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The aim of this study was twofold: 1) to use estimates of random and systematic error to ascertain the test-retest reliability of grip strength measurements obtained with the Jamar hand dynamometer in healthy and disabled women, and 2) to determine the size of the change required to detect a genuine change in grip strength for accurate and meaningful clinical interpretation. Previous research has shown grip strength measurements obtained with a Jamar hand dynamometer from healthy and disabled subjects on different occasions to be reliable. However, the test-retest reliability has been based on correlation coefficients rather than on the actual size of the test-retest differences required to detect a genuine change in grip. The test-retest reliability of maximum grip strength measurements in 32 healthy women and painfree grip in 10 disabled women with nonspecific regional pain (NSRP) was determined. Reliability, based on estimates of systematic and random error, was high in both subject groups. There was no statistically significant systematic error between tests. Test-retest measurement error was +/-5.7 kg (12.5 lb) and +/-5.9 kg (13.0 lb) in healthy and disabled subjects, respectively, 95% of the time. In this population of healthy women and women with NSRP, any change in grip of less than 6 kg (13.2 lb) could have occurred by chance. The results of our study suggest that a change of more than 6 kg (13.2 lb) is necessary to detect a genuine change in grip strength 95% of the time.

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Eighty-two athletes with 86 clinical navicular stress fractures, all imaged with computerized tomography, were followed for an average of 33 months (range, 6 to 108) after diagnosis. Initial treatment consisted of at least 6 weeks of nonweightbearing cast immobilization for 22 fractures, at least 6 weeks of limitation of activity with continued weightbearing for 34 fractures, and a period of less than 6 weeks of conservative treatment for another 19 fractures. Five patients attempted to continue playing sports. Six patients had immediate surgery. Nineteen of 22 patients (86%) who had initial non-weightbearing cast immobilization treatment returned to sports, compared with only 9 of 34 patients (26%) who initially continued weightbearing with limited activity (P < 0.001). After failure of the latter treatment, successful outcomes were seen for 6 of 7 patients (86%) treated with nonweightbearing cast immobilization, while 11 of 15 patients (73%) who had one surgical procedure were able to return to sports. These results indicate that nonweightbearing cast immobilization is the treatment of choice for navicular stress fractures. Also, this treatment compares favorably with surgical treatment for patients who present after failed weightbearing treatments. Computerized tomographic appearances of healing fractures do not necessarily mirror clinical union, and postimmobilization management should be monitored clinically.

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Back injury is one of the commonest claims for accident compensation. A survey carried out over three months in 1984 identified 420 claimants having details of their accidents. Labourers, freezing workers, coal miners and railway workers were at high risk. Over half (54.7%) developed back pain whilst lifting and for almost two-thirds (63.6%) there was a sudden strain. Half had a previous history of back pain and the incidence rose to 70% for those aged 40-59 years. Eighty-two percent returned to work within four weeks. Most were treated by a general practitioner and physiotherapy was increasingly used as the period of disability lengthened. Rest and pain killers were assessed as the most popular forms of treatment. There was a need for education of the workforce in the ergonomics of lifting.

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The purpose of this paper is to examine the problem of femoral neck fracture in the elderly New Zealand citizen, and to consider the prospects for prevention. Data are drawn chiefly from the Accident Compensation Corporation's claims data base, which has enabled identification of the mechanism of accident associated with such fractures. The data reveal a relative preponderance of femoral neck fracture in females of advanced age. In this group, the typical accident sequence is found to be mundane, 84% of victims falling to the ground without involvement of external agency. It is concluded that the resulting fractures are largely attributable to the heightened vulnerability of the subject as opposed to the magnitude of the blow. Hence, an appropriate intervention strategy should be aimed at strengthening the bone structure of individuals at risk. The practicability of this approach is discussed with particular reference to calcium and hormonal supplements. It is noted that cost and other factors make identification of a high risk sub-population desirable. Modern methods of bone density measurement have enhanced the feasibility of this procedure.

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The serum uric acid level of 30 patients with a rupture of the Achilles tendon was compared with that of 30 healthy control subjects matched for age and sex. In patients with a ruptured Achilles tendon the serum uric acid level was significantly higher than in the control subjects. This finding was not dependent on sex or race. It is possible that hyperuricaemia is a contributing factor in rupture of the Achilles tendon and warrants further study. It is suggested that this finding might be related to an adverse effect on the tendon's nutrition.

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Nabumetone, 500 mg two nocte, was compared with naproxen, 250 mg two nocte and one mane, in the management of 24 patients with rheumatoid arthritis attending an outpatients clinic. Both drugs were generally well tolerated and were of comparable efficacy in the dose employed. Similar numbers incurred side effects while taking either drug, but severe side effects, requiring withdrawal from the trial in two cases, were restricted to those patients taking naproxen. As patients known to be intolerant to naproxen were excluded from the trial, the results could have been expected to favour naproxen in this respect. Nabumetone may have a useful role in the management of patients with poor tolerance of other anti-inflammatory drugs.

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Fibroblasts derived from human foetal tendon, skin and lung were cultured in media containing dissolved oxygen at concentrations of 20%, 10% and 2.7%. Total protein and collagen synthesis were reduced at 2.7% oxygen, tendon-derived cells proving significantly less sensitive than lung and skin fibroblasts. The effects of hypoxia were more marked in low-density cultures than in confluent cultures. Proliferation rates varied greatly between the 3 cell lines but were not affected by hypoxia. The implications of these results with respect to tendon degeneration and rupture are discussed.

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In a study of cervical injury in New Zealand rugby football in the years 1973 to 1978 inclusive, 54 cases of injury were identified of which five were fatal. There is no evidence that the incidence of these injuries is increasing. Incomplete figures for the season of 1979/80 include two deaths and 14 cases of permanent cord compression or temporary quadriplegia. The scrum is confirmed as a danger area but the danger occurring during the formation of the scrum is seen to be greater than was previously thought. Young players appear to be particularly vulnerable in scrums. The ruck and maul are danger areas. One-third of the accidents occurred during training or social games. It is concluded that the incidence of injury could be reduced by appropriate player selection, better coaching and amendment of the laws. Since only one player was aware of his danger at the time of his accident, it would seem that coaching with an emphasis on awareness and precautionary measures would be effective in prevention of cervical injury.

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In a four week double-blind crossover study, flurbiprofen 200mg daily was compared with naproxen 750mg daily in the management of 30 patients with ankylosing spondylitis. Both treatments were found to be very effective in alleviating pain and stiffness. No significant difference in efficacy was discernible between the two drugs. Side-effects were more frequent with flurbiprofen. A small, but significant, increase in renal excretion of beta-n-acetyl glucosaminidase occurred during treatment with both naproxen and flurbiprofen. Although previous surveys have not shown evidence of renal damage, further surveillance of renal function in patients receiving long term treatment with these preparations to exclude possible renal impairment would be prudent.

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