery was performed bilaterally at 11 and 13 months after SCI (right and left arm respectively).FindingsUpon completion of surgical procedures, the patient underwent an intensive post-surgical rehabilitation program based on established goals, with follow-up every 3 months, up to 24 months after the surgery. Notable improvements were wheelchair propulsion, the ability to relieve pressure, grasp, pinch, and release an object. Standardized measures for SCI individuals (SCIM-III, CUE-Q, LiSAT-9 and UEMS) showed significant improvements.Clinical RelevanceNerve transfers in tetraplegia are an underused technique. The benefits of surgery along with an intensive neurorehabilitation program, can improve independence and function in daily living activities for a properly selected group of individuals.     

Effects of proprioceptive exercises and strengthening on pain and functionality for patellofemoral pain syndrome in women: A randomized controlled trial

ObjectiveThe objective of this study was to verify the effects of resisted and proprioceptive exercises program for the treatment of patients diagnosed with patellofemoral pain syndrome (PFPS).Design methodRandomized Controlled Trial – level of evidence, II.MethodsSixty female patients, clinically diagnosed with PFPS, were allocated into two experimental groups. The exercise group (ExG) underwent 6 weeks of a resisted and proprioceptive exercises for the trunk muscles, abductors and lateral hip rotators and knee extensors. The Guidance Group (GG) received educational, cognitive and behavioral guidance on healthcare. Before and after the program implementation period, all participants were evaluated in relation to the injured limb for pain assessment, subjective functionality, maximum isometric strength and 2D biomechanical analysis.ResultsAfter a six-week follow-up, ExG showed significant improvement in the Numerical Pain Rating Scale, Anterior Knee Pain Scale and Knee Outcome Survey- Activities of Daily Living Scale when compared to the control group (p ≤ 0,05). The ExG also proved superior for increased muscle strength of knee extensors, hip abductors, decreased dynamic knee valgus and pelvic drop in relation to GG (p ≤ 0.05). However, when we consider the strength of the hip lateral rotator muscles there was no difference between the two interventions (p > 0.05).ConclusionResisted and proprioceptive exercises yielded superior results to those of a treatment focused on educational, cognitive and behavioral guidance in improving pain and lower limb function for women with PFPS.     

The effect of training with vaginal weighted cones and pelvic floor exercises on the strength of the pelvic floor muscles: A pilot study

A pretest-post-test design (n=14) was used to investigate pelvic floor muscle (PFM) strength over a 2-month training period using vaginal cones with pelvic floor exercises in the treatment of female stress incontinence, and to correlate any changes in muscle strength with objective and subjective measures of stress incontinence. PFM strength was assessed by vaginal examination and the ability to retain the cones. The symptom of stress incontinence was assessed using rating scales, and measured objectively by the extended pad test. The results showed a significant increase in muscle strength (P<0.05). An unexpected finding was that most of the improvement in PFM function occurred in a 1-week baseline assessment period before training was commenced. It is therefore suggested that the increase in force generation occurred due to a process of neural adaptation rather than muscle hypertrophy. No significant correlations were found between muscle strength and objective or subjective measures of stress incontinence.Editorial Comment: Vaginal cones are gaining in popularity as a method of therapy for stress incontinence. As in this study, the symptom of stress incontinence was enough to begin treatment and objective documentation of the diagnosis was not undertaken. The therapy has no side-effects and only requires that the patient is motivated enough to put the cone in the vagina and take it out after a prescribed time period. Everything else is automatic. Biofeedback from the perception of the cone falling out provides the stimulus for pelvic floor contraction. Success rates are high, with 21% cured and 29% improved for an overall improvement rate of 50%. Such therapies may be tried before diagnosis, and certainly before expensive surgical treatment.     

Walking endurance,muscle oxygen extraction,and perceived fatigability after overground locomotor training in incomplete spinal cord injury: A pilot study

Objective: The purpose of this study was to examine the effects of overground locomotor training (OLT) on walking endurance and gastrocnemius oxygen extraction in people with chronic cervical motor-incomplete spinal cord injury (SCI).Design: Prospective single-arm pre–post pilot study.Setting: Human Performance Research Laboratory.Participants: Adult men with traumatic chronic cervical SCI (n = 6; age = 30.8 ± 12.5).Intervention: Twenty-four sessions of structured OLT.Outcome measures: Walking endurance was determined during a constant work-rate time-to-exhaustion treadmill test. Normalized perceived fatigability was calculated by dividing subjective ratings of tiredness by walking time. Cardiorespiratory outcomes and muscle oxygen extraction were analyzed using breath-by-breath gas-exchange and near-infrared spectroscopy.Results: OLT resulted in large effects on walking endurance (1232 ± 446 s vs 1645 ± 255 s; d = 1.1; P = 0.045) and normalized perceived fatigability (5.3 ± 1.5 a.u. vs 3.6 ± 0.9 a.u.; d = 1.3; P = 0.033). Small-to-medium effects on absolute (2.8 ± 2.5 a.u. vs 4.2 ± 3.5 a.u.; d = 0.42; P = 0.035) and isotime (2.8 ± 2.5 a.u. vs 3.8 ± 3.0 a.u.; d = 0.33; P = 0.023) muscle oxygen extraction were also observed after OLT.Conclusion: These findings provide preliminary data supporting the potential for improved walking endurance, enhanced muscle O₂ extraction, and reduced perceived fatigability in people with chronic cervical motor-incomplete SCI following the OLT program described in this study.     

Comparison of 24-hour cardiovascular and autonomic function in paraplegia, tetraplegia, and control groups: implications for cardiovascular risk

BACKGROUND: Fluctuations in 24-hour cardiovascular hemodynamics, specifically heart rate (HR) and blood pressure (BP), are thought to reflect autonomic nervous system (ANS) activity. Persons with spinal cord injury (SCI) represent a model of ANS dysfunction, which may affect 24-hour hemodynamics and predispose these individuals to increased cardiovascular disease risk. OBJECTIVE: To determine 24-hour cardiovascular and ANS function among individuals with tetraplegia (n=20; TETRA: C4-C8), high paraplegia (n=10; HP: T2-T5), low paraplegia (n=9; LP: T7-T12), and non-SCI controls (n=10). Twenty-four-hour ANS function was assessed by time domain parameters of heart rate variability (HRV); the standard deviation of the 5-minute average R-R intervals (SDANN; milliseconds/ms), and the root-mean square of the standard deviation of the R-R intervals (rMSSD; ms). Subjects wore 24-hour ambulatory monitors to record HR, HRV, and BP. Mixed analysis of variance (ANOVA) revealed significantly lower 24-hour BP in the tetraplegic group; however, BP did not differ between the HP, LP, and control groups. Mixed ANOVA suggested significantly elevated 24-hour HR in the HP and LP groups compared to the TETRA and control groups (P<0.05); daytime HR was higher in both paraplegic groups compared to the TETRA and control groups (P<0.01) and nighttime HR was significantly elevated in the LP group compared to the TETRA and control groups (P<0.01). Twenty-four-hour SDANN was significantly increased in the HP group compared to the LP and TETRA groups (P<0.05) and rMSSD was significantly lower in the LP compared to the other three groups (P<0.05). Elevated 24-hour HR in persons with paraplegia, in concert with altered HRV dynamics, may impart significant adverse cardiovascular consequences, which are currently unappreciated.     

Concurrent musculoskeletal complaints in elbows,shoulders, and necks after common hand and forearm injuries or conditions: A cross-sectional study among 600 patients

Study designThis is a cross-sectional study among 600 patients.IntroductionIsolated hand and forearm injuries or conditions are common in the emergency and orthopedic departments. So far, little is known about whether these patients suffer from concurrent musculoskeletal complaints (MSCs) besides their hand and forearm complaints. Neglecting concurrent MSCs in the upper limbs and necks could hamper rehabilitation and prolong the time taken to return to daily and work-related activities.Purpose of the studyThe purpose of this study was to investigate the prevalence of concurrent MSCs in the elbow, shoulder, and neck after common hand and/or forearm injuries or conditions.MethodsThis study included 600 patients with any type of diagnosis referred to rehabilitation after hand and/or forearm injuries or conditions. Basic characteristics, diagnoses, and location of patients' symptoms were collected and analyzed.ResultsThe overall prevalence of concurrent MSCs was 40%. Twenty-eight percent of the whole sample developed concurrent MSCs after the hand and forearm injury or condition. The gender distribution was 68% women and 32% men. The most common location for complaints was the shoulder (62%), followed by the elbow (49%), and the neck (32%).DiscussionThe present results suggest that MSCs from the elbows, shoulders, or necks are very common in patients with hand and/or forearm injuries or conditions.ConclusionClinicians treating patients with isolated hand and forearm injuries or conditions should be aware of the high prevalence of concurrent MSCs. Future research should investigate if specific rehabilitation, focusing on concurrent MSCs, may influence the outcome in this population.     

Shoulder injuries from birth to old age: A 1-year prospective study of 3031 shoulder injuries in an urban population

IntroductionShoulder injuries are commonly encountered in emergency departments. In spite of this, the epidemiology is only partly known, and soft tissue injuries in particular remain unclear. The aim of this study was to obtain an overview of shoulder injuries in a general population cohort, and to estimate the relative proportion of the main injury categories soft tissue injuries, fractures and dislocations, as well as their variation with age and gender.Patients and MethodsWe registered prospectively all patients admitted with a suspected shoulder injury at a combined casualty and primary health care facility during one year. The facility serves all hospitals and all citizens of Oslo. The patient-reported questionnaires, electronic patient records and radiology reports were examined.Results3031 shoulder injuries were registered from May 2013 through April 2014. The median age was 37 years (range 14 days–102 years), 51 years in women and 31 years in men (p < 0.001), 60% were male. The male/female shoulder injury incidence rate ratio in the 20–34 years age group was 3.6 (95%CI, 3.0 to 4.3; p < 0.001). Contrary, the female/male rate ratio above 75 years was 2.1 (95%CI, 1.6–2.8; p < 0.001). Almost half of the injuries were soft tissue injuries, 35% were fractures and 17% were dislocations. The age-stratified incidence rates differed substantially in men and women. Fractures dominated in children up to 10 years and in adults over 60 years, soft tissue injuries in the ages between. The highest dislocation incidence rates were found in young males. A rotator cuff tear was diagnosed in 4% of the injuries.ConclusionWhich shoulder structures that are affected by injury vary substantially with age and gender. The shoulder injury incidence rates of young men and the elderly are high. The findings are important for the understanding of the shoulder and the diagnostic process in A&Es.     

A prospective study of thyroid function,bone loss,and fractures in older men: The MrOS study

Excess thyroid hormone is associated with increased bone loss and fracture risk in older women, but few data exist for men. We sought to determine if thyroid function is independently associated with bone loss and fracture risk in older men. Data were analyzed from the Osteoporotic Fractures in Men (MrOS) study, a cohort of community‐dwelling U.S. men aged 65 years and older. Using a case‐cohort design, fasting baseline serum archived at ?80°C was assayed for thyroid‐stimulating hormone (thyrotropin) (TSH) and free thyroxine (FT4) in 397 men with confirmed nonspine fracture, including 157 hip fractures, and 1420 randomly selected men without fracture. TSH and FT4 were analyzed as continuous variables and as thyroid function categories (subclinical hyperthyroid, euthyroid, and subclinical hypothyroid). Hip dual‐energy X‐ray absorptiometry (DXA) (Hologic QDR4500) was measured at baseline and after a mean follow‐up of 4.6 years. Incident nonspine fractures were centrally adjudicated. Bone loss was evaluated with multivariate regression methods and fractures risk was evaluated using hazard models that accounted for the case‐cohort sampling, adjusted for age, clinic‐site, body mass index (BMI), race, physical activity, corticosteroid use, smoking, alcohol intake, and thyroid medication use. In fully adjusted analyses, TSH was not associated with risk of nonspine fracture (relative hazard [RH] 0.92 per SD decrease in TSH; 95% confidence interval [CI], 0.74–1.14), but was significantly associated with risk of hip fracture (RH 1.31; 95% CI, 1.01–1.71), which persisted among normal range TSH values (RH 1.21; 95% CI, 1.00–1.47). There was no association between TSH or FT4 and bone loss, and fracture risk did not differ significantly by thyroid function category. We conclude that although neither TSH nor FT4 are associated with bone loss, lower serum TSH may be associated with an increased risk of hip fractures in older men. © 2013 American Society for Bone and Mineral Research.     

Association between changes in global femoral offset after total hip arthroplasty and function,quality of life,and abductor muscle strength: A prospective cohort study of 222 patients

Background and purpose — There is no consensus on the association between global femoral offset (FO) and outcome after total hip arthroplasty (THA). We assessed the association between FO and patients’ reported hip function, quality of life, and abductor muscle strength.

Patients and methods — We included 250 patients with unilateral hip osteoarthritis who underwent a THA. Before the operation, the patient’s reported hip function was evaluated with the Western Ontario and McMaster Universities Osteoarthritis (WOMAC) index and quality of life was evaluated with EQ-5D. At 1-year follow-up, the same scores and also hip abductor muscle strength were measured. 222 patients were available for follow-up. These patients were divided into 3 groups according to the postoperative global FO of the operated hip compared to the contralateral hip, as measured on plain radiographs: the decreased FO group (more than 5 mm reduction), the restored FO group (within 5 mm restoration), and the increased FO group (more than 5 mm increment).

Results — All 3 groups improved (p?Interpretation — A reduction in global FO of more than 5 mm after THA appears to have a negative association with abductor muscle strength of the operated hip, and should therefore be avoided.     

Angry breathing: A prospective study of hostility and lung function in the Normative Aging Study

BACKGROUND: Hostility and anger are risk factors for, or co-occur with, many health problems of older adults such as cardiovascular diseases, all-cause mortality, and asthma. Evidence that negative emotions are associated with chronic airways obstruction suggests a possible role for hostility in the maintenance and decline of pulmonary function. This study tests the hypothesis that hostility contributes to a faster rate of decline in lung function in older adults. METHODS: A prospective examination was undertaken of the effect of hostility on change in lung function over time. Data are from the VA Normative Aging Study, an ongoing cohort of older men. Hostility was measured in 1986 in 670 men who also had an average of three pulmonary function examinations obtained over an average of 8.2 years of follow up. Hostility was ascertained using the 50-item MMPI based Cook-Medley Hostility Scale. Pulmonary function was assessed using spirometric tests to obtain measures of forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC). RESULTS: Baseline pulmonary function differed between high and medium/low hostility groups (mean (SE) percent predicted FEV(1) 88.9 (18.5) v 95.3 (16.9) and FVC 92.5 (16.5) v 98.9 (15.9), respectively; p < 0.01 for both). This overall association between higher hostility and reduced lung function remained significant after adjusting for smoking and education, although the effect size was attenuated for both FEV1 and FVC. Higher hostility was associated with a more rapid decline in lung function, and this effect was unchanged and remained significant for FEV1)in multivariate models but was attenuated for FVC. Each standard deviation increase in hostility was associated with a loss in FEV1 of approximately 9 ml/year. CONCLUSIONS: This study is one of the first to show prospectively that hostility is associated with poorer pulmonary function and more rapid rates of decline among older men.     

A prospective study of liver function in infants and children exposed to daily isoflurane for several weeks

Eleven infants and children presenting for daily radiotherapy for a period of at least 2 weeks were anaesthetised with isoflurane in 33% oxygen and nitrous oxide. They were unpremedicated and given no other agents to supplement anaesthesia. The average number of exposures was 24 (SD 11; range 10-39) and the total anaesthetic time per exposure varied between 15 and 30 minutes. Liver function was assessed by determining serum total bilirubin, aspartate amino transferase, gamma glutamyl transferase and alkaline phosphatase before the start of treatment and at 5-daily intervals thereafter. There was no measurable change in any of these determinants of liver function. All children accepted daily induction of anaesthesia with isoflurane. Induction, maintenance and recovery from anaesthesia were uncomplicated.     

Association of musculoskeletal pain,fear-avoidance factors,and quality of life in active manual wheelchair users with SCI: A pilot study

Objective: Limited evidence examines the association of psychological factors, such as fear of movement and pain catastrophizing, with musculoskeletal pain patterns in active manual wheelchair users with spinal cord injury (SCI). This study investigated the relationship among musculoskeletal pain, fear avoidance factors, quality of life (QoL), activity and duration of injury in individuals with SCI.

Design: Cross-sectional correlational.

Setting: Community setting.

Participants: Twenty-six individuals with SCI (age?=?42?±?14 years, duration manual wheelchair use?=?17?±?13 years, work/school/volunteer hours/week?=?31?±?14; recreation/sports hours/week 10?±?12).

Outcome Measures: Demographics and self-report measures including the Musculoskeletal Pain Survey (MPS), Wheelchair Users Shoulder Pain Index (WUSPI), Tampa Scale of Kinesiophobia (TSK-11), Pain Catastrophizing Scale (PCS), Fear of Pain (FPQ), Subjective Quality of Life Questionnaire (SQoL), and the Social Interaction Inventory (SII). Spearman’s rho (ρ) assessed correlation among measures.

Results: Strong association existed between age and duration of injury (ρ?=?0.66, P?<?0.001). SQoL offered a strong, direct correlation with age (ρ?=?0.63, P?=?0.01), duration of injury (ρ?=?0.70, P?=?0.001), and strong, inverse relationship with MPStotal (ρ?=??0.66, P?=?0.003) and MPS shoulder subscore (ρ?=??0.64, P?=?0.004). WUSPI demonstrated strong, inverse association with self-reported work hours (ρ?=??0.52, P?=?0.02) and a strong, direct relationship to PCS (ρ?=?0.79, P?=?<0001). PCS demonstrated a strong, inverse relationship to work/school/volunteer hours (ρ?=?0.71, P?<?0.001) and strong association to TSK-11_total (ρ?=?0.61, P?=?0.001). A moderate, inverse relationship was identified for recreational/sports hours and FPQ (ρ?=?0.48, P?=?0.03).

Conclusion: This cyclical relationship of musculoskeletal pain, reduced activity, and maladaptive psychological factors allude to interdependence of factors, supporting the multidisciplinary approach to care.     

The decline in sexual function,psychological disorders (anxiety and depression) and life satisfaction in older men: A cross-sectional study in a hospital-based population

This study explored the relationships between the decline in sexual function and psychological burdens and life satisfaction in older men with the aim of providing prospective targets for interventions. From January 2016 to January 2019, we selected 1,326 men aged over 50 years old. We adopted the International Index of Erectile Function-5 (IIEF-5), self-estimated intravaginal ejaculatory latency time (IELT), the premature ejaculation diagnostic tool (PEDT), the General Anxiety Disorder-7 (GAD-7), the Patients Health Questionnaire-9 (PHQ-9), the satisfaction with life scale and the control, autonomy, self-realisation and pleasure scale (CASP-19) to measure premature ejaculation, erectile dysfunction and well-being (including, depression, anxiety, and life quality and satisfaction) respectively. The individuals were divided into two main groups: the decline group and the no-decline group. The incidences of erectile dysfunction (ED), premature ejaculation (PE), anxiety and depression in men who reported a decline in sexuality were 73.83% (330/447), 63.98% (286/447), 75.84% (339/447) and 68.46% (306/447) respectively. Men who showed a decline in sexuality had significantly worse psychological and life satisfaction/quality scores than those in the no-decline group (p < .001 for all). When they had PE or ED simultaneously, these differences widened. Significantly worsened psychological status and life quality/satisfaction scores could be observed in patients who had declined sexual desire and declined frequency of sex (p < .001 for both). Under the impact of the decline in sexual function, the younger participants (age < 60) had significantly worsened negative emotions and life quality and satisfaction. Based on the results of the study, we found that the decline in sexuality was associated with depression and anxiety and worse life satisfaction and quality. Clinicians need to pay more attention to psychological status and life satisfaction and quality for those patients affected by a decline in sexuality.     

Evidence-based tailored nutrition educational intervention improves adherence to dietary guidelines,anthropometric measures and serum metabolic biomarkers in early-stage breast cancer patients: A prospective interventional study

PurposeThe impact of the adherence to dietary guidelines of early-stage breast cancer (EBC) patients on body composition changes during treatment is not entirely defined. This study aimed to evaluate the role of an evidence-based nutrition educational intervention, according to adherence to dietary guidelines, in EBC patients.MethodsThis prospective study included EBC patients, candidates for neoadjuvant/adjuvant therapy. Patients received an evidence-based tailored nutrition educational intervention. The adherence to dietary guidelines, anthropometric and dietary assessments, and blood glucose and lipid profile tests were evaluated at baseline and after a 12-months nutritional intervention.ResultsTwo hundred and forty-three patients were enrolled. At baseline, 38.3% and 23.9% of patients were overweight and obese, weight gain ≥5% (compared to 6-months before enrollment) and central obesity were observed in 47.3% and 52.7% of patients, respectively. Adherence to dietary guidelines was low (median Med-Diet score: 6 [IQR 4–8]). After the nutritional intervention (median follow-up: 22 months [range 12–45]), adherence to dietary guidelines significantly increased (median Med-Diet score: 12 [IQR 8–13]), p < 0.0001). High adherence to dietary guidelines (defines as Med-Diet score ≥10) significantly correlated with: 1) overall weight loss ≥5% (21.8% vs. 2.5%, p = 0.003); 2) median BMI drop (from 25.6 kg/m² to 24.4 kg/m², p = 0.003); 3) lower prevalence of central obesity (38.2% vs. 7.2%, p = 0.01); 4) improvement in blood glucose levels and lipid profile.ConclusionThis study suggests that an evidence-based tailored nutrition educational intervention during treatment for EBC significantly increases overall adherence to dietary guidelines, and it improves both anthropometric measures and serum metabolic biomarkers in patients with high adherence.