Operative treatment of the painful sternoclavicular joint: a new technique using interpositional arthroplasty

This study presents the results of a new surgical technique, resection of the medial end of the clavicle and interposition of the sternal head of the sternocleidomastoid muscle, that was used for the treatment of 17 painful sternoclavicular (SC) joints, 14 of which were available for review. The etiology of the pain was primary or posttraumatic degenerative arthritis in 10, osteitis condensans in 2, and SC joint infection in 2. The results of surgery, evaluated with the Rockwood SC joint rating scale and examination of the patients, were determined at a mean follow-up of 46 months. Results were excellent in 4 shoulders, good in 6, fair in 3, and poor in 1. All of the fair and poor results occurred in workers' compensation patients. Interposition arthroplasty performed in conjunction with resection of the medial clavicle proved to be a safe and effective method of treatment for the painful, degenerative or septic SC joint.     

Resistance training and bone mineral density in adolescent females

OBJECTIVE: To examine the effects of 15 months of resistance training on bone mineral density (BMD) in female adolescents (aged 14 to 17 years). STUDY DESIGN: Participants were randomly assigned to either a training (n = 46) or control group (n = 21). BMD and body composition were measured by using dual-energy x-ray absorptiometry. Strength was assessed by means of one-repetition maximums for the leg press and bench press. The exercise group trained 30 to 45 minutes a day, 3 days per week, using 15 different resistance exercises. Control participants remained sedentary (<2 hours of exercise per week). RESULTS: Leg strength increased significantly (40%) in the exercise group, but there were no changes in the control group. Femoral neck BMD increased significantly in the training group (1.035 to 1.073 g/cm(2), P <.01) but not in the control group (1.034 to 1.048 g/cm(2)). No significant changes were seen in either group in lumbar spine BMD (1.113 to 1.142 g/cm(2) and 1.158 to 1.190 g/cm(2), respectively) or total body BMD (1.103 to 1.134 g/cm(2) and 1.111 to 1.129 g/cm(2), respectively). CONCLUSION: Resistance training is a potential method for increasing bone density in adolescents, although such a program would be best done as part of the school curriculum.     

Trait anxiety and tamoxifen effects on bone mineral density and sex hormone- binding globulin

OBJECTIVE: Tamoxifen therapy preserves BMD of the lumbar spine and increases levels of SHBG. We assessed whether trait anxiety, a factor linked with a reactive endocrine system, is associated with differential changes in BMD and SHBG levels in response to tamoxifen therapy. METHODS: Postmenopausal women (N= 140) with axillary-node-negative breast cancer participated in a 2-year randomized, double-blind, placebo-controlled trial of tamoxifen (10 mg twice a day). Levels of BMD and SHBG were assessed at baseline and at 3, 6, 12, 18, and 24 months. RESULTS: Trait anxiety predicted tamoxifen-induced changes in lumbar spine BMD; high levels of trait anxiety were associated with significantly greater lumbar spine BMD at 3, 12, and 24 months (p values <.05) for women on tamoxifen therapy. High anxiety also was associated with lower levels of SHBG for women using tamoxifen at 3, 12, 18, and 24 months (p values <.05). CONCLUSIONS: Trait anxiety is associated with greater preservation of lumbar spine BMD in response to tamoxifen and with a suppression of tamoxifen-induced increases in SHBG. Trait anxiety and other affective traits may serve as indicators of underlying physiological processes that moderate the effects of estrogen receptor modulators (such as tamoxifen) in clinical trials. Such data may help to elucidate the physiological mechanisms responsible for some of the variation in individual responses to treatment.