RESUMEN
BACKGROUND: Youth baseball players are at high risk for elbow injuries, which can lead to future functional disability. PURPOSE: To evaluate the effectiveness of a prevention program to lower the risk of medial elbow injury in these athletes. STUDY DESIGN: Cohort study; Level of evidence, 2. METHODS: Youth baseball players, 8 to 11 years old, without a history of elbow and shoulder pain, were allocated to either the intervention (n = 136) or control (n = 169) group. The intervention consisted of 9 strengthening and 9 stretching exercises, performed during warm-up or at home, with high compliance defined as completion of the program 1 or more times per week. The following outcome variables were measured: clinical assessment of the elbow and shoulder joint, ultrasonography assessment of the elbow, and assessment of physical function (passive range of motion of the elbow, shoulder, and hip; strength of the shoulder and scapular muscles; and measurement of the thoracic kyphosis angle). The clinical and ultrasonography assessments were measured at baseline and at 3-month intervals over the 1-year follow-up. Physical function outcomes were measured at baseline and at the endpoint of the follow-up. The primary endpoint of effectiveness was the incidence of medial elbow injury. Secondary endpoints were absolute measures of physical function and change in these measures over the 1-year follow-up. RESULTS: The incidence rate of medial elbow injury was significantly lower in the intervention group (0.8/1000 athlete-exposures) than the control group (1.7/1000 athlete-exposures) (hazard ratio, 50.8%; 95% CI, 0.292-0.882; P = .016). The program improved total range of shoulder rotation (dominant side), hip internal rotation (nondominant side), shoulder internal rotation deficit (bilaterally), lower trapezius muscle strength (dominant side), and the thoracic kyphosis angle. Improvements in the following variables of physical function were predictive of a lower rate of medial elbow injury: increased total shoulder total rotation (odds ratio [OR], 0.973; 95% CI, 0.950-0.997), increased hip internal rotation of the nondominant side (OR, 0.962; 95% CI, 0.936-0.989), and decreased thoracic kyphosis angle (OR, 1.058; 95% CI, 1.015-1.103). CONCLUSION: A prevention program aiming to improve physical function can prevent medial elbow injury in youth baseball players.
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Traumatismos del Brazo/prevención & control , Béisbol/lesiones , Lesiones de Codo , Acondicionamiento Físico Humano , Traumatismos del Brazo/epidemiología , Atletas , Niño , Estudios de Cohortes , Codo/fisiología , Humanos , Incidencia , Masculino , Fuerza Muscular , Ejercicios de Estiramiento Muscular , Músculo Esquelético/fisiología , Rango del Movimiento Articular , Factores de Riesgo , Rotación , Hombro/fisiologíaRESUMEN
BACKGROUND: The physical risk factors for a medial elbow injury in junior baseball players are unknown. PURPOSE: To identify the risk factors for an initial medial elbow injury in junior baseball players. STUDY DESIGN: Case-control study; Level of evidence, 3. METHODS: Junior baseball players (aged 6-12 years) without a history of elbow pain underwent a clinical assessment, ultrasonography, and physical function measurements before the baseball season started. Bilateral passive range of motion (ROM) of elbow extension and flexion, external rotation (ER) and internal rotation (IR) of the shoulder, and ER and IR of the hip were measured. IR and ER strength of the shoulder and scapular muscles were measured on both sides. The thoracic kyphosis angle was measured with participants in a relaxed standing position. Before these examinations, every participant completed a questionnaire regarding his or her age, sex, total years of baseball played, position in baseball, number of balls thrown, and episodes of pain during throwing. After the initial test session, each participant was followed up for 12 months to assess for the occurrence of a new injury. Multiple regression analysis was used to identify the risk factors for a medial elbow injury. RESULTS: Seventy-eight players (22.1%) sustained a medial elbow injury. Age ≥9 years (odds ratio [OR], 2.708; 95% CI, 1.224-5.990), pitcher position (OR, 2.620; 95% CI, 1.389-4.941), >100 throws per day (OR, 1.936; 95% CI, 1.072-3.497), thoracic kyphosis angle ≥30° (OR, 2.501; 95% CI, 1.381-4.531), and elbow extension deficit ≥5° (OR, 1.973; 95% CI, 1.022-3.809) were significantly associated with a medial elbow injury. CONCLUSION: The incidence of an initial medial elbow injury was 22.1%. Age, number of throws per day, thoracic kyphosis angle, and elbow extension deficit are newly discovered risk factors related to physical function. Improvement of the posture and early detection of a silent elbow extension deficit may prevent a medial elbow injury.
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Traumatismos en Atletas/epidemiología , Béisbol/lesiones , Lesiones de Codo , Traumatismos en Atletas/etiología , Estudios de Casos y Controles , Niño , Estudios de Cohortes , Femenino , Humanos , Incidencia , Japón/epidemiología , Masculino , Estudios Prospectivos , Rango del Movimiento Articular , Factores de RiesgoRESUMEN
BACKGROUND: Functional ankle instability (FAI) may involve abnormal kinematics and contact mechanics during ankle internal rotation. Understanding of these abnormalities is important to prevent secondary problems in patients with FAI. However, there are no in vivo studies that have investigated talocrural joint contact mechanics during weightbearing ankle internal rotation. The objective of this study to determine talocrural contact mechanics during weightbearing ankle internal rotation in patients with FAI. METHODS: Twelve male subjects with unilateral FAI (age range, 18-26 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities were obtained during weightbearing passive ankle joint complex rotation. Three-dimensional bone models created from the computed tomographic images were matched to the fluoroscopic images to compute 6 degrees of freedom for talocrural joint kinematics. The closest contact area in the talocrural joint in ankle neutral rotation and maximum internal rotation during either dorsiflexion or plantar flexion was determined using geometric bone models and talocrural joint kinematics data. RESULTS: The closest contact area in the talus shifted anteromedially during ankle dorsiflexion-internal rotation, whereas it shifted posteromedially during ankle plantar flexion-internal rotation. The closest contact area in FAI joints was significantly more medial than that in healthy joints during maximum ankle internal rotation and was associated with excessive talocrural internal rotation or inversion. DISCUSSION: This study demonstrated abnormal talocrural kinematics and contact mechanics in FAI subjects. Such abnormal kinematics may contribute to abnormal contact mechanics and may increase cartilage stress in FAI joints. LEVEL OF EVIDENCE: Therapeutic, Level IV: cross-sectional case-control study.
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Articulación del Tobillo/fisiopatología , Simulación por Computador , Inestabilidad de la Articulación/fisiopatología , Adolescente , Adulto , Articulación del Tobillo/diagnóstico por imagen , Fenómenos Biomecánicos/fisiología , Estudios de Casos y Controles , Estudios Transversales , Fluoroscopía , Humanos , Imagenología Tridimensional , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Rotación , Tomografía Computarizada por Rayos X , Soporte de Peso/fisiología , Adulto JovenRESUMEN
STUDY DESIGN: Case series. OBJECTIVES: To determine whether abnormal fibular alignment is present in individuals with chronic ankle instability (CAI) using 3-D analysis of computed tomography (CT)-based bone models. BACKGROUND: A positional difference of the distal fibula in individuals with unilateral CAI, when compared to the contralateral side, has been suggested. However, previous studies report no consistent pattern of fibular malalignment in the anteroposterior direction and, to our knowledge, no study has investigated mediolateral malalignment. METHODS: Seventeen males with unilateral CAI (mean ± SD age, 21.0 ± 2.4 years) and no history of injury in the contralateral side were enrolled. Geometric bone models of the tibia and fibula were created from non-weight-bearing CT images, and anatomical coordinate systems were embedded in the tibia model. Bilateral tibiae were superimposed using a best-fit algorithm that moved the tibia to the position of best congruity, and the amount of side-to-side difference in position of the fibulae was measured. The anteroposterior and mediolateral positional difference of the fibula of the ankle with CAI relative to the contralateral ankle, for the distal 10 cm of the fibula length, was determined using a color-coded map. RESULTS: The fibula of the ankle with CAI was significantly more lateral (0.57-0.68 mm) than that of the contralateral healthy ankle at all reference points from distal 10 cm to the lateral malleolus. There was no significant difference in anteroposterior position between the healthy ankles and those with CAI. CONCLUSION: This study detected malalignment of the distal fibula in ankles with CAI in a non-weight-bearing position. The fibula of the ankles with CAI had a significantly more lateral position than that of the healthy ankles, which may contribute to recurrent lateral ankle sprain or giving-way episodes.
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Traumatismos del Tobillo/etiología , Articulación del Tobillo/fisiopatología , Desviación Ósea/complicaciones , Peroné , Inestabilidad de la Articulación/etiología , Esguinces y Distensiones/etiología , Desviación Ósea/diagnóstico por imagen , Humanos , Masculino , Radiografía , Recurrencia , Adulto JovenRESUMEN
BACKGROUND: A semi-rigid brace or taping is often used to prevent giving-ways in the joint with chronic ankle instability (CAI). However, it remains unknown whether the application of a semi-rigid brace or taping modifies abnormal kinematics in CAI joints. The objective of this study was to determine if the application of a semi-rigid brace or taping of the ankle normalizes abnormal weight-bearing kinematics in CAI joints during ankle internal rotation in plantar flexion. METHODS: A total of 14 male patients with unilateral CAI (mean age 21.1 ± 2.5 years) were enrolled. Three-dimensional bone models created from the computed tomography images were matched to the fluoroscopic images to compute the 6 degrees-of-freedom talocrural, subtalar, and ankle joint complex (AJC) kinematics for the healthy and contralateral CAI joints, as well as for CAI joints with a brace or taping. Selected outcome measures were talocrural anterior translation, talocrural internal rotation, and subtalar internal rotation. RESULTS: There was no significant difference in talocrural anterior translation and internal rotation induced by applying either a semi-rigid brace or taping (P > .05). For subtalar internal rotation, there was a tendency toward restoration of normal kinematics in CAI joints after applying a semi-rigid brace or taping. However, the difference was not significant (P > .05). DISCUSSION: Application of a semi-rigid brace or taping had limited effects on the CAI joint during weight-bearing ankle internal rotation in plantar flexion. Further studies using a variety of testing conditions should be conducted in the future. LEVELS OF EVIDENCE: Therapeutic, Level IV: Cross-Sectional Case Series.
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Articulación del Tobillo , Cinta Atlética , Tirantes , Inestabilidad de la Articulación/terapia , Adulto , Traumatismos del Tobillo/fisiopatología , Traumatismos del Tobillo/prevención & control , Articulación del Tobillo/diagnóstico por imagen , Fenómenos Biomecánicos , Enfermedad Crónica , Diseño de Equipo , Fluoroscopía , Humanos , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Recurrencia , Tomografía Computarizada por Rayos X , Soporte de Peso/fisiología , Adulto JovenRESUMEN
BACKGROUND: Chronic ankle instability (CAI) results in abnormal ankle kinematics, but there exists limited quantitative data characterizing these alterations. This study was undertaken to investigate kinematic alterations of the talocrural and subtalar joints in CAI. METHODS: A total of 14 male patients with unilateral CAI (mean age = 21.1 ± 2.5 years) were enrolled. Computed tomography and fluoroscopic imaging of both lower extremities during weightbearing passive ankle joint complex (AJC) rotation were obtained. Three-dimensional bone models created from the computed tomography images were matched with the fluoroscopic images to compute the 6 degrees-of-freedom talocrural, subtalar, and AJC kinematics. RESULTS: In 20° plantarflexion, ankles with CAI demonstrated significantly increased anterior translation of the talocrural joint during AJC internal rotation from 5° to 7° and significantly decreased talocrural internal rotation within an AJC arc of motion from -1° to 5°. CAI joints demonstrated significantly increased internal rotation of the subtalar joint within an AJC arc of motion from -1° to 3°. DISCUSSION: In CAI, altered subtalar internal rotation occurs with increased talocrural anterior translation and reduced talocrural internal rotation during weightbearing ankle internal rotation in plantarflexion. These results suggest that altered subtalar mechanics may contribute to CAI symptoms.
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Articulación del Tobillo/fisiopatología , Inestabilidad de la Articulación/fisiopatología , Rotación , Articulaciones Tarsianas/fisiopatología , Soporte de Peso/fisiología , Articulación del Tobillo/diagnóstico por imagen , Fenómenos Biomecánicos/fisiología , Enfermedad Crónica , Simulación por Computador , Fluoroscopía , Humanos , Imagenología Tridimensional , Inestabilidad de la Articulación/diagnóstico por imagen , Masculino , Modelos Biológicos , Articulaciones Tarsianas/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Adulto JovenRESUMEN
INTRODUCTION: Adjacent segment degeneration (ASD) is a complication of lumbar spinal fusion. There are some reports on the cause of this degeneration but none concerning its prevention. We performed sublaminar wiring stabilization to prevent ASD after posterolateral lumbar spinal fusion with instrumentation. The purpose of this study was to prospectively evaluate the efficacy of this procedure. PATIENTS AND METHODS: Between 2003 and 2004, 54 consecutive patients with lumbar spinal canal stenosis and multilevel instability of the lumbar spine underwent posterior decompression and posterolateral fusion with instrumentation. The mean age at the time of surgery was 66.7 +/- 1.3 years, and the mean follow-up period was 40.0 +/- 1.1 months, with a minimum of 29 months. Twenty-seven of the patients underwent conventional sublaminar wiring stabilization at the cephalad segment adjacent to the site of fusion to prevent ASD (group A), and the other 27 patients did not (group B). Some items were assessed, including clinical outcome using Japanese Orthopaedic Association (JOA) score, sagittal global lumbar alignment, and segmental motion in flexion-extension radiographs of the cephalad vertebral body adjacent to the site of fusion. RESULTS: There were no significant differences in JOA scores between two groups, but 2 patients in group B underwent subsequent surgery due to ASD. Sagittal lumbar alignment did not change in group A but was significantly decreased in group B. With respect to segmental motion in flexion-extension radiographs, group A showed a significant decrease from 6.9 degrees before surgery to 3.4 degrees after surgery, on the other hand group B showed a significant increase from 5.6 degrees before surgery to 8.4 degrees after surgery. CONCLUSIONS: In this study, it was suggested that sublaminar wiring stabilization significantly reduces the range of motion of the adjacent segment and preserves sagittal lumbar alignment, which lead to prevention of ASD. The clinical outcome of the subsequent surgeries is relatively poor, so it is important to prevent ASD by any prevention such as sublaminar wiring stabilization.
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Hilos Ortopédicos , Enfermedades de la Columna Vertebral/etiología , Enfermedades de la Columna Vertebral/prevención & control , Fusión Vertebral/efectos adversos , Fusión Vertebral/instrumentación , Anciano , Femenino , Humanos , Inestabilidad de la Articulación/cirugía , Vértebras Lumbares , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Fusión Vertebral/métodos , Estenosis Espinal/cirugíaRESUMEN
OBJECTIVES: To examine the relationship between muscle atrophy, ambulatory ability, and fracture type, and to make a specific rehabilitation regimen for each fracture type. DESIGN: Observational study. SETTING: Public hospital. PARTICIPANTS: Consecutive patients (N=53) with hip fracture (mean age, 83.6y) who underwent operative treatment. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The ambulatory ability score and the cross-sectional areas of lower-limb muscles as measured on computed tomography scans. RESULTS: Muscle atrophy was not related to fracture type. Although the mean ambulatory ability score decreased significantly from 4.5+/-0.3 points prior to injury to 3.0+/-0.6 points 1 month postadmission, the degree of muscle atrophy was not associated with the decrease in ambulatory ability. CONCLUSIONS: It seems likely that other factors are more important than muscle atrophy and fracture type in determining recovery after surgical repair of a fracture and that there is no need for rehabilitation regimens based on fracture types.
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Fracturas de Cadera/cirugía , Atrofia Muscular/etiología , Actividades Cotidianas , Adulto , Anciano , Anciano de 80 o más Años , Evaluación de la Discapacidad , Femenino , Fracturas de Cadera/diagnóstico por imagen , Humanos , Masculino , Persona de Mediana Edad , Atrofia Muscular/diagnóstico por imagen , Atrofia Muscular/fisiopatología , Estudios Prospectivos , Análisis de Regresión , Tomografía Computarizada por Rayos XRESUMEN
Posterior interosseous nerve palsy (PINP) is a rare complication of rheumatoid arthritis of the elbow. A 58-year-old woman with rheumatoid arthritis, who complained of an inability to extend her left fingers, was referred to our hospital. After a series of studies, extensor tendon ruptures were excluded, and PINP was diagnosed. By means of the Henry anterolateral approach, the radial nerve was exposed, which was compressed by swollen synovial membrane at the Frohse arcade. Elbow synovectomy was performed, and the arcade was opened to release the nerve. The PINP has been recovered completely within 2 weeks after surgery. Various examinations other than magnetic resonance imaging have been reported for the adjunctive diagnosis of PINP, but MR imaging was most useful as an adjunctive examination in this case.
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Artritis Reumatoide/complicaciones , Síndromes de Compresión Nerviosa/cirugía , Neuropatía Radial/etiología , Artritis Reumatoide/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Persona de Mediana Edad , Síndromes de Compresión Nerviosa/etiología , Procedimientos Ortopédicos , Neuropatía Radial/cirugíaRESUMEN
Extracts of normal mature articular cartilage contain aggrecan molecules which bear the G1 domain (the N-terminal globular domain of aggrecan) and are C-terminally truncated by proteolysis at a number of sites. A proportion of these molecules are generated by an aggrecanase and/or matrix-metalloproteinase-mediated cleavage in the IGD (interglobular domain between the G1 and G2 domains of aggrecan). However, the proteinase(s) responsible for formation of the majority of the larger G1-G2 and glycosaminoglycan-bearing truncated species is (are) unknown. N-terminal sequencing of aggrecan core fragments generated by m-calpain digestion of bovine aggrecan has identified four novel cleavage sites: one within the CS (chondroitin sulphate)-1 domain (at one or more of the bonds Ser1229-Val1230, Ser1249-Val1250, Ser1287-Val1288, Gly1307-Val1308 and Ser1346-Val1347), two within the IGD (at bonds Ala474-Ala475 and Gly365-Gly366) and one within the KS (keratan sulphate) domain (at Ala719-Ala720). A new monoclonal antibody (SK-28) to the C-terminal neoepitope at M710VTQVGPGVA719 showed that aggrecan products generated by this cleavage are present in high abundance in mature bovine articular cartilage extracts. We conclude that m-calpain, or an unidentified proteinase with the capacity to cleave at the same site, is active during aggrecan biosynthesis/secretion by mature chondrocytes or in the matrix of mature bovine articular cartilage in vivo.
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Alanina/metabolismo , Calpaína/metabolismo , Cartílago Articular/química , Proteínas de la Matriz Extracelular/metabolismo , Proteoglicanos/metabolismo , Agrecanos , Animales , Anticuerpos Monoclonales/metabolismo , Especificidad de Anticuerpos , Sitios de Unión , Western Blotting/métodos , Bovinos , Proteínas de la Matriz Extracelular/química , Proteínas de la Matriz Extracelular/inmunología , Hidrólisis , Riñón/enzimología , Lectinas Tipo C , Datos de Secuencia Molecular , Fragmentos de Péptidos/metabolismo , Péptidos/inmunología , Estructura Terciaria de Proteína , Proteoglicanos/química , Proteoglicanos/inmunología , Análisis de Secuencia de Proteína/métodos , PorcinosRESUMEN
The effects of proteolysis inhibitors on hydrogen peroxide (H(2)O(2))-induced apoptosis were examined in cultured human synovial cells of rheumatoid arthritis (RA) patients. RA synovial cells were resistant to apoptosis induced by H(2)O(2). In the presence of 100 microM N-acetyl-leucyl-leucyl-norleucinal (ALLN, known as calpain inhibitor 1 and also a proteasome inhibitor), but not N-acetyl-leucyl-leucyl-methioninal (ALLM), apoptotic cell death was elicited by 400 microM H(2)O(2) at a concentration that alone never induced cell death. ALLN induced the expression of tumor suppressor p53 protein and p21(WAF-1) protein, probably through inhibition of proteasome. H(2)O(2) further potentiated ALLN-induced p53 expression. H(2)O(2) appeared to activate c-Jun N-terminal kinase (JNK) as well as extracellular signal-regulated kinase (ERK) and AKT. After administration of H(2)O(2) and p53 induction by ALLN, we found that either one alone is insufficient to induce apoptosis of RA synovial cells but their combination synergistically does so. These results suggest that induction of p53 by ALLN may be potentially important for triggering H(2)O(2)-induced apoptosis processes in RA synovial cells.
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Apoptosis/efectos de los fármacos , Artritis Reumatoide/fisiopatología , Calpaína/antagonistas & inhibidores , Inhibidores de Cisteína Proteinasa/farmacología , Peróxido de Hidrógeno/farmacología , Leupeptinas/farmacología , Membrana Sinovial/citología , Células Cultivadas , Sinergismo Farmacológico , HumanosRESUMEN
STUDY DESIGN: The effects of calpain on intrathecal nerve tissue in the rabbit were investigated. OBJECTIVE: To evaluate the chemonucleolytic side effect of calpain on nerve tissue in the event of accidental intrathecal calpain injection. SUMMARY OF BACKGROUND DATA: Calpain has a degradative effect on proteoglycans, and as previously shown, it is associated with chemonucleolytic action in the rabbit. However, its effect on nerve tissue in the event of accidental intrathecal injection is not clear. METHODS: The inhibitory activity of cerebrospinal fluid against calpain was measured in human cerebrospinal fluid using mu-calpain, and in different cerebrospinal fluid fractions separated by molecular filtration. The presence of the endogenous calpain inhibitor, calpastatin, in human cerebrospinal fluid was examined by Western blotting with anticalpastatin antibody. After intrathecal application of calpain in rabbits, the spinal cord nerve tissue was examined by light microscopy. RESULTS: Cerebrospinal fluid inhibited the enzyme reaction of calpain at its normal concentration. Immunoblotting with anticalpastatin antibody did not yield positive staining. After the intrathecal application of calpain, there was no evidence of degeneration in the nerve tissue of the spinal cord. CONCLUSIONS: This study suggests that in the event of accidental intrathecal injection of calpain for chemonucleolysis, the enzyme activity of calpain will be neutralized by cerebrospinal fluid, and the calpain should not cause unwanted side effects in chemonucleolysis.