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Sample records for abnormal patellofemoral joint

  1. Functional MR imaging of the patellofemoral joint

    International Nuclear Information System (INIS)

    Muhle, C.; Brossmann, J.; Heller, M.

    1995-01-01

    Conventional X-ray examinations of the patellofemoral joint in 30 , 60 and 90 of knee flexion demonstrate the position of the patella. On the other hand, they have been shown to be insufficient for the diagnosis of patellofemoral maltracking in the critical range between 30 of flexion and full extension. Motion-triggered and ultrafast MRI offer new possibilities for functional diagnosis of the patellofemoral joint under active knee motion. Functional MRI of the patellofemoral joint is suggested as an alternative to arthroscopy, particularly in patients with anterior knee pain or suspected patellar maltracking. (orig.) [de

  2. On Patellofemoral joint replacement - Clinical, radiological, and numerical studies.

    NARCIS (Netherlands)

    Jonbergen, J.P.W. van

    2011-01-01

    Patellofemoral, osteoarthritis, joint replacement, arthroplasty, anterior knee pain Isolated patellofemoral joint osteoarthritis is a degenerative disorder of the knee estimated to occur in approximately 4% to 24% of patients with osteoarthritis of the knee. Mild isolated patellofemoral

  3. EFFECT OF HEEL LIFTS ON PATELLOFEMORAL JOINT STRESS DURING RUNNING.

    Science.gov (United States)

    Mestelle, Zachary; Kernozek, Thomas; Adkins, Kelly S; Miller, Jessica; Gheidi, Naghmeh

    2017-10-01

    Patellofemoral pain is a debilitating injury for many recreational runners. Excessive patellofemoral joint stress may be the underlying source of pain and interventions often focus on ways to reduce patellofemoral joint stress. Heel lifts have been used as an intervention within Achilles tendon rehabilitation programs and to address leg length discrepancies. The purpose of this study was to examine the effect of running with heel lifts on patellofemoral joint stress, patellofemoral stress impulse, quadriceps force, step length, cadence, and other related kinematic and spatiotemporal variables. A repeated-measures research design. Sixteen healthy female runners completed five running trials in a controlled laboratory setting with and without 11mm heel lifts inserted in a standard running shoe. Kinetic and kinematic data were used in combination with a static optimization technique to estimate individual muscle forces. These data were inserted into a patellofemoral joint model which was used to estimate patellofemoral joint stress and other variables during running. When running with heel lifts, peak patellofemoral joint stress and patellofemoral stress impulse were reduced by a 4.2% (p=0.049) and 9.3% (p=0.002). Initial center of pressure was shifted anteriorly 9.1% when running with heel lifts (p0.05) were shown between conditions. Heel lift use resulted in decreased patellofemoral joint stress and impulse without associated changes in step length or frequency, or other variables shown to influence patellofemoral joint stress. The center of pressure at initial contact was also more anterior using heel lifts. The use of heel lifts may have therapeutic benefits for runners with patellofemoral pain if the primary goal is to reduce patellofemoral joint stress. 3b.

  4. Medium term results of Avon patellofemoral joint replacement

    Directory of Open Access Journals (Sweden)

    Praveen K Sarda

    2011-01-01

    Conclusion: The Avon patellofemoral joint replacement provides predictably good results and excellent survivorship in the medium term, for isolated patellofemoral arthritis. However, progression of tibiofemoral arthritis remains unpredictable and therefore patient selection is crucial to ensure success. Clicking remains a potential problem and can compromise the postoperative results in upto 15% of the cases.

  5. A systematised MRI approach to evaluating the patellofemoral joint

    Energy Technology Data Exchange (ETDEWEB)

    Chhabra, Avneesh; Subhawong, Ty K.; Carrino, John A. [Johns Hopkins Hospital, Russell H. Morgan Department of Radiology and Radiological Science, Baltimore, MD (United States)

    2011-04-15

    Knee pain in young patients is a common indication for knee MRI. Many static and dynamic internal derangements of the patellofemoral joint in these patients lead to various secondary MRI findings. This article focuses on how to systematically approach, detect, and emphasize the importance of these findings in the diagnosis of patellofemoral tracking and impingement syndromes with relevant case examples. (orig.)

  6. Kinematic CT and MR imaging of the patellofemoral joint

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    Muhle, C.; Brossmann, J.; Heller, M. [Klinik fuer Radiologische Diagnostik, Christian-Albrechts-Universitaet, Kiel (Germany)

    1999-04-01

    Anterior knee pain is a frequently encountered orthopedic symptom and is often associated with patellofemoral malalignment, which may cause chondromalacia of the patella. The difficulty in determining the patellar position between 0 and 30 of knee flexion with a conventional axial radiographic examination is well known. The introduction of computed tomography (CT) and magnetic resonance (MR) imaging for the diagnosis of knee joint abnormalities has enabled assessment of the patellar position in this critical range. More recently, emphasis has been placed on dynamic visualization of patellar motion to detect an abnormal tracking pattern. The important influence of the quadriceps muscle on the patellar tracking pattern is well known and has been examined during active knee extension by the use of ultrafast CT, and motion-triggered and ultrafast MR imaging. This article provides an overview of the current status of kinematic CT and MR imaging in the diagnosis of patellofemoral alignment, its clinical implications, and future directions. (orig.) With 13 figs., 5 tabs., 47 refs.

  7. Increasing running step rate reduces patellofemoral joint forces.

    Science.gov (United States)

    Lenhart, Rachel L; Thelen, Darryl G; Wille, Christa M; Chumanov, Elizabeth S; Heiderscheit, Bryan C

    2014-03-01

    Increasing step rate has been shown to elicit changes in joint kinematics and kinetics during running, and it has been suggested as a possible rehabilitation strategy for runners with patellofemoral pain. The purpose of this study was to determine how altering step rate affects internal muscle forces and patellofemoral joint loads, and then to determine what kinematic and kinetic factors best predict changes in joint loading. We recorded whole body kinematics of 30 healthy adults running on an instrumented treadmill at three step rate conditions (90%, 100%, and 110% of preferred step rate). We then used a 3-D lower extremity musculoskeletal model to estimate muscle, patellar tendon, and patellofemoral joint forces throughout the running gait cycles. In addition, linear regression analysis allowed us to ascertain the relative influence of limb posture and external loads on patellofemoral joint force. Increasing step rate to 110% of the preferred reduced peak patellofemoral joint force by 14%. Peak muscle forces were also altered as a result of the increased step rate with hip, knee, and ankle extensor forces, and hip abductor forces all reduced in midstance. Compared with the 90% step rate condition, there was a concomitant increase in peak rectus femoris and hamstring loads during early and late swing, respectively, at higher step rates. Peak stance phase knee flexion decreased with increasing step rate and was found to be the most important predictor of the reduction in patellofemoral joint loading. Increasing step rate is an effective strategy to reduce patellofemoral joint forces and could be effective in modulating biomechanical factors that can contribute to patellofemoral pain.

  8. Evaluation of the patellofemoral joint with simple RX and TAC

    International Nuclear Information System (INIS)

    Mantilla M, Isabel; Villa R, Alfredo

    1992-01-01

    The different radiological and tomographic methods used in the evaluation o the patellofemoral joint are described, comparing the sensitivity of the different measurements and their correlation, and their relationship with the clinical presentation of the patient. The data were obtained from a comparative study in which radiological and tomographic studies were performed to a group of patients whose symptoms were related to the patellofemoral joints

  9. Prevalence of abnormal patellofemoral congruence in elite American football players and association with quadriceps isokinetic testing.

    Science.gov (United States)

    Brown, Christopher A; Carragee, Cat; Sox-Harris, Alex; Merchant, Alan C; Mcadams, Timothy R

    2014-02-01

    Abnormal patellofemoral joint alignment has been discussed as a potential risk factor for patellofemoral disorders and can impact the longevity of any elite athlete's career. The prevalence of abnormal patellofemoral congruence in elite American football athletes is similar to the general population and does not have a relationship with quadriceps isokinetic testing. A total of 125 athletes (220 knees) from the 2011 National Football League (NFL) Combine database who had radiographic and isokinetic studies were reviewed. Congruence angles (CA) and lateral patellofemoral angles (LPA) were calculated on a Merchant radiographic view. Isokinetic testing was used to determine quadriceps-to-hamstring strength (Q/H) ratio and side-to-side deficits. The relationships between abnormal CA and LPA with Q/H ratios, side-to-side deficits, and body mass index (BMI) were examined in separate logistic regression models. A Chi-square test was used to examine the association between CA and player position. Of all, 26.8% of the knees (95% CI: 21.1-33.2%) had an abnormal CA. Knees with normal CA (n = 161) did not significantly differ from those with an abnormal CA (n  = 59) in Q/H ratios (mean: 0.699 vs. 0.728, p = 0.19) or side-to-side quadriceps deficits (mean: 4.0 vs. 1.24, p  = 0.45). For each point increase in BMI, the odds ratio (OR) of abnormal congruence increased by 11.4% (p = 0.002). Of all the knees, 4.1% (95% CI: 1.9-7.6%) had an abnormal LPA, and this was not associated with Q/H ratios (p  =  0.13). For each point increase in BMI, the odds of abnormal LPA increased by 16% (p  = 0.036). CA abnormality had much higher odds of having an abnormal LPA (OR: 5.96, p = 0.014). We found that abnormal patellofemoral radiographic alignment in elite American football players is relatively common and there was no association with isokinetic testing. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  10. Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation

    OpenAIRE

    Syed, Farhan; Jenner, Edward; Faisal, Mohammad

    2015-01-01

    Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR) in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies...

  11. Patellofemoral Joint Loads During Running at the Time of Return to Sport in Elite Athletes With ACL Reconstruction.

    Science.gov (United States)

    Herrington, Lee; Alarifi, Saud; Jones, Richard

    2017-10-01

    Patellofemoral joint pain and degeneration are common in patients who undergo anterior cruciate ligament reconstruction (ACLR). The presence of patellofemoral joint pain significantly affects the patient's ability to continue sport participation and may even affect participation in activities of daily living. The mechanisms behind patellofemoral joint pain and degeneration are unclear, but previous research has identified altered patellofemoral joint loading in individuals with patellofemoral joint pain when running. It is unclear whether this process occurs after ACLR. To assess the patellofemoral joint stresses during running in ACLR knees and compare the findings to the noninjured knee and matched control knees. Controlled laboratory study. Thirty-four elite sports practitioners who had undergone ACLR and 34 age- and sex-matched controls participated in the study. The participants' running gait was assessed via 3D motion capture, and knee loads and forces were calculated by use of inverse dynamics. A significance difference was found in knee extensor moment, knee flexion angles, patellofemoral contact force (about 23% greater), and patellofemoral contact pressure (about 27% greater) between the ACLR and the noninjured limb ( P ≤ .04) and between the ACLR and the control limb ( P ≤ .04); no significant differences were found between the noninjured and control limbs ( P ≥ .44). Significantly greater levels of patellofemoral joint stress and load were found in the ACLR knee compared with the noninjured and control knees. Altered levels of patellofemoral stress in the ACLR knee during running may predispose individuals to patellofemoral joint pain.

  12. Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation.

    Science.gov (United States)

    Syed, Farhan; Jenner, Edward; Faisal, Mohammad

    2015-01-01

    Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR) in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded.

  13. Patellofemoral Joint Replacement and Nickel Allergy: An Unusual Presentation

    Directory of Open Access Journals (Sweden)

    Farhan Syed

    2015-01-01

    Full Text Available Metal allergy is an unusual complication of joint replacement that may cause aseptic loosening and necessitate joint revision surgery. We present the case of nickel allergy causing aseptic loosening following patellofemoral joint replacement (PFJR in a 54-year-old male. Joint revision surgery to a nickel-free total knee replacement was performed with good results. Our literature review shows that there is no evidence to guide the management of metal allergy in PFJR. The evidence from studies of total knee replacement is limited to retrospective case series and case reports and gives contradictory recommendations. The optimal management strategy for metal allergy in PFJR is not clear. We recommend allergy testing in patients with history of metal allergy and use of an allergen-free implant in those with positive tests. As there is no gold standard test to establish metal allergy, the choice of test should be guided by availability and recommendation from the local unit of dermatology and allergy testing. We recommend investigation for metal allergy in patients with implant loosening where other causes have been excluded.

  14. Correlation between radiographic findings of osteoarthritis and arthroscopic findings of articular cartilage degeneration within the patellofemoral joint

    Energy Technology Data Exchange (ETDEWEB)

    Kijowski, Richard; Blankenbaker, Donna; Stanton, Paul; De Smet, Arthur [University of Wisconsin Hospital Clinical Science Center-E3/311, Department of Radiology, Madison, WI (United States); Fine, Jason [University of Wisconsin Clinical Science Center-K6/4675, Department of Statistics, Madison, WI (United States)

    2006-12-15

    To correlate radiographic findings of osteoarthritis on axial knee radiographs with arthroscopic findings of articular cartilage degeneration within the patellofemoral joint in patients with chronic knee pain. The study group consisted of 104 patients with osteoarthritis of the patellofemoral joint and 30 patients of similar age with no osteoarthritis of the patellofemoral joint. All patients in the study group had an axial radiograph of the knee performed prior to arthroscopic knee surgery. At the time of arthroscopy, each articular surface of the patellofemoral joint was graded using the Noyes classification system. Two radiologists retrospectively reviewed the knee radiographs to determine the presence of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts. The sensitivity and specificity of the various radiographic features of osteoarthritis for the detection of articular cartilage degeneration within the patellofemoral joint were determined. The sensitivity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 73%, 37%, 4%, and 0% respectively. The specificity of marginal osteophytes, joint-space narrowing, subchondral sclerosis, and subchondral cysts for the detection of articular cartilage degeneration within the patellofemoral joint was 67%, 90%, 100%, and 100% respectively. Marginal osteophytes were the most sensitive radiographic feature for the detection of articular cartilage degeneration within the patellofemoral joint. Joint-space narrowing, subchondral sclerosis, and subchondral cysts were insensitive radiographic features of osteoarthritis, and rarely occurred in the absence of associated osteophyte formation. (orig.)

  15. Effects of front and back squat techniques on patellofemoral joint kinetics in males

    OpenAIRE

    Sinclair, Jonathan Kenneth; Atkins, Stephen; Kudiersky, Nik; Taylor, Paul John; Vincent, Hayley

    2015-01-01

    Purpose: The barbell squat is fundamental in strength and conditioning, with two principal variants; the back and front squat. Unfortunately, the propensity for injury is high particularly at the knee. The aim of the current investigation was examine the influence of front and back squat variations on patellofemoral joint load.\\ud Methods: Patellofemoral loads were obtained from thirty-five experienced male participants, who completed both back and front squats at 70% of 1 RM. Differences bet...

  16. Effects of front and back squat techniques on\\ud patellofemoral joint kinetics in males.

    OpenAIRE

    Sinclair, J; Atkins, Stephen John; Kudiersky, N; Taylor, P J; Vincent, H

    2015-01-01

    Purpose: The barbell squat is fundamental in strength and conditioning, with two principal variants; the back and front\\ud squat. Unfortunately, the propensity for injury is high particularly at the knee. The aim of the current investigation was\\ud examine the influence of front and back squat variations on patellofemoral joint load.\\ud Methods: Patellofemoral loads were obtained from thirty-five experienced male participants, who completed both back\\ud and front squats at 70% of 1 RM. Differ...

  17. Femoral component rotation in patellofemoral joint replacement: a study protocol for a prospective observational study.

    Science.gov (United States)

    Westerbeek, Robin E; Derks, Rosalie P H; Zonneveld, Bas J G L; van Jonbergen, Hans-Peter W

    2015-01-01

    Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. The short and mid-term outcomes are related to malposition and unexplained pain. Whether external rotation of the femoral component in isolated patellofemoral joint replacement is required is unclear. The primary aim of this study is to determine the CT-measured femoral component rotation of patellofemoral joint replacement relative to the transepicondylar axis. The secondary aim is to correlate the CT-measured femoral component rotation with the clinical outcomes at 1-year follow-up as assessed with the KOOS questionnaire. We designed a prospective observational study with medical research ethics committee and institutional review board approval. A total of 40 patients who will be treated with patellofemoral joint replacement for isolated patellofemoral osteoarthritis will be included. Intra-operatively, rotation of the femoral component will be assessed using anatomical landmarks including the epicondylar axis, Whiteside's line, and lower leg axis. The aim is to insert the femoral component between 3 and 6 degrees external rotation relative to the transepicondylar axis. Two experienced musculoskeletal radiologists will measure the angle between the transepicondylar axis and the femoral component, two to three days after surgery. The primary outcome is the CT-based femoral component rotation of the prosthesis relative to the transepicondylar axis. The secondary outcome is the patient reported KOOS questionnaire at 1-year follow-up. Successful completion of this study will provide data on the actual amount of femoral component rotation in patellofemoral joint replacement, and its relationship with clinical results. (Netherlands Trial Register NTR4175).

  18. A geometric approach to study the contact mechanisms in the patellofemoral joint of normal versus patellofemoral pain syndrome subjects.

    Science.gov (United States)

    Islam, Kamrul; Duke, Kajsa; Mustafy, Tanvir; Adeeb, Samer M; Ronsky, Janet L; El-Rich, Marwan

    2015-01-01

    The biomechanics of the patellofemoral (PF) joint is complex in nature, and the aetiology of such manifestations of PF instability as patellofemoral pain syndrome (PFPS) is still unclear. At this point, the particular factors affecting PFPS have not yet been determined. This study has two objectives: (1) The first is to develop an alternative geometric method using a three-dimensional (3D) registration technique and linear mapping to investigate the PF joint contact stress using an indirect measure: the depth of virtual penetration (PD) of the patellar cartilage surface into the femoral cartilage surface. (2) The second is to develop 3D PF joint models using the finite element analysis (FEA) to quantify in vivo cartilage contact stress and to compare the peak contact stress location obtained from the FE models with the location of the maximum PD. Magnetic resonance images of healthy and PFPS subjects at knee flexion angles of 15°, 30° and 45° during isometric loading have been used to develop the geometric models. The results obtained from both approaches demonstrated that the subjects with PFPS show higher PD and contact stresses than the normal subjects. Maximum stress and PD increase with flexion angle, and occur on the lateral side in healthy and on the medial side in PFPS subjects. It has been concluded that the alternative geometric method is reliable in addition to being computationally efficient compared with FEA, and has the potential to assess the mechanics of PFPS with an accuracy similar to the FEA.

  19. Differences in the stress distribution in the distal femur between patellofemoral joint replacement and total knee replacement: a finite element study

    NARCIS (Netherlands)

    van Jonbergen, H.P.; Innocenti, B.; Gervasi, G.L.; Labey, L.; Verdonschot, N.J.

    2012-01-01

    BACKGROUND: Patellofemoral joint replacement is a successful treatment option for isolated patellofemoral osteoarthritis. However, results of later conversion to total knee replacement may be compromised by periprosthetic bone loss. Previous clinical studies have demonstrated a decrease in distal

  20. Functional MR imaging of the patellofemoral joint; Funktionelle MRT des Femoropatellargelenkes

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, C. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany); Brossmann, J. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik, Kiel Univ. (Germany)

    1995-02-01

    Conventional X-ray examinations of the patellofemoral joint in 30 , 60 and 90 of knee flexion demonstrate the position of the patella. On the other hand, they have been shown to be insufficient for the diagnosis of patellofemoral maltracking in the critical range between 30 of flexion and full extension. Motion-triggered and ultrafast MRI offer new possibilities for functional diagnosis of the patellofemoral joint under active knee motion. Functional MRI of the patellofemoral joint is suggested as an alternative to arthroscopy, particularly in patients with anterior knee pain or suspected patellar maltracking. (orig.) [Deutsch] Tangentialaufnahmen der Patella in 30 -, 60 - und 90 -Kniebeugung koennen zwar die Lage der Kniescheibe im Femoropatellargelenk darstellen, sie erlauben jedoch keine Aussage ueber die funktionellen Aspekte des Patellagleitens zwischen 30 -Beugung und 0 -Streckung. Dieser fuer die Kniescheibenfuehrung kritische, mittels der konventionellen Roentgentechnik (aufgrund von Femur- und Patellaueberlagerung) nicht einsehbare Bereich, kann unter aktiver Kniestreckung mit der funktionellen MRT dargestellt werden. Durch bewegungsgetriggerte Gradientenechosequenzen oder neuerdings auch durch ultraschnelle Bildsequenzen ist es moeglich, funktionelle Informationen ueber das Patellagleiten in der endgradigen Streckenbewegung zu erhalten. Die funktionelle MRT des Femorpatellargelenkes bietet daher z.B. fuer die Abklaerung von unklaren, vorderen Kniegelenksbeschwerden und bei der Frage nach Patellagleitwegsstoerungen eine Alternative zur diagnostischen Arthroskopie. (orig.)

  1. [Influence of patellofemoral joint degeneration on outcome of medial unicompartmental knee arthroplasty].

    Science.gov (United States)

    Xu, B Y; Ji, B C; Guo, W T; Mu, W B; Cao, L

    2017-06-01

    Objective: To evaluate the influence of patellofemoral joint degeneration and pre-operative pain location on the outcome of medial Oxford unicompartmental knee arthroplasty (UKA). Methods: A total of 58 patients (58 knees) with medial Oxford UKA had been performed for medial osteoarthritis from March 2013 to July 2014 in Department of Orthopaedic Surgery at First Teaching Hospital of Xinjiang Medical University were retrospective reviewed. There were 24 males and 34 females, the age from 43 to 87 years with the mean age was 68.5 years. The mean body mass index was 25.2 kg/m(2) ranging from 19.7 to 31.5 kg/m(2). Patients were divided into anterior-medial pain group (35 knees), anterior knee pain group (17 knees) and general knee pain group (6 knees) according to pre-operative pain location. Pre-operative radiological statuses of the patellefemoral joint were defined by Ahlback system and divided into patellofemoral joint degeneration group (16 knees) and normal group (42 knees). Patients were also divided into medial patellofemoral degeneration group (20 knees), lateral patellofemoral degeneration group (12 knees) and normal group (26 knees) according to Altman scoring system. Outerbridge system was used intraoperatively and the patients were divided into patellofemoral joint degeneration group (21 knees) and normal group (37 knees). Pre- and post-operative outcomes were evaluated with Oxford Knee Score (OKS), Western Ontario and MacMaster (WOMAC) and patellofemoral score system of Lonner. T test and ANOVA were used to analyze the data. Results: The average duration of follow-up was 33 months (from 26 to 42 months). There were no patients had complications of infection, deep vein thrombosis, dislocation or loosing at the last follow-up. Compared to pre-operation, OKS (18.9±3.5 vs . 38.9±4.7, 19.3±4.2 vs . 39.6±4.6, 18.1±3.2 vs . 38.1±3.7)( t =5.64 to 7.08, all P anterior-medial pain group, anterior knee pain group and general knee pain group. According to

  2. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome

    OpenAIRE

    Kurt, Emine Eda; B?y?kturan, ?znur; Erdem, Hatice Rana; Tuncay, Figen; Sezgin, Hicabi

    2016-01-01

    [Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both ...

  3. Effects of Anterior Knee Displacement during Squatting on Patellofemoral Joint Stress.

    Science.gov (United States)

    Kernozek, Thomas W; Gheidi, Naghmeh; Zellmer, Matthew; Hove, Jordan; Heinert, Becky L; Torry, Michael R

    2017-04-19

    Squatting is a common rehabilitation training exercise for Patellofemoral pain syndrome (PFPS). Patellofemoral joint stress (PFJS) during squatting with more anterior knee displacement has not been systematically investigated. The aim was to compare PFJS during squatting using two techniques: Squat while keeping the knees before the toes (SBT) and squat while allowing the knees to go past the toes (SPT). University research laboratory. Twenty-five healthy females (Age: 22.69 ± 0.74 yrs.; Height: 169.39 ± 6.44 cm; Mass: 61.55 ± 9.74 kg) participated. Three dimensional kinematic and kinetic data were collected at 180 and 1800 Hz respectively. A musculoskeletal model was used to calculate muscle forces through static optimization. These muscle forces were used in a patellofemoral joint model to estimate PFJS. The magnitudes of PFJS, reaction force and quadriceps force were higher (P technique. Knee flexion, hip flexion, and ankle dorsiflexion angles were reduced when using the SBT technique. Findings provide some general support for minimizing forward knee translation during squats for patients that may have PFPS.

  4. Subfracture insult to the human cadaver patellofemoral joint produces occult injury.

    Science.gov (United States)

    Atkinson, P J; Haut, R C

    1995-11-01

    The current criterion used by the automotive industry for injury to the lower extremity is based on visible bone fracture. Studies suggest, however, that chronic joint degeneration may occur after subfracture impact loads on the knee. We hypothesized that subfracture loading of the patellofemoral joint could result in previously undocumented microtrauma in areas of high contact pressure. In the current study, seven patellofemoral joints from human cadavers were subjected to impact with successively greater energy until visible fracture was noted. Transverse and comminuted fractures of the patella were noted at 6.7 kN of load. Approximately 45% of the impact energy then was delivered to the contralateral joint. Subfracture loads of 5.2 kN resulted in no gross bone fracture in five of seven specimens. Histological examination of the patellae horizontal split fracture in the subchondral bone, at the tidemark, or at the interface of calcified cartilage and subchondral bone. The trauma appeared predominantly on the lateral facet, adjacent to or directly beneath preexisting fibrillation of the articular surface. Surface fibrillation was noted in histological sections of control patellae (not subjected to impact loading), but occult damages were not observed. Although the mechanism of this occult trauma is unknown, similar damage has been shown to occur from direct shear loading. As these microcracks can potentiate a disease process in the joint, this study may suggest that the current criterion for injury, based on bone fracture alone, is not sufficiently conservative.

  5. Patellofemoral pain in athletes

    Directory of Open Access Journals (Sweden)

    Petersen W

    2017-06-01

    Full Text Available Wolf Petersen,1 Ingo Rembitzki,2 Christian Liebau3 1Department of Orthopaedic and Trauma Surgery, Martin Luther Hospital, Grunewald, Berlin; 2German Sport University Cologne, 3Asklepios Clinic, Bad Harzburg, Germany Abstract: Patellofemoral pain (PFP is a frequent cause of anterior knee pain in athletes, which affects patients with and without structural patellofemoral joint (PFJ damage. Most younger patients do not have any structural changes to the PFJ, such as an increased Q angle and a cartilage damage. This clinical entity is known as patellofemoral pain syndrome (PFPS. Older patients usually present with signs of patellofemoral osteoarthritis (PFOA. A key factor in PFPS development is dynamic valgus of the lower extremity, which leads to lateral patellar maltracking. Causes of dynamic valgus include weak hip muscles and rearfoot eversion with pes pronatus valgus. These factors can also be observed in patients with PFOA. The available evidence suggests that patients with PFP are best managed with a tailored, multimodal, nonoperative treatment program that includes short-term pain relief with nonsteroidal anti-inflammatory drugs (NSAIDs, passive correction of patellar maltracking with medially directed tape or braces, correction of the dynamic valgus with exercise programs that target the muscles of the lower extremity, hip, and trunk, and the use of foot orthoses in patients with additional foot abnormalities. Keywords: anterior knee pain, dynamic valgus, hip strength, rearfoot eversion, single leg squat, hip strength 

  6. Imaging of patellofemoral disorders

    Energy Technology Data Exchange (ETDEWEB)

    Elias, D.A. E-mail: david.elias@kingsch.nhs.uk; White, L.M

    2004-07-01

    Anterior knee pain is a common symptom, which may have a large variety of causes including patellofemoral pathologies. Patellofemoral maltracking refers to dynamic abnormality of patellofemoral alignment and has been measured using plain film, computed tomography (CT) and magnetic resonance imaging (MRI) using static and kinematic techniques. Patellar dislocation is usually transient, but specific conventional radiographic and MRI features may provide evidence of prior acute or chronic dislocation. In addition, chondromalacia patellae, osteochondritis dissecans, patellofemoral osteoarthritis, excessive lateral pressure syndrome, and bipartite patella have all been implicated in causing patellofemoral pain. The imaging and clinical features of these processes are reviewed, highlighting the specific diagnostic features of each condition.

  7. Patellar subluxation syndrome. Observation of the patellofemoral joint using CT-scan

    Energy Technology Data Exchange (ETDEWEB)

    Yagi, Tomonori; Sasaki, Tetsuto; Susuda, Koichi; Moji, Junichi (Hokkaido Univ., Sapporo (Japan). School of Medicine)

    1983-10-01

    Clinical symptoms of patellar subluxation syndrome associated with pain were investigated for 24 knees of 20 patients, and the state of patella dislocation was observed by CT-scan. The patients had high incidence of an apprehension sign, showing their fear of patellar luxation. Many of them complained of patello-femoral joint pain due to chondromalacia patellae. In order to derive patellar subluxation, the method of CT-Q-contraction was carried out at the extended position of the patellar joint. In patients with patellar subluxation syndrome, the rate of shift in the diseased side was significantly higher than that of the other side, suggesting decreased muscular strength of the musculus vastus of the diseased side. Improvement of the symptoms was seen in all except one of 12 knees operated by the combined method of Green's method with Blauth's more than 6 months before. Availability of this operation was verified by the CT-Q-contraction.

  8. Precise measurement of cat patellofemoral joint surface geometry with multistation digital photogrammetry.

    Science.gov (United States)

    Ronsky, J L; Boyd, S K; Lichti, D D; Chapman, M A; Salkauskas, K

    1999-04-01

    Three-dimensional joint models are important tools for investigating mechanisms related to normal and pathological joints. Often these models necessitate accurate three-dimensional joint surface geometric data so that reliable model results can be obtained; however, in models based on small joints, this is often problematic due to limitations of the present techniques. These limitations include insufficient measurement precision the requirement of contact for the measurement process, and lack of entire joint description. This study presents a new non-contact method for precise determination of entire joint surfaces using multistation digital photogrammetry (MDPG) and is demonstrated by determining the cartilage and subchondral bone surfaces of the cat patellofemoral (PF) joint. The digital camera-lens setup was precisely calibrated using 16 photographs arranged to achieve highly convergent geometry to estimate interior and distortion parameters of the camera-lens setup. Subsequently, six photographs of each joint surface were then acquired for surface measurement. The digital images were directly imported to a computer and newly introduced semi-automatic computer algorithms were used to precisely determine the image coordinates. Finally, a rigorous mathematical procedure named the bundle adjustment was used to determine the three-dimensional coordinates of the joint surfaces and to estimate the precision of the coordinates. These estimations were validated by comparing the MDPG measurements of a cylinder and plane to an analytical model. The joint surfaces were successfully measured using the MDPG method with mean precision estimates in the least favorable coordinate direction being 10.3 microns for subchondral bone and 17.9 microns for cartilage. The difference in measurement precision for bone and cartilage primarily reflects differences in the translucent properties of the surfaces.

  9. Temporomandibular joint abnormalities in rheumatoid arthritis

    International Nuclear Information System (INIS)

    Larheim, T.A.; Tveito, L.; Dale, K.; Ruud, A.F.

    1981-01-01

    Transantral (infraorbital, transmaxillary) examination of the temporomandibular joint was compared with conventional transcranial examination and lateral tomography of patients with rheumatoid arthritis aged 23 to 83. Abnormalities were most frequently found at tomography, and equally frequent at transantral and transcranial examinations. The various examinations appeared to be rather supplementary. Bone erosion was frequently observed at transantral examination, which appeared to be the preferable radiographic method for detecting arthritis of this joint. Combined with transcranial examination, the method is recommended for the evaluation of temporomandibular joint abnormalities in rheumatoid arthritis if tomographic equipment is not available. (Auth.)

  10. Osseous temporomandibular joint abnormalities in rheumatic disease

    International Nuclear Information System (INIS)

    Larheim, T.A.; Kolbenstvedt, A.; Rikshospitalet, Oslo

    1990-01-01

    Computed tomography (CT) of the temporomandibular joint (TMJ) was compared with hypocycloidal tomography in 30 joints of 15 adults with rheumatic disease. CT included 1.5 mm thick axial scans (at 1.0 mm intervals) with reformatted oblique sagittal and oblique coronal sections. Multisection (at 2.0 mm intervals) tomography included oblique sagittal and occasionally, oblique coronal sections. CT demonstrated bone abnormalities in 21 and tomography in 20 joints, indicating high agreement between the imaging modalities regarding number of abnormal TMJs. Bone structures were, however, better visualized by multiplanar CT due to superior contrast and spatial resolution particularly in the most lateral and medial parts of the joint, indicating superiority of CT for depicting subtle bony TMJ abnormalities in patients with rheumatic disease. (orig.)

  11. Comparing Knee Joint Position Sense in Patellofemoral Pain and Healthy Futsal Women

    Directory of Open Access Journals (Sweden)

    Negar Kooroshfar

    2017-03-01

    Full Text Available Background: Proprioception, or joint position sense, probably plays an important role in joint function. A number of studies have shown that proper joint position sense can decrease the risk of injuries in sports. It is not very clear how patellofemoral pain syndrome (PFPS can affect athletes joint position sense (JPS. Regarding the importance of proper joint position sense for movement performance and injury prevention in athletes, the aim of this study was to evaluate knee JPS in athletes with PFPS and compare it with asymptomatic individuals under non-weight bearing (sitting conditions. Methods: The study design was comparative in which 15 patients and 15 healthy athletes participated. JPS was evaluated by active and passive replication of knee angles for 30, 45 and 60° of knee flexion target angle while visual cues were eliminated. Each test was repeated three times. By subtracting the test angle from the replicated angle, the absolute error was calculated as a dependent variable. T-statistical test was used to compare data between two groups and P value of 0.05 was considered as the level of statistical significance. Results: No significant difference (P<0.05 in active (A and passive (P knee JPS was found between two groups for three (30°, p-value (A =0.79, P=0.68, 45°, P value (A=0.12, P=0.54 and 60°, P value (A=0.74, P=0.71 target angles. Conclusion: According to results, both groups had the same JPS ability, it seems PFPS does not affect the knee JPS at least in athlete cases. It would be possible that deficiency of JPS compensated for the physical activity or on the other hand, maybe pain intensity was not high enough to interfere with JPS accuracy. According to our results, PFPS doesn’t reduce IPS but further investigation is needed to disclose if other factors such as skill

  12. Do Changes in Patellofemoral Joint Offset Lead to Adverse Outcomes in Total Knee Arthroplasty With Patellar Resurfacing? A Radiographic Review.

    Science.gov (United States)

    Matz, Jacob; Howard, James L; Morden, David J; MacDonald, Steven J; Teeter, Matthew G; Lanting, Brent A

    2017-03-01

    Patellofemoral joint biomechanics contribute to anterior knee pain, instability, and dysfunction following total knee arthroplasty (TKA). Information about specific factors leading to anterior knee pain and dysfunction is currently limited. Changes in patellofemoral joint offset (PFO) refers to a mismatch between the preoperative and postoperative anteroposterior geometry of the patellofemoral joint. It remains unclear whether these changes lead to adverse outcomes in TKA. A retrospective radiographic review of 970 knees pre-TKA and post-TKA was completed to correlate the radiographic and clinical outcomes of changing the PFO using a posterior-stabilized single knee design with patellar resurfacing. A total of 970 patients were reviewed. Postoperatively, the anterior femoral offset, anteroposterior femoral size, and anterior patellar offset were changed in 40%, 60%, and 71% of knees, respectively, compared to preoperative values. The Western Ontario and McMasters Osteoarthritis Index total score as well as subscale scores for pain and function were not significantly affected by an increase or decrease in PFO. Similarly, Knee Society Scores and range of motion were not significantly affected. Increased anterior patellar offset was, however, associated with increased postoperative patellar tilt. Postoperative patellar tilt was not correlated with adverse patient satisfaction scores or loss of range of motion. Changes in PFO (decreased, maintained, or increased) are common post-TKA and are not associated with a difference in clinical outcomes. Increases in anterior patellar offset led to increased patellar tilt, which was not associated with adverse patient satisfaction scores. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. TIBIOFEMORAL JOINT MOBILIZATION IN THE SUCCESSFUL MANAGEMENT OF PATELLOFEMORAL PAIN SYNDROME: A CASE REPORT.

    Science.gov (United States)

    Lantz, Justin M; Emerson-Kavchak, Alicia J; Mischke, John J; Courtney, Carol A

    2016-06-01

    Patellofemoral pain syndrome (PFPS) is a common source of anterior knee pain. Controversy exists over the exact clinical findings which define PFPS, thus, diagnosis and management can be challenging for clinicians. There is paucity in the literature concerning joint mobilization as treatment for PFPS, particularly at the tibiofemoral joint, as standard management is currently focused on therapeutic exercise, orthotics, bracing and taping. Therefore, the purpose of this case report is to describe the effects of tibiofemoral joint mobilization in the successful treatment of an individual with chronic PFPS as it relates to pain, function and central processing of pain. Case Report. The subject was a 28-year-old female with a two year history of left anterior, inferior patellar knee pain consistent with chronic PFPS. She demonstrated diminished pressure pain threshold (PPT) and allodynia at the anterior knee, suggesting a component of central sensitization to her pain. She met several common diagnostic criteria for PFPS, however, only tibiofemoral anterior-posterior joint mobilization increased her pain. Subsequent treatment sessions (Visits 1-6) consisted of solely joint mobilization supplemented by instruction in a home exercise program (therapeutic exercise and balance training). As outcomes improved, treatment sessions (Visits 7-8) consisted of solely therapeutic exercise and balance training with focus on return to independent pain free functional activity. Improvements consistent with the minimally clinically important difference were noted on the Kujala Anterior Knee Pain Scale, Numeric Pain Rating Scale, Global Rating of Change (GROC). Scores on the Fear Avoidance-Belief Questionnaire (6/24 to 2/24 PA, 31/42 to 5/42 W), PPT (119 to 386 kPa) and Step Down Test (11 to 40 steps) also demonstrated improvement. At a two month follow up, the subject reported continued improvement in functional activity, 0/10 pain and GROC = +5. This case describes the successful

  14. Association between increase in vertical ground reaction force loading rate and pain level in women with patellofemoral pain after a patellofemoral joint loading protocol.

    Science.gov (United States)

    Briani, Ronaldo Valdir; Pazzinatto, Marcella Ferraz; Waiteman, Marina Cabral; de Oliveira Silva, Danilo; de Azevedo, Fábio Mícolis

    2018-04-11

    The etiology of patellofemoral pain (PFP) is thought to be the result of increased patellofemoral joint (PFJ) load and aberrant lower extremity mechanics, including altered vertical ground reaction forces (VGRF). However, few studies have investigated the association between an increase in pain and VGRF loading rates in the context of PFP. Thus, this study aimed to investigate the immediate effects of PFJ loading on pain and VGRF loading rate, and to see if there is a link between modification of both pain and VGRF loading rate during stair negotiation. Thirty-four women with PFP underwent VGRF analysis during stair negotiation under two conditions: with (condition 2) and without (condition 1) being previously submitted to a PFJ loading protocol in order to or not to exacerbate their knee pain, respectively. The VGRF loading rates were significantly higher in condition 2 (Mean ± standard deviation (SD)=4.0±0.6N/s) compared to condition 1 (Mean±SD=3.6±0.5N/s) during stair ascent and during stair descent (Mean±SD: condition 1=6.3±1.1N/s; condition 2=7.0±1.4N/s). In addition, VGRF loading rates were higher during stair descent compared to stair ascent in both conditions. There were significant correlations between the increase in pain and VGRF loading rate during both tasks. There seemed to be an important relation between the increase in pain and VGRF loading rates in women with PFP. Based on these findings, interventions aimed at reducing VGRF loading rates are important in the context of PFP. Copyright © 2018 Elsevier B.V. All rights reserved.

  15. INVESTIGATING THE EFFECTIVENESS OF KINESIO® TAPING SPACE CORRECTION METHOD IN HEALTHY ADULTS ON PATELLOFEMORAL JOINT AND SUBCUTANEOUS SPACE.

    Science.gov (United States)

    Lyman, Katie J; Keister, Kassiann; Gange, Kara; Mellinger, Christopher D; Hanson, Thomas A

    2017-04-01

    Limited quantitative, physiological evidence exists regarding the effectiveness of Kinesio® Taping methods, particularly with respect to the potential ability to impact underlying physiological joint space and structures. To better understand the impact of these techniques, the underlying physiological processes must be investigated in addition to the examination of more subjective measures related to pain in unhealthy tissues. The purpose of this study was to determine whether the Kinesio® Taping Space Correction Method created a significant difference in patellofemoral joint space, as quantified by diagnostic ultrasound. Pre-test/post-test prospective cohort study. Thirty-two participants with bilaterally healthy knees and no past history of surgery took part in the study. For each participant, diagnostic ultrasound was utilized to collect three measurements: the patellofemoral joint space, the distance from the skin to the superficial patella, and distance from the skin to the patellar tendon. The Kinesio® Taping Space Correction Method was then applied. After a ten-minute waiting period in a non-weight bearing position, all three measurements were repeated. Each participant served as his or her own control. Paired t tests showed a statistically significant difference (mean difference = 1.1 mm, t [3,1]  = 2.823, p  = 0.008, g  = .465) between baseline and taped conditions in the space between the posterior surface of the patella to the medial femoral condyle. Neither the distance from the skin to the superficial patella nor the distance from the skin to the patellar tendon increased to a statistically significant degree. The application of the Kinesio® Taping Space Correction Method increases the patellofemoral joint space in healthy adults by increasing the distance between the patella and the medial femoral condyle, though it does not increase the distance from the skin to the superficial patella nor to the patellar tendon. 3.

  16. Short-term effects of kinesio tape on joint position sense, isokinetic measurements, and clinical parameters in patellofemoral pain syndrome.

    Science.gov (United States)

    Kurt, Emine Eda; Büyükturan, Öznur; Erdem, Hatice Rana; Tuncay, Figen; Sezgin, Hicabi

    2016-07-01

    [Purpose] To evaluate the short-term effects of kinesio tape on joint position sense, isokinetic measurements, kinesiophobia, symptoms, and functional limitations in patients with patellofemoral pain syndrome. [Subjects and Methods] A total of 90 patients (112 knees) with patellofemoral pain syndrome were randomized into a kinesio tape group (n=45) or placebo kinesio tape group (n=45). Baseline isokinetic quadriceps muscle tests and measurements of joint position sense were performed in both groups. Pain was measured with a Visual Analog Scale, kinesiophobia with the Tampa kinesiophobia scale, and symptoms and functional limitations with the Kujala pain scale. Measurements were repeated 2 days after kinesio tape application. [Results] No differences were found between baseline isokinetic muscle measurements and those taken 2 days after application. However, significant improvements were observed in the kinesio tape group, with regard to joint position sense, pain, kinesiophobia, symptoms, and functional limitations after treatment. Examination of the differences between pre- and post-treatment values in both groups revealed that the kinesio tape group demonstrated greater improvements compared to the placebo kinesio tape group. [Conclusion] Although short-term kinesio tape application did not increase hamstring muscle strength, it may have improved joint position sense, pain, kinesiophobia, symptoms, and daily limitations.

  17. Targeted physiotherapy for patellofemoral joint osteoarthritis: A protocol for a randomised, single-blind controlled trial

    Directory of Open Access Journals (Sweden)

    Schache Anthony G

    2008-09-01

    Full Text Available Abstract Background The patellofemoral joint (PFJ is one compartment of the knee that is frequently affected by osteoarthritis (OA and is a potent source of OA symptoms. However, there is a dearth of evidence for compartment-specific treatments for PFJ OA. Therefore, this project aims to evaluate whether a physiotherapy treatment, targeted to the PFJ, results in greater improvements in pain and physical function than a physiotherapy education intervention in people with symptomatic and radiographic PFJ OA. Methods 90 people with PFJ OA (PFJ-specific history, signs and symptoms and radiographic evidence of PFJ OA will be recruited from the community and randomly allocated into one of two treatments. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of physiotherapy (8 individual sessions over 12 weeks, as well as a home exercise program 4 times/week compared to a physiotherapist-delivered OA education control treatment (8 individual sessions over 12 weeks. Physiotherapy treatment will consist of (i quadriceps muscle retraining; (ii quadriceps and hip muscle strengthening; (iii patellar taping; (iv manual PFJ and soft tissue mobilisation; and (v OA education. Resistance and dosage of exercises will be tailored to the participant's functional level and clinical state. Primary outcomes will be evaluated by a blinded examiner at baseline, 12 weeks and 9 months using validated and reliable pain, physical function and perceived global effect scales. All analyses will be conducted on an intention-to-treat basis using linear mixed regression models, including respective baseline scores as a covariate, subjects as a random effect, treatment condition as a fixed factor and the covariate by treatment interaction. Conclusion This RCT is targeting PFJ OA, an important sub-group of knee OA patients, with a specifically designed conservative intervention. The project's outcome will influence PFJ OA rehabilitation, with the

  18. Targeted physiotherapy for patellofemoral joint osteoarthritis: A protocol for a randomised, single-blind controlled trial

    Science.gov (United States)

    Crossley, Kay M; Vicenzino, Bill; Pandy, Marcus G; Schache, Anthony G; Hinman, Rana S

    2008-01-01

    Background The patellofemoral joint (PFJ) is one compartment of the knee that is frequently affected by osteoarthritis (OA) and is a potent source of OA symptoms. However, there is a dearth of evidence for compartment-specific treatments for PFJ OA. Therefore, this project aims to evaluate whether a physiotherapy treatment, targeted to the PFJ, results in greater improvements in pain and physical function than a physiotherapy education intervention in people with symptomatic and radiographic PFJ OA. Methods 90 people with PFJ OA (PFJ-specific history, signs and symptoms and radiographic evidence of PFJ OA) will be recruited from the community and randomly allocated into one of two treatments. A randomised controlled trial adhering to CONSORT guidelines will evaluate the efficacy of physiotherapy (8 individual sessions over 12 weeks, as well as a home exercise program 4 times/week) compared to a physiotherapist-delivered OA education control treatment (8 individual sessions over 12 weeks). Physiotherapy treatment will consist of (i) quadriceps muscle retraining; (ii) quadriceps and hip muscle strengthening; (iii) patellar taping; (iv) manual PFJ and soft tissue mobilisation; and (v) OA education. Resistance and dosage of exercises will be tailored to the participant's functional level and clinical state. Primary outcomes will be evaluated by a blinded examiner at baseline, 12 weeks and 9 months using validated and reliable pain, physical function and perceived global effect scales. All analyses will be conducted on an intention-to-treat basis using linear mixed regression models, including respective baseline scores as a covariate, subjects as a random effect, treatment condition as a fixed factor and the covariate by treatment interaction. Conclusion This RCT is targeting PFJ OA, an important sub-group of knee OA patients, with a specifically designed conservative intervention. The project's outcome will influence PFJ OA rehabilitation, with the potential to reduce

  19. Assessment of in vivo loading history of the patellofemoral joint: a study combining patellar position, tilt, alignment and bone SPECT/CT.

    Science.gov (United States)

    Schön, Stephan N; Afifi, Faik K; Rasch, Helmut; Amsler, Felix; Friederich, Niklaus F; Arnold, Markus P; Hirschmann, Michael T

    2014-12-01

    The current study investigates whether patella height and tilt or leg alignment influence the intensity values as well as the distribution pattern of single photon emission computerized tomography/computerized tomography (SPECT/CT) tracer uptake in the patellofemoral joint. 99mTc-HDP-SPECT/CT and radiographs of consecutive 84 knees were prospectively obtained. Lateral radiographs were analyzed in terms of patellar height, Insall-Salvati index and modified Insall-Salvati index. Skyline views were analyzed for Laurin's lateral patellofemoral angle. On long-leg radiographs, the mechanical leg alignment was classified as varus, valgus or neutral. SPECT/CT was analyzed for each anatomical region using a previously validated SPECT/CT localization and grading algorithm. Mean, standard deviation, minimum and maximum of grading for each area of the localization scheme were recorded. Nonparametric Spearman's correlations were used to correlate patellar height, lateral patellar angle and leg alignment with the tracer uptake intensity. Chi-square statistics were used for categorical data (p tracer uptake in all patellar and lateral femoral regions (p tracer uptake in the superior lateral femoral parts and the tibial tubercle. In mechanically varus aligned knees, there was significantly higher SPECT/CT tracer uptake on the medial and in valgus knees on the lateral part of the patellofemoral joint (p < 0.05). As the intensity and distribution of the SPECT/CT significantly correlated with patella baja and patellar tilt, SPECT/CT might be considered as imaging modality for evaluating patients with patellofemoral disorders and for follow-up of patients after patellofemoral realignment procedures. Diagnostic study, Level II.

  20. Effect of tibial tuberosity advancement on the contact mechanics and the alignment of the patellofemoral and femorotibial joints.

    Science.gov (United States)

    Guerrero, Tomás G; Pozzi, Antonio; Dunbar, Nicholas; Kipfer, Nicolas; Haessig, Michael; Beth Horodyski, Mary; Montavon, Pierre M

    2011-10-01

    To evaluate the effect of tibial tuberosity advancement (TTA) on patellofemoral (PF) contact mechanics, and alignment of the PF and femorotibial (FT) joints in cranial cruciate ligament (CrCL)-deficient stifles of dogs. Ex vivo biomechanical study. Unpaired cadaveric hind limbs (n=9). Digital pressure sensors placed in the PF joint were used to measure contact force, contact area, peak and mean contact pressure, and peak pressure location with the limb under an axial load of 30% body weight and a stifle angle of 135°. The FT and PF poses were obtained using a 2-dimensional computer digitization technique. Each specimen was tested under normal, CrCL-deficient, and TTA-treated conditions. Data was normalized and analyzed, after testing for normality by Wilk-Shapiro, using 1 sample T-test, paired T-test, and ANOVA; P≤.05 was considered significant. Bonferroni's correction was used when needed. A significant cranioproximal tibial displacement and increase in patellar tilt were found in the CrCL-deficient joints. Both FT and PF alignments were restored after TTA. Contact areas and peak pressure did not vary between conditions. Peak pressure location displaced proximally from intact to CrCL-deficient condition and returned to normal after TTA. Total force measured in the CrCL-deficient stifle and TTA conditions were significantly lower than in the control. TTA restored the normal FT and PF alignment, and reduced the retropatellar force by about 20%. © Copyright 2011 by The American College of Veterinary Surgeons.

  1. Functional MRI of the patellofemoral joint: comparison of ultrafast MRI, motion-triggered cine MRI and static MRI

    International Nuclear Information System (INIS)

    Muhle, C.; Brossmann, J.; Melchert, U.H.; Schroeder, C.; Boer, R. de; Spielmann, R.P.; Heller, M.

    1995-01-01

    To evaluate the feasibility and usefulness of ultrafast MRI (u), patellar tracking from 30 of flexion to knee extension (0 ) was analysed and compared with motion-triggered cine MRI (m) and a static MRI technique (s). The different imaging methods were compared in respect of the patellofemoral relationship, the examination time and image quality. Eight healthy subjects and four patients (in total 18 joints) with patellar subluxation or luxation were examined. Significant differences between the static MRI series without quadriceps contraction and the functional MRI studies (motion-triggered cine MRI and ultrafast MRI) were found for the patellar tilt angle. In the dynamic joint studies there was no statistical difference of the regression coefficients between the motion-triggered cine MRI studies and the ultrafast MRI studies. The findings of the functional MRI studies compared with the static MRI images were significantly different for the lateralisation of the patella, expressed by the lateral patellar displacement and bisect offset. No significant differences in patellar lateralisation were found between motion-triggered cine MRI and ultrafast MRI. Ultrafast MRI was superior to motion-triggered cine MRI in terms of the reduction in imaging time and improvement of the image quality. (orig.)

  2. Functional MRI of the patellofemoral joint: comparison of ultrafast MRI, motion-triggered cine MRI and static MRI

    Energy Technology Data Exchange (ETDEWEB)

    Muhle, C. [Klinik fuer Radiologische Diagnostik, Univ. Kiel (Germany); Brossmann, J. [Klinik fuer Radiologische Diagnostik, Univ. Kiel (Germany); Melchert, U.H. [Klinik fuer Radiologische Diagnostik, Univ. Kiel (Germany); Schroeder, C. [Radiologische Abt., Universitaets-Kinderklinik, Christian-Albrechts-Universitaet, Kiel (Germany); Boer, R. de [Philips Medical Systems, Best (Netherlands); Spielmann, R.P. [Klinik fuer Radiologische Diagnostik, Univ. Kiel (Germany); Heller, M. [Klinik fuer Radiologische Diagnostik, Univ. Kiel (Germany)

    1995-12-31

    To evaluate the feasibility and usefulness of ultrafast MRI (u), patellar tracking from 30 of flexion to knee extension (0 ) was analysed and compared with motion-triggered cine MRI (m) and a static MRI technique (s). The different imaging methods were compared in respect of the patellofemoral relationship, the examination time and image quality. Eight healthy subjects and four patients (in total 18 joints) with patellar subluxation or luxation were examined. Significant differences between the static MRI series without quadriceps contraction and the functional MRI studies (motion-triggered cine MRI and ultrafast MRI) were found for the patellar tilt angle. In the dynamic joint studies there was no statistical difference of the regression coefficients between the motion-triggered cine MRI studies and the ultrafast MRI studies. The findings of the functional MRI studies compared with the static MRI images were significantly different for the lateralisation of the patella, expressed by the lateral patellar displacement and bisect offset. No significant differences in patellar lateralisation were found between motion-triggered cine MRI and ultrafast MRI. Ultrafast MRI was superior to motion-triggered cine MRI in terms of the reduction in imaging time and improvement of the image quality. (orig.)

  3. Correlation between varus knee malalignment and patellofemoral osteoarthritis.

    Science.gov (United States)

    Otsuki, Shuhei; Nakajima, Mikio; Okamoto, Yoshinori; Oda, Shuhei; Hoshiyama, Yoshiaki; Iida, Go; Neo, Masashi

    2016-01-01

    To evaluate the relationship between patellofemoral osteoarthritis (OA) and varus OA of the knee with a focus on the location of joint space narrowing. Eighty-five patients scheduled to undergo total knee arthroplasty caused by varus OA were enrolled in this study. The relationship between patellofemoral OA and varus knee malalignment was elucidated. To determine the alignment of the patellofemoral joint in varus knees, patellar tilt, and the tibial tuberosity-trochlear groove (TT-TG) distance were measured, and patellofemoral OA was classified using computed tomography. The femorotibial angles in patients with stage II-IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA, and the patellar tilt in patients with stage II-IV patellofemoral OA and the TT-TG distance in patients with stage IV patellofemoral OA were significantly larger than those in patients with stage I patellofemoral OA. The TT-TG distance was strongly correlated with patellar tilt (R(2) = 0.41, P Varus knee malalignment was induced by patellofemoral OA, especially at the lateral facet. Patellar tilt and the TT-TG distance are considered critical factors for the severity of patellofemoral OA. Understanding the critical factors for patellofemoral OA in varus knees such as the TT-TG distance and patellar will facilitate the prevention of patellofemoral OA using procedures such as high tibial osteotomy and total knee arthroplasty to correct knee malalignment. Retrospective cohort study, Level III.

  4. High mid-term revision rate after treatment of large, full-thickness cartilage lesions and OA in the patellofemoral joint using a large inlay resurfacing prosthesis

    DEFF Research Database (Denmark)

    Laursen, Jens Ole

    2017-01-01

    pain but high mid-term revision rate after patellofemoral inlay resurfacing using the HemiCAP-Wave® implant. Patellofemoral resurfacing implantation treatment with a large inlay prosthesis can offer temporary treatment for large isolated patellofemoral cartilage lesions or OA in younger patients...

  5. The diagnostic performance of anterior knee pain and activity-related pain in identifying knees with structural damage in the patellofemoral joint: the Multicenter Osteoarthritis Study.

    Science.gov (United States)

    Stefanik, Joshua J; Neogi, Tuhina; Niu, Jingbo; Roemer, Frank W; Segal, Neil A; Lewis, Cora E; Nevitt, Michael; Guermazi, Ali; Felson, David T

    2014-08-01

    To determine the diagnostic test performance of location of pain and activity-related pain in identifying knees with patellofemoral joint (PFJ) structural damage. The Multicenter Osteoarthritis Study is a US National Institutes of Health-funded cohort study of older adults with or at risk of knee osteoarthritis. Subjects identified painful areas around the knee on a knee pain map and the Western Ontario and McMaster Universities Osteoarthritis Index was used to assess pain with stairs and walking on level ground. Cartilage damage and bone marrow lesions were assessed from knee magnetic resonance imaging. We determined the sensitivity, specificity, positive and negative predictive values for presence of anterior knee pain (AKP), pain with stairs, absence of pain while walking on level ground, and combinations of tests in discriminating knees with isolated PFJ structural damage from those with isolated tibiofemoral joint (TFJ) or no structural damage. Knees with mixed PFJ/TFJ damage were removed from our analyses because of the inability to determine which compartment was causing pain. There were 407 knees that met our inclusion criteria. "Any" AKP had a sensitivity of 60% and specificity of 53%; and if AKP was the only area of pain, the sensitivity dropped to 27% but specificity rose to 81%. Absence of moderate pain with walking on level ground had the greatest sensitivity (93%) but poor specificity (13%). The combination of "isolated" AKP and moderate pain with stairs had poor sensitivity (9%) but the greatest specificity (97%) of strategies tested. Commonly used questions purported to identify knees with PFJ structural damage do not identify this condition with great accuracy.

  6. Disk abnormality coexists with any degree of synovial and osseous abnormality in the temporomandibular joints of children with juvenile idiopathic arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Kirkhus, Eva; Smith, Hans-Joergen [Oslo University Hospital, Rikshospitalet, Department of Radiology and Nuclear Medicine, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Oslo (Norway); Arvidsson, Linda Z.; Larheim, Tore A. [University of Oslo, Department of Maxillofacial Radiology, Institute of Clinical Dentistry, Oslo (Norway); Flatoe, Berit; Hetlevik, Siri O. [Oslo University Hospital, Rikshospitalet, Department of Rheumatology, Oslo (Norway); University of Oslo, Institute of Clinical Medicine, Oslo (Norway)

    2016-03-15

    MRI manifestation of temporomandibular joint arthritis is frequently reported in children with juvenile idiopathic arthritis. However, little attention has been paid to temporomandibular joint disk abnormalities. To assess combinations of MRI findings in the symptomatic temporomandibular joint in children with juvenile idiopathic arthritis with focus on disk abnormalities. This was a retrospective study of 46 patients with juvenile idiopathic arthritis, mean age 12 years (range: 5-17 years). Mean disease duration was 70 months (standard deviation: 61 months). MR images of 92 temporomandibular joints were scored for thickness of abnormally enhancing synovium (synovitis), joint effusion, bone marrow oedema, abnormal bone shape, bone erosion and disk abnormalities. The 92 temporomandibular joints were categorized as A: No synovitis and normal bone shape (30/92; 33%), B: Synovitis and normal bone shape (14/92: 15%), C: Synovitis and abnormal bone shape (38/92; 41%) and D: No synovitis but abnormal bone shape (10/92; 11%). Thirty-six of the 46 patients (78%) had synovitis and 33/46 (72%) had abnormal bone shape, most frequently in combination (30/46; 65%). Disk abnormalities (flat disk, fragmented disk, adherent disk and displaced disk) were found in 29/46 patients (63%). Disk abnormalities were found in all categories of juvenile idiopathic arthritis involved temporomandibular joints (B: 8/14 [57%]; C: 25/38 [66%] and D: 7/10 [70%]). Disk displacement was found in half of the joints (7/14) in category B. Synovitis was most pronounced in this category. Disk abnormalities were frequent. Disk displacement also occurred in joints with early temporomandibular joint arthritis, i.e., with normal bone shape. Other disk abnormalities were found in joints with bone abnormalities. Attention should be paid to disk abnormalities both in early and long-standing temporomandibular joint arthritis in children with juvenile idiopathic arthritis. (orig.)

  7. Bone signal abnormality, as seen on knee joint MRI : relationship between its location and associated injury

    International Nuclear Information System (INIS)

    Kim, Young Nam; Kim, Baek Hyun; Jung, Hoe Seok; Na, Eui Sung; Seol, Hye Young; Cha, In Ho; Lim, Hong Chul

    1998-01-01

    The purpose of the study was to evaluate the relationship between the location of bone signal abnormality and associated injury, as seen on MR, in patients with acute knee joint injury. Materials and Methods: Thirty-six patients with acute knee injury and bone signal abnormalities on MR were included in this study. The femur and tibia were each divided into six compartments, namely the anteromedial, medial, posteromedial,anterolateral, lateral, and posterolateral ; these were obtained in each knee joint. We evaluated the location of bone signal abnormality and the corresponding arthroscopic or operative findings of injury to ligaments and menisci. Cases with signal abnormalities involving more than three compartments were excluded. Results : Bone signal abnormalities were demonstrated in 51 compartments. Most(84%, 43/51) were noted in the lateral half of the knee joint, the most common location being the tibio- posterolateral compartment(13/51). The femoro-lateral(11/51) and tibio- anterolateral compartment(8/51) were the next most common locations. All cases(13/13)with bone signal abnormality in the tibio- posterolateral compartment had tears at the anterior cruciate ligament,while 9 of 11 cases(81%) with abnormality in the femoro- lateral compartment had tears at the anterior cruciate ligament. Six of eight cases(75%) with signal abnormality in the tibio- anterolateral compartment had tears at the posterior cruciate ligament ; 31 of 43 cases (72%) with abnormality in the lateral half of the knee joint had tears at the medial collateral ligament. Six of eight cases(75%) with signal abnormality in the medial half of the knee joint had tears at the medial meniscus, but no lateral meniscal tear was found. Among patients with signal abnormality in the lateral half of the knee joint, the tear was lateral meniscal in nine of 43 cases(21%) and medial meniscal in six of 43(14%). Conclusion : The location of bone signal abnormality, as seen on knee MR, inpatients with

  8. The impact of elbow and knee joint lesions on abnormal gait and posture of sows

    Directory of Open Access Journals (Sweden)

    Jørgensen Bente

    2008-02-01

    Full Text Available Abstract Background Joint lesions occur widespread in the Danish sow population and they are the most frequent cause for euthanasia. Clinically, it is generally impossible to differentiate between various types of non-inflammatory joint lesions. Consequently, it is often necessary to perform a post mortem examination in order to diagnose these lesions. A study was performed in order to examine the relation of abnormal gait and posture in sows with specific joint lesions, and thereby obtaining a clinical diagnostic tool, to be used by farmers and veterinarians for the evaluation of sows with joint problems. Methods The gait, posture and lesions in elbow- and knee joints of 60 randomly selected sows from one herd were scored clinically and pathologically. Associations between the scorings were estimated. Results The variables 'fore- and hind legs turned out' and 'stiff in front and rear' were associated with lesions in the elbow joint, and the variables 'hind legs turned out' and 'stiff in rear' were associated with lesions in the knee joint. Conclusion It was shown that specified gait and posture variables reflected certain joint lesions. However, further studies are needed to strengthen and optimize the diagnostic tool.

  9. Femoral articular geometry and patellofemoral stability.

    Science.gov (United States)

    Iranpour, Farhad; Merican, Azhar M; Teo, Seow Hui; Cobb, Justin P; Amis, Andrew A

    2017-06-01

    Patellofemoral instability is a major cause of anterior knee pain. The aim of this study was to examine how the medial and lateral stability of the patellofemoral joint in the normal knee changes with knee flexion and measure its relationship to differences in femoral trochlear geometry. Twelve fresh-frozen cadaveric knees were used. Five components of the quadriceps and the iliotibial band were loaded physiologically with 175N and 30N, respectively. The force required to displace the patella 10mm laterally and medially at 0°, 20°, 30°, 60° and 90° knee flexion was measured. Patellofemoral contact points at these knee flexion angles were marked. The trochlea cartilage geometry at these flexion angles was visualized by Computed Tomography imaging of the femora in air with no overlying tissue. The sulcus, medial and lateral facet angles were measured. The facet angles were measured relative to the posterior condylar datum. The lateral facet slope decreased progressively with flexion from 23°±3° (mean±S.D.) at 0° to 17±5° at 90°. While the medial facet angle increased progressively from 8°±8° to 36°±9° between 0° and 90°. Patellar lateral stability varied from 96±22N at 0°, to 77±23N at 20°, then to 101±27N at 90° knee flexion. Medial stability varied from 74±20N at 0° to 170±21N at 90°. There were significant correlations between the sulcus angle and the medial facet angle with medial stability (r=0.78, pgeometry with knee flexion to patellofemoral stability. Copyright © 2017 Elsevier B.V. All rights reserved.

  10. The contemporary management of anterior knee pain and patellofemoral instability.

    Science.gov (United States)

    Smith, Toby O; McNamara, Iain; Donell, Simon T

    2013-09-01

    In this review the evidence for the management of patients with patellofemoral disorders is presented confined to anterior knee pain and patellar dislocation (excluding patellofemoral arthritis). Patients present along a spectrum of these two problems and are best managed with both problems considered. The key to managing these patients is by improving muscle function, the patient losing weight (if overweight), and judicious use of analgesics if pain is an important feature. Hypermobility syndrome should always be looked for since this is a prognostic indicator for a poor operative outcome. Operations should be reserved for those with correctable anatomical abnormalities that have failed conservative therapy. The current dominant operation is a medial patellofemoral ligament reconstruction. Copyright © 2013 Elsevier B.V. All rights reserved.

  11. Development of a Method to Determine Abnormal Joint Torque Coupling Patterns During Walking In Chronic Hemiparetic Stroke

    NARCIS (Netherlands)

    Fricke, S.S.; Dragunas, Andrew C.; Gordon, Keith E.; van der Kooij, H.; van Asseldonk, E.H.F.; Dewald, Julius P. A.

    Motor impairments following stroke may lead to a reduced walking ability, however, no reliable assessments to quantify these impairments during walking are available [1]. For example, abnormal joint torque coupling between hip extension and hip adduction, previously reported under isometric

  12. Patellofemoral morphometry in patients with idiopathic patellofemoral pain syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Mar Carrion Martin, Maria del [Department of Rehabilitation, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Ruiz Santiago, Fernando, E-mail: ferruizsan@terra.e [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Pozuelo Calvo, Rocio [Department of Rehabilitation, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain); Guzman Alvarez, Luis [Department of Radiology, Hospital of Traumatology (Ciudad Sanitaria Virgen de las Nieves), Carretera de Jaen SN, 18014 Granada (Spain)

    2010-07-15

    Purpose: To compare clinical and computed tomography (CT) measures in extension, 20{sup o} and 30{sup o} of flexion of symptomatic knees of patient with idiopathic patellofemoral pain syndrome with the contra lateral asymptomatic knee. Materials and methods: Knees of 52 consecutive patients with idiopathic patellofemoral pain were studied with CT. In 28 patients this condition was unilateral and asymptomatic knee was used as control; 76 knees were symptomatic. Results: In patients with idiopathic patellofemoral pain we found a greater Q angle and internal condylar facet width in symptomatic knees with regard to asymptomatic knees. Conclusion: Greater Q angle and medial condylar facet can lead to overpressure on the medial knee compartment during maneuvers that increase contact between patella and medial condylar facet, such as knee flexion and squatting, contributing to development of idiopathic patellofemoral pain.

  13. No bias for developer publications and no difference between first-generation trochlear-resurfacing versus trochlear-cutting implants in 15,306 cases of patellofemoral joint arthroplasty.

    Science.gov (United States)

    Reihs, Birgit; Reihs, Florian; Labek, Gerold; Hochegger, Markus; Leithner, Andreas; Böhler, Nikolaus; Sadoghi, Patrick

    2017-08-24

    The study aim was to assess the outcome of patellofemoral arthroplasty (PFA), paying particular interest to 'revisions for any reason'. The hypothesis was that there is a superior outcome of PFA reported in dependent clinical studies in contrast to independent clinical literature and that there is a superior outcome of 'trochlear-cutting' PFA in comparison with 'first-generation trochlear-resurfacing' implants. Studies on PFA from its market introduction in 1955 onwards were systematically reviewed. The revision rate, which was calculated as 'revisions per 100 component years (CY)', was evaluated in 45 studies published in indexed, peer-reviewed international scientific journals. In addition, 'first-generation trochlear-resurfacing' and 'trochlear-cutting' implants as well as dependent and independent clinical literature were analysed. Furthermore, the data of three arthroplasty registers were analysed. A total of 15,306 PFA were included consisting of 2266 cases in worldwide literature data and of 13,040 cases in register data. 2.22 revisions per 100 CY were observed in worldwide literature data, which corresponds to a revision rate of 22.2% after 10 years. Revision rates between 18.9 and 27% after 10 years were shown by the included three national joint registers. In the group analyses no significant differences were detected. This meta-analysis did not reveal significant differences in the comparison between developer over independent publications and between 'first-generation-resurfacing' over 'trochlear-cutting' implants. In conclusion the data of developer publications do not seem to be biased. 'Trochlear-cutting' devices of PFA had slightly superior outcomes, but that benefit was not statistically significant. Nevertheless, we would recommend 'trochlear-cutting' devices for further use in PFA. Meta-analysis of Level IV case series.

  14. Anterior knee pain and evidence of osteoarthritis of the patellofemoral joint should not be considered contraindications to mobile-bearing unicompartmental knee arthroplasty: a 15-year follow-up.

    Science.gov (United States)

    Hamilton, T W; Pandit, H G; Maurer, D G; Ostlere, S J; Jenkins, C; Mellon, S J; Dodd, C A F; Murray, D W

    2017-05-01

    It is not clear whether anterior knee pain and osteoarthritis (OA) of the patellofemoral joint (PFJ) are contraindications to medial unicompartmental knee arthroplasty (UKA). Our aim was to investigate the long-term outcome of a consecutive series of patients, some of whom had anterior knee pain and PFJ OA managed with UKA. We assessed the ten-year functional outcomes and 15-year implant survival of 805 knees (677 patients) following medial mobile-bearing UKA. The intra-operative status of the PFJ was documented and, with the exception of bone loss with grooving to the lateral side, neither the clinical or radiological state of the PFJ nor the presence of anterior knee pain were considered a contraindication. The impact of radiographic findings and anterior knee pain was studied in a subgroup of 100 knees (91 patients). There was no relationship between functional outcomes, at a mean of ten years, or 15-year implant survival, and pre-operative anterior knee pain, or the presence or degree of cartilage loss documented intra-operatively at the medial patella or trochlea, or radiographic evidence of OA in the medial side of the PFJ. In 6% of cases there was full thickness cartilage loss on the lateral side of the patella. In these cases, the overall ten-year function and 15-year survival was similar to those without cartilage loss; however they had slightly more difficulty with descending stairs. Radiographic signs of OA seen in the lateral part of the PFJ were not associated with a definite compromise in functional outcome or implant survival. Severe damage to the lateral side of the PFJ with bone loss and grooving remains a contraindication to mobile-bearing UKA. Less severe damage to the lateral side of the PFJ and damage to the medial side, however severe, does not compromise the overall function or survival, so should not be considered to be a contraindication. However, if a patient does have full thickness cartilage loss on the lateral side of the PFJ they may

  15. Clinically insignificant association between anterior knee pain and patellofemoral lesions which are found incidentally.

    Science.gov (United States)

    Elson, D W; Jones, S; Caplan, N; St Clair Gibson, A; Stewart, S; Kader, D F

    2013-12-01

    Patellofemoral chondral lesions are frequently identified incidentally during the arthroscopic treatment of other knee pathologies. A role has been described for arthroscopic debridement when symptoms are known to originate from pathology of the patellofemoral joint. However, it remains unclear how to manage lesions which are found incidentally whilst tackling other pathologies. The purpose of this study was to establish the strength of association between anterior knee pain and patellofemoral lesions identified incidentally in a typical arthroscopic population. A consecutive series of patients undergoing arthroscopy for a range of standard indications formed the basis of this cross section study. We excluded those with patellofemoral conditions in order to identify patellofemoral lesions which were solely incidental. Pre-operative assessments were performed on 64 patients, where anterior knee pain was sought by three methods: an annotated photographic knee pain map (PKPM), patient indication with one finger and by palpated tenderness. A single blinded surgeon, performed standard arthroscopies and recorded patellofemoral lesions. Statistical correlations were performed to identify the association magnitude. Associations were identified between incidental patellofemoral lesions and tenderness palpated on the medial patella (P = 0.007, χ(2) = 0.32) and the quadriceps tendon (P = 0.029, χ(2) = 0.26), but these associations were at best fair, which could be interpreted as clinically insignificant. Incidental patellofemoral lesions are not necessarily associated with anterior knee pain, we suggest that they could be left alone. This recommendation is only applicable to patellofemoral lesions which are found incidentally whilst addressing other pathology. Copyright © 2013 Elsevier B.V. All rights reserved.

  16. The comparison of measurement between ultrasound and computed tomography for abnormal degenerative facet joints: A STROBE-compliant article.

    Science.gov (United States)

    Shi, Wen; Tian, Dan; Liu, Da; Yin, Jing; Huang, Ying

    2017-08-01

    Besides the study on examining facet joints of lumbar spine by ultrasound in normal population, there has not been any related report about examining normal facet joints of lumbar spine by ultrasound so far. This study was aimed to explore the feasibility of ultrasound assessment of lumber spine facet joints by comparing ultrasound measure values of normal and degenerative lumber spine facet joints, and by comparing measure values of ultrasound and computed tomography (CT) of degenerative lumber spine facet joints.This study included 15 patients who had chronic low back pain because of degenerative change in lumbar vertebrae, and 19 volunteers who did not have low back pain or pain in the lower limb. The ultrasound measure values (height [H] and width [W]) of normal and degenerative lumber spine facet joints were compared. And the differentiation between measure values (H and W) of ultrasound and CT of degenerative lumber spine facet joints was also analyzed.The ultrasound clearly showed abnormal facet joints lesion, which was characterized by hyperostosis on the edge of joints, bone destruction under joints, and thinner or thicker articular cartilage. There were significant differences between the ultrasound measure values of the normal (H: 1.26 ± 0.03 cm, W: 0.18 ± 0.01 cm) and abnormal facet joints (H: 1.43 ± 0.05 cm, W: 0.15 ± 0.02 cm) (all P  .05).Ultrasound can clearly show the structure of facet joints of lumbar spine. It is precise and feasible to assess facet joints of lumbar spine by ultrasound. This study has important significance for the diagnosis of lumbar facet joint degeneration.

  17. VASTUS LATERALIS OBLIQUE ACTIVITY DURING GAIT OF SUBJECTS WITH PATELLOFEMORAL PAIN

    Directory of Open Access Journals (Sweden)

    Gilmar Moraes Santos

    Full Text Available ABSTRACT Introduction: So far, little is known about the behavior of electromyographic activity of vastus lateralis oblique muscle during treadmill gait in subjects with and without patellofemoral pain syndrome. Objective: The purpose of this study was to investigate the electromyographic activity of the patellar stabilizers muscles and the angle of the knee joint flexion in subjects with and without patellofemoral pain syndrome. Method: Fifteen subjects without (21 ± 3 years and 12 with patellofemoral pain syndrome (20 ± 2 years were evaluated. The electromyographic activity and flexion angle of the knee joint were obtained during gait on the treadmill with a 5 degree inclination. Results: The knee flexion angle was significantly lower in the subjects with patellofemoral pain syndrome when compared with the healthy controls. The electromyographic activity of vastus lateralis longus was significantly greater during gait on the treadmill with inclination in subjects with patellofemoral pain syndrome. The results also showed that the electromyographic activity of vastus lateralis oblique and vastus medialis oblique were similar in both groups, regardless of the condition (with/without inclination. Conclusion: We have shown that knee kinematics during gait differs among patients with and without patellofemoral pain syndrome and healthy controls and that a different motor strategy persists even when the pain is no longer present. In addition, the findings suggested that the vastus lateralis oblique has a minor role in patellar stability during gait.

  18. Radiographic temporomandibular joint abnormality in adults with micrognathia and juvenile rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Larheim, T.A.; Haanaes, H.R.; Dale, K. (Oslo Univ. (Norway))

    1981-01-01

    Radiographic findings of the upper and lower jaw bone of 20 adult patients with micrognathia, bird face, and juvenile rheumatoid arthritis are reported. In all patients a symmetrically underdeveloped mandible with the chin posteriorly positioned was found at cephalometry. Arthritic lesion of the temporomandibular joint, mostly symmetric, with limitation of movement and secondary arthrosis, was observed in all patients. Complete absence of the mandibular head was frequent (75%). The fossa was generally flat, probably due to growth disturbance of the tubercle. Abnormal anterior position of the mandibular head occurred in almost half of the patients. The degree of mandibular growth disturbance seemed to be correlated to the severity of the arthritis, indicating the arthritis to be a causal mechanism of micrognathia.

  19. Young adolescents with autism show abnormal joint attention network: A gaze contingent fMRI study

    Directory of Open Access Journals (Sweden)

    E. Oberwelland

    2017-01-01

    Full Text Available Behavioral research has revealed deficits in the development of joint attention (JA as one of the earliest signs of autism. While the neural basis of JA has been studied predominantly in adults, we recently demonstrated a protracted development of the brain networks supporting JA in typically developing children and adolescents. The present eye-tracking/fMRI study now extends these findings to adolescents with autism. Our results show that in adolescents with autism JA is subserved by abnormal activation patterns in brain areas related to social cognition abnormalities which are at the core of ASD including the STS and TPJ, despite behavioral maturation with no behavioral differences. Furthermore, in the autism group we observed increased neural activity in a network of social and emotional processing areas during interactions with their mother. Moreover, data indicated that less severely affected individuals with autism showed higher frontal activation associated with self-initiated interactions. Taken together, this study provides first-time data of JA in children/adolescents with autism incorporating the interactive character of JA, its reciprocity and motivational aspects. The observed functional differences in adolescents ASD suggest that persistent developmental differences in the neural processes underlying JA contribute to social interaction difficulties in ASD.

  20. [Joint effect of birth weight and obesity measures on abnormal glucose metabolism at adulthood].

    Science.gov (United States)

    Xi, Bo; Cheng, Hong; Chen, Fangfang; Zhao, Xiaoyuan; Mi, Jie

    2016-01-01

    To investigate the joint effect of birth weight and each of obesity measures (body mass index (BMI) and waist circumference (WC)) on abnormal glucose metabolism (including diabetes) at adulthood. Using the historical cohort study design and the convenience sampling method, 1 921 infants who were born in Beijing Union Medical College Hospital from June 1948 to December 1954 were selected to do the follow-up in 1995 and 2001 respectively. Through Beijing Household Registration and Management System, they were invited to participate in this study. A total of 972 subjects (627 were followed up in 1995 and 345 were followed up in 2001) with complete information on genders, age, birth weight, family history of diabetes, BMI, WC, fasting plasma glucose (FPG) and 2-hour plasma glucose (2 h PG) met the study inclusion criteria at the follow-up visits. In the data analysis, they were divided into low, normal, and high birth weight, respectively. The ANOVA and Chi-squared tests were used to compare the differences in their characteristics by birth weight group. In addition, multiple binary Logistic regression model was used to investigate the single effect of birth weight, BMI, and waist circumference on abnormal glucose metabolism at adulthood. Stratification analysis was used to investigate the joint effect of birth weight and each of obesity measures (BMI and WC) on abnormal glucose metabolism. There were 972 subjects (males: 50.7%, mean age: (46.0±2.2) years) included in the final data analysis. The 2 h PG in low birth weight group was (7.6±3.2) mmol/L , which was higher than that in normal birth weight group (6.9±2.1) mmol/L and high birth weight group (6.4±1.3) mmol/L (F=3.88, P=0.021). After adjustment for genders, age, body length, gestation age, family history of diabetes, physical activity, smoking and alcohol consumption, and duration of follow-up, subjects with overweight and obesity at adulthood had 2.73 (95% confidence interval (CI) =2.06- 3.62) times risk

  1. Power Doppler Ultrasound Evaluation of Peripheral Joint, Entheses, Tendon, and Bursa Abnormalities in Psoriatic Patients: A Clinical Study.

    Science.gov (United States)

    Tang, Yuanjiao; Yang, Yujia; Xiang, Xi; Wang, Liyun; Zhang, Lingyan; Qiu, Li

    2018-04-15

    To evaluate the prevalence rates of peripheral joint, enthesis, tendon, and bursa abnormalities by power Doppler (PD) ultrasonic examination in patients with psoriatic arthritis (PsA), psoriatic patients without clinical signs of arthritis (non-PsA psoriasis group), and healthy individuals, to detect subclinical PsA. A total of 253 healthy volunteers, 242 non-PsA psoriatic patients, and 86 patients with PsA were assessed by 2-dimensional and power Doppler (PD) ultrasound. Peripheral joint, enthesis, tendon, and bursa abnormalities were observed, characterizing abnormal PD. The affected patients and sites with abnormalities in various ages were compared among groups; PD signal grades for the abnormalities were also compared. In the PsA group, significantly higher percentages of sites showing joint effusion/synovitis, enthesitis, and tenosynovitis in all age groups, and markedly higher rates of sites with bursitis were found in young and middle age groups, compared with the non-PsA and control groups (all p the non-PsA group showed significantly higher rates of joint effusion/synovitis and enthesitis sites, and elevated PD signal grades of synovitis, enthesitis, and tenosynovitis in comparison with the control group, both in young and middle age groups (all p tenosynovitis.

  2. Standardization of patellofemoral morphology in the pediatric knee

    Energy Technology Data Exchange (ETDEWEB)

    Mundy, Andrew; Yang, Jingzhen [Department of Orthopedic Surgery, Nationwide Children' s Hospital, Columbus, OH (United States); Ravindra, Amy [The Ohio State University, Department of Orthopaedics, Columbus, OH (United States); Adler, Brent H. [Department of Radiology, Nationwide Children' s Hospital, Columbus, OH (United States); Klingele, Kevin E. [Department of Orthopedic Surgery, Nationwide Children' s Hospital, Columbus, OH (United States); The Ohio State University, Department of Orthopaedics, Columbus, OH (United States)

    2016-02-15

    Our understanding of osseous morphology and pathology of the patellofemoral joint continues to improve with the use of magnetic resonance imaging (MRI), but a paucity of data currently exists in the pediatric population. We aim to formulate a reproducible means of quantitative assessment of patellofemoral morphology in children using MRI and to describe morphological changes based on sex and age. We identified 414 children presenting between 2002 and 2014 who obtained a knee MRI to evaluate for knee pain or clinically suspected knee pathology. After application of inclusion criteria, 144 ''normal'' MRIs in 131 children (71 boys, 60 girls) were included in the analysis. The following MRI measurements were recorded: lateral trochlear inclination, trochlear facet asymmetry, trochlear depth, tibial tuberosity-trochlear groove distance, sulcus angle and patellar height ratio. To assess intraobserver reliability, measurements in 30 randomly selected children were repeated. Differences between patient age and sex were assessed using independent t-tests and adjusted regression analysis. All recorded measurements had strong to very strong inter- and intraobserver reliability: lateral trochlear inclination (0.91/0.82), trochlear facet asymmetry (0.81/0.83), trochlear depth (0.83/0.90), tibial tuberosity-trochlear groove distance (0.97/0.87), sulcus angle (0.84/0.78) and patellar height ratio (0.96/0.83). When age and sex were mutually adjusted, statistically significant differences between males and females were observed in trochlear depth (P = 0.0084) and patellar height ratio (P = 0.0035). However, statistically significant age differences were found on all measurements except for lateral trochlear inclination. As expected, mean measurement values approached adult norms throughout skeletal maturation suggestive of age-dependent patellofemoral maturation. Our data verify the development of patellofemoral morphology with advancing age. We found that six

  3. The effect of trochlear dysplasia on patellofemoral biomechanics: a cadaveric study with simulated trochlear deformities.

    Science.gov (United States)

    Van Haver, Annemieke; De Roo, Karel; De Beule, Matthieu; Labey, Luc; De Baets, Patrick; Dejour, David; Claessens, Tom; Verdonk, Peter

    2015-06-01

    Trochlear dysplasia appears in different geometrical variations. The Dejour classification is widely used to grade the severity of trochlear dysplasia and to decide on treatment. To investigate the effect of trochlear dysplasia on patellofemoral biomechanics and to determine if different types of trochlear dysplasia have different effects on patellofemoral biomechanics. Controlled laboratory study. Trochlear dysplasia was simulated in 4 cadaveric knees by replacing the native cadaveric trochlea with different types of custom-made trochlear implants, manufactured with 3-dimensional printing. For each knee, 5 trochlear implants were designed: 1 implant simulated the native trochlea (control condition), and 4 implants simulated 4 types of trochlear dysplasia. The knees were subjected to 3 biomechanical tests: a squat simulation, an open chain extension simulation, and a patellar stability test. The patellofemoral kinematics, contact area, contact pressure, and stability were compared between the control condition (replica implants) and the trochlear dysplastic condition and among the subgroups of trochlear dysplasia. The patellofemoral joint in the trochlear dysplastic group showed increased internal rotation, lateral tilt, and lateral translation; increased contact pressures; decreased contact areas; and decreased stability when compared with the control group. Within the trochlear dysplastic group, the implants graded as Dejour type D showed the largest deviations for the kinematical parameters, and the implants graded as Dejour types B and D showed the largest deviations for the patellofemoral contact areas and pressures. Patellofemoral kinematics, contact area, contact pressure, and stability are significantly affected by trochlear dysplasia. Of all types of trochlear dysplasia, the models characterized with a pronounced trochlear bump showed the largest deviations in patellofemoral biomechanics. Investigating the relationship between the shape of the trochlea and

  4. Osteotomy of anterior and intern displacement of the tuberosity of the tibia (Fulkerson) in-patient with arthrosis and bad patellofemoral joint

    International Nuclear Information System (INIS)

    Carrillo Arango, German; Parada Gomez, Camilo

    2004-01-01

    The following paper is an observational study of a case series based on the analysis of 32 patients with persistent anterior knee pain, associated to degenerative joint disease and mal alignment, treated with a reorientation Fulkerson osteotomy. All patients had a previous arthroscopy that showed a control lesion type 4; according to the Outer bridge classification. Twenty-four 24 women and eight 8 men, 39 years old in average in a range between 27 and 56.They were all followed up by more than two 2 years (2 to 7 years). The evaluation was done according to the Lysbolm classification, modified by Fulkerson. According to the parameters, we found good results in 25 cases (78%) regular results in 3 cases (9%) and bad results in 4 cases (13%). During the immediate post op, the patients began to have a partial weight bearing with crutches, quadriceps isometrics and started movements in a range between o and 90 degrees. Complications: Two patients had persistent pain and one developed an infection around the osteosinthesis material

  5. An Isolated Medial Patellofemoral Ligament Reconstruction with Patellar Tendon Autograft

    Directory of Open Access Journals (Sweden)

    Dariusz Witoński

    2013-01-01

    Full Text Available The aim of the study was to evaluate the results of the medial patellofemoral ligament reconstruction with a medial strip of patellar tendon autograft after a minimum 2-year followup. Ten patients (10 knees were operated on by one surgeon, according to the modified technique, described by Camanho, without any bone plug at free graft end. The mean age of the patients was 27.2 years (ranging from 18 to 42 years. The mean follow-up period was 3 years and 7 months. All patients were reviewed prospectively. At the last follow-up visit, all the patients demonstrated a significant improvement in terms of patellofemoral joint stability, all aspects of the KOOS questionnaire, and Kujala et al.’s score (59.7 points preoperatively and 84.4 points at the last followup. No patient revealed recurrent dislocation. The SF-36 score revealed a significant improvement in bodily pain, general health, physical role functioning, social role functioning, and physical functioning domains. The described MPFL reconstruction with the use of the medial 1/3rd of patella tendon is an effective procedure that gives satisfactorily patellofemoral joint functions, improves the quality of life, and provides much pain relief. It is relatively simple, surgically not extensive, and economically cost-effective procedure.

  6. Patellofemoral pain, instability, and arthritis. Clinical presentation, imaging, and treatment

    Energy Technology Data Exchange (ETDEWEB)

    Zaffagnini, Stefano [Laboratorio di Biomeccanica, Bologna (Italy). Istituti Ortopedici Rizzoli; Dejour, David [Lyon-Ortho-Clinic (France). Knee Surgery Orthopaedic Dept.; Arendt, Elizabeth A. (eds.) [Minnesota Univ., Minneapolis, MN (United States). Dept. of Orthopaedics

    2010-07-01

    Despite numerous studies, a lack of consensus still exists over many aspects of patellofemoral pain, instability, and arthritis. This book adopts an evidence-based approach to assess each of these topics in depth. The book reviews general features of clinical examination and global evaluation techniques including the use of different imaging methods, e.g. x-rays, CT, MRI, stress x-rays, and bone scan. Various conservative and surgical treatment approaches for each of the three presentations - pain, instability, and arthritis - are then explained and assessed. Postoperative management and options in the event of failed surgery are also evaluated. Throughout, careful attention is paid to the literature in an attempt to establish the level of evidence for the efficacy of each imaging and treatment method. It is hoped that this book will serve as an informative guide for the practitioner when confronted with disorders of the patellofemoral joint. (orig.)

  7. Treatment options for patellofemoral instability in sports traumatology

    Directory of Open Access Journals (Sweden)

    Philippe M. Tscholl

    2013-09-01

    Full Text Available Patellofemoral instability not only involves lateral patellar dislocation, patellar mal-tracking or subluxation but can also cause a limiting disability for sports activities. Its underlying causes are known as morphological anomalies of the patellofemoral joint or the mechanical axis, femorotibial malrotation, variants of the knee extensor apparatus, and ligamentous insufficiencies often accompanied by poor proprioception. Athletes with such predisposing factors are either suffering from unspecific anterior knee pain or from slightly traumatic or recurrent lateral patellar dislocation Treatment options of patellar instability are vast, and need to be tailored individually depending on the athlete’s history, age, complaints and physical demands. Different conservative and surgical treatment options are reviewed and discussed, especially limited expectations after surgery.

  8. Clinical study of lateral patellofemoral crush syndrome caused by military training

    Directory of Open Access Journals (Sweden)

    De-hui ZHANG

    2012-05-01

    Full Text Available Objective  To explore diagnostic method and surgical outcome of lateral patellofemoral crush syndrome caused by military training. Methods  Fifteen patients with lateral patellofemoral crush syndrome caused by military training from May 2006 to May 2008 were enrolled in this study, including 12 men (14 knees and 3 women (3 knees, aged from 22 to 43 years old with an average of 27.3 years. Randomly selected 18 healthy volunteers with similar age and gender but no knee pain symptom were selected to serve as a control group. Anteroposterior and lateral X-ray photographs of knee joint and axial photographs of the patella were taken in both groups for observing the bone architecture of the knee joint and measuring the femoral trochlear angle, patellofemoral congruence angle and patellofemoral index, and the data were compared. The 17 knee joints in patient group were treated with lateral patellar retinaculum release. Then the preoperative and postoperative pain severity was evaluated with visual analogue scale (VAS. Results  Patellofemoral congruence angle was 7.67°± 5.81° and patellofemoral index was 2.49±1.40 in patient group, while they were -2.2°±-2.71° and 1.25±0.15 in control group. The difference between two groups showed statistical significance (P < 0.05. The change in bone architecture was obvious in patient group. The preoperative pain score was 7.06±0.85, and postoperative pain score was 3.87±0.24 after 6 months and 3.01+0.17 after 1 year in patient group. The difference between preoperative pain score and postoperative pain score showed statistical significance (P < 0.05. Conclusions  Diagnosis of patellofemoral crush syndrome caused by military training requires a combination of case history, typical symptoms, objective sign and X-ray examination. Among these, X-ray examination is the fundamental auxiliary diagnostic tool for lateral patellofemoral crush syndrome, and the patellofemoral index is convenient for

  9. Patellofemoral Pain Syndrome and Exercise Therapy

    NARCIS (Netherlands)

    R. van Linschoten (Robbart)

    2012-01-01

    textabstractPatellofemoral Pain Syndrome (PFPS) can be considered as a clinical entity evolving during adolescence and young adult age.Though the complaints may be self-limiting and follow a benign course there are claims that exercise therapy may be beneficial for patients with patellofemoral pain

  10. Patellofemoral pain syndrome in Tibetan Buddhist monks.

    Science.gov (United States)

    Koehle, Michael Stephen

    2006-01-01

    Patellofemoral pain syndrome is a common diagnosis in athletes and especially runners. This article discusses 3 cases of patellofemoral pain caused by pronounced inactivity and prolonged knee hyperflexion at altitude in a unique population of Tibetan Buddhist monks. In this case, the monks responded well to a program of activity modification and exercises.

  11. The value of emission computer tomography (ECT) for chronic abnormalities of the knee joint

    International Nuclear Information System (INIS)

    Koenig, H.; Geiger, A.; Feine, U.; Tuebingen Univ.

    1987-01-01

    Twenty-eight patients with chronic abnormalities of the knee were examined by 3-phase scintigraphy and ECT. The unobscured images produced by ECT provide additional information for evaluating the localisation, extent and activity of the lesions. The diagnosis of meniscus abnormalities in particular revealed pathognomonic patterns. The indications and value of ECT was compared with other diagnostic measures and particularly with invasive techniques (arthroscopy and arthrotomy). (orig.) [de

  12. Low tendon stiffness and abnormal ultrastructure distinguish classic Ehlers-Danlos syndrome from benign joint hypermobility syndrome in patients

    DEFF Research Database (Denmark)

    Nielsen, Rie Harboe; Couppé, Christian; Jensen, Jacob Kildevang

    2014-01-01

    There is a clinical overlap between classic Ehlers-Danlos syndrome (cEDS) and benign joint hypermobility syndrome (BJHS), with hypermobility as the main symptom. The purpose of this study was to investigate the role of type V collagen mutations and tendon pathology in these 2 syndromes. In patients...... the patients' hypermobility, whereas no tendon pathology was found that explained the hypermobility in BJHS.-Nielsen, R. H., Couppé, C., Jensen, J. K., Olsen, M. R., Heinemeier, K. M., Malfait, F., Symoens, S., De Paepe, A., Schjerling, P., Magnusson, S. P., Remvig, L., Kjaer, M. Low tendon stiffness...... and abnormal ultrastructure distinguish classic Ehlers-Danlos syndrome from benign joint hypermobility syndrome in patients....

  13. Magnetic resonance imaging changes of sacroiliac joints in patients with recent-onset inflammatory back pain: inter-reader reliability and prevalence of abnormalities

    NARCIS (Netherlands)

    Heuft-Dorenbosch, Liesbeth; Weijers, René; Landewé, Robert; van der Linden, Sjef; van der Heijde, Désirée

    2006-01-01

    To study the inter-reader reliability of detecting abnormalities of sacroiliac (SI) joints in patients with recent-onset inflammatory back pain by magnetic resonance imaging (MRI), and to study the prevalence of inflammation and structural changes at various sites of the SI joints. Sixty-eight

  14. Joint ultrasound baseline abnormalities predict a specific long-term clinical outcome in systemic lupus erythematosus patients.

    Science.gov (United States)

    Corzo, P; Salman-Monte, T C; Torrente-Segarra, V; Polino, L; Mojal, S; Carbonell-Abelló, J

    2017-06-01

    Objective To describe long-term clinical and serological outcome in all systemic lupus erythematosus (SLE) domains in SLE patients with hand arthralgia (HA) and joint ultrasound (JUS) inflammatory abnormalities, and to compare them with asymptomatic SLE patients with normal JUS. Methods SLE patients with HA who presented JUS inflammatory abnormalities ('cases') and SLE patients without HA who did not exhibit JUS abnormalities at baseline ('controls') were included. All SLE clinical and serological domain involvement data were collected. End follow-up clinical activity and damage scores (systemic lupus erythematosus disease activity index (SLEDAI), Systemic Lupus International Collaborating Clinics/American College of Rheumatology (SLICC/ACR)) were recorded. JUS inflammatory abnormalities were defined based on the Proceedings of the Seventh International Consensus Conference on Outcome Measures in Rheumatology Clinical Trials (OMERACT-7) definitions. Statistical analyses were carried out to compare 'cases' and 'controls'. Results A total of 35 patients were recruited. The 'cases', n = 18/35, had a higher incidence of musculoskeletal involvement (arthralgia and/or arthritis) through the follow-up period (38.9% vs 0%, p = 0.008) and received more hydroxychloroquine (61.1% vs 25.0%, p = 0.034) and methotrexate (27.8% vs 0%, p = 0.046) compared to 'controls', n = 17/35. Other comparisons did not reveal any statistical differences. Conclusions We found SLE patients with arthralgia who presented JUS inflammatory abnormalities received more hydroxychloroquine and methotrexate, mainly due to persistent musculoskeletal involvement over time. JUS appears to be a useful technique for predicting worse musculoskeletal outcome in SLE patients.

  15. Relationship between Fatigue and Gait Abnormality in Joint Hypermobility Syndrome/Ehlers-Danlos Syndrome Hypermobility Type

    Science.gov (United States)

    Celletti, Claudia; Galli, Manuela; Cimolin, Veronica; Castori, Marco; Albertini, Giorgio; Camerota, Filippo

    2012-01-01

    Ehlers-Danlos syndrome (EDS) is a clinically and genetically heterogeneous group of inherited connective tissue disorders characterised by joint hypermobility, skin hyperextensibility and tissue fragility. It has recently been shown that muscle weakness occurs frequently in EDS, and that fatigue is a common and clinically important symptom. The…

  16. WITHDRAWN : Exercise therapy for patellofemoral pain syndrome

    NARCIS (Netherlands)

    Heintjes, Edith M; Berger, Marjolein; Bierma-Zeinstra, Sita Ma; Bernsen, Roos Md; Verhaar, Jan An; Koes, Bart W

    2015-01-01

    BACKGROUND: Patellofemoral pain syndrome (PFPS) is a common problem among adolescents and young adults, characterised by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) when ascending or descending stairs, squatting or sitting with flexed knees. Etiology, structures

  17. Talonavicular joint abnormalities and walking ability of patients with rheumatoid arthritis

    International Nuclear Information System (INIS)

    Miyamoto, Noriyoshi; Senda, Masuo; Hamada, Masanori; Katayama, Yoshimi; Kinosita, Atsushi; Uchida, Kensuke; Inoue, Hajime

    2004-01-01

    Rheumatoid arthritis (RA) is often associated with deformities of the feet, and foot pain often arises in the talonavicular joint of patients with RA. The object of this study was to assess the relationship between magnetic resonance imaging (MRI) findings of the talonavicular joint and walking ability. The subjects were 35 RA patients (10 feet in 5 males and 56 feet in 30 females) aged 34-87 years (mean: 70 years±12.1), with a disease duration from 1-54 years (mean: 14 years±12.1). MRI findings were classified as follows: Grade 1, almost normal; Grade 2, early articular destruction; Grade 3, moderate articular destruction; Grade 4, severe articular destruction; and Grade 5, bony ankylosis dislocation. Walking ability was classified into one of 9 categories ranging from normal gait to bedridden status according to the system of Fujibayashi. As the grade of MRI images became higher the walking ability decreased, and these parameters showed a correlation by Spearman's rank correlation coefficient analysis (P=0.003). Thus, in the present cohort group of patients with RA, the deterioration of walking ability increased with the severity of destruction of the talonavicular joint. (author)

  18. Propulsion phase of the single leg triple hop test in women with patellofemoral pain syndrome: a biomechanical study.

    Directory of Open Access Journals (Sweden)

    Andre Serra Bley

    Full Text Available Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS, caused by an increase in patellofemoral (PF joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT, which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM, gluteus medius (GMed, biceps femoris (BF and vastus lateralis (VL. Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress.

  19. Propulsion Phase of the Single Leg Triple Hop Test in Women with Patellofemoral Pain Syndrome: A Biomechanical Study

    Science.gov (United States)

    Bley, Andre Serra; Correa, João Carlos Ferrari; Reis, Amir Curcio Dos; Rabelo, Nayra Deise Dos Anjos; Marchetti, Paulo Henrique; Lucareli, Paulo Roberto Garcia

    2014-01-01

    Asymmetry in the alignment of the lower limbs during weight-bearing activities is associated with patellofemoral pain syndrome (PFPS), caused by an increase in patellofemoral (PF) joint stress. High neuromuscular demands are placed on the lower limb during the propulsion phase of the single leg triple hop test (SLTHT), which may influence biomechanical behavior. The aim of the present cross-sectional study was to compare kinematic, kinetic and muscle activity in the trunk and lower limb during propulsion in the SLTHT using women with PFPS and pain free controls. The following measurements were made using 20 women with PFPS and 20 controls during propulsion in the SLTHT: kinematics of the trunk, pelvis, hip, and knee; kinetics of the hip, knee and ankle; and muscle activation of the gluteus maximus (GM), gluteus medius (GMed), biceps femoris (BF) and vastus lateralis (VL). Differences between groups were calculated using three separate sets of multivariate analysis of variance for kinematics, kinetics, and electromyographic data. Women with PFPS exhibited ipsilateral trunk lean; greater trunk flexion; greater contralateral pelvic drop; greater hip adduction and internal rotation; greater ankle pronation; greater internal hip abductor and ankle supinator moments; lower internal hip, knee and ankle extensor moments; and greater GM, GMed, BL, and VL muscle activity. The results of the present study are related to abnormal movement patterns in women with PFPS. We speculated that these findings constitute strategies to control a deficient dynamic alignment of the trunk and lower limb and to avoid PF pain. However, the greater BF and VL activity and the extensor pattern found for the hip, knee, and ankle of women with PFPS may contribute to increased PF stress. PMID:24830289

  20. [The theoretical substantiation of myofunctional correction of sagittal occlusion abnormalities and temporomandibular joint dysfunction].

    Science.gov (United States)

    Danilova, M A; Ishmurzin, P V; Zakharov, S V

    2012-01-01

    Simulation in 3D-model of skeletal forms of sagittal malocclusion revealed tendency in tonus' modification of muscles of mastication in formation of distal and mesial occlusion. It's shown that distal occlusion is characterized by hypotonic condition of muscles of mastication, except posterior fibers of temporal muscle. Mesial occlusion is characterized by complex combination of muscle tone with prevalence of hypotonic condition of anterior fibers of temporal muscle, superficial portion of masseter muscle and medial pterygoid muscle. We have detected that using of myofunctional devices in treatment of sagittal malocclusion, temporomandibular joint dysfunction promotes of tone increasing of muscles of mastication.

  1. Lower-extremity musculoskeletal geometry affects the calculation of patellofemoral forces in vertical jumping and weightlifting.

    Science.gov (United States)

    Cleather, D I; Bull, A M J

    2010-01-01

    The calculation of the patellofemoral joint contact force using three-dimensional (3D) modelling techniques requires a description of the musculoskeletal geometry of the lower limb. In this study, the influence of the complexity of the muscle model was studied by considering two different muscle models, the Delp and Horsman models. Both models were used to calculate the patellofemoral force during standing, vertical jumping, and Olympic-style weightlifting. The patellofemoral forces predicted by the Horsman model were markedly lower than those predicted by the Delp model in all activities and represented more realistic values when compared with previous work. This was found to be a result of a lower level of redundancy in the Delp model, which forced a higher level of muscular activation in order to allow a viable solution. The higher level of complexity in the Horsman model resulted in a greater degree of redundancy and consequently lower activation and patellofemoral forces. The results of this work demonstrate that a well-posed muscle model must have an adequate degree of complexity to create a sufficient independence, variability, and number of moment arms in order to ensure adequate redundancy of the force-sharing problem such that muscle forces are not overstated.

  2. Walking abnormalities

    Science.gov (United States)

    ... include: Arthritis of the leg or foot joints Conversion disorder (a mental disorder) Foot problems (such as a ... injuries. For an abnormal gait that occurs with conversion disorder, counseling and support from family members are strongly ...

  3. Test Procedures to Assess Somatosensory Abnormalities in Individuals with Peripheral Joint Pain: A Systematic Review of Psychometric Properties.

    Science.gov (United States)

    Alqarni, Abdullah Mohammad; Manlapaz, Donald; Baxter, David; Tumilty, Steve; Mani, Ramakrishnan

    2018-01-19

    Test procedures that were developed to assess somatosensory abnormalities should possess optimal psychometric properties (PMPs) to be used in clinical practice. The aim of this systematic review was to evaluate the literature to assess the level of evidence for PMPs of test procedures investigated in individuals with peripheral joint pain (PJP). A comprehensive electronic literature search was conducted in 7 databases from inception to March 2016. The Quality Appraisal for Reliability Studies (QAREL) checklist and the Consensus-based Standards for the Selection of Health Status Measurement Instruments (COSMIN) tool were used to assess risk for bias of the included studies. Level of evidence was evaluated based on the methodological quality and the quality of the measurement properties. Forty-one studies related to PJP were included. The majority of included studies were considered to be of insufficient methodological quality, and the level of evidence for PMPs varied across different test procedures. The level of evidence for PMPs varied across different test procedures in different types of PJP. Hand-held pressure algometry is the only test procedure that showed moderate positive evidence of intrarater reliability, agreement, and responsiveness, simultaneously, when it was investigated in patients with chronic knee osteoarthritis. This systematic review identified that the level of evidence for PMPs varied across different testing procedures to assess somatosensory abnormalities for different PJP populations. Further research with standardized protocols is recommended to further investigate the predictive ability and responsiveness of reported test procedures in order to warrant their extended utility in clinical practice. © 2018 World Institute of Pain.

  4. Occupational kneeling and radiographic tibiofemoral and patellofemoral osteoarthritis

    DEFF Research Database (Denmark)

    Rytter, Søren; Egund, Niels; Jensen, Lilli Kirkeskov

    2009-01-01

    intervals (CI) of TF and PF OA was computed among floor layers compared to graphic designers in three age groups (/= 60 years). Using logistic regression, estimates were adjusted for body mass index and knee-straining sports. In addition, the association between trade seniority and TF OA was assessed in age......ABSTRACT: BACKGROUND: The objective of our study was to evaluate the association between occupational kneeling and compartment specific radiographic tibiofemoral (TF) and patellofemoral (PF) osteoarthritis (OA). METHODS: Questionnaire data and bilateral knee radiographs were obtained in 134 male...... floor layers and 120 male graphic designers (referents). Weight-bearing radiographs in three views (postero-anterior, lateral and axial) were classified according to joint space narrowing. After the exclusion of subjects with reports of earlier knee injuries the odds ratio (OR) with 95% confidence...

  5. AN EVALUATION OF THE REARFOOT POSTURE IN INDIVIDUALS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Wendy Gilleard

    2004-11-01

    Full Text Available Structural abnormalities of the foot may cause abnormal subtalar joint compensatory motion in order to attain normal function of the lower extremity during gait although studies have not been conclusive. Current conflict in the literature may be related to the differing measures focused on the varying protocols and also the absence of a control group in some studies. This study investigated the rearfoot posture including Subtalar Joint Neutral Position (STJN and Relaxed Calcaneal Standing (RCS measurements in patellofemoral pain syndrome (PFPS and healthy subjects. The angle of STJN during non-weight bearing position and the two dimensional (2D rearfoot RCS posture was measured using a goniometer in 14 healthy females and 13 females with PFPS. The RCS posture was also measured three dimensionally (3D by attaching external markers to a tibia shell and the calcaneus and videoing with a four-camera three-dimensional motion analysis system. A one way ANOVA was used to assess the differences between the groups. The 2D and 3D RCS were significantly different between the groups (p ¡Ü 0.001 with mean -0.23¡ã ¡À 1.35¡ã , 2.52¡ã ¡À 3.11¡ã for the control group and 2.35¡ã ¡À 1.4¡ã, 7.02¡ã ¡À 3.33¡ã for the clinical group respectively. STJN showed a slight rearfoot varus (although significant p = 0.04 in PFPS (-2.20¡ã ¡À 1.51¡ã compared to the control group (-1.00¡ã ¡À 1.36¡ã. Negative values indicated inversion and positive values indicated eversion. The 2D and 3D RCS showed a significantly more everted posture of the rearfoot for the PFPS group. Subtalar joint varus may contribute to the increased eversion during relaxed standing in the PFPS group. Rearfoot measurements may be an important addition to other clinical measurements taken to explore the underlying aetiology of subjects with PFPS.

  6. Mirror gait retraining for the treatment of patellofemoral pain in female runners.

    Science.gov (United States)

    Willy, Richard W; Scholz, John P; Davis, Irene S

    2012-12-01

    Abnormal hip mechanics are often implicated in female runners with patellofemoral pain. We sought to evaluate a simple gait retraining technique, using a full-length mirror, in female runners with patellofemoral pain and abnormal hip mechanics. Transfer of the new motor skill to the untrained tasks of single leg squat and step descent was also evaluated. Ten female runners with patellofemoral pain completed 8 sessions of mirror and verbal feedback on their lower extremity alignment during treadmill running. During the last 4 sessions, mirror and verbal feedback were progressively removed. Hip mechanics were assessed during running gait, a single leg squat and a step descent, both pre- and post-retraining. Subjects returned to their normal running routines and analyses were repeated at 1-month and 3-month post-retraining. Data were analyzed via repeated measures analysis of variance. Subjects reduced peaks of hip adduction, contralateral pelvic drop, and hip abduction moment during running (Psquatting and step descent was noted (Psquatting and step descent indicated that a higher level of motor learning had occurred. Extended follow-up is needed to determine the long term efficacy of this treatment. Copyright © 2012 Elsevier Ltd. All rights reserved.

  7. Reduced knee flexion is a possible cause of increased loading rates in individuals with patellofemoral pain.

    Science.gov (United States)

    Silva, Danilo de Oliveira; Briani, Ronaldo Valdir; Pazzinatto, Marcella Ferraz; Ferrari, Deisi; Aragão, Fernando Amâncio; Azevedo, Fábio Mícolis de

    2015-11-01

    Stair ascent is an activity that exacerbates symptoms of individuals with patellofemoral pain. The discomfort associated with this activity usually results in gait modification such as reduced knee flexion in an attempt to reduce pain. Although such compensatory strategy is a logical approach to decrease pain, it also reduces the normal active shock absorption increasing loading rates and may lead to deleterious and degenerative changes of the knee joint. Thus, the aims of this study were (i) to investigate whether there is reduced knee flexion in adults with PFP compared to healthy controls; and (ii) to analyze loading rates in these subjects, during stair climbing. Twenty-nine individuals with patellofemoral pain and twenty-five control individuals (18-30 years) participated in this study. Each subject underwent three-dimensional kinematic and kinetic analyses during stair climbing on two separate days. Between-groups analyses of variance were performed to identify differences in peak knee flexion and loading rates. Intraclass correlation coefficient was performed to verify the reliability of the variables. On both days, the patellofemoral pain group demonstrated significantly reduced peak knee flexion and increased loading rates. In addition, the two variables obtained high to very high reliability. Reduced knee flexion during stair climbing as a strategy to avoid anterior knee pain does not seem to be healthy for lower limb mechanical distributions. Repeated loading at higher loading rates may be damaging to lower limb joints. Copyright © 2015 Elsevier Ltd. All rights reserved.

  8. Orthotic devices for treating patellofemoral pain syndrome

    NARCIS (Netherlands)

    D'hondt, N. E.; Struijs, P. A.; Kerkhoffs, G. M.; Verheul, C.; Lysens, R.; Aufdemkampe, G.; van Dijk, C. N.

    2002-01-01

    BACKGROUND: Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of

  9. The Maquet procedure: effect of tibial shingle length on patellofemoral pressures.

    Science.gov (United States)

    Pan, H Q; Kish, V; Boyd, R D; Burr, D B; Radin, E L

    1993-03-01

    The Maquet procedure--elevation of the anterior tibial tubercle--has been recommended for treatment of symptomatic osteoarthrosis of the patellofemoral joint. Although the operation was first described 30 years ago, it remains controversial, both on a clinical and on a biomechanical basis. In addition, deterioration of the long-term results has been suggested. One of the variables that has been ignored in both clinical and biomechanical studies has been tibial shingle length. In order to judge its effect, we examined contact pressures and areas in 15 cadaver knees with 7 and 20 cm tibial shingle lengths. We found significant patellofemoral pressure diminution only with 2 cm elevations. The short anterior tibial shingle with 2 cm of elevation tipped the patella on its superior pole, with a significant change in angle between the patella and the shingle. We suggest that this creates a potentially less than desirable biomechanical circumstance and believe it may explain the discrepancies among previously published reports.

  10. The Effect of Patellofemoral Pain Syndrome on Gait Parameters: A Literature Review

    Directory of Open Access Journals (Sweden)

    Mokhtar Arazpour

    2016-10-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS is one of the most frequent causes of anterior knee pain in adolescents and adults. This disorder can have a big effect on patients’ ability and quality of life and gait.   Methods: This review included all articles published during 1990 to 2016. An extensive literature search was performed in databases of Science Direct, Google Scholar, PubMed and ISI Web of Knowledge using OR, AND, NOT between the selected keywords. Finally, 16 articles were selected from final evaluation. Results: In PFPS subjects, there was lower gait velocity, decreased cadence, and reduced knee extensor moment in the loading response and terminal stance, delayed peak rear foot eversion during gait and greater hip adduction compared to healthy subjects, while for hip rotation, there was controversy in studies. Conclusion: Changes in the walking patterns of PFPS subjects may be associated with the strategy used for the reduction of patellofemoral joint reaction force and pain.

  11. Patellofemoral Osteoarthritis: Are We Missing an Important Source of Symptoms After Anterior Cruciate Ligament Reconstruction?

    Science.gov (United States)

    Culvenor, Adam G; Crossley, Kay M

    2016-04-01

    Anterior cruciate ligament (ACL) rupture is a well-established risk factor for knee osteoarthritis (OA). Fifty to ninety percent of individuals will develop radiographic tibiofemoral OA within a decade after ACL injury and anterior cruciate ligament reconstruction (ACLR). Although less well recognized, radiographic patellofemoral OA is present in approximately 50% of individuals at more than 10 years after ACLR. This early-onset OA and its associated pain and functional limitations pose a particular challenge to younger adults with OA compared to an older OA population. Targeted interventions need to be developed to reduce the burden of early-onset OA following ACLR. Emerging evidence suggests that such interventions should target both the patellofemoral and tibiofemoral joints.

  12. The association between reduced knee joint proprioception and medial meniscal abnormalities using MRI in knee osteoarthritis: results from the Amsterdam osteoarthritis cohort.

    Science.gov (United States)

    van der Esch, M; Knoop, J; Hunter, D J; Klein, J-P; van der Leeden, M; Knol, D L; Reiding, D; Voorneman, R E; Gerritsen, M; Roorda, L D; Lems, W F; Dekker, J

    2013-05-01

    Osteoarthritis (OA) of the knee is characterized by pain and activity limitations. In knee OA, proprioceptive accuracy is reduced and might be associated with pain and activity limitations. Although causes of reduced proprioceptive accuracy are divergent, medial meniscal abnormalities, which are highly prevalent in knee OA, have been suggested to play an important role. No study has focussed on the association between proprioceptive accuracy and meniscal abnormalities in knee OA. To explore the association between reduced proprioceptive accuracy and medial meniscal abnormalities in a clinical sample of knee OA subjects. Cross-sectional study in 105 subjects with knee OA. Knee proprioceptive accuracy was assessed by determining the joint motion detection threshold in the knee extension direction. The knee was imaged with a 3.0 T magnetic resonance (MR) scanner. Number of regions with medial meniscal abnormalities and the extent of abnormality in the anterior and posterior horn and body were scored according to the Boston-Leeds Osteoarthritis Knee Score (BLOKS) method. Multiple regression analyzes were used to examine whether reduced proprioceptive accuracy was associated with medial meniscal abnormalities in knee OA subjects. Mean proprioceptive accuracy was 2.9° ± 1.9°. Magnetic resonance imaging (MRI)-detected medial meniscal abnormalities were found in the anterior horn (78%), body (80%) and posterior horn (90%). Reduced proprioceptive accuracy was associated with both the number of regions with meniscal abnormalities (P pain, age, gender, body mass index (BMI) and duration of knee complaints. This is the first study showing that reduced proprioceptive accuracy is associated with medial meniscal abnormalities in knee OA. The study highlights the importance of meniscal abnormalities in understanding reduced proprioceptive accuracy in persons with knee OA. Copyright © 2013 Osteoarthritis Research Society International. All rights reserved.

  13. The Effect of Diacutaneous Fibrolysis on Patellar Position Measured Using Ultrasound Scanning in Patellofemoral Pain Syndrome Patients.

    Science.gov (United States)

    Fanlo-Mazas, Pablo; Bueno-Gracia, Elena; de Escudero-Zapico, Alazne Ruiz; Tricás-Moreno, José Miguel; Lucha-López, María Orosia

    2018-04-13

    Tightness or lack of flexibility of flexibility of several muscles of the thigh has been associated with patellofemoral-join pain. A tight iliotibial band can lead to laterally located patella and an abnormal patellar tracking pattern. Diacutaneous fibrolysis is commonly used to reduce muscle tightness, but no studies have evaluated the effects of this technique in the treatment of patellofemoral pain syndrome patients. To assess the effect of diacutaneous fibrolysis on patellar position in patients with patellofemoral pain syndrome. A single-group, pretest-posttest clinical trial. University of Zaragoza. 46 subjects with patellofemoral pain (20 males, 26 females (age 27.8 ± 6.9 years)). 3 sessions of diacutaneous fibrolysis. Patellar position measurement using real time ultrasound scanning, pain intensity measured with visual analogue scale and function measured with the Anterior Knee Pain Scale. The application of three sessions of diacutaneous fibrolysis significantly increased the patellar position at post-treatment evaluation (pdiacutaneous fibrolysis and at one week follow up.

  14. Reliability of the Superimposed-Burst Technique in Patients With Patellofemoral Pain: A Technical Report.

    Science.gov (United States)

    Norte, Grant E; Frye, Jamie L; Hart, Joseph M

    2015-11-01

    The superimposed-burst (SIB) technique is commonly used to quantify central activation failure after knee-joint injury, but its reliability has not been established in pathologic cohorts. To assess within-session and between-sessions reliability of the SIB technique in patients with patellofemoral pain. Descriptive laboratory study. University laboratory. A total of 10 patients with self-reported patellofemoral pain (1 man, 9 women; age = 24.1 ± 3.8 years, height = 167.8 ± 15.2 cm, mass = 71.6 ± 17.5 kg) and 10 healthy control participants (3 men, 7 women; age = 27.4 ± 5.0 years, height = 173.5 ± 9.9 cm, mass = 78.2 ± 16.5 kg) volunteered. Participants were assessed at 6 intervals spanning 21 days. Intraclass correlation coefficients (ICCs [3,3]) were used to assess reliability. Quadriceps central activation ratio, knee-extension maximal voluntary isometric contraction force, and SIB force. The quadriceps central activation ratio was highly reliable within session (ICC [3,3] = 0.97) and between sessions through day 21 (ICC [3,3] = 0.90-0.95). Acceptable reliability of knee extension (ICC [3,3] = 0.75-0.91) and SIB force (ICC [3,3] = 0.77-0.89) was observed through day 21. The SIB technique was reliable for clinical research up to 21 days in patients with patellofemoral pain.

  15. The Effect of Step Frequency Training on a Male Runner with Patellofemoral Pain

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    Shelley Payne

    2016-10-01

    Full Text Available Running is a very popular form of exercise. The most common site of injury for runners is the knee with patellofemoral pain being the most common complaint. Patellofemoral pain is described as pain around the patella that is worse with activities such as running, squatting, ascending or descending stairs, or sitting for long periods. Much of the recent work with the treatment of patellofemoral pain has involved strengthening of the hip musculature to reduce pain about the knee. However, the ability of these strengthening programs to change lower extremity mechanics or sustain long-term pain reduction has been unproven. More recently, researchers have started to examine the impact of step frequency modification on the forces encountered in the lower extremity, and specifically about the patellofemoral joint. The purpose of this study was to examine the short term effects of step frequency training in a recreational runner with PFP. Methods: This was a single-subject case study design. The subject completed a pre- and post-training assessment to determine the preferred step frequency. The subject also completed a Visual Analog Scale (VAS and a Lower Extremity Functional Scale (LEFS. Results: After the initial evaluation, the subject completed training 2 times per week for 4 weeks using auditory feedback to increase their step frequency by 5% above their preferred step frequency. The subject experienced a decrease in pain as measured by the VAS and an increase in function as measured by the LEFS across the 4 week training. Discussion: Although the results of this case study may not be generalized, the positive findings support additional research to determine both the short and long-term effects of step frequency training on PFP.

  16. Patellofemoral Pain Syndrome in Iranian Female Athletes

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    Hamid Reza Baradaran

    2011-03-01

    Full Text Available Patellofemoral pain syndrome (PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who come to the sports medicine clinic. Patellofemoral pain is more common among female athletes especially adolescents and young adults. Symptoms include: persistent pain behind the patella or peripatella. Pain increases on ascending and descending stairs and squatting and prolonged sitting. The aim of this study was to evaluate the prevalence of PFPS in Iranian female athletes. 418 female athletes aged 15-35 years were examined in five sports: Soccer (190, volleyball (103, running (42, fencing (45 and rock climbing (38. The athletes who had non- traumatic onset anterior knee pain of at least 3 months that increased in descending and ascending stairs and squatting, had no other causes of anterior knee pain such as ligament instability, bursitis, meniscal injury, tendonitis and arthritis and no history of knee surgery during the one past year were diagnosed as PFPS. 26/190 (13.68 % soccer players, 21/103(20.38 % volleyball players, 7/42 (16.66 % runners, 6/45(13.33 % fencers and 10/38 (26.31% rock climbers had patellofemoral pain. Among the 418 female athletes who were evaluated 70 had PFPS. Rock climbers were the most common athletes with PFPS followed by volleyball players and runners.

  17. Increased medial foot loading during drop jump in subjects with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Richter, Camilla; Brushøj, Christoffer

    2014-01-01

    pressure distribution was collected during drop jump and single leg squat using pressure-sensitive Pedar insoles, inserted into a standard flat shoe. The primary outcome was the medial-to-lateral force, quantified as the peak force under the medial forefoot as the percentage of force under the total...... display a more medially oriented loading pattern of the forefoot compared to individuals without knee pain. This loading pattern may be associated with the distribution of forces acting on the patellofemoral joint and suggest treatment of PFP should consider interventions that target normalisation of foot...

  18. CT arthrography and virtual arthroscopy in the diagnosis of the anterior cruciate ligament and meniscal abnormalities of the knee joint

    International Nuclear Information System (INIS)

    Lee, Whal; Chung, Jin-Wook; Kang, Heung-Sik; Hong, Sung-Hwan; Choi, Ja-Young; Kim, Ho-Sung; Kim, Seok-Jung; Kim, Hyung-Ho

    2004-01-01

    To determine the diagnostic accuracy of CT arthrography and virtual arthroscopy in the diagnosis of anterior cruciate ligament and meniscus pathology. Thirty-eight consecutive patients sho underwent CT arthrography and arthroscopy of the knee were included in this study. The ages of the patients ranged from 19 to 52 years and all of the patients were male. Sagittal, coronal, transverse and oblique coronal multiplanar reconstruction images were reformatted from CT arthrography. Virtual arthroscopy was performed from 6 standard views using a volume rendering technique. Three radiologists analyzed the MPR images and two orthopedic surgeons analyzed the virtual arthroscopic images. The sensitivity and specificity of CT arthrography for the diagnosis of anterior cruciate ligament abnormalities were 87.5%-100% and 93.3%-96.7%, respectively and those for meniscus abnormalities were 91.7%-100% and 98.1%, respectively. The sensitivity and specificity of virtual arthroscopy for the diagnosis of anterior cruciate ligament abnormalities were 87.5% and 83.3%-90%, respectively, and those for meniscus abnormalities were 83.3%-87.5% and 96.1-98.1%, respectively. CT arthrography and virtual arthroscopy showed good diagnostic accuracy for anterior cruciate ligament and meniscal abnormalities

  19. Nail-patella-syndrome in a young patient followed up over 10 years: relevance of the sagittal trochlear septum for patellofemoral pathology

    Directory of Open Access Journals (Sweden)

    Konrads Christian

    2016-01-01

    Full Text Available Introduction: Nail-patella-syndrome (NPS is a rare autosomal-dominant inherited disease with pathologies of nails, skeleton, kidneys, and eyes. Linkage to a mutated gene was found. It codes for the transcription-factor LMX1B. In most cases knees are symptomatic. Patients have hypoplastic patellae, which are laterally subluxated. In those individuals a sagittal trochlear fibrous septum was found, dividing the anterior knee-joint-space. In the literature the etiology and clinical significance of this anatomic abnormality is unclear. Based on clinical and intraoperative findings we developed a theory regarding knee pathology in nail-patella-syndrome. Successful treatment via early resection of the septum with sustained good outcome is presented. Methods: In a symptomatic six-year-old boy with nail-patella-syndrome we resected the fibrous sagittal septum adherent to the trochlea femoris and we balanced the patella via lateral release and medial plication in both knee joints. We analyzed the clinical outcome of this procedure prospectively over 10 years. Results: Postoperatively the hypoplastic patellae stayed centered and stable during further skeletal development. The patient was still pain free with normal range of motion of both operated knee joints after 10 years of follow-up. Discussion: In patients with nail-patella-syndrome and a subluxated or dislocated patella we recommend diagnostics with magnetic-resonance-imaging and early surgical treatment via resection of the trochlear septum and soft-tissue-balancing of the patella. When the septum displaces the patella and prevents physiological articulation of the patella with the trochlea femoris, early septum resection is likely to be important for a good functional outcome and proper development of the patellofemoral joint during growth.

  20. Knee orthoses for treating patellofemoral pain syndrome.

    Science.gov (United States)

    Smith, Toby O; Drew, Benjamin T; Meek, Toby H; Clark, Allan B

    2015-12-08

    Patellofemoral pain syndrome (PFPS) is a painful musculoskeletal condition, which is characterised by knee pain located in the anterior aspect (front) and retropatellar region (behind) of the knee joint. Various non-operative interventions are suggested for the treatment of this condition. Knee orthoses (knee braces, sleeves, straps or bandages) are worn over the knee and are thought to help reduce knee pain. They can be used in isolation or in addition to other treatments such as exercise or non-steroidal anti-inflammatory medications. To assess the effects (benefits and harms) of knee orthoses (knee braces, sleeves, straps or bandages) for treating PFPS. We searched the Cochrane Bone, Joint and Muscle Trauma Group Specialised Register (11 May 2015), the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2015 Issue 5), MEDLINE (1946 to 8 May 2015), EMBASE (1980 to 2015 Week 18), SPORTDiscus (1985 to 11 May 2015), AMED (1985 to 8 May 2015), CINAHL (1937 to 11 May 2015), PEDro (1929 to June 2015), trial registries and conference proceedings. Randomised and quasi-randomised controlled clinical trials evaluating knee orthoses for treating people with PFPS. Our primary outcomes were pain and function. Two review authors independently assessed studies for eligibility, assessed study risk of bias and extracted data. We calculated mean differences (MD) or, where pooling data from different scales, standardised mean differences (SMD) with 95% confidence intervals (CI) for continuous outcomes and risk ratios (RR) with 95% CIs for binary outcomes. We pooled data using the fixed-effect model. We included five trials (one of which was quasi-randomised) that reported results for 368 people who had PFPS. Participants were recruited from health clinics in three trials and were military recruits undergoing training in the other two trials. Although no trials recruited participants who were categorised as elite or professional athletes, military training

  1. Arthroscopic Patelloplasty and Circumpatellar Denervation for the Treatment of Patellofemoral Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Gang Zhao

    2015-01-01

    Full Text Available Background: Patellofemoral osteoarthritis commonly occurs in older people, often resulting in anterior knee pain and severely reduced quality of life. The aim was to examine the effectiveness of arthroscopic patelloplasty and circumpatellar denervation for the treatment of patellofemoral osteoarthritis (PFOA. Methods: A total of 156 PFOA patients (62 males, 94 females; ages 45-81 years, mean 66 years treated in our department between September 2012 and March 2013 were involved in this study. Clinical manifestations included recurrent swelling and pain in the knee joint and aggravated pain upon ascending/descending stairs, squatting down, or standing up. PFOA was treated with arthroscopic patelloplasty and circumpatellar denervation. The therapeutic effects before and after surgery were statistically evaluated using Lysholm and Kujala scores. The therapeutic effects were graded by classification of the degree of cartilage defect. Results: A total of 149 cases were successfully followed up for 14.8 months, on average. The incisions healed well, and no complications occurred. After surgery, the average Lysholm score improved from 73.29 to 80.93, and the average Kujala score improved from 68.34 to 76.48. This procedure was highly effective for patients with cartilage defects I-III but not for patients with cartilage defect IV. Conclusions: For PFOA patients, this procedure is effective for significantly relieving anterior knee pain, improving knee joint function and quality of life, and deferring arthritic progression.

  2. Factors associated with patellofemoral pain syndrome: A systematic review

    NARCIS (Netherlands)

    N.E. Lankhorst (Nienke); S.M. Bierma-Zeinstra (Sita); M. van Middelkoop (Marienke)

    2013-01-01

    markdownabstractABSTRACT This review systematically summarises factors associated with patellofemoral pain syndrome (PFPS). A systematic literature search was conducted. Studies including ≥20 patients with PFPS that examined ≥1 possible factor associated with PFPS were included. A

  3. PATELLOFEMORAL MODEL OF THE KNEE JOINT UNDER NON- STANDARD SQUATTING

    Directory of Open Access Journals (Sweden)

    GUSZTÁV FEKETE

    2014-01-01

    Full Text Available Los modelos analíticos disponibles para calcular las fuerzas patelofemorales de la rodilla están limitados al movimiento estándar de cuclillas cuando el centro de gravedad es fijo horizontalmente. En este artículo se presenta un modelo para calcular con exactitud las fuerzas patelofemorales, teniendo en cuenta el cambio de posición del centro de gravedad del tronco durante una sentadilla profunda (posición de sentadilla modificada. Se valida la exactitud del modelo desarrollado mediante comparaciones con resultados de la técnica de dinámica inversa.

  4. Trochlear groove osteochondritis dissecans of the knee patellofemoral joint.

    Science.gov (United States)

    Wall, Eric J; Heyworth, Benton E; Shea, Kevin G; Edmonds, Eric W; Wright, Rick W; Anderson, Allen F; Eismann, Emily A; Myer, Gregory D

    2014-09-01

    The trochlear groove is the rarest location for osteochondritis dissecans (OCD) of the knee, with only about 50 previously reported cases, most of which were treated before the advent of magnetic resonance imaging (MRI) and modern techniques of cartilage fixation or osteochondral transplantation. The purpose of this multicenter study was to assess the patient presentation and clinical, radiographic, and functional results of treatment for trochlear groove OCD lesions. Hospital records from 5 institutions of the Research in Osteochondritis of the Knee (ROCK) study group were retrospectively reviewed for cases of trochlear groove OCD. Demographics, clinical presentation, diagnosis, treatment, time to pain resolution, and return to sports were recorded. Lesion appearance, size, stability, and time to radiographic healing were evaluated on plain x-rays and MRIs. Trochlear groove OCD lesions were evaluated in 24 knees in 21 adolescents (17 male, 4 female), with an average age of 14 years (range, 10 to 18 y). Fifty-four percent (13/24) of the lesions were identifiable on radiographs, and all were identifiable on MRI, 38% of which (9/24) was unstable. One fourth (6/24) of knees had coexistent femoral condyle OCD lesions. Treatment outcomes were evaluated in patients with a minimum of 1-year follow-up (average: 3 y; range: 1 to 12 y) or healing before 1 year. Half of the knees (2/4) treated nonoperatively and two thirds (8/12) treated operatively showed radiographic signs of healing with patients returning to full activity without pain. Operative treatment success rates were as follows: drilling (3/3), fixation (3/3), microfracture (1/2), drilling with subsequent delayed microfracture (1/1), and drilling with fixation (0/3). MRI aids in the diagnosis and staging of trochlear groove OCD lesions, as almost one half may not be identifiable on radiographs, and one quarter are associated with OCD lesions in other locations of the same knee. Multiple operative treatments can be used to achieve healing or resolution of symptoms in stable and unstable lesions; however, a larger comparative study is needed to make specific recommendations. Therapeutic Level IV.

  5. Assessment of patellofemoral pain syndrome in women

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    Altair Argentino Pereira Júnior

    2011-03-01

    Full Text Available Objective: To assess women diagnosed with patellofemoral pain syndrome (PFPS. Methods: A descriptive study held with 40 women aged between 18 to 40 years, with defined medical diagnosis of PFPS. We conducted the verification of knee function using the Lysholm scale;kinetic- functional and radiologic assessment; determination of body mass index (BMI and investigation of physical activity level by the International Physical Activity Questionnaire. Results: There was a predominance of genu valgum, internal femoral rotation and highlateral patella. The level of physical activity was less than 150 minutes in 21 (52.5%of the sample. Overweight was found in 16 (40%and knee function classified as unsatisfactory in 31 (77.5%of the participants. Conclusion: The study participants had similar kineticfunction alterations and presence of overweight. The PFPS commits the knee function, hindering the activities of daily living and sports.

  6. New aetiology of patellofemoral pain syndrome.

    Science.gov (United States)

    Chas, Julie; Mariot, Philippe; Tassart, Marc; Pialoux, Gilles

    2014-05-23

    We report the case of a 30-year-old man with more than 100 different male sexual partners per year. He reported using cocaine, ecstasy, γ-hydroxybutyric acid and crystal mephedrone and presented with bilateral gonalgia resistant to standard analgesia. He had no noteworthy medical history, and physical examination and laboratory tests were uninformative. MRI showed marked intra-articular effusion but no meniscus or ligament damage. The aetiological diagnosis in this case was made by excluding other potential causes. Patellofemoral pain syndrome (PFPS) is one of the most common and challenging injuries. In this first case reported, the aetiology was found to be mechanical, due to the position adopted during fellatio with multiple male partners. 2014 BMJ Publishing Group Ltd.

  7. Effect of aquatic and land-based exercise programs on the pain and motor function of weight lifters with patellofemoral pain syndrome

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    Farideh Babakhani

    2015-09-01

    Full Text Available Background: Patellofemoral Syndrome (PFPS is one of the most common knee joint problems among the athletes. The present study was aimed to compare the effect of aquatic and land-based exercise methods on the pain level and motor function of the weight lifters with patellofemoral syndrome. Methods: A total of twenty weight lifters with patellofemoral syndrome participated in this quasi-experimental study. They were randomly divided to two groups of aquatic exercise and land-based exercise. Visual Analog Scale (VAS and Kujala Scale were used before and after the exercise period to measure the pain and motor function, respectively. To compare the pre-test and post-test scores of the participating groups, dependent t-test was used and to compare the differences between groups, ANOVA was applied. Results: The results of post-test showed a significant difference in both groups in terms of pain level and motor function compared to pre-test after eight weeks of strength exercise. However, the comparison of data indicated no significant difference between groups with regard to pain level and motor function. Conclusion: According to the findings of this study, exercise in water and on land can reduce the pain and improve the performance of the patients with patellofemoral syndrome.

  8. No difference in anterior knee pain after medial unicompartmental knee arthroplasty in patients with or without patellofemoral osteoarthritis.

    Science.gov (United States)

    Song, Eun-Kyoo; Park, Ju-Kwon; Park, Chan-Hee; Kim, Min-Cheol; Agrawal, Pranav R; Seon, Jong Keun

    2016-01-01

    The purpose of the present study was to compare functional outcomes of medial unicompartmental knee arthroplasty (UKA) in patients with patellofemoral osteoarthritis (PF OA) and those without PF OA and to evaluate the effect of PF OA on functional outcomes after UKA. The outcomes of 48 knees in patients without PF OA who underwent medial UKA (non-PF OA group) were compared to the outcomes of 57 knees in patients with PF OA [Kellgren-Lawrence (K-L) grade ≤ 2] who underwent medial UKA (PF OA group) with a median follow-up of 5.4 years (range 3.1-10.2 years). Clinical outcomes including anterior knee pain, HSS scores, radiological parameters, and the progression of patellofemoral osteoarthritis were compared, and their effects on functional outcomes were evaluated at the final follow-up visits. At final follow-up visits, no significant inter-group difference was found in terms of anterior knee pain (1.9 vs. 1.9 in non-PF OA and PF OA groups, respectively), HSS score, or range of motion. Preoperative anterior knee pain and patellofemoral joint degeneration were found to be unrelated to poor outcome in patients that underwent medial UKA. Furthermore, no correlation was found between any functional outcome variable and chondral lesion pattern. The result of UKA for medial unicompartmental knee osteoarthritis was excellent regardless of PF OA (K-L grade ≤ 2). Hence, the patients with medial unicompartmental OA combined with a moderate degree of anterior knee pain or patellofemoral arthritis should be viewed as appropriate candidates for medial UKA. III.

  9. Patellofemoral and tibiofemoral forces during knee extension: simulations to strength training and rehabilitation exercises

    Directory of Open Access Journals (Sweden)

    Rodrigo Rico Bini

    Full Text Available Abstract Introduction: Limited evidence has been shown on ways to optimize the mechanical design of machines in order to minimize knee loads. Objective: This study compared six computer simulated models of open kinetic knee extension exercises for patellofemoral pressure and tibiofemoral forces. Methods: A musculoskeletal model of the lower limb was developed using six different cam radius to change resistive forces. A default machine, a constant cam radius, a torque-angle model, a free-weight model and two optimized models were simulated. Optimized models reduced cam radius at target knee flexion angles to minimize knee forces. Cam radius, human force, tibiofemoral compressive and shear force, and patellofemoral pressure were compared for the six models using data from five knee flexion angles. Results: Large reductions in cam radius comparing the free-weight model to other models (73-180% were limited to the large human force for the constant cam model to other models (9-36%. Larger human force (13 -36% was estimated to perform knee extension using a constant cam radius compared other models without large effects in knee joint forces. Conclusion: Changes in cam design effected human without a potential impact in knee loads.

  10. Footwear characteristics are related to running mechanics in runners with patellofemoral pain.

    Science.gov (United States)

    Esculier, Jean-Francois; Dubois, Blaise; Bouyer, Laurent J; McFadyen, Bradford J; Roy, Jean-Sébastien

    2017-05-01

    Running footwear is known to influence step rate, foot inclination at foot strike, average vertical loading rate (VLR) and peak patellofemoral joint (PFJ) force. However, the association between the level of minimalism of running shoes and running mechanics, especially with regards to these relevant variables for runners with patellofemoral pain (PFP), has yet to be investigated. The objective of this study was to explore the relationship between the level of minimalism of running shoes and habitual running kinematics and kinetics in runners with PFP. Running shoes of 69 runners with PFP (46 females, 23 males, 30.7±6.4years) were evaluated using the Minimalist Index (MI). Kinematic and kinetic data were collected during running on an instrumented treadmill. Principal component and correlation analyses were performed between the MI and its subscales and step rate, foot inclination at foot strike, average VLR, peak PFJ force and peak Achilles tendon force. Higher MI scores were moderately correlated with lower foot inclination (r=-0.410, Pminimalism are associated with lower inclination angle and lower peak PFJ force in runners with PFP. Thus, this population may potentially benefit from changes in running mechanics associated with the use of shoes with a higher level of minimalism. Copyright © 2017 Elsevier B.V. All rights reserved.

  11. Significantly worse isokinetic hamstring-quadriceps ratio in patellofemoral compared to condylar defects 4 years after autologous chondrocyte implantation.

    Science.gov (United States)

    Müller, Sebastian; Hirschmüller, Anja; Erggelet, Christoph; Beckmann, Nicholas A; Kreuz, Peter C

    2015-08-01

    Detailed biomechanical analysis including isokinetic muscle strength measurements after autologous chondrocyte implantation (ACI) are still rare, but might be of crucial importance for long-term outcomes. The present prospective study was performed to evaluate whether defect location had any influence on clinical and biomechanical outcomes 4 years after ACI. Forty-four patients with full-thickness cartilage defects ICRS grade III B and C underwent ACI and were assigned to two groups, the femoral condyle group or the patellofemoral joint group. Clinical scores were gathered preoperatively and 6, 12 and 48 months after implantation using the International Knee Documentation Committee (IKDC) score and the International Cartilage Repair Society (ICRS) form. Isokinetic strength measurements were performed 48 months postoperatively comparing healthy and operated knee joint of each patient. Clinical scores (ICRS, IKDC) showed continuous significant (p Hamstring-quadriceps ratios of the operated extremity revealed a significant change in physiological muscle balancing (ratios >1.0) based on significantly impaired extensor muscle strength in the patellofemoral joint group. All patients showed significant strength deficits on the operated extremity 4 years after ACI. Furthermore, the patellofemoral compartment in particular showed significantly worse hamstring-quadriceps ratios compared to condylar defects. Consequently, more efforts should be made to restore muscular strength especially of the quadriceps and the rehabilitation protocol should be adjusted accordingly. II.

  12. Association of bone scintigraphic abnormalities with knee malalignment and pain.

    Science.gov (United States)

    Kraus, V B; McDaniel, G; Worrell, T W; Feng, S; Vail, T P; Varju, G; Coleman, R E

    2009-11-01

    The information content of knee bone scintigraphy was evaluated, including pattern, localisation and intensity of retention relative to radiographic features of knee osteoarthritis, knee alignment and knee symptoms. A total of 308 knees (159 subjects) with symptomatic and radiographic knee osteoarthritis of at least one knee was assessed by late-phase (99m)Technetium methylene disphosphonate bone scintigraph, fixed-flexion knee radiograph, full limb radiograph for knee alignment and for self-reported knee symptom severity. Generalised linear models were used to control for within-subject correlation of knee data. The compartmental localisation (medial vs lateral) and intensity of knee bone scan retention were associated with the pattern (varus vs valgus) (p<0.001) and severity (p<0.001) of knee malalignment and localisation and severity of radiographic osteoarthritis (p<0.001). Bone scan agent retention in the tibiofemoral, but not patellofemoral, compartment was associated with severity of knee symptoms (p<0.001) and persisted after adjusting for radiographic osteoarthritis (p<0.001). To the authors' knowledge, this is the first study describing a relationship between knee malalignment, joint symptom severity and compartment-specific abnormalities by bone scintigraphy. This work demonstrates that bone scintigraphy is a sensitive and quantitative indicator of symptomatic knee osteoarthritis. Used selectively, bone scintigraphy is a dynamic imaging modality that holds great promise as a clinical trial screening tool and outcome measure.

  13. Medial patellofemoral ligament reconstruction: patient selection and perspectives

    Directory of Open Access Journals (Sweden)

    Baer MR

    2017-09-01

    Full Text Available Michael R. Baer, Jeffrey A. Macalena Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA Abstract: Patellofemoral instability is a painful and often recurring disorder with many negative long-term consequences. After a period of failed nonoperative management, surgical intervention has been used to reduce the incidence of patellar subluxation and dislocations. Medial patellofemoral ligament (MPFL reconstruction successfully addresses patellofemoral instability by restoring the deficient primary medial patellar soft tissue restraint. When planning MPFL reconstruction for instability, it is imperative to consider the patient’s unique anatomy including the tibial tuberosity–trochlear groove (TT–TG distance, trochlear dysplasia, and patella alta. Additionally, it is important to individualize surgical treatment in the skeletally immature, hypermobile, and athletic populations. Keywords: MPFL, indications, considerations, contraindications

  14. Neuromuscular activity and knee kinematics in adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Samani, Afshin; Olesen, Jens Lykkegaard

    2013-01-01

    This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS).......This study aimed to investigate the neuromuscular control of the knee during stair descent among female adolescents with patellofemoral pain (PFP) and to report its association with self-reported clinical status assessed by the Knee Injury and Osteoarthritis Outcome Score (KOOS)....

  15. The relationship between patellofemoral and tibiofemoral morphology and gait biomechanics following arthroscopic partial medial meniscectomy

    DEFF Research Database (Denmark)

    Dempsey, Alasdair R.; Wang, Yuanyuan; Thorlund, Jonas Bloch

    2013-01-01

    osteoarthritis at arthroscopic partial medial meniscectomy, underwent gait analysis and MRI on the operated knee once for each sub-cohort of 3 months, 2 years, or 4 years post-surgery. Cartilage volume, cartilage defects, and bone size were assessed from the MRI using validated methods. The 1st peak in the knee......Purpose To examine the relationship between tibiofemoral and patellofemoral joint articular cartilage and subchondral bone in the medial and gait biomechanics following partial medial meniscectomy. Methods For this cross-sectional study, 122 patients aged 30–55 years, without evidence of knee...... adduction moment, knee adduction moment impulse, 1st peak in the knee flexion moment, knee extension range of motion, and the heel strike transient from the vertical ground reaction force trace were identified from the gait data. Results Increased knee stance phase range of motion was associated...

  16. Temporomandibular joint

    International Nuclear Information System (INIS)

    Westesson, P.L.; Hatala, M.; Tallents, R.H.; Katzberg, R.W.; Musgrave, M.; Levitt, S.

    1990-01-01

    This paper determines the frequency of MR signs of abnormal temporomandibular joints (TMJs) in asymptomatic volunteers. Forty-two volunteers with 84 clinically normal TMJs were imaged in the sagittal and coronal planes with surface coil MR imaging. Sagittal closed and open and coronal closed views were obtained bilaterally in all volunteers. The images were classified as normal (superior disk position) or abnormal (disk displacement of degenerative joint disease). Eighteen joints in 11 volunteers were abnormal; 12 had disk displacement with reduction and six had disk displacement without reduction, with associated degenerative joint disease in three of the six. Asymptomatic internal derangement and degenerative joint disease occur in about one-fourth of asymptomatic volunteers

  17. Patellofemoral arthrodesis as pain relief in extreme patella alta

    NARCIS (Netherlands)

    Venkatesan, S.; Kampen, A. van

    2014-01-01

    PURPOSE: There is no golden standard management for neglected, chronic patellar tendon rupture as they are fairly rare. Nevertheless, accompanying pain can be highly debilitating. By presenting a case of patellar tendon repair, the exceptional results of a patellofemoral arthrodesis are described.

  18. WITHDRAWN: Orthotic devices for treating patellofemoral pain syndrome

    NARCIS (Netherlands)

    D'hondt, Norman E.; Aufdemkampe, Geert; Kerkhoffs, Gino M. M. J.; Struijs, Peter A. A.; Verheul, Claire; van Dijk, C. N.

    2009-01-01

    BACKGROUND: Patellofemoral pain syndrome is a frequently reported condition in active adults. A wide variety of conservative treatment strategies have been described. As yet, no optimal strategy has been identified. Application of orthotic devices e.g. knee braces, knee straps, forms of taping of

  19. Patellofemoral Pain : Where does the pain come from?

    NARCIS (Netherlands)

    R.A. van der Heijden (Rianne)

    2016-01-01

    markdownabstractMy thesis is about patellofemoral pain (PFP), a common knee complaint among physically active young individuals. It is also known as ’anterior knee pain’, ’retropatellar chondropathy’ or more recently suggested ‘theatre or moviegoers knee’. PFP is characterized by retropatellar pain

  20. Assessment of MRI abnormalities of the sacroiliac joints and their ability to predict axial spondyloarthritis: a retrospective pilot study on 110 patients

    Energy Technology Data Exchange (ETDEWEB)

    Larbi, Ahmed; Viala, Pierre; Baron, Marie Pierre; Taourel, Patrice; Cyteval, Catherine [Hopital Lapeyronie, Medical Imaging Department, Montpellier Cedex 5 (France); Molinari, Nicolas [Hopital Lapeyronie, Medical Data Processing Department, Montpellier Cedex 5 (France); Lukas, Cedric [Hopital Lapeyronie, Rheumatology Department, Montpellier Cedex 5 (France)

    2014-03-15

    To assess sacroiliac joint (SIJ) modifications on MRI and their ability to predict axial spondyloarthritis (SpA) with the purpose of identifying parameters for future prospective studies. Retrospective study was carried out of 110 consecutive patients referred for SIJ MRI with coronal, axial short TI inversion recovery (STIR), and axial T1 sequences over 6 months. Factors associated with SpA, including MRI SIJ modifications (fat deposition, structural abnormalities on T1-weighted images, and bone marrow edema [BME] on STIR sequences) and age were explored using multivariate logistic regression. The reference diagnosis was made 1-1.5 years later based on clinical, radiological, and biological findings, according to Assessment of SpondyloArthritis International Society (ASAS) criteria. Twenty-eight patients were diagnosed with SpA (female/male: 19/9, age 41 ± 13 years). Abnormal findings were found in up to 21 % of patients without SpA (including 11 % with BME), versus 64 % of SpA patients (50 % with BME). A threshold age of 42.6 years was found to discriminate SpA patients (ROC AUC: 0.71, 95 % CI: 0.59-0.81). BME location in the sacral (OR: 7.07 [1.05, 47.6], p = 0.044) and both sacral and iliac areas (OR: 36.0 [5.61, 231], p = 0.0002), as well as age (OR: 0.95 [0.92, 0.98], p = 0.0019) were found to be independent predictors of SpA. 83.6 % of patients were effectively diagnosed using BME location and patient age in a classification and regression tree (CART) algorithm (sensitivity: 61 %, specificity: 91 %, PPV: 71 %, NPV: 87 %). The BME location combined with the patient's age (threshold 42.6 years) could help predict SpA. Further studies are required before these features can be used by radiologists to boost their confidence in reporting SIJ MRI. (orig.)

  1. Abnormal Grain Growth in the Heat Affected Zone of Friction Stir Welded Joint of 32Mn-7Cr-1Mo-0.3N Steel during Post-Weld Heat Treatment

    Directory of Open Access Journals (Sweden)

    Yijun Li

    2018-04-01

    Full Text Available The abnormal grain growth in the heat affected zone of the friction stir welded joint of 32Mn-7Cr-1Mo-0.3N steel after post-weld heat treatment was confirmed by physical simulation experiments. The microstructural stability of the heat affected zone can be weakened by the welding thermal cycle. It was speculated to be due to the variation of the non-equilibrium segregation state of solute atoms at the grain boundaries. In addition, the pressure stress in the welding process can promote abnormal grain growth in the post-weld heat treatment.

  2. Role of pathophysiology of patellofemoral instability in the treatment of spontaneous medial patellofemoral subluxation: a case report

    Directory of Open Access Journals (Sweden)

    Doğruyol Dağhan

    2010-05-01

    Full Text Available Abstract Introduction Medial patellar subluxation is usually seen after lateral retinacular release. Spontaneous medial subluxation of the patella is a very rare condition. There are few reports in the literature on the pathophysiology of iatrogenic medial patellar subluxation. To our knowledge, there are no reports of the pathophysiology of non-iatrogenic medial patellar subluxation in the English literature. In this study we present a case of spontaneous medial patellar instability that is more prominent in extension during weight bearing. We also try to define the treatment protocol based on pathophsiology. Case presentation We report the case of a 21-year-old Turkish man with spontaneous medial patellar instability. He had suffered right knee pain, clicking and popping sensation in the affected knee for three months prior to presentation. Clinical examination demonstrated medial patellar subluxation that is more prominent in extension during the weight bearing phase of gait and while standing. Increased medial tilt was observed when the patella was stressed medially. Conventional anterior to posterior, lateral and Merchant radiographs did not reveal any abnormalities. After three months of physical therapy, our patient was still suffering from right knee pain which disturbed his gait pattern. Throughout the surgery, medial patellar translation was tested following the imbrication of lateral structures. He still had a medial patellar translation that was more than 50% of his patellar width. Patellotibial ligament augmentation using an iliotibial band flap was added. When examined after surgery, the alignment of the patella was effectively corrected. Conclusions Chronic imbalance between the strengths of vastus lateralis and vastus medialis results in secondary changes in passive ligamentous structures and causes additional instability. Physical therapy modalities that aim to strengthen the vastus lateralis might be sufficient for the

  3. Tratamento cirúrgico da instabilidade fêmoro-patelar Surgical treatment of patellofemoral instability

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    Marco Antônio Percope de Andrade

    2009-01-01

    Full Text Available OBJETIVO: Descrever os resultados funcionais do tratamento cirúrgico de pacientes portadores de instabilidade fêmoro-patelar submetidos a realinhamento do aparelho extensor. Métodos: Trata-se de estudo retrospectivo de 34 joelhos operados devido à instabilidade fêmoro-patelar no período de 1989 a 2004. Os pacientes foram avaliados no pós-operatório remoto, sendo aplicado questionário funcional. RESULTADOS: Em um seguimento médio de seis anos e cinco meses, o valor médio de pontuação foi de 82,94 pontos no grupo operado (p = 0,00037. Melhora do quadro de dor (97,05% de excelentes e bons resultados e baixa taxa de recorrência dos episódios de luxação (5,88% foram observadas no grupo, embora pontuações mais baixas tenham sido obtidas em atividades de maior demanda articular (agachamento, prática de corridas e execução de saltos. Nenhum dos pacientes avaliados desenvolveu artrose no tempo de seguimento. CONCLUSÃO: O procedimento de realinhamento articular descrito neste artigo mostrou-se eficaz no tratamento dos pacientes com instabilidade fêmoro-patelar recidivante.OBJECTIVE: To describe functional outcomes following surgical treatment of patients with patellofemoral instability submitted to patellar realignment. METHODS: This was a retrospective study evaluating 34 operated knees for patellofemoral instability between 1989 and 2004. The patients were evaluated in the late postoperative period when a functional questionnaire was applied. RESULTS: After a mean follow-up time of 6 years and 5 months, the mean score was 82.94 in the surgical group (p=0.00037. The results of this investigation showed pain relief in 97.05% and low rate of recurrent dislocation (5.88%, although lower scores were seen in intense articular activities (squatting, running and jumping. No patient deve-loped osteoarthritis while being followed up. CONCLUSION: The procedure for joint described in this paper was shown to be effective for treating patients

  4. Exercise therapy for patellofemoral pain syndrome.

    Science.gov (United States)

    Heintjes, E; Berger, M Y; Bierma-Zeinstra, S M A; Bernsen, R M D; Verhaar, J A N; Koes, B W

    2003-01-01

    Patellofemoral pain syndrome (PFPS) is a common problem among adolescents and young adults, characterised by retropatellar pain (behind the kneecap) or peripatellar pain (around the kneecap) when ascending or descending stairs, squatting or sitting with flexed knees. Etiology, structures causing the pain and treatment methods are all debated in literature, but consensus has not been reached so far. Exercise therapy to strengthen the quadriceps is often prescribed, though its efficacy is still debated. This review aims to summarise the evidence of effectiveness of exercise therapy in reducing anterior knee pain and improving knee function in patients with PFPS. We searched the Cochrane Musculoskeletal Injuries Group and Cochrane Rehabilitation and Related Therapies Field specialised registers, the Cochrane Controlled Trials Register, PEDro - The Physiotherapy Evidence Database, MEDLINE, EMBASE, CINAHL, up till December 2001 for controlled trials (randomised or not) comparing exercise therapy with control groups, or comparing different types of exercise therapy. Only trials focusing on exercise therapy in patients with PFPS were considered. Trials in patients with other diagnoses such as tendinitis, Osgood Schlatter syndrome, bursitis, traumatic injuries, osteoarthritis, plica syndrome, Sinding-Larssen-Johansson syndrome and patellar luxations were excluded. From 750 publications 12 trials were selected. All included trials studied quadriceps strengthening exercises. Outcome assessments for knee pain and knee function in daily life were used in a best evidence synthesis to summarise evidence for effectiveness. One high and two low quality studies used a control group not receiving exercise therapy. Significantly greater pain reduction in the exercise groups was found in one high and one low quality study, though at different time points. Only one low quality study reported significantly greater functional improvement with exercise. Five studies compared exercise

  5. Role of MRI in assessment of patello-femoral derangement in patients with anterior knee pain

    Directory of Open Access Journals (Sweden)

    Hadeer Safwat Fahmy

    2016-12-01

    Conclusion: MRI is reliable imaging modality in identifying the risk factors that may contribute to the development of patello-femoral maltracking or impingement permitting individual tailored treatment.

  6. Preoperative Patellofemoral Chondromalacia is Not a Contraindication for Fixed-Bearing Medial Unicompartmental Knee Arthroplasty.

    Science.gov (United States)

    Adams, Alexander J; Kazarian, Gregory S; Lonner, Jess H

    2017-06-01

    Patellofemoral chondromalacia (PFCM) has historically been considered a contraindication for unicompartmental knee arthroplasty (UKA), but there is limited data assessing PFCM's impact on the results of fixed-bearing UKA. Our objective was to assess the impact of medial patellar and/or medial trochlear PFCM on overall and patellofemoral-specific 2-year outcomes after fixed-bearing medial UKA. Intraoperative notes defined the presence and location of PFCM during fixed bearing medial UKA. Outcome measures included the New Knee Society Score (NKSS), Kneeling Ability Score (KAS) and Forgotten Joint Score (FJS-12). Thirty-one knees with PFCM (PFCM group), and 52 knees without PFCM (N-PFCM group) were included for analysis. Mann-Whitney U tests assessed the statistical significance of observed differences, and a Bonferroni correction was applied, adjusting threshold for significance to P = .005. At minimum follow-up of 2 years, no statistical differences were detected between the N-PFCM and PFCM groups in the postoperative NKSS (159 vs 157, P = .731), preoperative to postoperative NKSS change (P = .447), FJS-12 (70.5 vs 67.6, P = .471), or KAS (71% vs 65%, P = .217). Patients with isolated patellar chondromalacia (n = 13) demonstrated trends toward worse outcomes according to NKSS (147, P = .198), FJS-12 (58, P = .094), and KAS (46%, P = .018), but were statistically insignificant. No failures occurred in either group. Functional outcomes of fixed-bearing medial UKA are not adversely impacted by the presence of PFCM involving the medial patellar facet and/or medial or central trochlea. Further follow-up is needed to determine longer-term implications of fixed-bearing medial UKA in patients with PFCM. Copyright © 2017 Elsevier Inc. All rights reserved.

  7. Reconstruction of the medial patellofemoral ligament by means of the anatomical double-bundle technique using metal anchors

    Directory of Open Access Journals (Sweden)

    David Sadigursky

    2016-06-01

    Full Text Available ABSTRACT OBJECTIVE: To evaluate double-bundle reconstruction of the medial patellofemoral ligament (MPFL using a graft from the semitendinosus tendon and fixation with metal anchors over the medium term. METHODS: This was a prospective cross-sectional study. After approval from the research ethics committee, 31 patients with patellofemoral instability who underwent MPFL reconstruction by means of the anatomical double-bundle technique, with fixation using metal anchors, were analyzed between May 2010 and January 2015. To evaluate the effectiveness of the MPFL reconstruction surgery, the Kujala scale and the Tegner-Lysholm score were assessed before the procedure and one year afterwards, along with clinical data such as pain levels, range of motion and J sign. The data were tabulated in the Excel(r software and were analyzed using the SPSS Statistics(r software, version 21. The statistical analysis was performed using the Wilcoxon T test and the McNemar test. RESULTS: The mean preoperative score from the Kujala test was 45.64 ± 1.24 and the postoperative score was 94.03 ± 0.79 (p < 0.001. The preoperative Tegner-Lysholm score was 40.51 ± 1.61 and the postoperative score was 91.64 ± 0.79 (p < 0.001. The preoperative range of motion was 125.96 ± 2.11 and the postoperative range was 138.38 ± 1.49 (p < 0.05. CONCLUSION: MPFL reconstruction by means of the anatomical double-bundle technique is easily reproducible, without episodes of recurrence, with satisfactory results regarding restoration of stability and function of the patellofemoral joint.

  8. Galeazzi semitendinosus tenodesis for patellofemoral instability in skeletally immature patients.

    Science.gov (United States)

    Grannatt, Kathryn; Heyworth, Benton E; Ogunwole, Olabode; Micheli, Lyle J; Kocher, Mininder S

    2012-09-01

    Numerous surgical treatments have been described to address subluxation or dislocation of the patella, but many are not suitable for the skeletally immature patient, as they risk injury to the proximal tibial physis or tibial tubercle apophysis. The Galeazzi semitendinosus tenodesis is a soft-tissue reconstruction technique designed to stabilize the patella without altering the femoral or the bony structures about the knee. We sought to determine if this semitendinosus tenodesis is a safe and effective treatment for patellofemoral instability in skeletally immature patients. We retrospectively analyzed the records of a population of skeletally immature patients who underwent semitendinosus tenodesis for patellofemoral instability at our institution from 1990 to 2006. Condition-specific outcome and function were prospectively collected, including the International Knee Documentation Committee (IKDC) score, Kujala Score, and Marx Activity Scale. Recurrent instability was defined as patient-reported postoperative subluxation, dislocation, or both. Twenty-eight patients (34 total knees) were included in the study. Average follow-up was 70 months (range, 27 to 217 mo). Patients reported recurrent instability in 28 of the 34 knees (82%). Overall, 41% of patients had IKDC scores Galeazzi semitendinosus tenodesis is a safe procedure for patellofemoral instability in skeletally immature patients, but our long-term data suggest it may not be as successful as previously reported. Approximately 82% of patients experienced recurrent subluxation or dislocation despite surgical intervention, which may be due in large part to various predisposing factors, and there was a 35% rate of second surgeries. However, given the variability in techniques and reported results of patellofemoral stabilizing procedures in skeletally immature patients, the Galeazzi procedure may still be a reasonable way to temporize the difficult problem of patellar instability until patients reach skeletal

  9. Magnetic Resonance Imaging for Patellofemoral Chondromalacia: Is There a Role for T2 Mapping?

    Science.gov (United States)

    van Eck, Carola F; Kingston, R Scott; Crues, John V; Kharrazi, F Daniel

    2017-11-01

    Patellofemoral pain is common, and treatment is guided by the presence and grade of chondromalacia. To evaluate and compare the sensitivity and specificity in detecting and grading chondral abnormalities of the patella between proton density fat suppression (PDFS) and T2 mapping magnetic resonance imaging (MRI). Cohort study; Level of evidence, 2. A total of 25 patients who underwent MRI of the knee with both a PDFS sequence and T2 mapping and subsequently underwent arthroscopic knee surgery were included. The cartilage surface of the patella was graded on both MRI sequences by 2 independent, blinded radiologists. Cartilage was then graded during arthroscopic surgery by a sports medicine fellowship-trained orthopaedic surgeon. Reliability, sensitivity, specificity, and accuracy were determined for both MRI methods. The findings during arthroscopic surgery were considered the gold standard. Intraobserver and interobserver agreement for both PDFS (98.5% and 89.4%, respectively) and T2 mapping (99.4% and 91.3%, respectively) MRI were excellent. For T2 mapping, the sensitivity (61%) and specificity (64%) were comparable, whereas for PDFS there was a lower sensitivity (37%) but higher specificity (81%) in identifying cartilage abnormalities. This resulted in a similar accuracy for PDFS (59%) and T2 mapping (62%). Both PDFS and T2 mapping MRI were reliable but only moderately accurate in predicting patellar chondromalacia found during knee arthroscopic surgery.

  10. Patellofemoral ligament reconstruction in a patient with Rubinstein-Taybi syndrome.

    Directory of Open Access Journals (Sweden)

    Fardin Mirzatolooei

    2014-03-01

    Full Text Available Recurrent dislocation of patella may occur in patients with ligament laxity. Method of treatment in this condition is controversial but patellofemoral ligament reconstruction is the most accepted method. We present a patient with Rubinstein-Taybi syndrome and recurrent patellar dislocation who managed successfully by patellofemoral ligament reconstruction.

  11. Appendicular joint dislocations.

    Science.gov (United States)

    Hindle, Paul; Davidson, Eleanor K; Biant, Leela C; Court-Brown, Charles M

    2013-08-01

    This study defines the incidence and epidemiology of joint dislocations and subluxations of the appendicular skeleton. All patients presenting acutely to hospital with a dislocation or subluxation of the appendicular skeleton from a defined population were included in the study. There were 974 dislocations or subluxations over one year between the 1st November 2008 and the 31st October 2009. There was an overall joint dislocation incidence of 157/10(5)/year (188/10(5)/year in males and 128/10(5)/year in females). Males demonstrated a bimodal distribution with a peak incidence of 446/10(5)/year at 15-24 years old and another of 349/10(5)/year in those over 90 years. Females demonstrate an increasing incidence from the seventh decade with a maximum incidence of 520/10(5)/year in those over 90 years. The most commonly affected joints are the glenohumeral (51.2/10(5)/year), the small joints of the hand (29.9/10(5)/year), the patellofemoral joint (21.6/10(5)/year), the prosthetic hip (19.0/10(5)/year), the ankle (11.5/10(5)/year), the acromioclavicular joint (8.9/10(5)/year) and the elbow (5.5/10(5)/year). Unlike fractures, dislocations are more common in the both the most affluent and the most socially deprived sections of the population. Joint disruptions are more common than previously estimated. Copyright © 2013 Elsevier Ltd. All rights reserved.

  12. An outcome study of chronic patellofemoral pain syndrome. Seven-year follow-up of patients in a randomized, controlled trial.

    Science.gov (United States)

    Kannus, P; Natri, A; Paakkala, T; Järvinen, M

    1999-03-01

    trend, with thirty-four patients (76 percent) having had complete recovery at six months compared with thirty (67 percent) at seven years; however, with the numbers available, this change was not significant (p = 0.420). Magnetic resonance imaging, performed for thirty-seven patients, revealed no abnormalities in twenty-four (65 percent), mild abnormalities in four (11 percent), moderate abnormalities (a 25 to 75 percent decrease in the thickness of the cartilage) in seven (19 percent), and overt patellofemoral osteoarthritis in two (5 percent) at seven years. The seven-year overall outcome was good in approximately two-thirds of the patients. However, the remaining patients still had symptoms or objective signs of a patellofemoral abnormality.

  13. Congenital Abnormalities

    Science.gov (United States)

    ... Stages Ages and Stages Prenatal Baby (0-12 mos.) Toddler 1-3yrs. Preschool 3-5yrs Grade School ... Categories of Congenital Abnormalities Chromosome Abnormalities Chromosomes are structures that carry genetic material inherited from one generation ...

  14. Diseases of the joints

    International Nuclear Information System (INIS)

    Rogers, L.F.

    1987-01-01

    Radiographs are used in diseases of the joints to confirm the clinical diagnosis of joint disease, determine the type of joint disease, and evaluate the extent of clinically known disease. The radiographic findings may be either consistent or inconsistent with the clinical diagnosis. If inconsistent, an alternative diagnosis should be made on the basis of the radiographic appearance of the disease process. On other occasions, joint disease is observed on a radiograph obtained for some other reason, such as for peripheral trauma; on a chest radiograph demonstrating changes in the spine or pectoral girdle; or on radiographs of the abdomen and pelvis revealing abnormalities of the spine, sacroiliac joints, or hips. In the latter situations, the joint disease should be categorized and included in the radiographic report. There are four principal radiographic signs of joint abnormalities or joint disease. These are (1) abnormalities of the apposing margins of both bones at a joint, (2) change in the width of the joint space, usually narrowing, but occasionally, widening due to an increase in synovial fluid, (3) malalignment of the joint (subluxation or dislocation with the joint margins no longer in apposition), and (4) periarticular swelling due to distension of the joint capsule. The most common findings are narrowing of the joint space and abnormalities of the apposing articular margins of bone

  15. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

    Energy Technology Data Exchange (ETDEWEB)

    Balcarek, Peter, E-mail: peter.balcarek@med.uni-goettingen.de [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M. [Department of Trauma Surgery, Plastic and Reconstructive Surgery, University Medicine, 37075 Goettingen (Germany); Frosch, Karl-Heinz [Department of Trauma and Reconstructive Surgery, Asklepios Clinic St. Georg, Hamburg (Germany)

    2011-09-15

    Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

  16. Patellar dislocations in children, adolescents and adults: A comparative MRI study of medial patellofemoral ligament injury patterns and trochlear groove anatomy

    International Nuclear Information System (INIS)

    Balcarek, Peter; Walde, Tim Alexander; Frosch, Stephan; Schuettrumpf, Jan P.; Wachowski, Martin M.; Stuermer, Klaus M.; Frosch, Karl-Heinz

    2011-01-01

    Purpose: The first aim was to compare medial patellofemoral ligament injury patterns in children and adolescents after first-time lateral patellar dislocations with the injury patterns in adults. The second aim was to evaluate the trochlear groove anatomy at different developmental stages of the growing knee joint. Materials and methods: Knee magnetic resonance (MR) images were collected from 22 patients after first-time patellar dislocations. The patients were aged 14.2 years (a range of 11-15 years). The injury pattern of the medial patellofemoral ligament was analysed, and trochlear dysplasia was evaluated with regard to sulcus angle, trochlear depth and trochlear asymmetry. The control data consisted of MR images from 21 adult patients who were treated for first-time lateral patellar dislocation. Results: After patellar dislocation, injury to the medial patellofemoral ligament was found in 90.2% of the children and in 100% of the adult patients. Injury patterns of the medial patellofemoral ligament were similar between the study group and the control group with regard to injury at the patellar attachment site (Type I), to the midsubstance (Type II) and to injury at the femoral origin (Type III) (all p > 0.05). Combined lesions (Type IV) were significantly less frequently observed in adults when compared to the study group (p = 0.02). The magnitude of trochlear dysplasia was similar in children, adolescents and adults with regard to all three of the measured parameter-values (all p > 0.05). In addition, the articular cartilage had a significant effect on the distal femur geometry in both paediatrics and adults. Conclusion: First, the data from our study indicated that the paediatric medial patellofemoral ligament injury patterns, as seen on MR images, were similar to those in adults. Second, the trochlear groove anatomy and the magnitude of trochlear dysplasia, respectively, did not differ between adults and paediatrics with patellar instability. Thus

  17. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    Full Text Available Background:   Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.    

  18. Evidence Based Conservative Management of Patello-femoral Syndrome

    Directory of Open Access Journals (Sweden)

    E. Carlos Rodriguez-Merchan

    2014-03-01

    Full Text Available Background:   Patellofemoral pain syndrome (PFPS is defined as pain surrounding the patella when sitting with bent knees for prolonged periods of time or when performing activities like ascending or descending stairs, squatting or   athletic activities. Patella dislocation is not included in PFPS.     Purpose:   This review analyzes the evidence based conservative management of PFPS.   Methods:   A Cochrane Library search related to PFPS was performed until 18 January 2014. The key words were: patellofemoral pain syndrome. Eight papers were found, of which three were reviewed because they were focused   on the topic of the article. We also searched the PubMed using the following keywords: evidence based conservative   management of patellofemoral pain syndrome. Twelve articles were found, of which seven were reviewed because   they were focused on the topic of the article. Overall ten articles were analyzed.     Results:   Different treatments can be tried for PFPS, including pharmacotherapy, therapeutic ultrasound, exercise therapy, and taping and braces.     Conclusions:   Non-steroidal anti-inflammatory drugs (NSAIDs may reduce pain in the short term, but pain does not improve after three months. Therapeutic ultrasound appears not to have a clinically important effect on pain relief for   patients with PFPS. The evidence that exercise therapy is more effective in treating PFPS than no exercise is limited   with respect to pain reduction, and conflicting with respect to functional improvement. No significant difference has   been found between taping and non-taping. The role of knee braces is still controversial. More well-designed studies are needed.

  19. Effect of Quadriceps Exercise Training on Muscle Fiber Angle in Patients With Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Honarpishe

    2015-10-01

    Full Text Available Background Imbalance between the vastus medialis oblique (VMO muscle and the vastus lateralis oblique (VTO Vastus lateralis has been thought to be a primary cause of abnormal patellar tracking, possibly leading to patellofemoral pain syndrome (PFPS. Objectives The purpose of this study was to investigate the effect of quadriceps muscle strengthening exercises on the ratio of VMO to VL oblique and longus muscle fiber angles. Patients and Methods Thirty-five subjects (23 females and 12 males, mean age 26.6 years ± 1.1 SD with PFPS were randomized into an exercise group or a control group. The exercise group performed knee extension exercises for four weeks based on the Kaya exercise program (three times per week, while the control group received no treatment. Measurements included knee extensor concentric and eccentric muscle torque using a Biodex isokinetic machine and the fiber angle of the VMO, VL oblique and longus muscles using ultrasonography, all of which were evaluated at the time of the initial examination and at the end of the four-week period. Results There were no significant differences in the muscle strength and fiber angle of the VMO, VL oblique and longus muscles after training between the control and experimental groups (P > 0.05. Conclusions The study findings indicate that short-term exercises had no significant effect on the ratio of VMO to VL muscle fiber angles in patients with PFPS.

  20. Management of patients with patellofemoral pain syndrome using a multimodal approach: a case series.

    Science.gov (United States)

    Lowry, Carina D; Cleland, Joshua A; Dyke, Kelly

    2008-11-01

    A case series of consecutive patients referred to physical therapy with patellofemoral pain syndrome (PFPS). Physical therapists often treat patients with PFPS, yet there is currently no consensus as to the most effective management strategies. The purpose of this case series is to describe the outcomes of patients referred to physical therapy with PFPS who were treated with a multimodal approach. Five patients were treated with a combination of thrust and nonthrust manipulation directed at the joints of the lower quarter, trunk and hip stabilization exercises, patellar taping, and foot orthotics. Outcome measures used to capture change in patient status included the Numeric Pain Rating Scale, the Kujala Anterior Knee Pain Scale, the Lower Extremity Functional Scale, and the Global Rating of Change. Five patients (median age, 15 years; range, 14-50 years) with a median duration of knee pain for 8 months (range, 3-24 months) were included in this prospective case series. Four (80%) of the 5 patients demonstrated decreased pain and a clinically significant improvement in function. These gains in function were maintained at a 6-month follow-up. Although a cause-and-effect relationship cannot be inferred from a case series, the outcomes achieved by the patients are consistent with studies incorporating manual physical therapy, exercise, patellar taping, and orthotic prescription to the management of conditions of the lower extremity. Further randomized controlled trials should be performed to determine the effectiveness of this multimodal approach for the management of individuals with PFPS.

  1. MRI after patellofemoral replacement: the component-bone interface and rotational alignment.

    Science.gov (United States)

    Heyse, Thomas J; Figiel, Jens; Hähnlein, Ulrike; Timmesfeld, Nina; Schofer, Markus D; Fuchs-Winkelmann, Susanne; Efe, Turgay

    2013-07-01

    In an earlier paper, it was shown that tailored magnetic resonance imaging (MRI) allows for reproducible analysis of the preserved knee joint structures after patellofemoral replacement (PFR). This pilot study investigates to what degree MRI could produce reliable assessment of the implant-bone interface of femoral and patellar components and rotational alignment following PFR. MRI tailored for reduction of metallic artefacts was performed in seven patients who had undergone PFR. Two independent investigators evaluated the implant-bone interface at femoral and patellar components and the rotational alignment of the femoral component. They also assessed their degree of confidence in evaluation using a five-point scale. The inter-observer reliability was determined. Implant-induced MRI artefact was barely observed and there was no interference with component-bone interface evaluation. There was excellent inter-observer reliability, inter-observer agreement, and confidence for the implant-bone interface at femoral and patellar components and for rotational alignment. The applied score for the interface was found to be reliable. Tailored MRI allows reproducible analysis of the implant-bone interface and of rotational alignment of the femoral component in patients who have had PFR. It might prove helpful in the assessment of painful PFR.

  2. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    Directory of Open Access Journals (Sweden)

    Thiago R. T. Santos

    2015-06-01

    Full Text Available Introduction: Patellofemoral pain syndrome (PFPS is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1 to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2 to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength.

  3. Effectiveness of hip muscle strengthening in patellofemoral pain syndrome patients: a systematic review

    Science.gov (United States)

    Santos, Thiago R. T.; Oliveira, Bárbara A.; Ocarino, Juliana M.; Holt, Kenneth G.; Fonseca, Sérgio T.

    2015-01-01

    Introduction: Patellofemoral pain syndrome (PFPS) is characterized by anterior knee pain, which may limit the performance of functional activities. The influence of hip joint motion on the development of this syndrome has already been documented in the literature. In this regard, studies have investigated the effectiveness of hip muscle strengthening in patients with PFPS. Objectives: The aims of this systematic review were (1) to summarize the literature related to the effects of hip muscle strengthening on pain intensity, muscle strength, and function in individuals with PFPS and (2) to evaluate the methodological quality of the selected studies. Method: A search for randomized controlled clinical trials was conducted using the following databases: Google Scholar, MEDLINE, PEDro, LILACS, and SciELO. The selected studies had to distinguish the effects of hip muscle strengthening in a group of patients with PFPS, as compared to non-intervention or other kinds of intervention, and had to investigate the following outcomes: pain, muscle strength, and function. The methodological quality of the selected studies was analyzed by means of the PEDro scale. Results: Seven studies were selected. These studies demonstrated that hip muscle strengthening was effective in reducing pain. However, the studies disagreed regarding the treatments' ability to improve muscle strength. Improvement in functional capabilities after hip muscle strengthening was found in five studies. Conclusion: Hip muscle strengthening is effective in reducing the intensity of pain and improving functional capabilities in patients with PFPS, despite the lack of evidence for its ability to increase muscle strength. PMID:26039034

  4. The Efficacy of Treatment of Different Intervention Programs for Patellofemoral Pain Syndrome–A Single Blinded Randomized Clinical Trial. Pilot Study

    Directory of Open Access Journals (Sweden)

    Feazadeh Avraham

    2007-01-01

    Full Text Available Patello-femoral pain syndrome (PFPS is a common knee joint disability. The integration of hip soft tissue regimens are not always emphasized, although current literature implies that there is a significant relationship between the two and there is a lack of randomized clinical trials to substantiate this relationship in clinical practice. A randomized controlled assessor blinded trial was designed to explore different rehabilitation programs related to PFPS. The study was conducted at RAZIEL institute of physical therapy, Netania, Israel with a total of 30 consecutive patients (mean age 35y, diagnosed with PFPS. All patients were randomly allocated into 3 groups. Group I conventional knee rehabilitation program. Included quadriceps strengthening and Trans Electric Neuromuscular Stimulation (TENS. Group II hip oriented rehabilitation program. included stretching, Hip external rotators strengthening and TENS. Group III a combination of the two above programs. Pain and function were documented on initial of the program and again 3 weeks later, on the completion. Pain was assessed by a numeric visual analogue scale (VAS; function was assessed by Patello-femoral joint evaluation scale (PFJES (0-100 points. At end of trial, all groups showed significant improvements in VAS and PFJES (p<0.0001; these improvements did not vary significantly between the 3 groups. The conclusions were that the explored different rehabilitation programs showed a similar beneficial effect.

  5. Supervised exercise therapy versus usual care for patellofemoral pain syndrome: an open label randomised controlled trial.

    NARCIS (Netherlands)

    R. van Linschoten (Robbart); M. van Middelkoop (Marienke); M.Y. Berger (Marjolein); E.M. Heintjes (Edith); J.A.N. Verhaar (Jan); S.P. Willemsen (Sten); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita)

    2009-01-01

    textabstractOBJECTIVE: To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. DESIGN: Open label randomised controlled trial. SETTING: General practice and sport physician

  6. Supervised exercise therapy versus usual care for patellofemoral pain syndrome : an open label randomised controlled trial

    NARCIS (Netherlands)

    van Linschoten, R.; van Middelkoop, M.; Berger, M. Y.; Heintjes, E. M.; Verhaar, J. A. N.; Willemsen, S. P.; Koes, B. W.; Bierma-Zeinstra, S. M.

    2009-01-01

    Objective To assess the effectiveness of supervised exercise therapy compared with usual care with respect to recovery, pain, and function in patients with patellofemoral pain syndrome. Design Open label randomised controlled trial. Setting General practice and sport physician practice. Participants

  7. Meiotic abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    Chapter 19, describes meiotic abnormalities. These include nondisjunction of autosomes and sex chromosomes, genetic and environmental causes of nondisjunction, misdivision of the centromere, chromosomally abnormal human sperm, male infertility, parental age, and origin of diploid gametes. 57 refs., 2 figs., 1 tab.

  8. Crepitus is a first indication of patellofemoral osteoarthritis (and not of tibiofemoral osteoarthritis).

    Science.gov (United States)

    Schiphof, D; van Middelkoop, M; de Klerk, B M; Oei, E H G; Hofman, A; Koes, B W; Weinans, H; Bierma-Zeinstra, S M A

    2014-05-01

    The patellofemoral joint (PFJ) is important in early detection of knee osteoarthritis (OA). Little is known about the relationship between specific clinical findings and PFJ Magnetic resonance Imaging (MRI) features. The objective was to examine the relationship between (early) clinical findings and PFJ MRI features in females (45-60 years) without knee OA (PFJ or tibiofemoral joint (TFJ) OA) based on a recently suggested MRI definition. MRIs of knees of women of a sub-study of the Rotterdam Study were scored with semi-quantitative scoring. Specific patellar tests were performed on physical examination. Current knee pain and history of patellar knee pain were reported. Binomial logistic generalized estimated equations were used to determine the association between clinical findings of OA and PFJ MRI features. All associations were adjusted for age, body mass index (BMI) and TFJ MRI features. In 888 women (1776 knees, mean age: 55.1 years and mean BMI: 27.0 kg/m(2)) we found significant associations between crepitus and all PFJ MRI features (Odds ratios (OR) range: 2.61-5.49). A history of patellar pain was significantly associated with almost all PFJ MRI features (ORcartilage: 1.95; ORcysts: 1.86; ORbone marrow lesions: 1.83), except for osteophytes. No significant associations were found between the clinical findings and TFJ MRI features. Crepitus and history of patellar pain are clinical findings that indicate PFJ lesions seen on MRI. These tests could help to indicate signs of PFJOA. Follow-up data needs to confirm whether these tests have an additional diagnostic value for early knee OA in PFJ or TFJ. Copyright © 2014 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  9. Superior-inferior position of patellar component affects patellofemoral kinematics and contact forces in computer simulation.

    Science.gov (United States)

    Nakamura, Shinichiro; Tanaka, Yoshihisa; Kuriyama, Shinichi; Nishitani, Kohei; Ito, Hiromu; Furu, Moritoshi; Matsuda, Shuichi

    2017-06-01

    Anterior knee pain has been reported as a major postoperative complication after total knee arthroplasty, which may lead to patient dissatisfaction. Rotational alignment and the medial-lateral position correlate with patellar maltracking, which can cause knee pain postoperatively. However, the superior-inferior position of the patellar component has not been investigated. The purpose of the current study was to investigate the effects of the patellar superior-inferior position on patellofemoral kinematics and kinetics. Superior, central, and inferior models with a dome patellar component were constructed. In the superior and inferior models, the position of the patellar component translated superiorly and inferiorly, respectively, by 3mm, relative to the center model. Kinematics of the patellar component, quadriceps force, and patellofemoral contact force were calculated using a computer simulation during a squatting activity in a weight-bearing deep knee bend. In the inferior model, the flexion angle, relative to the tibial component, was the greatest among all models. The inferior model showed an 18.0%, 36.5%, and 22.7% increase in the maximum quadriceps force, the maximum medial patellofemoral force, and the maximum lateral patellofemoral force, respectively, compared with the superior model. Superior-inferior positions affected patellofemoral kinematic and kinetics. Surgeons should avoid the inferior position of the patellar component, because the inferior positioned model showed greater quadriceps and patellofemoral force, resulting in a potential risk for anterior knee pain and component loosening. Copyright © 2017. Published by Elsevier Ltd.

  10. Prevalence and clinical significance of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease: observations at MR imaging.

    LENUS (Irish Health Repository)

    Chan, V O

    2013-08-01

    To determine the prevalence of chondromalacia isolated to the anterior margin of the lateral femoral condyle as a component of patellofemoral disease in patients with anterior knee pain and to correlate it with patient demographics, patellar shape, and patellofemoral alignment.

  11. Supervised exercise versus usual care for patellofemoral pain syndrome.

    Science.gov (United States)

    Hart, Lawrence

    2010-03-01

    To compare the effectiveness of supervised exercise therapy with usual care on self-reported recovery, pain, and function in persons with patellofemoral pain syndrome. Randomized, controlled, unblinded, multicenter trial of 3 month's duration. Sample size was calculated with 80% power to show a minimum clinically important difference of 22% in recovery after 1 year, at P or=18y). Sport and general medicine practices in the Netherlands. Inclusion criteria were: age, 14 to 40 years; presence of symptoms for between 2 months and 2 years; >or=3 of: pain when ascending or descending stairs, squatting, running, cycling, or sitting with flexed knees; grinding of the patella; and a positive clinical patellar test. Exclusion criteria were knee osteoarthritis, patellar tendinopathy, or other pathological conditions of the knee, previous knee injuries or surgery or treatment with supervised exercise. Patients were recruited by general practitioners or sport physicians (n randomized = 131; mean age, 24y; 70% 18y or older; 64% women; bilateral knee symptoms, 60%; participation in sport, 76%). The standardized 25-minute exercise protocol was tailored to individual achievement and supervised by a physical therapist. It comprised warm-up, followed by static and dynamic exercises for the quadriceps, adductor, and gluteal muscles, and included balance and thigh-muscle flexibility components. The load was increased progressively by increasing repetitions or intensity of the exercises. Patients attended 9 sessions, and were asked to practice the exercises daily for 3 months. The intervention and control patients received a pamphlet from their physicians about patellofemoral pain syndrome, advice to refrain from sports activities that provoked pain, and instructions for daily isometric quadriceps contractions. Analgesics were recommended for severe pain. Additional interventions, other than referrals to a physical therapist, were permitted. Patients reported the primary outcomes at 3

  12. Reduced step length reduces knee joint contact forces during running following anterior cruciate ligament reconstruction but does not alter inter-limb asymmetry.

    Science.gov (United States)

    Bowersock, Collin D; Willy, Richard W; DeVita, Paul; Willson, John D

    2017-03-01

    Anterior cruciate ligament reconstruction is associated with early onset knee osteoarthritis. Running is a typical activity following this surgery, but elevated knee joint contact forces are thought to contribute to osteoarthritis degenerative processes. It is therefore clinically relevant to identify interventions to reduce contact forces during running among individuals after anterior cruciate ligament reconstruction. The primary purpose of this study was to evaluate the effect of reducing step length during running on patellofemoral and tibiofemoral joint contact forces among people with a history of anterior cruciate ligament reconstruction. Inter limb knee joint contact force differences during running were also examined. 18 individuals at an average of 54.8months after unilateral anterior cruciate ligament reconstruction ran in 3 step length conditions (preferred, -5%, -10%). Bilateral patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, loading rate, impulse, and impulse per kilometer were evaluated between step length conditions and limbs using separate 2 factor analyses of variance. Reducing step length 5% decreased patellofemoral, tibiofemoral, and medial tibiofemoral compartment peak force, impulse, and impulse per kilometer bilaterally. A 10% step length reduction further decreased peak forces and force impulses, but did not further reduce force impulses per kilometer. Tibiofemoral joint impulse, impulse per kilometer, and patellofemoral joint loading rate were lower in the previously injured limb compared to the contralateral limb. Running with a shorter step length is a feasible clinical intervention to reduce knee joint contact forces during running among people with a history of anterior cruciate ligament reconstruction. Copyright © 2017 Elsevier Ltd. All rights reserved.

  13. The effect of rotational deformity on patellofemoral parameters following the treatment of femoral shaft fracture.

    Science.gov (United States)

    Yildirim, Ahmet Ozgur; Aksahin, Ertuğrul; Sakman, Bulent; Kati, Yusuf Alper; Akti, Sefa; Dogan, Ozgur; Ucaner, Ahmet; Bicimoglu, Ali

    2013-05-01

    The purpose of this study was to investigate the effect of rotational deformities on patellofemoral alignment using the dynamic magnetic resonance imaging method on patients whose femur fractures were treated with intramedullary locking nails. The dynamic patellofemoral magnetic resonance imaging results of 33 patients (5 females and 28 males) were reviewed. The mean age of the patients was 36.3 (range 19-61) years. The mean follow-up was 30.2 months (range 24-38). All the patients were given Kujala patellofemoral clinical evaluation scores at the latest follow-up. Those with less than 10° of rotational deformity in either direction were classified as Group A, those with more than a 10° of internal rotation deformity as Group B and more than a 10° of external rotation deformity as Group C. The three groups were then compared regarding to clinical scores. Patellofemoral parameters of operated and contralateral side were also compared in each group. There were 14 (42.4 %) patients in Group A, 12 (36.4 %) patients in Group B and 7 (21.2 %) patients in Group C. The mean patella score in Group C (74 ± 7.02) was significantly lower when compared with Group B (87.6 ± 9.9) and group A (90.6 ± 6.1) (p < 0.05). In Group C patients, medial patellar tilt was detected when compared with the intact side. There were no significant changes in patellofemoral position in either Group A or Group B. The results of this study revealed that more than 10° of external rotation deformity could cause a detoriation in the patellofemoral scores. Anatomic reduction of the fracture site should be performed as soon as possible and external rotational deformities should especially be avoided in order to prevent patellofemoral malalignment.

  14. ORIGINAL ARTICLE: Comparison between Mc Connell Patellar Taping and Conventional Physiotherapy Treatment in the Management of Patellofemoral Pain Syndrome A Randomised Controlled Trial –

    Directory of Open Access Journals (Sweden)

    Chhaya Verma

    2012-07-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS, also called Peripatellar Tendinitis in Merchant’s classification (1988, is the clinical entity of pain on - activity, on patellofemoral joint examination and on stair climbing, squatting, pseudo locking, prolonged sitting etc [1]. Varieties of conservative treatments aresuggested, including quadriceps strengthening, patellar taping, stretching, electrotherapy and biofeedback with no single intervention being most effective. Hence, comparison between thetwo techniques – patellar taping and the conventional method was undertaken to determine their effectiveness with respect topain and function. Methods: 20 subjects diagnosed with unilateral PFPS knee were randomly selected and allocated into two group- Group A (Mc Connell taping and vastus medialis oblique’s (VMO exercises and Group B (Short Wave Diathermy and VMO exercises.Treatment was continued for two weeks with pre and post Pain and Function recorded. Student’s ‘t’ test was used for statistical analysis.Results: Both groups showed statistically significant pain relief and functional improvements. On comparison, Group A showed highly significant pain relief and higher % change for functional increment. Conclusion: Taping and Short Wave Diathermy (SWD bothshowed significant pain relief and functional improvement. Taping showed highly significant pain relief for eccentric activities with a high % change in function. Thus, patellar taping appears more effective in treating PFPS.

  15. Bone Cysts After Osteochondral Allograft Repair of Cartilage Defects in Goats Suggest Abnormal Interaction Between Subchondral Bone and Overlying Synovial Joint Tissues

    Science.gov (United States)

    Pallante-Kichura, Andrea L.; Cory, Esther; Bugbee, William D.; Sah, Robert L.

    2013-01-01

    The efficacy of osteochondral allografts (OCA) may be affected by osseous support of the articular cartilage, and thus affected by bone healing and remodeling in the OCA and surrounding host. Bone cysts, and their communication pathways, may be present in various locations after OCA insertion and reflect distinct pathogenic mechanisms. Previously, we analyzed the effect of OCA storage (FRESH, 4°C/14d, 4°C/28d, FROZEN) on cartilage quality in fifteen adult goats after 12 months in vivo. The objectives of this study were to further analyze OCA and contralateral non-operated (Non-Op) CONTROLS from the medial femoral condyle to (1) determine the effect of OCA storage on local subchondral (ScB) and trabecular (TB) bone structure, (2) characterize the location and structure of bone cysts and channels, and (3) assess the relationship between cartilage and bone properties. (1) Overall bone structure after OCA was altered compared to Non-Op, with OCA samples displaying bone cysts, ScB channels, and ScB roughening. ScB BV/TV in FROZEN OCA was lower than Non-Op and other OCA. TB BV/TV in FRESH, 4°C/14d, and 4°C/28d OCA did not vary compared to Non-Op, but BS/TV was lower. (2) OCA contained “basal” cysts, localized to deeper regions, some “subchondral” cysts, localized near the bone-cartilage interface, and some ScB channels. TB surrounding basal cysts exhibited higher BV/TV than Non-Op. (3) Basal cysts occurred (a) in isolation, (b) with subchondral cysts and ScB channels, (c) with ScB channels, or (d) with subchondral cysts, ScB channels, and ScB erosion. Deterioration of cartilage gross morphology was strongly associated with abnormal μCT bone structure. Evidence of cartilage-bone communication following OCA repair may favor fluid intrusion as a mechanism for subchondral cyst formation, while bone resorption at the graft-host interface without affecting overall bone and cartilage structure may favor bony contusion mechanism for basal cyst formation. These

  16. The Association of Forefoot Varus Deformity with Patellofemoral Cartilage Damage in Older Adult Cadavers.

    Science.gov (United States)

    Lufler, Rebecca S; Stefanik, Joshua J; Niu, Jingbo; Sawyer, F Kip; Hoagland, Todd M; Gross, K Douglas

    2017-06-01

    Forefoot alignment may contribute to patellofemoral joint (PFJ) osteoarthritis (OA) via its influence on the closed chain kinematics of the lower limb. The purpose of this cadaveric study was to investigate the relationship between forefoot varus and ipsilateral cartilage damage in the medial and lateral PFJ. Forefoot alignment measurements were obtained from the feet of 25 cadavers (n = 50). Cartilage damage in the medial and lateral PFJ of each knee was scored using the Outerbridge scale. The relative odds of medial and lateral PFJ cartilage damage in limbs with forefoot varus and valgus were determined using logistic regression. The relationship between increasing varus alignment and increasing odds of medial and lateral PFJ cartilage damage was assessed. Of the 51% of limbs with forefoot varus, 91.3% had medial, and 78.3% had lateral PFJ cartilage damage, compared with 54.6% and 68.2% of those with forefoot valgus. The former also had 3.0 times (95% CI 1.2, 7.7) the odds of medial PFJ damage; no association was found with lateral damage (OR 1.4, 95% CI 0.7, 3.0). Feet in the highest tertile of varus alignment had 3.9 times (95% CI 10, 15.3, P = 0.058) the odds of medial PFJ damage as those in the lowest tertile. The results of this study suggest a relationship between forefoot varus and medial PFJ cartilage damage in older adults. As forefoot varus may be modified with foot orthoses, these findings indicate a potential role for orthoses in the treatment of medial PFJ OA. Anat Rec, 300:1032-1038, 2017. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  17. Association of varus thrust with prevalent patellofemoral osteoarthritis: A cross-sectional study.

    Science.gov (United States)

    Iijima, Hirotaka; Fukutani, Naoto; Yamamoto, Yuko; Hiraoka, Masakazu; Miyanobu, Kazuyuki; Jinnouchi, Masashi; Kaneda, Eishi; Isho, Takuya; Aoyama, Tomoki; Kuroki, Hiroshi; Matsuda, Shuichi

    2017-10-01

    This cross-sectional study investigated (i) the association of varus thrust during gait with the presence of patellofemoral osteoarthritis (PFOA) in patients with medial knee osteoarthritis (OA) and (ii) patellar alignment in the knees with varus thrust. Participants from orthopedic clinics (n=171; mean age, 73.4 years; 71.9% female) diagnosed with radiographic medial knee OA (Kellgren/Lawrence [K/L] grade ≥1) were included in this study, and underwent gait observation for varus thrust assessment using 2D video analysis. A radiographic skyline view was used to assess the presence of medial PFOA using the grading system from the Osteoarthritis Research Society International Atlas. The tibiofemoral joint K/L grade, patellar alignment (i.e., lateral shift and tilting angle), and knee pain intensity were also evaluated as covariates. Thirty-two (18.7%) of 171 patients exhibited varus thrust and they presented significantly higher knee pain (46.0±3.04mm vs. 32.4±2.73mm; P=0.024), a lower patellar tilting angle (P=0.024), and a higher prevalence of PFOA compared with those without varus thrust. A logistic regression analysis with adjustment of covariates showed that varus thrust was significantly associated with higher odds of the presence of mixed and medial PFOA, and trended to significantly associate with any PFOA, including lateral PFOA. This indicates that varus thrust was associated with PFOA in a compartment-nonspecific manner in patients with medial knee OA. Varus thrust may represent a clinical disease feature of more advanced and multicompartmental disease. Copyright © 2017 Elsevier B.V. All rights reserved.

  18. PATELLOFEMORAL CHONDRAL DEFECT IN A PREADOLESCENT SKIER: A CASE REPORT IN EARLY SPORT SPECIALIZATION.

    Science.gov (United States)

    DePhillipo, Nicholas N; Cinque, Mark E; Kennedy, Nicholas I; Chahla, Jorge; Moatshe, Gilbert; LaPrade, Robert F

    2018-02-01

    Early sport specialization (ESS) refers to intense training year round in a specific sport starting at a young age with no or limited participation in other sports. This approach to training is highly controversial; recent literature suggests that this type of specialized training could be a contributing source to overuse injuries in youth athletes. The purpose of this case report was to describe a patellofemoral articular cartilage defect of the knee in a preadolescent skier due to overuse and repetitive microtrauma as a result of ESS. Case Report. A healthy 11-year-old male competitive alpine skier presented with recurrent swelling of his right knee and persistent anterior knee pain while skiing without evidence of any specific history of injury or traumatic event. The patient failed a conservative treatment regimen including rest and formal physical therapy focused on generalized knee strengthening. Magnetic resonance imaging was ordered and revealed an articular cartilage defect of the medial patellar facet. The patient was treated with an arthroscopic debridement of his articular cartilage defect. At 12 weeks postoperatively, the patient presented with a normalized gait pattern, no evidence of knee effusion, full knee range of motion and patellar mobility symmetric to his contralateral limb, and no patellar crepitation or painful palpation on physical exam. The patient was released to begin return to sport progression at 12 weeks, and was cleared for full activities/returned to competitive skiing at 15 weeks postoperatively. At 16 weeks postoperatively, he won an international alpine ski race in Europe for his age group. Cartilage injuries and osteochondral defects are very common in adolescent athletes and often go undiagnosed. Allied healthcare professionals must be educated on the known causes of recurrent knee effusions and how early sport specialization may result in overuse injuries to knee joint cartilage. 4.

  19. Influence of patellofemoral pain syndrome on plantar pressure in the foot rollover process during gait

    Directory of Open Access Journals (Sweden)

    Sandra Aliberti

    2011-01-01

    Full Text Available BACKGROUND: Patellofemoral Pain Syndrome is one of the most common knee disorders among physically active young women. Despite its high incidence, the multifactorial etiology of this disorder is not fully understood. OBJECTIVES: To investigate the influence of Patellofemoral Pain Syndrome on plantar pressure distribution during the foot rollover process (i.e., the initial heel contact, midstance and propulsion phases of the gait. MATERIALS AND METHODS: Fifty-seven young adults, including 22 subjects with Patellofemoral Pain Syndrome (30 ± 7 years, 165 ± 9 cm, 63 ± 12 kg and 35 control subjects (29 ± 7 years, 164 ± 8 cm, 60 ± 11 kg, volunteered for the study. The contact area and peak pressure were evaluated using the Pedar-X system (Novel, Germany synchronized with ankle sagittal kinematics. RESULTS: Subjects with Patellofemoral Pain Syndrome showed a larger contact area over the medial (p = 0.004 and central (p = 0.002 rearfoot at the initial contact phase and a lower peak pressure over the medial forefoot (p = 0.033 during propulsion when compared with control subjects. CONCLUSIONS: Patellofemoral Pain Syndrome is related to a foot rollover pattern that is medially directed at the rearfoot during initial heel contact and laterally directed at the forefoot during propulsion. These detected alterations in the foot rollover process during gait may be used to develop clinical interventions using insoles, taping and therapeutic exercise to rehabilitate this dysfunction.

  20. Bone mineral density in the chronic patellofemoral pain syndrome.

    Science.gov (United States)

    Leppälä, J; Kannus, P; Natri, A; Sievänen, H; Järvinen, M; Vuori, I

    1998-06-01

    Bone mineral density (BMD) and clinical status of 40 patients with a chronic, unilateral patellofemoral pain syndrome (PFPS) were determinated. The mean duration of the disease at the time of the follow-up was 7.6 +/- 1.8 (SD) years. The BMD was measured at the spine (L2-L4), and the femoral neck, trochanter area of the femur, distal femur, patella, proximal tibia, and calcaneus of both lower extremities using a dual-energy X-ray absorptiometric (DXA) scanner. The mean BMD of the affected limb (compared with the unaffected side) was significantly lower in the distal femur (-3.3%; P = 0.002), patella (-2.5%; P = 0.016), and proximal tibia (-1.9%; P = 0.008). The femoral neck, trochanter area of the femur, and calcaneus showed no significant side-to-side differences, and the spinal BMDs of men and women with the PFPS were comparable with the manufacturer's age-adjusted reference values for Western European men and women. The relative BMDs of the affected knee showed strongest correlation with the muscle strength of the same knee: the better the muscle strength compared with the healthy knee, the higher the relative BMD (r = 0.56-0.58 with P < 0.001 in each anatomic site of the knee). In the stepwise regression analysis, low body weight or low body mass index, high level of physical activity, the patient's good subjective overall assessment of his/her affected knee, and short duration of the symptoms were also independent predictors of the high relative BMD in the affected knee so that along with the muscle strength these variables could account for 51% of the variation seen in the relative BMD of the femur, 61% in the patella, and 54% in the proximal tibia. In conclusion, chronic patellofemoral pain syndrome results in a significantly decreased BMD in the knee region of the affected limb. The spine, proximal femur, and calcaneus are not affected. Recovery of normal muscle strength and knee function seems to be of great importance for good BMD.

  1. Gait Kinematics in Individuals with Acute and Chronic Patellofemoral Pain.

    Science.gov (United States)

    Fox, Aaron; Ferber, Reed; Saunders, Natalie; Osis, Sean; Bonacci, Jason

    2018-03-01

    This study aimed to identify the discriminating kinematic gait characteristics between individuals with acute and chronic patellofemoral pain (PFP) and healthy controls. Ninety-eight runners with PFP (39 male, 59 female) and 98 healthy control runners (38 male, 60 female) ran on a treadmill at a self-selected speed while three-dimensional lower limb kinematic data were collected. Runners with PFP were split into acute (n = 25) and chronic (n = 73) subgroups on the basis of whether they had been experiencing pain for less or greater than 3 months, respectively. Principal component analysis and linear discriminant analysis were used to determine the combination of kinematic gait characteristics that optimally separated individuals with acute PFP and chronic PFP and healthy controls. Compared with controls, both the acute and chronic PFP subgroups exhibited greater knee flexion across stance and greater ankle dorsiflexion during early stance. The acute PFP subgroup demonstrated greater transverse plane hip motion across stance compared with healthy controls. In contrast, the chronic PFP subgroup demonstrated greater frontal plane hip motion, greater knee abduction, and reduced ankle eversion/greater ankle inversion across stance when compared with healthy controls. This study identified characteristics that discriminated between individuals with acute and chronic PFP when compared with healthy controls. Certain discriminating characteristics were shared between both the acute and chronic subgroups when compared with healthy controls, whereas others were specific to the duration of PFP.

  2. Evaluation of anterior stability of knee joint following arthroscopic ACL reconstruction with patellar ligament.

    Science.gov (United States)

    Fibiger, Wojciech; Kukiełka, Radosław T Kukiełka

    2011-01-01

    The aim of the study was to investigate and assess anterior stability of the knee joint before and during 12-month rehabilitation after arthroscopic reconstruction of the anterior cruciate ligament with the central third of the patellar ligament and stabilization with interference screws (Kenneth-Jones method) and to analyse the effectiveness of the surgery and rehabilitation by patient self-assessment of pain and crepitation in the patello-femoral joint. The study involved a group of 46 patients after arthroscopic ACL reconstruction with the patellar ligament performed in 2005 and 2006. All patients underwent examinations of anterior stability of the knee joint using a KT-1000/S arthrometer. Stability measurements were performed on both knees on the day before surgery, and at 3, 6 and 12 months after the operation. Additionally, the patients subjectively evaluated post-operative pain and crepitation in the patello-femoral joint at 3, 6 and 12 months. Knee stability after ACL reconstruction according to the Mazurkiewicz scale using a KT-1000 arthrometer was rated as good and excellent, while the patients subjectively assessed the treatment process in terms of pain and crepitation in the patello-femoral joint at 12 months after the operation as excellent (10.8%), good (74%), and satisfactory (15.2%). Arthroscopic ACL reconstruction with the central third of the patellar ligament and stabilization with interference screws fully restored the lost stability of the knee, but the possibility of pain and crepitations in the patello-femoral joint needs to be taken into account. In the course of rehabilitation, it is natural that an ACL graft may extend as a result of remodeling and the impact of rehabilitation being administered.

  3. Simultaneous MPFL and LPFL reconstruction for recurrent lateral patellar dislocation with medial patellofemoral instability

    Directory of Open Access Journals (Sweden)

    Masashi Kusano

    2014-01-01

    Full Text Available We report an extremely rare case of both recurrent lateral patella dislocation and medial patellofemoral instability, following prior operations to correct patella maltracking. Manual translation of the patella revealed medial and lateral instability with a positive apprehension sign. 3-D computer modelling of kinematics based on MRI data demonstrated that the patella deviated laterally at full extension and translated medially with knee flexion. The medial and lateral patellofemoral ligaments were reconstructed simultaneously with hamstring tendons, alleviating peripatellar pain and patellar instability in both directions.

  4. Occupation-related squatting, kneeling, and heavy lifting and the knee joint: a magnetic resonance imaging-based study in men.

    Science.gov (United States)

    Amin, Shreyasee; Goggins, Joyce; Niu, Jingbo; Guermazi, Ali; Grigoryan, Mikayel; Hunter, David J; Genant, Harry K; Felson, David T

    2008-08-01

    We examined the relation between occupational exposures to frequent squatting/kneeling and/or heavy lifting with cartilage morphology, based on magnetic resonance imaging (MRI), at the tibiofemoral and patellofemoral joints in men and determined which compartments are most affected. We evaluated 192 men with symptomatic knee osteoarthritis (OA). The more symptomatic knee was imaged using MRI. Cartilage was scored using the Whole Organ MRI Score semiquantitative method at the medial and lateral tibiofemoral joint and patellofemoral joint. Occupational exposures to frequent squatting, kneeling, and/or heavy lifting were assessed using a validated questionnaire. Among the 192 men [mean (+/- standard deviation) age 69 +/- 9 yrs, body mass index (BMI) 30.8 +/- 4.7 kg/m(2)], those reporting occupational exposure to squatting/kneeling alone, heavy lifting alone, both squatting/kneeling and heavy lifting, or none of these activities numbered 7, 40, 47, and 98, respectively. Compared with men with no occupational exposure to these activities, and following adjustment for age, BMI, and history of knee injury or surgery, we found that men reporting occupational exposures to both squatting/kneeling and heavy lifting had a modest increased risk for worse cartilage morphology scores at the patellofemoral joint [odds ratio (OR) 1.8, 95% confidence interval (CI) 1.1 to 3.2] and medial tibiofemoral joint (OR 1.6, 95% CI 0.9, 3.0), although the latter did not reach statistical significance. Men with frequent occupational squatting/kneeling and heavy lifting have a greater likelihood for worse cartilage morphology scores at the patellofemoral joint. These findings add support to the important role of biomechanical loading on the pathogenesis of knee OA, particularly patellofemoral OA.

  5. Effects of upright weight bearing and the knee flexion angle on patellofemoral indices using magnetic resonance imaging in patients with patellofemoral instability.

    Science.gov (United States)

    Becher, Christoph; Fleischer, Benjamin; Rase, Marten; Schumacher, Thees; Ettinger, Max; Ostermeier, Sven; Smith, Tomas

    2017-08-01

    This study analysed the effects of upright weight bearing and the knee flexion angle on patellofemoral indices, determined using magnetic resonance imaging (MRI), in patients with patellofemoral instability (PI). Healthy volunteers (control group, n = 9) and PI patients (PI group, n = 16) were scanned in an open-configuration MRI scanner during upright weight bearing and supine non-weight bearing positions at full extension (0° flexion) and at 15°, 30°, and 45° flexion. Patellofemoral indices included the Insall-Salvati Index, Caton-Deschamp Index, and Patellotrochlear Index (PTI) to determine patellar height and the patellar tilt angle (PTA), bisect offset (BO), and the tibial tubercle-trochlear groove (TT-TG) distance to assess patellar rotation and translation with respect to the femur and alignment of the extensor mechanism. A significant interaction effect of weight bearing by flexion angle was observed for the PTI, PTA, and BO for subjects with PI. At full extension, post hoc pairwise comparisons revealed a significant effect of weight bearing on the indices, with increased patellar height and increased PTA and BO in the PI group. Except for the BO, no such changes were seen in the control group. Independent of weight bearing, flexing the knee caused the PTA, BO, and TT-TG distance to be significantly reduced. Upright weight bearing and the knee flexion angle affected patellofemoral MRI indices in PI patients, with significantly increased values at full extension. The observations of this study provide a caution to be considered by professionals when treating PI patients. These patients should be evaluated clinically and radiographically at full extension and various flexion angles in context with quadriceps engagement. Explorative case-control study, Level III.

  6. The effect of a dynamic PCL brace on patellofemoral compartment pressures in PCL-and PCL/PLC-deficient knees.

    Science.gov (United States)

    Welch, Tyler; Keller, Thomas; Maldonado, Ruben; Metzger, Melodie; Mohr, Karen; Kvitne, Ronald

    2017-12-01

    The natural history of posterior cruciate ligament (PCL) deficiency includes the development of arthrosis in the patellofemoral joint (PFJ). The purpose of this biomechanical study was to evaluate the hypothesis that dynamic bracing reduces PFJ pressures in PCL- and combined PCL/posterolateral corner (PLC)-deficient knees. Controlled Laboratory Study. Eight fresh frozen cadaveric knees with intact cruciate and collateral ligaments were included. PFJ pressures and force were measured using a pressure mapping system via a lateral arthrotomy at knee flexion angles of 30°, 60°, 90°, and 120° in intact, PCL-deficient, and PCL/PLC-deficient knees under a combined quadriceps/hamstrings load of 400 N/200 N. Testing was then repeated in PCL- and PCL/PLC-deficient knees after application of a dynamic PCL brace. Application of a dynamic PCL brace led to a reduction in peak PFJ pressures in PCL-deficient knees. In addition, the brace led to a significant reduction in peak pressures in PCL/PLC-deficient knees at 60°, 90°, and 120° of flexion. Application of the dynamic brace also led to a reduction in total PFJ force across all flexion angles for both PCL- and PCL/PLC-deficient knees. Dynamic bracing reduces PFJ pressures in PCL- and combined PCL/PLC-deficient knees, particularly at high degrees of knee flexion.

  7. Automatic string generation for estimating in vivo length changes of the medial patellofemoral ligament during knee flexion.

    Science.gov (United States)

    Graf, Matthias; Diether, Salomon; Vlachopoulos, Lazaros; Fucentese, Sandro; Fürnstahl, Philipp

    2014-06-01

    Modeling ligaments as three-dimensional strings is a popular method for in vivo estimation of ligament length. The purpose of this study was to develop an algorithm for automated generation of non-penetrating strings between insertion points and to evaluate its feasibility for estimating length changes of the medial patellofemoral ligament during normal knee flexion. Three-dimensional knee models were generated from computed tomography (CT) scans of 10 healthy subjects. The knee joint under weight-bearing was acquired in four flexion positions (0°-120°). The path between insertion points was computed in each position to quantify string length and isometry. The average string length was maximal in 0° of flexion (64.5 ± 3.9 mm between femoral and proximal patellar point; 62.8 ± 4.0 mm between femoral and distal patellar point). It was minimal in 30° (60.0 ± 2.6 mm) for the proximal patellar string and in 120° (58.7 ± 4.3 mm) for the distal patellar string. The insertion points were considered to be isometric in 4 of the 10 subjects. The proposed algorithm appears to be feasible for estimating string lengths between insertion points in an automatic fashion. The length measurements based on CT images acquired under physiological loading conditions may give further insights into knee kinematics.

  8. The relationship between the MRI features of mild osteoarthritis in the patellofemoral and tibiofemoral compartments of the knee

    International Nuclear Information System (INIS)

    Kornaat, Peter R.; Watt, Iain; Bloem, Johan L.; Riyazi, Naghmeh; Kloppenburg, Margreet

    2005-01-01

    The aim of this work was to demonstrate the relationship between osteoarthritic changes seen on magnetic resonance (MR) images of the patellofemoral (PF) or tibiofemoral (TF) compartments in patients with mild osteoarthritis (OA) of the knee. MR images of the knee were obtained in 105 sib pairs (210 patients) who had been diagnosed with OA at multiple joints. Entry criteria included that the degree of OA in the knee examined should be between a Kellgren and Lawrence score of 2 or 3. MR images were analyzed for the presence of cartilaginous lesions, bone marrow edema (BME) and meniscal tears. The relationship between findings in the medial and lateral aspects of the PF and TF compartments was examined. The number of cartilaginous defects on either side of the PF compartment correlated positively with number of cartilaginous defects in the ipsilateral TF compartment (odds ratio, OR, 55, confidence interval, CI, 7.8-382). The number of cartilaginous defects in the PF compartment correlated positively with ipsilateral meniscal tears (OR 3.7, CI 1.0-14) and ipsilateral PF BME (OR 17, CI 3.8-72). Cartilaginous defects in the TF compartment correlated positively with ipsilateral meniscal tears (OR 9.8, CI 2.5-38) and ipsilateral TF BME (OR 120, CI 6.5-2,221). Osteoarthritic defects lateralize or medialize in the PF and TF compartments of the knee in patients with mild OA. (orig.)

  9. Reliability of measures of impairments associated with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Hando Benjamin R

    2006-03-01

    Full Text Available Abstract Background The reliability and measurement error of several impairment measures used during the clinical examination of patients with patellofemoral pain syndrome (PFPS has not been established. The purpose was to determine the inter-tester reliability and measurement error of measures of impairments associated with PFPS in patients with PFPS. Methods A single group repeated measures design was used. Two pairs of physical therapists participated in data collection. Examiners were blinded to each others' measurements. Results Thirty patients (age 29 +/- 8; 17 female with PFPS participated in this study. Inter-tester reliability coefficients were substantial for measures of hamstrings, quadriceps, plantarflexors, and ITB/TFL complex length, hip abductors strength, and foot pronation (ICCs from .85 to .97; moderate for measures of Q-angle, tibial torsion, hip external rotation strength, lateral retinacular tightness, and quality of movement during a step down task (ICCs from .67 to .79; and poor for femoral anteversion (ICC of .45. Standard error of measurement (SEM for measures of muscle length ranged from 1.6 degrees to 4.3 degrees. SEM for Q-angle, tibial torsion, and femoral anteversion were 2.4 degrees, 2.9 degrees, and 4.5 degrees respectively. SEM for foot pronation was 1 mm. SEM for measures of muscle strength was 1.8 Kg for abduction and 2.4 Kg for external rotation. Conclusion Several of the impairments associated with PFPS had sufficient reliability and low measurement error. Further investigation is needed to test if these impairment measurements are related to physical function and whether or not they are useful for decision-making.

  10. Feedback Leads to Better Exercise Quality in Adolescents with Patellofemoral Pain

    DEFF Research Database (Denmark)

    Riel, Henrik; Matthews, Mark; Vicenzino, Bill

    2018-01-01

    PURPOSE: Adolescents with patellofemoral pain (PFP) do not comply with their exercise prescription, performing too few and too fast repetitions, compromising recovery. We investigated if real-time feedback on contraction time would improve the ability of adolescents with PFP to perform exercises ...

  11. Early intervention for adolescents with patellofemoral pain syndrome--a pragmatic cluster randomised controlled trial

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Roos, Ewa M.; Olesen, Jens

    2012-01-01

    Self-reported knee pain is highly prevalent among adolescents. As much as 50% of the non-specific knee pain may be attributed to Patellofemoral Pain Syndrome (PFPS). In the short term, exercise therapy appears to have a better effect than patient education consisting of written information...

  12. Q-angle static or dynamic measurements, which is the best choice for patellofemoral pain?

    Science.gov (United States)

    Silva, Danilo de Oliveira; Briani, Ronaldo Valdir; Pazzinatto, Marcella Ferraz; Gonçalves, Ana Valéria; Ferrari, Deisi; Aragão, Fernando Amâncio; de Azevedo, Fábio Mícolis

    2015-12-01

    The elevated Q-angle seems to be one of the most suggested factors contributing to patellofemoral pain. Females with patellofemoral pain are often evaluated through static clinical tests in clinical practice. However, the adaptations seem to appear more frequently in dynamic conditions. Performing static vs. dynamic evaluations of widely used measures would add to the knowledge in this area. Therefore, the aim of this study was to determine the reliability and discriminatory capability of three Q-angle measurements: a static clinical test, peak dynamic knee valgus during stair ascent and a static measurement using a three-dimensional system. Twenty-nine females with patellofemoral pain and twenty-five pain-free females underwent clinical Q-angle measurement and static and dynamic knee valgus measurements during stair ascent, using a three-dimensional system. All measurements were obtained and comparisons between groups, reliability and discriminatory capability were calculated. Peak dynamic knee valgus was found to be greater in the patellofemoral pain group. On the other hand, no significant effects were found for static knee valgus or clinical Q-angle measurements between groups. The dynamic variable demonstrated the best discriminatory capability. Low values of reliability were found for clinical Q-angle, in contrast to the high values found for the three-dimensional system measurements. Based on our findings, avoiding or correcting dynamic knee valgus during stair ascent may be an important component of rehabilitation programs in females with patellofemoral pain who demonstrate excessive dynamic knee valgus. Q-angle static measurements were not different between groups and presented poor values of discriminatory capability. Copyright © 2015 Elsevier Ltd. All rights reserved.

  13. A novel technique for reconstruction of the medial patellofemoral ligament in skeletally immature patients.

    Science.gov (United States)

    Yercan, Hüseyin S; Erkan, Serkan; Okcu, Güvenir; Ozalp, R Taçkın

    2011-08-01

    Habitual or recurrent dislocation of the patella in the skeletally immature patient is a particularly demanding problem since the etiology is frequently multifactorial. The surgical techniques successfully performed in adults with patellar instability may risk injury to an open growth plate if applied to children. We present a technique that preserves femoral and patellar insertion anatomy of medial patellofemoral ligament (MPFL) using a free semitendinosus autograft together with tenodesis to the adductor magnus tendon without damaging open physis on the patellar attachment of MPFL. A 3-cm long longitudinal skin incision is performed 10 mm distal to the tibial tuberosity on the anteromedial side. The semitendinosus tendon is harvested with the stripper. The semitendinosus tendon is placed on a preparation board and cleaned of muscle tissue. The usable part of the tendon should be at least 20 cm long and 4 mm wide. The two free ends of the graft are sutured with Krakow technique. A medial longitudinal incision 2 cm in length is made to expose the MPFL and to abrade the patellar attachment of vastus medialis obliquus. The first patellar tunnel is created with 4.5 mm drill at the mid aspect of the medial patella in the anteroposterior and proximal-distal direction. The drill hole is formed parallel to the articular surface of the center of the patella. The second tunnel is created with 3.2 mm drill and the entry point is localized at the center of the patella. These two tunnels intersect to form a single tunnel. The semitendinosus autograft is run through the bone tunnel in the patella. Double-stranded semitendinosus autograft is placed in the presynovial fatty plane between the second and the third layer of the medial retinaculum, and tenodesis to adductor magnus tendon is applied by a moderate medial force with the knee flexed at 30°. Aftercare includes immobilization of the joint limited to 30° flexion using an above-knee splint for 2 weeks. No recurrent

  14. 21 CFR 888.3540 - Knee joint patellofemoral polymer/metal semi-constrained cemented prosthesis.

    Science.gov (United States)

    2010-04-01

    ...: Articulating Surfaces Made of Metal, Ceramic and Plastic Materials,” and (viii) ISO 9001:1994 “Quality Systems... for this device are: (1) FDA's: (i) “Use of International Standard ISO 10993 ‘Biological Evaluation of... Locked’ Modular Implant Components,” and (2) International Organization for Standardization's (ISO): (i...

  15. A study to determine the effectiveness of core stabilisation exercises in the treatment of patellofemoral pain syndrome

    OpenAIRE

    2010-01-01

    M.Tech. This study compared the effectiveness of two different Chiropractic treatment protocols in the treatment of patellofemoral pain syndrome. This was done in order to establish whether or not core stabilisation exercises play a role in the treatment of patellofemoral pain syndrome. Thirty participants were used for this study. They were randomly placed into two groups namely; group 1 and group 2. Group 1 received strengthening exercises of the quadriceps muscle group and stretching ex...

  16. Comparison of the Effect of Exercise Therapy with Transcutaneous Electrical Nerve Stimulation on Improvement of Pain and Function in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    A Akbari

    2008-04-01

    Full Text Available ABSTRACT: Introduction & Objective: One of the most common disorders of the knee joint in adult is patellofemoral pain syndrome. Sometimes it becomes chronic and causes activity limitation. This study aimed to compare the efficacy of exercise therapy with Transcutaneous Electrical Nerve Stimulation on improvement of pain intensity, knee function, muscle atrophy and range of knee flexion. Materials & Methods: This double-blind, randomized clinical trial was carried out in Zahedan Razmejo-Moghadam Physiotherapy Clinic, in 2007. Thirty-two patients with patellofemoral pain syndrome were recruited through simple non-probability sampling. Subjects were randomly assigned to one of the equal groups, exercise therapy (including hip, knee, and leg muscles strengthening and stretching exercises or electrical stimulation group. Before and after intervention, we assessed pain through Visual Analog Scale (VAS (ordinal, function (ordinal with Knee Injury and Osteoarthritis Outcome Score (KOOS, thigh circumference with tape measure (centimeter and range of knee flexion with goniometer (degree. A 10 session treatment program, three sessions per week and one hour per session was performed for both groups. Independent t-test or Mann-Whitney U and paired t-test or Wilcoxon were used for comparison between the pretreatment and post treatment results between groups and within groups, in SPSS software, respectively. Results: The mean total score of knee function increased from 100.53±19.25 to 130.87±18.25 in the electrical stimulation group and from 107.67±22.69 to 131.47±15.11 in the exercise therapy group (p=0.001. The mean score of knee function subscales including symptoms, pain, functional limitation, recreational activity, and life style improved in both groups (p<0.05. The pain score and range of knee flexion improved in both groups (p<0.05. After treatment, range of knee flexion significantly increased in the exercise group compared with the electrical

  17. A 21% conversion rate to total knee arthroplasty of a first-generation patellofemoral prosthesis at a mean follow-up of 9.7 years.

    Science.gov (United States)

    Hoogervorst, Paul; de Jong, Richard J; Hannink, Gerjon; van Kampen, Albert

    2015-09-01

    To evaluate the mid- to long-term results of the Richards' type II patellofemoral arthroplasty (PFA) in terms of functional scores, number and type of complications, patient satisfaction and survival. We retrospectively studied patients that received a Richards' type II PFA at our institution between 1998 and 2007. Patients with a functioning PFA at the time of this study were evaluated. Outcomes included survival rates with endpoint loss of prosthesis, number and type of complications, Knee Society Scores (KSS) and Visual Analogue Scale (VAS) for pain. In addition, patients were asked how surgery influenced their original symptoms. Twenty-four patients (33 prostheses) were included. Follow-up ranged from 2.2 to 18.8 years with a mean of 9.7 years. Survival at 10 years was 73% (95% CI, 57-93%). Median KSS score was 163 (range, 110-200). Median VAS Pain was 30 (range, 0-80) and VAS Satisfaction median was 90 (range, 50-100). Thirteen (62%) PFAs were rated excellent, six (28%) as good and two (10%) as fair. Twelve (36%) of the cases required further surgery within 4 years after implantation. Seven of these (21%) were converted to TKA after a mean time of 5.5 years, five out of seven were converted because of ongoing tibiofemoral osteoarthritis (TFOA). We found a rate of 21% (7/33) conversion of the Richards' II PFA to TKA after a mean of 5.5 years; 71% (5/7) of cases were because of TFOA. We strongly advise not to use PFA if there is any sign of joint disease in other compartments than patellofemoral.

  18. The influence of malalignment and ageing following sterilisation by gamma irradiation in an inert atmosphere on the wear of ultra-high-molecular-weight polyethylene in patellofemoral replacements.

    Science.gov (United States)

    Maiti, Raman; Cowie, Raelene M; Fisher, John; Jennings, Louise M

    2017-07-01

    Complications of patellofemoral arthroplasty often occur soon after implantation and, as well as other factors, can be due to the design of the implant or its surgical positioning. A number of studies have previously considered the wear of ultra-high-molecular-weight polyethylene patellae following suboptimal implantation; however, studies have primarily been carried out under a limited number of degrees of freedom. The aim of this study was to develop a protocol to assess the wear of patellae under a malaligned condition in a six-axis patellofemoral joint simulator. The malalignment protocol hindered the tracking of the patella centrally in the trochlear groove and imparted a constant 5° external rotation (tilt) on the patella button. Following 3 million cycles of wear simulation, this condition had no influence on the wear of ultra-high-molecular-weight polyethylene patellae aged for 4 years compared to well-positioned non-aged implants (p > 0.05). However, under the malaligned condition, ultra-high-molecular-weight polyethylene patellae aged 8-10 years after unpacking (following sterilisation by gamma irradiation in an inert atmosphere) and worn ultra-high-molecular-weight polyethylene components also aged 4 years after unpacking (following the same sterilisation process) exhibited a high rate of wear. Fatigue failure due to elevated contact stress led to delamination of the ultra-high-molecular-weight polyethylene and in some cases complete failure of the patellae. The results suggest that suboptimal tracking of the patella in the trochlear groove and tilt of the patella button could have a significant effect on the wear of ultra-high-molecular-weight polyethylene and could lead to implant failure.

  19. Effect of exercise therapy on neuromuscular activity and knee strength in female adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Samani, Afshin; Olesen, Jens L

    2016-01-01

    BACKGROUND: Female adolescents with patellofemoral pain are characterized by altered neuromuscular knee control and reduced maximal quadriceps torque. The purpose of this study is to investigate whether exercise therapy and patient education are associated with larger improvements in neuromuscular...... knee control and maximal quadriceps torque compared with patient education alone. METHODS: This is an ancillary analysis of a cluster randomized controlled trial investigating the effect of patient education and exercise therapy on self-reported recovery in 121 adolescents with patellofemoral pain...... flexion/extension kinematics and maximal quadriceps torque. FINDINGS: There was an 8-15% greater decrease in the complexity of surface electromyography suggesting an improvement in neuromuscular knee control among those randomized to exercise therapy (0.08exercise...

  20. Biomechanics Associated with Patellofemoral Pain and ACL Injuries in Sports.

    Science.gov (United States)

    Weiss, Kaitlyn; Whatman, Chris

    2015-09-01

    Knee injuries are prevalent among a variety of competitive sports and can impact an athlete's ability to continue to participate in their sport or, in the worst case, end an athlete's career. The aim was to evaluate biomechanics associated with both patellofemoral pain syndrome (PFPS) and anterior cruciate ligament (ACL) injuries (in sports involving landing, change in direction, or rapid deceleration) across the three time points frequently reported in the literature: pre-injury, at the time of injury, and following injury. A search of the literature was conducted for research evaluating biomechanics associated with ACL injury and PFPS. The Web of Science, SPORTDiscus, EBSCO, PubMed, and CINAHL databases, to March 2015, were searched, and journal articles focused on ACL injuries and PFPS in sports that met the inclusion criteria were reviewed. The search methodology was created with the intent of extracting case-control, case, and cohort studies of knee injury in athletic populations. The search strategy was restricted to only full-text articles published in English. These articles were included in the review if they met all of the required selection criteria. The following inclusion criteria were used: (1) The study must report lower extremity biomechanics in one of the following settings: (a) a comparison of currently injured and uninjured participants, (b) a prospective study evaluating risk factors for injury, or (c) a study reporting on the injury event itself. (2) The study must include only currently active participants who were similar at baseline (i.e. healthy, high school level basketball players currently in-season) and include biomechanical analysis of either landing, change in direction, or rapid deceleration. (3) The study must include currently injured participants. The studies were graded on the basis of quality, which served as an indication of risk of bias. An adapted version of the 'Strengthening the Reporting of Observational Studies in

  1. The Relationship between Fuctional Tests and Knee Muscles Isokinetic Parameters in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Shahin Goharpey

    2007-04-01

    Full Text Available Objective: Patellofemoral pain syndrome is the most prevalent problem involving25 percent of all knee disorders. Such problems might be lead to functional disabilities. The goal of this study was to evaluate the relationship between functional tests and Isokinetic parameters of knee muscles and subjective assessment of knee function in patellofemoral pain syndrome and to compare between patient and control group. Materials & Methods: In this analytical and case – control research fifteen normal subjects and 15 patients with patellofemoral pain syndrome were selected with purposive sampling method in performing two main levels of this study: 1- Functional tests (bilateral squat and step down test which performed randomly with considering of repetitions per 30 seconds, within 3 minutes rest between them applied and followed by subjective assessment of knee function with Kujala questionnaire. 2- Isokinetic tests performed with Biodex dynamometer device, during 10 to 90 degree of knee flexion with two distinct speeds, 60 and 120 degree per second. Results: No relationship was found between functional tests and Isokinetic parameters in patient group, but we observed a low significant relationship between functional tests and subjective assessment in this group (r=0/47 for Squat test and 0/37 for Step down test. Moderate significant relationship was found between subjective assessment of knee function and functional Hamstring: Quadriceps ratio for knee flexion at 60 degree per second (r = - 0/58. All of the Isokinetic parameters of quadriceps muscle in patient group were lower than control group. Conclusion: As there were low correlation between Isokinetic strength measurement and functional tests and subjective assessment of knee function, it is not recommended using these methods of assessment interchangeable in patients with patellofemoral pain syndrome.

  2. Patellofemoral pain syndrome (PFPS): a systematic review of anatomy and potential risk factors

    OpenAIRE

    Waryasz, Gregory R; McDermott, Ann Y

    2008-01-01

    Background Patellofemoral Pain Syndrome (PFPS), a common cause of anterior knee pain, is successfully treated in over 2/3 of patients through rehabilitation protocols designed to reduce pain and return function to the individual. Applying preventive medicine strategies, the majority of cases of PFPS may be avoided if a pre-diagnosis can be made by clinician or certified athletic trainer testing the current researched potential risk factors during a Preparticipation Screening Evaluation (PPSE)...

  3. Correlation between Intrinsic Patellofemoral Pain Syndrome in Young Adults and Lower Extremity Biomechanics

    Science.gov (United States)

    Kwon, Ohjeoung; Yun, Mijung; Lee, Wanhee

    2014-01-01

    [Purpose] The purpose of this study was to evaluate the correlation between intrinsic patellofemoral pain syndrome (PFPS) in young adults and lower extremity biomechanics. [Subjects] This experiment was carried out with sixty (24 men and 32 women), who are normal university students as subjects. [Methods] All subjects underwent 3 clinical evaluations. For distinguishing the intrinsic PFPS from controls, we used the Modified Functional Index Questionnaire (MFIQ), Clarke’s test and the Eccentric step test. Based on the results of the tests, subjects who were classified as positive for 2 more tests were allocated to the bilateral or unilateral intrinsic PFPS group (n=14), and the others were allocated to the control group (n=42). These two groups were tested for hamstring tightness, foot overpronation, and static Q-angle and dynamic Q-angle. These are the four lower extremity biomechanic, cited as risk factors of patellofemoral pain syndrome. [Results] The over pronation, static Q-angle and the dynamic Q-angle were not significantly different between the two groups. However, the hamstring tightness of the PFPS group was significantly greater than that of the controls. [Conclusion] We examined individuals for intrinsic patellofemoral pain syndrome in young adults and lower extremity biomechanics. We found a strong correlation between intrinsic PFPS and hamstring tightness. PMID:25140074

  4. How isometric are the medial patellofemoral, superficial medial collateral, and lateral collateral ligaments of the knee?

    Science.gov (United States)

    Victor, Jan; Wong, Pius; Witvrouw, Eric; Sloten, Jos Vander; Bellemans, Johan

    2009-10-01

    Ligament isometry is a cornerstone in the description of normal knee function and thorough knowledge is mandatory for successful repair of torn ligaments. This study was undertaken to validate a novel experimental model for the study of ligament strains and to determine the length changes in the superficial medial collateral, lateral collateral, and medial patellofemoral ligaments. Descriptive laboratory study. Passive motions and loaded squats of 12 cadaveric specimens were performed while controlling ankle load and optically tracking the motion of the bones. Preexperiment and postexperiment computed axial tomography scans allow the transformation of rigid body motion to relative motion of relevant anatomic landmarks on the femur, tibia, and patella. The superficial medial collateral ligament is a near-isometric ligament with a strain of less than 2%. The ligament is a little more slack in midflexion (30 degrees to 50 degrees ) and in deep flexion, but length changes are not significant (P > .05). The lateral collateral ligament behaves near isometric (tension from the collateral ligaments (P superficial medial collateral ligament is a near-isometric ligament with no significant length changes. The medial patellofemoral ligament behaves differently in its cranial and caudal parts. In knees with chronic medial collateral ligament insufficiency, isometric repair of the superficial medial collateral ligament can be attempted. A medial patellofemoral ligament reconstruction with a double fixation on the medial patellar border is supported. The cranial bundle should be tightened at full extension and the caudal bundle at 30 degrees of knee flexion.

  5. Abnormal Head Position

    Science.gov (United States)

    ... Frequently Asked Questions Español Condiciones Chinese Conditions Abnormal Head Position En Español Read in Chinese What is an abnormal head posture? An abnormal or compensatory head posture occurs ...

  6. AN INVESTIGATION OF A REFERENCE POSTURE USED IN DETERMINING REARFOOT KINEMATICS FOR BOTH HEALTHY AND PATELLOFEMORAL PAIN SYNDROME INDIVIDUALS

    Directory of Open Access Journals (Sweden)

    Pazit Levinger

    2005-09-01

    Full Text Available The choice of a reference posture is important when investigating rearfoot motion in clinical populations. The reference posture used may affect the magnitude of the peak angles and therefore may not enable comparison of the rearfoot kinematics across different populations. This study examined the relationship between the rearfoot frontal plane pattern of motion and three reference postures during the stance phase of walking in healthy and patellofemoral pain syndrome (PFPS subjects. The three reference postures investigated were: Relaxed Standing posture, subtalar joint neutral position (STJN and when the calcaneus and the lower leg were vertically aligned (Vertical Alignment. The rearfoot inversion/eversion during the stance phase was measured in 14 healthy subjects and 13 subjects with diagnosed PFPS using three dimensional motion analysis with the three different reference postures. The graphs of rearfoot inversion/eversion motion were overlaid with the angle at the rearfoot in the static posture and any intersection between the static angle and rearfoot motion was noted. An ANOVA showed significant differences in static posture between the groups for Relaxed Standing (p = 0.01, and STJN (p = 0.02. For both groups, with Relaxed Standing as a reference posture, the mean rearfoot pattern of motion did not intersect the Relaxed Standing static angle during the stance phase. The use of Vertical Alignment reference posture, however, showed an intersection of this reference posture through the rearfoot pattern of motion. The use of the Vertical Alignment reference posture also generated a typical rearfoot motion pattern for both groups and therefore it may be an appropriate reference posture for both healthy and PFPS individuals

  7. Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Darnell Ross

    2008-02-01

    Full Text Available Abstract Background Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy. Methods/design A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and

  8. Patellofemoral Arthritis After Lateral Patellar Dislocation: A Matched Population-Based Analysis.

    Science.gov (United States)

    Sanders, Thomas L; Pareek, Ayoosh; Johnson, Nicholas R; Stuart, Michael J; Dahm, Diane L; Krych, Aaron J

    2017-04-01

    The rate of patellofemoral arthritis after lateral patellar dislocation is unknown. Purpose/Hypothesis: The purpose of this study was to compare the risk of patellofemoral arthritis and knee arthroplasty between patients who experienced a lateral patellar dislocation and matched individuals without a patellar dislocation. Additionally, factors predictive of arthritis after patellar dislocation were examined. The hypothesis was that the rate of arthritis is likely higher among patients who experience a patellar dislocation compared with those who do not. Cohort study; Level of evidence, 3. In this study, 609 patients who had a first-time lateral patellar dislocation between 1990 and 2010 were compared with an age- and sex-matched cohort of patients who did not have a patellar dislocation. Medical records were reviewed to collect information related to the initial injury, recurrent dislocation, treatment, and progression to clinically significant patellofemoral arthritis (defined as symptoms with degenerative changes on patellar sunrise radiographs). Factors associated with arthritis (age, sex, recurrence, osteochondral injury, trochlear dysplasia) were examined. At a mean follow-up of 12.3 ± 6.5 years from initial dislocation, 58 patients (9.5%) in the dislocation cohort were diagnosed with patellofemoral arthritis, corresponding to a cumulative incidence of arthritis of 1.2% at 5 years, 2.7% at 10 years, 8.1% at 15 years, 14.8% at 20 years, and 48.9% at 25 years. In the control cohort, 8 patients (1.3%) were diagnosed with arthritis, corresponding to a cumulative incidence of arthritis of 0% at 5 years, 0% at 10 years, 1.3% at 15 years, 2.9% at 20 years, and 8.3% at 25 years. Therefore, patients who experienced a lateral patellar dislocation had a significantly higher risk of developing arthritis (hazard ratio [HR], 7.8; 95% CI, 3.9-17.6; P arthritis after patellar dislocation. Patellar dislocation is a significant risk factor for patellofemoral arthritis, as

  9. Epidemiology of Patellofemoral Instability Injuries Among High School Athletes in the United States.

    Science.gov (United States)

    Mitchell, Joshua; Magnussen, Robert A; Collins, Christy L; Currie, Dustin W; Best, Thomas M; Comstock, R Dawn; Flanigan, David C

    2015-07-01

    Patellofemoral instability injuries, including dislocations and subluxations, are relatively rare in the general population but are believed to be much more common in young athletic patient populations, such as high school athletes. In spite of the relatively high risk, the epidemiology of such injuries in this population has not been clearly elucidated. To provide a comprehensive understanding of the epidemiology of patellofemoral instability injuries among high school athletes in the United States. Cross-sectional study; Level of evidence, 3. Data were obtained from the National High School Sports-Related Injury Surveillance System, High School RIO (Reporting Information Online), an Internet-based sports injury surveillance system. Athletic trainers from high schools across the country uploaded data regarding athlete exposures (defined as practice or game participation) and injuries across 22 sports from 2007-2008 through 2012-2013. Data were collected regarding athlete demographics, injury mechanism and details, practice versus competition, return to sport, and the need for surgery. A total of 421 patellar instability (143 dislocations and 278 subluxations) injuries occurred during 21,556,515 athlete exposures (AEs) during the study period, for an overall injury rate of 1.95 per 100,000 AEs. The highest injury rates were noted in girls' gymnastics (6.19 per 100,000 AEs), boys' football (4.10), and boys' wrestling (3.45). The overall injury rate was significantly lower for girls than boys (1.66 and 2.15, respectively; rate ratio [RR], 0.77; 95% CI, 0.62-0.94). In contrast, among only the sex-comparable sports, the injury rate was higher for girls than boys (1.47 and 0.88, respectively; RR, 1.67; 95% CI, 1.19-2.34). The rate of injury was higher in competition (3.72) than practice (1.34) (RR, 2.78; 95% CI, 2.29-3.36). A no-contact injury mechanism was the most commonly reported mechanism (37.8% of injuries), followed by player-to-player contact (36.8%). When all

  10. Feedback Leads to Better Exercise Quality in Adolescents with Patellofemoral Pain.

    Science.gov (United States)

    Riel, Henrik; Matthews, Mark; Vicenzino, Bill; Bandholm, Thomas; Thorborg, Kristian; Rathleff, Michael Skovdal

    2018-01-01

    Adolescents with patellofemoral pain (PFP) do not comply with their exercise prescription, performing too few and too fast repetitions, compromising recovery. We investigated if real-time feedback on contraction time would improve the ability of adolescents with PFP to perform exercises as prescribed. A randomized, controlled, participant-blinded, superiority trial with a 6-wk intervention of three weekly sessions of three elastic band exercises was undertaken. Forty 15- to 19-yr-old adolescents with PFP were randomized to real-time BandCizer™-iPad feedback on contraction time or not by a physiotherapist. The primary outcome was the mean deviation from the prescribed contraction time of 8 s per repetition. Secondary outcomes included isometric hip and knee strength, Kujala Patellofemoral Scale, and Global Rating of Change. The mean deviation from prescribed 8 s per repetition contraction time was 1.5 ± 0.5 s for the feedback group, compared with 4.3 ± 1.0 s for the control group (mean difference: 2.7 s (95% confidence interval = 2.2-3.2, P feedback group received 35.4% of the prescribed exercise dose whereas the control group received 20.3%. Isometric hip and knee strength increased significantly more in the feedback group compared with controls (mean difference = 1.35 N·kg, 95% confidence interval = 0.02-2.68, P = 0.047). There were no significant differences in Kujala Patellofemoral Scale and Global Rating of Change between groups, but the study was not powered for this. Real-time feedback on contraction time resulted in the ability to perform exercises closer to the prescribed dose and also induced larger strength gains.

  11. Partial lateral facetectomy plus Insall's procedure for the treatment of isolated patellofemoral osteoarthritis: survival analysis.

    Science.gov (United States)

    Montserrat, Ferran; Alentorn-Geli, Eduard; León, Vicente; Ginés-Cespedosa, Alberto; Rigol, Pau

    2014-01-01

    The purpose of this study was to report the survival analysis of partial lateral facetectomy and Insall's procedure in patients with isolated patellofemoral osteoarthritis, and to assess the risk and protective factors for failure of this procedure. From 1992 to 2004, all subjects with isolated patellofemoral osteoarthritis who met the inclusion criteria and underwent this procedure were enrolled. Risk and protective factors for failure (failure considered as the need for total knee arthroplasty) were assessed by comparing obtained baseline data between failed and non-failed cases. Eighty-seven cases (mean (SD) age 61.8 (7.7) years, mean (SD) follow-up 9.6 (3.2) years) were included. Twenty-three failed cases were found. Mean (SD) survival time was 13.6 (0.5) years. At 13 years (last failure case), the cumulative survival was 59.3 %. Baseline medial tibiofemoral pain, genu flexum, and worst grade of tibiofemoral osteoarthritis were significant risk factors for failure (p < 0.0001, p = 0.02, p < 0.0001, respectively). In contrast, higher anatomical (p = 0.02) and total (p = 0.03) knee society score (KSS) scores, absence of knee effusion (p = 0.03), higher value of the Caton-Deschamps index (p = 0.03), and lateral position of the patella (p = 0.01) were all protective factors against failure. The treatment for isolated patellofemoral osteoarthritis through partial lateral facetectomy and Insall's procedure demonstrated good long-term survival. The presence of preoperative medial tibiofemoral pain, genu flexum, and incipient tibiofemoral osteoarthritis increased the risk of failure of this procedure. In contrast, higher anatomical and total KSS scores, absence of knee effusion, higher value of the Caton-Deschamps index, and lateral position of the patella were found to protect against failure.

  12. Elevated Knee Joint Kinetics and Reduced Ankle Kinetics Are Present During Jogging and Hopping After Achilles Tendon Ruptures.

    Science.gov (United States)

    Willy, Richard W; Brorsson, Annelie; Powell, Hayley C; Willson, John D; Tranberg, Roy; Grävare Silbernagel, Karin

    2017-04-01

    Deficits in plantarflexor function are common after an Achilles tendon rupture. These deficits may result in an altered distribution of joint loads during lower extremity tasks. We hypothesized that, regardless of treatment, the Achilles tendon-ruptured limb would exhibit deficits in ankle kinematics and joint power while exhibiting elevated knee joint power and patellofemoral joint loads during walking, jogging, and hopping. We further hypothesized that this loading pattern would be most evident during jogging and hopping. Controlled laboratory study. Thirty-four participants (17 participants treated surgically, 17 treated nonsurgically) were tested at a mean 6.1 ± 2.0 years after an Achilles tendon rupture. Lower extremity kinematics and kinetics were assessed while participants completed walking, jogging, and single-legged hopping trials. Patellofemoral joint stress was calculated via a musculoskeletal model. Data were analyzed via mixed-model repeated analyses of variance (α = .05) and the limb symmetry index (LSI). No differences ( P ≥ .05) were found between the surgical and nonsurgical groups. In both groups, large side-to-side deficits in the plantarflexion angle at toeoff (LSI: 53.5%-73.9%) were noted during walking, jogging, and hopping in the involved limb. Side-to-side deficits in the angular velocity were only present during jogging (LSI: 93.5%) and hopping (LSI: 92.5%). This pattern was accompanied by large deficits in eccentric (LSI: 80.8%-94.7%) and concentric (LSI: 82.2%-84.7%) ankle joint powers in the involved limb during all tasks. Interestingly, only jogging and hopping demonstrated greater knee joint loads when compared with the uninvolved limb. Concentric knee power was greater during jogging (LSI: 117.2%) and hopping (LSI: 115.9%) compared with the uninvolved limb. Similarly, peak patellofemoral joint stress was greater in the involved limb during jogging (LSI: 107.5%) and hopping (LSI: 107.1%), while only hopping had a greater loading

  13. Braking and propulsive impulses in individuals with patellofemoral pain syndrome when walking up and down stairs

    Directory of Open Access Journals (Sweden)

    Marcelo Camargo Saad

    2014-12-01

    Full Text Available Patellofemoral pain syndrome (PFPS is a prevalent clinical condition and it affects gait behavior. Braking and propulsive impulses are important biomechanical parameters obtained from ground reaction forces (GRF, which combine the amount of force applied over a period of time. The aim of this study was to evaluate these impulses while walking up and down stairs in healthy controls and PFPS individuals. The results did not reveal significant differences in braking and propulsive impulses between groups during these activities. Thus, the painful condition on a simple functional activity was insufficient to change the motor strategy to walking up or down the stairs.

  14. Tooth - abnormal colors

    Science.gov (United States)

    ... medlineplus.gov/ency/article/003065.htm Tooth - abnormal colors To use the sharing features on this page, please enable JavaScript. Abnormal tooth color is any color other than white to yellowish- ...

  15. Urine - abnormal color

    Science.gov (United States)

    ... medlineplus.gov/ency/article/003139.htm Urine - abnormal color To use the sharing features on this page, please enable JavaScript. The usual color of urine is straw-yellow. Abnormally colored urine ...

  16. Abnormal uterine bleeding

    Science.gov (United States)

    Anovulatory bleeding; Abnormal uterine bleeding - hormonal; Polymenorrhea - dysfunctional uterine bleeding ... ACOG committee opinion no. 557: Management of acute abnormal uterine bleeding in nonpregnant reproductive-aged women. Reaffirmed 2015. ACOG. ...

  17. The Comparison of Ankle Muscles Isometric Strength and Foot Eversion in Male Individuals with Patellofemoral Pain Syndrome and Healthy Peers: A Case-Control Study

    Directory of Open Access Journals (Sweden)

    V. Mazloum

    2017-01-01

    Full Text Available Introduction: Proximal and distal factors to the knee joint can be assumed as etiology of patellofemoral pain syndrome (PFPS. Some distal factors include excessive foot pronation and medial tibia torsion. The purpose of this study was to compare ankle musculature strength and rearfoot eversion in individuals with and without PFPS. Methods: Forty males (20 healthy and 20 patients voluntarily participated in this case-control study. Isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion range of motion (ROM, and Navicular depression were respectively evaluated by handheld dynamometer, goniometry, and Navicular Drop Test by a single examiner for both groups. To analyze the measurements, Independent Samples t test for parametric data and Mann-Whitney U test for nonparametric data at P0.05. Furthermore, no significant differences were observed between patients with PFPS and healthy counterparts regarding rearfoot eversion and Navicular depression (P>0.05. Conclusion: It can be deduced that isometric ankle dorsiflexor and invertor muscles strength, rearfoot eversion ROM, and foot pronation are not difference in patients with PFPS and healthy persons. 

  18. Variations in foot posture and mobility between individuals with patellofemoral pain and those in a control group.

    Science.gov (United States)

    McPoil, Thomas G; Warren, Meghan; Vicenzino, Bill; Cornwall, Mark W

    2011-01-01

    We sought to determine whether foot posture and foot mobility were increased in individuals with patellofemoral pain syndrome compared with individuals in a control group. A nested case-control design was used with two controls matched to each patient by sex and age (±1 year). Participants included 43 individuals with a history of unilateral or bilateral patellofemoral pain syndrome and 86 participants in a control group. Data collected included height, weight, and five different measures of foot height and width in weightbearing and nonweightbearing that have been previously shown to have high levels of reliability. Individuals with patellofemoral pain syndrome were found to be four times more likely (odds ratio, 4.04; 95% confidence interval, 1.45-11.32) to have a larger-than-normal difference between nonweightbearing and weightbearing arch height compared with those in the control group. The mean values for difference in arch height and foot mobility magnitude were also statistically significant between the patient and control groups. Foot posture, as determined using the arch height ratio, was not significant between groups (odds ratio, 0.94; 95% confidence interval, 0.34-2.61). Although foot posture may not be different between individuals with patellofemoral pain syndrome and controls, foot mobility assessed using difference in arch height and foot mobility magnitude is different between the two groups.

  19. Long-term results of patellofemoral arthroplasty - A report of 56 arthroplasties with 17 years of follow-up

    NARCIS (Netherlands)

    Kooijman, HJ; Driessen, APPM; van Horn, [No Value

    We studied retrospectively the outcome of patellofemoral arthroplasty (PFA) using the Richards prosthesis in 51 patients (56 knees). Their mean age was 50 years (30 to 77). In 43 patients (45 knees), the American Knee Society score and the patients' subjective judgement were assessed. Excellent or

  20. [Reconstruction of medial patellofemoral ligament with transposition of great adductor muscular tendon for the treatment of teenagers' recurrent patellar dislocation].

    Science.gov (United States)

    Shao, Chuan-Qiang; Chen, Chang-Chun; Zhao, Chun-Cheng; Yang, Hong-Mei; Kang, Yan-Zhong

    2017-06-25

    To investigate surgical method and clinical curative effects of medial patellofemoral ligament (MPFL) reconstruction with great adductor muscular tendon in treating teenagers' recurrent patellar dislocation. From May 2012 to September 2014, 19 patients with recurrent dislocation of patellar, including 6 males and 13 females with an average of 16 years old (ranged from 13 to 17 years), the courses of disease ranged from 3 to 18 months(averaged 6 months). All patients were underwent great adductor muscular tendon transposition to reconstruct medial patellofemoral ligament. The curative effects were evaluated by preoperative and postoperative with Lysholm scores and Patellofemoral angle and Q angle. All patients were followed up from 12 to 18 months with an average of 16.5 months. Primary healing was achieved at stage I. No pain, swelling and patellar dislocation or subluxation occurred. Patellofemoral angle increased from preoperative (-3.8±4.9)° to (10.3±4.1)° postoperatively. Q angle decreased from preoperative(16.4±3.1)° to(10.5±1.2)° postoperatively; Lysholm scores were improved from preoperative (68.6±8.5) to (93.7±6.5) final follow-up ( P teenagers' recurrent patellar dislocation.

  1. Patellofemoral pain syndrome in female athletes: A review of diagnoses, etiology and treatment options

    Directory of Open Access Journals (Sweden)

    Molly Vora

    2018-02-01

    Full Text Available Patellofemoral pain syndrome (PFPS is one of the most common causes of knee pain and is present in females disproportionately more relative to males. PFPS causes tend to be multifactorial in nature and are described in this review. From a review of the current literature, it is clear that there needs to be further research on PFPS in order to better understand the complex etiology of this disorder in both males and females. It is known that females with patellofemoral pain syndrome demonstrate a decrease in abduction, external rotation and extension strength of the affected side compared with healthy patients. Conservative management, including optimizing muscle balance between the vastus medialis and lateralis around the patella along with formal therapy should be the first line of treatment in patients presenting with PFPS. Surgery should be reserved for patients in which all conservative management options have failed. This review aims to guide physicians in accurate clinicaldecision making regarding conservative and surgical treatment options when specifically faced with PFPS in a female athlete. Furthermore, we will discuss the anatomic variants, incidence and prevalence, etiology, diagnosis and treatment of PFPS.

  2. Current management strategies for patellofemoral pain: an online survey of 99 practising UK physiotherapists.

    Science.gov (United States)

    Smith, Benjamin E; Hendrick, Paul; Bateman, Marcus; Moffatt, Fiona; Rathleff, Michael Skovdal; Selfe, James; Smith, Toby O; Logan, Pip

    2017-05-08

    Patellofemoral pain (PFP) is considered one of the commonest forms of knee pain. This study aimed to identify how physiotherapists in the United Kingdom (UK) currently manage patellofemoral pain (PFP), particularly in relation to exercise prescription, and response to pain. An anonymous survey was designed with reference to previous surveys and recent systematic reviews. Practising UK physiotherapists who treat patients with PFP were invited to take part via an invitation email sent through professional networks, the 'interactive Chartered Society of Physiotherapy (iCSP)' message board, and social media (Twitter). Descriptive statistics were used to analyse the data. A total of 99 surveys were completed. Responders reported a wide range of management strategies, including a broad selection of type and dose of exercise prescription. The five most common management strategies chosen were: closed chain strengthening exercises (98%); education and advice (96%); open chain strengthening exercises (76%); taping (70%) and stretches (65%). Physiotherapists with a special interest in treating PFP were statistically more likely to manage patients with orthotics (P = 0.02) and bracing (P = 0.01) compared to physiotherapists without a special interest. Approximately 55% would not prescribe an exercise if it was painful. Thirty-one percent of physiotherapists would advise patients not to continue with leisure and/or sporting activity if they experienced any pain. Current UK practice in the management strategies of PFP is variable. Further high quality research on which to inform physiotherapy practice is warranted for this troublesome musculoskeletal condition.

  3. Predictors of short and long term outcome in patellofemoral pain syndrome: a prospective longitudinal study

    Directory of Open Access Journals (Sweden)

    Crossley Kay M

    2010-01-01

    Full Text Available Abstract Background Patellofemoral pain syndrome (PFP is a common musculoskeletal condition that has a tendency to become chronic and problematic in a proportion of affected individuals. The objective of this study was to identify prognostic factors that may have clinical utility in predicting poor outcome on measures of pain and function in individuals with PFP. Methods A prospective follow-up study was conducted of 179 participants in a randomised clinical trial. Nine baseline factors (age, gender, body mass index, arch height, duration of knee pain, worst pain visual analogue scale, Kujala Patellofemoral Score (KPS, functional index questionnaire (FIQ, step down repetitions were investigated for their prognostic ability on outcome assessed at six, 12 and 52 weeks (worst pain, KPS and FIQ. Factors with significant univariate associations were entered into multivariate linear regression models to identify a group of factors independently associated with poor outcome. Results Long symptom duration was the most consistent predictor of poor outcome over 52 weeks rated on the KPS and the FIQ (β-0.07, 95% confidence interval -0.1 to -0.03, p p Conclusions Patients presenting with PFP of long duration who score worse on the KPS have a poorer prognosis, irrespective of age, gender and morphometry. These results suggest that strategies aimed at preventing chronicity of more severe PFP may optimise prognosis.

  4. PATELLAR REALIGNMENT AND FUNCTIONAL PERFORMANCE IN PATIENTS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Abeer Farag Hanafy

    2016-02-01

    Full Text Available Background: Patellar taping is used for pain relief in patients with patello-femoral pain syndrome (PFPS. Yet, there is lack of knowledge regarding its effect on the functional performance. The purpose of the study was to examine the effects of therapeutic patellar taping on the Visual Analogue Scale (VAS pain scores, number of bilateral squats, and stair climbing time in patients with PFPS. Methods: 30 female patients with PFPS with mean age 20.3± 1.46 years, weight 66.1± 9.68 kg, height 165.83 ± 3.89 cm and BMI 23.91 ± 3.50kg/m2 participated in the study. The subjects were tested randomly under three taping conditions;namely therapeutic, placebo and no-tape. The tested limb was determined to be the affected limb in patients with unilateral affection, and the symptomatic limb in patients with bilateral affection. Data was collected using the Visual Analogue Scale (VAS, Bilateral Squat Test and Timed Stair Ambulation Test. Results: Repeated measures Multivariate Analysis of Variance (MANOVA revealed that the number of bilateral squats increased significantly (p0.05 in between for the number of bilateral squats and stair climbing time. Conclusion: The findings indicated that therapeutic patellar taping is effective in improving functional performance and reducing pain in patients with patellofemoral pain syndrome (PFPS.

  5. Gait biomechanics and hip muscular strength in patients with patellofemoral osteoarthritis.

    Science.gov (United States)

    Pohl, Michael B; Patel, Chirag; Wiley, J Preston; Ferber, Reed

    2013-03-01

    A significant number of patients with patellofemoral osteoarthritis (PFOA) have described a history of patellofemoral pain syndrome (PFPS). This leads to speculation that the underpinning mechanical causes of PFPS and PFOA may be similar. Although alterations in gait biomechanics and hip strength have been reported in PFPS, this relationship has not yet been explored in PFOA. Therefore the purpose of this study was compare gait biomechanics and hip muscular strength between PFOA patients and a healthy control group. Fifteen patients with symptomatic, radiographic PFOA and 15 controls participated. All patients underwent a walking gait analysis and maximal hip strength testing. Biomechanical variables of interest included the peak angular values of contra-lateral pelvic drop, hip adduction and hip internal rotation during the stance phase. Hip abduction and external rotation strength were assessed using maximal voluntary isometric contractions. The PFOA group demonstrated significantly lower hip abduction strength compared to controls but no difference in hip external rotation strength. There were no statistical differences between the PFOA and control groups for contra-lateral pelvic drop, hip adduction and hip internal rotation angles during walking. Despite patients with PFOA exhibiting weaker hip abductor muscle strength compared to their healthy counterparts they did not demonstrate alterations in pelvis or hip biomechanics during gait. These preliminary data suggests that weaker hip abductor strength does not result in biomechanical alterations during gait in this population. Copyright © 2012 Elsevier B.V. All rights reserved.

  6. Distal femoral bone mineral density decreases following patellofemoral arthroplasty: 1-year follow-up study of 14 patients

    Directory of Open Access Journals (Sweden)

    Innocenti Bernardo

    2010-04-01

    Full Text Available Abstract Background The bone mineral density (BMD of the distal femur decreases by 16-36% within one year after total knee arthroplasty (TKA because of the femoral component's stress-shielding effect. The aim of this prospective study was to determine the quantitative change from the baseline BMD in the distal femur 1 year after patellofemoral arthroplasty using dual-energy X-ray absorptiometry (DXA. Methods Between December 2007 and December 2008, 14 patients had patellofemoral arthroplasty for isolated patellofemoral osteoarthritis. Distal femoral BMD was assessed using DXA in 2 regions of interest (ROI on the lateral view 2 weeks before and 12 months after patellofemoral arthroplasty. The contra-lateral knee was used as a control, with BMD measurements performed in identical ROIs. Results The mean change from baseline BMD in the operated knees after 1 year was -0.169 g/cm2 (95% CI: -0.293 to -0.046 g/cm2 behind the anterior flange (-15%, and -0.076 g/cm2 (95% CI: -0.177 to 0.024 g/cm2 in the supracondylar area 1 cm above the prosthesis (-8% (p = 0.01 and p = 0.13, respectively. The mean change from baseline BMD in the non-operated knees after 1 year was 0.016 g/cm2 (95% CI: -0.152 to 0.185 g/cm2 behind the anterior flange (2%, and 0.023 g/cm2 (95% CI: -0.135 to 0.180 g/cm2 in the supracondylar area 1 cm above the prosthesis (2% (p = 0.83, and p = 0.76, respectively. Conclusions Our findings suggest that patellofemoral arthroplasty results in a statistically significant decrease in BMD behind the anterior flange.

  7. Temporomandibular joint in rheumatoid arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Syrjaenen, S.M.

    The temporomandibular joint (TMJ) was investigated clinically and by orthopantomography in 110 patients with rheumatoid arthritis (RA) and in 73 control subjects. Clinical symptoms in the TMJ were established in 34% of the RA patients and in 18% of the controls. Radiographic abnormalities were found in 60% of the RA patients compared with 15% in the controls. No single radiographic abnormality was characteristic of joint involvement by RA. The most common radiologic features in RA patients were changes in the morphology of the condylar head and articular eminentia, marginal irregularities, reduced mobility, and an anterior position of the condylar head. No abnormalities were encountered in the early stage of the disease, which at least in part could be attributed to the inherent limitations of orthopantomography. The incidence of joint lesions increased with duration of the RA. (orig.).

  8. From joint to single audits

    DEFF Research Database (Denmark)

    Holm, Claus; Thinggaard, Frank

    2018-01-01

    This study analyses audit quality differences between audits by a single big audit firm and joint audits with either one or two big audit firms. We exploit the unique situation in Denmark beginning on 1 January 2005, at which time a long-standing mandatory joint audit system for listed companies...... was replaced by a voluntary joint audit system. First, we report the results of a survey of Danish CFOs’ views on and their experiences with the choice of single or joint audits and their perceptions of audit quality. Second, based on data from the mandatory joint audit abolition year and the following two...... years, we test the audit quality differences using abnormal accruals. Most CFOs perceive that audit quality by a single big four audit firm is the same as it is in joint audits with either one or two big four audit firms. The results of our empirical analysis are in line with the perceptions. We find...

  9. Hip and knee joint loading during vertical jumping and push jerking

    Science.gov (United States)

    Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony MJ

    2014-01-01

    Background The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. Methods In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. Findings The knee experienced mean peak loadings of 2.4-4.6 × body weight at the patellofemoral joint, 6.9-9.0 × body weight at the tibiofemoral joint, 0.3-1.4 × body weight anterior tibial shear and 1.0-3.1 × body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4 × body weight and the ankle 8.9-10.0 × body weight. Interpretation The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations. PMID:23146164

  10. Hip and knee joint loading during vertical jumping and push jerking.

    Science.gov (United States)

    Cleather, Daniel J; Goodwin, Jon E; Bull, Anthony M J

    2013-01-01

    The internal joint contact forces experienced at the lower limb have been frequently studied in activities of daily living and rehabilitation activities. In contrast, the forces experienced during more dynamic activities are not well understood, and those studies that do exist suggest very high degrees of joint loading. In this study a biomechanical model of the right lower limb was used to calculate the internal joint forces experienced by the lower limb during vertical jumping, landing and push jerking (an explosive exercise derived from the sport of Olympic weightlifting), with a particular emphasis on the forces experienced by the knee. The knee experienced mean peak loadings of 2.4-4.6×body weight at the patellofemoral joint, 6.9-9.0×body weight at the tibiofemoral joint, 0.3-1.4×body weight anterior tibial shear and 1.0-3.1×body weight posterior tibial shear. The hip experienced a mean peak loading of 5.5-8.4×body weight and the ankle 8.9-10.0×body weight. The magnitudes of the total (resultant) joint contact forces at the patellofemoral joint, tibiofemoral joint and hip are greater than those reported in activities of daily living and less dynamic rehabilitation exercises. The information in this study is of importance for medical professionals, coaches and biomedical researchers in improving the understanding of acute and chronic injuries, understanding the performance of prosthetic implants and materials, evaluating the appropriateness of jumping and weightlifting for patient populations and informing the training programmes of healthy populations. Copyright © 2012 Elsevier Ltd. All rights reserved.

  11. Joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret......Afhandlingen analysere de konkurrenceretlige og selskabsretlige regler som er bestemmende for hvordan et joint venture samarbejde er struktureret...

  12. A systematic review of randomized controlled trials on exercise parameters in the treatment of patellofemoral pain: what works?

    Directory of Open Access Journals (Sweden)

    Kumar S

    2011-10-01

    Full Text Available Daniel Harvie, Timothy O'Leary, Saravana Kumar International Centre for Allied Health Evidence (iCAHE, City East Campus, University of South Australia, Adelaide, Australia Purpose: There is research evidence which supports the effectiveness of exercise in reducing pain and increasing function in patients with patellofemoral pain syndrome. However, what is unclear are the parameters underpinning this intervention. This has led to uncertainty when operationalizing exercises for patients with patellofemoral pain syndrome in clinical practice. The aim of this review was to evaluate the parameters of exercise programs reported in primary research, to provide clinicians with evidence-based recommendations for exercise prescription for patellofemoral pain. Methods: A systematic review of randomized controlled trials was undertaken. Only trials that identified exercise to be effective in treating patellofemoral pain were included. Appropriate databases and reference lists were searched using established keywords. Data relating to common exercise parameters such as the type of exercise, length, and frequency of intervention, intensity, repetitions, sets, and specific technique were extracted, along with details of co-interventions that may have been used. Results: A total of ten randomized controlled trials were included in this review and from these trials 14 interventions arms were evaluated. All 14 interventions focused on active exercises, all but two of which also included a passive stretching component. The current body of evidence demonstrates positive results with exercise interventions such as knee extension, squats, stationary cycling, static quadriceps, active straight leg raise, leg press, and step-up and down exercises for patients with patellofemoral pain syndrome. A progressive regime of daily exercises of two to four sets of ten or more repetitions over an intervention period of 6 weeks or more, combined with exercises to address

  13. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical....../ultrasound. Conclusions: Acute anterior knee pain should be regarded as a subgroup of PFPS as both symptoms and clinical examination suggests this. The clinical examination with disseminated pain in all synovial covered structures is consistent with ideas of the importance of synovium in the genesis of pain...

  14. The experience of living with patellofemoral pain-loss, confusion and fear-avoidance

    DEFF Research Database (Denmark)

    Smith, Benjamin E; Moffatt, Fiona; Hendrick, Paul

    2018-01-01

    were: (1) impact on self; (2) uncertainty, confusion and sense making; (3) exercise and activity beliefs; (4) behavioural coping strategies and (5) expectations of the future. CONCLUSIONS: These findings offer an insight into the lived experience of individuals with PFP. Previous literature has focused......OBJECTIVES: To investigate the experience of living with patellofemoral pain (PFP). DESIGN: Qualitative study design using semistructured interviews and analysed thematically using the guidelines set out by Braun and Clarke. SETTING: A National Health Service physiotherapy clinic within a large UK...... teaching hospital. PARTICIPANTS: A convenience sample of 10 participants, aged between 18 and 40 years, with a diagnosis of PFP and on a physiotherapy waiting list, prior to starting physiotherapy. RESULTS: Participants offered rich and detailed accounts of the impact and lived experience of PFP, including...

  15. In vivo Evaluation of Patellar Tendon Stiffness in Individuals with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Hsin-Yi Liu

    2008-01-01

    Full Text Available The objective of this study was to utilise an ultrasonic technique to assess the effect of patellofemoral pain syndrome (PFPS on the mechanical properties of the patellar tendon. Seven subjects with PFPS and seven matched control subjects volunteered to participate in this study. Subjects were asked to perform isometric maximal voluntary contractions of the knee extensors while their knee extension torque was monitored and the displacement of the patellar tendon was recorded with an ultrasonic system. Our results showed significantly lower tendon stiffness (by ∼30% in the PFPS subjects. Although tendon secant modulus was lower by 34% in the PFPS subjects, the difference was not statistically significant. Therefore, we conclude that the ultrasonic technique was able to detect a decrease in the structural stiffness of the patellar tendon associated with PFPS. The decrease in tendon stiffness was moderately correlated with the length of symptoms in these individuals.

  16. Acute patellofemoral pain: aggravating activities, clinical examination, MRI and ultrasound findings

    DEFF Research Database (Denmark)

    Brushoj, C.; Holmich, P.; Nielsen, M.B.

    2008-01-01

    knee loading activities were the most painful, while sitting with knee bend for prolonged time caused surprisingly little pain. Pain was most commonly perceived in the peripatellar area (25 patients (83%)). The most common site of pain on clinical examination was the peripatellar area (25 patients (83......Objective: To investigate acute anterior knee pain caused by overuse in terms of pain location, aggravating activities, findings on clinical examination and ultrasound/MRI examination. To determine if acute anterior knee pain caused by overuse should be classified as a subgroup of patellofemoral...... pain syndrome (PFPS). Methods: In a observational study design 30 army recruits with anterior knee pain (mean duration of pain 4 weeks) were examined using the PFPS pain severity scale (PSS), knee pain diagrams, standardised clinical examination, ultrasound and MRI examinations. Results: On PSS typical...

  17. Anchor proximal migration in the medial patellofemoral ligament reconstruction in skeletally immature patients

    Directory of Open Access Journals (Sweden)

    Fabiano Kupczik

    2013-09-01

    Full Text Available The medial patellofemoral ligament (MPFL injury has been considered instrumental in lateral patellar instability after patellar dislocation. Consequently, the focus on the study of this ligament reconstruction has increased in recent years. The MPFL femoral anatomical origin point has great importance at the moment of reconstruction surgery, because a graft fixation in a non anatomical position may result in medial overload, medial subluxation of the patella or excessive tensioning of the graft with subsequent failure. In the pediatric population, the location of this point is highlighted by the presence of femoral physis. The literature is still controversial regarding the best placement of the graft. We describe two cases of skeletally immature patients in whom LPFM reconstruction was performed. The femoral fixation was through anchors that were placed above the physis. With the growth and development of the patients, the femoral origin point of the graft moved proximally, resulting in failure in these two cases.

  18. Defining Abnormally Low Tenders

    DEFF Research Database (Denmark)

    Ølykke, Grith Skovgaard; Nyström, Johan

    2017-01-01

    The concept of an abnormally low tender is not defined in EU public procurement law. This article takes an interdisciplinary law and economics approach to examine a dataset consisting of Swedish and Danish judgments and verdicts concerning the concept of an abnormally low tender. The purpose...

  19. Lower extremity rotational deformities and patellofemoral alignment parameters in patients with anterior knee pain.

    Science.gov (United States)

    Erkocak, Omer Faruk; Altan, Egemen; Altintas, Murat; Turkmen, Faik; Aydin, Bahattin Kerem; Bayar, Ahmet

    2016-09-01

    Anterior knee pain is a common musculoskeletal condition amongst young adult population. Lower extremity structural factors, such as increased femoral anteversion and lateral tibial torsion, may contribute to patellofemoral malalignment and anterior knee pain. The aim of this study was to evaluate the lower extremity structural factors and related patellofemoral alignment parameters that play a role in the aetiology of anterior knee pain. This study involved three groups: patients with unilateral symptomatic knees (n = 35), asymptomatic contralateral knees in the same patients and a control group (n = 40). All subjects were physically examined, and Q-angles were measured. The lower extremities of all subjects were imaged by a very low-dose CT scan, and the symptomatic knees of patients were compared with their asymptomatic contralateral knees and with the healthy knees of controls regarding femoral anteversion, tibial torsion, sulcus angle, patellar tilt angle and lateral patellar displacement. Regarding the Q-angle, femoral anteversion and lateral tibial torsion, no significant differences were found between the symptomatic and asymptomatic knees, whereas significant differences were found between the symptomatic knees and controls. The symptomatic group demonstrated significantly greater sulcus angle only in 30° of knee flexion than did the controls. Patients with unilateral anterior knee pain may have similar morphology at their contralateral asymptomatic lower extremity, and different morphology compared with healthy controls. Lower extremity rotational deformities may increase the risk of anterior knee pain; however, these deformities alone are not sufficient to cause knee pain, and may be predisposing factor rather than a direct aetiology. Diagnostic study, Level III.

  20. Knee arthroscopy and exercise versus exercise only for chronic patellofemoral pain syndrome: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Seitsalo Seppo

    2007-12-01

    Full Text Available Abstract Background Arthroscopy is often used to treat patients with chronic patellofemoral pain syndrome (PFPS. As there is a lack of evidence, we conducted a randomized controlled trial to study the efficacy of arthroscopy in patients with chronic PFPS. Methods A total of 56 patients with chronic PFPS were randomized into two treatment groups: an arthroscopy group (N = 28, treated with knee arthroscopy and an 8-week home exercise program, and a control group (N = 28, treated with the 8-week home exercise program only. The arthroscopy included finding-specific surgical procedures according to current recommendations. The primary outcome was the Kujala score on patellofemoral pain and function at 9 months following randomization. Secondary outcomes were visual analog scales (VASs to assess activity-related symptoms. We also estimated the direct healthcare costs. Results Both groups showed marked improvement during the follow-up. The mean improvement in the Kujala score was 12.9 (95% confidence interval (CI 8.2–17.6 in the arthroscopy group and 11.4 (95% CI 6.9–15.8 in the control group. However, there was no difference between the groups in mean improvement in the Kujala score (group difference 1.1 (95% CI -7.4 - 5.2 or in any of the VAS scores. Total direct healthcare costs in the arthroscopy group were estimated to exceed on average those of the control group by €901 per patient (p Conclusion In this controlled trial involving patients with chronic PFPS, the outcome when arthroscopy was used in addition to a home exercise program was no better than when the home exercise program was used alone. Trial registration Current Controlled Trials ISRCTN 41800323

  1. Medial patellofemoral ligament and medial patellotibial ligament reconstruction in children: preliminary results

    Directory of Open Access Journals (Sweden)

    David Sadigursky

    Full Text Available ABSTRACT OBJECTIVE: The aim of this study was to evaluate the reconstruction of the medial patellofemoral ligament associated with the medial patellotibial ligament in skeletally immature patients. METHOD: This is a case series study in patients with patellar instability with open physis. In total, seven patients were evaluated: four males and three females were operated using the proposed technique. Patients with open physis who had more than two episodes of recurring patellar dislocation were included. No patients underwent additional procedures. The distance from the anterior tibial tuberosity to the trochlea grove (TT-TG was measured in all patients. On physical examination, the inverted J-sign, the apprehension sign, and the knee range of motion parameters were used in the pre- and post-operative period. In addition, the Kujala and Lysholm scores were applied before and 12 months after surgery. The results were analyzed with the Wilcoxon test. RESULTS: The mean age of the patients was 11.28 in both genders. Comparing the data of the pre- and post-operative period, the inverted J-sign was present in six patients (85.7% vs. absent in one (14.3%. The apprehension sign was absent in cases in the postoperative period; the range of motion was 117.85 ± 8.09 vs. 148.57 ± 3.77. The Kujala score was 42.57 ± 8.9 vs. 88.57 ± 5.09 and the Lysholm scores were classified as excellent or good in 28.6% and 71.4%, respectively. CONCLUSION: The combined reconstruction of the medial patellofemoral ligament combined with the medial patellotibial ligament in skeletally immature patients with predisposing factors, presents satisfactory results without episodes of recurrence or residual subluxation; according to these preliminary results, it should be considered as a treatment option.

  2. Using Augmented Feedback to Decrease Patellofemoral Pain in Runners: A Pilot Study

    Directory of Open Access Journals (Sweden)

    Lauren M. Cornwell

    2016-05-01

    Full Text Available Objective: Patellofemoral pain (PFP is a common injury in running. The cause of patellofemoral pain is multifactorial in nature, which results varied treatment approaches for this disorder. Many studies have examined the effect of using strengthening protocols targeted at subjects’ hip and quadriceps strength. Although these studies have resulted in a reduction in short-term PFP for runners, many continue to experience PFP after undergoing these treatment strategies. A more recent theory regarding the treatment of PFP in runners involves the use of augmented verbal and visual feedback. This treatment strategy involves giving the runner scheduled visual feedback to adapt their running strategies in hopes of reducing their PFP. Much of this research has been done with experienced runners in the age range of 18-22 years old. The purpose of this study was to examine the effects of augmented verbal and real-time visual feedback on patellofemoral pain. The hypothesis was that training with the use of auditory and visual feedback would improve patellofemoral pain in this runner. In clinical practice, auditory and visual feedback to change hip and knee mechanics while running may be used as a treatment strategy for patellofemoral pain. Design and Setting: The study was conducted in a controlled laboratory setting and was an experimental design including a single-subject. Participants: The subject was a recreational female runner that was 22 years of age. The subject was recruited via a flyer distributed on campus. Once the individual agreed to participate, they were given a date to begin the study. This study was approved by the Institutional Review Board at the institution. When the subject arrived at the first meeting, the informed consent was reviewed and signed by the subject. Intervention: At the first visit, the subject was given a PFP questionnaire to determine if they were eligible for the study. For this study, the subject was classified as

  3. Computed tomography in abnormalities of the hip

    Energy Technology Data Exchange (ETDEWEB)

    Visser, J.D.; Jonkers, A.; Klasen, H.J. (Rijksuniversiteit Groningen (Netherlands). Academisch Ziekenhuis); Hillen, B. (Rijksuniversiteit Groningen (Netherlands). Lab. voor Anatomie en Embryologie)

    1982-06-26

    The value of computed tomography in the assessment of abnormalities of the hip is demonstrated with the aid of an anatomical preparation and in patients with, respectively, congenital dislocation of a hip, dislocation of the hip in spina bifida, an acetabular fracture and a Ewing tumour. The anteversion of the acetabulum and femur and the instability index of the hip joint can be measured by means of computed tomography.

  4. Effectiveness of Orthoses and Foot Training in patients with Patellofemoral Pain and hyperpronation

    DEFF Research Database (Denmark)

    Mølgaard, Carsten; Kaalund, Søren; Christensen, Marianne

    of treatment with functional foot orthoses, exercises, or orthoses with exercises. The intrinsic pedal muscles play an important role in support of the medial longitudinal arch. (2) There are however very little information of the effect from specific foot exercise as an imperative part of exercise program...... adolescent females (3). Soft foot orhtoses in addition to an exercise program resulted in significantly greater improvements in pain than treatment with flat insoles and exercises over eight weeks. A study from 2004 by Wiener-Ogilvie & Jones (4) found however no difference in outcome between 8 weeks...... to PFPS patients. The purpose of this prospective single blinded randomised study was to determine the effectiveness of a standardized foot training program combined with foot orthoses in patients with patellofemoral pain. This treatment was additional to a regular conservative patellofemoral regime...

  5. Plant abnormality diagnosis device

    International Nuclear Information System (INIS)

    Saeki, Akira.

    1992-01-01

    The device of the present invention diagnose an abnormal event occurred in a large-scaled plant, such as a nuclear power plant. The device comprises the following four functions. (1) Abnormality candidates are estimated based on an intelligence base storing characteristics established between the characteristics/functions and physical amounts of the plant components, and detected abnormality and measured values. Among the candidates, one which coincidents with the measured value such as an actual process amount is judged as a first cause. (2) In addition, a real time plant behavior is estimated based on parameters determining a plant operation mode. The candidate for the abnormality cause is estimated by the comparison between the result of the estimation and the measured value such as a process amount. (3) Characteristics established between the characteristics/functions and the physical amount of the plant components are structured stepwise thereby identifying the first abnormality cause. (4) Inactuated or failed portions of the components for restoring the abnormality to normal state are identified based on the intelligence base simultaneously with the estimation for the first abnormality cause. (I.S.)

  6. Physiotherapy with and without Superficial Dry Needling Affects Pain and Muscle Strength in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Hamideh Miri Abyaneh

    2016-03-01

    Discussion: Physiotherapy with and without superficial dry needling were seen to reduce pain and increase muscle strength of patients with patellofemoral pain syndrome. However, performing physiotherapy with superficial dry needling had a more significant effect on reducing knee pain. Superficial needling can cause many physiological and neurophysiological effects. Through stimulation of pain control mechanisms, it can help in further reduction of pain.

  7. IMMEDIATE EFFECT OF KINESIO VERSUS MCCONNELL TAPING ON PATELLOFEMORAL PAIN SYNDROME DURING FUNCTIONAL ACTIVITIES- A COMPARATIVE STUDY

    Directory of Open Access Journals (Sweden)

    Sai Kumar. N

    2015-12-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS is a condition presenting with anterior knee pain or pain behind the patella (retro-patellar pain. The purpose of the study is to find the immediate effect of Kinesio taping versus McConnell taping in patellofemoral pain syndrome subjects during functional activities- stair ascent, stair descent and squat lift. Methods: An experimental study design with three groups, 45 subjects with patellofemoral pain syndrome was randomized. 15 subjects into each Kinesiotaping group, McConnell group and Sham group. Kinesiotaping group received patellofemoral kinesio taping technique, McConnell group received McConnell taping technique and Sham group received sham taping technique. Outcome measure pain was measured using visual analogue scale during pre and post taping pain levels that were measured during three functional activities: stair ascent, stair descent and squat lift. Results: When analysed within the group using paired ‘t’ test and wilcoxon signed rank test, there is statistically significant improvement in post pain levels in KT, MT and Sham group during stair climbing, stair descent and squat lift. When compared measuring of pre and post pain levels between three groups, there is no significant change in pain level between Kinesio taping and McConnell taping as also compared to sham taping. Conclusion: The study concluded that Kinesio taping, McConnell taping and sham taping shown immediate effect on reducing pain during functional activities such as stair climbing, stair descent and squat lift with greater percentage of pain reduction was found following Kinesiotaping and McConnell taping.

  8. Treatment of isolated patellofemoral osteoarthritis with lateral facetectomy plus Insall's realignment procedure: long-term follow-up.

    Science.gov (United States)

    Montserrat, Ferran; Alentorn-Geli, Eduard; León, Vicens; Ginés-Cespedosa, Alberto; Rigol, Pau

    2013-11-01

    To assess the long-term results of lateral facetectomy plus Insall's realignment procedure to treat isolated patellofemoral osteoarthritis. All consecutive patients undergoing this procedure with a follow-up between 10 and 14 years were included in this study. Subjects were excluded if they had previous patellar dislocation, patellar fracture, tibiofemoral osteoarthritis (except mild cases) or follow-up 14 years. Failure cases (need for total knee arthroplasty) of this surgical procedure before 10 years of follow-up were considered in the overall failure rate. Clinical, functional and radiographic outcomes were obtained at baseline and compared to postoperative values. Forty-three patients (mean (SD) age 59.7 (8.1) years) had a follow-up between 10 and 14 years and were finally included in this study. The failure rate in the whole series and included patients was 26.4 and 16.3 %, respectively, for a mean (SD) follow-up of 9.2 (3.2) years and 11.7 (1.4) years, respectively. Patellofemoral pain (p < 0.0001), need for NSAIDs (p < 0.0001), longitudinal (p < 0.0001) and transversal (p < 0.0001) patellar glide tests, Zholen's sign (p = 0.0007) and knee effusion (p = 0.02) significantly improved in the follow-up. Postoperative Knee Society Score (KSS) anatomical (p < 0.0001), functional (p < 0.0001) and total (p < 0.0001) scores and Kujala's score (p = 0.001) were significantly higher compared to preoperative values. The patellar tilt (p = 0.001) and shift (p = 0.04) significantly improved postoperatively, whereas the patellofemoral osteoarthritis was not modified (n.s.) with respect to preoperative assessment. The lateral facetectomy plus Insall's realignment procedure was a successful treatment for isolated patellofemoral osteoarthritis from a clinical, functional and radiographic point of view in the long-term follow-up.

  9. Knee kinetic pattern during gait and anterior knee pain before and after rehabilitation in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Claudon, B; Poussel, M; Billon-Grumillier, C; Beyaert, C; Paysant, J

    2012-05-01

    Patellofemoral pain is likely due to compressive force acting on the patella related in turn to knee extension moment. The latter variable was assumed to be (i) reduced during short-distance free walking in case of patellofemoral pain syndrome and (ii) increased after therapeutic pain reduction. Peak knee extension moment at beginning of stance phase was recorded by three-dimensional gait analysis in 22 controls and in 23 patients with patellofemoral pain syndrome before and after rehabilitation of knee extensors and flexors to reduce the pain. Pain would occur mainly in stressful activities such as stair negotiation or squatting and was quantified by the anterior knee pain scale. Peak knee extension moment was significantly reduced in all the patients before treatment (n=23) compared to controls, although no one had pain during free walking. In the 17 patients who experienced significant post-rehabilitation pain reduction in their stressful activities, the peak knee extension moment was significantly reduced before treatment compared to controls and significantly increased after treatment, reaching values similar to control values. The peak knee extension moment during free walking appears to be a good kinetic variable related to a compensatory mechanism limiting or avoiding anterior knee pain and may be of interest in assessing knee dynamics alteration in patients with PFPS. Copyright © 2012 Elsevier B.V. All rights reserved.

  10. Chromosomal Abnormalities in ADHD

    Directory of Open Access Journals (Sweden)

    J Gordon Millichap

    2002-07-01

    Full Text Available The prevalence of fragile X syndrome, velocardiofacial syndrome (VCFS, and other cytogenetic abnormalities among 100 children (64 boys with combined type ADHD and normal intelligence was assessed at the NIMH and Georgetown University Medical Center.

  11. "Jeopardy" in Abnormal Psychology.

    Science.gov (United States)

    Keutzer, Carolin S.

    1993-01-01

    Describes the use of the board game, Jeopardy, in a college level abnormal psychology course. Finds increased student interaction and improved application of information. Reports generally favorable student evaluation of the technique. (CFR)

  12. Chromosomal abnormalities and autism

    Directory of Open Access Journals (Sweden)

    Farida El-Baz

    2016-01-01

    Conclusion: Chromosomal abnormalities were not detected in the studied autistic children, and so the relation between the genetics and autism still needs further work up with different study methods and techniques.

  13. Joint-dependent response to impact and implications for post-traumatic osteoarthritis

    DEFF Research Database (Denmark)

    Novakofski, K D; Berg, Lise Charlotte; Bronzini, I

    2015-01-01

    was that cartilage in different joints would have varying cell death and anabolic gene expression profiles after injury. METHODS: Adult equine cartilage explants were harvested from shoulder (SH), elbow (EL), carpal (CA), metacarpophalangeal (MC), patellofemoral (FP), tarsal (TA), metatarsophalangeal (MT...... in the superficial zone in all samples, with MC and MT having the highest peak density. Injured samples had significantly increased cell death (13.5%, 95% CI 9.1 to 17.9%) than non-injured samples (6.8%, 95% CI 2.5 to 11.1%, P = 0.016); however, cell death after injury was not significantly different between joints....... Gene expression was significantly different between joints. CD-RAP expression in normal cartilage was lowest in FP (Cp = 21, 95% CI -80 to 122). After injury, the change in CD-RAP expression increased and was highest in FP (147% relative increase after injury, 95% CI 64 to 213). CONCLUSION: Different...

  14. Abnormal sound detection device

    International Nuclear Information System (INIS)

    Yamada, Izumi; Matsui, Yuji.

    1995-01-01

    Only components synchronized with rotation of pumps are sampled from detected acoustic sounds, to judge the presence or absence of abnormality based on the magnitude of the synchronized components. A synchronized component sampling means can remove resonance sounds and other acoustic sounds generated at a synchronously with the rotation based on the knowledge that generated acoustic components in a normal state are a sort of resonance sounds and are not precisely synchronized with the number of rotation. On the other hand, abnormal sounds of a rotating body are often caused by compulsory force accompanying the rotation as a generation source, and the abnormal sounds can be detected by extracting only the rotation-synchronized components. Since components of normal acoustic sounds generated at present are discriminated from the detected sounds, reduction of the abnormal sounds due to a signal processing can be avoided and, as a result, abnormal sound detection sensitivity can be improved. Further, since it is adapted to discriminate the occurrence of the abnormal sound from the actually detected sounds, the other frequency components which are forecast but not generated actually are not removed, so that it is further effective for the improvement of detection sensitivity. (N.H.)

  15. Joint Commission

    Science.gov (United States)

    ... FAQs Universal Protocol Standards Quick Links E-dition - Electronic Standards Manuals Joint Commission Requirements Patient Safety Systems Chapter Measurement Measurement Performance Measurement Pioneers ...

  16. Which factors predict the long-term outcome in chronic patellofemoral pain syndrome? A 7-yr prospective follow-up study.

    Science.gov (United States)

    Natri, A; Kannus, P; Järvinen, M

    1998-11-01

    The aim of this prospective study was to determine which factors predict the long-term (7-yr) outcome of conservative treatment of chronic patellofemoral pain syndrome. The general predictors registered were age, gender, body composition, athletic activity, duration of symptoms, and follow-up time. The remaining 13 predictors were clinical or radiological measurements of the knee joint. In 45 consecutive patients, these predictors were measured at the beginning of the 6-wk treatment protocol (rest, NSAID, and intense isometric quadriceps exercises) and at the end of the follow-up. The outcome criteria were the 100-mm Visual Analog Scale (VAS) pain score, and the Lysholm and Tegner functional knee scores. The extension strength of the affected knee was a significant predictor of the outcome scores (Lysholm score: r = 0.37, P < 0.05, and the Tegner score: r = 0.39, P < 0.01): the smaller the strength difference between the affected and unaffected knee, the better the outcome. In a multiple stepwise regression analysis, the variables pain in the patella apprehension test, patella crepitation at baseline and at follow-up, bilateral symptoms developed during the follow-up, and patient's age and height were also independent predictors of the final outcome and could together account 60% for the variation seen in the Lysholm score and 52% in the Tegner score, respectively. Neither the radiologic nor the magnetic resonance imaging changes at the affected knee had a clear association with the 7-yr outcome. The results of the current and our previous (15) observations support the concept that restoration of good quadriceps strength and function to the affected extremity is important for good recovery of the patient. In addition, negative findings in the clinical tests of patellar pain and crepitation, nonappearance of bilateral symptoms during the follow-up, low body height, and young age are associated with good long-term outcome.

  17. Long-term clinical and radiographic outcome of patello-femoral realignment procedures: a minimum of 15-year follow-up.

    Science.gov (United States)

    Vivod, Gregor; Verdonk, Peter; Drobnič, Matej

    2014-11-01

    A retrospective single-centre study was focused on the long-term outcome after different patello-femoral (PF) realignment procedures. Thirty-nine patients treated for recurrent PF instability were examined after a mean post-operative time of 22.5 years. Their 78 knees were divided into: non-operated knees (NON-OPERATED)-N = 24, isolated proximal procedures (PROXIMAL)-N = 22, isolated distal procedures (DISTAL)-N = 10, and combined procedures (COMBINED)-N = 22. PF-related medical history together with clinical, subjective (KOOS and Kujala scores), and radiographic (Caton-Deschamps PF height index, Kellgren-Lawrence scale for tibio-femoral OA, and Iwano classification for PF OA) evaluation was conducted. PF re-dislocation rate was comparable between PROXIMAL (36%), DISTAL (20%), and COMBINED (32%). Isolated proximal procedures revealed less central patella positions (PROXIMAL 64%; DISTAL 90%; COMBINED 95%) and more frequent PF apprehension test (PROXIMAL 82%; DISTAL 40%, COMBINED 50%). KOOS and Kujala scores were similar in all three surgical subgroups, but significantly lower than in NON-OPERATED. Patellas were positioned lower after DISTAL, 0.8 (0.5-1.0) or COMBINED, 0.9 (0.4-1.3). Kellgren-Lawrence scores ≥2 were found in 42% NON-OPERATED, 37% PROXIMAL, 70% DISTAL, and 59% COMBINED, whereas Iwano classification ≥2 was confirmed in 46% NON-OPERATED, 64% PROXIMAL, 80% DISTAL, and 86% COMBINED. High PF re-dislocation rates together with a very high incidence of PF OA indicate that PF realignment strategies used traditionally had failed to reach their long-term expectations. The transfer of tibial tuberosity resulted in more constrained PF joints than isolated proximal procedures which allowed for more residual PF instability. Distal procedures additionally increased the likelihood for tibio-femoral OA. III.

  18. The Effects of Patellar Taping on Dynamic Balance and Reduction of Pain in Athletic Women with Patellofemoral Pain Syndrome(PFPS

    Directory of Open Access Journals (Sweden)

    N Khoshraftare Yazdi

    2012-08-01

    Full Text Available Introduction: Patellofemoral pain syndrome(PFPS is the most common overuse syndrome in athletes. It is one of the causes of anterior knee pain in athletic population who attend to the sport medical clinics. Patellofemoral is more common among female athletes especially adolescents and young adults. Patellar taping provides an effective treatment in alleviating the symptoms of a high proportion of subjects who suffer from PFPS, though the mechanisms of pain reduction have not completely been established following its application. The purpose of this study was to investigate the effects of taping on dynamic balance and reduction of pain in athletic women with patellofemoral pain syndrome. Methods: Fifteen female athletes with patellofemoral pain syndrome participated in the study. Therefore, dynamic balance was assessed using a SEBT(Star Excursion Balance Test before and after application of patellar taping. The severity of pain was measured by VAS(Visual Analog Scale. Results: The results of variance analysis by VAS(p<0/008 in repeated measure indicated a statistically significant improvement in pain and in knee function in anterior, anteromedial, medial, posteromedial and anterolateral directions(p<0/05. Conclusion: The study results confirmed a significant improvement in reducing pain and increasing function (dynamic balance of female athletes with patellofemoral pain syndrome after patellar taping.

  19. Temporomandibular Joint Septic Arthritis

    Directory of Open Access Journals (Sweden)

    Gianfranco Frojo, MD

    2018-01-01

    Full Text Available Summary:. Infection of the temporomandibular joint (TMJ is a rare pediatric condition resulting from the introduction of pathogens into the joint by hematogenous seeding, local extension, or trauma. Early recognition of the typical signs and symptoms including fever, trismus, preauricular swelling, and TMJ region tenderness are critical in order to initiate further evaluation and prevent feared complications of fibrosis, ankylosis, abnormal facial structure, or persistence of symptoms. Contrast-enhanced computed tomography with ancillary laboratory analysis including erythrocyte sedimentation rate, C-reactive protein, and white blood cell count are beneficial in confirming the suspected diagnosis and monitoring response to therapy. Initial intervention should include empiric parenteral antibiotics, early mandibular mobilization, and joint decompression to provide synovial fluid for analysis including cultures. This report describes a case of TMJ bacterial arthritis in a healthy 6-year-old male who was promptly treated nonsurgically with intravenous antibiotics and localized needle joint decompression with return to normal function after completion of oral antibiotics and physical therapy.

  20. Early intervention for adolescents with Patellofemoral Pain Syndrome - a pragmatic cluster randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Rathleff Michael S

    2012-01-01

    Full Text Available Abstract Background Self-reported knee pain is highly prevalent among adolescents. As much as 50% of the non-specific knee pain may be attributed to Patellofemoral Pain Syndrome (PFPS. In the short term, exercise therapy appears to have a better effect than patient education consisting of written information and general advice on exercise or compared with placebo treatment. But the long-term effect of exercise therapy compared with patient education is conflicting. The purpose of this study is to examine the short- and long-term effectiveness of patient education compared with patient education and multimodal physiotherapy applied at a very early stage of the condition among adolescents. Methods/Design This study is a single blind pragmatic cluster randomised controlled trial. Four upper secondary schools have been invited to participate in the study (approximately 2500 students, aged 15-19 years. Students are asked to answer an online questionnaire regarding musculoskeletal pain. The students who report knee pain are contacted by telephone and offered a clinical examination by a rheumatologist. Subjects who fit the inclusion criteria and are diagnosed with PFPS are invited to participate in the study. A minimum of 102 students with PFPS are then cluster-randomised into two intervention groups based on which school they attend. Both intervention groups receive written information and education. In addition to patient education, one group receives multimodal physiotherapy consisting primarily of neuromuscular training of the muscles around the foot, knee and hip and home exercises. The students with PFPS fill out self-reported questionnaires at baseline, 3, 6, 12 and 24 months after inclusion in the study. The primary outcome measure is perception of recovery measured on a 7-point Likert scale ranging from "completely recovered" to "worse than ever" at 12 months. Discussion This study is designed to investigate the effectiveness of patient

  1. Joint Replacement (Finger and Wrist Joints)

    Science.gov (United States)

    ... wrist joints can all be replaced (Figure 1). Artificial joints in the hand may help: Reduce joint pain Restore or maintain joint motion Improve the look and alignment of the joint(s) Improve overall hand function Causes In a normal joint, bones have a smooth surface made of a substance ...

  2. Triple-phase bone image abnormalities in Lyme arthritis

    Energy Technology Data Exchange (ETDEWEB)

    Brown, S.J.; Dadparvar, S.; Slizofski, W.J.; Glab, L.B.; Burger, M. (Hahnemann Univ. Hospital, Philadelphia, PA (USA))

    1989-10-01

    Arthritis is a frequent manifestation of Lyme disease. Limited triple-phase Tc-99m MDP bone imaging of the wrists and hands with delayed whole-body images was performed in a patient with Lyme arthritis. This demonstrated abnormal joint uptake in the wrists and hands in all three phases, with increased activity seen in other affected joints on delayed whole-body images. These findings are nonspecific and have been previously described in a variety of rheumatologic conditions, but not in Lyme disease. Lyme disease should be considered in the differential diagnosis of articular and periarticular bone scan abnormalities.

  3. Skeletal muscle abnormalities and genetic factors related to vertical talus.

    Science.gov (United States)

    Merrill, Laura J; Gurnett, Christina A; Connolly, Anne M; Pestronk, Alan; Dobbs, Matthew B

    2011-04-01

    Congenital vertical talus is a fixed dorsal dislocation of the talonavicular joint and fixed equinus contracture of the hindfoot, causing a rigid deformity recognizable at birth. The etiology and epidemiology of this condition are largely unknown, but some evidence suggests it relates to aberrations of skeletal muscle. Identifying the tissue abnormalities and genetic causes responsible for vertical talus has the potential to lead to improved treatment and preventive strategies. We therefore (1) determined whether skeletal muscle abnormalities are present in patients with vertical talus and (2) identified associated congenital anomalies and genetic abnormalities in these patients. We identified associated congenital anomalies and genetic abnormalities present in 61 patients affected with vertical talus. We obtained abductor hallucis muscle biopsy specimens from the affected limbs of 11 of the 61 patients and compared the histopathologic characteristics with those of age-matched control subjects. All muscle biopsy specimens (n = 11) had abnormalities compared with those from control subjects including combinations of abnormal variation in muscle fiber size (n = 7), type I muscle fiber smallness (n = 6), and abnormal fiber type predominance (n = 5). Isolated vertical talus occurred in 23 of the 61 patients (38%), whereas the remaining 38 patients had associated nervous system, musculoskeletal system, and/or genetic and genomic abnormalities. Ten of the 61 patients (16%) had vertical talus in one foot and clubfoot in the other. Chromosomal abnormalities, all complete or partial trisomies, were identified in three patients with vertical talus who had additional congenital abnormalities. Vertical talus is a heterogeneous birth defect resulting from many diverse etiologies. Abnormal skeletal muscle biopsies are common in patients with vertical talus although it is unclear whether this is primary or secondary to the joint deformity. Associated anomalies are present in 62

  4. Lower limb joint forces during walking on the level and slopes at different inclinations.

    Science.gov (United States)

    Alexander, Nathalie; Schwameder, Hermann

    2016-03-01

    Sloped walking is associated with an increase of lower extremity joint loading compared to level walking. Therefore, the aim of this study was to analyse lower limb joint compression forces as well as tibiofemoral joint shear forces during sloped walking at different inclinations. Eighteen healthy male participants (age: 27.0 ± 4.7 years, height: 1.80 ± 0.05 m, mass: 74.5 ± 8.2 kg) were asked to walk at a pre-set speed of 1.1m/s on a ramp (6 m × 1.5 m) at the slopes of -18°, -12°, -6°, 0°, 6°, 12° and 18°. Kinematic data were captured with a twelve-camera motion capture system (Vicon). Kinetic data were recorded with two force plates (AMTI) imbedded into a ramp. A musculoskeletal model (AnyBody) was used to compute lower limb joint forces. Results showed that downhill walking led to significantly increased hip, tibiofemoral and patellofemoral joint compression forces (pforces (pforces with increasing inclination (pforces did not increase with the gradient. Due to diverse tibiofemoral joint shear force patterns in the literature, results should be treated with caution in general. Finally, lower limb joint force analyses provided more insight in the structure loading conditions during sloped walking than joint moment analyses. Copyright © 2016 Elsevier B.V. All rights reserved.

  5. Correlation between quadriceps to hamstring ratio and functional outcomes in patellofemoral pain.

    Science.gov (United States)

    Guney, Hande; Yuksel, Inci; Kaya, Defne; Doral, Mahmut Nedim

    2016-08-01

    The aim of this study was to investigate the correlation between quadriceps to hamstring (Q:H) ratio and the functional outcomes in Patellofemoral Pain (PFP) patients. The study included forty-four women diagnosed with unilateral PFP. Eccentric and concentric quadriceps and hamstring strength were recorded. Conventional Q:H ratio was calculated as the concentric quadriceps to concentric hamstring peak torque (Ratio 1). Functional ratios were calculated as the eccentric quadriceps to concentric hamstring peak torque (Ratio 2) and as the concentric quadriceps to eccentric hamstring torque (Ratio 3). Functional levels of the patients were determined by using Kujala scores, hop test and step test. Pain levels during activities were recorded. The relationship among Ratio 1, Ratio 2 and Ratio 3 with functional outcomes and pain levels were evaluated using Spearman's correlation coefficient test. Eccentric and concentric quadriceps and hamstring strength were lower on involved side than uninvolved side. Ratio 2 correlated stronger with Kujala score (r=0.69) than Ratio 1 (r=0.49) and Ratio 3 (r=0.30). Step test (r=0.35) and hop test (r=0.38) only correlated with Ratio 2. Pain levels correlated more with Ratio 2 (r values ranged between 0.38 and 0.48). Eccentric quadriceps to concentric hamstring ratio was observed more related to the functional outcomes and painful activities in patients with PFP. Cross-sectional study. Copyright © 2016 Elsevier B.V. All rights reserved.

  6. Implementation of a portable electronic system for providing pain relief to patellofemoral pain syndrome patients

    Science.gov (United States)

    Chang Chien, Jia-Ren; Lin, Guo-Hong; Hsu, Ar-Tyan

    2011-10-01

    In this study, a portable electromyogram (EMG) system and a stimulator are developed for patellofemoral pain syndrome patients, with the objective of reducing the pain experienced by these patients; the patellar pain is caused by an imbalance between the vastus medialis obliquus (VMO) and the vastus lateralis (VL). The EMG measurement circuit and the electrical stimulation device proposed in this study are specifically designed for the VMO and the VL; they are capable of real-time waveform recording, possess analyzing functions, and can upload their measurement data to a computer for storage and analysis. The system can calculate and record the time difference between the EMGs of the VMO and the VL, as well as the signal strengths of both the EMGs. As soon as the system detects the generation of the EMG of the VL, it quickly calculates and processes the event and stimulates the VMO as feedback through electrical stimulation units, in order to induce its contraction. The system can adjust the signal strength, time length, and the sequence of the electrical stimulation, both manually and automatically. The output waveform of the electrical stimulation circuit is a dual-phase asymmetrical pulse waveform. The primary function of the electrical simulation circuit is to ensure that the muscles contract effectively. The performance of the device can be seen that the width of each pulse is 20-1000 μs, the frequency of each pulse is 10-100 Hz, and current strength is 10-60 mA.

  7. Reliability of electromyography parameters during stair deambulation in patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Marcella Ferraz Pazzinatto

    2015-06-01

    Full Text Available Reliability is essential to all aspects of the measure, as it shows the quality of the information and allows rational conclusions with regard to the data. There has been controversial results regarding the reliability of electromyographic parameters assessed during stair ascent and descent in individuals with patellofemoral pain syndrome (PFPS. Therefore, this study aims to determine the reliability of time and frequency domain electromyographic parameters on both gestures in women with PFPS. Thirty-one women with PFPS were selected to participate in this study. Data from vastus lateralis and medialis were collected during stair deambulation. The selected parameters were: automatic onset, median frequency bands of low, medium and high frequency. Reliability was determined by intraclass correlation coefficient and the standard error of measurement. The frequency domain variables have shown good reliability, with the stair ascent presenting the best rates. On the other hand, onset has proved to be inconsistent in all measures. Our findings suggest that stair ascent is more reliable than stair descent to evaluate subjects with PFPS in the most cases.

  8. LATENCY DELAY OF THE VASTUS MEDIALIS OBLIQUE AND VASTUS LATERALIS IN INDIVIDUALS WITH PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Eduardo Enrique Guzmán Muñoz

    2016-11-01

    Full Text Available Purpose: To determine the onset latency of the vastus medialis oblique (VMO and vastus lateralis (VL muscles in individuals with patellofemoral pain syndrome (PFPS. Methodology: A case-control study. Fourteen female participants with PFPS and fifteen female participants without PFPS performed a sudden lower extremity perturbation test in anterior and posterior directions. The electromyographic onset latency of the VMO and VL were measured during this test. A student’s t-test was used to compare muscle latency between the groups. Significance level was established a priori at P < 0.05. Results: During sudden anterior perturbation a significant latency delay of the VMO (p < 0.001 and VL muscles (p = 0.019 was observed in participants with PFPS. In the sudden posterior perturbation a delayed response in the activation of VMO (p = 0.023 and VL (p < 0.038 muscles was observed in individuals with PFPS. Conclusions: The results of this study indicate that individuals with PFPS have a motor deficit reflected in the latency delay of VMO and VL muscles during a sudden perturbation in the sagittal plane.

  9. Comparison of the Balance Indices of professional Athletes with and without Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Farhad Rezazadeh

    2012-07-01

    Full Text Available Objective: The aim at this study was the comparison of balance indices between professional athletes with patellofemoral pain syndrome (PFPS and healthy athletes. Materials & Methods: In this comparative and Case-Control study, 16 national teams’ male athletes who were selected purposefullyand 16 healthy national teams’ male athletes who were matched based on variables such as weight, height, age, sport, predominance of the lower limbs, have participated. The Biodex balance system was utilized to assess postural balance as overall stability, anterior-posterior and mediolateral stability indices in open and blind conditions on dominant limb. The K-S test has been used to examine the normality of distribution, while the independent T for comparing the target groups. Results: There was a significant difference between two groups in the open situation only for the overall stability index (P<0.05. In addition, there was a significant differences between the blind condition of both overall stability index (P<0.004 and the anterior-posterior stability index (P<0.01. There was no significant relationship between the other variables. Conclusion: May be the dynamic stability indices in the athletes with PFPS have been distorted due to ineffectual activity of muscles.

  10. Comparative Criteria Study of Dynamic Balancing in Pateints with Patello-Femoral Pain

    Directory of Open Access Journals (Sweden)

    Hamid Reza Mokhtari-Nia

    2005-10-01

    Full Text Available Objective: Reduced proprioception, Pain, changes in muscle activity patterns are sawn in PFPS. Balance is dependent on proprioception, visual, somatosensory and vestibular systems. So it is possible that balance be weaker in PFPS. The objectives of this study was the evaluation of the effect of patellofemoral pain on balance status of patients and comparing the balance between two groups.Anterior-Posterior, Medio-lateral and overall indexes were evaluated. Materials & Methods: The research design was nonexperimental (case-control study and the sampling was nonpropability (Sample of Convenience. We measured balance on a Biodex Stability System. Dynamic stability test was used for evaluation in two groups. Results: Findings showed that balance indexes had difference between two groups.So that, overal index in close and open eye conditions had meaningful difference, but anterior-posterior and medial-lateral indexs did not show this difference. Conclusion: Dynamic balance is weaker in patients with patello – femoral pain than others. Its main causes are Reduce of proprioception & changes in muscle activity patterns.

  11. Development of a clinical tool and patient questionnaire for evaluation of patellofemoral pain syndrome patients.

    Science.gov (United States)

    Harrison, E; Magee, D; Quinney, H

    1996-07-01

    To develop an evaluation tool for patellofemoral pain syndrome (PFPS) patients. Exploratory, descriptive content validation study. Convenience sample, three groups of clinicians: 15 sports physical therapists, 9 sports medicine physicians, and 10 physical therapists and physicians with limited experience with PFPS. Selection based on specialization qualifications and experience with PFPS patients. DESCRIPTION OF TESTS: Content validation questionnaire to determine importance of clinical outcomes in determining change in PFPS patients. Using 10-cm visual analogue scales, reviewers rated the importance of five domains and rated the importance of twenty-one clinical tests; using a categorical scale, determined appropriateness and clarity of potential patient questionnaire items. Correlation values indicated significant correlation (p limitations (r = 0.068) and activity and functional limitations (r = 0.67), indicating that functional limitation may not be a unique component, but is integrated with pain and activity. A set of five pain questions, twelve function questions and six activity questions was developed. No statistical differences (p report questionnaire items and clinical tests.

  12. Short-term results of medial patellofemoral ligament reconstruction for patellar dislocation

    International Nuclear Information System (INIS)

    Sakuraba, Koji; Miura, Hiromasa; Matsuda, Shuichi; Okazaki, Ken; Iwamoto, Yukihide; Fukuoka, Shinji

    2009-01-01

    The short-term results of medial patellofemoral ligament (MPFL) reconstruction were reviewed. MPFL reconstruction surgery was performed on 13 patients (13 knees, three male, five female, mean age 24.1 years) with recurrent and habitual dislocation of the patella. After average 18.5 month follow-up, there has been no recurrence of dislocation and limitation of range of motion except for one case. The mean Kujula score was 60±20.2 preoperatively and 91±15 postoperatively. According to the Crosby and Insall grading system, six ceses were excellent, six cases were good, and one case was fair to poor. On axial radiographs, the mean congruence angle was 31.3±21.4deg preoperatively and -3.65±20.72deg postoperatively. The mean tilting angle was 32.1±7.9deg preoperatively and 21.9±8.39deg postoperatively. The mean lateral shift was 41.6±9.7% preoperatively and 24.5±9.9% postoperatively. These results demonstrate the short-term effectiveness of MPFL reconstruction. (author)

  13. Strength and Pain Threshold Handheld Dynamometry Test Reliability in Patellofemoral Pain.

    Science.gov (United States)

    van der Heijden, R A; Vollebregt, T; Bierma-Zeinstra, S M A; van Middelkoop, M

    2015-12-01

    Patellofemoral pain syndrome (PFPS), characterized by peri- and retropatellar pain, is a common disorder in young, active people. The etiology is unclear; however, quadriceps strength seems to be a contributing factor, and sensitization might play a role. The study purpose is determining the inter-rater reliability of handheld dynamometry to test both quadriceps strength and pressure pain threshold (PPT), a measure for sensitization, in patients with PFPS. This cross-sectional case-control study comprises 3 quadriceps strength and one PPT measurements performed by 2 independent investigators in 22 PFPS patients and 16 matched controls. Inter-rater reliability was analyzed using intraclass correlation coefficients (ICC) and Bland-Altman plots. Inter-rater reliability of quadriceps strength testing was fair to good in PFPS patients (ICC=0.72) and controls (ICC=0.63). Bland-Altman plots showed an increased difference between assessors when average quadriceps strength values exceeded 250 N. Inter-rater reliability of PPT was excellent in patients (ICC=0.79) and fair to good in controls (ICC=0.52). Handheld dynamometry seems to be a reliable method to test both quadriceps strength and PPT in PFPS patients. Inter-rater reliability was higher in PFPS patients compared to control subjects. With regard to quadriceps testing, a higher variance between assessors occurs when quadriceps strength increases. © Georg Thieme Verlag KG Stuttgart · New York.

  14. A feasibility study comparing two chiropractic protocols in the treatment of patellofemoral pain syndrome.

    Science.gov (United States)

    Brantingham, James W; Globe, Gary A; Jensen, Muffit L; Cassa, Tammy K; Globe, Denise R; Price, Jennifer L; Mayer, Stephan N; Lee, Felix T

    2009-09-01

    The purpose of this pilot study was to determine the feasibility of (1) using the existing clinic, clinicians, interns, faculty, and staff from our college in conducting all components of a planned randomized controlled clinical trial; (2) successfully recruiting patients with patellofemoral pain syndrome (PFPS); and (3) consistently, effectively, and safely implementing the study protocols and therapy. Diagnostic, treatment, and blind assessment procedures were carried out while recruitment and administrative techniques for managing long-term storage of data and files were developed. Thirty-one patients were randomized into a local manipulative group (group A) or to a full kinetic chain manipulative therapy group (group B), each combined with exercise and soft tissue treatment. The Anterior Knee Pain Scale, visual analog scale, and Patient Satisfaction Scale were used. All phases of the feasibility study including use of the clinic, staff, recruitment techniques, treatment protocols, data collection, input, and analysis were effectively and safely carried out. A feasibility study investigating the ability to conduct a randomized controlled trial of a manipulative therapy protocol for PFPS using available chiropractic college infrastructure was accomplished. A fully powered PFPS trial is feasible and merited.

  15. Prevalence of myofascial trigger points in the hip in patellofemoral pain.

    Science.gov (United States)

    Roach, Sean; Sorenson, Eric; Headley, Barbara; San Juan, Jun G

    2013-03-01

    To determine the prevalence of myofascial trigger points (MTrPs) in the gluteus medius (GMe) and quadratus lumborum (QL) for subjects with patellofemoral pain (PFP), and to examine the relationship between MTrPs and force production of the GMe after treatment. Randomized controlled trial. A physical therapy clinic. Subjects (N=52; mean age ± SD, 30±12y; mean height ± SD, 172±10cm; mean mass ± SD, 69±14kg) volunteered and were divided into 2 groups: a PFP group (n=26) consisting of subjects with PFP, and a control group (n=26) with no history of PFP. Patients with PFP received trigger point pressure release therapy (TPPRT). Hip abduction isometric strength and the presence of MTrPs. Prevalence of bilateral GMe and QL MTrPs for the PFP group was significantly higher compared with controls (P=.001). Subjects in the PFP group displayed significantly less hip abduction strength compared with the control group (P=.007). However, TPPRT did not result in increased force production. Subjects with PFP have a higher prevalence of MTrPs in bilateral GMe and QL muscles. They demonstrate less hip abduction strength compared with controls, but the TPPRT did not result in an increase in hip abduction strength. Copyright © 2013 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  16. Analysis of pain, functional capacity, muscular strength and balance in young women with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Camile Ludovico Zamboti

    Full Text Available Abstract Introduction: Patellofemoral Pain Syndrome (PFPS is associated with anterior knee pain, changes in functional capacity, balance and muscle strength disorders. Objective: To quantify pain, functional capacity, strength in quadriceps (Q, gluteus medium (GM, hip external rotator (ER muscles and balance in sedentary women with PFPS. Methods: Twenty sedentary women, aged 18 to 25 years, were divided into two groups: PFPS (N=10 and control group (N=10. All the volunteers answered the items of the Visual Analogue Scale (VAS, the Lysholm Knee Score Scale, the Anterior Knee Pain Scale (AKPS, and the Lower Extremity Functional Scale (LEFS. The participants performed the following tests: maximal voluntary isometric contraction measured by dynamometry; postural balance using the Star Excursion Balance Test (SEBT and a force platform. Statistical analyses were performed using the Shapiro Wilk test, the Mann Whitney U test and Spearman’s correlation coefficient. Data were submitted to SPSS 20 software. Results: The PFPS group presented greater pain, balance impairment and higher average velocity of oscillation; however, no differences were observed in Q, GM and RE muscle strength and in balance analyzed by SEBT. Conclusion: Women with PFPS exhibited greater pain, worse functional capacity and body balance. Moderate correlation between both balance tests suggests the use of SEBT when the force platform is not available, which could facilitate and highlight the importance of clinical diagnosis with regard to postural balance.

  17. Nitrofurantoin and congenital abnormalities

    DEFF Research Database (Denmark)

    Czeizel, A.E.; Rockenbauer, M.; Sørensen, Henrik Toft

    2001-01-01

    Objective: To study human teratogenic potential of oral nitrofurantoin treatment during pregnancy. Materials and Methods: Pair analysis of cases with congenital abnormalities and matched population controls in the population-based dataset of the Hungarian Case-Control Surveillance of Congenital...

  18. CT of pleural abnormalities

    International Nuclear Information System (INIS)

    Webb, W.R.

    1995-01-01

    Briefly discussed were CT diagnosis of pleural thickening, CT technique for examining the pleura or pleuro-pulmonary disease, diagnosis of pleural collections, diagnosis of pleural fluid abnormalities in patients with pneumonia, pleural neoplasms, malignant (diffuse) mesothelioma, metastases, local fibrous tumor of the pleura (benign mesothelioma) (21 refs.)

  19. Chromosomal abnormalities and autism

    African Journals Online (AJOL)

    Farida El-Baz

    2015-06-19

    Jun 19, 2015 ... ORIGINAL ARTICLE. Chromosomal abnormalities and autism. Farida El-Baz a. , Mohamed Saad Zaghloul a. , Ezzat El Sobky a. ,. Reham M Elhossiny a,. *, Heba Salah a. , Neveen Ezy Abdelaziz b a Pediatric Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt b Children with Special ...

  20. Joint pain

    Science.gov (United States)

    ... or conditions. It may be linked to arthritis , bursitis , and muscle pain . No matter what causes it, ... Autoimmune diseases such as rheumatoid arthritis and lupus Bursitis Chondromalacia patellae Crystals in the joint: Gout (especially ...

  1. How can we implement exercise therapy for patellofemoral pain if we don't know what was prescribed?

    DEFF Research Database (Denmark)

    Holden, Sinead; Rathleff, Michael Skovdal; Jensen, Martin Bach

    2018-01-01

    OBJECTIVE: To evaluate the completeness of exercise prescription in randomised controlled trials (RCTs) for patellofemoral pain (PFP), identify which elements are most frequently missing and supplement recommendations based on additional data from authors. DESIGN: Systematic review. DATA SOURCES......) and 'rationale' (n=36).The least reported items from the exercise descriptors were 'volitional muscular failure', 'temporal distribution of contraction modes', 'time under tension' and 'recovery between exercise sessions' (all n=2/38). From TIDieR, the least reported item was 'How well (fidelity and adherence...

  2. Custom-Made Foot Orthoses Decrease Medial Foot Loading During Drop Jump in Individuals With Patellofemoral Pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Richter, Camilla; Brushøj, Christoffer

    2016-01-01

    OBJECTIVE: To investigate the effect of foot orthoses on medial-to-lateral plantar forces during drop jump and single leg squat, and second, to explore the self-reported change in symptoms after 12 weeks of wearing the orthoses in individuals with patellofemoral pain (PFP). DESIGN: Cohort study w...... in medially directed foot loading among individuals with PFP. Individuals, who have an immediate decrease in the medial-to-lateral peak force after fitting the orthoses, were more likely to report improvements after 12 weeks of use....

  3. Neurological abnormalities predict disability

    DEFF Research Database (Denmark)

    Poggesi, Anna; Gouw, Alida; van der Flier, Wiesje

    2014-01-01

    To investigate the role of neurological abnormalities and magnetic resonance imaging (MRI) lesions in predicting global functional decline in a cohort of initially independent-living elderly subjects. The Leukoaraiosis And DISability (LADIS) Study, involving 11 European centres, was primarily aimed...... at evaluating age-related white matter changes (ARWMC) as an independent predictor of the transition to disability (according to Instrumental Activities of Daily Living scale) or death in independent elderly subjects that were followed up for 3 years. At baseline, a standardized neurological examination.......0 years, 45 % males), 327 (51.7 %) presented at the initial visit with ≥1 neurological abnormality and 242 (38 %) reached the main study outcome. Cox regression analyses, adjusting for MRI features and other determinants of functional decline, showed that the baseline presence of any neurological...

  4. Equipment abnormality monitoring device

    International Nuclear Information System (INIS)

    Ando, Yasumasa

    1991-01-01

    When an operator hears sounds in a plantsite, the operator compares normal sounds of equipment which he previously heard and remembered with sounds he actually hears, to judge if they are normal or abnormal. According to the method, there is a worry that abnormal conditions can not be appropriately judged in a case where the number of objective equipments is increased and in a case that the sounds are changed gradually slightly. Then, the device of the present invention comprises a plurality of monitors for monitoring the operation sound of equipments, a recording/reproducing device for recording and reproducing the signals, a selection device for selecting the reproducing signals among the recorded signals, an acoustic device for converting the signals to sounds, a switching device for switching the signals to be transmitted to the acoustic device between to signals of the monitor and the recording/reproducing signals. The abnormality of the equipments can be determined easily by comparing the sounds representing the operation conditions of equipments for controlling the plant operation and the sounds recorded in their normal conditions. (N.H.)

  5. Joint Intentionality

    Directory of Open Access Journals (Sweden)

    Koreň Ladislav

    2016-03-01

    Full Text Available According to the shared intentionality hypothesis proposed by Michael Tomasello, two cognitive upgrades – joint and collective intentionality, respectively – make human thinking unique. Joint intentionality, in particular, is a mindset supposed to account for our early, species-specific capacity to participate in collaborative activities involving two (or a few agents. In order to elucidate such activities and their proximate cognitive-motivational mechanism, Tomasello draws on philosophical accounts of shared intentionality. I argue that his deference to such cognitively demanding accounts of shared intentional activities is problematic if his theoretical ambition is in part to show that and how early (prelinguistic and precultural capacities for joint action contribute to the development of higher cognitive capacities.

  6. Reconstruction of the medial patellofemoral ligament using the adductor magnus tendon: an anatomic study.

    Science.gov (United States)

    Jacobi, Matthias; Reischl, Nikolaus; Bergmann, Mathias; Bouaicha, Samy; Djonov, Valentin; Magnussen, Robert A

    2012-01-01

    The aims of this study were to evaluate the anatomic feasibility of medial patellofemoral ligament (MPFL) reconstruction using a part of the adductor magnus tendon and to identify possible risks. Twenty cadaveric knees were dissected. The distal part of the adductor magnus tendon was evaluated with respect to the anatomic topography and its utility for MPFL reconstruction. To estimate the risk of injuring the neurovascular structures, the distance from the adductor tubercle to the adductor hiatus was evaluated. An MPFL reconstruction was carried out by preserving the distal insertion on the adductor tubercle and redirecting the proximal portion of the tendon to the medial aspect of the patella. The anatomic investigation showed the following relationships: The mean distance from the adductor tubercle to the adductor hiatus was 99 ± 14 mm (range, 80 to 120 mm). A graft length of 52 ± 5 mm (range, 45 to 63 mm) with the addition of 10 to 20 mm for fixation was found to be necessary for MPFL reconstruction. The difference between the desired graft length and the distance to the adductor hiatus was found to be at least 30 mm in all cases (mean, 46 mm). Leaving the graft attached to the adductor tubercle resulted in a nearly anatomic femoral attachment of the reconstructed MPFL. Complete detachment of the distal adductor magnus attachment was consistently avoidable. The adductor magnus tendon was found to be a useful graft for MPFL reconstruction. However, anatomic dangers (damage to the neurovascular bundle of the adductor hiatus, the saphenous nerve, or the saphenous branch of the descending genicular artery) during graft harvest must be considered. Anatomic knowledge is essential during adductor magnus tendon harvest to avoid damage to neurovascular structures. The adductor magnus tendon is an interesting alternative graft option for MPFL reconstruction if anatomic dangers are considered and avoided. Copyright © 2012 Arthroscopy Association of North America

  7. Immediate Effects of Lumbopelvic Manipulation and Lateral Gluteal Kinesio Taping on Unilateral Patellofemoral Pain Syndrome

    Science.gov (United States)

    Miller, Joseph; Westrick, Richard; Diebal, Angela; Marks, Christopher; Gerber, J. Parry

    2013-01-01

    Objectives: To determine the immediate effects of Kinesio taping directed to the hip and manipulation directed to the lumbopelvic region in individuals with unilateral patellofemoral pain syndrome (PFPS). Background: PFPS affects up to 25% of the general population. Despite the high prevalence, this condition is not clearly understood, as evidenced by the numerous proposed causes and recommended treatments. Notwithstanding, recent evidence suggests that treatments directed at the hip or spine may lead to beneficial results. Methods: A convenience sample of 18 participants (12 men and 6 women, 19.5 ± 1.15 years old) with unilateral PFPS was recruited. Participants were randomized by sex to 1 of 3 groups: Kinesio taping, manipulation, and control taping. The main outcome measures included the Y-balance test, squatting range of motion (ROM), and the Lower Extremity Functional Scale. Results: Compared with the lumbopelvic manipulation and control groups, those in the Kinesio taping group performed significantly better on the Y-balance test (F = 5.59, P = 0.02) and with squatting ROM (F = 3.93, P = 0.04). The Kinesio taping and lumbopelvic groups were also significantly better than the control (sham) group with double-leg squatting ROM performance 3 days later. Conclusion: Kinesio taping may facilitate gluteus medius activation and improve postural stability and a double-leg squat. Clinical Relevance: The improvement in affected limb reach and double-leg squatting ROM highlights the potential for Kinesio taping to improve gluteus medius activation. Lumbopelvic manipulation may also immediately improve rehabilitation programs for PFPS. PMID:24427391

  8. The anatomy and isometry of a quasi-anatomical reconstruction of the medial patellofemoral ligament.

    Science.gov (United States)

    Pérez-Prieto, Daniel; Capurro, Bruno; Gelber, Pablo E; Ginovart, Gerard; Reina, Francisco; Sanchis-Alfonso, Vicente; Monllau, Joan C

    2017-08-01

    To describe the anatomy of the medial patellofemoral ligament (MPFL) and its relationship to the Adductor Magnus (AM) tendon as well as the behaviour exhibited in length changes during knee flexion. Ten cadaveric knees were dissected. The length from the superior and inferior patellar origin of the MPFL to its femoral insertion was measured at different degrees of knee flexion (0°, 30°, 60°, 90° and 120°). The same measures were made from both patellar origins of the MPFL up to the femoral insertion of the AM. The distance between the insertion of the AM and the Hunter canal was also measured. In general, isometry up to 90° was seen in all measures of the MPFL and those of the AM. The most isometric behaviour was seen in 2 measures: the length of the AM femoral insertion up to the inferior origin of the MPFL on the patella and the length of the femoral insertion of the MPFL up to the inferior origin of the MPFL on the patella. Similar behaviour was seen regardless of the anatomical or quasi-anatomical femoral point of attachment (n.s.). The distance from the AM tendon to the Hunter canal had a mean value of 78.6 mm (SD 9.4 mm). The behaviour exhibited during the changes in the length of the anatomical femoral footprint of the MPFL and the AM is similar. Neurovascular structures were not seen at risk. This is relevant in the daily clinical practice since the AM tendon might be a suitable point of insertion for MPFL reconstruction.

  9. Morphology of insertion sites on patellar side of medial patellofemoral ligament.

    Science.gov (United States)

    Kikuchi, Shuhei; Tajima, Goro; Yan, Jun; Kamei, Youichi; Maruyama, Moritaka; Sugawara, Atsushi; Fujino, Kotaro; Takeda, Sanjuro; Doita, Minoru

    2017-08-01

    The purpose of this study was to clarify the insertion sites on the patellar side of the medial patellofemoral ligament (MPFL). A total of 35 nonpaired human cadaveric knees were used in this study. After identification of the MPFL, the insertion sites on the patellar side of the MPFL were marked. Three-dimensional images were created, and the location and morphology of these insertion sites were analysed. The morphology of the insertion sites on the patellar side of the MPFL was consistent. The proximal fibres of the MPFL were inserted to the deep fascia of the vastus medialis obliquus (VMO) and medial margin of the vastus intermedius (VI). The distal fibres of the MPFL were inserted to the medial margin of the patella directly. The insertion lengths of the VMO, VI, and patella were 26.7 ± 5.0, 28.5 ± 4.4, and 18.5 ± 4.4 mm, respectively. The rate of the vertical distance from the superior pole of the patella to the superior edge of the MPFL in relation to the total patellar height was 12 ± 4.4 %. At the distal edge, the rate was 58 ± 9.6 %. The insertion sites on the patellar side of the MPFL were consistent. The MPFL inserted into the VMO and VI was significantly longer than into the patella. The clinical relevance of this study is to improve understanding of the anatomy of the insertion sites on the patellar side of the MPFL and the pathophysiology of patellar dislocation.

  10. Lower limb control and strength in runners with and without patellofemoral pain syndrome.

    Science.gov (United States)

    Esculier, Jean-Francois; Roy, Jean-Sébastien; Bouyer, Laurent Julien

    2015-03-01

    Recreational runners with patellofemoral pain syndrome (PFPS) have been shown to present altered movement kinematics, muscle activations, and ground reaction forces (GRF) during running as well as decreased lower limb strength. However, these variables have never been concurrently evaluated in a specific cohort. Therefore, the aim of this study was to compare lower limb control variables during running in recreational runners with and without PFPS. Lower limb control during treadmill running under typical training conditions (usual shoes, foot strike pattern, and speed) was compared between runners with (n=21) and without (n=20) PFPS using lower limb kinematics, electromyographic (EMG) recordings from representative muscles (gluteus medius/maximus, quadriceps and soleus), and vertical GRF. Isometric muscle strength was also evaluated. When comparing all runners from both groups, no between-group differences were found in variables commonly associated with PFPS such as peak hip adduction, hip internal rotation, contralateral pelvic drop, EMG of gluteal and quadriceps muscles, vertical loading rate, or lower limb strength. However, runners with PFPS showed significantly higher hip adduction at toe-off, lower excursion in hip adduction during late-stance, and longer duration of soleus activation. Sub-analyses were performed for females and for rearfoot strikers (RFS), and revealed that these subgroups accounted for most of between-group differences in hip adduction kinematics. Specifically for RFS with PFPS, lower activation of gluteus medius as well as lower GRF were observed. Our results suggest that deficits reported in runners with PFPS may vary depending on gender and on foot strike pattern. Copyright © 2015 Elsevier B.V. All rights reserved.

  11. Validity of Combining History Elements and Physical Examination Tests to Diagnose Patellofemoral Pain.

    Science.gov (United States)

    Décary, Simon; Frémont, Pierre; Pelletier, Bruno; Fallaha, Michel; Belzile, Sylvain; Martel-Pelletier, Johanne; Pelletier, Jean-Pierre; Feldman, Debbie; Sylvestre, Marie-Pierre; Vendittoli, Pascal-André; Desmeules, François

    2018-04-01

    To assess the validity of diagnostic clusters combining history elements and physical examination tests to diagnose or exclude patellofemoral pain (PFP). Prospective diagnostic study. Orthopedic outpatient clinics, family medicine clinics, and community-dwelling. Consecutive patients (N=279) consulting one of the participating orthopedic surgeons (n=3) or sport medicine physicians (n=2) for any knee complaint. Not applicable. History elements and physical examination tests were obtained by a trained physiotherapist blinded to the reference standard: a composite diagnosis including both physical examination tests and imaging results interpretation performed by an expert physician. Penalized logistic regression (least absolute shrinkage and selection operator) was used to identify history elements and physical examination tests associated with the diagnosis of PFP, and recursive partitioning was used to develop diagnostic clusters. Diagnostic accuracy measures including sensitivity, specificity, positive and negative predictive values, and positive and negative likelihood ratios with associated 95% confidence intervals (CIs) were calculated. Two hundred seventy-nine participants were evaluated, and 75 had a diagnosis of PFP (26.9%). Different combinations of history elements and physical examination tests including the age of participants, knee pain location, difficulty descending stairs, patellar facet palpation, and passive knee extension range of motion were associated with a diagnosis of PFP and used in clusters to accurately discriminate between individuals with PFP and individuals without PFP. Two diagnostic clusters developed to confirm the presence of PFP yielded a positive likelihood ratio of 8.7 (95% CI, 5.2-14.6) and 3 clusters to exclude PFP yielded a negative likelihood ratio of .12 (95% CI, .06-.27). Diagnostic clusters combining common history elements and physical examination tests that can accurately diagnose or exclude PFP compared to various knee

  12. Anterior knee pain in younger adults as a precursor to subsequent patellofemoral osteoarthritis: a systematic review

    Directory of Open Access Journals (Sweden)

    Thomas Martin J

    2010-09-01

    Full Text Available Abstract Background Patellofemoral osteoarthritis (PFOA is a common form of knee OA in middle and older age, but its relation to PF disorders and symptoms earlier in life is unclear. Our aim was to conduct a systematic review to investigate the strength of evidence for an association between anterior knee pain (AKP in younger adults and subsequent PFOA. Methods The search strategy included electronic databases (Pubmed, EMBASE, AMED, CINAHL, Cochrane, PEDro, SportDiscus: inception to December 2009, reference lists of potentially eligible studies and selected reviews. Full text articles in any language, - identified via English titles and abstracts, were included if they were retrospective or prospective in design and contained quantitative data regarding structural changes indicative of PFOA, incident to original idiopathic AKP. Eligibility criteria were applied to titles, abstracts and full-texts by two independent reviewers. Data extraction included study location, design, date, sampling procedure, sample characteristics, AKP/PFOA definitions, follow-up duration and rate, and main findings. Foreign language articles were translated into English prior to examination. Results Seven articles satisfied eligibility (5 English, 2 German. Only one case-control study directly investigated a link between PFOA and prior AKP, providing level 3b evidence in favour of an association (OR 4.4; 95%CI 1.8, 10.6. Rough estimates of the annual risk of PFOA from the remaining six small, uncontrolled, observational studies (mean follow-up range: 5.7 to 23 years ranged from 0% to 3.4%. This was not the primary aim of these studies, and limitations in design and methodology mean this data should be interpreted with caution. Conclusions There is a paucity of high-quality evidence reporting a link between AKP and PFOA. Further, well-designed cohort studies may be able to fill this evidence gap.

  13. Age-related differences in foot mobility in individuals with patellofemoral pain.

    Science.gov (United States)

    Tan, Jade M; Crossley, Kay M; Vicenzino, Bill; Menz, Hylton B; Munteanu, Shannon E; Collins, Natalie J

    2018-01-01

    Age-related changes in midfoot mobility have the potential to influence success with foot orthoses intervention in people with patellofemoral pain (PFP). The aim of this study was to determine whether older people with PFP demonstrate less foot mobility than younger adults with PFP. One hundred ninety four participants (113 (58%) women, age 32 ± 7 years, BMI 25 ± 4.9 kg/m 2 ) with PFP (≥ 6 weeks duration) were included, with foot mobility quantified using reliable and valid methods. K-means cluster analysis classified participants into three homogenous groups based on age. After cluster formation, univariate analyses of co-variance (covariates: sex, weight) were used to compare midfoot height mobility, midfoot width mobility, and foot mobility magnitude between age groups (significance level 0.05). Cluster analysis revealed three distinct age groups: 18-29 years ( n  = 70); 30-39 years ( n  = 101); and 40-50 years ( n  = 23). There was a significant main effect for age for midfoot height mobility ( p  mobility magnitude ( p  = 0.006). Post-hoc analyses revealed that midfoot height mobility differed across all three groups (moderate to large effect sizes), and that foot mobility magnitude was significantly less in those aged 40-50 years compared to those aged 18-25 years (moderate effect size). There were no significant main effects for age for midfoot width mobility ( p  > 0.05). Individuals with PFP aged 40-50 years have less foot mobility than younger adults with PFP. These findings may have implications for evaluation and treatment of older individuals with PFP.

  14. Comparison of patellar distraction with patellar glides in female patients with patellofemoral pain syndrom

    International Nuclear Information System (INIS)

    Syed, S.; Chaudhary, M.A.; Noor, R.; Bashir, M.S.; Manzoor, B.

    2017-01-01

    To analyse effectiveness of patellar glides and patellar distraction in the patients with patellofemoral pain syndrome (PFPS). Methodology: This longitudinal interventional comparative study was conducted at Physiotherapy Department, Mayo Hospital Lahore, Pakistan from September 2015 to March 2016. A total of 70 patients were divided into 2 groups randomly; group A received hot pack, quadriceps strengthening exercises and patellar distraction whereas group B received hot pack, quadriceps strengthening exercises and patellar glides. Age of the female patients was 18-40 years. Visual Analogue Scale (VAS) and Knee Injury and osteoarthritis outcome score (KOOS) questionnaire were used to compare the effectiveness of both treatments. The data were analysed using SPSS v. 21.0. Results: There was reduction in pain at VAS and KOOS showed improvement in function as well as the range of motion also increased in both groups. Both treatment techniques were effective in reducing pain in PFPS (P <0.005). Pre-treatment KOOS score in patellar glides group was 34.77+10.84 and post-treatment KOOS score was 62.155+15.75 and for patellar distraction group pre-treatment KOOS score was 35.42+10.07 that increased to 55.77+14.66 after treatment which showed that patellar glides had better effect on PFPS. Conclusion: Both treatments were effective in managing PFPS in terms of decreasing pain and increasing ROM as there was no significant difference between two techniques, however patellar glides were superior as compared to patellar distraction in decreasing pain and increasing ROM. (author)

  15. In vivo patellofemoral contact mechanics during active extension using a novel dynamic MRI-based methodology.

    Science.gov (United States)

    Borotikar, B S; Sheehan, F T

    2013-12-01

    To establish an in vivo, normative patellofemoral (PF) cartilage contact mechanics database acquired during voluntary muscle control using a novel, dynamic, magnetic resonance (MR) imaging-based, computational methodology and validate the contact mechanics sensitivity to the known sub-millimeter methodological accuracies. Dynamic cine phase-contrast and multi-plane cine (MPC) images were acquired while female subjects (n = 20, sample of convenience) performed an open kinetic chain (knee flexion-extension) exercise inside a 3-T MR scanner. Static cartilage models were created from high resolution three-dimensional static MR data and accurately placed in their dynamic pose at each time frame based on the cine-PC (CPC) data. Cartilage contact parameters were calculated based on the surface overlap. Statistical analysis was performed using paired t-test and a one-sample repeated measures ANOVA. The sensitivity of the contact parameters to the known errors in the PF kinematics was determined. Peak mean PF contact area was 228.7 ± 173.6 mm(2) at 40° knee angle. During extension, contact centroid and peak strain locations tracked medially on the femoral and patellar cartilage and were not significantly different from each other. At 25°, 30°, 35°, and 40° of knee extension, contact area was significantly different. Contact area and centroid locations were insensitive to rotational and translational perturbations. This study is a first step towards unfolding the biomechanical pathways to anterior PF pain and osteoarthritis (OA) using dynamic, in vivo, and accurate methodologies. The database provides crucial data for future studies and for validation of, or as an input to, computational models. Published by Elsevier Ltd.

  16. The PEX study - Exercise therapy for patellofemoral pain syndrome : design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749

    NARCIS (Netherlands)

    van Linschoten, R; van Middelkoop, M; Berger, MY; Heintjes, EM; Koopmanschap, MA; Verhaar, JA; Koes, BW; Bierma-Zeinstra, SMA

    2006-01-01

    Background: Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome. Exercise therapy is

  17. Comparison of the electrical activity of trunk core muscles and knee muscles in subjects with and without patellofemoral pain syndrome during gait

    Directory of Open Access Journals (Sweden)

    Raheleh Dorosti

    2017-10-01

    Conclusion: It seems that electromyographic activities of some of core muscles in patients with patellofemoral pain syndrome in comparison with healthy subjects are different. However, there was no differences in electromyographic activities in some of the muscles around the knee between patients and healthy subjects.

  18. The PEX study - Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749].

    NARCIS (Netherlands)

    R. van Linschoten (Robbart); M. van Middelkoop (Marienke); E.M. Heintjes (Edith); M.A. Koopmanschap (Marc); J.A.N. Verhaar (Jan); B.W. Koes (Bart); S.M. Bierma-Zeinstra (Sita); M.Y. Berger (Marjolein)

    2006-01-01

    textabstractBACKGROUND: Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome.Exercise

  19. Hip and knee strength is not affected in 12-16 year old adolescents with patellofemoral pain - a cross-sectional population-based study

    DEFF Research Database (Denmark)

    Rathleff, Camilla Rams; Baird, William Neill; Olesen, Jens Lykkegaard

    2013-01-01

    One of the rationales behind using strength training in the treatment of adolescents with Patellofemoral Pain (PFP) is that reduced strength of the lower extremity is a risk factor for PFP and a common deficit. This rationale is based on research conducted on adolescents >15 years of age but has...

  20. Feeling Abnormal: Simulation of Deviancy in Abnormal and Exceptionality Courses.

    Science.gov (United States)

    Fernald, Charles D.

    1980-01-01

    Describes activity in which student in abnormal psychology and psychology of exceptional children classes personally experience being judged abnormal. The experience allows the students to remember relevant research, become sensitized to the feelings of individuals classified as deviant, and use caution in classifying individuals as abnormal.…

  1. Abnormal glucose tolerance and lipid abnormalities in Indian ...

    African Journals Online (AJOL)

    Discussion. Regardless of varying diagnostic classification, abnormal glucose tolerance is a well-documented risk factor. 16 Abnormalities in. Because ofthe small number offemale MI survivors, the effect of obesity and abnormal glucose tolerance on lipid levels was studied in the male patients only. There was no significant.

  2. Global sensitivity analysis of the joint kinematics during gait to the parameters of a lower limb multi-body model.

    Science.gov (United States)

    El Habachi, Aimad; Moissenet, Florent; Duprey, Sonia; Cheze, Laurence; Dumas, Raphaël

    2015-07-01

    Sensitivity analysis is a typical part of biomechanical models evaluation. For lower limb multi-body models, sensitivity analyses have been mainly performed on musculoskeletal parameters, more rarely on the parameters of the joint models. This study deals with a global sensitivity analysis achieved on a lower limb multi-body model that introduces anatomical constraints at the ankle, tibiofemoral, and patellofemoral joints. The aim of the study was to take into account the uncertainty of parameters (e.g. 2.5 cm on the positions of the skin markers embedded in the segments, 5° on the orientation of hinge axis, 2.5 mm on the origin and insertion of ligaments) using statistical distributions and propagate it through a multi-body optimisation method used for the computation of joint kinematics from skin markers during gait. This will allow us to identify the most influential parameters on the minimum of the objective function of the multi-body optimisation (i.e. the sum of the squared distances between measured and model-determined skin marker positions) and on the joint angles and displacements. To quantify this influence, a Fourier-based algorithm of global sensitivity analysis coupled with a Latin hypercube sampling is used. This sensitivity analysis shows that some parameters of the motor constraints, that is to say the distances between measured and model-determined skin marker positions, and the kinematic constraints are highly influencing the joint kinematics obtained from the lower limb multi-body model, for example, positions of the skin markers embedded in the shank and pelvis, parameters of the patellofemoral hinge axis, and parameters of the ankle and tibiofemoral ligaments. The resulting standard deviations on the joint angles and displacements reach 36° and 12 mm. Therefore, personalisation, customisation or identification of these most sensitive parameters of the lower limb multi-body models may be considered as essential.

  3. Effects of strength training on the treatment of patellofemoral pain syndrome - a meta-analysis of randomized controlled trials

    Directory of Open Access Journals (Sweden)

    Rodrigo Kohn Cardoso

    Full Text Available Abstract Introduction: Palletofemoral pain syndrome (PFPS is anterior knee pain that affects around 25% of the population at some point in their lives. Muscle weakness is one of the main causal factors related to PFPS. Objective: Conduct a quantitative analysis on the effectiveness of strength training at reducing pain in PFPS sufferers. Methods: An electronic search was conducted on the MEDLINE, Pubmed, EMBASE, Lilacs and Scielo databases for studies published between January 2005 and September 2014. The following descriptors were used: “patellofemoral pain syndrome”, “patellofemoral pain”, “retropatellar pain”, “exercise”, “exercise therapy”, “strength”, “rehabilitation”. Only randomized controlled trials (RCTs that compared the effects of strength training to no exercise in terms of reducing pain among PFPS sufferers were included. Data were extracted by two independent authors using predefined quality indicators. Results: A total of 39 RCTs were initially identified in the search. However, only five met the inclusion criteria. Strength training exhibited a positive effect on PFPS (SMD = 0.85, CI: 0.45-1.25. However, high heterogeneity was observed between the studies (p < 0.05; I 2 = 68.3%. Conclusion: Strength training showed a statistically positive response in the treatment of PFPS.

  4. Clinical and Functional Outcomes following Primary Repair versus Reconstruction of the Medial Patellofemoral Ligament for Recurrent Patellar Instability

    Directory of Open Access Journals (Sweden)

    Marc Tompkins

    2014-01-01

    Full Text Available Background. The purpose of this study was to compare outcomes of medial patellofemoral ligament (MPFL repair or reconstruction. Methods. Fourteen knees that underwent MPFL repair and nine (F5, M4 knees that underwent reconstruction at our institution were evaluated for objective and subjective outcomes. The mean age at operation was 20.1 years for repair and 19.8 years for reconstruction. All patients had a minimum of 2 years of follow-up (range: 24–75 months. Patient subjective outcomes were obtained using the International Knee Documentation Committee (IKDC and Kujala patellofemoral subjective evaluations, as well as Visual Analog (VAS and Tegner Activity Scales. Bilateral isometric quadriceps strength and vastus medialis obliquus (VMO and vastus lateralis (VL surface EMG were measured during maximal isometric quadriceps contractions at 30° and 60° of flexion. Results. There were no redislocations in either group. There was no difference in IKDC (P=0.16, Kujala (P=0.43, Tegner (P=0.12, or VAS (P=0.05 scores at follow-up. There were no differences between repair and reconstruction in torque generation of the involved side at 30° (P=0.96 and 60° (P=0.99. In addition, there was no side to side difference in torque generation or surface EMG activation of VL or VMO. Conclusions. There were minimal differences found between patients undergoing MPFL repair and MPFL reconstruction for the objective and subjective evaluations in this study.

  5. Exercises to Improve Gait Abnormalities

    Science.gov (United States)

    ... Articles Directories Videos Resources Contact Exercises to Improve Gait Abnormalities Home » Article Categories » Exercise and Fitness Font Size: A A A A Exercises to Improve Gait Abnormalities Next Page The manner of how a ...

  6. Joint imaging

    International Nuclear Information System (INIS)

    Hengst, W.

    1984-01-01

    Joint imaging is a proven diagnostic procedure which has become indispensable to the detection and treatment of different joint diseases in almost all disciplines. The method is suited for early diagnosis of joint affections both in soft tissue and bone which cannot be detected by X-ray or other procedures. The local activity accumulation depends on the rate of metabolism and is visualized in the scan, which in turn enables the extension and floridity of focal lesions to be evaluated and followed-up. Although joint scans may often give hints to probabilities relevant to differential diagnosis, the method is non-specific and only useful if based on the underlying clinical picture and X-ray finding, if possible. The radiation exposure is very low and does not represent a hazard in cases of adequate assessment of indication. In pregnant women and children the assessment of indication has to be based on very strict principles. The method is suited for out-patient diagnosis and can be applied in all installations equipped with a gamma camera and a technetium generator. (orig.) [de

  7. Joint purpose?

    DEFF Research Database (Denmark)

    Pristed Nielsen, Helene

    2013-01-01

    of anti-discrimination in Europe today? And what empirical evidence may be found for such a joint approach? The paper discusses how the contemporary EU context differs from the American context which prompted Crenshaw to raise the point about intersectionality, and it analyses documents and interviews...

  8. Skeleton-Based Abnormal Gait Detection

    Directory of Open Access Journals (Sweden)

    Trong-Nguyen Nguyen

    2016-10-01

    Full Text Available Human gait analysis plays an important role in musculoskeletal disorder diagnosis. Detecting anomalies in human walking, such as shuffling gait, stiff leg or unsteady gait, can be difficult if the prior knowledge of such a gait pattern is not available. We propose an approach for detecting abnormal human gait based on a normal gait model. Instead of employing the color image, silhouette, or spatio-temporal volume, our model is created based on human joint positions (skeleton in time series. We decompose each sequence of normal gait images into gait cycles. Each human instant posture is represented by a feature vector which describes relationships between pairs of bone joints located in the lower body. Such vectors are then converted into codewords using a clustering technique. The normal human gait model is created based on multiple sequences of codewords corresponding to different gait cycles. In the detection stage, a gait cycle with normality likelihood below a threshold, which is determined automatically in the training step, is assumed as an anomaly. The experimental results on both marker-based mocap data and Kinect skeleton show that our method is very promising in distinguishing normal and abnormal gaits with an overall accuracy of 90.12%.

  9. The immediate effect of lumbopelvic manipulation on EMG of vasti and gluteus medius in athletes with patellofemoral pain syndrome: A randomized controlled trial.

    Science.gov (United States)

    Motealleh, Alireza; Gheysari, Elham; Shokri, Esmaeil; Sobhani, Sobhan

    2016-04-01

    To evaluate the immediate effect of lubmopelvic manipulation on EMG activity of vastus medialis, vastus lateralis and gluteus medius as well as pain and functional performance of athletes with patellofemoral pain syndrome. Randomized placebo-controlled trial. Twenty eight athletes with patellofemoral pain syndrome were randomly assigned to two groups. One group received a lubmopelvic manipulation at the side of the involved knee while the other group received a sham manipulation. EMG activity of the vasti and gluteus medius were recorded before and after manipulation while performing a rocking on heel task. The functional abilities were evaluated using two tests: step-down and single-leg hop. Additionally, the pain intensity during the functional tests was assessed using a visual analog scale. The onset and amplitude of EMG activity from vastus medialis and gluteus medius were, respectively, earlier and higher in the manipulation group compared to the sham group. There were no significant differences, however, between two groups in EMG onset of vastus lateralis. While the scores of one-leg hop test were similar for both groups, significant improvement was observed in step-down test and pain intensity in the manipulation group compared to the sham group. Lubmopelvic manipulation might improve patellofemoral pain and functional level in athletes with patellofemoral pain syndrome. These effects could be due to the changes observed in EMG activity of gluteus medius and vasti muscles. Therefore, the lubmopelvic manipulation might be considered in the rehabilitation protocol of the athletes with patellofemoral pain syndrome. Copyright © 2016 Elsevier Ltd. All rights reserved.

  10. [Penile congenital abnormalities].

    Science.gov (United States)

    Boillot, B; Teklali, Y; Moog, R; Droupy, S

    2013-07-01

    Congenital abnormalities of the penis are usually diagnosed at birth and pose aesthetic and functional problems sometimes requiring surgical management. A literature review was conducted on Medline considering the articles listed until January 2012. Hypospadias is the most common malformation (1 in 250 boys. Familial forms: 7%). The causes remain hypothetical but the doubling of the incidence in 30 years could be linked to fetal exposure to endocrine disruptors "estrogen-like" used in the food industry in particular. Surgical treatment is usually intended to improve the aesthetic appearance but sometimes, in case of significant curvature or posterior meatus, necessary for normal sexual life and fertility. Other malformations (epispades, buried penis, transpositions, twists and preputial abnormalities) as well as management for functional or aesthetic consequences of these malformations in adulthood require complex surgical care in a specialized environment. The improvement of surgical techniques and pediatric anesthesia allows an early and effective specialized surgical approach of penile malformations. Management of sequelae in adulthood must be discussed and requires experience of surgical techniques on pediatric and adult penis. Copyright © 2013 Elsevier Masson SAS. All rights reserved.

  11. Model predictions of increased knee joint loading in regions of thinner articular cartilage after patellar tendon adhesion.

    Science.gov (United States)

    Fernandez, Justin W; Akbarshahi, Massoud; Crossley, Kay M; Shelburne, Kevin B; Pandy, Marcus G

    2011-08-01

    Patellar tendon adhesion is a complication from anterior cruciate ligament (ACL) reconstruction that may affect patellofemoral and tibiofemoral biomechanics. A computational model was used to investigate the changes in knee joint mechanics due to patellar tendon adhesion under normal physiological loading during gait. The calculations showed that patellar tendon adhesion up to the level of the anterior tibial plateau led to patellar infera, increased patellar flexion, and increased anterior tibial translation. These kinematic changes were associated with increased patellar contact force, a distal shift in peak patellar contact pressure, a posterior shift in peak tibial contact pressure, and increased peak tangential contact sliding distance over one gait cycle (i.e., contact slip). Postadhesion, patellar and tibial contact locations corresponded to regions of thinner cartilage. The predicted distal shift in patellar contact was in contrast to other patellar infera studies. Average patellar and tibial cartilage pressure did not change significantly following patellar tendon adhesion; however, peak medial tibial pressure increased. These results suggest that changes in peak tibial cartilage pressure, contact slip, and the migration of contact to regions of thinner cartilage are associated with patellar tendon adhesion and may be responsible for initiating patellofemoral pain and knee joint structural damage observed following ACL reconstruction. Copyright © 2011 Orthopaedic Research Society.

  12. A Rare Stapes Abnormality

    Directory of Open Access Journals (Sweden)

    Hala Kanona

    2015-01-01

    Full Text Available The aim of this study is to increase awareness of rare presentations, diagnostic difficulties alongside management of conductive hearing loss and ossicular abnormalities. We report the case of a 13-year-old female reporting progressive left-sided hearing loss and high resolution computed tomography was initially reported as normal. Exploratory tympanotomy revealed an absent stapedius tendon and lack of connection between the stapes superstructure and footplate. The footplate was fixed. Stapedotomy and stapes prosthesis insertion resulted in closure of the air-bone gap by 50 dB. A review of world literature was performed using MedLine. Middle ear ossicular discontinuity can result in significant conductive hearing loss. This can be managed effectively with surgery to help restore hearing. However, some patients may not be suitable or decline surgical intervention and can be managed safely conservatively.

  13. Meniscal abnormalities in soccer players: prevalence and MR imaging

    Energy Technology Data Exchange (ETDEWEB)

    Song, In Sup; Lee, Jong Ik; Kwak, Byeung Kook; Shim, Hyung Jin; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang; Seo, Kyung Mook [Chung-Ang University Hospital, Seoul (Korea, Republic of)

    1995-02-15

    We aimed to know the prevalence of abnormal meniscal signal on MR imaging in asymptomatic soccer players and its radiologic significance. Using T1 and gradient echo T2 weighted sagittal and coronal MR image, 48 knees in twenty-four full time soccer players were evaluated for the meniscal abnormalities, the status of ligament and existence of joint effusion. Meniscal abnormalities were interpreted using grading system of Lotysch. By using Chi-square method. We analyzed the existence of joint effusion could divide the healing state and healed state of the meniscus. The prevalence of Grade 2 and more and Grade 3 were 42% and 39% of asymptomatic knees. In the 24 knees with meniscus tear, nine of the 14 asymptomatic knee showed effusion while eight of the 10 symptomatic knee did. Of 24 knees with meniscal tear, only eleven knees were related to previous history of major knee trauma. The prevalence of meniscal abnormalities on MR imaging in asymptomatic soccer players was higher (grade 3: 39%) than we expected. The joint effusion was not helpful to divide the healing state and healed state of the meniscus. So we suggest baseline MR imaging in the athletes who have been using the knee vigorously could give decisive information for the interpretation of subsequent MRI that may be performed when the players wounded.

  14. Meniscal abnormalities in soccer players: prevalence and MR imaging

    International Nuclear Information System (INIS)

    Song, In Sup; Lee, Jong Ik; Kwak, Byeung Kook; Shim, Hyung Jin; Lee, Jong Beum; Lee, Yong Chul; Kim, Kun Sang; Seo, Kyung Mook

    1995-01-01

    We aimed to know the prevalence of abnormal meniscal signal on MR imaging in asymptomatic soccer players and its radiologic significance. Using T1 and gradient echo T2 weighted sagittal and coronal MR image, 48 knees in twenty-four full time soccer players were evaluated for the meniscal abnormalities, the status of ligament and existence of joint effusion. Meniscal abnormalities were interpreted using grading system of Lotysch. By using Chi-square method. We analyzed the existence of joint effusion could divide the healing state and healed state of the meniscus. The prevalence of Grade 2 and more and Grade 3 were 42% and 39% of asymptomatic knees. In the 24 knees with meniscus tear, nine of the 14 asymptomatic knee showed effusion while eight of the 10 symptomatic knee did. Of 24 knees with meniscal tear, only eleven knees were related to previous history of major knee trauma. The prevalence of meniscal abnormalities on MR imaging in asymptomatic soccer players was higher (grade 3: 39%) than we expected. The joint effusion was not helpful to divide the healing state and healed state of the meniscus. So we suggest baseline MR imaging in the athletes who have been using the knee vigorously could give decisive information for the interpretation of subsequent MRI that may be performed when the players wounded

  15. Medial patellofemoral ligament injury patterns and associated pathology in lateral patella dislocation: an MRI study

    Directory of Open Access Journals (Sweden)

    Guerrero Patrick

    2009-07-01

    Full Text Available Abstract Background Lateral Patella dislocations are common injuries seen in the active and young adult populations. Our study focus was to evaluate medial patellofemoral ligament (MPFL injury patterns and associated knee pathology using Magnetic Resonance Imaging studies. Methods MRI studies taken at one imaging site between January, 2007 to January, 2008 with the final diagnosis of patella dislocation were screened for this study. Of the 324 cases that were found, 195 patients with lateral patellar dislocation traumatic enough to cause bone bruises on the lateral femoral trochlea and the medial facet of the patella were selected for this study. The MRI images were reviewed by three independent observers for location and type of MPFL injury, osteochondral defects, loose bodies, MCL and meniscus tears. The data was analyzed as a single cohort and by gender. Results This study consisted of 127 males and 68 females; mean age of 23 yrs. Tear of the MPFL at the patellar attachment occurred in 93/195 knees (47%, at the femoral attachment in 50/195 knees (26%, and at both the femoral and patella attachment sites in 26/195 knees (13%. Attenuation of the MPFL without rupture occurred in 26/195 knees (13%. Associated findings included loose bodies in 23/195 (13%, meniscus tears 41/195 (21%, patella avulsion/fracture in 14/195 (7%, medial collateral ligament sprains/tears in 37/195 (19% and osteochondral lesions in 96/195 knees (49%. Statistical analysis showed females had significantly more associated meniscus tears than the males (27% vs. 17%, p = 0.04. Although not statistically significant, osteochondral lesions were seen more in male patients with acute patella dislocation (52% vs. 42%, p = 0.08. Conclusion Patients who present with lateral patella dislocation with the classic bone bruise pattern seen on MRI will likely rupture the MPFL at the patellar side. Females are more likely to have an associated meniscal tear than males; however, more males

  16. Effect of Transosseous Tunnels on Patella Fracture Risk After Medial Patellofemoral Ligament Reconstruction: A Cadaveric Study.

    Science.gov (United States)

    Bonazza, Nicholas A; Lewis, Gregory S; Lukosius, Eric Z; Roush, Evan P; Black, Kevin P; Dhawan, Aman

    2018-02-01

    To determine whether (1) tunnels that breach the anterior cortex of the patella result in increased fracture risk and (2) transosseous tunnels drilled across the patella significantly reduce the tensile force needed to fracture the patella. Twenty-six fresh-frozen cadaveric human patellas were randomized to 1 of 3 groups: a control group with unmodified patellas, a group with 2 transverse tunnels (TT) that did not breach the anterior cortex, and a group with 2 TT that breached the anterior cortex of the patella (PA). Patellas were connected in series to a load cell via freeze clamp attachments to the quadriceps and patellar tendons. Pull was fixed at 45° with the patella set in the trochlear groove of a synthetic femur. Patellas were loaded cyclically, then to failure. Twenty-six patellas were tested (mean age = 71.4 years; range = 37-95, standard deviation [STD] = 11.5 years). PA patellas were more likely to fracture through the tunnel than TT patellas (100% vs 25%, P = .033). Control, TT, and PA groups failed at 1,915 N (STD = 508 N), 1,901 N (STD = 884 N), and 1,640 N (STD = 625 N), respectively. There was no statistically significant difference in overall load to failure between control and TT (P = .969), control and PA (P = .321), and TT and PA (P = .488) groups. Transosseous patellar tunnels for medial patellofemoral ligament reconstruction that breached the anterior cortex were more likely to fracture during longitudinal load than those that did not breach the anterior cortex. However, we found no statistically significant difference in the tensile load to failure between native patellas and patellas with either type of transosseous tunnel. The results of this study show that breaching the anterior cortex during transosseous drilling increases the risk of a patellar fracture occurring through the transosseous tunnel. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. The Effect of the Mulligan Knee Taping Technique on Patellofemoral Pain and Lower Limb Biomechanics.

    Science.gov (United States)

    Hickey, Anne; Hopper, Diana; Hall, Toby; Wild, Catherine Y

    2016-05-01

    Patellofemoral pain (PFP) affects 25% of the general population, occurring 2 times more often in females compared with males. Taping is a valuable component of the management plan for altering lower limb biomechanics and providing pain relief; however, the effects of alternative taping techniques, such as Mulligan knee taping, appear yet to be researched. To determine whether the Mulligan knee taping technique altered levels of perceived knee pain and lower limb biomechanics during a single-legged squat (SLSq) in adult females with PFP. Controlled laboratory study. A total of 20 female patients with PFP, aged 18 to 35 years, participated in this study. Participants performed 3 to 5 SLSq on their most symptomatic limb during a taped (Mulligan knee taping technique) and nontaped (control) condition. During the eccentric phase of the SLSq, the 3-dimensional kinematics (250 Hz) of the knee and hip and the ground-reaction forces (1000 Hz) and muscle activation patterns (1000 Hz) of the gluteus medius, vastus lateralis, and vastus medialis oblique were measured. Participants' perceived maximum knee pain was also recorded after the completion of each squat. Between-condition differences were found for hip kinematics and gluteus medius activation but not for kinetics or vastus medialis oblique and vastus lateralis muscle activity (timing and activation). Compared with the nontaped condition, the Mulligan knee taping technique significantly (P = .001) reduced perceived pain during the SLSq (mean ± SD: 2.29 ± 1.79 and 1.29 ± 1.28, respectively). In the taped condition compared with the control, the onset timing of the gluteus medius occurred significantly earlier (120.6 ± 113.0 and 156.6 ± 91.6 ms, respectively; P = .023) and peak hip internal rotation was significantly reduced (6.38° ± 7.31° and 8.34° ± 7.92°, respectively; P = .002). The Mulligan knee taping technique successfully reduced knee pain in participants with PFP. This is the first study to establish a

  18. Eccentric hip muscle function in females with and without patellofemoral pain syndrome.

    Science.gov (United States)

    Baldon, Rodrigo de Marche; Nakagawa, Theresa Helissa; Muniz, Thiago Batista; Amorim, César Ferreira; Maciel, Carlos Dias; Serrão, Fábio Viadanna

    2009-01-01

    Patellofemoral pain syndrome (PFPS) is a common knee condition in athletes. Recently, researchers have indicated that factors proximal to the knee, including hip muscle weakness and motor control impairment, contribute to the development of PFPS. However, no investigators have evaluated eccentric hip muscle function in people with PFPS. To compare the eccentric hip muscle function between females with PFPS and a female control group. Cross-sectional study. Musculoskeletal laboratory. two groups of females were studied: a group with PFPS (n = 10) and a group with no history of lower extremity injury or surgery (n = 10). Eccentric torque of the hip musculature was evaluated on an isokinetic dynamometer. Eccentric hip abduction, adduction, and external and internal rotation peak torque were measured and expressed as a percentage of body mass (Nm/kg x 100). We also evaluated eccentric hip adduction to abduction and internal to external rotation torque ratios. The peak torque value of 5 maximal eccentric contractions was used for calculation. Two-tailed, independent-samples t tests were used to compare torque results between groups. Participants with PFPS exhibited much lower eccentric hip abduction (t(18) = -2.917, P = .008) and adduction (t(18) = -2.764, P = .009) peak torque values than did their healthy counterparts. No differences in eccentric hip external (t(18) = 0.45, P = .96) or internal (t(18) = -0.742, P = .47) rotation peak torque values were detected between the groups. The eccentric hip adduction to abduction torque ratio was much higher in the PFPS group than in the control group (t(18) = 2.113, P = .04), but we found no difference in the eccentric hip internal to external rotation torque ratios between the 2 groups (t(18) = -0.932, P = .36). Participants with PFPS demonstrated lower eccentric hip abduction and adduction peak torque and higher eccentric adduction to abduction torque ratios when compared with control participants. Thus, clinicians should

  19. Pelvic organ prolapse and connective tissue abnormalities in Korean women.

    Science.gov (United States)

    Bai, Sang Wook; Choe, Byung Hoon; Kim, Jeong Yeon; Park, Ki Hyun

    2002-03-01

    To evaluate the relationship between pelvic organ prolapse in Korean women and joint hypermobility, which suggests a metabolic collagen fiber abnormality. Between March 1998 and March 2000, we investigated 55 patients with prolapse. The prevalence of joint hypermobility, by measuring finger extension angle, and the proportion of patients with joint hypermobility were measured in patients with pelvic organ prolapse and benign gynecologic patients (control group). In middle-aged women (40-59 years), the average finger extension angles were higher in the POP group than in the control group (50.04 +/- 9.70 degrees vs. 39.50 +/- 12.19 degrees, respectively; P .05). The prevalence of joint hypermobility was higher in the POP group and with advanced POP stage (III, IV) than in the control group and early POP stage (I, II). Our results suggest that intrinsic connective tissue abnormality is related to the development of pelvic organ prolapse. Further study involving more patients with pelvic organ prolapse is warranted, and molecular studies to determine the genetic basis of pelvic organ prolapse are also required to further elucidate this abnormality.

  20. Anterior knee pain caused by patellofemoral pain syndrome can be relieved by Botulinum toxin type A injection.

    Science.gov (United States)

    Chen, John Tzu-Ning; Tang, Alice Chu-Wen; Lin, Shih-Cherng; Tang, Simon Fuk-Tan

    2015-02-01

    To investigate the therapeutic effects of Botulinum toxin type A (BTA) for anterior knee pain caused by patellofemoral pain syndrome (PFPS). Prospective case control study for intervention. A tertiary hospital rehabilitation center. Twelve bilateral PFPS patients with anterior knee pain were recruited. The worse pain knee was selected for injection, and the counterpart was left untreated. Injection of BTA to vastus lateralis (VL) muscle. Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) was used to assess pain, stiffness, and functional status of the knee, and CYBEX isokinetic dynamometer to assess isokinetic muscle force before and after BTA application to VL. Remarkable improvement after receiving BTA injection was obtained not only in the questionnaire of WOMAC (pknee flexion torque (pknee extension torque was noted (p=0.682). BTA injection is a good alternative treatment to improve anterior knee pain, knee function and isokinetic flexion torque. © 2015 Elsevier B.V. All rights reserved.

  1. Self-reported Recovery is Associated with Improvement in Localised Hyperalgesia Among Adolescent Females with Patellofemoral Pain

    DEFF Research Database (Denmark)

    Rathleff, Michael Skovdal; Roos, Ewa M.; Olesen, Jens Lykkegaard

    2016-01-01

    OBJECTIVES: Adolescent females with PFP have localised (around the knee) and distal (tibialis anterior muscle) hyperalgesia assessed by decreased Pressure Pain Thresholds (PPT). This may have implications for treating PFP as both localised and central pain mechanisms may contribute...... to the manifestations of pain. The objective of this study was to compare the change in localised and distal hyperalgesia among female adolescents with Patellofemoral Pain (PFP) deeming themselves recovered compared to those not recovered 3 months after patient education with or without exercise therapy. METHODS...... adolescents. Changes in localised and distal hyperalgesia from baseline to follow-up were compared to self-reported recovery. Adolescents were categorized as recovered if they rated themselves as "completely recovered" or "strongly recovered" (category 1 or 2) on a 7-point Likert scale. RESULTS: 39...

  2. Exercise during school hours when added to patient education improves outcome for 2 years in adolescent patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, M S; Roos, Ewa M.; Olesen, J L

    2015-01-01

    and 6 months (OR 1.88 and 1.43) while the effect was further increased at 24 months (OR of 2.52, NNT of 5). A higher total number of weekly exercise sessions increased the odds of recovery. CONCLUSIONS: In adolescent PFP, the addition of exercise therapy for 3 months was more effective than patient...... education alone. The effect was apparent at 3 months and increased up to 2 years. Adherence to exercises was important and improved the odds of recovery. TRIAL REGISTRATION NUMBER: clinicaltrials.gov reference: NCT01438762.......BACKGROUND: Patellofemoral pain (PFP) is common among adolescents and associated with long-lasting pain and disability. Patient education and exercise therapy are commonly used treatments in primary and secondary care but the effect of these treatments in adolescents is unknown. We aimed...

  3. Computed Tomography of the lumbar facet joints

    Energy Technology Data Exchange (ETDEWEB)

    Choi, Mi Ryoung; Kim, Yung Soon; Lee, Joo Hyuk; Jeon, Hae Sang; Kim, Dae Yung [Kang Nam General Hospital, Seoul (Korea, Republic of)

    1989-08-15

    The lumbar facet disease is a frequently overlooked cause of sciatic pain, but the lumbar facet joints are well-recognized source of low back pain and radiating leg pain which can be confused with sciatica due to herniated disc. We measured the angulation of the facet joints on axial spine CT films in 149 cases which contains 41 normal group and 108 abnormal group and studied the relationship between the angulation and degeneration of the facets, the asymmetry of each sided facets and facet degeneration, the asymmetry and disc protrusion, and the asymmetry and annular bulging of the disc. The results were as follows: 1. Facet angulation in abnormal group were more sagittally oriented than the normal group. 2. The angulation of right facet was more sagittally oriented than the left in L4-5 level of abnormal group. 3. Degeneration of facet joints occur asymmetrically, and the more facet joint degenerates, the more it orients sagittally, particularly in L4-5. 4. Asymmetry in facet joint degeneration and unilateral disc protrusion of L5-SI level is greater than the normal gro0008.

  4. Comparing the Effect of Open and Closed Kinetic Chain Exercises in Patients Suffering From Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Zahra Firoozkoohi Moghadam

    2016-11-01

    Full Text Available Introduction: Patellofemoral pain syndrome is one of the most prevalent problems in physically active people. The syndrome is a multifactorial disorder with different therapeutic approaches. Conservative treatment of the syndrome has been a crucial matter in different studies. Quadriceps muscle strengthening exercise is a recommended approach which is performed in forms of open and closed kinetic chain exercises. This study was designed to compare the efficacy of these exercises on this syndrome. Methods: Totally 30 women suffering from the syndrome aged 30-40 were randomly allocated into three groups: open, and closed kinetic chain exercises, and control group, as groups A, B, and C, respectively. Groups A and B participated in 28 sessions of exercises in a period of four weeks and group C did not do any exercise in this period. Before and after the period, pain and function of the participants were assessed using visual analog scale (VAS and Kujala patellofemoral scale, respectively. Data were analyzed using independent t test, dependent t test, and univariate variance analysis, while significance of data was determined at P < 0.05. Results: The study indicated that open kinetic chain exercises (group A for 4 weeks brought significant changes in relieving the pain along with improving the function (P = 0.001. Likewise, it was revealed a significant pain relief as well as function improvement in group B (P = 0.001. Comparing two groups illustrated that benefits of open kinetic chain exercises outweigh closed ones (P = 0.001. Conclusion: Overall, both exercises were efficient in relieving pain as well as improving function, however open kinetic chain exercises were more contributory.

  5. New exercise-integrated technology can monitor the dosage and quality of exercise performed against an elastic resistance band by adolescents with patellofemoral pain

    DEFF Research Database (Denmark)

    Rathleff, Michael S; Bandholm, Thomas; McGirr, Kate A

    2016-01-01

    . The system made it possible to capture detailed data about the TUT, repetitions and sets during home-based exercises together with pain intensity before and after each exercise. [Rathleff MS, Bandholm T, McGirr KA, Harring SI, Sørensen AS, Thorborg K (2016) New exercise-integrated technology can monitor......QUESTION: Is the exercise-integrated Bandcizer™ system feasible for recording exercise dosage (time under tension (TUT) and repetitions) and pain scores among adolescents with patellofemoral pain? Do adolescents practise the exercises as prescribed (TUT and repetitions)? Do adolescents accurately...... report the exercises they do in an exercise diary? DESIGN: Observational feasibility study. PARTICIPANTS: Twenty adolescents between 15 and 19 years of age with patellofemoral pain. INTERVENTION: Participants were prescribed three exercise sessions per week (one with and two without supervision) for 6...

  6. Abnormal pressure in hydrocarbon environments

    Science.gov (United States)

    Law, B.E.; Spencer, C.W.

    1998-01-01

    Abnormal pressures, pressures above or below hydrostatic pressures, occur on all continents in a wide range of geological conditions. According to a survey of published literature on abnormal pressures, compaction disequilibrium and hydrocarbon generation are the two most commonly cited causes of abnormally high pressure in petroleum provinces. In young (Tertiary) deltaic sequences, compaction disequilibrium is the dominant cause of abnormal pressure. In older (pre-Tertiary) lithified rocks, hydrocarbon generation, aquathermal expansion, and tectonics are most often cited as the causes of abnormal pressure. The association of abnormal pressures with hydrocarbon accumulations is statistically significant. Within abnormally pressured reservoirs, empirical evidence indicates that the bulk of economically recoverable oil and gas occurs in reservoirs with pressure gradients less than 0.75 psi/ft (17.4 kPa/m) and there is very little production potential from reservoirs that exceed 0.85 psi/ft (19.6 kPa/m). Abnormally pressured rocks are also commonly associated with unconventional gas accumulations where the pressuring phase is gas of either a thermal or microbial origin. In underpressured, thermally mature rocks, the affected reservoirs have most often experienced a significant cooling history and probably evolved from an originally overpressured system.

  7. The PEX study – Exercise therapy for patellofemoral pain syndrome: design of a randomized clinical trial in general practice and sports medicine [ISRCTN83938749

    Directory of Open Access Journals (Sweden)

    Verhaar Jan AN

    2006-03-01

    Full Text Available Abstract Background Patellofemoral complaints are frequently seen in younger and active patients. Clinical strategy is usually based on decreasing provoking activities as sports and demanding knee activities during work and leisure and reassuring the patient on the presumed good outcome. Exercise therapy is also often prescribed although evidence on effectiveness is lacking. The objective of this article is to present the design of a randomized clinical trial that examines the outcome of exercise therapy supervised by a physical therapist versus a clinically accepted "wait and see" approach (information and advice about the complaints only. The research will address to both effectiveness and cost effectiveness of supervised exercise therapy in patients with patellofemoral pain syndrome (PFPS. Methods/design 136 patients (adolescents and young adults with patellofemoral pain syndrome are recruited in general practices and sport medicine centers. They will be randomly allocated receiving either 3 months of exercise therapy (or usual care. The primary outcome measures are pain, knee function and perception of recovery after 3 months and 12 months of follow up and will be measured by self reporting. Measurements will take place at baseline, 6 weeks, and 3 monthly until 1 year after inclusion in the study. Secondary outcome measurements include an economic evaluation. A cost-utility analysis will be performed that expresses health improvements in Quality Adjusted Life Years (QALYs and incorporates direct medical costs and productivity costs Discussion This study has been designed after reviewing the literature on exercise therapy for patellofemoral pain syndrome. It was concluded that to merit the effect of exercise therapy a trial based on correct methodological concept needed to be executed. The PEX study is a randomized clinical trial where exercise therapy is compared to usual care. This trial started in April 2005 and will finish in June 2007

  8. Comparison of Static Force Sense of Knee Extension between Women with Patellofemoral Pain Syndrome and Healthy Women

    Directory of Open Access Journals (Sweden)

    Zahra Salah-Zadeh

    2008-01-01

    Full Text Available Objectives: Patellofemoaral pain syndrome (PFPS is a common musculoskeletal disorder. Proprioception is important factor in neuromuscular control. Others studies showed that, because of pain and abnormal stresses on soft tissue around joint and Proprioception may be change in these patients. The aim of this study was investigation of sense of quadriceps muscle force accuracy in patients with PFPS. Materials & Methods: In this cross-sectional and case –control study, thirty four young women with and without PFPS were participated. Biodex isokinetic dynamometer was used to measure isometric torque and sense of quadriceps static force. Force matching with ipsilateral limb was used by determining of reference force levels (20 and 60% of maximal voluntary isometric force (MVIF in 20 and 60 degree of knee flexion and attempting to perception and reproduction of target forces .Absolute error (AE, constant error (CE and variability error (VE were calculated for evaluation sense of force accuracy. Data were analyzed by independent T test and Logistics Regression. Results: There was statistically difference in force reproduction error in 60 degree and 60% MVIF between two groups (P<0.005. Sense of force errors were high in patient group. Conclusion: The results confirmed the past studies and showed that proprioception may be altered in PFPS patients because of changes proprioception afferents, specially for quadriceps muscle receptors.

  9. Association between magnetic resonance imaging, temporo-mandibular joint scanographic findings and clinical manifestations of joint pain and sounds in temporo-mandibular disorders

    International Nuclear Information System (INIS)

    Goodarzi Pour, D.; Rajaee, E.; Golestan, B.

    2010-01-01

    Exploring the association between magnetic resonance imaging, temporomandibular joint scanography and clinical manifestations of joint pain and sounds in patients with temporomandibular disorder. Patients and Methods: This study included 62 temporomandibular joints with internal derangement. Sagittal scanography and magnetic resonance imaging of these temporomandibular joints were obtained and reported blindly by the consensus of two radiologists. Results: No significant association was observed between clinical and scanographic findings with magnetic resonance imaging. The abnormal range of motion had significant relationship with pain (P=0.017) and sound (P=0.046). There was a strong association between sound and condylar flattening (P=0.007). Conclusion: It was demonstrated that joint pain and sounds were predictors of the abnormal range of motion in temporomandibular joint scanography. Sound could be heard more often in patients with condylar flattening, and temporomandibular joint scanographic findings as well as joint pain and sounds had limited value in the diagnosis of disk position or effusion.

  10. Reliability of Tubular Joints

    DEFF Research Database (Denmark)

    Sørensen, John Dalsgaard; Thoft-Christensen, Palle

    In this paper the preliminary results obtained by tests on tubular joints are presented. The joints are T-joints and the loading is static. It is the intention in continuation of these tests to perform tests on other types of joints (e.g. Y-joints) and also with dynamic loading. The purpose of th...

  11. Joint Instability and Osteoarthritis

    Directory of Open Access Journals (Sweden)

    Darryl Blalock

    2015-01-01

    Full Text Available Joint instability creates a clinical and economic burden in the health care system. Injuries and disorders that directly damage the joint structure or lead to joint instability are highly associated with osteoarthritis (OA. Thus, understanding the physiology of joint stability and the mechanisms of joint instability-induced OA is of clinical significance. The first section of this review discusses the structure and function of major joint tissues, including periarticular muscles, which play a significant role in joint stability. Because the knee, ankle, and shoulder joints demonstrate a high incidence of ligament injury and joint instability, the second section summarizes the mechanisms of ligament injury-associated joint instability of these joints. The final section highlights the recent advances in the understanding of the mechanical and biological mechanisms of joint instability-induced OA. These advances may lead to new opportunities for clinical intervention in the prevention and early treatment of OA.

  12. Joint Advanced Warfighting School

    National Research Council Canada - National Science Library

    Davis, Jon

    2003-01-01

    When the United States employs military power, it does so as a joint force. The cornerstone for effective joint force employment remains Service competency, but truly effective Service warfighters must think, plan and fight jointly...

  13. Somatosensory abnormalities in knee OA.

    Science.gov (United States)

    Wylde, Vikki; Palmer, Shea; Learmonth, Ian D; Dieppe, Paul

    2012-03-01

    The aim of this study was to use quantitative sensory testing (QST) to explore the range and prevalence of somatosensory abnormalities demonstrated by patients with advanced knee OA. One hundred and seven knee OA patients and 50 age- and sex-matched healthy participants attended a 1-h QST session. Testing was performed on the medial side of the knee and the pain-free forearm. Light-touch thresholds were assessed using von Frey filaments, pressure pain thresholds using a digital pressure algometer, and thermal sensation and pain thresholds using a Thermotest MSA. Significant differences in median threshold values from knee OA patients and healthy participants were identified using Mann-Whitney U-tests. The z-score transformations were used to determine the prevalence of the different somatosensory abnormalities in knee OA patients. Testing identified 70% of knee OA patients as having at least one somatosensory abnormality. Comparison of median threshold values between knee OA patients and healthy participants revealed that patients had localized thermal and tactile hypoaesthesia and pressure hyperalgesia at the osteoarthritic knee. Tactile hypoaesthesia and pressure hyperalgesia were also present at the pain-free forearm. The most prevalent somatosensory abnormalities were tactile hypoaesthesia and pressure hyperalgesia, evident in between 20 and 34% of patients. This study found that OA patients demonstrate an array of somatosensory abnormalities, of which the most prevalent were tactile hypoaesthesia and pressure hyperalgesia. Further research is now needed to establish the clinical implications of these somatosensory abnormalities.

  14. Patellofemoral knee pain treatment using neuromuscular retraining of the hip musculature in an adolescent female: a case report.

    Science.gov (United States)

    Frounfelter, Gregory G; Stutzriem, David E

    2011-10-01

    The purpose of this case study is to demonstrate the treatment of patella-femoral knee pain in an adolescent female athlete with emphasis on neuromuscular training of the knee and hip in synergy movement strategies. A 1.67-m, 61.5-kg, 15-year-old woman athlete reported to rehabilitation with the complaint of a 1-year history of bilateral knee pain. The patient noted that the symptoms were exacerbated with any sports-specific training. The patient played softball as an infielder. The athlete was referred by her family practice physician. After the patient was assessed, a clinical hypothesis was generated. It was thought that neuromuscular dysfunction of the hips and knees was causing faulty knee mechanics. These abnormal mechanics were presenting as patella-femoral knee pain. Initially, the athlete was assigned a home exercise program of side-lying hip abduction and lateral step-downs. At her first follow-up appointment, she noted increased symptoms that were aggravated with her home program. Upon inspecting her exercise technique, faulty step-down mechanics were contributing to her symptoms. Step-downs were discontinued, and the patient was instructed in and performed a chair squatting exercise, which was added to her home program. At her next follow-up, the patient noted being asymptomatic for 2 days. Her exercises were increased in intensity to include a Stairmaster and hip abduction and adduction on a 4-way hip machine. Eventually, over her treatment course, perturbation and proprioceptive training were initiated. By the sixth visit, the patient reported no symptoms and felt comfortable with self-management. A phone interview 3 months later indicated that the patient had no recurrent symptoms and was participating in sports without difficulty. This case demonstrates effectiveness of using hip and knee joint synergy to treat patella-femoral pain (PFP). The use of this synergy promotes proper patella–femoral alignment and improved knee mechanics. This case also

  15. Joint-dependent response to impact and implications for post-traumatic osteoarthritis.

    Science.gov (United States)

    Novakofski, K D; Berg, L C; Bronzini, I; Bonnevie, E D; Poland, S G; Bonassar, L J; Fortier, L A

    2015-07-01

    The prevalence of osteoarthritis (OA) varies between joints. Cartilage in eight different joints was evaluated to elucidate the disparate susceptibilities between joints to post-traumatic OA (PTOA) and provide evidence for joint-specific clinical treatments. The hypothesis was that cartilage in different joints would have varying cell death and anabolic gene expression profiles after injury. Adult equine cartilage explants were harvested from shoulder (SH), elbow (EL), carpal (CA), metacarpophalangeal (MC), patellofemoral (FP), tarsal (TA), metatarsophalangeal (MT), and proximal interphalangeal (PP) joints, and injured by loading with 30 MPa within 1 s. Fractional dissipated energy, cell density, cell death, and gene expression were quantified. PP had the highest fractional dissipated energy (94%, 95% confidence interval [CI] 88 to 101%). Cell density was highest in the superficial zone in all samples, with MC and MT having the highest peak density. Injured samples had significantly increased cell death (13.5%, 95% CI 9.1 to 17.9%) than non-injured samples (6.8%, 95% CI 2.5 to 11.1%, P = 0.016); however, cell death after injury was not significantly different between joints. Gene expression was significantly different between joints. CD-RAP expression in normal cartilage was lowest in FP (Cp = 21, 95% CI -80 to 122). After injury, the change in CD-RAP expression increased and was highest in FP (147% relative increase after injury, 95% CI 64 to 213). Different joints have different baseline characteristics, including cell density and gene expression, and responses to injury, including energy dissipation and gene expression. These unique characteristics may explain differences in OA prevalence and suggest differences in susceptibility to PTOA. Understanding differences in the response to injury and potential susceptibility to OA can lead to the development of preventative or treatment strategies. Gene expression, cartilage injury, chondrocyte

  16. International joint ventures

    DEFF Research Database (Denmark)

    Sørensen, Karsten Engsig

    2001-01-01

    The article analysis problems connected with corporate joint ventures. Among others the possible conflicts between the joint venture agreement and the statutes of the companies is examined, as well as certain problems connected to the fact that the joint venture partners have created commen control...... over their joint company....

  17. Adolescent knee pain and patellar dislocations are associated with patellofemoral osteoarthritis in adulthood: A case control study.

    Science.gov (United States)

    Conchie, Henry; Clark, Damian; Metcalfe, Andrew; Eldridge, Jonathan; Whitehouse, Michael

    2016-08-01

    There is a lack of information about the association between patellofemoral osteoarthritis (PFOA) and both adolescent anterior knee pain (AKP) and previous patellar dislocations. This case-control study involved 222 participants from our knee arthroplasty database answering a questionnaire. One hundred and eleven patients suffering from PFOA were 1:1 matched by gender with a unicompartmental tibiofemoral arthritis control group. Multivariate correlation and binary logistic regression analysis were performed, with odds ratios (ORs) and 95% confidence intervals (CIs) calculated. An individual is 7.5 times more likely to develop PFOA if they have suffered from adolescent AKP (OR 7.5, 95% CIs 1.51 to 36.94). Additionally, experiencing a patellar dislocation increases the likelihood of development of PFOA, with an adjusted odds ratio of 3.2 (95% CIs 1.25 to 8.18). A 44-year difference in median age of first dislocation was also observed between the groups. This should bring into question the traditional belief that adolescent anterior knee pain is a benign pathology. Patellar dislocation is also a significant risk factor. These patients merit investigation, we encourage clinical acknowledgement of the potential consequences when encountering patients suffering from anterior knee pain or patellar dislocation. Copyright © 2016. Published by Elsevier B.V.

  18. Dose-response effects of medical exercise therapy in patients with patellofemoral pain syndrome: a randomised controlled clinical trial.

    Science.gov (United States)

    Østerås, Berit; Østerås, Håvard; Torstensen, Tom Arild; Vasseljen, Ottar

    2013-06-01

    To evaluate two different therapeutic exercise regimens in patients with patellofemoral pain syndrome (PFPS). Multicentre, randomised controlled clinical trial. Three primary healthcare physiotherapy clinics. Forty-two patients with PFPS were assigned at random to an experimental group or a control group. Forty participants completed the study. Both groups received three treatments per week for 12 weeks. The experimental group received high-dose, high-repetition medical exercise therapy, and the control group received low-dose, low-repetition exercise therapy. The groups differed in terms of number of exercises, number of repetitions and sets, and time spent performing aerobic/global exercises. Outcome parameters were pain (measured using a visual analogue scale) and function [measured using the step-down test and the modified Functional Index Questionnaire (FIQ)]. At baseline, there were no differences between the groups. After the interventions, there were statistically significant (Pexercise therapy has a dose-response effect on pain and functional outcomes in patients with PFPS. This indicates that high-dose, high-repetition medical exercise therapy is more efficacious than low-dose, low-repetition exercise therapy for this patient group. Copyright © 2012 Chartered Society of Physiotherapy. Published by Elsevier Ltd. All rights reserved.

  19. A mini-invasive adductor magnus tendon transfer technique for medial patellofemoral ligament reconstruction: a technical note.

    Science.gov (United States)

    Sillanpää, Petri J; Mäenpää, Heikki M; Mattila, Ville M; Visuri, Tuomo; Pihlajamäki, Harri

    2009-05-01

    Patellar dislocations are associated with injuries to the medial patellofemoral ligament (MPFL). Several techniques for MPFL reconstruction have been recently published with some disadvantages involved, including large skin incisions and donor site morbidity. Arthroscopic stabilizing techniques carry the potential of inadequate restoration of MPFL function. We present a minimally invasive technique for MPFL reconstruction using adductor magnus tendon autograft. This technique is easily performed, safe, and provides a stabilizing effect equal to current MPFL reconstructions. Skin incision of only 3-4 cm is located at the level of the proximal half of the patella. After identifying the distal insertion of the adductor magnus tendon, a tendon harvester is introduced to harvest the medial two-thirds of the tendon, while the distal insertion is left intact. The adductor magnus tendon is cut at 12-14 cm from its distal insertion and transferred into the patellar medial margin. Two suture anchors are inserted through the same incision at the superomedial aspect of the patella in the anatomic MPFL origin. The graft is tightened at 30 degrees knee flexion. Aftercare includes 4 weeks of brace treatment with restricted range of motion.

  20. Effectiveness of different exercises and stretching physiotherapy on pain and movement in patellofemoral pain syndrome: a randomized controlled trial.

    Science.gov (United States)

    Moyano, F Revelles; Valenza, M C; Martin, L Martin; Caballero, Y Castellote; Gonzalez-Jimenez, E; Demet, G Valenza

    2013-05-01

    To compare the effectiveness of proprioceptive neuromuscular facilitation combined with exercise, classic stretching physiotherapy intervention, and educational intervention at improving patient function and pain in patients with patellofemoral pain syndrome. Randomized, controlled, blind trial over four months. Urban population, Spain. Patients undergoing primary care for retropatellar pain. Subjects were allocated on three different treatment options: a proprioceptive neuromuscular facilitation and aerobic exercise group, a classic stretching group, and a control treatment were applied over four months under the supervision of a physiotherapist. Knee Society Score, pain reported (Visual analogue scale) and knee range of motion. Assessments were completed at baseline and after four months. 74 patients were enrolled in the study and distributed between groups. Both the proprioceptive neuromuscular facilitation and classic stretching group showed significant changes in all variables after four months intervention (p stretching group vs. proprioceptive neuromuscular facilitation group vs. control group) at four months was -24.05 (95% confidence interval (CI) -30.19, -17.90), p ≤ 0.001; vs. -39.03 (95% confidence interval (CI) -42.5, -35.5), p ≤ 0.001; vs. -0.238 (95% confidence interval (CI) -1.2, 0.726), p = 0.621, respectively. A proprioceptive neuromuscular facilitation intervention protocol combined with aerobic exercise showed a better outcome than a classic stretching protocol after four months.

  1. Effects of Kinesio Taping® on knee function and pain in athletes with patellofemoral pain syndrome.

    Science.gov (United States)

    Aghapour, Elaheh; Kamali, Fahimeh; Sinaei, Ehsan

    2017-10-01

    To compare the knee performance and pain in athletes with patellofemoral pain syndrome (PFPS) before and after applying Kinesio Tape ® (KT) on vastus medialis obliquus (VMO) muscle. Fifteen participants (10 females, five males) with unilateral PFPS were examined and compared under taped and untaped conditions. VMO of the involved leg was taped from origin to insertion, with 75% of KT's maximal length tension. Maximal eccentric and concentric peak torques of quadriceps were measured at 60 and 180°/s angular velocities by an isokinetic dynamometer. Functional performance and pain were evaluated by functional tests (step-down and bilateral squat) and visual analog scale, respectively. Paired t-test showed statistically significant increase in VMO peak torque and also repetition of step-down test and bilateral squat after using KT. Pain intensity was also decreased significantly following KT application (p < 0.05). KT application over VMO can decrease pain and improve the functional performance, generally and quadriceps muscle strength, particularly, in athletes with PFPS. However, more research is needed to evaluate the long-term effects of this therapeutic procedure. Copyright © 2017 Elsevier Ltd. All rights reserved.

  2. Immediate effects of lumbopelvic manipulation and lateral gluteal kinesio taping on unilateral patellofemoral pain syndrome: a pilot study.

    Science.gov (United States)

    Miller, Joseph; Westrick, Richard; Diebal, Angela; Marks, Christopher; Gerber, J Parry

    2013-05-01

    To determine the immediate effects of Kinesio taping directed to the hip and manipulation directed to the lumbopelvic region in individuals with unilateral patellofemoral pain syndrome (PFPS). PFPS affects up to 25% of the general population. Despite the high prevalence, this condition is not clearly understood, as evidenced by the numerous proposed causes and recommended treatments. Notwithstanding, recent evidence suggests that treatments directed at the hip or spine may lead to beneficial results. A convenience sample of 18 participants (12 men and 6 women, 19.5 ± 1.15 years old) with unilateral PFPS was recruited. Participants were randomized by sex to 1 of 3 groups: Kinesio taping, manipulation, and control taping. The main outcome measures included the Y-balance test, squatting range of motion (ROM), and the Lower Extremity Functional Scale. Compared with the lumbopelvic manipulation and control groups, those in the Kinesio taping group performed significantly better on the Y-balance test (F = 5.59, P = 0.02) and with squatting ROM (F = 3.93, P = 0.04). The Kinesio taping and lumbopelvic groups were also significantly better than the control (sham) group with double-leg squatting ROM performance 3 days later. Kinesio taping may facilitate gluteus medius activation and improve postural stability and a double-leg squat. The improvement in affected limb reach and double-leg squatting ROM highlights the potential for Kinesio taping to improve gluteus medius activation. Lumbopelvic manipulation may also immediately improve rehabilitation programs for PFPS.

  3. The Effect of Kinesio Taping on Anterior Knee Pain Consistent With Patellofemoral Pain Syndrome: A Critically Appraised Topic.

    Science.gov (United States)

    Campbell, Samantha A; Valier, Alison R

    2016-08-01

    Patellofemoral pain syndrome (PFPS) occurs in 25% of adolescents and adults and is the leading cause of knee pain in runners. Pain is commonly felt when ascending or descending stairs, deep squatting, kneeling, or running. There is no consensus on the etiology of this condition, but insufficient hip strength, malalignment of the lower extremity, hyperpronation of the foot, and patellar incongruence have been suggested. Common treatments of PFPS include strengthening of quadriceps and hip muscles, McConnell taping, electrical stimulation, and foot orthotics, but effectiveness of these treatments is inconclusive. Kinesio Taping is an alternative taping technique for musculoskeletal injuries including PFPS. Although research suggests that Kinesio Taping decreases pain and improves range of motion for some musculoskeletal injuries, its effectiveness in decreasing pain in patients with PFPS in unknown. Furthermore, Kinesio Taping has not been compared with other taping techniques including McConnell taping. Focused Clinical Question: For patients with anterior knee pain consistent with PFPS, does treatment with Kinesio Taping decrease pain more than McConnell taping or no tape at all?

  4. Carryover effect of hip and knee exercises program on functional performance in individuals with patellofemoral pain syndrome.

    Science.gov (United States)

    Ahmed Hamada, Hamada; Hussein Draz, Amira; Koura, Ghada Mohamed; Saab, Ibtissam M

    2017-08-01

    [Purpose] This study was carried out to investigate the carryover effect of hip and knee exercises program on functional performance (single legged hop test as functional performance test and Kujala score for functional activities). [Subjects and Methods] Thirty patients with patellofemoral pain syndrome were randomly assigned into two equal groups. Group (A) consisted of 15 patients undergoing hip strengthening exercises for four weeks then measuring all variables followed by additional four weeks of knee exercises program then measuring all variables again. Group (B): consisted of 15 patients undergoing knee exercises program for four weeks then measuring all variables followed by additional four weeks of hip strengthening exercises then measuring all variables. Functional abilities and knee muscles performance were assessed using Kujala questionnaire and single legged hop test respectively pre and after the completion of the first 4 weeks then after 8 weeks for both groups. [Results] Significantly increase in Kujala questionnaire in group A compared with group B was observed. While, there were significant increase in single legged hop performance test in group B compared with group A. [Conclusion] Starting with hip exercises improve the performance of subjects more than functional activities while starting with knee exercises improve the functional activities of subjects more than performance.

  5. Q-angle in patellofemoral pain: relationship with dynamic knee valgus, hip abductor torque, pain and function

    Directory of Open Access Journals (Sweden)

    Gabriel Peixoto Leão Almeida

    2016-04-01

    Full Text Available OBJECTIVE: To investigate the relationship between the q-angle and anterior knee pain severity, functional capacity, dynamic knee valgus and hip abductor torque in women with patellofemoral pain syndrome (PFPS. METHODS: This study included 22 women with PFPS. The q-angle was assessed using goniometry: the participants were positioned in dorsal decubitus with the knee and hip extended, and the hip and foot in neutral rotation. Anterior knee pain severity was assessed using a visual analog scale, and functional capacity was assessed using the anterior knee pain scale. Dynamic valgus was evaluated using the frontal plane projection angle (FPPA of the knee, which was recorded using a digital camera during step down, and hip abductor peak torque was recorded using a handheld dynamometer. RESULTS: The q-angle did not present any significant correlation with severity of knee pain (r = -0.29; p = 0.19, functional capacity (r = -0.08; p = 0.72, FPPA (r = -0.28; p = 0.19 or isometric peak torque of the abductor muscles (r = -0.21; p = 0.35. CONCLUSION: The q-angle did not present any relationship with pain intensity, functional capacity, FPPA, or hip abductor peak torque in the patients with PFPS.

  6. Diagnostic accuracy of the electromyography parameters associated with anterior knee pain in the diagnosis of patellofemoral pain syndrome.

    Science.gov (United States)

    Ferrari, Deisi; Kuriki, Heloyse Uliam; Silva, Cristiano Rocha; Alves, Neri; Mícolis de Azevedo, Fábio

    2014-08-01

    To assess the diagnostic accuracy of the surface electromyography (sEMG) parameters associated with referred anterior knee pain in diagnosing patellofemoral pain syndrome (PFPS). Sensitivity and specificity analysis. Physical rehabilitation center and laboratory of biomechanics and motor control. Pain-free subjects (n=29) and participants with PFPS (n=22) selected by convenience. Not applicable. The diagnostic accuracy was calculated for sEMG parameters' reliability, precision, and ability to differentiate participants with and without PFPS. The selected sEMG parameter associated with anterior knee pain was considered as an index test and was compared with the reference standard for the diagnosis of PFPS. Intraclass correlation coefficient, SEM, independent t tests, sensitivity, specificity, negative and positive likelihood ratios, and negative and positive predictive values were used for the statistical analysis. The medium-frequency band (B2) parameter was reliable (intraclass correlation coefficient=.80-.90), precise (SEM=2.71-3.87 normalized unit), and able to differentiate participants with and without PFPS (Ppain showed positive diagnostic accuracy values (specificity, .87; sensitivity, .70; negative likelihood ratio, .33; positive likelihood ratio, 5.63; negative predictive value, .72; and positive predictive value, .86). The results provide evidence to support the use of EMG signals (B2-frequency band of 45-96 Hz) of the vastus lateralis and vastus medialis muscles with referred anterior knee pain in the diagnosis of PFPS. Copyright © 2014 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.

  7. Effects of Kinesio Taping versus McConnell Taping for Patellofemoral Pain Syndrome: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Wen-Dien Chang

    2015-01-01

    Full Text Available Objectives. To conduct a systematic review comparing the effects of Kinesio taping with McConnell taping as a method of conservative management of patients with patellofemoral pain syndrome (PFPS. Methods. MEDLINE, PUBMED, EMBASE, AMED, and the Cochrane Central Register of Control Trials electronic databases were searched through July 2014. Controlled studies evaluating the effects of Kinesio or McConnell taping in PFPS patients were retrieved. Results. Ninety-one articles were selected from the articles that were retrieved from the databases, and 11 articles were included in the analysis. The methods, evaluations, and results of the articles were collected, and the outcomes of patellar tapings were analyzed. Kinesio taping can reduce pain and increase the muscular flexibility of PFPS patients, and McConnell taping also had effect in pain relief and patellar alignment. Meta-analysis showed small effect in pain reduction and motor function improvement and moderate effect in muscle activity change among PFPS patients using Kinesio taping. Conclusions. Kinesio taping technique used for muscles can relieve pain but cannot change patellar alignment, unlike McConnell taping. Both patellar tapings are used differently for PFPS patients and substantially improve muscle activity, motor function, and quality of life.

  8. Post-traumatic changes of the temporo-mandibular joint by bone scintigraphy

    International Nuclear Information System (INIS)

    Harris, S.A.; Rood, J.P.; Testa, H.J.

    1988-01-01

    13 patients who sustained mandibular trauma were investigated with radiographs and scintiscans. The scintiscans showed abnormal uptake of radiopharmaceutical in the temporomandibular joint (TMJ). In patients with a long history of traumatic arthrosis, there was more positive correlation between the scintiscans, and clinical symptoms and histology than between radiographs, and symptoms and histology. In patients with mandibular body fractures and no TMJ symptoms, the scans showed abnormal uptake in the TMJ in 7/8 joints, in the absence of radiographic abnormality. The significance of the abnormal uptake and the value of scintigraphy is discussed. (author)

  9. Post-traumatic changes of the temporo-mandibular joint by bone scintigraphy

    Energy Technology Data Exchange (ETDEWEB)

    Harris, S.A.; Rood, J.P.; Testa, H.J.

    1988-01-01

    13 patients who sustained mandibular trauma were investigated with radiographs and scintiscans. The scintiscans showed abnormal uptake of radiopharmaceutical in the temporomandibular joint (TMJ). In patients with a long history of traumatic arthrosis, there was more positive correlation between the scintiscans, and clinical symptoms and histology than between radiographs, and symptoms and histology. In patients with mandibular body fractures and no TMJ symptoms, the scans showed abnormal uptake in the TMJ in 7/8 joints, in the absence of radiographic abnormality. The significance of the abnormal uptake and the value of scintigraphy is discussed.

  10. Neuroimaging abnormalities in Griscelli's disease

    International Nuclear Information System (INIS)

    Sarper, Nazan; Akansel, Guer; Aydogan, Metin; Gedikbasi, Demet; Babaoglu, Kadir; Goekalp, Ayse Sevim

    2002-01-01

    Griscelli's disease is a rare autosomal recessive immunodeficiency syndrome. We report a 7-1/2-month-old white girl who presented with this syndrome, but initially without neurological abnormalities. Initial CT of the brain was normal. Despite haematological remission with chemotherapy, she developed neurological symptoms, progressing to coma. At this time, CT showed areas of coarse calcification in the globi pallidi, left parietal white matter and left brachium pontis. Hypodense areas were present in the genu and posterior limb of the internal capsule on the right side, as well as posterior aspects of both thalami, together with minimal generalised atrophy. MRI revealed areas of increased T2 signal and a focal area of abnormal enhancement in the subcortical white matter. Griscelli's disease should be added to the list of acquired neuroimaging abnormalities in infants. (orig.)

  11. Relationships between rotator cuff tear types and radiographic abnormalities

    Energy Technology Data Exchange (ETDEWEB)

    Lee, Soo Hyun; Chun, Kyung Ah; Lee Soo Jung; Kang, Min Ho; Yi, Kyung Sik; Zhang, Ying [Dept. of Diagnostic Radiology, College of Medicine, Chungbuk National University, Cheongju (Korea, Republic of)

    2014-11-15

    To determine relationships between different types of rotator cuff tears and radiographic abnormalities. The shoulder radiographs of 104 patients with an arthroscopically proven rotator cuff tear were compared with similar radiographs of 54 age-matched controls with intact cuffs. Two radiologists independently interpreted all radiographs for; cortical thickening with subcortical sclerosis, subcortical cysts, osteophytes in the humeral greater tuberosity, humeral migration, degenerations of the acromioclavicular and glenohumeral joints, and subacromial spurs. Statistical analysis was performed to determine relationships between each type of rotator cuff tears and radiographic abnormalities. Inter-observer agreements with respect to radiographic findings were analyzed. Humeral migration and degenerative change of the greater tuberosity, including sclerosis, subcortical cysts, and osteophytes, were more associated with full-thickness tears (p < 0.01). Subacromial spurs were more common for full-thickness and bursal-sided tears (p < 0.01). No association was found between degeneration of the acromioclavicular or glenohumeral joint and the presence of a cuff tear. Different types of rotator cuff tears are associated with different radiographic abnormalities.

  12. Anterior knee pain following anterior cruciate ligament reconstruction does not increase the risk of patellofemoral osteoarthritis at 15- and 20-year follow-ups.

    Science.gov (United States)

    Culvenor, A G; Øiestad, B E; Holm, I; Gunderson, R B; Crossley, K M; Risberg, M A

    2017-01-01

    To prospectively evaluate the relationship between the presence or persistence of anterior knee pain (AKP) during the first 2-years following anterior cruciate ligament reconstruction (ACLR) and patellofemoral osteoarthritis (PFOA) at 15- and 20-years. This study was ancillary to a long-term prospective cohort study of 221 participants following bone-patellar-tendon-bone ACLR. AKP was assessed at 1- and 2-years post-ACLR using part of the Cincinnati knee score with an additional pain location question (persistence defined as presence at both follow-ups). Radiographic PFOA (definite patellofemoral osteophyte) and symptomatic PFOA (patellofemoral osteophyte, with knee pain during past 4 weeks) was assessed at 15- and 20-years follow-up. We used generalized linear models with Poisson regression to assess the relationship between AKP and PFOA. Of the 181 participants (82%) who were assessed at 15-years post-ACLR (age 39 ± 9 years; 42% female), 36 (24%) and 33 (22%) had AKP at 1- and 2-years, respectively, while 14 (8%) reported persistent AKP. Radiographic and symptomatic PFOA was observed at 15-years in 130 (72%) and 70 (39%) participants, respectively, and at 20-years in 115 (80%) and 60 (42%) participants, respectively. Neither the presence nor persistence of AKP at 1- and/or 2-years post-ACLR was associated with significantly higher risk of radiographic or symptomatic PFOA at 15- or 20-years (risk ratios <2.1). Although AKP and PFOA were prevalent, AKP does not appear to be associated with long-term PFOA following ACLR. Copyright © 2016 Osteoarthritis Research Society International. Published by Elsevier Ltd. All rights reserved.

  13. Improvements in kinematics, muscle activity and pain during functional tasks in females with patellofemoral pain following a single patterned electrical stimulation treatment.

    Science.gov (United States)

    Glaviano, Neal R; Huntsman, Stephanie; Dembeck, Ashley; Hart, Joseph M; Saliba, Susan

    2016-02-01

    Individuals with patellofemoral pain present with altered hip muscle activation, faulty movement patterns, and pain during functional tasks. Examining new treatment options to address these impairments may better treat those with patellofemoral pain. The purpose of this study was to determine if patterned electrical stimulation to the lower extremity affects muscle activity, movement patterns, and pain following a single treatment. Fifteen females with patellofemoral pain were randomized to receive a single 15-minute treatment of either a patterned electrical neuromuscular stimulation or a sham. Peak kinematics of the knee, hip, and trunk, electromyography and pain were examined pre and post-intervention during a single leg squat and lateral step-down task. Group means and pre/post reduced kinematic values were also plotted during the entire task with 90% confidence intervals to identify differences in movement strategies. No baseline differences were found in peak kinematics between groups. No pre to post-intervention differences in peak knee, hip and trunk kinematics were found, however differences were seen when the quality of movement across the entire tasks was assessed. The electrical stimulation group had improved knee flexion and hip abduction during the lateral step-down. A significant improvement in gluteus medius activation following patterned electrical neuromuscular stimulation occurred during the step-down (P=0.039). Significant pain improvements were also seen in both the single leg squat (P=0.025) and lateral step-down (P=0.006). A single treatment of patterned electrical neuromuscular stimulation improved muscle activation, lower extremity kinematics during functional tasks, and pain. Copyright © 2015 Elsevier Ltd. All rights reserved.

  14. Triorchidism: A Rare Genitourinary Abnormality

    African Journals Online (AJOL)

    During early adulthood it will be carried out by palpation, ultrasonography, semen analysis, serum testosterone and follicle stimulating hormone levels and during late adulthood follow up will be done by ultrasonography for malignancy every 2 years. CONCLUSION. Polyorchidism is a rare genitourinary abnormality and its.

  15. Chromosomal abnormalities associated with omphalocele.

    Science.gov (United States)

    Chen, Chih-Ping

    2007-03-01

    Fetuses with omphalocele have an increased risk for chromosomal abnormalities. The risk varies with maternal age, gestational age at diagnosis, association with umbilical cord cysts, complexity of associated anomalies, and the contents of omphalocele. There is considerable evidence that genetics contributes to the etiology of omphalocele. This article provides an overview of chromosomal abnormalities associated with omphalocele and a comprehensive review of associated full aneuploidy such as trisomy 18, trisomy 13, triploidy, trisomy 21, 45,X, 47,XXY, and 47,XXX, partial aneuploidy such as dup (3q), dup (11p), inv (11), dup (1q), del (1q), dup (4q), dup (5p), dup (6q), del (9p), dup (15q), dup(17q), Pallister-Killian syndrome with mosaic tetrasomy 12p and Miller-Dieker lissencephaly syndrome with deletion of 17p13.3, and uniparental disomy (UPD) such as UPD 11 and UPD 14. Omphalocele is a prominent marker for chromosomal abnormalities. Perinatal identification of omphalocele should alert chromosomal abnormalities and familial unbalanced translocations, and prompt thorough cytogenetic investigations and genetic counseling.

  16. Chromosomal Abnormalities Associated With Omphalocele

    Directory of Open Access Journals (Sweden)

    Chih-Ping Chen

    2007-03-01

    Full Text Available Fetuses with omphalocele have an increased risk for chromosomal abnormalities. The risk varies with maternal age, gestational age at diagnosis, association with umbilical cord cysts, complexity of associated anomalies, and the contents of omphalocele. There is considerable evidence that genetics contributes to the etiology of omphalocele. This article provides an overview of chromosomal abnormalities associated with omphalocele and a comprehensive review of associated full aneuploidy such as trisomy 18, trisomy 13, triploidy, trisomy 21, 45,X, 47,XXY, and 47,XXX, partial aneuploidy such as dup(3q, dup(11p, inv(11, dup(1q, del(1q, dup(4q, dup(5p, dup(6q, del(9p, dup(15q, dup(17q, Pallister-Killian syndrome with mosaic tetrasomy 12p and Miller-Dieker lissencephaly syndrome with deletion of 17p13.3, and uniparental disomy (UPD such as UPD 11 and UPD 14. Omphalocele is a prominent marker for chromosomal abnormalities. Perinatal identification of omphalocele should alert chromosomal abnormalities and familial unbalanced translocations, and prompt thorough cytogenetic investigations and genetic counseling.

  17. Admission haematological abnormalities and postoperative ...

    African Journals Online (AJOL)

    Admission haematological abnormalities and postoperative outcomes in neonates with acute surgical conditions in Alexandria, Egypt. HL Wella, SMM Farahat. Abstract. No Abstract. Full Text: EMAIL FREE FULL TEXT EMAIL FREE FULL TEXT · DOWNLOAD FULL TEXT DOWNLOAD FULL TEXT · AJOL African Journals ...

  18. Synovial folds in the knee joint. The plica parapatellaris medialis

    Energy Technology Data Exchange (ETDEWEB)

    Schaefer, H.

    1987-12-01

    Stimulated by arthroscopic insight into central abnormalities of the knee joint and by the large number of unexplained case of 'anterior knee pain', we have studied the synovia in more than 2000 contrast examinations of the joint. Surprisingly, and contrary to the views expressed in the literature, the clinically significant plica parapatellaris medialis was seen as frequently during pneumo-arthrography as during more complex procedures. Abnormalities in the synovial fold emerged as a discreet disease identified as the 'medial shelf syndrome' and should be included in the differential diagnosis of causes of pain round the lower end of the femur and patella.

  19. A retrospective study of radiographic abnormalities in the repositories for Thoroughbreds at yearling sales in Japan

    OpenAIRE

    MIYAKOSHI, Daisuke; SENBA, Hiroyuki; SHIKICHI, Mitsumori; MAEDA, Masaya; SHIBATA, Ryo; MISUMI, Kazuhiro

    2017-01-01

    This study aimed to evaluate whether radiographic abnormalities at yearling sales were associated with the failure to start racing at 2–3 years of age. Radiographic abnormalities in the carpal (n=852), tarsal (n=976), metacarpophalangeal (n=1,055), and metatarsophalangeal joints (n=1,031) from 1,082 horses, recorded at yearling sale, were reviewed. Eighty-two horses (7.6%) failed to start racing. Radiographic abnormalities such as wedged or collapsed tarsal bones, irregular lucency of a sagit...

  20. Dynamic magnetic resonance imaging of the metacarpophalangeal joints in rheumatoid arthritis, early unclassified polyarthritis, and healthy controls

    DEFF Research Database (Denmark)

    Klarlund, Mette; Østergaard, Mikkel; Rostrup, Egill

    2000-01-01

    .00001). From the healthy control group, an upper limit (mean+2SD) of normal enhancement was established for the 2nd to 5th MCP joints, which served to identify abnormal EE rates in the corresponding joints of patients. The patients had higher EE rates in the 2nd to 5th MCP joints than had the healthy controls...

  1. A retrospective study of radiographic abnormalities in the repositories for Thoroughbreds at yearling sales in Japan

    Science.gov (United States)

    MIYAKOSHI, Daisuke; SENBA, Hiroyuki; SHIKICHI, Mitsumori; MAEDA, Masaya; SHIBATA, Ryo; MISUMI, Kazuhiro

    2017-01-01

    This study aimed to evaluate whether radiographic abnormalities at yearling sales were associated with the failure to start racing at 2–3 years of age. Radiographic abnormalities in the carpal (n=852), tarsal (n=976), metacarpophalangeal (n=1,055), and metatarsophalangeal joints (n=1,031) from 1,082 horses, recorded at yearling sale, were reviewed. Eighty-two horses (7.6%) failed to start racing. Radiographic abnormalities such as wedged or collapsed tarsal bones, irregular lucency of a sagittal ridge at the distal aspect of the distal third metatarsal bone, and proximal dorsal fragmentation of the first phalanx in metatarsophalangeal joints were associated with failure to start racing in these horses. In the follow-up survey of 12 horses with one or more these radiographic abnormalities, the horses failed to start racing due to reasons unrelated to these radiographic abnormalities such as pelvic fractures (2 horses), fracture of a distal phalanx (1 horse), cervical stenotic myelopathy and proximal sesamoid fracture (1 horse), superficial digital flexor tendonitis (2 horses), laryngeal hemiplegia (1 horse), economic problems (2 horses) and unknown causes (3 horses). Although radiographic abnormalities at yearling sales can be associated with failure to start racing at 2–3 years of age, these radiographically detected abnormalities might not necessarily cause that failure. PMID:28993565

  2. A retrospective study of radiographic abnormalities in the repositories for Thoroughbreds at yearling sales in Japan.

    Science.gov (United States)

    Miyakoshi, Daisuke; Senba, Hiroyuki; Shikichi, Mitsumori; Maeda, Masaya; Shibata, Ryo; Misumi, Kazuhiro

    2017-11-10

    This study aimed to evaluate whether radiographic abnormalities at yearling sales were associated with the failure to start racing at 2-3 years of age. Radiographic abnormalities in the carpal (n=852), tarsal (n=976), metacarpophalangeal (n=1,055), and metatarsophalangeal joints (n=1,031) from 1,082 horses, recorded at yearling sale, were reviewed. Eighty-two horses (7.6%) failed to start racing. Radiographic abnormalities such as wedged or collapsed tarsal bones, irregular lucency of a sagittal ridge at the distal aspect of the distal third metatarsal bone, and proximal dorsal fragmentation of the first phalanx in metatarsophalangeal joints were associated with failure to start racing in these horses. In the follow-up survey of 12 horses with one or more these radiographic abnormalities, the horses failed to start racing due to reasons unrelated to these radiographic abnormalities such as pelvic fractures (2 horses), fracture of a distal phalanx (1 horse), cervical stenotic myelopathy and proximal sesamoid fracture (1 horse), superficial digital flexor tendonitis (2 horses), laryngeal hemiplegia (1 horse), economic problems (2 horses) and unknown causes (3 horses). Although radiographic abnormalities at yearling sales can be associated with failure to start racing at 2-3 years of age, these radiographically detected abnormalities might not necessarily cause that failure.

  3. MP Joint Arthritis

    Science.gov (United States)

    ... Find a Hand Surgeon Home Anatomy MP Joint Arthritis Email to a friend * required fields From * To * ... important for both pinching and gripping. MP joint arthritis is most common in the thumb and index ...

  4. Detection of degenerative disease of the temporomandibular joint by bone scintigraphy: concise communication

    International Nuclear Information System (INIS)

    Goldstein, H.A.; Bloom, C.Y.

    1980-01-01

    Nine patients with facial pain were evaluated with limited bone scans. The scintigrams correlated with microscopy in all patients, although radiographs correlated with microscopy in only five patients. The degenerative disease process in the temporomandibular joint was more extensive in the patients with radiographic and scintigraphic abnormalities than in those with scintigraphic abnormalities alone. The limited bone scan appears useful in detecting early degenerative changes in the temporomandibular joint

  5. Managing Joint Production Motivation

    DEFF Research Database (Denmark)

    Lindenberg, Siegwart; Foss, Nicolai Juul

    2011-01-01

    We contribute to the microfoundations of organizational performance by proffering the construct of joint production motivation. Under such motivational conditions individuals see themselves as part of a joint endeavor, each with his or her own roles and responsibilities; generate shared...... representations of actions and tasks; cognitively coordinate cooperation; and choose their own behaviors in terms of joint goals. Using goal-framing theory, we explain how motivation for joint production can be managed by cognitive/symbolic management and organizational design....

  6. Design of mechanical joints

    CERN Document Server

    Blake, Alexander

    2018-01-01

    A cornerstone publication that covers the basic principles and practical considerations of design methodology for joints held by rivets, bolts, weld seams, and adhesive materials, Design of Mechanical Joints gives engineers the practical results and formulas they need for the preliminary design of mechanical joints, combining the essential topics of joint mechanics...strength of materials...and fracture control to provide a complete treatment of problems pertinent to the field of mechanical connections.

  7. The Effects of a Multimodal Rehabilitation Program on Symptoms and Ground-Reaction Forces in Runners With Patellofemoral Pain Syndrome.

    Science.gov (United States)

    Esculier, Jean-Francois; Bouyer, Laurent J; Roy, Jean-Sébastien

    2016-02-01

    Patellofemoral pain (PFP) is one of the most frequent running-related injuries. However, few interventions taking into consideration the specificity of running have been shown to be effective in runners with PFP. To evaluate the effects of a multimodal rehabilitation program including lower-limb-strengthening/ motor-control exercises, advice on running biomechanics, and symptoms management on symptoms, strength, and ground-reaction forces in runners with PFP. Pre- to post- quasi-experimental. Gait-analysis laboratory and private physical therapy clinic. 21 runners with PFP (34.1 ± 6.0 y old, symptoms duration 38.1 ± 45.5 mo). An 8-wk multimodal rehabilitation program including lower-limb- and core-strengthening and motor-control exercises, as well as advice on running gait and symptoms management. The Activities of Daily Living Scale of the Knee Outcome Survey (KOS-ADLS) questionnaire and visual analog scales for usual pain (VAS-U), worst pain (VAS-W), and pain during running (VAS-R) were used to assess changes in symptoms and function. Vertical ground-reaction forces (VGRF) during running and lower-limb isometric strength were also measured. Statistically and clinically significant improvements (P < .001) were reported on KOS-ADLS (+17.8 pts), VAS-U (-19.2 pts), VAS-W (-28.7 pts), and VAS-R (-32.2 pts) after the intervention. No significant changes in isometric strength were observed. The instantaneous vertical loading rate was decreased after the intervention (P = .002), and this reduction was correlated with changes in KOS-ADLS scores (P = .028). This multimodal intervention was successful in reducing pain and improving function of runners with PFP. However, no significant changes in lower-limb strength were observed. It appears that changes in VGRF combined with appropriate training advice could explain the clinical outcomes.

  8. Outcomes following Hip and Quadriceps Strengthening Exercises for Patellofemoral Syndrome: A Systematic Review and Meta-Analysis

    Directory of Open Access Journals (Sweden)

    Adebisi Bisi-Balogun

    2015-10-01

    Full Text Available There is growing evidence to support change in the rehabilitation strategy of patellofemoral pain syndrome (PFPS from traditional quadriceps strengthening exercises to inclusion of hip musculature strengthening in individuals with PFPS. Several studies have evaluated effects of quadriceps and hip musculature strengthening on PFPS with varying outcomes on pain and function. This systematic review and meta-analysis aims to synthesize outcomes of pain and function post-intervention and at follow-up to determine whether outcomes vary depending on the exercise strategy in both the short and long term. Electronic databases including MEDLINE, EMBASE, CINAHL, Web of Science, PubMed, Pedro database, Proquest, Science direct, and EBscoHost databases were searched for randomized control trials published between 1st of January 2005 and 31st of June 2015, comparing the outcomes of pain and function following quadriceps strengthening and hip musculature strengthening exercises in patients with PFPS. Two independent reviewers assessed each paper for inclusion and quality. Means and SDs were extracted from each included study to allow effect size calculations and comparison of results. Six randomized control trials met the inclusion criteria. Limited to moderate evidence indicates that hip abductor strengthening was associated with significantly lower pain post-intervention (SMD −0.88, −1.28 to −0.47 95% CI, and at 12 months (SMD −3.10, −3.71 to −2.50 95% CI with large effect sizes (greater than 0.80 compared to quadriceps strengthening. Our findings suggest that incorporating hip musculature strengthening in management of PFPS tailored to individual ability will improve short-term and long-term outcomes of rehabilitation. Further research evaluating the effects of quadriceps and hip abductors strengthening focusing on reduction in anterior knee pain and improvement in function in management of PFPS is needed.

  9. Strengthening of the hip and core versus knee muscles for the treatment of patellofemoral pain: a multicenter randomized controlled trial.

    Science.gov (United States)

    Ferber, Reed; Bolgla, Lori; Earl-Boehm, Jennifer E; Emery, Carolyn; Hamstra-Wright, Karrie

    2015-04-01

    Patellofemoral pain (PFP) is the most common injury in running and jumping athletes. Randomized controlled trials suggest that incorporating hip and core strengthening (HIP) with knee-focused rehabilitation (KNEE) improves PFP outcomes. However, no randomized controlled trials have, to our knowledge, directly compared HIP and KNEE programs. To compare PFP pain, function, hip- and knee-muscle strength, and core endurance between KNEE and HIP protocols after 6 weeks of rehabilitation. We hypothesized greater improvements in (1) pain and function, (2) hip strength and core endurance for patients with PFP involved in the HIP protocol, and (3) knee strength for patients involved in the KNEE protocol. Randomized controlled clinical trial. Four clinical research laboratories in Calgary, Alberta; Chicago, Illinois; Milwaukee, Wisconsin; and Augusta, Georgia. Of 721 patients with PFP screened, 199 (27.6%) met the inclusion criteria (66 men [31.2%], 133 women [66.8%], age = 29.0 ± 7.1 years, height = 170.4 ± 9.4 cm, weight = 67.6 ± 13.5 kg). Patients with PFP were randomly assigned to a 6-week KNEE or HIP protocol. Primary variables were self-reported visual analog scale and Anterior Knee Pain Scale measures, which were conducted weekly. Secondary variables were muscle strength and core endurance measured at baseline and at 6 weeks. Compared with baseline, both the visual analog scale and the Anterior Knee Pain Scale improved for patients with PFP in both the HIP and KNEE protocols (P KNEE group. Both groups increased in strength (P KNEE group. Both the HIP and KNEE rehabilitation protocols produced improvements in PFP, function, and strength over 6 weeks. Although outcomes were similar, the HIP protocol resulted in earlier resolution of pain and greater overall gains in strength compared with the KNEE protocol.

  10. Greek cultural adaption and validation of the Kujala anterior knee pain scale in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Papadopoulos, Costas; Constantinou, Antonis; Cheimonidou, Areti-Zoi; Stasinopoulos, Dimitrios

    2017-04-01

    To cross-culturally adapt and validate the Greek version of the Kujala anterior knee pain scale (KAKPS). The Greek KAKPS was translated from the original English version following standard forward and backward translation procedures. The survey was then conducted in clinical settings by a questionnaire comprising the Greek KAKPS and patellofemoral pain syndrome (PFPS) severity scale. A total of 130 (62 women and 68 men) Greek-reading patients between 18 and 45 years old with anterior knee pain (AKP) for at least four weeks were recruited from physical therapy clinics. To establish test-retest reliability, the patients were asked to complete the KAKPS at initial visit and 2-3 days after the initial visit. The Greek version of the PFPS severity scale was also administered once at initial visit. Internal consistency of the translated instrument was measured using Cronbach's α. An intraclass correlation coefficient was used to assess the test-retest reliability of the KAKPS. Concurrent validity was measured by correlating the KAKPS with the PFPS severity scale using Pearson's correlation coefficient. The results showed that the Greek KAKPS has good internal consistency (Cronbach's α = 0.942), test-retest reliability (ICC = 0.921) and concurrent validity (r > 0.7). This study has shown that the Greek KAKPS has good internal consistency, test-retest reliability and concurrent validity when correlated with the PFPS severity scale in adult patients with AKP for at least four weeks. Implications for rehabilitation The Greek version of the KAKPS has been found to be reliable and valid when used in adult patients with AKP for at least four weeks. The results of the psychometric characteristics were compatible with those of the original English version. The KAKPS could be applied in a Greek-speaking population to assess functional limitations and symptoms in patients aged 18-45 years old with AKP for at least four weeks.

  11. Predictors of treatment response to strengthening and stretching exercises for patellofemoral pain: An examination of patellar alignment.

    Science.gov (United States)

    Peng, Hsien-Te; Song, Chen-Yi

    2015-12-01

    Closed kinetic chain and quadriceps strengthening, combined with flexibility exercises of the lower limb musculature, is a common treatment for patellofemoral pain syndrome (PFPS). The effectiveness has been well documented; however, very little is known about which factors predict treatment success. A total of 43 female subjects with PFPS participated in an eight-week progressive leg press (LP) strengthening and stretching exercise program. A decrease of 1.5 cm on a 10 cm visual analog scale (VAS) score was used as an indicator for treatment success. The baseline patellar tilt angle difference (PTA-d) due to quadriceps contraction prior to treatment was evaluated as a predictor of treatment success. The logistic regression and receiver operating characteristics (ROC) curve analysis were performed to investigate the predictive value of PTA-d. PTA-d could significantly predict the treatment success of LP strengthening and stretching exercises. The odds ratio (OR) for having an unsuccessful outcome was 1.19 (95% confidence interval (CI), 1.03-1.39, Pstretching exercise was -1.5° of PTA-d (sensitivity=0.74, specificity=0.71). The area under the ROC curve was 0.73 (standard error=0.08). Female patients with PFPS whose quadriceps contraction reduced the lateral patellar tilt prior to LP strengthening and stretching exercise treatment are more likely to experience pain relief. It seems clinically important to check dynamic patellar tilt characteristics before treatment to aid in clinical decision making. Copyright © 2014 Elsevier B.V. All rights reserved.

  12. Capturing patient-reported area of knee pain: a concurrent validity study using digital technology in patients with patellofemoral pain.

    Science.gov (United States)

    Matthews, Mark; Rathleff, Michael S; Vicenzino, Bill; Boudreau, Shellie A

    2018-01-01

    Patellofemoral pain (PFP) is often reported as a diffuse pain at the front of the knee during knee-loading activities. A patient's description of pain location and distribution is commonly drawn on paper by clinicians, which is difficult to quantify, report and compare within and between patients. One way of overcoming these potential limitations is to have the patient draw their pain regions using digital platforms, such as personal computer tablets. To assess the validity of using computer tablets to acquire a patient's knee pain drawings as compared to paper-based records in patients with PFP. Patients ( N = 35) completed knee pain drawings on identical images (size and colour) of the knee as displayed on paper and a computer tablet. Pain area expressed as pixel density, was calculated as a percentage of the total drawable area for paper and digital records. Bland-Altman plots, intraclass correlation coefficient (ICC), Pearson's correlation coefficients and one-sample tests were used in data analysis. No significant difference in pain area was found between the paper and digital records of mapping pain area ( p = 0.98), with the mean difference = 0.002% (95% CI [-0.159-0.157%]). A very high agreement in pain area between paper and digital pain drawings (ICC = 0.966 (95% CI [0.93-0.98], F = 28.834, df = 31, p digital drawings. Pain drawings as acquired using paper and computer tablet are equivalent in terms of total area of reported knee pain. The advantages of digital recording platforms, such as quantification and reporting of pain area, could be realized in both research and clinical settings.

  13. Effect of Knee Isokinetic Extension Training with Maximum Lateral Tibial Rotation on Vastus Amplitudes in Patellofemoral Pain Syndrome Patients

    Directory of Open Access Journals (Sweden)

    Seyyed Hossein Hosseini

    2016-01-01

    Full Text Available Objective: Patellofemoral pain syndrome (PFPS is one of the most common knee chronic disorders especially among females that is closely related to forces imbalance of vastus medial is oblique (VMO and vastus lateral is (VL muscles. The purpose of study was to examine the effect of knee isokinetic extension in maximum lateral tibia rotation on VMO and VL amplitudes in PFPS patients. Materials & Methods:  Thirty-six women with PFPS participated voluntarily in this study and were randomly placed in one of three groups included the VMO selective isokinetic strengthening exercise, quadriceps general strengthening and control groups. Each exercise was performed for 8 weeks. Muscle RMS of VMO and VL and VMO/VL RMS ratio were recorded and calculated before and after training using of an 8-channels electromyography system. Data analysis was made by analyses of variance with repeated measures. Results: In baseline, VMO amplitude was less than VL in all groups (P≤0.05, but after interventions, it was more than VL in selective group (P=0.01 and less than VL in general (P=0.001 and control (P=0.036 groups. Before interventions, there was no difference between groups in muscles amplitude (P>0.05. Yet, after interventions, VMO amplitude and VMO/VL amplitude ratio were more in selective group than in general and control groups (P≤0.001, and VL amplitude was more in general group than in selective and control groups (P≤0.01. Conclusion: According to the study results, isokinetic extension training with maximum lateral tibia rotation and in close to knee full extension can be recommended as an appropriate training for improving VMO/VL electrical activity ratio and decreasing imbalance between lateral and medial vastus muscles amplitudes in patients with PFPS.

  14. Evaluation of medial patellofemoral ligament tears after acute lateral patellar dislocation: comparison of high-frequency ultrasound and MR

    International Nuclear Information System (INIS)

    Zhang, Guang-Ying; Ding, Hong-Yu; Zheng, Lei; Sun, Bai-Sheng; Li, En-Miao; Shi, Hao

    2015-01-01

    The purpose of this study was to compare the diagnostic performance of high-frequency ultrasound with MR in the evaluation of medial patellofemoral ligament (MPFL) lesions after acute lateral patellar dislocation (LPD). High-frequency ultrasound and MR images were prospectively obtained in 97 consecutive patients with acute LPD. Images were acquired using standardised protocols and were independently evaluated by two radiologists. The MPFL was assessed at three sites (patellar insertion, femoral attachment, and mid-substance) for signs of injury. Of a total of 291 sites in 97 MPFLs, 127 showed proven MPFL tear at surgery, including 51 sites of complete tear and 76 sites of partial tear. In a site-based analysis, the sensitivity, specificity, and accuracy of high-frequency ultrasound was 90.8 %, 96.3 %, and 94.6 %, respectively, for partial MPFL tear and 86.3 %, 96.3 %, and 94 %, respectively, for complete tear. For MR, the sensitivity, specificity, and accuracy was 81.6 %, 95.7 %, and 91.3 %, respectively, for partial MPFL tear and 80.4 %, 95.7 %, and 92.1 %, respectively, for complete tear. There was no statistical difference between high-frequency ultrasound and MR in the assessment of partial (P = 0.1, 0.777, 0.155) or complete (P = 0.425, 0.777, 0.449) MPFL lesions. Interobserver agreement was very good for high-frequency ultrasound and good for MR. Data suggest that high-frequency ultrasound and MR have similar diagnostic performance in the evaluation of MPFL lesions after acute LPD. (orig.)

  15. Echocardiographic abnormalities in hypertensive patients

    International Nuclear Information System (INIS)

    Rodulfo Garcia, Maikel; Tornes Perez, Victor Manuel; Castellanos Tardo, Juan Ramon

    2012-01-01

    A descriptive cross-sectional study was carried out in 120 hypertensive patients with a course of 5 or more years, who went to the emergency room of 'Saturnino Lora' Provincial Teaching Hospital from November 2010 to November 2011 in order to determine the presence or absence of echocardiographic abnormalities typical of hypertension. Of these, 78,3 % was affected, most of whom reported not to continue with regular previous medical treatment, and 21,7 % had not these abnormalities. Age group of 50-60 years, males and blacks prevailed in the case material. The most significant echocardiographic findings were left ventricular hypertrophy and heart failure with ejection fraction of left ventricle preserved

  16. Glial abnormalities in mood disorders.

    Science.gov (United States)

    Öngür, Dost; Bechtholt, Anita J; Carlezon, William A; Cohen, Bruce M

    2014-01-01

    Multiple lines of evidence indicate that mood disorders are associated with abnormalities in the brain's cellular composition, especially in glial cells. Considered inert support cells in the past, glial cells are now known to be important for brain function. Treatments for mood disorders enhance glial cell proliferation, and experimental stimulation of cell growth has antidepressant effects in animal models of mood disorders. These findings suggest that the proliferation and survival of glial cells may be important in the pathogenesis of mood disorders and may be possible targets for the development of new treatments. In this article we review the evidence for glial abnormalities in mood disorders, and we discuss glial cell biology and evidence from postmortem studies of mood disorders. The goal is not to carry out a comprehensive review but to selectively discuss existing evidence in support of an argument for the role of glial cells in mood disorders.

  17. Abnormal Metabolite in Alcoholic Subjects,

    Science.gov (United States)

    1982-01-01

    0.01 0.12 81 A.A. 51 M 0 ɘ.01 0.09 Schizophrenia 85a W.G. 67 M 0 ɘ.01 0.21 Proteins & Ketones in Urine b 0 ɘ.01 0.11 86a W.H. 67 M 0 ɘ.01 0.15 b 0...AD-AS 90 TOTTS GAP MEDICAL RESEARCH LABS INC BANGOR PA F/G 6/5 ABNORMAL METABOLITE IN ALCOHOLIC SUBJECTS, U) 1982 R L BEECH, M E FELVER, M R...LAKSCHMANAN NOOBIN 70 C 0233 UNJCLASSIFIED NL I ,I/ ABNORMAL METABOLITE IN ALCOHOLIC SUBJECTS Richard L . Veech, Michael E. Felver, M.R. Lakschmanan, Stewart

  18. A Prospective Investigation of Biomechanical Risk Factors for Patellofemoral Pain Syndrome. The Joint Undertaking to Monitor and Prevent ACL Injury (JUMP-ACL) Cohort

    Science.gov (United States)

    2009-09-24

    varus were determined during the stance phase. The stance phase was defined as the period between initial ground contact with the force plate until...BW·ht) −0.06 ± 0.03 −0.08 ± 0.05 4.64 .03 Knee extension moment (%BW·ht) −0.21 ± 0.05 −0.23 ± 0.05 4.70 .03 Knee varus moment (%BW·ht) 0.05 ± 0.03...0.69,4.42 6.37 .23 1.54 0.54,4.37 8.09 .42 Knee extension moment (%BW·ht) 2.00 0.79,5.05 6.38 .14 1.69 0.57,5.01 8.80 .34 Knee varus moment

  19. Computed tomography abnormalities in hanging

    International Nuclear Information System (INIS)

    Bianco, F.; Floris, R.

    1987-01-01

    The CT pattern of bilateral and symmetrical round low density areas in the globi pallidi has been observed in a young man who attempted suicide by hanging. These CT abnormalities are similar to those described in other conditions such as carbon monoxide, hydrogen sulfide, cyanide and methanol poisoning, hypoglycaemia, drowning and acute global central nervous system hypoperfusion.The findings appear to be correlated with acute cerebral hypoxia. (orig.)

  20. GLIAL ABNORMALITIES IN MOOD DISORDERS

    OpenAIRE

    Öngür, Dost; Bechtholt, Anita J.; Carlezon, William A.; Cohen, Bruce M.

    2014-01-01

    Multiple lines of evidence indicate that mood disorders are associated with abnormalities in the brain's cellular composition, especially in glial cells. Considered inert support cells in the past, glial cells are now known to be important for brain function. Treatments for mood disorders enhance glial cell proliferation, and experimental stimulation of cell growth has antidepressant effects in animal models of mood disorders. These findings suggest that the proliferation and survival of glia...

  1. Mastoid abnormalities in Down syndrome

    International Nuclear Information System (INIS)

    Glass, R.B.J.; Yousefzadeh, D.K.; Roizen, N.J.

    1989-01-01

    Hearing loss and otitis media are commonly associated with Down syndrome. Hypoplasia of the mastoids is seen in many affected children and sclerosis of mastoid bones is not uncommon in Down syndrome. Awareness and early recognition of mastoid abnormality may lead to appropriate and timely therapy, thereby preserving the child's hearing or compensating for hearing loss; factors which are important for learning and maximum development. (orig.)

  2. Mastoid abnormalities in Down syndrome

    Energy Technology Data Exchange (ETDEWEB)

    Glass, R.B.J.; Yousefzadeh, D.K.; Roizen, N.J.

    1989-06-01

    Hearing loss and otitis media are commonly associated with Down syndrome. Hypoplasia of the mastoids is seen in many affected children and sclerosis of mastoid bones is not uncommon in Down syndrome. Awareness and early recognition of mastoid abnormality may lead to appropriate and timely therapy, thereby preserving the child's hearing or compensating for hearing loss; factors which are important for learning and maximum development.

  3. Abnormal uterine bleeding in perimenopause.

    Science.gov (United States)

    Goldstein, S R; Lumsden, M A

    2017-10-01

    Abnormal uterine bleeding is one of the commonest presenting complaints encountered in a gynecologist's office or primary-care setting. The wider availability of diagnostic tools has allowed prompt diagnosis and treatment of an increasing number of menstrual disorders in an office setting. This White Paper reviews the advantages and disadvantages of transvaginal ultrasound, blind endometrial sampling and diagnostic hysteroscopy. Once a proper diagnosis has been established, appropriate therapy may be embarked upon. Fortunately, only a minority of such patients will have premalignant or malignant disease. When bleeding is sufficient to cause severe anemia or even hypovolemia, prompt intervention is called for. In most of the cases, however, the abnormal uterine bleeding will be disquieting to the patient and significantly affect her 'quality of life'. Sometimes, reassurance and expectant management will be sufficient in such patients. Overall, however, in cases of benign disease, some intervention will be required. The use of oral contraceptive pills especially those with a short hormone-free interval, the insertion of the levonorgestrel intrauterine system, the incorporation of newer medical therapies including antifibrinolytic drugs and selective progesterone receptor modulators and minimally invasive treatments have made outpatient therapy increasingly effective. For others, operative hysteroscopy and endometrial ablation are proven therapeutic tools to provide both long- and short-term relief of abnormal uterine bleeding, thus avoiding, or deferring, hysterectomy.

  4. [Amyoplasia congenita: a serious congenital abnormality with a relatively favorable prognosis

    NARCIS (Netherlands)

    Petru, R.; Verrips, A.; Ravenswaaij-Arts, C.M.A. van

    2002-01-01

    After an uneventful pregnancy a girl was born with serious joint contractures and several fractures of the long bones. The family history was negative for congenital abnormalities. Based on the distinct clinical presentation the diagnosis was 'amyoplasia', which is a partial aplasia of skeletal

  5. The Vastus Medialis Oblique: Vastus Lateralis Electromyographic Intensity Ratio During Squat with Hip Adduction in Athletes with and Without Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Farhad Reza-zadeh

    2012-07-01

    Full Text Available Objective: This study was designed to compare vastus medialis oblique (VMO: vastus lateralis longus (VLL electromyographic intensity ratio during squat with hip adduction in athletes with and without patellofemoral pain syndrome (PFPS. Materials & Methods: In this non-experimental and case-control study, 16 male athletes with PFPS were selected purposefully and 16 healthy male athletes aged 18-30 years from national teams (Volleyball, Handball and Taekwondo were matched based on variables such as weight, height, age, dominancy. All subjects selected based on inclusion and exclusion criteria. EMG activity of VMO and VLL muscles was recorded by surface electrodes with Telemetric EMG System at 15, 30 and 45 degrees of squat and VMO: VLL ratio was calculated. One way ANOVA was used to compare these muscles ratio between two groups. Results: The ratio of VMO: VLL in both groups with and without PFPS in almost all angles were lower than one. However, healthy athletes had lower ratios. Also, there were no significant differences in VMO: VLL ratio at various angles. Conclusion: It seems that sports activities prevent VMO weakening in athletes. However, VMO: VLL ratio in athletes with and without patellofemoral pain does not influence by this syndrome.

  6. Radiographic study on temporomandibular joint Arthrosis

    Energy Technology Data Exchange (ETDEWEB)

    Yoo, Dong Soo [Dept. of Radiology, College of Dentistry, Seoul National University , Seoul (Korea, Republic of)

    1980-11-15

    The author analysed the routine radiographic changes and clinical symptoms of 205 cases of temporomandibular joint arthrosis. The clinical symptoms of the patients were classified and the morphological changes of condylar head, articular eminence, and articular fossa were analyzed and discussed from radiographic view point. The positional change of condylar head and articular fossa relation in TMJ arthrosis were observed. The frequencies of coincidence between the site of complaints and the site of the abnormal images which could be detected were examined. The results were obtained as follows; 1. Bone erosion, deformity, marginal proliferation and sclerosis were selected from many abnormal images as the radiographic diagnostic criteria of TMJ arthritic lesions. 2. Abnormal radiographic findings were revealed in 150 cases (73.9%) of 205 total TMJ arthrosis cases and site with abnormal findings coincided with the site of complaints in 105 cases (70.7%) of 150 cases and coincidence rates were higher above fourth decades than below third decades. 3. Sclerosis of the abnormal radiographic findings could be found more often below third decades than above fourth decades. 4. The positional changes of condylar head were revealed in 176 cases (85.9%) of 205 total cases. 5. Pain complaints were revealed in 170 cases(82.9%) and clicking sounds were revealed in 120 cases (58.6%) of clinical symptoms of TMJ arthrosis. 6. No tendency was found so far the differential diagnosis between pain dysfunction syndrome and osteoarthrosis of TMJ.

  7. Radiographic study on temporomandibular joint Arthrosis

    International Nuclear Information System (INIS)

    Yoo, Dong Soo

    1980-01-01

    The author analysed the routine radiographic changes and clinical symptoms of 205 cases of temporomandibular joint arthrosis. The clinical symptoms of the patients were classified and the morphological changes of condylar head, articular eminence, and articular fossa were analyzed and discussed from radiographic view point. The positional change of condylar head and articular fossa relation in TMJ arthrosis were observed. The frequencies of coincidence between the site of complaints and the site of the abnormal images which could be detected were examined. The results were obtained as follows; 1. Bone erosion, deformity, marginal proliferation and sclerosis were selected from many abnormal images as the radiographic diagnostic criteria of TMJ arthritic lesions. 2. Abnormal radiographic findings were revealed in 150 cases (73.9%) of 205 total TMJ arthrosis cases and site with abnormal findings coincided with the site of complaints in 105 cases (70.7%) of 150 cases and coincidence rates were higher above fourth decades than below third decades. 3. Sclerosis of the abnormal radiographic findings could be found more often below third decades than above fourth decades. 4. The positional changes of condylar head were revealed in 176 cases (85.9%) of 205 total cases. 5. Pain complaints were revealed in 170 cases(82.9%) and clicking sounds were revealed in 120 cases (58.6%) of clinical symptoms of TMJ arthrosis. 6. No tendency was found so far the differential diagnosis between pain dysfunction syndrome and osteoarthrosis of TMJ.

  8. Abnormal thermography in Parkinson's disease.

    Science.gov (United States)

    Antonio-Rubio, I; Madrid-Navarro, C J; Salazar-López, E; Pérez-Navarro, M J; Sáez-Zea, C; Gómez-Milán, E; Mínguez-Castellanos, A; Escamilla-Sevilla, F

    2015-08-01

    An autonomic denervation and abnormal vasomotor reflex in the skin have been described in Parkinson's disease (PD) and might be evaluable using thermography with cold stress test. A cross-sectional pilot study was undertaken in 35 adults: 15 patients with PD and abnormal [(123)I]-metaiodobenzylguanidine cardiac scintigraphy and 20 healthy controls. Baseline thermography of both hands was obtained before immersing one in cold water (3 ± 1 °C) for 2 min. Continuous thermography was performed in: non-immersed hand (right or with lesser motor involvement) during immersion of the contralateral hand and for 6 min afterward; and contralateral immersed hand for 6 min post-immersion. The region of interest was the dorsal skin of the third finger, distal phalanx. PD patients showed a lower mean baseline hand temperature (p = 0.037) and greater thermal difference between dorsum of wrist and third finger (p = 0.036) and between hands (p = 0.0001) versus controls, regardless of the motor laterality. Both tests evidenced an adequate capacity to differentiate between groups: in the non-immersed hand, the PD patients did not show the normal cooling pattern or final thermal overshoot observed in controls (F = 5.29; p = 0.001), and there was an AUC of 0.897 (95%CI 0.796-0.998) for this cooling; in the immersed hand, thermal recovery at 6 min post-immersion was lesser in patients (29 ± 17% vs. 55 ± 28%, p = 0.002), with an AUC of 0.810 (95%CI 0.662-0.958). PD patients reveal abnormal skin thermal responses in thermography with cold stress test, suggesting cutaneous autonomic dysfunction. This simple technique may be useful to evaluate autonomic dysfunction in PD. Copyright © 2015 Elsevier Ltd. All rights reserved.

  9. Temporomandibular joint arthrography: normal anatomy and technique of examination

    International Nuclear Information System (INIS)

    Duvoisin, B.; Schnyder, P.; Klaus, E.; Jacques, B.

    1990-01-01

    Temporomandibular joint (TMJ) dysfunction is common. This entity is most often consecutive to internal derangements of the TMJ, which are not recognizable on plain films and tomograms. TMJ arthrography has proved a valuable tool in diagnosing these abnormalities. The technique of examination and normal arthrographic anatomy are reviewed. (author) [pt

  10. Abnormal Cervical Cancer Screening Test Results

    Science.gov (United States)

    ... lesion? • What are the different types of abnormal Pap test results? • What testing is needed after an abnormal ... that could lead to cancer. Screening includes the Pap test and, for some women, testing for a virus ...

  11. MR imaging of abnormal synovial processes

    International Nuclear Information System (INIS)

    Quinn, S.F.; Sanchez, R.; Murray, W.T.; Silbiger, M.L.; Ogden, J.; Cochran, C.

    1987-01-01

    MR imaging can directly image abnormal synovium. The authors reviewed over 50 cases with abnormal synovial processes. The abnormalities include Baker cysts, semimembranous bursitis, chronic shoulder bursitis, peroneal tendon ganglion cyst, periarticular abscesses, thickened synovium from rheumatoid and septic arthritis, and synovial hypertrophy secondary to Legg-Calve-Perthes disease. MR imaging has proved invaluable in identifying abnormal synovium, defining the extent and, to a limited degree, characterizing its makeup

  12. Abnormal visuomotor processing in schizophrenia

    Directory of Open Access Journals (Sweden)

    Siân E. Robson

    2016-01-01

    Full Text Available Subtle disturbances of visual and motor function are known features of schizophrenia and can greatly impact quality of life; however, few studies investigate these abnormalities using simple visuomotor stimuli. In healthy people, electrophysiological data show that beta band oscillations in sensorimotor cortex decrease during movement execution (event-related beta desynchronisation (ERBD, then increase above baseline for a short time after the movement (post-movement beta rebound (PMBR; whilst in visual cortex, gamma oscillations are increased throughout stimulus presentation. In this study, we used a self-paced visuomotor paradigm and magnetoencephalography (MEG to contrast these responses in patients with schizophrenia and control volunteers. We found significant reductions in the peak-to-peak change in amplitude from ERBD to PMBR in schizophrenia compared with controls. This effect was strongest in patients who made fewer movements, whereas beta was not modulated by movement in controls. There was no significant difference in the amplitude of visual gamma between patients and controls. These data demonstrate that clear abnormalities in basic sensorimotor processing in schizophrenia can be observed using a very simple MEG paradigm.

  13. Operator training for the abnormal

    International Nuclear Information System (INIS)

    Marzec, R.J.

    1977-01-01

    Training of nuclear power plant control room operators, on actions to be taken for an abnormal event, has classically been limited to discussion, on-shift and/or during requalification training classes, of symptoms, logical thought processes, systems analysis, and operator experience. The prerequisites for these discussions are a common technical vocabulary, and a minimum basic comprehension of nuclear power plant fundamentals, plant component theory of operation, system configuration, system control philosophy and operating procedures. Nuclear power plant control room operators are not the only personnel who are or should be involved in these discussions. The shift supervisors, operations management, and auxiliary equipment operators require continuing training in abnormal operations, as well. More in-depth training is necessary for shift supervisors and control room operators. The availability of vendor simulators has improved the effectiveness of training efforts for these individuals to some extent by displaying typical situations and plant performance characteristics and by providing a degree of ''hands on'' experience. The evolution of in-depth training with these simulators is reviewed

  14. Effectiveness of Inclusion of Dry Needling in a Multimodal Therapy Program for Patellofemoral Pain: A Randomized Parallel-Group Trial.

    Science.gov (United States)

    Espí-López, Gemma V; Serra-Añó, Pilar; Vicent-Ferrando, Juan; Sánchez-Moreno-Giner, Miguel; Arias-Buría, Jose L; Cleland, Joshua; Fernández-de-Las-Peñas, César

    2017-06-01

    Study Design Randomized controlled trial. Background Evidence suggests that multimodal interventions that include exercise therapy may be effective for patellofemoral pain (PFP); however, no study has investigated the effects of trigger point (TrP) dry needling (DN) in people with PFP. Objectives To compare the effects of adding TrP DN to a manual therapy and exercise program on pain, function, and disability in individuals with PFP. Methods Individuals with PFP (n = 60) recruited from a public hospital in Valencia, Spain were randomly allocated to manual therapy and exercises (n = 30) or manual therapy and exercise plus TrP DN (n = 30). Both groups received the same manual therapy and strengthening exercise program for 3 sessions (once a week for 3 weeks), and 1 group also received TrP DN to active TrPs within the vastus medialis and vastus lateralis muscles. The pain subscale of the Knee injury and Osteoarthritis Outcome Score (KOOS; 0-100 scale) was used as the primary outcome. Secondary outcomes included other subscales of the KOOS, the Knee Society Score, the International Knee Documentation Committee Subjective Knee Evaluation Form (IKDC), and the numeric pain-rating scale. Patients were assessed at baseline and at 15-day (posttreatment) and 3-month follow-ups. Analysis was conducted with mixed analyses of covariance, adjusted for baseline scores. Results At 3 months, 58 subjects (97%) completed the follow-up. No significant between-group differences (all, P>.391) were observed for any outcome: KOOS pain subscale mean difference, -2.1 (95% confidence interval [CI]: -4.6, 0.4); IKDC mean difference, 2.3 (95% CI: -0.1, 4.7); knee pain intensity mean difference, 0.3 (95% CI: -0.2, 0.8). Both groups experienced similar moderate-to-large within-group improvements in all outcomes (standardized mean differences of 0.6 to 1.1); however, only the KOOS function in sport and recreation subscale surpassed the prespecified minimum important change. Conclusion The current

  15. Relationships between the Foot Posture Index and foot kinematics during gait in individuals with and without patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Crossley Kay M

    2011-03-01

    Full Text Available Abstract Background Foot posture assessment is commonly undertaken in clinical practice for the evaluation of individuals with patellofemoral pain syndrome (PFPS, particularly when considering prescription of foot orthoses. However, the validity of static assessment to provide insight into dynamic function in individuals with PFPS is unclear. This study was designed to evaluate the extent to which a static foot posture measurement tool (the Foot Posture Index - FPI can provide insight into kinematic variables associated with foot pronation during level walking in individuals with PFPS and asymptomatic controls. Methods Twenty-six individuals (5 males, 21 females with PFPS aged 25.1 ± 4.6 years and 20 control participants (4 males, 16 females aged 23.4 ± 2.3 years were recruited into the study. Each participant underwent clinical evaluation of the FPI and kinematic analysis of the rearfoot and forefoot during walking using a three-dimensional motion analysis system. The association of the FPI score with rearfoot eversion, forefoot dorsiflexion, and forefoot abduction kinematic variables (magnitude, timing of peak and range of motion were evaluated using partial correlation coefficient statistics with gait velocity entered as a covariate. Results A more pronated foot type as measured by the FPI was associated with greater peak forefoot abduction (r = 0.502, p = 0.013 and earlier peak rearfoot eversion relative to the laboratory (r = -0.440, p = 0.031 in the PFPS group, and greater rearfoot eversion range of motion relative to the laboratory (r = 0.614, p = 0.009 in the control group. Conclusion In both individuals with and without PFPS, there was fair to moderate association between the FPI and some parameters of dynamic foot function. Inconsistent findings between the PFPS and control groups indicate that pathology may play a role in the relationship between static foot posture and dynamic function. The fair association between pronated foot

  16. Short-term effects of patellar kinesio taping on pain and hop function in patients with patellofemoral pain syndrome.

    Science.gov (United States)

    Freedman, Scott R; Brody, Lori Thein; Rosenthal, Michael; Wise, Justin C

    2014-07-01

    Patellofemoral pain syndrome (PFPS) is the most prevalent orthopaedic condition among physically active individuals, contributing to an estimated 30% to 40% of all sports medicine visits. Techniques using Kinesio Tape (KT) have become increasingly popular; however, there has been scant research supporting its use on patients with PFPS. The use of patellar KT to treat patients with PFPS will provide a statistically significant improvement in short-term pain and single-leg hop measures as compared with sham placement of KT. Nonrandomized controlled clinical trial with repeated-measures design. Level 3. Forty-nine subjects (41 females, 8 males) between the ages of 12 and 24 years with PFPS participated in this study. Each subject underwent patellar kinesio taping with both experimental and sham applications while completing 4 functional tasks and the single-leg triple jump test (STJT). The treatment outcome was analyzed using separate paired t tests to measure improvement on a numeric pain rating scale. A 2-way, 2 × 2 analysis of variance was used to analyze the relationship between taping condition (experimental vs sham) and side (involved vs uninvolved) for STJT scores. Separate paired t tests found step-up, step-down, and STJT pain improvement statistically significant between taping conditions. The 2-factor analysis of variance yielded a significant main effect for taping condition, but the main effect for side was not significant. The interaction between taping condition and side was significant. This showed there was little change in STJT distance between repeated measures performed on the untaped, noninvolved leg. However, subjects' STJT distances were significantly greater for the experimental KT application than the sham application for the involved side. Patellar kinesio taping provided an immediate and statistically significant improvement in pain and single-leg hop function in patients with PFPS when compared with a sham application. However, improvement

  17. Abnormal Event Detection Using Local Sparse Representation

    DEFF Research Database (Denmark)

    Ren, Huamin; Moeslund, Thomas B.

    2014-01-01

    We propose to detect abnormal events via a sparse subspace clustering algorithm. Unlike most existing approaches, which search for optimized normal bases and detect abnormality based on least square error or reconstruction error from the learned normal patterns, we propose an abnormality...... measurement based on the difference between the normal space and local space. Specifically, we provide a reasonable normal bases through repeated K spectral clustering. Then for each testing feature we first use temporal neighbors to form a local space. An abnormal event is found if any abnormal feature...

  18. What Exactly Is Jointness?

    National Research Council Canada - National Science Library

    Wilkerson, Lawrence

    1997-01-01

    ... it right and well-and their feeling the same way about you. All frills and lobbying aside, the essence of jointness is understanding and trust. As General Colin Powell stated in the first edition of Joint Pub 1, "jolnt warfare is team warfare." But what about seamlessness, synergy, joint doctrine, interoperability, and all the other buzzwords? Let's examine some of the more prevalent ones.

  19. Abnormal Returns and Contrarian Strategies

    Directory of Open Access Journals (Sweden)

    Ivana Dall'Agnol

    2003-12-01

    Full Text Available We test the hypothesis that strategies which are long on portfolios of looser stocks and short on portfolios of winner stocks generate abnormal returns in Brazil. This type of evidence for the US stock market was interpreted by The Bondt and Thaler (1985 as reflecting systematic evaluation mistakes caused by investors overreaction to news related to the firm performance. We found evidence of contrarian strategies profitability for horizons from 3 months to 3 years in a sample of stock returns from BOVESPA and SOMA from 1986 to 2000. The strategies are more profitable for shorter horizons. Therefore, there was no trace of the momentum effect found by Jagadeesh and Titman (1993 for the same horizons with US data. There are remaing unexplained positive returns for contrarian strategies after accounting for risk, size, and liquidity. We also found that the strategy profitability is reduced after the Real Plan, which suggests that the Brazilian stock market became more efficient after inflation stabilization.

  20. An explorative, cross-sectional study into abnormal muscular coupling during reach in chronic stroke patients

    Directory of Open Access Journals (Sweden)

    Stienen Arno HA

    2010-03-01

    Full Text Available Abstract Background In many stroke patients arm function is limited, which can be related to an abnormal coupling between shoulder and elbow joints. The extent to which this can be translated to activities of daily life (ADL, in terms of muscle activation during ADL-like movements, is rather unknown. Therefore, the present study examined the occurrence of abnormal coupling on functional, ADL-like reaching movements of chronic stroke patients by comparison with healthy persons. Methods Upward multi-joint reaching movements (20 repetitions at a self-selected speed to resemble ADL were compared in two conditions: once facilitated by arm weight compensation and once resisted to provoke a potential abnormal coupling. Changes in movement performance (joint angles and muscle activation (amplitude of activity and co-activation between conditions were compared between healthy persons and stroke patients using a repeated measures ANOVA. Results The present study showed slight changes in joint excursion and muscle activation of stroke patients due to shoulder elevation resistance during functional reach. Remarkably, in healthy persons similar changes were observed. Even the results of a sub-group of the more impaired stroke patients did not point to an abnormal coupling between shoulder elevation and elbow flexion during functional reach. Conclusions The present findings suggest that in mildly and moderately affected chronic stroke patients ADL-like arm movements are not substantially affected by abnormal synergistic coupling. In this case, it is implied that other major contributors to limitations in functional use of the arm should be identified and targeted individually in rehabilitation, to improve use of the arm in activities of daily living.

  1. Does anterior knee pain severity and function relate to the frontal plane projection angle and trunk and hip strength in women with patellofemoral pain?

    Science.gov (United States)

    Almeida, Gabriel Peixoto Leão; Carvalho E Silva, Ana Paula de Moura Campos; França, Fábio Jorge Renovato; Magalhães, Maurício Oliveira; Burke, Thomaz Nogueira; Marques, Amélia Pasqual

    2015-07-01

    The aim of the present study was to determine the relationship between knee pain severity and function with the frontal plane projection angle (FPPA) and trunk and hip peak torque (PT) in women with patellofemoral pain (PFPS). Twenty-two women with PFPS were assessed. Knee pain severity (KPS) was assessed with an 11-point visual analog scale and function with an Anterior Knee Pain Scale. The FPPA was recorded with a digital camera. PT of extensors, abductors, and the lateral rotators of hip and lateral core stability were measured with a handheld dynamometer. FPPA was the only predictor for the KPS. Regarding predictors of function, PT of lateral core stability and the extensor and abductor of the hip explained 41.4% of the function. Increase in FPPA was associated with greater KPS, and the lowest PT of lateral core stability, hip abductors, and extensors was associated with lower function in women with PFPS. Copyright © 2015 Elsevier Ltd. All rights reserved.

  2. Joint Hub Network Development

    NARCIS (Netherlands)

    Cruijssen, F.C.A.M.; Borm, P.E.M.; Dullaert, W.; Hamers, H.J.M.

    2007-01-01

    This paper introduces a framework for joint hub network development. Building a joint physical hub for transhipment of goods is expensive and therefore involves considerable risks for the cooperating companies. In a practical setting, it is unlikely that an entire network will be built at once.

  3. Bistable Articulated Joint

    Science.gov (United States)

    Graighead, Norwood D., II; Preliasco, R. J.; Hult, T. D.

    1986-01-01

    Joint with four-bar-linkage geometry has following attributes: Springs to fully extended fully folded positions. Automatically locks in its extended position. Joint combines zero backlash, positive locking, and centerline pivoting. Used in folding tool handles, portable antenna booms, and many other deployable structures.

  4. 13. Sacroiliac joint pain

    NARCIS (Netherlands)

    Vanelderen, P.; Szadek, K.M.; Cohen, S.P.; Witte, J.; Lataster, A.; Patijn, J.; Mekhail, N.; van Kleef, M.; van Zundert, J.

    2010-01-01

    The sacroiliac joint accounts for approximately 16% to 30% of cases of chronic mechanical low back pain. Pain originating in the sacroiliac joint is predominantly perceived in the gluteal region, although pain is often referred into the lower and upper lumbar region, groin, abdomen, and/ or lower

  5. Temporomandibular Joint Dysfunction

    Science.gov (United States)

    The temporomandibular joint (TMJ) connects your jaw to the side of your head. When it works well, it enables you to talk, chew, and yawn. For people with TMJ dysfunction, problems with the joint and muscles around it may cause Pain that travels through the face, jaw, ...

  6. Elbow joint instability

    DEFF Research Database (Denmark)

    Olsen, Bo Sanderhoff; Henriksen, M G; Søjbjerg, Jens Ole

    1994-01-01

    The effect of simultaneous ulnar and radial collateral ligament division on the kinematics of the elbow joint is studied in a cadaveric model. Severance of the anterior part of the ulnar collateral ligament and the annular ligament led to significant elbow joint instability in valgus and varus...

  7. JET Joint Undertaking

    International Nuclear Information System (INIS)

    Keen, B.E.

    1987-03-01

    The paper presents the progress report of the Joint European Torus (JET) Joint Undertaking, 1986. The report contains a survey of the scientific and technical achievements on JET during 1986; the more important articles referred to in this survey are reproduced as appendices to this Report. The last section discusses developments which might improve the overall performance of the machine. (U.K.)

  8. Joint replacement in Zambia

    African Journals Online (AJOL)

    MJZ

    Objective: This paper presents the short-term findings from a joint replacement register started at the Zambian-Italian Orthopaedic Hospital (ZIOH) in Lusaka and compares the variables entered in this register with those captured in the Malawian. National Joint Register for purposes of synchronizing these in the near future ...

  9. Postanesthetic temporomandibular joint dysfunction.

    OpenAIRE

    Knibbe, M. A.; Carter, J. B.; Frokjer, G. M.

    1989-01-01

    Internal derangements, myofascial pain dysfunction, and chronic dislocation of the temporomandibular joint (TMJ) are three common sequelae resulting from mandibular trauma. Etiologic factors include prolonged dental and otolaryngologic procedures, and intraoperative use of the laryngoscope and bronchoscope. Three cases are reported to document postanesthetic TMJ dysfunction arising from normal preoperative joints. Four types of TMJ dysfunction are discussed: anterior meniscus dislocation with...

  10. Comparative Evaluation of Core and Knee Extensor Mechanism Muscle Activation Patterns in a Stair Stepping Task in Healthy Controls and Patellofemoral Pain Patients

    Directory of Open Access Journals (Sweden)

    Alireza Motealleh

    2014-12-01

    Full Text Available Background: Patellofemoral pain (PFP is a common affliction and complex clinical entity. Deficit in neuromotor control of the core may be a remote contributing factor to the development of PFPS. Comparative evaluation of core and extensor mechanism muscle activation patterns between healthy group and patients involved by patellofemoral pain syndrome (PFPS in a stair stepping task is the aim of this study. Methods: In this non-randomized interventional study fifteen males with PFPS and fifteen asymptomatic controls participated. Electromyographic (EMG activity of Vastusmedialisobliquus (VMO, Vastuslateralis (VL, Gluteus medius (GMED, Gluteus Maximus (GMAX, Internal oblique (IO and Erector spinae (ES were recorded and EMG onsets were assessed in both stepping up (SU and down (SD. The time of foot contact determined by a foot switch. Results: During SU: Onset times of all muscles except, VL and ES in the controls were significantly less than PFPS group (P<0.05. In PFPS group the temporal sequence of ES, VL and VMO were different from control groups. During SD: Onset times of all muscles except, GMAX and ES in the control group were significantly less than PFP group (P<0.05. The sequence of muscle activity in both healthy and PFP groups were the same. Conclusion: Our findings are in line with previous researches about the effects of core on function and control of lower extremity. Activation patterns of core and vasti muscles are different between control and PFPS group during stair stepping task. Designing exercises to correct inappropriate timing of core muscles may have a role in management of PFPS and it needs more future researches.

  11. PENGGUNAAN KINESIOTAPE SELAMA TIGA HARI TIDAK BERBEDA DENGAN PEREKAT PLASEBO DALAM MENGURANGI RESIKO CEDERA BERULANG DAN DERAJAT Q-ANGLE PADA PENDERITA PATELLOFEMORAL PAIN SYNDROME

    Directory of Open Access Journals (Sweden)

    Abdurrasyid -

    2014-03-01

    Full Text Available Many athletes who suffer Patellofemoral Pain Syndrome (PFPS, they using kinesiotape while playing or less than two weeks, this condition make a question of there are efficacy when used kinesiotape while playing and practicing. The purpose of this study to ensure the use of kinesiotape for three days did not differ with adhesive placebo in reducing the risk of repetitive injury and q-angle in patients with patellofemoral pain syndrome (PFPS. The experimental research method to design randomized clinical trial design. Sample of 17 athletes who suffer from PFPS and time of observation for three days. Divided into two groups, kinesiotape groups (n = 9 as the treatment and placebo groups (n = 8 as a control. Measurement instruments used were Functional Movement Screening (FMS and Q-angle. The results of this study, kinesiotape group able to reduce the risk of repetitive injury with p = 0.002 (p <0,05. Placebo group was also able to reduce the risk of repetitive injury p = 0.01 (p <0,05. Kinesiotape able to decrease q- angle with p = 0.004 (p <0,05. Placebo group was also able to reduce the q-angle with p = 0.008 (p <0,05. At different test measurements FMS using independent t-test p = 0.777 (p> 0.05, and a different test with q-angle measurements using the Mann-Whitney test p = 0.63 (p> 0,05. The conclusion that the use of kinesiotape and adhesives placebo can reduce the risk of recurrent injury and the degree of q-angle for three days. It is clear that using kinesiotape have the same effectiveness with placebo were not elastic adhesive while playing a game and practicing.

  12. Joint Force Fires Coordination: Towards a Joint Force Answer

    National Research Council Canada - National Science Library

    Fearn, William

    1997-01-01

    .... Components compete for decisive effect not only with each other but with the joint force. The contemporary joint force is confederated, the joint force headquarters a weak arbitration authority...

  13. Abnormal findings on knee magnetic resonance imaging in asymptomatic NBA players.

    Science.gov (United States)

    Walczak, Brian E; McCulloch, Patrick C; Kang, Richard W; Zelazny, Anthony; Tedeschi, Fred; Cole, Brian J

    2008-01-01

    The purpose of this study was to evaluate the knees of asymptomatic National Basketball Association (NBA) players via magnetic resonance imaging (MRI) and confirm or dispute findings reported in the previous literature. It is thought that a variety of significant abnormalities affecting the knee exist in asymptomatic patients and that these findings can be accurately identified on MRI. Two months prior to the 2005 season, bilateral knee MRI examinations of 14 asymptomatic NBA players (28 knees) were evaluated for abnormalities of the articular cartilage, menisci, and patellar and quadriceps tendons. The presence of joint effusion, subchondral edema, and cystic lesions and the integrity of the collateral and cruciate ligaments were also assessed.

  14. Hemostatic abnormalities in liver cirrhosis

    Directory of Open Access Journals (Sweden)

    Kendal YALÇIN

    2009-06-01

    Full Text Available In this study, 44 patients with liver cirrhosis were investigated for hemostatic parameters. Patients with spontaneous bacterial peritonitis, hepatocellular carcinoma, hepatorenal syndrome and cholestatic liver diseases were excluded. Patients were classified by Child-Pugh criterion and according to this 4 patients were in Class A, 20 in Class B and 20 in C. Regarding to these results, it was aimed to investigate the haematological disturbances in liver cirrhotic patients.In the result there was a correlation between activated partial thromboplastin time, serum iron, ferritin, transferrin, haptoglobin and Child-Pugh classification. Besides there was no correlation between prothrombin time, factor 8 and 9, protein C and S, anti-thrombin 3, fibrinogen, fibrin degradation products, serum iron binding capacity, hemoglobin, leukocyte, mean corpuscular volume and Child-Pugh classification.There were significant difference, in terms of AST, ferritin, haptoglobulin, sex and presence of ascites between groups (p0.05. In the summary, we have found correlation between hemostatic abnormalities and disease activity and clinical prognosis in patients with liver cirrhosis which is important in the management of these patients. This is also important for identification of liver transplant candidiates earlier.

  15. Biochemical abnormalities in Pearson syndrome.

    Science.gov (United States)

    Crippa, Beatrice Letizia; Leon, Eyby; Calhoun, Amy; Lowichik, Amy; Pasquali, Marzia; Longo, Nicola

    2015-03-01

    Pearson marrow-pancreas syndrome is a multisystem mitochondrial disorder characterized by bone marrow failure and pancreatic insufficiency. Children who survive the severe bone marrow dysfunction in childhood develop Kearns-Sayre syndrome later in life. Here we report on four new cases with this condition and define their biochemical abnormalities. Three out of four patients presented with failure to thrive, with most of them having normal development and head size. All patients had evidence of bone marrow involvement that spontaneously improved in three out of four patients. Unique findings in our patients were acute pancreatitis (one out of four), renal Fanconi syndrome (present in all patients, but symptomatic only in one), and an unusual organic aciduria with 3-hydroxyisobutyric aciduria in one patient. Biochemical analysis indicated low levels of plasma citrulline and arginine, despite low-normal ammonia levels. Regression analysis indicated a significant correlation between each intermediate of the urea cycle and the next, except between ornithine and citrulline. This suggested that the reaction catalyzed by ornithine transcarbamylase (that converts ornithine to citrulline) might not be very efficient in patients with Pearson syndrome. In view of low-normal ammonia levels, we hypothesize that ammonia and carbamylphosphate could be diverted from the urea cycle to the synthesis of nucleotides in patients with Pearson syndrome and possibly other mitochondrial disorders. © 2015 Wiley Periodicals, Inc.

  16. Evaluation of Chromosomal Abnormalities and Common ...

    African Journals Online (AJOL)

    Evaluation of Chromosomal Abnormalities and Common Trombophilic Mutations in Cases with Recurrent Miscarriage. Ahmet Karatas, Recep Eroz, Mustafa Albayrak, Tulay Ozlu, Bulent Cakmak, Fatih Keskin ...

  17. Generalised joint hypermobility and knee joint hypermobility

    DEFF Research Database (Denmark)

    Junge, Tina; Henriksen, Peter; Hansen, Sebrina

    2017-01-01

    (GJHk) is unknown for a general population. Therefore, the objectives were to report the prevalence of self-reported GJHk and KJH, as well as the association of these conditions to knee joint symptoms, severity and duration of symptoms, and health-related quality of life (HRQoL) in a Danish adult...... population. METHOD: This study is a cross-sectional population-based survey of 2056 Danish adults. Respondents received online questionnaires of GJHk and KJH, knee joint symptoms, the severity and duration of these, as well as HRQoL. RESULTS: Total response rate was 49% (n = 1006). The prevalence of self...... HRQoL. The impact of these conditions on HRQoL is comparable with knee osteoarthritis....

  18. Repolarization abnormalities in the newborn.

    Science.gov (United States)

    Schwartz, Peter J; Stramba-Badiale, Marco

    2010-06-01

    The recognition of ventricular repolarization abnormalities in the newborn carries several and significant implications, because it calls attention to the possibility of dealing with an infant affected by the long QT syndrome (LQTS). This article provides key elements for the correct measurement of the QT interval in newborns and succinctly reviews some aspects of the disease. It gives normative values on the QT interval distribution in the first month of life based on a prospective study in more than 44,000 infants. It shows the probability, based on the QTc observed in two recordings, to find disease-causing mutations. The data indicate clearly that widespread electrocardiographic screening in the newborn allows early identification of most, if not all, the infants affected by LQTS with marked QT prolongation and thus of those at higher risk for life-threatening arrhythmias and sudden death. Through the affected infants, it becomes possible to identify the family members affected by LQTS, including the "silent mutation carriers"; our study shows that disease-causing mutations are found in 51% of the family members. Because early recognition leads to the implementation of effective preventive strategies, it follows that electrocardiographic screening will avoid preventable deaths either in the first year of life when they are usually labeled as "sudden infant death syndrome" or later in life. The case is made for medicolegal implications whenever neonatologists and pediatricians fail to inform the parents of a newborn child of the prevalence of LQTS (one in 2000), of the effectiveness of existing therapies, and of the diagnosis with a simple electrocardiogram.

  19. Finite Element Analysis of the Biomechanical Effects of 3 Posterolateral Corner Reconstruction Techniques for the Knee Joint.

    Science.gov (United States)

    Kang, Kyoung-Tak; Koh, Yong-Gon; Son, Juhyun; Kim, Sung-Jae; Choi, Sungryul; Jung, Moonki; Kim, Sung-Hwan

    2017-08-01

    To compare the forces exerted on the cruciate ligaments and the contact stresses on the tibiofemoral (TF) and patellofemoral (PF) joints with respect to 3 different tibial- and fibular-based posterolateral corner (PLC) reconstructions under dynamic loading conditions. A subject-specific finite element knee model was developed by using 3-dimensional anatomic data from motion captures in gait and squat activities, including in vivo knee joint kinematics and muscle forces for the single subject. Cruciate ligament forces and contact stresses on the TF and PF joints under 3 PLC reconstruction techniques (tibial-based, TBR; modified fibular-based, mFBR; conventional fibular-based, cFBR) and PLC-deficient models were compared with those of the intact model in gait and squat loading conditions. The cruciate ligament forces in the 3 surgical models differed from those in the intact model. The greatest differences in ligament forces from the intact model were found in the cFBR model, whereas there were no remarkable differences between the TBR and mFBR models in both gait and squat loading conditions. Contact stresses on the lateral TF and PF joints of the 3 surgical models were greater than those of the intact model under the squat loading condition. The biomechanical effects achieved using the anatomic reconstruction technique were found to be improved compared with those using nonanatomic reconstruction techniques. However, the ligament forces and contact stresses under normal conditions could not be restored through any of the 3 techniques. Anatomic TBR and FBR for grade III PLC injuries could restore better biomechanics in the knee joint compared with nonanatomic reconstruction. However, discrepancy with the normal condition requires further modification of surgical techniques. Copyright © 2017 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  20. Hip joint replacement - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100006.htm Hip joint replacement - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Hip Replacement A.D.A.M., Inc. is accredited by ...

  1. Hip joint replacement

    Science.gov (United States)

    Hip arthroplasty; Total hip replacement; Hip hemiarthroplasty; Arthritis - hip replacement; Osteoarthritis - hip replacement ... your activities. Most of the time, hip joint replacement is done in people age 60 and older. ...

  2. Knee joint replacement - slideshow

    Science.gov (United States)

    ... medlineplus.gov/ency/presentations/100088.htm Knee joint replacement - series—Normal anatomy To use the sharing features ... M. Editorial team. Related MedlinePlus Health Topics Knee Replacement A.D.A.M., Inc. is accredited by ...

  3. Improved orthopedic arm joint

    Science.gov (United States)

    Dane, D. H.

    1971-01-01

    Joint permits smooth and easy movement of disabled arm and is smaller, lighter and less expensive than previous models. Device is interchangeable and may be used on either arm at the shoulder or at the elbow.

  4. Joint Quantum Institute

    Data.gov (United States)

    Federal Laboratory Consortium — The Joint Quantum Institute (JQI) is pursuing that goal through the work of leading quantum scientists from the Department of Physics of the University of Maryland...

  5. Concrete pavement joint deterioration.

    Science.gov (United States)

    2015-12-01

    Concrete pavements are an important part of our national infrastructure. In recent years the relatively small number of reported joints deteriorating prematurely in concrete pavements around Indiana has increased. Changes over the past 45 years in IN...

  6. Temporomandibular Joint Disorder

    Science.gov (United States)

    ... Baby Bottle Tooth Decay? Pacifiers Have Negative and Positive Effects What is Dental Amalgam (Silver Filling)? Check Menstrual Calendar for Tooth Extraction Temporomandibular Joint Disorder Learn what those dental words mean. Check out how your teeth and mouth ...

  7. Joint Services Electronics Program.

    Science.gov (United States)

    1983-09-30

    Compound Semiconductors." 4 ......... I-*. Univesity of California. Berkeley Electronics Research Laboratory Joint Services Electronics Program August 15...reduction techniques [SCH-66,MCG- 73,HAM-75], for essentially i educing the proportionality constant. A significant portion of the probabilistic literature

  8. Congenital absence of the lumbar facet joint associated with bilateral spondylolysis of the fifth lumbar vertebra.

    Science.gov (United States)

    Wang, Zhuo; Sakakibara, Toshihiko; Kasai, Yuichi

    2013-01-01

    A 14-year-old boy presented with a rare case of congenital absence of lumbar facet joint manifesting as low back pain. Physical examination showed no neurological or hematologic abnormalities. Radiography revealed absence of a facet joint on the right side of L4-5. Computed tomography and three-dimensional computed tomography revealed absence of the facet joint on the right side of L4-5 and spondylolysis on both sides of L5. Pain subsided after conservative treatment. This is an extremely rare case of congenital absence of lumbar facet joint associated with bilateral spondylolysis.

  9. Nail abnormalities in patients with vitiligo.

    Science.gov (United States)

    Topal, Ilteris Oguz; Gungor, Sule; Kocaturk, Ozgur Emek; Duman, Hatice; Durmuscan, Mustafa

    2016-01-01

    Vitiligo is an acquired pigmentary skin disorder affecting 0.1-4% of the general population. The nails may be affected in patients with an autoimmune disease such as psoriasis, and in those with alopecia areata. It has been suggested that nail abnormalities should be apparent in vitiligo patients. We sought to document the frequency and clinical presentation of nail abnormalities in vitiligo patients compared to healthy volunteers. We also examined the correlations between nail abnormalities and various clinical parameters. This study included 100 vitiligo patients and 100 healthy subjects. Full medical histories were collected from the subjects, who underwent thorough general and nail examinations. All nail changes were noted. In the event of clinical suspicion of a fungal infection, additional mycological investigations were performed. Nail abnormalities were more prevalent in the patients (78%) than in the controls (55%) (p=0.001). Longitudinal ridging was the most common finding (42%), followed by (in descending order): leukonychia, an absent lunula, onycholysis, nail bed pallor, onychomycosis, splinter hemorrhage and nail plate thinning. The frequency of longitudinal ridging was significantly higher in patients than in controls (pNail abnormalities were more prevalent in vitiligo patients than in controls. Systematic examination of the nails in such patients is useful because nail abnormalities are frequent. However, the causes of such abnormalities require further study. Longitudinal ridging and leukonychia were the most common abnormalities observed in this study.

  10. Effects of theophylline administration and intracranial abnormalities ...

    African Journals Online (AJOL)

    Objective: To determine effects of theophylline therapy for recurrent apnoea of prematurity and abnormal early (within the first 24 hours) cranial ultrasound abnormalities on protective neck turning response in preterm infants. Design: A cross sectional descriptive study. Setting: The Neonatal Unit of Hammersmith Hospital, ...

  11. Prevalence of biochemical and immunological abnormalities in ...

    African Journals Online (AJOL)

    Tile prevalence of biochemical and immunological abnormalities was studied in a group of 256 patients with rheumatoid arthritis (104 coloureds, 100 whites and 52 blacks). The most common biochemical abnormalities detected were a reduction in the serum creatinine value (43,4%), raised globulins (39,7%), raised serum ...

  12. First Trimester Ultrasound Screening for Congenital Abnormalities ...

    African Journals Online (AJOL)

    approach used, especially with the introduction of first trimester ultrasound as a reliable screening method. Objective: To give a comprehensive review of the basis for first trimester ultrasound screening for congenital abnormalities, it's utilization in the prenatal screening for chromosomal, structural and genetic abnormalities ...

  13. An Abnormal Psychology Community Based Interview Assignment

    Science.gov (United States)

    White, Geoffry D.

    1977-01-01

    A course option in abnormal psychology involves students in interviewing and observing the activities of individuals in the off-campus community who are concerned with some aspect of abnormal psychology. The technique generates student interest in the field when they interview people about topics such as drug abuse, transsexualism, and abuse of…

  14. Joint Program Management Handbook

    Science.gov (United States)

    1994-12-01

    saevic= formal acqusition mviews include an analysis of poemtol for joint program desigimtiom LiAW sa.vice-uque p niranh, joint progams must have...Acquisition Program Depu Director, Acqusition = 0.y o Defense for Integration (Dir, API) Pogram Intetgraton for Acquistion Systems Management (DepDir, ASM...leadership of the Navy, resulting from the merger of the Navy’s Advanced Interdiction Weapon System (AIWS) Program and some Air Force weapons programs that

  15. Semiautomated digital analysis of knee joint space width using MR images

    International Nuclear Information System (INIS)

    Agnesi, Filippo; Amrami, Kimberly K.; Frigo, Carlo A.; Kaufman, Kenton R.

    2007-01-01

    The goal of this study was to (a) develop a semiautomated computer algorithm to measure knee joint space width (JSW) from magnetic resonance (MR) images using standard imaging techniques and (b) evaluate the reproducibility of the algorithm. Using a standard clinical imaging protocol, bilateral knee MR images were obtained twice within a 2-week period from 17 asymptomatic research participants. Images were analyzed to determine the variability of the measurements performed by the program compared with the variability of manual measurements. Measurement variability of the computer algorithm was considerably smaller than the variability of manual measurements. The average difference between two measurements of the same slice performed with the computer algorithm by the same user was 0.004 ± 0.07 mm for the tibiofemoral joint (TF) and 0.009 ± 0.11 mm for the patellofemoral joint (PF) compared with an average of 0.12 ± 0.22 mm TF and 0.13 ± 0.29 mm PF, respectively, for the manual method. Interuser variability of the computer algorithm was also considerably smaller, with an average difference of 0.004 ± 0.1 mm TF and 0.0006 ± 0.1 mm PF compared with 0.38 ± 0.59 mm TF and 0.31 ± 0.66 mm PF obtained using a manual method. The between-day reproducibility was larger but still within acceptable limits at 0.09 ± 0.39 mm TF and 0.09 ± 0.51 mm PF. This technique has proven consistently reproducible on a same slice base,while the reproducibility comparing different acquisitions of the same subject was larger. Longitudinal reproducibility improvement needs to be addressed through acquisition protocol improvements. A semiautomated method for measuring knee JSW from MR images has been successfully developed. (orig.)

  16. Arthrography of the lumber facet joint and facet block

    International Nuclear Information System (INIS)

    Cho, Hee Kyung; Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Moon, Jae Ho; Suh, Jung Ho; Kim, Dong Ik

    1988-01-01

    In spite of numerous clinical and patho-anatomical studied made in the past, there are still different opinions concerning the mechanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with sciatica. So we have studied and analyzed the finding of arthrography of facet joint and effect of the injection of methyprednisolone acetate suspension (Depomedrol) 20mg into the each facet joint. Our results are as follows: 1. Abnormal findings of facet joint arthrogram were degenerative osteoarthritis of facet joint (70.5%), synovial cyst (11.8%), accessory bone (11.8%), and spondylolysis (5.9%). 2. The mean facet angulations of patients of facet syndrome were abnormal on lower lumbar facet joint in 9 of 13 cases (69.2%). 3. On initial assessment, 11 of 17 cases (64.7%) showed complete relief and one month later, 6 of 11 cases (35.3%) showed continuous relief, after steroid injection.

  17. Arthrography of the lumber facet joint and facet block

    Energy Technology Data Exchange (ETDEWEB)

    Cho, Hee Kyung; Chung, Tae Sub; Kim, Young Soo; Park, Hyung Chun; Moon, Jae Ho; Suh, Jung Ho; Kim, Dong Ik [Yonsei University College of Medicine, Seoul (Korea, Republic of)

    1988-12-15

    In spite of numerous clinical and patho-anatomical studied made in the past, there are still different opinions concerning the mechanism of low back pain. We have focused attention on the posterior structures as an alternative source of low back pain with sciatica. So we have studied and analyzed the finding of arthrography of facet joint and effect of the injection of methyprednisolone acetate suspension (Depomedrol) 20mg into the each facet joint. Our results are as follows: 1. Abnormal findings of facet joint arthrogram were degenerative osteoarthritis of facet joint (70.5%), synovial cyst (11.8%), accessory bone (11.8%), and spondylolysis (5.9%). 2. The mean facet angulations of patients of facet syndrome were abnormal on lower lumbar facet joint in 9 of 13 cases (69.2%). 3. On initial assessment, 11 of 17 cases (64.7%) showed complete relief and one month later, 6 of 11 cases (35.3%) showed continuous relief, after steroid injection.

  18. [Mechanics of joint stress].

    Science.gov (United States)

    Gruber, K; Denoth, J; Ruder, H; Stüssi, E

    1991-01-01

    The calculation of the possible load on human joints is of great importance in orthopedics. The magnitude of the force transmitted in the joints during the process of movement, whether in everyday life or in athletics, plays a decisive role. Especially at moments of impact, as in sports, high accelerations are transmitted through the human body. Bones and tissue (muscles, tendons and ligaments) react quite differently in this phase, and their reactions have a large influence on the magnitude and course of the forces working within the body, particularly in the joints. In previously developed methods of load-determination on joints during dynamic movements, these reactions were not considered. In the following paper, however, we will introduce a physical model that takes the various materials of the body's constitution into account. By introducing "wobbling mass", which, elastically damped, is coupled to the bony parts of the body, we can simulate the reaction of the body tissues, and a realistic calculation of the forces and moments transported through the body can be reached. The temporal sequence of these magnitudes for the knee and hip joints will be illustrated using an exemplary selected movement and interpreted using simplified joint structures. The main features of the method of calculation, using simple examples from statics, will be shown in Part One of this paper.

  19. Report to Congress on abnormal occurrences

    International Nuclear Information System (INIS)

    1993-06-01

    Section 208 of the Energy Reorganization Act of 1974 identifies an abnormal occurrence as an unscheduled incident or event that the Nuclear Regulatory Commission determines to be significant from the standpoint of public health and safety and requires a quarterly report of such events to be made to Congress. This report covers the period January through March 1993. There is one abnormal occurrence at a nuclear power plant disposed in this report that involved a steam generator tube rupture at Palo Verde Unit 2, and none for fuel cycle facilities. Three abnormal occurrences involving medical misadminstrations (two therapeutic and one diagnostic) at NRC-licensed facilities are also discussed in this report. No abnormal occurrences were reported by NRC's Agreement States. The report also contains information updating previously reported abnormal occurrences

  20. Joint imaging in childhood and adolescence

    Energy Technology Data Exchange (ETDEWEB)

    Lopes Viana, Sergio [Hospital da Crianca de Brasilia - Jose Alencar Clinica Vila Rica (Brazil); Machado, Ribeiro, Maria Custodia [Hospital da Crianca de Brasilia - Jose Alencar Hospital de Base do Distrito Federal (Brazil); Beber Machado, Bruno [Clinica Radiologica Med Imagem, Unimed Sul Caprixaba, Santa Casa de Misericordia de Cachoeiro de Itapemirim (Brazil)

    2013-11-01

    First book to be devoted to the imaging of skeletally immature joints since the advent of cross-sectional methods. Covers a wide range of pathologic conditions. Identifies the advantages and weak points of each imaging method. Highlights anatomic and developmental peculiarities of the growing skeleton. Richly illustrated, with up-to-date references and summaries of key points. Since the advent of cross-sectional imaging methods, few works have been devoted to pediatric musculoskeletal imaging, and information is especially limited on the skeletally immature joint. Furthermore, reduced emphasis on pediatric training means that general radiologists are increasingly unfamiliar with normal and abnormal imaging findings in children and adolescents. Knowledge of the imaging appearances of the immature joint is, however, crucial for correct image interpretation. This book covers key selected topics in the imaging evaluation of the skeletally immature joint. The opening chapters consider the current role, advantages, and limitations of each modality in pediatric assessment and present the imaging appearances of anatomic and developmental peculiarities of the growing skeleton. Findings in a wide range of important conditions are then described in a series of richly illustrated chapters that document appearances on diverse imaging studies, from conventional radiography through to modern high-tech modalities. By presenting the essential information on imaging of the immature joint, the authors hope to provide radiologists (musculoskeletal specialists and generalists alike) with a new tool that will assist greatly in overcoming the daily challenges posed by interpretation of pediatric examinations in the twenty-first century. The book will also be of interest to all other specialists involved in the diagnosis and treatment of children and adolescents with articular complaints.

  1. Patellofemoral Pain Syndrome

    Science.gov (United States)

    ... at a time. Talk to your doctor about footwear. It may help to bring your shoes in ... Sugar Substitutes Exercise and Fitness Exercise Basics Sports Safety Injury Rehabilitation Emotional Well-Being Mental Health Sex ...

  2. Temporomandibular joint disorder in systemic sclerosis: a case report

    Science.gov (United States)

    Chebbi, Raja; Khalifa, Hanen Ben; Dhidah, Monia

    2016-01-01

    Systemic sclerosis have several effects on the orofacial region such as widening of the periodontal ligament space, xerostomia and bone resorption of the mandible. We report a case of systemic sclerosis with temporomandibular joint involvement in a 45-year-old female patient accompanied by severe limited mouth opening and pain in the right and left preauricular regions and tenderness in masseter muscles with a morning stiffness of jaws.Magnetic resonance imaging showed a resorption of mandibular condylar process, with disk and joint abnormalities. PMID:28292126

  3. MRI of joint fluid in femoral head osteonecrosis

    International Nuclear Information System (INIS)

    Chan, W.P.; Liu, Y.-J.; Huang, G.-S.; Jiang, C.-C.; Huang, S.; Chang, Y.-C.

    2002-01-01

    To evaluate the relationship between joint fluid, intramedullary pressure (IMP), bone marrow edema, and stages of osteonecrosis of the femoral head (ONFH). Material and methods: We reviewed the magnetic resonance (MR) images of 28 patients with 40 documented ONFHs. IMP was measured in 16 symptomatic hips. The amount of joint fluid was graded as 0 (no fluid), 1 (fluid <5 mm in width), or 2 (fluid ≥ 5 mm in width) adjacent to the entire length of the femoral neck. Associated focal and diffuse bone marrow abnormalities were evaluated. A control group of 29 recruited individuals without symptoms related to hip disease were examined. Follow-up MR images were obtained in four patients (five affected hips) 6-10 months after core decompression. Results: Of the 40 affected hips, the severity of ONFH was divided into stages 0 (n=4), I (n=28), and II (n=8 hips) on MR findings. The correlation of joint fluid to IMP and to the presence of bone marrow edema was poor. The amount of joint fluid correlated significantly with the stage of ONFH. None of the five affected hips showed decreased joint fluid on follow-up MR images. Conclusion: The amount of joint fluid correlates well with the stage of ONFH. The amount of joint fluid does not correlate with IMP or bone marrow edema. (orig.)

  4. MRI of joint fluid in femoral head osteonecrosis

    Energy Technology Data Exchange (ETDEWEB)

    Chan, W.P. [Chief in Department of Radiology, Taipei Medical University, Municipal Wan Fang Hospital, 111 Hsing-Long Road, Section 3, Taipei 116 (Taiwan); Liu, Y.-J. [Institute of Electric Engineering, National Taiwan University, 1 Roosevelt Road, Section 4, Taipei 106 (Taiwan); Huang, G.-S. [Department of Radiology, Tri-Service General Hospital, National Defense Medical Center, 325 Cheng-Kung Road, Section 2, Taipei 114 (Taiwan); Jiang, C.-C.; Huang, S. [Department of Orthopedic Surgery, National Taiwan University Hospital, 7 Chung-San S. Road, Taipei 100 (Taiwan); Chang, Y.-C. [Department of Mathematics, Tamkang University, 151 Ying-Chuan Road, Tamsui, Taipei 251 (Taiwan)

    2002-11-01

    To evaluate the relationship between joint fluid, intramedullary pressure (IMP), bone marrow edema, and stages of osteonecrosis of the femoral head (ONFH). Material and methods: We reviewed the magnetic resonance (MR) images of 28 patients with 40 documented ONFHs. IMP was measured in 16 symptomatic hips. The amount of joint fluid was graded as 0 (no fluid), 1 (fluid <5 mm in width), or 2 (fluid {>=} 5 mm in width) adjacent to the entire length of the femoral neck. Associated focal and diffuse bone marrow abnormalities were evaluated. A control group of 29 recruited individuals without symptoms related to hip disease were examined. Follow-up MR images were obtained in four patients (five affected hips) 6-10 months after core decompression. Results: Of the 40 affected hips, the severity of ONFH was divided into stages 0 (n=4), I (n=28), and II (n=8 hips) on MR findings. The correlation of joint fluid to IMP and to the presence of bone marrow edema was poor. The amount of joint fluid correlated significantly with the stage of ONFH. None of the five affected hips showed decreased joint fluid on follow-up MR images. Conclusion: The amount of joint fluid correlates well with the stage of ONFH. The amount of joint fluid does not correlate with IMP or bone marrow edema. (orig.)

  5. Distribution pattern of MRI abnormalities within the knee and wrist of juvenile idiopathic arthritis patients: signature of disease activity

    NARCIS (Netherlands)

    Nusman, Charlotte M.; Hemke, Robert; Schonenberg, Dieneke; Dolman, Koert M.; van Rossum, Marion A. J.; van den Berg, J. Merlijn; Kuijpers, Taco W.; Maas, Mario

    2014-01-01

    The aim of this study in clinically active juvenile idiopathic arthritis (JIA) was to assess the frequency and distribution pattern of synovitis as hallmark of disease and additional soft-tissue and bony abnormalities on MRI in the knee and wrist as two target joints. MRI datasets of 153 clinically

  6. Chromosomal abnormalities in patients with sperm disorders

    Directory of Open Access Journals (Sweden)

    L. Y. Pylyp

    2013-02-01

    Full Text Available Chromosomal abnormalities are among the most common genetic causes of spermatogenic disruptions. Carriers of chromosomal abnormalities are at increased risk of infertility, miscarriage or birth of a child with unbalanced karyotype due to the production of unbalanced gametes. The natural selection against chromosomally abnormal sperm usually prevents fertilization with sperm barring in cases of serious chromosomal abnormalities. However, assisted reproductive technologies in general and intracytoplasmic sperm injection in particular, enable the transmission of chromosomal abnormalities to the progeny. Therefore, cytogenetic studies are important in patients with male factor infertility before assisted reproduction treatment. The purpose of the current study was to investigate the types and frequencies of chromosomal abnormalities in 724 patients with infertility and to estimate the risk of chromosomal abnormalities detection in subgroups of patients depending on the severity of spermatogenic disruption, aiming at identifying groups of patients in need of cytogenetic studies. Karyotype analysis was performed in 724 blood samples of men attending infertility clinic. Chromosomal preparation was performed by standard techniques. At least 20 GTG-banded metaphase plates with the resolution from 450 to 750 bands per haploid set were analysed in each case. When chromosomal mosaicism was suspected, this number was increased to 50. Abnormal karyotypes were observed in 48 (6.6% patients, including 67% of autosomal abnormalities and 33% of gonosomal abnormalities. Autosomal abnormalities were represented by structural rearrangements. Reciprocal translocations were the most common type of structural chromosomal abnormalities in the studied group, detected with the frequency of 2.6% (n = 19, followed by Robertsonian translocation, observed with the frequency of 1.2% (n = 9. The frequency of inversions was 0.6% (n = 4. Gonosomal abnormalities included 14 cases

  7. Acromioclavicular joint separation

    Directory of Open Access Journals (Sweden)

    Devan Pandya, BS

    2018-04-01

    Full Text Available History of present illness: A 30-year-old male was brought in by ambulance to the emergency department as a trauma activation after a motorcycle accident. The patient was the helmeted rider of a motorcycle traveling at an unknown speed when he lost control and was thrown off his vehicle. He denied loss of consciousness, nausea, or vomiting. The patient’s vital signs were stable and his only complaint was pain around his left shoulder. On exam, the patient had a prominent left clavicle without skin compromise. He had adequate range of motion in the left shoulder with moderate pain, and his left upper extremity was neurovascularly intact. Significant findings: Plain films of the left shoulder showed elevation of the left clavicle above the acromion. There was an increase in the acromioclavicular (AC and coracoclavicular (CC distances (increased joint distances marked with red and blue arrows, respectively. A normal AC joint measures 1-3 mm whereas a normal CC distance measures 11-13 mm.1 The injury was classified as a Rockwood type III AC joint separation. Discussion: The AC joint is a synovial joint between an oval facet on the acromion and a similar facet on the distal end of the clavicle. Horizontal stability is provided by the AC joint while axial stability is provided by the CC joint.2,3 AC joint injuries account for about 9%-12% of shoulder girdle injuries, and the most common mechanism is direct trauma.4,5 Initial evaluation with imaging includes plain films with three views: the anterior-posterior (AP view with the shoulder in internal and external rotation as well as an axillary, or scapula-Y view (sensitivity 40%, specificity 90% for all films.6,7 AC joint injuries are classified by the Rockwood system.8 Type I involves a sprain or incomplete tear of the AC ligaments with an intact CC ligament. The AC joint appears normal on X-ray, but can become widened with stress, achieved by having the patient hold a 10-15 pound weight from each

  8. The Standard Joint Unit.

    Science.gov (United States)

    Casajuana Kögel, Cristina; Balcells-Olivero, María Mercedes; López-Pelayo, Hugo; Miquel, Laia; Teixidó, Lídia; Colom, Joan; Nutt, David John; Rehm, Jürgen; Gual, Antoni

    2017-07-01

    Reliable data on cannabis quantities is required to improve assessment of cannabis consumption for epidemiological analysis and clinical assessment, consequently a Standard Joint Unit (SJU) based on quantity of 9-Tetrahydrocannabinol (9-THC) has been established. Naturalistic study of a convenience sample recruited from February 2015-June 2016 in universities, leisure spaces, mental health services and cannabis clubs in Barcelona. Adults, reporting cannabis use in the last 60 days, without cognitive impairment or language barriers, answered a questionnaire on cannabis use and were asked to donate a joint to further determine their 9-THC and Cannabidiol (CBD) content. 492 participants donated 315 valid joints. Donators were on average 29 years old, mostly men (77%), single (75%), with at least secondary studies (73%) and in active employment (63%). Marijuana joints (N=232) contained a median of 6.56mg of 9-THC (Interquartile range-IQR=10,22) and 0.02mg of CBD (IQR=0.02); hashish joints (N=83) a median of 7.94mg of 9-THC (IQR=10,61) and 3.24mg of CBD (IQR=3.21). Participants rolled 4 joints per gram of cannabis and paid 5€ per gram (median values). Consistent 9-THC-content in joints lead to a SJU of 7mg of 9-THC, the integer number closest to the median values shared by both cannabis types. Independently if marijuana or hashish, 1 SJU = 1 joint = 0.25 g of cannabis = 7 mg of 9-THC. For CBD, only hashish SJU contained relevant levels. Similarly to the Standard Drink Unit for alcohol, the SJU is useful for clinical, epidemiological and research purposes. Copyright © 2017 Elsevier B.V. All rights reserved.

  9. Quadriceps weakness predicts risk for knee joint space narrowing in women in the MOST cohort

    Science.gov (United States)

    Segal, Neil A; Glass, Natalie A; Torner, James; Yang, Mei; Felson, David T; Sharma, Leena; Nevitt, Michael; Lewis, Cora E.

    2010-01-01

    Objective Quadriceps weakness has been reported with incident but not progressive knee osteoarthritis (OA) in longitudinal studies. This study examined the relationship between quadriceps strength and worsening of knee joint space narrowing (JSN) over 30 months. Methods Longitudinal, observational study of adults aged 50-79 years with OARSI JSN score quadriceps and hamstring strength, height and weight, and physical activity. Hamstring:quadriceps (H:Q) strength ratios also were evaluated. Worsening was defined as an increase in JSN score in the tibiofemoral and/or patellofemoral compartments on 30-month radiographs or total knee replacement. Knee-based analyses used generalized estimating equations, stratified by sex, to assess relationships between strength and knee JSN while controlling for covariance between knees within subjects as well as age, BMI, history of knee injury and/or surgery, physical activity level and alignment. Results 3856 knees (1602 male and 2254 female) with JSN score quadriceps strength had an increased risk of whole knee JSN (OR=1.66, 95% CI=1.26, 2.19) and tibiofemoral JSN (OR=1.69, 95% CI=1.26, 2.28). However, no associations were found between strength and JSN in men or H:Qquadriceps weakness was associated with increased risk for tibiofemoral and whole knee JSN. PMID:20188686

  10. CLINICAL AND GENETIC ASPECTS OF ABNORMAL TORTUOSITY OF PRECEREBRAL ARTERIES IN ISCHEMIC STROKE

    Directory of Open Access Journals (Sweden)

    N. M. Poplavskaya

    2015-01-01

    Full Text Available Background: Inherited connective tissue pathology is the most frequent genetic abnormality. Weakness of connective tissue in this group of disorders is manifested not only by excessive joint mobility, but also by abnormalities in other organs and systems, including vessels. In inherited connective tissue disorders brain artery aneurysms and abnormal vascular tortuosity is found that can be a risk factor for stroke.Aim: To study frequency of abnormal tortuosities of brachiocephalic vessels in post-ischemic stroke patients, as well as efficacy of secondary stroke prevention in such patients.Materials and methods: One hundred and seventy two adult patients with ischemic stroke were examined. Neurological deficiency was assessed with the National Institute of Health Stroke Scale (NIHSS and with the modified Rankin scale. Abnormalities of precerebral arteries were found by ultrasound dopplerography and duplex scanning. To diagnose any abnormalities of connective tissue, clinical and genetic analysis, dermatoglyphic assessment and scoring of excessive joint mobility (Beyton scale were used.Results: Abnormal tortuosity of precerebral arteries is found in 47% of patients with ischemic stroke. The screening performed in 25 of such patients showed connective tissue disorders in one third of them (in 2 patients, Ehlers-Danlos syndrome, in 2 patients, connective tissue dysplasia, in 4 patients, mild symptoms of abnormal connective tissue, such as excessive joint mobility scoring to 1–2. In patients without inherited syndromes, some dermatoglyphic traits were found, i.e., distal shift of the axial palmar triradius, higher frequency of patterns on the skin of the thenar, lower pattern frequency on the skin of the hypothenar, higher frequency of simple digital patterns (A and T, lower frequency of complex patterns, such as whorls (W, lower palmar and digital ridgecounts. The results of secondary stroke prevention with antiplatelet agents, antihypertensives

  11. Forming a multinational joint venture

    International Nuclear Information System (INIS)

    Bhatia, N.K.; Garb, R.H.; Statton, T.D.

    1990-01-01

    This paper discusses the basis and mechanics for forming a multinational joint venture. The topics of the paper include the motivations for a joint venture, selection of the appropriate co-venturer, management of the multinational joint venture, and the joint venture agreement. The authors state that a joint venture is not applicable or desirable in all instances and to be successful, must be carefully planned

  12. Periprosthetic Joint Infections

    Directory of Open Access Journals (Sweden)

    Ana Lucia L. Lima

    2013-01-01

    Full Text Available Implantation of joint prostheses is becoming increasingly common, especially for the hip and knee. Infection is considered to be the most devastating of prosthesis-related complications, leading to prolonged hospitalization, repeated surgical intervention, and even definitive loss of the implant. The main risk factors to periprosthetic joint infections (PJIs are advanced age, malnutrition, obesity, diabetes mellitus, HIV infection at an advanced stage, presence of distant infectious foci, and antecedents of arthroscopy or infection in previous arthroplasty. Joint prostheses can become infected through three different routes: direct implantation, hematogenic infection, and reactivation of latent infection. Gram-positive bacteria predominate in cases of PJI, mainly Staphylococcus aureus and Staphylococcus epidermidis. PJIs present characteristic signs that can be divided into acute and chronic manifestations. The main imaging method used in diagnosing joint prosthesis infections is X-ray. Computed tomography (CT scan may assist in distinguishing between septic and aseptic loosening. Three-phase bone scintigraphy using technetium has high sensitivity, but low specificity. Positron emission tomography using fluorodeoxyglucose (FDG-PET presents very divergent results in the literature. Definitive diagnosis of infection should be made by isolating the microorganism through cultures on material obtained from joint fluid puncturing, surgical wound secretions, surgical debridement procedures, or sonication fluid. Success in treating PJI depends on extensive surgical debridement and adequate and effective antibiotic therapy. Treatment in two stages using a spacer is recommended for most chronic infections in arthroplasty cases. Treatment in a single procedure is appropriate in carefully selected cases.

  13. Dissimilar metals joint evaluation

    Science.gov (United States)

    Wakefield, M. E.; Apodaca, L. E.

    1974-01-01

    Dissimilar metals tubular joints between 2219-T851 aluminum alloy and 304L stainless steel were fabricated and tested to evaluate bonding processes. Joints were fabricated by four processes: (1) inertia (friction) weldings, where the metals are spun and forced together to create the weld; (2) explosive welding, where the metals are impacted together at high velocity; (3) co-extrusion, where the metals are extruded in contact at high temperature to promote diffusion; and (4) swaging, where residual stresses in the metals after a stretching operation maintain forced contact in mutual shear areas. Fifteen joints of each type were prepared and evaluated in a 6.35 cm (2.50 in.) O.D. size, with 0.32 cm (0.13 in.) wall thickness, and 7.6 cm (3.0 in) total length. The joints were tested to evaluate their ability to withstand pressure cycle, thermal cycle, galvanic corrosion and burst tests. Leakage tests and other non-destructive test techniques were used to evaluate the behavior of the joints, and the microstructure of the bond areas was analyzed.

  14. Facet joint syndrome

    International Nuclear Information System (INIS)

    Zigrai, M.; Zakovic, J.; Brezinova, M.; Pavlovicova, M.

    2002-01-01

    It is the purpose of the study to demonstrate the clinical relevance of degenerative changes in the facet joint of patients with low back pain irradiating to the lower extremities, and discuss some problems relating to diagnosis and different diagnosis. 119 patients presenting the listed bellow syndromes are covered by the study: scoliosis, polytopic pain vertebral syndrome, paresis and history of trauma. all patients undergo comprehensive neurological examination with special attention focused on the spine: CT and plain x-rays are taken of the lumbosacral segment to assess the condition of the facet joints. The neurological examination demonstrates in all cases pain syndrome in the lumbar spine referred to one or both lower extremities. In 56% it is a matter of persisting pain, and in 44% - recurrent. More than half of the patients complain of sacroiliac (SI) dislocation and palpatory pain. Unilateral or bilateral degenerative changes are documented by imaging studies in all patients, including: subchondral thickening, osteopathy narrowing the lateral or central part of the spinal canal with ensuing nerve root compression. The lumbosacral zygoapophyseal joints are source of pseudoradicular pain. A correlation between clinical picture and GT changes is noted in all patients with facet joint syndrome. CT is an indispensable method in diagnosing facet joint syndrome. (authors)

  15. Formation of Exfoliation Joints

    Science.gov (United States)

    Martel, S. J.

    2004-12-01

    The Earth's internal stresses interact with the topographic surface to affect many phenomena. Exfoliation joints, or sheeting joints, are widespread manifestations of this interaction. These opening-mode fractures form subparallel to the Earth's surface, bounding roughly concentric slabs of rock that resemble the layers of an onion. They occur worldwide in all major bedrock types, attain in-plane dimensions of hundreds of meters, exert a strong influence on groundwater flow, and help produce spectacular scenery, as in Yosemite National Park. The mechanism that causes them has been enigmatic. They are widely regarded as forming in response to "removal of overburden", but large fractures do not open in rocks merely by relieving a compressive stress. High fluid pressures, thermal effects, rock heterogeneity, and weathering also are rejected as primary causes of these fractures. Tensile stresses normal to the surface are required for large exfoliation fractures to open. Intriguingly, high surface-parallel compressive stresses are widely documented where exfoliation joints occur. Both numerical and analytical solutions for two-dimensional elastic bodies show that localized tensile stresses perpendicular to the ground surface must develop beneath certain topographies subject to strong compressive stresses parallel to the surface. This highly non-intuitive effect reflects the profound influence that topography can have on stresses near the surface of the Earth, and it can explain how exfoliation joints open. The theoretical results also indicate that exfoliation joint distributions could be used to infer the horizontal stresses near the Earth's surface.

  16. Numerically abnormal chromosome constitutions in humans

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1993-12-31

    Chapter 24, discusses numerically abnormal chromosome constitutions in humans. This involves abnormalities of human chromosome number, including polyploidy (when the number of sets of chromosomes increases) and aneuploidy (when the number of individual normal chromosomes changes). Chapter sections discuss the following chromosomal abnormalities: human triploids, imprinting and uniparental disomy, human tetraploids, hydatidiform moles, anomalies caused by chromosomal imbalance, 13 trisomy (D{sub 1} trisomy, Patau syndrome), 21 trisomy (Down syndrome), 18 trisomy syndrome (Edwards syndrome), other autosomal aneuploidy syndromes, and spontaneous abortions. The chapter concludes with remarks on the nonrandom participation of chromosomes in trisomy. 69 refs., 3 figs., 4 tabs.

  17. Prediction of heart abnormality using MLP network

    Science.gov (United States)

    Hashim, Fakroul Ridzuan; Januar, Yulni; Mat, Muhammad Hadzren; Rizman, Zairi Ismael; Awang, Mat Kamil

    2018-02-01

    Heart abnormality does not choose gender, age and races when it strikes. With no warning signs or symptoms, it can result to a sudden death of the patient. Generally, heart's irregular electrical activity is defined as heart abnormality. Via implementation of Multilayer Perceptron (MLP) network, this paper tries to develop a program that allows the detection of heart abnormality activity. Utilizing several training algorithms with Purelin activation function, an amount of heartbeat signals received through the electrocardiogram (ECG) will be employed to condition the MLP network.

  18. Quantitative T2{sup *} assessment of knee joint cartilage after running a marathon

    Energy Technology Data Exchange (ETDEWEB)

    Hesper, Tobias [University Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf (Germany); Miese, Falk R. [University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf (Germany); Hosalkar, Harish S. [Center of Hip Preservation and Children' s Orthopaedics, San Diego, CA (United States); Behringer, Michael [German Sport University, Cologne (Germany); Zilkens, Christoph [University Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf (Germany); Antoch, Gerald [University Düsseldorf, Medical Faculty, Department of Diagnostic and Interventional Radiology, Düsseldorf (Germany); Krauspe, Rüdiger [University Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf (Germany); Bittersohl, Bernd, E-mail: bbittersohl@partners.org [University Düsseldorf, Medical Faculty, Department of Orthopaedics, Düsseldorf (Germany)

    2015-02-15

    Highlights: • This is the first descriptive report on the effects of repetitive joint loading on the T2{sup **} relaxation assessment of articular cartilage. • This study on marathon runners who underwent MRI within 48 hours prior to and following the running event as well as after a period of convalescence of approximately four weeks confirms the feasibility of T2{sup **} mapping of knee joint cartilage under the consideration of repetitive joint loading prior to MRI as we noted only small differences in the T2{sup **} after running a marathon. • Despite the small study group (nn = 10) and the presence of morphologically normal appearing cartilage, we noted lower cartilage T2{sup **} values in the medial tibial plateau that may be related to functional demand or early signs of cartilage degeneration. - Abstract: Objective: To study the effect of repetitive joint loading on the T2{sup *} assessment of knee joint cartilage. Materials and methods: T2{sup *} mapping was performed in 10 non-professional marathon runners (mean age: 28.7 ± 3.97 years) with no morphologically evident cartilage damage within 48 h prior to and following the marathon and after a period of approximately four weeks. Bulk and zonal T2{sup *} values at the medial and lateral tibiofemoral compartment and the patellofemoral compartment were assessed by means of region of interest analysis. Pre- and post-marathon values were compared. Results: There was a small increase in the T2{sup *} after running the marathon (30.47 ± 5.16 ms versus 29.84 ± 4.97 ms, P < 0.05) while the T2{sup *} values before the marathon and those after the period of convalescence were similar (29.84 ± 4.97 ms versus 29.81 ± 5.17 ms, P = 0.855). Regional analyses revealed lower T2{sup *} values in the medial tibial plateau (P < 0.001). Conclusions: It appears that repetitive joint loading has a transient influence on the T2{sup *} values. However, this effect is small and probably not clinically relevant. The low T2

  19. Mechanics of the knee. A study of joint and muscle load with clinical applications.

    Science.gov (United States)

    Nisell, R

    1985-01-01

    The load moment of force about the knee joint during machine milking and when lifting a 12.8 kg box was quantified using a computerized static sagittal plane body model. Surface electromyography of quadriceps and hamstrings muscles was normalized and expressed as a percentage of an isometric maximum voluntary test contraction. Working with straight knees and the trunk flexed forwards induced extending knee load moments of maximum 55 Nm. Lifting the box with flexed knees gave flexing moments of 50 Nm at the beginning of the lift, irrespective of whether the burden was between or in front of the feet. During machine milking, a level difference between operator and cow of 0.70 m - 1.0 m significantly lowered the knee extending moments. To quantify the force magnitudes acting in the tibio-femoral and patello-femoral joints, a local biomechanical model of the knee was developed using a combination of cadaver knee dissections and lateral knee radiographs of healthy subjects. The moment arm of the knee extensor was significantly shorter for women than for men, which resulted in higher knee joint forces in women if the same moment was produced. A diagram for quantifying patellar forces was worked out. The force magnitudes given by the knee joint biomechanical model correlated well with experimentally forces measured by others. During the parallel squat in powerlifting, the maximum flexing knee load moment was estimated to 335-550 Nm when carrying a 382.5 kg burden and the in vivo force of a complete quadriceps tendon-muscle rupture to between 10,900 and 18,300 N. During isokinetic knee extension, the tibio-femoral compressive force reached peak magnitudes of 9 times body weight and the anteroposterior shear force was close to 1 body weight at knee angles straighter than 60 degrees, indicating that high forces stress the anterior cruciate ligament. A proximal resistance pad position decreased the shear force considerably, and this position is recommended in early

  20. Varied response to mirror gait retraining of gluteus medius control, hip kinematics, pain, and function in 2 female runners with patellofemoral pain.

    Science.gov (United States)

    Willy, Richard W; Davis, Irene S

    2013-12-01

    Case report. The underlying mechanism of the changes in running mechanics after gait retraining is presently unknown. This case report assesses changes in muscle coordination and kinematics during treadmill running and step ascent in 2 female runners with patellofemoral pain after mirror gait retraining. Two female runners with chronic patellofemoral pain underwent 8 sessions of mirror gait retraining during treadmill running. Subjective measures and hip abductor strength were recorded at baseline and after the retraining phase. Changes in hip mechanics and electromyography data of the gluteus medius during treadmill running and step ascent were also assessed. Both runners reported improvements in pain and function that were maintained for at least 3 months. During running, peak contralateral pelvic drop (baseline-postretraining difference: runner 1, 2.6° less; runner 2, 1.7° less) and peak hip adduction (baseline-postretraining difference: runner 1, 5.2° less; runner 2, 6.3° less) were reduced after retraining. Kinematic reductions accompanied earlier activation of the gluteus medius relative to foot strike (baseline-postretraining difference: runner 1, 12.6 milliseconds earlier; runner 2, 37.3 milliseconds earlier) and longer duration of gluteus medius activity (runner 1, 55.8 milliseconds longer; runner 2, 44.4 milliseconds longer). Runner 1 transferred reduced contralateral pelvic drop to step ascent, whereas runner 2 did not (contralateral pelvic drop baseline-postretraining difference: runner 1, 3.6° less; runner 2, 1.5° more; hip adduction baseline-postretraining difference: runner 1, 3.0° less; runner 2, 0.5° more). Both runners demonstrated earlier onset of gluteus medius activity during step ascent (baseline-postretraining difference: runner 1, 48.0 milliseconds earlier; runner 2, 28.3 milliseconds earlier), but only runner 1 demonstrated longer activation duration (runner 1, 25.0 milliseconds longer; runner 2, 69.4 milliseconds shorter). While

  1. KOMBINASI TEKNIK MULLIGAN DAN FASILITASI VASUS MEDIALIS OBLIQUUS LEBIH EFEKTIF MENINGKATKAN AKTIVITAS FUNGSIONAL DARIPADA APLIKASI KINESIO TAPING PADA SINDROMA NYERI SENDI PATELLOFEMORAL

    Directory of Open Access Journals (Sweden)

    Atika Yulianti

    2013-11-01

    Full Text Available Patellofemoral pain syndrome is complained of knee pain by young adults who are productive oftenly, syndrome characterized by pain that is felt around the kneecap, and aggravated the activity squat and stand, up and down stairs, and change the position of the knee after a long standstill ( stand up after sitting for a long time. This is due to the weakness of the thigh muscles especially vasus medialis obliquus. Reinforcement of weak muscle in particular strengthening of the vastus medialis  oblique an appropriate treatment to increase the functional activity of the syndrome. The study was a randomized experiment with pre and post-test group design. This study aimed to compare the combining of mulligan techniques and facilitate of vasus medialis obliquus with application of kinesio taping to increase the functional activity of the lower extremities. In this study, 11 respondents were given a combination of mulligan techniques and facilitation of vastus medialis oblique for 5 weeks with a frequency of exercise 3 times a week, and 11 respondents provided application of kinesio taping for 5 weeks with 3 days and replaced with a new taping. Each treatment was measured by the Lower Extremity Fungtional Scale before and after 5 weeks. Statistical analysis parametric paired sample t-test results is the influence of a combining of mulligan techniques and facilitate of vastus medialis oblique and application of kinesio taping to increase the functional activity of the lower extremities with p<0.05. Test of different with the independent sample t-test with a result there are significant difference between the combining of techniques mulligan and facilitation of vasus medialis obliquus with application of kinesio taping values with  p <0.05. Conclusions in this study that a combining of mulligan techniques and facilitation of vasus medialis obliquus, 3 times a week for 5 weeks effectively to increase the functional activity of the lower extremities of

  2. Structural abnormalities and persistent complaints after an ankle sprain are not associated: an observational case control study in primary care.

    Science.gov (United States)

    van Ochten, John M; Mos, Marinka C E; van Putte-Katier, Nienke; Oei, Edwin H G; Bindels, Patrick J E; Bierma-Zeinstra, Sita M A; van Middelkoop, Marienke

    2014-09-01

    Persistent complaints are very common after a lateral ankle sprain. To investigate possible associations between structural abnormalities on radiography and MRI, and persistent complaints after a lateral ankle sprain. Observational case control study on primary care patients in general practice. Patients were selected who had visited their GP with an ankle sprain 6-12 months before the study; all received a standardised questionnaire, underwent a physical examination, and radiography and MRI of the ankle. Patients with and without persistent complaints were compared regarding structural abnormalities found on radiography and MRI; analyses were adjusted for age, sex, and body mass index. Of the 206 included patients, 98 had persistent complaints and 108 did not. No significant differences were found in structural abnormalities between patients with and without persistent complaints. In both groups, however, many structural abnormalities were found on radiography in the talocrural joint (47.2% osteophytes and 45.1% osteoarthritis) and the talonavicular joint (36.5% sclerosis). On MRI, a high prevalence was found of bone oedema (33.8%) and osteophytes (39.5) in the talocrural joint; osteophytes (54.4%), sclerosis (47.2%), and osteoarthritis (55.4%, Kellgren and Lawrence grade >1) in the talonavicular joint, as well as ligament damage (16.4%) in the anterior talofibular ligament. The prevalence of structural abnormalities is high on radiography and MRI in patients presenting in general practice with a previous ankle sprain. There is no difference in structural abnormalities, however, between patients with and without persistent complaints. Using imaging only will not lead to diagnosis of the explicit reason for the persistent complaint. © British Journal of General Practice 2014.

  3. Structural abnormalities and persistent complaints after an ankle sprain are not associated: an observational case control study in primary care

    Science.gov (United States)

    van Ochten, John M; Mos, Marinka CE; van Putte-Katier, Nienke; Oei, Edwin HG; Bindels, Patrick JE; Bierma-Zeinstra, Sita MA; van Middelkoop, Marienke

    2014-01-01

    Background Persistent complaints are very common after a lateral ankle sprain. Aim To investigate possible associations between structural abnormalities on radiography and MRI, and persistent complaints after a lateral ankle sprain. Design and setting Observational case control study on primary care patients in general practice. Method Patients were selected who had visited their GP with an ankle sprain 6–12 months before the study; all received a standardised questionnaire, underwent a physical examination, and radiography and MRI of the ankle. Patients with and without persistent complaints were compared regarding structural abnormalities found on radiography and MRI; analyses were adjusted for age, sex, and body mass index. Results Of the 206 included patients, 98 had persistent complaints and 108 did not. No significant differences were found in structural abnormalities between patients with and without persistent complaints. In both groups, however, many structural abnormalities were found on radiography in the talocrural joint (47.2% osteophytes and 45.1% osteoarthritis) and the talonavicular joint (36.5% sclerosis). On MRI, a high prevalence was found of bone oedema (33.8%) and osteophytes (39.5) in the talocrural joint; osteophytes (54.4%), sclerosis (47.2%), and osteoarthritis (55.4%, Kellgren and Lawrence grade >1) in the talonavicular joint, as well as ligament damage (16.4%) in the anterior talofibular ligament. Conclusion The prevalence of structural abnormalities is high on radiography and MRI in patients presenting in general practice with a previous ankle sprain. There is no difference in structural abnormalities, however, between patients with and without persistent complaints. Using imaging only will not lead to diagnosis of the explicit reason for the persistent complaint. PMID:25179068

  4. Abnormal findings in hallucal sesamoids on MR imaging-Associated with different pathologies of the forefoot? An observational study

    International Nuclear Information System (INIS)

    Kulemann, Vanessa; Mayerhoefer, Marius; Trnka, Hans-Joerg; Kristen, Karl-Heinz; Steiner, Erich

    2010-01-01

    Background: To evaluate the prevalence and localization of abnormalities in the hallucal sesamoids detectable by magnetic resonance (MR) imaging in patients with forefoot pain and to determine which pathologies of tarsus, metatarsus and phalanges are associated with these abnormalities. Materials and methods: The forefoot MRI examinations of 50 consecutive patients (32 females, 18 males; mean age 51 years, age range 20-86 years) were retrospectively analyzed by two musculoskeletal radiologists. A minimum of coronal and sagittal T1-weighted images and STIR images or T2-weighted images with fat saturation were performed on a 1.5-T scanner. Abnormal findings in the sesamoids were correlated with pathology in the I.MTP (metatarsal-phalangeal) joint, pathology in other parts of the forefoot and clinical information. Results: Signal abnormalities of the sesamoids were found in 7 patients out of 50 (14%). Two patients presented a bone marrow edema (BME) in both sesamoids, in 1 patient only the lateral one was affected; all three associated with pathology and pain in the I.MTP joint. In four patients only the medial sesamoid was affected, not associated with pathology in the I.MTP joint but with pathology in other parts of the forefoot. Conclusion: The prevalence of signal abnormalities in hallucal sesamoids was 14%. BME of the lateral sesamoid or of both were predominantly associated with pathology in the I.MTP joint. In contrast, signal abnormalities of the medial sesamoid, without affection of the lateral one, were associated with pathology in other parts of the forefoot suggesting an overuse injury as a result of compensating posture.

  5. Total ankle joint replacement.

    Science.gov (United States)

    2016-02-01

    Ankle arthritis results in a stiff and painful ankle and can be a major cause of disability. For people with end-stage ankle arthritis, arthrodesis (ankle fusion) is effective at reducing pain in the shorter term, but results in a fixed joint, and over time the loss of mobility places stress on other joints in the foot that may lead to arthritis, pain and dysfunction. Another option is to perform a total ankle joint replacement, with the aim of giving the patient a mobile and pain-free ankle. In this article we review the efficacy of this procedure, including how it compares to ankle arthrodesis, and consider the indications and complications. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  6. [Dental abnormalities after treatment for childhood cancer].

    Science.gov (United States)

    Mladosievičová, B; Jurkovič, R; Izakovičová Hollá, L

    2015-01-01

    Childhood cancer therapy often increases the risk of dental complications, such as tooth and roots agenesis, microdontia, abnormal development of tooth enamel, increased risk of cavity and other abnormalities. In a comparison with other late adverse effects of chemotherapy, radiotherapy and hematopoietic stem cell transplantion, a relative small number of clinical stud-ies observing patients for more than two years after completion of anticancer treatment was published. In this article, we review the incidence of dental abnormalities caused by commonly used anticancer treatment modalities as well as discuss their risk factors. Early identification of high-risk patients, early detection and management of dental abnormalities and better education of patients or their guardians, may have an impact on quality of life of cancer survivors.

  7. On two abnormal sharks from Gujarat

    Digital Repository Service at National Institute of Oceanography (India)

    Gopalan, U.K.

    The description of the two abnormal sharks, Carchariaswalbeehmi and Eulamia dussumieri collected from Gujarat, India, is given Of these C walbeehmi was double-headed The other shark E dussumieri had thumb snouted albino...

  8. Video Traffic Analysis for Abnormal Event Detection

    Science.gov (United States)

    2010-01-01

    We propose the use of video imaging sensors for the detection and classification of abnormal events to be used primarily for mitigation of traffic congestion. Successful detection of such events will allow for new road guidelines; for rapid deploymen...

  9. Low-set ears and pinna abnormalities

    Science.gov (United States)

    ... because they do not affect hearing. However, sometimes cosmetic surgery is recommended. Skin tags may be tied off, ... 5 years old. More severe abnormalities may require surgery for cosmetic reasons as well as for function. Surgery to ...

  10. Report to Congress on abnormal occurrences

    International Nuclear Information System (INIS)

    1990-10-01

    Section 208 of the Energy Reorganization Act of 1974 identifies an abnormal occurrence as an unscheduled incident or event that the Nuclear Regulatory Commission determines to be significant from the standpoint of public health or safety and requires a quarterly report of such events to be made to Congress. This report covers the period from April 1 through June 30, 1990. The report discusses six abnormal occurrences, none involving a nuclear power plant. There were five abnormal occurrences at NRC licensees: (1) deficiencies in brachytherapy program; (2) a radiation overexposure of a radiographer; (3) a medical diagnostic misadministration; (4) administration of iodine-131 to a lactating female with subsequent uptake by her infant; and (5) a medical therapy misadministration. An Agreement State (Arizona) reported an abnormal occurrence involving a medical diagnostic misadministration. The report also contains information that updates a previously reported occurrence

  11. Errata :Chromosomal Abnormalities in Couples with Recurrent ...

    African Journals Online (AJOL)

    Chromosomal Abnormalities in Couples with Recurrent Abortions in Lagos, Nigeria. Akinde OR, Daramola A O, Taiwo I A, Afolayan M O and Akinsola Af. Sonographic Mammary Gland Density Pattern in Women in Selected ommunities of Southern Nigeria.

  12. Video traffic analysis for abnormal event detection.

    Science.gov (United States)

    2010-01-01

    We propose the use of video imaging sensors for the detection and classification of abnormal events to : be used primarily for mitigation of traffic congestion. Successful detection of such events will allow for : new road guidelines; for rapid deplo...

  13. Expansion joints for LMFBR

    International Nuclear Information System (INIS)

    Dzenus, M.; Hundhausen, W.; Jansing, W.

    1980-01-01

    This discourse recounts efforts put into the SNR-2 project; specifically the development of compensation devices. The various prototypes of these compensation devices are described and the state of the development reviewed. Large Na (sodium)-heat transfer systems require a lot of valuable space if the component lay-out does not include compensation devices. So, in order to condense the spatial requirement as much as possible, expansion joints must be integrated into the pipe system. There are two basic types to suit the purpose: axial expansion joints and angular expansion joints. The expansion joints were developed on the basis of specific design criteria whereby differentiation is made between expansion joints of small and large nominal diameter. Expansion joints for installation in the sodium-filled primary piping are equipped with safety bellows in addition to the actual working bellows. Expansion joints must be designed and mounted in a manner to completely withstand seismic forces. The design must exclude any damage to the bellows during intermittent operations, that is, when sodium is drained the bellows' folds must be completely empty; otherwise residual solidified sodium could destroy the bellows when restarting. The expansion joints must be engineered on the basis of the following design data for the secondary system of the SNR project: working pressure: 16 bar; failure mode pressure: 5 events; failure mode: 5 sec., 28.5 bar, 520 deg. C; working temperature: 520 deg. C; temperature transients: 30 deg. C/sec.; service life: 200,000 h; number of load cycles: 10 4 ; material: 1.4948 or 1.4919; layer thickness of folds: 0.5 mm; angular deflection (DN 800): +3 deg. C or; axial expansion absorption (DN 600): ±80 mm; calculation: ASME class. The bellows' development work is not handled within this scope. The bellows are supplied by leading manufacturers, and warrant highest quality. Multiple bellows were selected on the basis of maximum elasticity - a property

  14. Transversely Compressed Bonded Joints

    DEFF Research Database (Denmark)

    Hansen, Christian Skodborg; Schmidt, Jacob Wittrup; Stang, Henrik

    2012-01-01

    The load capacity of bonded joints can be increased if transverse pressure is applied at the interface. The transverse pressure is assumed to introduce a Coulomb-friction contribution to the cohesive law for the interface. Response and load capacity for a bonded single-lap joint was derived using...... non-linear fracture mechanics. The results indicated a good correlation between theory and tests. Furthermore, the model is suggested as theoretical base for determining load capacity of bonded anchorages with transverse pressure, in externally reinforced concrete structures....

  15. Prosthetic Joint Infection

    Science.gov (United States)

    Tande, Aaron J.

    2014-01-01

    SUMMARY Prosthetic joint infection (PJI) is a tremendous burden for individual patients as well as the global health care industry. While a small minority of joint arthroplasties will become infected, appropriate recognition and management are critical to preserve or restore adequate function and prevent excess morbidity. In this review, we describe the reported risk factors for and clinical manifestations of PJI. We discuss the pathogenesis of PJI and the numerous microorganisms that can cause this devastating infection. The recently proposed consensus definitions of PJI and approaches to accurate diagnosis are reviewed in detail. An overview of the treatment and prevention of this challenging condition is provided. PMID:24696437

  16. Prevalence of asymptomatic urinary abnormalities among adolescents

    Directory of Open Access Journals (Sweden)

    Mohamed Fouad

    2016-01-01

    Full Text Available To determine the prevalence of asymptomatic urinary abnormalities in adolescents, first morning clean mid-stream urine specimens were obtained from 2500 individuals and examined by dipstick and light microscopy. Adolescents with abnormal screening results were reexamined after two weeks and those who had abnormal results twice were subjected to systemic clinical examination and further clinical and laboratory investigations. Eight hundred and three (32.1% individuals had urinary abnormalities at the first screening, which significantly decreased to 345 (13.8% at the second screening, (P <0.001. Hematuria was the most common urinary abnormalities detected in 245 (9.8% adolescents who had persistent urine abnormalities; 228 (9.1% individuals had non glomerular hematuria. The hematuria was isolated in 150 (6% individuals, combined with leukocyturia in 83 (3.3% individuals, and combined with proteinuria in 12 (0.5% individuals. Leukocyturia was detected in 150 (6% of all studied adolescents; it was isolated in 39 (1.6% individuals and combined with proteinuria in 28 (1.1% of them. Asymp- tomatic bacteriuria was detected in 23 (0.9% of all studied adolescents; all the cases were females. Proteinuria was detected in 65 (2.6% of all the studied adolescents; 45 (1.8% indivi- duals had <0.5 g/day and twenty (0.8% individuals had 0.5-3 g/day. Asymptomatic urinary abnormalities were more common in males than females and adolescents from rural than urban areas (P <0.01 and (P <0.001, respectively. The present study found a high prevalence of asymptomatic urinary abnormalities among adolescents in our population.

  17. Abnormal ''Contamination' Levels On Garden Appliances

    International Nuclear Information System (INIS)

    German, U.; Levinson, S.; Elmelech, V.; Pelled, O.; Tshuva, A.; Laichter, Y.

    1999-01-01

    During routine contamination checks we encountered an abnormal high level of Alpha and Beta emitting radioisotopes on working gloves of employees of the gardening department. It came out that the source was due to ''contamination'' levels on steering wheels of some gardening machines. In order to ensure that no real contamination of these workers was involved , a series of checks was started to identity the source of the abnormal levels found during monitoring

  18. Normal and Abnormal Behavior in Early Childhood

    OpenAIRE

    Spinner, Miriam R.

    1981-01-01

    Evaluation of normal and abnormal behavior in the period to three years of age involves many variables. Parental attitudes, determined by many factors such as previous childrearing experience, the bonding process, parental psychological status and parental temperament, often influence the labeling of behavior as normal or abnormal. This article describes the forms of crying, sleep and wakefulness, and affective responses from infancy to three years of age.

  19. Familial eccrine syringofibroadenomatosis with associated ophthalmologic abnormalities.

    Science.gov (United States)

    Chen, S; Palay, D; Templeton, S F

    1998-08-01

    Eccrine syringofibroadenoma (ESFA) is a rare benign adnexal tumor, generally with sporadic occurrence and not linked to other diseases. Only one familial occurrence of ESFA has been reported. We describe the familial occurrence of multiple ESFAs in a father and his two sons, all of whom also had similar eyelid abnormalities and progressive corneal scarring. This description of hereditary ESFA is the first to link ESFA with periocular and ocular abnormalities.

  20. The EULAR-OMERACT rheumatoid arthritis MRI reference image atlas: the wrist joint

    DEFF Research Database (Denmark)

    Ejbjerg, B; McQueen, F; Lassere, M

    2005-01-01

    , capitate, and a metacarpal base. In these bones, grades 0-3 of bone oedema are illustrated, and for bone erosion, grades 0-3 and examples of higher grades are presented. The presented reference images can be used to guide scoring of wrist joints according to the OMERACT RA MRI scoring system......This paper presents the wrist joint MR images of the EULAR-OMERACT rheumatoid arthritis MRI reference image atlas. Reference images for scoring synovitis, bone oedema, and bone erosions according to the OMERACT RA MRI scoring (RAMRIS) system are provided. All grades (0-3) of synovitis...... are illustrated in each of the three wrist joint areas defined in the scoring system-that is, the distal radioulnar joint, the radiocarpal joint, and the intercarpal-carpometacarpal joints. For reasons of feasibility, examples of bone abnormalities are limited to five selected bones: the radius, scaphoid, lunate...

  1. [Hysteroscopic polypectomy, treatment of abnormal uterine bleeding].

    Science.gov (United States)

    de Los Rios, P José F; López, R Claudia; Cifuentes, P Carolina; Angulo, C Mónica; Palacios-Barahona, Arlex U

    2015-07-01

    To evaluate the effectiveness of the hysteroscopic polypectomy in terms of the decrease of the abnormal uterine bleeding. A cross-sectional and analytical study was done with patients to whom a hysteroscopic polypectomy was done for treating the abnormal uterine bleeding, between January 2009 and December 2013. The response to the treatment was evaluated via a survey given to the patients about the behavior of the abnormal uterine bleeding after the procedure and about overall satisfaction. The results were obtained after a hysteroscopic polypectomy done to 128 patients and were as follows. The average time from the polypectomy applied until the survey was 30.5 months, with a standard deviation of 18 months. 67.2% of the patients reported decreased abnormal uterine bleeding and the 32.8% reported a persistence of symptoms. On average 82.8% of the. patients were satisfied with the treatment. Bivariate and multivariate analysis showed no association between the variables studied and no improvement of abnormal uterine bleeding after surgery (polypectomy). There were no complications. Hysteroscopic polypectomy is a safe surgical treatment, which decreases on two of three patients the abnormal uterine bleeding in the presence of endometrial polyps, with an acceptable level of satisfaction.

  2. Calcific shoulder joint periarthritis

    International Nuclear Information System (INIS)

    Gussetti, P.; Moroso, P.; Palazzo, C.

    1986-01-01

    The authors report their results in the laser therapy of 30 calcific joint periarthritis. In two out of the ten radiographed cases, at the end of therapy, the complete disappearance of calcifications has been shown and in one case a decrease in calcification volume has been demonstrated. In the follow up after 6 months, 80% of clinically checked patients had no painful relapse

  3. Joint-Use Libraries

    Science.gov (United States)

    Casstevens, Susan

    2017-01-01

    The joint-use library is a place where people of all ages, interests, and income levels can find items of interest at no personal cost. The mission of A. H. Meadows Public and High School Library in Midlothian, Texas, is to offer what other public libraries provide: educational and entertainment resources to a community. Yet, the staff also wants…

  4. Joint Programming Initiative Climate

    NARCIS (Netherlands)

    Swart, R.J.; Berkhout, F.; Deelen, van C.L.; Driessen, P.P.J.

    2012-01-01

    From 2008 to 2011, Knowledge for Climate contributed to the development of the Joint Programming Initiative “Connecting Climate Knowledge for Europe” (JPI Climate). In 2010, a proposal was developed and accepted, followed in 2011 by the development and adoption of a governance structure and a

  5. Osteomyelitis and pyogenic infection of the sacroiliac joint. MRI findings and review

    International Nuclear Information System (INIS)

    Haliloglu, M.; Kleiman, M.B.; Siddiqui, A.R.; Cohen, M.D.

    1994-01-01

    Acute pyogenic sacroiliac joint infection and osteomyelitis of adjacent bones often present with severe, poorly localized lower back, pelvic of hip pain. Five cases of sacroiliac joint infection or sacroiliac bone osteomyelitis were evaluated by MRI. MRI may be a helpful diagnostic tool to evaluate early changes of infection in the sacroiliac area. It is very sensitive for detecting bone marrow abnormalities; however, it is non-specific and can not accurately differentiate osteomyelitis from sacroiliitis. (orig.)

  6. Radiological characteristics of the knee joint in nail patella syndrome

    NARCIS (Netherlands)

    Tigchelaar, S.J.; Rooy, J.W. de; Hannink, G.J.; Koeter, S.; Kampen, A. van; Bongers, E.M.

    2016-01-01

    AIM: Nail patella syndrome (NPS) is a skeletal dysplasia with patellofemoral dysfunction as a key symptom. We present the first in-depth radiological evaluation of the knee in a large series of NPS patients and describe the typical malformations. PATIENTS AND METHODS: Conventional radiological

  7. Injury patterns of medial patellofemoral ligament after acute lateral patellar dislocation in children: Correlation analysis with anatomical variants and articular cartilage lesion of the patella

    Energy Technology Data Exchange (ETDEWEB)

    Zhang, Guang-ying; Ding, Hong-yu [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Ultrasonography, Jinan (China); Zheng, Lei; Ji, Bing-jun [Shandong Provincial Corps Hospital of Chinese People' s Armed Police Force, Department of Radiology, Jinan (China); Shi, Hao [Shandong Provincial Qianfoshan Hospital of Shandong University, Department of Radiology, Jinan (China); Feng, Yan [Affiliated Hospital of Binzhou Medical College, Department of Radiology, Binzhou (China)

    2017-03-15

    To assess the relationship between injury patterns of medial patellofemoral ligament (MPFL) and anatomical variants and patellar cartilage lesions after acute lateral patellar dislocation (LPD) in children. MR images were obtained in 140 children with acute LPD. Images were acquired and evaluated using standardised protocols. Fifty-eight cases of partial MPFL tear and 75 cases of complete MPFL tear were identified. Injuries occurred at an isolated patellar insertion (PAT) in 52 cases, an isolated femoral attachment (FEM) in 42 cases and an isolated mid-substance (MID) in five cases. More than one site of injury was identified in 34 cases. Compared with Wiberg patellar type C, Wiberg patellar type B predisposed to complete MPFL tear (P = 0.042). No correlations were identified between injury patterns of MPFL and trochlear dysplasia, patellar height and tibial tuberosity-trochlear groove distance (P > 0.05). Compared with partial MPFL tear, complete MPFL tear predisposed to Grade-IV and Grade-V patellar chondral lesion (P = 0.02). There were no correlations between incidence of patellar cartilage lesion and injury locational-subgroups of MPFL (P = 0.543). MPFL is most easily injured at the PAT in children. Wiberg patellar type B predisposes to complete MPFL tear. Complete MPFL tear predisposes to a higher grade of patellar chondral lesion. (orig.)

  8. The Comparison of the Effects of Trigger Points Pressure Release and Kinesio Taping on Pain and Hip Abductor Muscles Strength in Patients with Patellofemoral Pain Syndrome

    Directory of Open Access Journals (Sweden)

    Vahid Mazloum

    2016-10-01

    Full Text Available Background & objectives: Hip muscles insufficiency plays a significant role in deterioration of patellofemoral pain syndrome (PFPS, which can be manifested as myofascial trigger point (MTrPs in hip muscles. Then, our purpose was to determine the prevalence of MTrPs in the gluteus medius (GMe and quadratus lumborum (QL muscles and to investigate the effect of a therapeutic intervention on pain intensity and hip abductor muscles isometric strength in patients with PFPS. Methods: Forty volunteer subjects (20 patients and 20 healthy participated in the study. Latent MTrPs in GMe and QL were evaluated and a handheld dynamometer was used to measure peak isometric strength test (PIST for hip abductors. Patients with PFPS having MTrPs in GMe were randomly divided into either a treatment group (Mean age±SD: 23.2±4.3 years or control (Mean age±SD: 24.4±4.6 years. The therapeutic intervention included trigger point pressure release (TrPPR and Kinesio Taping® (KT. Pain intensity and PIST for hip abductors were assessed at baseline and after intervention in both groups. Results: There is more significant patients with PFPS having latent MTrPs in GMe and QL than the healthy counterparts (p0.05. Conclusion: Concomitant using of TrPPR therapy and KT method can decrease pain intensity in individuals with PFPS. Further studies are required to understand the underlying mechanisms.

  9. Muscle Activation of Vastus Medialis Oblique and Vastus Lateralis in Sling-Based Exercises in Patients with Patellofemoral Pain Syndrome: A Cross-Over Study

    Directory of Open Access Journals (Sweden)

    Wen-Dien Chang

    2015-01-01

    Full Text Available Objectives. To examine what changes are caused in the activity of the vastus medialis oblique (VMO and vastus lateralis (VL at the time of sling-based exercises in patients with patellofemoral pain syndrome (PFPS and compare the muscular activations in patients with PFPS among the sling-based exercises. Methods. This was a cross-over study. Sling-based open and closed kinetic knee extension and hip adduction exercises were designed for PFPS, and electromyography was applied to record maximal voluntary contraction during the exercises. The VMO and VL activations and VMO : VL ratios for the three exercises were analyzed and compared. Results. Thirty male (age = 21.19 ± 0.68 y and 30 female (age = 21.12 ± 0.74 y patients with PFPS were recruited. VMO activations during the sling-based open and closed kinetic knee extension exercises were significantly higher (P=0.04 and P=0.001 than those during hip adduction exercises and VMO : VL ratio for the sling-based closed kinetic knee extension and hip adduction exercises approximated to 1. Conclusions. The sling-based closed kinetic knee extension exercise produced the highest VMO activation. It also had an appropriate VMO : VL ratio similar to sling-based hip adduction exercise and had beneficial effects on PFPS.

  10. Effect of intraarticular glycosaminoglycan polysulfate treatment on patellofemoral pain syndrome. A prospective, randomized double-blind trial comparing glycosaminoglycan polysulfate with placebo and quadriceps muscle exercises.

    Science.gov (United States)

    Kannus, P; Natri, A; Niittymäki, S; Järvinen, M

    1992-09-01

    To compare the effects of intraarticular (IA) injections of glycosaminoglycan polysulfate (GAGPS) plus basic conservative treatment with the effects of placebo injections plus conservative treatment and with the effects of conservative treatment alone in patients with chronic patellofemoral pain syndrome (PFPS). We treated 53 patients who presented with chronic PFPS in 1 knee, according to 1 of the 3 protocols, in a prospective, randomized, double-blind study. Basic conservative treatment consisted of a 6-week program of quadriceps muscle exercise, elimination of symptom-producing activities, and oral doses of nonsteroidal antiinflammatory drugs. Physiologic saline served as placebo for injection. During the 6-week treatment period, 5 injections were given 1 week apart. Along with measurements of quadriceps strength, standardized subjective, functional, and clinical assessments were performed at presentation, after 6 weeks of treatment, and after 6 months. Results at 6 months indicated that IA injections of GAGPS or saline did not result in significant improvement beyond the good results achieved by the basic conservative treatment alone. More than two-thirds of the patients in each group experienced complete recovery. Neither the GAGPS injections nor the physiologic saline injections are more effective than conservative therapy in the treatment of chronic PFPS. Restoration of normal quadriceps muscle function to the affected knee seems to be crucial in treating PFPS.

  11. High eccentric hip abduction strength reduces the risk of developing patellofemoral pain among novice runners initiating a self-structured running program: a 1-year observational study.

    Science.gov (United States)

    Ramskov, Daniel; Barton, Christian; Nielsen, Rasmus O; Rasmussen, Sten

    2015-03-01

    Observational prospective cohort study with 1-year follow-up. To investigate the relationship between eccentric hip abduction strength and the development of patellofemoral pain (PFP) in novice runners during a self-structured running regime. Recent research indicates that gluteal muscle weakness exists in individuals with PFP. However, current prospective research has been limited to the evaluation of isometric strength, producing inconsistent findings. Considering that hip muscles, including the gluteus maximus and medius, activate eccentrically to control hip and pelvic motion during weight-bearing activities such as running, the potential link between eccentric strength and PFP risk should be evaluated. Eight hundred thirty-two novice runners were included at baseline, and 629 participants were included in the final analysis. Maximal eccentric hip abduction strength was measured using a handheld dynamometer prior to initiating a self-structured running program. The diagnostic criteria to classify knee pain as PFP were based on a thorough clinical examination. Participants were followed for 12 months and training characteristics were gathered with a global positioning system. Results from the unadjusted generalized linear regression model for cumulative risk at 25 and 50 km indicated differences in cumulative risk of PFP between high strength, normal strength, and low strength (Pabduction strength that is higher than normal may reduce the risk of PFP during the first 50 km of a self-structured running program.

  12. Comparison of the effects of knee and hip and single knee muscles strengthening/ stretching exercises on pain intensity and function in athletes with patellofemoral pain syndrome

    Directory of Open Access Journals (Sweden)

    Vahid Mazloum

    2016-08-01

    Full Text Available Background: Patellofemoral pain syndrome (PFPS is a common musculoskeletal condition among athletes. The evidence emphasizes on the importance of hip musculature strengthening exercises for such patients. Objective: To investigate the effects of strengthening-stretching knee muscles exercises and hip posterolateral musculature exercises in athletes with PFPS. Methods: In this clinical trial, 28 athletes with age average of 22.7±2.4 years with PFPS were allocated into conventional knee muscles exercises (CKME (n=14 and posterolateral hip muscles exercises (PHME (n=14. The subjects of both groups performed the supervised exercise protocols in 12 sessions. The Visual Analogue Scale and 6-minute walking tests were administrated respectively to evaluate pain intensity and function. The data were analyzed using Shapiro-wilk test, Independent-sample t test, and Repeated Measure ANOVA test. Findings: Demographic, pain intensity, and physical function data were similar between groups at baseline. Both groups significantly improved in pain intensity and function following a 4-week exercise program. Additionally, the athletes in PHME group had higher level of decreased pain intensity and improved function in follow-up assessment than the subjects in CKME group. Conclusion: Using hip posterolateral musculature exercises in addition to the knee conventional exercises is more effective for athletes with PFPS.

  13. An analysis of a joint shear model for jointed media with orthogonal joint sets

    International Nuclear Information System (INIS)

    Koteras, J.R.

    1991-10-01

    This report describes a joint shear model used in conjunction with a computational model for jointed media with orthogonal joint sets. The joint shear model allows nonlinear behavior for both joint sets. Because nonlinear behavior is allowed for both joint sets, a great many cases must be considered to fully describe the joint shear behavior of the jointed medium. An extensive set of equations is required to describe the joint shear stress and slip displacements that can occur for all the various cases. This report examines possible methods for simplifying this set of equations so that the model can be implemented efficiently form a computational standpoint. The shear model must be examined carefully to obtain a computationally efficient implementation that does not lead to numerical problems. The application to fractures in rock is discussed. 5 refs., 4 figs

  14. Temporomandibular joint space in children without joint disease

    International Nuclear Information System (INIS)

    Larheim, T.A.

    1981-01-01

    Bilateral assessment of the temporomandibular joint space in children without joint disease is reported. Twenty-eight children were examined with conventional radiography and 23 with tomography. High prevalence of asymmetric joint spaces with both techniques indicated that great care should be taken when using narrowing or widening of the joint space as a diagnostic criterion in children with juvenile rheumatoid arthritis. Other signs, such as restricted translation of the mandibular head, and clinical symptoms should be evaluated. (Auth.)

  15. Ocular abnormalities in healthy Standardbred foals.

    Science.gov (United States)

    Barsotti, Giovanni; Sgorbini, Micaela; Marmorini, Paola; Corazza, Michele

    2013-07-01

    To determine the prevalence and describe ocular abnormalities in healthy Standardbred foals within 48 h of birth. One hundred and two neonatal foals. All foals had an unassisted delivery. On the basis of physical examination and the results of hematological and biochemical parameters, all foals were unaffected by systemic diseases. A complete ophthalmic examination was performed within 48 h of birth. Foals with ocular hemorrhages were re-examined weekly until the abnormalities were resolved. 65/102 (63.7%) foals did not show ocular abnormalities, while in 37/102 (36.3%) cases, ocular abnormalities were present. Retinal and subconjunctival hemorrhages were recorded in 19/102 (18.6%), and in 13/102 (12.7%), respectively. In 4/102 (3.9%) animals, an entropion of the lower eyelid was present. Only one foal (1%) showed a congenital nuclear unilateral cataract. No other ocular abnormalities were detected. However, all foals showed various degrees of remnants of hyaloid system. One week after the first ocular examination, retinal hemorrhages had resolved in 100% of the eyes, whereas subconjunctival hemorrhages had disappeared in all eyes by the second week following the first examination. The acquired ocular lesions observed with relatively high frequency in the examined healthy Standardbred foals were ocular hemorrhages, which always showed a good outcome. Although these abnormalities were present at birth, they were not considered strictly congenital but likely acquired during parturition. Instead, congenital ocular abnormalities were rarely diagnosed, and the entropion of the lower eyelid was the most common disease in the breed. © 2012 American College of Veterinary Ophthalmologists.

  16. Detecting Kidney and Urinary Tract Abnormalities Before Birth

    Science.gov (United States)

    ... Guide Detecting Kidney and Urinary Tract Abnormalities Before Birth Print Email Ultrasound examinations are often done as ... What causes urinary tract abnormalities to occur before birth? In about one of 500 births, some abnormality ...

  17. Inter-rater reliability of diagnostic criteria for sacroiliac joint-, disc- and facet joint pain.

    Science.gov (United States)

    van Tilburg, Cornelis W J; Groeneweg, Johannes G; Stronks, Dirk L; Huygen, Frank J P M

    2017-01-01

    Several diagnostic criteria sets are described in the literature to identify low back pain subtypes, but very little is known about the inter-rater reliability of these criteria. We conducted a study to determine the reliability of diagnostic tests that point towards SI joint-, disc- or facet joint pain. Inter-rater reliability study alongside three randomized clinical trials. Multidisciplinary pain center of general hospital. Patients aged 18 or more with medical history and physical examination suggestive of sacroiliac joint-, disc- and facet joint pain on lumbar level. Making use of nowadays most common used diagnostic criteria, a physical examination is taken independently by three physicians (two pain physicians and one orthopedic surgeon). Inter-rater reliability (Kappa (κ) measure of agreement) and significance (p) between raters are presented. Strengths of agreement, indicated with κ values above 0,20, are presented in order of agreement. One hundred patients were included. None of the parameters from the physical investigation had κ values of more than 0.21 (fair) in all pairs of raters. Between two raters (C and D), there was an almost perfect agreement on three parameters, more specifically ``Abnormal sensory and motor examination, hyperactive or diminished reflexes'', ``Sitting exam shows no reflex, motor or sensory signs in the legs'' and ``Straight leg raising (Laségue) negative between 30 and 70 degrees of flexion''. The ``Drop test positive'' parameters had moderate strength of agreement between raters A and D and fair strength between raters A and B. The ``Digital interspinous pressure test positive'' had moderate strength of agreement between raters C and D and fair strength of agreement between raters A and B as well as raters B and C. Three other parameters had a fair strength of agreement between two raters, all other parameters had a slight or poor strength of agreement. Inter-rater reliability, confidence intervals and significance of

  18. Upright CT of the knee: the effect of weight-bearing on joint alignment

    Energy Technology Data Exchange (ETDEWEB)

    Hirschmann, Anna [Orthopedic University Hospital Balgrist, University of Zurich, Department of Radiology, Zurich (Switzerland); University of Basel Hospital, Clinic of Radiology and Nuclear Medicine, Basel (Switzerland); Buck, Florian M.; Pfirrmann, Christian W.A. [Orthopedic University Hospital Balgrist, University of Zurich, Department of Radiology, Zurich (Switzerland); Fucentese, Sandro F. [Orthopedic University Hospital Balgrist, University of Zurich, Orthopedic Surgery, Zurich (Switzerland)

    2015-11-15

    To prospectively compare patellofemoral and femorotibial alignment in supine non-weight-bearing computed tomography (NWBCT) and upright weight-bearing CT (WBCT) and assess the differences in joint alignment. NWBCT and WBCT images of the knee were obtained in 26 patients (mean age, 57.0 ± 15.9 years; range, 21-81) using multiple detector CT for NWBCT and cone-beam extremity CT for WBCT. Two musculoskeletal radiologists independently quantified joint alignment by measuring femorotibial rotation, tibial tuberosity-trochlear groove distance (TTTG), lateral patellar tilt angle, lateral patellar shift, and medial and lateral femorotibial joint space widths. Significant differences between NWBCT and WBCT were sought using Wilcoxon signed-rank test (P-value < 0.05). Significant differences were found for femorotibial rotation (the NWBCT mean changed from 2.7 ± 5.1 (reader 1)/2.6 ± 5.6 (reader 2) external rotation to WBCT 0.4 ± 7.7/0.2 ± 7.5 internal rotation; P = 0.009/P = 0.004), TTTG decrease from NWBCT (13.8 mm ± 5.1/13.9 mm ± 3.9) to WBCT (10.5 mm ± 5.0/10.9 mm ± 5.2; P = 0.008/P = 0.002), lateral patellar tilt angle decrease from NWBCT (15.6 ± 6.7/16.9 ± 7.4) to WBCT (12.5 ± 7.7/15.0 ± 6.2; P = 0.011/P = 0.188). The medial femorotibial joint space decreased from NWBCT (3.9 mm ± 1.4/4.5 mm ± 1.3) to WBCT (2.9 mm ± 2.2/3.5 mm ± 2.2; P = 0.003/P = 0.004). Inter-reader agreement ranged from 0.52-0.97. Knee joint alignment changes significantly in the upright weight-bearing position using CT when compared to supine non-weight-bearing CT. (orig.)

  19. Ability of sagittal kinematic variables to estimate ground reaction forces and joint kinetics in running.

    Science.gov (United States)

    Wille, Christa M; Lenhart, Rachel L; Wang, Sijian; Thelen, Darryl G; Heiderscheit, Bryan C

    2014-10-01

    Controlled laboratory study, cross-sectional design. To determine if sagittal kinematic variables can be used to estimate select running kinetics. Excessive loading during running has been implicated in a variety of injuries, yet this information is typically not assessed during a standard clinical examination. Developing a clinically feasible strategy to estimate ground reaction forces and joint kinetics may improve the ability to identify those at an increased risk of injury. Three-dimensional kinematics and ground reaction forces of 45 participants were recorded during treadmill running at self-selected speed. Kinematic variables used to estimate specific kinetic metrics included vertical excursion of the center of mass, foot inclination angle at initial contact, horizontal distance between the center of mass and heel at initial contact, knee flexion angle at initial contact, and peak knee flexion angle during stance. Linear mixed-effects models were fitted to explore the association between the kinetic and kinematic measures, including step rate and sex, with final models created using backward variable selection. Models were developed to estimate peak knee extensor moment (R(2) = 0.43), energy absorbed at the knee during loading response (R(2) = 0.58), peak patellofemoral joint reaction force (R(2) = 0.55), peak vertical ground reaction force (R(2) = 0.48), braking impulse (R(2) = 0.50), and average vertical loading rate (R(2) = 0.04). Our findings suggest that insights into important running kinetics can be obtained from a subset of sagittal plane kinematics common to a clinical running analysis. Of note, the limb posture at initial contact influenced subsequent loading patterns in stance.

  20. Synovial cysts of the hip joint and iliopsoas bursitis: A spectrum of imaging abnormalities

    International Nuclear Information System (INIS)

    Sartoris, D.J.; Resnick, D.; Greenway, G.

    1985-01-01

    Synovium-related soft tissue disease around the hip constitutes a spectrum ranging from isolated iliopsoas bursitis to pure articular synovial herniations without bursal involvement. The clinical, pathologic, and radiographic features of these entities are discussed as they pertain to the variety of underlying disorder which predispose to their occurrence. Nine case reports are utilized to illustrate the variable clinical and radiographic presentations which may be encountered. Based upon these cases as well as those in the literature, an imaging algorithm has been developed which should eliminate unnecessary studies and allow prompt and accurate diagnosis. (orig.)

  1. Longitudinal joint specifications and performance.

    Science.gov (United States)

    2012-08-01

    Deterioration of longitudinal joints is widely recognized as one of the major factors contributing to failure of asphalt pavements. Finding : ways to improve the durability of longitudinal joints will lead to improved service lives and lower life cyc...

  2. Acupuncture for peripheral joint osteoarthritis.

    NARCIS (Netherlands)

    Manheimer, Eric; Cheng, K.; Linde, Klaus; Lao, Lixing; Yoo, Junghee; Wieland, Susan; van der Windt, Daniëlle Awm; Berman, Brian M.; Bouter, Lex M.

    2010-01-01

    BACKGROUND: Peripheral joint osteoarthritis is a major cause of pain and functional limitation. Few treatments are safe and effective. OBJECTIVES: To assess the effects of acupuncture for treating peripheral joint osteoarthritis. SEARCH STRATEGY: We searched the Cochrane Central Register of

  3. A 3D lower limb musculoskeletal model for simultaneous estimation of musculo-tendon, joint contact, ligament and bone forces during gait.

    Science.gov (United States)

    Moissenet, Florent; Chèze, Laurence; Dumas, Raphaël

    2014-01-03

    Musculo-tendon forces and joint reaction forces are typically estimated using a two-step method, computing first the musculo-tendon forces by a static optimization procedure and then deducing the joint reaction forces from the force equilibrium. However, this method does not allow studying the interactions between musculo-tendon forces and joint reaction forces in establishing this equilibrium and the joint reaction forces are usually overestimated. This study introduces a new 3D lower limb musculoskeletal model based on a one-step static optimization procedure allowing simultaneous musculo-tendon, joint contact, ligament and bone forces estimation during gait. It is postulated that this approach, by giving access to the forces transmitted by these musculoskeletal structures at hip, tibiofemoral, patellofemoral and ankle joints, modeled using anatomically consistent kinematic models, should ease the validation of the model using joint contact forces measured with instrumented prostheses. A blinded validation based on four datasets was made under two different minimization conditions (i.e., C1 - only musculo-tendon forces are minimized, and C2 - musculo-tendon, joint contact, ligament and bone forces are minimized while focusing more specifically on tibiofemoral joint contacts). The results show that the model is able to estimate in most cases the correct timing of musculo-tendon forces during normal gait (i.e., the mean coefficient of active/inactive state concordance between estimated musculo-tendon force and measured EMG envelopes was C1: 65.87% and C2: 60.46%). The results also showed that the model is potentially able to well estimate joint contact, ligament and bone forces and more specifically medial (i.e., the mean RMSE between estimated joint contact force and in vivo measurement was C1: 1.14BW and C2: 0.39BW) and lateral (i.e., C1: 0.65BW and C2: 0.28BW) tibiofemoral contact forces during normal gait. However, the results remain highly influenced by the

  4. The range and prevalence of pathological abnormalities associated with lameness in working horses from developing countries.

    Science.gov (United States)

    Broster, C E; Burn, C C; Barr, A R S; Whay, H R

    2009-05-01

    Lameness is highly prevalent in working horses, but published reports on the associated pathological abnormalities are lacking. With over 42 million horses in developing countries and the majority used for work, lameness has major welfare implications. To describe the range and prevalence of pathological abnormalities associated with lameness in working horses. A standard lameness assessment was adapted for field use in working equids. Data on pathological abnormalities and pain responses in the feet, limbs and spine were collected through observation, palpation, manipulations and gait assessment in working horses from India (n = 110) and Pakistan (n = 117). Lameness at the walk was scored on a scale of 0-4 (sound-nonweightbearing). All horses examined were lame. Overall, 98% showed a gait abnormality in all 4 limbs and 87% had at least one limb scoring 3 or 4 on the lameness scale. Multiple pathological abnormalities within each limb were associated with lameness, with similar results in both countries. Chronic foot pathology was seen in every horse; 94% horses showed signs of chronic joint disease; 83% had digital flexor tendonitis in at least one limb. Lameness and pathological abnormalities were associated with specific pain responses in the feet, limbs and spine. The extremely high prevalence of multilimb lameness and its association with pain is of great concern. The multiple pathological abnormalities present in working horses makes lameness complex to address. The results of this detailed study of lameness should facilitate the identification of risk factors and the implementation of interventions to reduce the prevalence of lameness in working equids.

  5. Chromosomal abnormality in patients with secondary amenorrhea.

    Science.gov (United States)

    Safai, Akbar; Vasei, Mohammad; Attaranzadeh, Armin; Azad, Fariborz; Tabibi, Narjes

    2012-04-01

    Secondary amenorrhea is a condition in which there is cessation of menses after at least one menstruation. It is a symptom of different diseases, such as hormonal disturbances which range from pituitary to ovarian origin, as well as chromosomal abnormalities. Knowledge of the distinct cause of secondary amenorrhea is of tremendous benefit for the management and monitoring of patients. In this study, we determine the chromosomal abnormalities in patients with secondary amenorrhea in Southwest Iran. We selected 94 patients with secondary amenorrhea who referred to our Cytogenetic Ward from 2004 until 2009. For karyotyping, peripheral blood lymphocyte cultures were set up by conventional technique. In this study, 5.3% (n=5) of patients with secondary amenorrhea presented with chromosomal abnormalities, of which all contained an X element. The chromosomal abnormalities were: i) 45, X (n=1); ii) 47, XXX (n=1); iii) 45, X [13]/ 45, Xi(X)q[17] (n=1);  iv) 45, X[12]/46,X,+mar[12] (n=1); and v) 46,X,del(Xq)(q23q28) (n=1). Our study revealed that some causes of secondary amenorrhea could be due to chromosomal abnormalities. Therefore, cytogenetic studies should be important tests in the evaluation of patients with secondary amenorrhea.

  6. Determination of Parachute Joint Factors using Seam and Joint Testing

    Science.gov (United States)

    Mollmann, Catherine

    2015-01-01

    This paper details the methodology for determining the joint factor for all parachute components. This method has been successfully implemented on the Capsule Parachute Assembly System (CPAS) for the NASA Orion crew module for use in determining the margin of safety for each component under peak loads. Also discussed are concepts behind the joint factor and what drives the loss of material strength at joints. The joint factor is defined as a "loss in joint strength...relative to the basic material strength" that occurs when "textiles are connected to each other or to metals." During the CPAS engineering development phase, a conservative joint factor of 0.80 was assumed for each parachute component. In order to refine this factor and eliminate excess conservatism, a seam and joint testing program was implemented as part of the structural validation. This method split each of the parachute structural joints into discrete tensile tests designed to duplicate the loading of each joint. Breaking strength data collected from destructive pull testing was then used to calculate the joint factor in the form of an efficiency. Joint efficiency is the percentage of the base material strength that remains after degradation due to sewing or interaction with other components; it is used interchangeably with joint factor in this paper. Parachute materials vary in type-mainly cord, tape, webbing, and cloth -which require different test fixtures and joint sample construction methods. This paper defines guidelines for designing and testing samples based on materials and test goals. Using the test methodology and analysis approach detailed in this paper, the minimum joint factor for each parachute component can be formulated. The joint factors can then be used to calculate the design factor and margin of safety for that component, a critical part of the design verification process.

  7. Joint and Soft Tissue Injections

    Science.gov (United States)

    ... Injections Joint and Soft Tissue Injections Share Print What is a joint and soft tissue injection? Joint and soft tissue injections are shots ... many injections do I need and how often? What restrictions do I have after an ... tissue injection, treatment April 1, 2004 Copyright © American Academy ...

  8. Cardiac abnormality prediction using HMLP network

    Science.gov (United States)

    Adnan, Ja'afar; Ahmad, K. A.; Mat, Muhamad Hadzren; Rizman, Zairi Ismael; Ahmad, Shahril

    2018-02-01

    Cardiac abnormality often occurs regardless of gender, age and races but depends on the lifestyle. This problem sometimes does not show any symptoms and usually detected once it already critical which lead to a sudden death to the patient. Basically, cardiac abnormality is the irregular electrical signal that generate by the pacemaker of the heart. This paper attempts to develop a program that can detect cardiac abnormality activity through implementation of Hybrid Multilayer Perceptron (HMLP) network. A certain amount of data of the heartbeat signals from the electrocardiogram (ECG) will be used in this project to train the MLP and HMLP network by using Modified Recursive Prediction Error (MRPE) algorithm and to test the network performance.

  9. Radiographic abnormalities in tricyclic acid overdose

    International Nuclear Information System (INIS)

    Varnell, R.M.; Richardson, M.L.; Vincent, J.M.; Godwin, J.D.

    1987-01-01

    Several case reports have described adult respiratory distress syndrome (ARDS) secondary to tricyclic acid (TCA) overdose. During a 1-year period 83 patients requiring intubation secondary to drug overdose were evaluated. Abnormalities on chest radiographs occurred in 26 (50%) of the 54 patients with TCA overdose, compared to six (21%) of the 29 patients overdosed with other drugs. In addition, five (9%) of the patients with TCA overdose subsequently had radiographic and clinical abnormalities meeting the criteria for ARDS. Only one (3%) of the patients with non-TCA overdose subsequently had change suggesting ARDS. TCAs should be added to the list of drugs associated with ARDS, and TCA overdose should be considered a major risk factor in the development of radiographically evident abnormalities

  10. Schizophrenia and abnormal brain network hubs.

    Science.gov (United States)

    Rubinov, Mikail; Bullmore, Ed

    2013-09-01

    Schizophrenia is a heterogeneous psychiatric disorder of unknown cause or characteristic pathology. Clinical neuroscientists increasingly postulate that schizophrenia is a disorder of brain network organization. In this article we discuss the conceptual framework of this dysconnection hypothesis, describe the predominant methodological paradigm for testing this hypothesis, and review recent evidence for disruption of central/hub brain regions, as a promising example of this hypothesis. We summarize studies of brain hubs in large-scale structural and functional brain networks and find strong evidence for network abnormalities of prefrontal hubs, and moderate evidence for network abnormalities of limbic, temporal, and parietal hubs. Future studies are needed to differentiate network dysfunction from previously observed gray- and white-matter abnormalities of these hubs, and to link endogenous network dysfunction phenotypes with perceptual, behavioral, and cognitive clinical phenotypes of schizophrenia.

  11. Folate metabolism abnormalities in autism: potential biomarkers.

    Science.gov (United States)

    Frye, Richard E; Slattery, John C; Quadros, Edward V

    2017-08-03

    Autism spectrum disorder (ASD) has been linked to abnormalities in folate metabolism. Polymorphisms in folate genes may act in complex polygenic ways to increase the risk of developing ASD. Autoantibodies that block folate transport into the brain have been associated with ASD and children with ASD and these autoantibodies respond to high doses of a reduced form of folate known as folinic acid (leucovorin calcium). Some of the same abnormalities are also found in mothers of children with ASD and supplementing folate during preconception and gestational periods reduces the risk to the offspring from developing ASD. These data suggest that folate pathway abnormalities may be a major metabolic disturbance underlying ASD that can be leveraged as biomarkers to improve symptoms and prevent ASD.

  12. Abnormal cervical cytology and health care use

    DEFF Research Database (Denmark)

    Frederiksen, Maria Eiholm; Baillet, Miguel Vázquez-Prada; Dugué, Pierre-Antoine

    2015-01-01

    OBJECTIVE: This study aimed to assess the long-term use of health care services in women with abnormal cytology results compared to women with normal cytology results. METHODS: We did a nationwide population-based study, using women aged 23 to 59years participating in the national organized...... cervical cancer screening program. We included a study population of 40,153 women with abnormal cytology (exposed) and 752,627 women with normal cytology (non-exposed). We retrieved data from the Danish Civil Registration System, the Danish Pathology Data Bank, the National Health Service, the National...... the "before" to the "after" period. This increase was significantly higher for exposed than non-exposed women regarding contacts to GP, admissions to hospitals, and drug use. CONCLUSION: Women with abnormal cytology results constitute a selected group with a higher health care use than other women even before...

  13. Abnormal Grain Growth Suppression in Aluminum Alloys

    Science.gov (United States)

    Hales, Stephen J. (Inventor); Claytor, Harold Dale (Inventor); Alexa, Joel A. (Inventor)

    2015-01-01

    The present invention provides a process for suppressing abnormal grain growth in friction stir welded aluminum alloys by inserting an intermediate annealing treatment ("IAT") after the welding step on the article. The IAT may be followed by a solution heat treatment (SHT) on the article under effectively high solution heat treatment conditions. In at least some embodiments, a deformation step is conducted on the article under effective spin-forming deformation conditions or under effective superplastic deformation conditions. The invention further provides a welded article having suppressed abnormal grain growth, prepared by the process above. Preferably the article is characterized with greater than about 90% reduction in area fraction abnormal grain growth in any friction-stir-welded nugget.

  14. Enhanced monitoring of abnormal emergency department demands

    KAUST Repository

    Harrou, Fouzi

    2016-06-13

    This paper presents a statistical technique for detecting signs of abnormal situation generated by the influx of patients at emergency department (ED). The monitoring strategy developed was able to provide early alert mechanisms in the event of abnormal situations caused by abnormal patient arrivals to the ED. More specifically, This work proposed the application of autoregressive moving average (ARMA) models combined with the generalized likelihood ratio (GLR) test for anomaly-detection. ARMA was used as the modelling framework of the ARMA-based GLR anomaly-detection methodology. The GLR test was applied to the uncorrelated residuals obtained from the ARMA model to detect anomalies when the data did not fit the reference ARMA model. The ARMA-based GLR hypothesis testing scheme was successfully applied to the practical data collected from the database of the pediatric emergency department (PED) at Lille regional hospital center, France. © 2015 IEEE.

  15. Report on Congress on abnormal occurrences

    International Nuclear Information System (INIS)

    1991-06-01

    Section 208 of the energy Reorganization Act of 1974 identifies an abnormal occurrence as an unscheduled incident or event that the Nuclear Regulatory Commission determines to be significant from the standpoint of public health or safety and requires a quarterly report of such events to be made to Congress. This report covers the period from January 1 through March 31, 1991. The report discusses six abnormal occurrences, none of which involved a nuclear power plant. Five of the events occurred at NRC-licensed facilities: one involved a significant degradation of plant safety at a nuclear fuel cycle facility, one involved a medical diagnostic misadministration, and three involved medical therapy misadministrations. An Agreement State (Arizona) reported one abnormal occurrence that involved medical therapy misadministrations

  16. Abnormal fetal head shape: aetiology and management

    DEFF Research Database (Denmark)

    Petersen, Olav Bjørn; David, Anna; Thomasson, Louise

    2007-01-01

    and define management pathways for fetuses with an abnormal skull shape. Methods: Our FMU databases were searched to ascertain all fetuses with an abnormal skull shape. Sonographic findings, diagnosis and outcome were reviewed. Results: Of the 370 cases identified, 31.6% were associated with spinabifida......Background: Abnormal head shape is an uncommon finding on prenatal ultrasound, often associated with breech presentation, spinabifida, aneuploidy or secondary to oligohydramnios or fetal position. Other aetiologies are rarer and may be more difficult to define. Objective: To determine the aetiology...... incidence of genetic syndromes, in the absence of a clear diagnosis, referral to a tertiary centre and genetic input is advised as detection of subtle sonographic features may aid diagnosis, allowing for targeted molecular analysis. An algorithm for management will be proposed....

  17. [Abnormal peripheral circulation in heart failure].

    Science.gov (United States)

    Cohen-Solal, A; Laperche, T; Caviezel, B; Dahan, M; Gourgon, R

    1994-06-01

    Left ventricular failure leads to circulatory failure which causes clinical symptoms and in which regional blood flow changes play an important role. An abnormality of systemic vasodilatation on exercise or on pharmacological intervention has been shown. This affects both the resistance and conductive vessels and is mainly functional, related to neurohormonal stimulation with a predominance of vasoconstrictive factors amongst which increased adrenergic tone probably plays an essential part. A modification of the endothelium-dependent response has recently been confirmed. The presence of structural vascular abnormalities (increase in parietal sodium and water concentrations, "remodelling" remains debatable in the human. These abnormalities have a common factor in their chronicity and take time to regress with medical treatment or after cardiac transplantation. Physical training seems to induce more marked and, above all, more rapid effects.

  18. Joint International Accelerator School

    CERN Multimedia

    CERN Accelerator School

    2014-01-01

    The CERN and US Particle Accelerator Schools recently organised a Joint International Accelerator School on Beam Loss and Accelerator Protection, held at the Hyatt Regency Hotel, Newport Beach, California, USA from 5-14 November 2014. This Joint School was the 13th in a series of such schools, which started in 1985 and also involves the accelerator communities in Japan and Russia.   Photo courtesy of Alfonse Pham, Michigan State University.   The school attracted 58 participants representing 22 different nationalities, with around half from Europe and the other half from Asia and the Americas. The programme comprised 26 lectures, each of 90 minutes, and 13 hours of case study. The students were given homework each day and had an opportunity to sit a final exam, which counted towards university credit. Feedback from the participants was extremely positive, praising the expertise and enthusiasm of the lecturers, as well as the high standard and quality of their lectures. Initial dis...

  19. Peripheral degenerative joint diseases

    Directory of Open Access Journals (Sweden)

    Nilzio Antonio da Silva

    2008-03-01

    Full Text Available Osteoarthritis, a degenerative joint disease, is the most commonrheumatic disorder mainly in a geriatric population. Manifestationsare pain, stiffness and functional loss in the affected joint.According to etiology it is classifi ed as primary (or idiopathicand secondary. Some risk factors for disease development aregenetics, race, age, sex, obesity, occupational activities andarticular biomechanics. Pathogenesis is the same for any cause orlocalization, being catabolic alterations, with synthesis, inhibitionand reparing intent of the cartilage matrix. Metalloproteinases andcytokines (IL-1,IL-6,TNF-α actions promote infl ammatory reactionand cartilage degradation. Pain, the most important symptom,does not correlate with radiologic fi ndings. Peripheral osteoarthritisoccurs predominantly in the knee, hip and hand. Diagnosis is basedon clinical features, laboratorial tests and radiological changes.Rheumatological associations’ guidelines for treatment includenon-pharmacologic (education, physiotherapy, assistive devices,and pharmacologic (analgesics, anti-infl ammatory drugs therapyand surgery. Arthroplasty seems to work better than medicines, butshould be used if other treatments have failed.

  20. A joint venturer perspective

    International Nuclear Information System (INIS)

    Bond, R.

    1992-01-01

    Many joint ventures are facing potentially huge and usually unquantifiable prospective liabilities as a consequence of the abandonment of energy and resource projects and associated reclamation obligations. It is possible for abandonment costs to be met at least partly by government or collective industry actions. There is, however, a realization amongst joint venturers that where such action has not been taken they need to enter into arrangements amongst themselves. The circumstances under which such security arrangements should be entered into and the form they should take are discussed. Aspects of security provision such as transfer of interest in the project, failure of a participant to provide the security when due and how long security agreements should continue, are also considered. (UK)