Use of ultrasound to increase effectiveness of isokinetic exercise for knee osteoarthritis

OBJECTIVE: To investigate the effects of ultrasound (US) in isokinetic muscle strengthening exercises on functional status of patients with knee osteoarthritis (OA). DESIGN: Effectiveness of isokinetic muscle strengthening exercises for treatment of periarticular soft tissue disorders was compared with and without pulsed and continuous US. SETTING: Outpatient exercise program in a Taiwan medical university hospital. PARTICIPANTS: One hundred twenty subjects with bilateral knee OA (Altman grade II). INTERVENTION: Subjects were randomized sequentially into 1 of 4 groups. Group I received isokinetic muscular strengthening exercises, group II received isokinetic exercise and continuous US, group III received isokinetic exercise and pulsed US treatment, and group IV was the control group. MAIN OUTCOME MEASURES: Therapeutic effects of isokinetic exercise were evaluated by changes in ambulation speed and the Lequesne index. In addition, changes in knee range of motion (ROM), visual analog scale for pain, and muscle peak torques during knee flexion and extension were compared. Compliance in each group was recorded. RESULTS: Each treated group had increased muscle peak torques and significantly reduced pain and disability after treatment and at follow-up. However, only patients in groups II and III had significant improvement in ROM and ambulation speed after treatment. Fewer participants in group III discontinued treatment due to knee pain during exercise. Patients in group III also showed the greatest increase in walking speed and decrease in disability after treatment and at follow-up. Gains in muscular strength in 60 degrees /s angular velocity peak torques were also noted in groups II and III. However, group III showed the greatest muscular strength gains with 180 degrees /s angular velocity peak torques after treatment and follow-up. CONCLUSIONS: US treatment could increase the effectiveness of isokinetic exercise for functional improvement of knee OA, and pulsed ultrasound has a greater effect than continuous US.     

Changes in sagittal ground reaction forces after intra-articular hyaluronate injections for knee osteoarthritis

OBJECTIVES: To examine the gait patterns and the sagittal ground reaction forces (GRFs) in persons with knee osteoarthritis (OA) after intra-articular injection of hyaluronate and to investigate the duration of its treatment effectiveness. DESIGN: Case-comparison study. SETTING: Gait laboratory in a tertiary care center. PARTICIPANTS: Fifteen subjects (30 knees) with symptomatic knee OA (stage I or II, according to the Ahlb?ck grading system), and 15 age-, mass-, and gender-matched non-OA control subjects (30 knees). INTERVENTION: After initial gait analysis, the group with knee OA received 5 weekly intra-articular injections of hyaluronate to bilateral knees. Gait analysis was performed again for the group with knee OA after the completion of hyaluronate injections. MAIN OUTCOME MEASURES: Forceplate sagittal GRFs and gait parameters of velocity, cadence, step length, and stride time. RESULTS: The distinctive 2-peak force vector GRF was lost in persons with knee OA. The first peak rise time was significantly delayed (P<.05). The group with knee OA also revealed slower walking velocity and cadence, as well as longer stride time, than the control group (P<.05). The distinctive 2-peak force vector GRF diagram could be recovered in patients with knee OA after the completion of hyaluronate injections. CONCLUSIONS: Gait patterns and GRFs improved significantly after intra-articular knee injection of hyaluronate in persons with Ahlb?ck stages I and II knee OA. The clinical treatment effect was immediate and may last for 6 months or more.     

超声波结合股四头肌肌力训练治疗老年膝关节骨关节炎

目的探讨超声波结合股四头肌肌力增强训练对老年膝关节骨关节炎的疗效. 方法将76例老年膝关节骨关节炎患者随机分为实验组和对照组,每组38例.实验组采用超声波结合股四头肌肌力训练,对照组应用综合物理疗法治疗.对患膝治疗前和治疗4周后的日常活动(ADL)能力、疼痛程度及伸直位最大负荷量进行评定. 结果实验组在缓解疼痛、改善膝关节ADL能力方面略优于对照组(P>0.05),但其股四头肌肌力较治疗前及对照组明显增强(P<0.01). 结论超声波结合股四头肌肌力强化训练治疗老年膝关节骨关节炎,可获得较满意的治疗结果.     

膝关节骨关节炎膝屈伸肌训练效果的差异性

目的 探讨膝关节骨关节炎患者屈、伸膝肌练习效果的差异性。方法 18例膝关节骨关节炎患者(26个患膝)进行3～6周、每周3次的肌力练习,伸膝肌和屈膝肌练习的程度相同。练习前、后测定60°/s、120°/s和180°/s等速运动的峰力矩、单次最佳做功和力矩加速能。结果 屈膝肌参数(包括60°/s的单次最佳做功,120°/s的峰力矩、单次最佳做功和力矩加速能,180°/s的峰力矩和力矩加速能)均较伸膝肌参数有显著增加。结论 膝关节骨关节炎患者的伸膝肌和屈膝肌的练习效果不同,屈膝肌力改善程度好于伸膝肌。伸膝肌在功能性活动中起的作用更大,必须更注重伸膝肌的练习。     

Effects of progressive resistance strength training on knee biomechanics during single leg step-up in persons with mild knee osteoarthritis

Background

The goal of this study was to determine if increasing strength in primary knee extensors and flexors would directly affect net knee joint moments during a common functional task in persons with knee osteoarthritis.

Methods

An exploratory single sample clinical trial with pre-post treatment measures was used to study volunteers with clinical diagnosis of mild knee osteoarthritis (OA) in one knee. Subjects participated in an individually supervised training program 3 times a week for eight weeks consisting of progressive resistive exercises for knee extensors and knee flexors. Pre and post training outcome assessments included: 1. Net internal knee joint moments, 2. Electromyography of primary knee extensors and flexors, and 3. Self-report measures of knee pain and function. The distribution of lower extremity joint moments as a percent of the total support moment was also investigated.

Findings

Pain, symptoms, activities of daily life, quality of life, stiffness, and function scores showed significant improvement following strength training. Knee internal valgus and hip internal rotation moments showed increasing but non-statistically significant changes post-training. There were no significant differences in muscle co-contraction activation of the Quadriceps and Hamstrings.

Interpretation

While exercise continues to be an important element of OA management, the results of this study suggest improvements in function, pain, and other symptoms, as a result of strength training may not be causally related to specific biomechanical changes in net joint moments.     

分米波理疗结合股四头肌肌力训练治疗老年人膝关节骨关节炎

目的　探讨分米波理疗结合股四头肌肌力强化训练对老年人膝关节骨关节炎的疗效。方法　将76例老年膝关节骨关节炎患者随机分为实验组和对照组 ,每组 38例。实验组采用分米波理疗结合股四头肌肌力训练 ,对照组应用综合物理疗法治疗。对患膝治疗前和治疗 4周后的日常活动 (ADL)能力 ,疼痛程度及伸直位最大负荷量进行评定。结果　实验组在缓解疼痛 ,改善膝关节ADL能力方面较对照组明显增强 (P <0 0 1)。结论　分米波理疗结合股四头肌肌力强化训练治疗老年膝关节骨关节炎 ,可获得较满意的治疗效果。     

The prevalence of knee pain and symptomatic knee osteoarthritis among veteran traumatic amputees and nonamputees

OBJECTIVE: To determine whether amputees have an increased risk of knee pain or symptomatic osteoarthritis (OA) compared with nonamputees. DESIGN: Retrospective cohort study. SETTING: Veterans Administration Patient Treatment and Outpatient Care files. PARTICIPANTS: All male unilateral (transtibial or transfemoral) traumatic amputee patients and a random sample of male nonamputees. Patients were excluded if they were younger than 40 years, had sustained a significant injury to their knee(s), or had a rheumatic disease. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The prevalence of knee pain and symptomatic knee OA. RESULTS: The age and average weight-adjusted prevalence ratio of knee pain among transtibial amputees, compared with nonamputees, was 1.3 (95% confidence interval [CI], 0.7-2.1) for the knee of the intact limb and 0.2 (95% CI, .05-0.7) for the knee of the amputated limb. The standardized prevalence ratio of knee pain in the intact limb and symptomatic OA among transfemoral amputees, compared with nonamputees, was 3.3 (95% CI, 1.5-6.3) and 1.3 (95% CI, 0.2-4.8), respectively. CONCLUSIONS: Stresses on the contralateral knee of amputees may contribute to secondary disability. Possible explanations include gait abnormalities, increased physiologic loads on the knee of the intact limb, and the hopping and stumbling behavior common in many younger amputees.     

Comparison of Intra-articular Hyaluronic Acid Injections With Transcutaneous Electric Nerve Stimulation for the Management of Knee Osteoarthritis: A Randomized Controlled Trial

Objective

To compare the effects of intra-articular hyaluronic acid (HA; ARTZ) and transcutaneous electric nerve stimulation (TENS) in the treatment of patients with knee osteoarthritis.

Design

A prospective, randomized controlled trial.

Setting

Rehabilitation clinic of a teaching hospital.

Participants

Patients with knee osteoarthritis (N=50; aged 51–80y) were randomly assigned to the HA group (n=27) or the TENS group (n=23).

Interventions

The HA group received intra-articular HA injection into the affected knee once a week for 5 consecutive weeks, and the TENS group received a 20- minute session of TENS 3 times a week for 4 consecutive weeks.

Main Outcome Measures

The primary outcome measures used were the visual analog scale (VAS) for pain and the Lequesne index. The secondary outcome measures were range of motion of the knee, walking time, pain threshold, patient global assessment, and disability in activities of daily living. All subjects were assessed at baseline, and at 2 weeks, 2 months, and 3 months after the treatments were completed.

Results

The TENS group exhibited a significantly greater improvement in VAS than the HA group at 2 weeks' follow-up (4.17±1.98 vs 5.31±1.78, respectively; P=.03). In addition, the TENS group also exhibited a significantly greater improvement in the Lequesne index than the HA group at 2 weeks' follow-up (7.78±2.08 vs 9.85±3.54, respectively; P=.01) and at 3 months' follow-up (7.07±2.85 vs 9.24±4.04, respectively; P=.03).

Conclusions

TENS with silver spike point electrodes was observed to be more effective than intra-articular HA injection for patients with knee osteoarthritis in improving the VAS for pain at 2 weeks' follow-up as well as the Lequesne index at 2 weeks' and 3 months' follow-up.     

Factors affecting self-reported pain and physical function in patients with hip osteoarthritis

Juhakoski R, Tenhonen S, Anttonen T, Kauppinen T, Arokoski JP. Factors affecting self-reported pain and physical function in patients with hip osteoarthritis.

Objective

To determine the factors associated with self-reported pain and physical function in patients with hip osteoarthritis (OA).

Design

Cross-sectional study.

Setting

Rehabilitation clinic in a Finnish hospital.

Participants

Participants with hip OA (N=118; 35 men, 83 women; age, 66.7±6.5y; range, 55-80y).

Interventions

Not applicable.

Main Outcome Measures

Self-reported pain and self-reported disease-specific physical function were recorded by using the Western Ontario McMaster Universities Osteoarthritis Index. Self-reported generic physical function was analyzed by using the Finnish version of the RAND 36-Item Short-Form Health Survey. As listed in the International Classification of Functioning, Disability and Health model, the effects of personal factors (age, sex, education, depression, life satisfaction, smoking, years of sporting activities), pathophysiologic factors (radiologic score of hip OA, body mass index [BMI], comorbidities, duration of knee pain) and body functions and structures (measurement of leg extensor power, passive internal rotation and flexion of the hip joint, the six-minute walk test [6MWT], Timed Up & Go [TUG] test, ten-meter walk test, sock test) were analyzed.

Results

The educational level (r=−.264, P<.001), comorbidities (r=.313, P<.001), and BMI (r=.252, P<.001) were identified as significant factors for self-reported disease-specific physical function as well as the educational level (r=.291, P<.001), life-satisfaction (r=−.319, P<.001), BMI (r=−.290, P<.001), and comorbidities (r=−.220, P<.005) for the self-reported generic physical function. No direct relationship with the pain and psychologic factors was detected. The number of comorbidities and duration of knee pain and life satisfaction explained 22% of self-reported pain. The number of comorbidities, passive hip flexion, and the TUG test explained 20% of self-reported disease-specific physical function whereas the passive hip flexion, 6MWT, and educational level explained 25% of self-reported generic physical function.

Conclusions

Educational level, life satisfaction, and number of comorbidities were identified as significant factors for both self-reported pain and physical functioning in hip OA. Performance measures are better predictors of physical function than pain in hip OA. Factors explaining disability and pain in hip OA are multidimensional and no single predicting factor was found to be superior to any other.     

Hyaluronic acid as a treatment for ankle osteoarthritis

Viscosupplementation refers to the concept of synovial fluid replacement with intra-articular injections of hyaluronic acid (HA) for the relief of pain associated with osteoarthritis (OA). Intra-articular viscosupplementation was approved by the Food and Drug Administration (FDA) in 1997. It is currently indicated only for the treatment of pain associated with knee OA. However, OA can occur in several of the weight-bearing joints of the foot and ankle. Ankle OA produces chronic disability that directly impacts the quality of life. There is only limited published literature relating to the use of HA in the ankle. This paper will review the authors’ experience, indications, clinical outcomes, and complications of viscosupplementation therapy in patients with ankle OA.     

Test methods to detect hip and knee muscle weakness and gait disturbance in patients with hip osteoarthritis

OBJECTIVE: To evaluate test methods for hip and knee muscle weakness and gait disturbance. DESIGN: Test-retest. SETTING: Orthopedic university clinic. PARTICIPANTS: Ten young (age, 36+/-6 y) and 13 elderly (age, 69+/-8 y) healthy volunteers and 11 patients (age, 69+/-8 y) with unilateral hip osteoarthritis (OA) were tested for muscular strength. Twenty-five volunteers (age, 42+/-14 y) underwent gait analysis. INTERVENTIONS: A dynamometer assessing maximal voluntary isometric force of hip and knee muscles and an optosensor walkway detecting limp were developed. Tests evaluated reproducibility and tolerance in patients with OA and elderly subjects. MAIN OUTCOME MEASURES: Relative coefficient of variation (CV%) and force (in newtons). RESULTS: CV% for unilateral strength measurements ranged from 7% to 12% for specific muscle groups. CV% for gait parameters ranged from 4% to 8%, except for the double-support phase. Tests were well tolerated, and no patient had to discontinue because of fatigue. Differences related to sex, age, and disease were detected. CONCLUSIONS: Our dynamometer system provides reliable measurements of hip and knee muscle strength in young and old people, and variation is comparable to previous data. Our photocell technique for gait analysis is reliable in people with normal gait. Both methods are attractive because they are affordable, nonstationary, and easy to use.     

股四头肌等张训练治疗膝关节骨关节病

采用股四头肌等张训练治疗膝关节骨关节病(59膝)并与另组接受理疗的51膝做了比较。结果显示,肌力训练组在缓解疼痛、改善关节日常动作能力方面优于理疗组,且股四头肌肌力有明显增强(P<0.05)。由于股四头肌力强化训练能增强膝关节的稳定性,所以对膝关节骨关节病有较满意的治疗结果。     

Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis

Fantini Pagani CH, Böhle C, Potthast W, Brüggemann G-P. Short-term effects of a dedicated knee orthosis on knee adduction moment, pain, and function in patients with osteoarthritis.

Objective

To analyze knee joint loading, subjective pain relief, and improvements in function in patients with osteoarthritis (OA) with the use of 2 orthosis adjustments.

Design

Patients were tested under 3 different conditions (without orthosis, orthosis at 4° valgus, and a neutral very flexible adjustment) in a crossover trial.

Setting

University gait analysis laboratory with 3-dimensional motion analysis and force platforms.

Participants

Patients (N=11) with a clinical and radiographic diagnosis of unilateral OA in the medial knee compartment.

Interventions

Patients wore a knee orthosis designed to unload the medial knee compartment for 4 weeks in 2 different adjustments (2 weeks in each adjustment).

Main Outcome Measures

Net knee adduction moment and net knee adduction angular impulse during the stance phase were analyzed by using inverse dynamics. Subjective pain relief, stiffness, and function improvement were evaluated using a questionnaire (Western Ontario and McMaster Universities Osteoarthritis Index). A 6-minute walk test and stair-climbing test also were performed.

Results

Both orthosis adjustments induced subjective pain relief and improvement in function compared with the condition without orthosis. Knee adduction moment was significantly decreased with both adjustments, whereas the decrease observed with the 4° valgus adjustment was significantly greater than the flexible adjustment (25% vs 12.5%). Compared with the condition without orthosis, changes in knee adduction angular impulse of 29% and 15% were found with 4° valgus and the neutral flexible orthosis, respectively. Time required for the stair-climbing activity was significantly decreased using the orthosis in 4° valgus adjustment compared with the condition without orthosis. No significant differences were observed among conditions during the 6-minute walk test.

Conclusions

Both orthosis adjustments were effective in decreasing symptoms; however, a decrease in knee loading was more effective using the 4° valgus adjustment, which could contribute to avoidance of disease progression.     

Limited effect of a self-management exercise program added to spa therapy for increasing physical activity in patients with knee osteoarthritis: A quasi-randomized controlled trial

BackgroundThe efficacy of spa therapy in osteoarthritis (OA) has ever been demonstrated, with a good level of evidence for pain and disability. The effect of a self-management program with spa therapy on physical activity (PA) level has never been demonstrated.ObjectiveThis study aimed to assess, at 3 months, the effectiveness of 5 sessions of a self-management exercise program in patients with knee OA (KOA) who benefit from 18 days of spa therapy and received an information booklet (on proposed physical exercises) on improvement in at least one PA level.MethodsThis was an interventional, multicentre, quasi-randomized controlled trial with a cluster randomized design (1-month period). People 50 to 75 years old with symptomatic knee OA were included in 3 spa therapy centres in France (Bourbon Lancy, Le Mont Dore, Royat). Both groups received conventional spa therapy sessions during 18 days and an information booklet on the benefits of PA practice for KOA. The intervention group additionally received 5 self-management exercise sessions. The main outcome was improvement in at least one PA level according to the International Physical Activity Questionnaire (IPAQ) short-form categorical score (low to moderate or high, or moderate to high) at 3 months. Secondary outcomes were the evolution of PA (MET-min/week), disability, pain, anxiety, depression, self-efficacy, fears and beliefs concerning KOA, barriers to and facilitators of regular PA practice, consumption of painkillers and adherence to physical exercise program at 3 months. Assessors but not participants or caregivers were blinded.ResultsIn total, 123 patients were randomized, 54 to the intervention group and 69 to the control group. Considering the main outcome, at 3 months, 37% of patients in the intervention group showed improvement in at least one PA level according to the IPAQ categorical score versus 30.4% in the control group (P = 0.44). In the intervention group, 13 (24.1%) patients showed improvement from low to moderate PA level (vs. 8 [11.6%] in the control group), 2 (3.7%) from low to high (vs. 2 [2.9%]) and 5 (9.3%) from moderate to highvs. 11 [15.9%]). Both intervention and control groups showed increased IPAQ continuous scores (MET-min/week) at 3 months, although not significantly. HAD anxiety and depression scores were significantly reduced in the intervention group (P = 0.001 and P = 0.049, respectively) and the perception of PA was better in the intervention than control group for motivation and barriers scores (P = 0.019 and P = 0.002, respectively).ConclusionsThis study showed the lack of impact of a short self-management program on PA level in addition to 18-day spa therapy for KOA, but both intervention and control groups showed improved PA level.     

Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis

Chen C-Y, Chen C-L, Hsu SC-C, Chou S-W, Wang K-C. Effect of magnetic knee wrap on quadriceps strength in patients with symptomatic knee osteoarthritis.

Objective

To determine the effects of magnetic knee wrap on isokinetic quadriceps strength in patients with painful knee osteoarthritis (OA).

Design

Randomized, double-blinded, placebo-controlled and before-after trial.

Setting

Rehabilitation clinic in a tertiary hospital.

Participants

Eligible patients (N=50) (mean age ± SD, 66.0±8.6y) with mild to moderate knee OA were recruited from the outpatient department and 37 (74%) completed the trial. Only 3 (6%) withdrew due to study-related adverse effects.

Interventions

Wearing the active (n=24) or sham (n=26) magnetic knee wrap for 12 weeks.

Main Outcome Measures

The primary outcome measure was isokinetic quadriceps strength. Secondary outcome measures included the Health Assessment Questionnaire Disability Index (HAQ-DI) and the Health Assessment Questionnaire (HAQ) Pain Scale.

Results

Using intention-to-treat analyses, the peak isokinetic quadriceps strength increased significantly in the treated leg at 30°/s (P=.007) and 60°/s (P=.022) after wearing the magnetic knee wrap. Compared with baseline, the median strength increase for the treated leg in the study group significantly exceeded that in the control group at week 4 (.05Nm/kg vs −.09Nm/kg at 60°/s, P=.038) and week 12 (30°/s, .09Nm/kg vs .04Nm/kg, P=.044; 60°/s, .17Nm/kg vs .02Nm/kg, P=.031). The HAQ-DI and HAQ Pain Scales improved significantly in both groups. Compared with baseline, the improvement at week 12 in terms of the HAQ-DI in the study group significantly exceeded that in the control group.

Conclusions

Magnetic knee wrap may significantly facilitate isokinetic quadriceps strength in patients with mild to moderate knee OA.     

Management of knee osteoarthritis: knee lavage combined with hylan versus hylan alone

OBJECTIVE: To assess the difference in efficacy between knee lavage plus the standard hylan G-F 20 (a derivative of hyaluronan) protocol and the standard hylan G-F 20 as per standard usage protocol alone for the treatment of knee osteoarthritis (OA). DESIGN: Nonrandomized prospective study in which patients chose their treatment group. Follow-up averaged 1.1 years. SETTING: Faculty practice of a single physician at a major teaching hospital. PARTICIPANTS: Eighty-one patients with documented knee OA on magnetic resonance imaging. INTERVENTIONS: Group 1 (n=44) received a single-needle lavage 1 week before the standard hylan G-F 20 protocol; group 2 (n=37) received the standard hylan G-F 20 protocol alone. MAIN OUTCOME MEASURES: Pre- and posttreatment scores on the Lysholm-II Questionnaire and a visual analog scale (VAS) were documented for each patient. The Wilcoxon signed-rank test was used for statistical analysis. RESULTS: A successful outcome was noted in 79.5% of group 1 patients and in 54% of group 2 patients (P<.05). CONCLUSIONS: In the management of knee OA, the use of knee lavage before viscosupplementation with hylan G-F 20 yields better results than using hylan G-F 20 alone. The presence of radiologic grade IV knee OA or moderate to severe patellofemoral arthritis are negative prognostic factors.     

Physical function in men with and without hip osteoarthritis

OBJECTIVES: To assess the subjective joint pain and function and the objective physical function of lower extremities in men with hip osteoarthritis (OA), to compare the results with those from age- and sex-matched controls, and to evaluate the reproducibility of the functional tests. DESIGN: A cross-sectional study. SETTING: Rehabilitation clinic in a university hospital. PARTICIPANTS: Twenty-seven volunteer men (age range, 47-64 y) with hip OA and 30 randomly selected, healthy age-matched men. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The Western Ontario and McMaster Universities (WOMAC) Osteoarthritis Index, passive range of motion (ROM) of the hip joint measured with a standard goniometer, and physical functioning evaluated with a test battery. RESULTS: The function and the composite scores of the WOMAC correlated (P<.05) with the degree of radiographically estimated severity of OA. The hips of the control subjects were 13% to 52% more flexible (P range, <.0001-.001) than those of the OA patients. The more the hip was deteriorated, the lower the ROM of the hip was in abduction and in both internal and external rotations. The reproducibility of marching on-the-spot and walking up and down stairs was good in both groups, but in other functional tests the reproducibility was poorer. The controls were significantly (P range, <.05-.01) better at marching, ascending and descending stairs, performing a 25-m walk, and in flexion-extension and abduction-adduction movements compared with the hip OA patients. Most of the WOMAC items were significantly (P<.05) related to the performance tests. CONCLUSIONS: The WOMAC and the ROM can be considered useful hip OA indicators. Marching on-the-spot and walking up and down stairs are the most reproducible physical functioning tests and can thus be recommended for use for patients with hip OA.     

Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis

Liikavainio T, Lyytinen T, Tyrväinen E, Sipilä S, Arokoski JP. Physical function and properties of quadriceps femoris muscle in men with knee osteoarthritis.

Objectives

To examine the objective physical function of the lower extremities, to measure the properties of quadriceps femoris muscle (QFM), and to assess subjective disabilities in men with knee osteoarthritis (OA) and to compare the results with those obtained from age- and sex-matched control subjects.

Design

Cross-sectional study.

Setting

Rehabilitation clinic in a university hospital.

Participants

Male volunteers (n=54) (age range, 50-69y) with knee OA and randomly selected healthy, age- and sex-matched control subjects (n=53).

Interventions

Not applicable.

Main Outcome Measures

Physical function evaluated with a test battery including the QFM composition measurement, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and the RAND 36-Item Short-Form Health Survey, version 1.0.

Results

Knee OA patients had 13% to 26% poorer (P range, .050-.001) physical function and muscle strength compared with the controls. There were also significant differences in QFM composition. WOMAC (P range, .050-.001) and muscle strength (P<.001) associated with physical function tests, but subjective pain correlated with neither physical function nor muscle strength in knee OA patients. The radiographic knee OA grade did not have any significant effect on physical function, but passive knee motion, knee extension strength, and WOMAC were related to the severity of the disease (P<.05).

Conclusions

The patients with knee OA exhibited impaired physical function and muscle strength and QFM composition compared with healthy controls. The severity of radiographic knee OA clearly had adverse effects on functional ability at the later stages of the disease. The results highlight the effect of QFM strength on physical function as well as the importance of patient's subjective and objective physical function when deciding on knee OA treatment policy.     

Geotherapy combined with kinesiotherapy is efficient in reducing pain in patients with osteoarthritis

IntroductionPatients with osteoarthritis (OA) suffer from a degenerative disease that causes several physical disabilities and pain. Despite the few studies involving exercise combined with geotherapy (a therapy using poultices made from earth materials such as clay or mud) for patients with OA, this subject is still under debate, as effect of the earth material remains unclear. The aim of this study was to compare pain, joint stiffness and disability in patients who underwent kinesiotherapy (K) or geotherapy combined with kinesiotherapy (GK).MethodThis was a clinical randomized single-blinded prospective study, in which 48 individuals participated. Volunteers were evaluated for pain perception, pressure pain tolerance thresholds, and responded to questionnaires about pain, joint stiffness and physical disability (WOMAC) and about symptoms and disability (Lequesne Algofunctional Index). Patients in K group underwent 15 twice-weekly sessions of kinesiotherapy consisting of stretching and strengthening exercises for lower limbs. GK patients received a poultice of powder dolomite mixed with hot water on the knees for 25 min before each of the 15 sessions of the same kinesiotherapy program.ResultsBoth interventions were effective in reducing pain, joint stiffness and physical disability (p < 0.001), and in increasing pressure pain thresholds (p < 0.05); however, patients who underwent GK presented a more pronounced reduction in pain perception (p = 0.006) than those in K group. They also exhibited more tolerance to pain in all sites evaluated.ConclusionBoth interventions were effective in reducing pain, joint stiffness and physical disability, but GK produced significantly better results in pain perception.     

The Effects of Scapulothoracic Bursa Injections in Patients With Scapular Pain: A Pilot Study

Chang WH, Im SH, Ryu JA, Lee SC, Kim JS. The effects of scapulothoracic bursa injections in patients with scapular pain: a pilot study.

Objective

To assess the effects of steroid plus hyaluronate injections for scapulothoracic bursitis in patients with scapular pain.

Design

Prospective open-label unicenter trial with a 3-month follow-up.

Setting

University rehabilitation hospital.

Participants

Twenty-two cases of suspected scapulothoracic bursitis.

Intervention

Injections into scapulothoracic bursa were performed with steroid plus hyaluronate. Injections were administered once a week for 3 weeks.

Main Outcome Measures

Visual analog scale (VAS), Rubin scale, adverse events, and injection-associated complications.

Results

Mean outcome scores at 3-month follow-up visits showed significant improvements versus baseline (mean VAS increased from 7.8 to 2.2) (P<.05). Furthermore, mean VAS scores at 1, 2, and 3 weeks after treatment commencement showed significant improvements versus baseline (P<.05). No serious complication occurred during the study.

Conclusions

Scapulothoracic bursitis should be considered when treating patients with perimarginal scapular pain or subscapular pain. Our findings show that steroid plus hyaluronate injections into the scapulothoracic bursa provide an effective means of treating patients with scapulothoracic bursitis.